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Biomaterials
www.biomat.net 10/1/2004
ª   Marrow stem cells could heal broken bones
    , Betterhumans
ª   Newly grown kidneys can sustain life in rat
    , Bio.com
ª   Doctors grow new jaw in man's back,
    CNN
ª   FDA approves implanted lens for nearsighte
    , CNN
ª   Stent recall may raise quality expectations
    , Medical Device Link
Wright Medical Technology-TN
The REPIPHYSIS® works by inserting an
  expandable implant made from titanium in an
  aerospace polymer into the child’s healthy
  bone, after which standard recovery and
  rehabilitation are expected. However, instead
  of undergoing repeated surgeries to extend
  the bone, the REPIPHYSIS® uses an
  electromagnetic field to slowly lengthen the
  implant internally.
A biomaterial is "any substance (other than drugs)
or combination of substances synthetic or natural
in origin, which can be used for any period of time,
as a whole or as a part of a system which treats,
augments, or replaces any tissue, organ, or
function of the body".

Biocompatibility — The ability of a material to
perform with an appropriate host response in a
specific application
Host Response — The response of the host
organism (local and systemic) to the implanted
material or device.
MicroTest Laboratories - example


In- Vivo Services:          In-Vitro Services:
Rabbit Pyrogen              Cytotoxicity
USP Class Testing           Hemolysis
Sensitization               Complement Activation
                                                     Our In-vitro toxicity services are
Implantation                PT/PTT Testing           performed by our experienced and
Sub-Chronic/Chronic         AMES Mutagenicity
                                                     fully trained microbiologists
Toxicity                    Carcinogencity Testing
Intracutaneous Reactivity
Irritation Testing
Necropsy Services                                     Methods
Histology Services                                    USP
                                                      ISO
                             All Animal Testing is    JP
                             performed in a fully
                                                      EP/BP
                             AAALAC accredited
                             facility                 FDA
                                                      ASTM
Keywords
 Metallic/glass/Polymeric/Ceramic/Composite
 Fracture/fatigue/creep/corrosion/degradation
 Tissue response/healing/biocompatibility/host
  response/carcinogenicity
 Hard/soft tissue implants
 Vascular/Breast/Urological/Art. Organ
 Mucosal contacting …
Material Selection Parameters
 Mechanical
 Thermal/Electrical Conductivity
 Diffusion
 Water Absorption
 Biostability
 Biocompatibility
Test Conditions:

                              Value               Location
pH                            6.8                 Intracellular
                              7.0                 Interstitial
                              7.15-7.35           Blood
pO2                           2-40                Interstitial (mm Hg)
                              40                  Venous
                              100                 Arterial
Temperature                   37                  Normal Core
                              28 7      -2
                                                  Normal Skin
Mechanical Stress             4x108 N m-2         Muscle (peak stress)
                              4x105 N m           Tendon (peak stress)
Stress Cycles (per year)      3x106        7
                                                  Peristalsis
                              5x10 - 4x10         Heart muscle contraction



  Length of implant: Day: Month:               Longer:

     Where used: skin/blood/brain/mucosal/etc.
Biocompatibility is primarily a surface phenomenon
…




                Bulk
                Material




                           Adsorbed layer of     Cells in
        Surface Layer       water, ions &      biological
        of Material            proteins             fluid
Test Animals
•   Rabbits – ear, skin, pyrogen
•   Guinea Pigs – skin, esp C@
•   Mice – genotoxicity
•   Horseshoe Crab – endotoxins
•   Pig – implant
•   Bacteria - genotoxicity
•   Test actual & elutants & extracts…
•   People – long term
Some Commonly Used Biomaterials


 Material                    Applications
 Silicone rubber             Catheters, tubing
 Dacron                      Vascular grafts
 Cellulose                    Dialysis membranes
 Poly(methyl methacrylate)    Intraocular lenses, bone cement
 Polyurethanes                Catheters, pacemaker leads
 Hydogels                     Opthalmological devices, Drug Delivery
 Stainless steel               Orthopedic devices, stents
 Titanium                      Orthopedic and dental devices
 Alumina                       Orthopedic and dental devices
 Hydroxyapatite               Orthopedic and dental devices
 Collagen (reprocessed)       Opthalmologic applications, wound
                                            dressings
An Interdisciplinary Field
            Bioengineers
          Material Scientists
           Immunologists
              Chemists
              Biologists
              Surgeons
                  ...
Journals
 Biomaterials World News
 Materials Today
 Nature
 Journal of Biomedical Materials Research
 Cells and Materials
 Journal of Biomaterials Science
 Artificial Organs
 ASAIO Transactions
 Tissue Engineering
 Annals of Biomedical Engineering
 Medical Device Link
 … see: http://www.biomat.net/biomatnet.asp?group=1_5
A Little History on Biomaterials
• Romans, Chinese, and Aztecs used gold in
    dentistry over 2000 years ago, Cu not good.
•   Ivory & wood teeth
•   Aseptic surgery 1860 (Lister)
•   Bone plates 1900, joints 1930
•   Turn of the century, synthetic plastics came
    into use
    – WWII, shards of PMMA unintentionally got lodged
      into eyes of aviators
    – Parachute cloth used for vascular prosthesis
• 1960- Polyethylene and stainless steel being
    used for hip implants
Uses of Biomaterials
•   Replace diseased part – dialysis
•   Assist in healing – sutures
•   Improve function – contacts
•   Correct function – spinal rods
•   Correct cosmetic – nose, ear
•   Aid dx – probe
•   Aid tx – catheter
•   Replace rotten – amalgam
•   Replace dead - skin
Problems/test for w
Biomaterials
•   Acute toxicity (cytotoxicity) arsenic
•   Sub chronic/chronic Pb
•   Sensitization Ni, Cu
•   Genotoxicity
•   Carcinogenicity
•   Reproductive &/or developmental Pb
•   Neurotoxicity
•   Immunotoxicity
•   Pyrogen, endotoxins
FDA & ISO 10993
• FDA mandates tests based on length of
    contact (24 Hr, 1-30 Days, >30 days)
•   See table for details
•   ISO 10993 – required for European
    Union Certification – see flowchart for
    exemptions
•   See Device Categories & examples
•   Harmonization – in process…
First Generation Implants
• “ad hoc” implants
• specified by physicians using common and borrowed
  materials
• most successes were accidental rather than by
  design

Examples — First Generation Implants
  •   gold fillings, wooden teeth, PMMA dental prosthesis
  •   steel, gold, ivory, etc., bone plates
  •   glass eyes and other body parts
  •   dacron and parachute cloth vascular implants
Intraocular Lens
3 basic materials - PMMA, acrylic, silicone
Vascular Grafts
Second generation implants
 • engineered implants using common and borrowed materials
 • developed through collaborations of physicians and engineers
 • built on first generation experiences
 • used advances in materials science (from other fields)




Examples — Second generation implants
 •   titanium alloy dental and orthopaedic implants
 •   cobalt-chromium-molybdinum orthopaedic implants
 •   UHMW polyethylene bearing surfaces for total joint replacements
 •   heart valves and pacemakers
Artificial Hip Joints




   http://www.totaljoints.info/Hip.jpg
Third generation implants
  • bioengineered implants using bioengineered materials
  • few examples on the market
  • some modified and new polymeric devices
  • many under development



Example - Third generation implants
  •tissue engineered implants designed to regrow rather than replace tissues
  •Integra LifeSciences artificial skin
  •Genzyme cartilage cell procedure
  •some resorbable bone repair cements
  •genetically engineered “biological” components (Genetics Institute and
  Creative Biomolecules BMPs)
Substitute Heart Valves
SEM displaying the cross section of a composite disk,
which had been seeded with cultured bone marrow
stromal cells.
Synthetic polymer scaffolds




  ... in the shape of a nose (left) is "seeded" with cells called
chondrocytes that replace the polymer with cartilage over time
                (right) to make a suitable implant.
Evolution of Biomaterials
Structural




             Soft Tissue
             Replacements




                            Functional Tissue
                            Engineering Constructs
Advances in
Biomaterials Technology
• Cell matrices for 3-D growth and tissue
  reconstruction
• Biosensors, Biomimetic , and smart devices
• Controlled Drug Delivery/ Targeted delivery
• Biohybrid organs and Cell immunoisolation
   – New biomaterials - bioactive, biodegradable,
     inorganic
   – New processing techniques
Skin/cartilage
                  Drug Delivery
                  Devices
                                                 Ocular implants
                                  Polymers

Orthopedic                                                    Bone
screws/fixation                                               replacements


                                                                             Heart
                                                                             valves
             Metals                Synthetic             Ceramics
                                BIOMATERIALS


   Dental Implants                                               Dental Implants

                                Semiconductor
              Implantable
                                  Materials      Biosensors

              Microelectrodes
Biomaterials for Tissue
Replacements
• Bioresorbable
  vascular graft

• Biodegradable nerve
  guidance channel

• Skin Grafts


• Bone Replacements
Biomaterials - An Emerging
Industry
• Next generation of medical implants
  and therapeutic modalities
• Interface of biotechnology and
  traditional engineering
• Significant industrial growth in the next
  15 years -- potential of a multi-billion
  dollar industry
Biomaterials Companies
• BioForma Research & Consulting, Inc., fibrinolytic systems, protein-material interactions

• Baxter International develops technologies related to the blood and circulatory system.

• Biocompatibles Ltd. develops commercial applications for technology in the field of biocompatibility.

• Carmeda makes a biologically active surface that interacts with and supports the bodys own control mechanisms

• Collagen Aesthetics Inc. bovine and human placental sourced collagens, recombinant collagens, and PEG-polymers

• Endura-Tec Systems Corp. bio-mechanical endurance testing ofstents, grafts, and cardiovascular materials

• Howmedica develops and manufactures products in orthopaedics.

• MATECH Biomedical Technologies, development of biomaterials by chemical polymerization methods.

• Medtronic, Inc. is a medical technology company specializing in implantable and invasive therapies.

• Molecular Geodesics Inc., biomimetic materials for biomedical, industrial, and military applications

• Polymer Technology Group is involved in the synthesis, characterization, and manufacture of new polymer products.

• SurModics, offers PhotoLink(R) surface modification technology that can be used to immobilize biomolecules

• W.L. Gore Medical Products Division, PTFE microstructures configured to exclude or accept tissue ingrowth.

• Zimmer, design, manufacture and distribution of orthopaedic implants and related equipment and supplies
What are some of the
Challenges?
• To more closely replicate complex tissue
  architecture and arrangement in vitro
• To better understand extracellular and
  intracellular modulators of cell function
• To develop novel materials and processing
  techniques that are compatible with biological
  interfaces
• To find better strategies for immune
  acceptance

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Chapter 10

  • 2. www.biomat.net 10/1/2004 ª Marrow stem cells could heal broken bones , Betterhumans ª Newly grown kidneys can sustain life in rat , Bio.com ª Doctors grow new jaw in man's back, CNN ª FDA approves implanted lens for nearsighte , CNN ª Stent recall may raise quality expectations , Medical Device Link
  • 3. Wright Medical Technology-TN The REPIPHYSIS® works by inserting an expandable implant made from titanium in an aerospace polymer into the child’s healthy bone, after which standard recovery and rehabilitation are expected. However, instead of undergoing repeated surgeries to extend the bone, the REPIPHYSIS® uses an electromagnetic field to slowly lengthen the implant internally.
  • 4. A biomaterial is "any substance (other than drugs) or combination of substances synthetic or natural in origin, which can be used for any period of time, as a whole or as a part of a system which treats, augments, or replaces any tissue, organ, or function of the body". Biocompatibility — The ability of a material to perform with an appropriate host response in a specific application Host Response — The response of the host organism (local and systemic) to the implanted material or device.
  • 5. MicroTest Laboratories - example In- Vivo Services: In-Vitro Services: Rabbit Pyrogen Cytotoxicity USP Class Testing Hemolysis Sensitization Complement Activation Our In-vitro toxicity services are Implantation PT/PTT Testing performed by our experienced and Sub-Chronic/Chronic AMES Mutagenicity fully trained microbiologists Toxicity Carcinogencity Testing Intracutaneous Reactivity Irritation Testing Necropsy Services Methods Histology Services USP ISO All Animal Testing is JP performed in a fully EP/BP AAALAC accredited facility FDA ASTM
  • 6. Keywords  Metallic/glass/Polymeric/Ceramic/Composite  Fracture/fatigue/creep/corrosion/degradation  Tissue response/healing/biocompatibility/host response/carcinogenicity  Hard/soft tissue implants  Vascular/Breast/Urological/Art. Organ  Mucosal contacting …
  • 7. Material Selection Parameters  Mechanical  Thermal/Electrical Conductivity  Diffusion  Water Absorption  Biostability  Biocompatibility
  • 8. Test Conditions: Value Location pH 6.8 Intracellular 7.0 Interstitial 7.15-7.35 Blood pO2 2-40 Interstitial (mm Hg) 40 Venous 100 Arterial Temperature 37 Normal Core 28 7 -2 Normal Skin Mechanical Stress 4x108 N m-2 Muscle (peak stress) 4x105 N m Tendon (peak stress) Stress Cycles (per year) 3x106 7 Peristalsis 5x10 - 4x10 Heart muscle contraction Length of implant: Day: Month: Longer: Where used: skin/blood/brain/mucosal/etc.
  • 9. Biocompatibility is primarily a surface phenomenon … Bulk Material Adsorbed layer of Cells in Surface Layer water, ions & biological of Material proteins fluid
  • 10. Test Animals • Rabbits – ear, skin, pyrogen • Guinea Pigs – skin, esp C@ • Mice – genotoxicity • Horseshoe Crab – endotoxins • Pig – implant • Bacteria - genotoxicity • Test actual & elutants & extracts… • People – long term
  • 11. Some Commonly Used Biomaterials Material Applications Silicone rubber Catheters, tubing Dacron Vascular grafts Cellulose Dialysis membranes Poly(methyl methacrylate) Intraocular lenses, bone cement Polyurethanes Catheters, pacemaker leads Hydogels Opthalmological devices, Drug Delivery Stainless steel Orthopedic devices, stents Titanium Orthopedic and dental devices Alumina Orthopedic and dental devices Hydroxyapatite Orthopedic and dental devices Collagen (reprocessed) Opthalmologic applications, wound dressings
  • 12. An Interdisciplinary Field Bioengineers Material Scientists Immunologists Chemists Biologists Surgeons ...
  • 13. Journals  Biomaterials World News  Materials Today  Nature  Journal of Biomedical Materials Research  Cells and Materials  Journal of Biomaterials Science  Artificial Organs  ASAIO Transactions  Tissue Engineering  Annals of Biomedical Engineering  Medical Device Link  … see: http://www.biomat.net/biomatnet.asp?group=1_5
  • 14. A Little History on Biomaterials • Romans, Chinese, and Aztecs used gold in dentistry over 2000 years ago, Cu not good. • Ivory & wood teeth • Aseptic surgery 1860 (Lister) • Bone plates 1900, joints 1930 • Turn of the century, synthetic plastics came into use – WWII, shards of PMMA unintentionally got lodged into eyes of aviators – Parachute cloth used for vascular prosthesis • 1960- Polyethylene and stainless steel being used for hip implants
  • 15. Uses of Biomaterials • Replace diseased part – dialysis • Assist in healing – sutures • Improve function – contacts • Correct function – spinal rods • Correct cosmetic – nose, ear • Aid dx – probe • Aid tx – catheter • Replace rotten – amalgam • Replace dead - skin
  • 16. Problems/test for w Biomaterials • Acute toxicity (cytotoxicity) arsenic • Sub chronic/chronic Pb • Sensitization Ni, Cu • Genotoxicity • Carcinogenicity • Reproductive &/or developmental Pb • Neurotoxicity • Immunotoxicity • Pyrogen, endotoxins
  • 17. FDA & ISO 10993 • FDA mandates tests based on length of contact (24 Hr, 1-30 Days, >30 days) • See table for details • ISO 10993 – required for European Union Certification – see flowchart for exemptions • See Device Categories & examples • Harmonization – in process…
  • 18. First Generation Implants • “ad hoc” implants • specified by physicians using common and borrowed materials • most successes were accidental rather than by design Examples — First Generation Implants • gold fillings, wooden teeth, PMMA dental prosthesis • steel, gold, ivory, etc., bone plates • glass eyes and other body parts • dacron and parachute cloth vascular implants
  • 19. Intraocular Lens 3 basic materials - PMMA, acrylic, silicone
  • 21. Second generation implants • engineered implants using common and borrowed materials • developed through collaborations of physicians and engineers • built on first generation experiences • used advances in materials science (from other fields) Examples — Second generation implants • titanium alloy dental and orthopaedic implants • cobalt-chromium-molybdinum orthopaedic implants • UHMW polyethylene bearing surfaces for total joint replacements • heart valves and pacemakers
  • 22. Artificial Hip Joints http://www.totaljoints.info/Hip.jpg
  • 23. Third generation implants • bioengineered implants using bioengineered materials • few examples on the market • some modified and new polymeric devices • many under development Example - Third generation implants •tissue engineered implants designed to regrow rather than replace tissues •Integra LifeSciences artificial skin •Genzyme cartilage cell procedure •some resorbable bone repair cements •genetically engineered “biological” components (Genetics Institute and Creative Biomolecules BMPs)
  • 25. SEM displaying the cross section of a composite disk, which had been seeded with cultured bone marrow stromal cells.
  • 26. Synthetic polymer scaffolds ... in the shape of a nose (left) is "seeded" with cells called chondrocytes that replace the polymer with cartilage over time (right) to make a suitable implant.
  • 27. Evolution of Biomaterials Structural Soft Tissue Replacements Functional Tissue Engineering Constructs
  • 28. Advances in Biomaterials Technology • Cell matrices for 3-D growth and tissue reconstruction • Biosensors, Biomimetic , and smart devices • Controlled Drug Delivery/ Targeted delivery • Biohybrid organs and Cell immunoisolation – New biomaterials - bioactive, biodegradable, inorganic – New processing techniques
  • 29. Skin/cartilage Drug Delivery Devices Ocular implants Polymers Orthopedic Bone screws/fixation replacements Heart valves Metals Synthetic Ceramics BIOMATERIALS Dental Implants Dental Implants Semiconductor Implantable Materials Biosensors Microelectrodes
  • 30. Biomaterials for Tissue Replacements • Bioresorbable vascular graft • Biodegradable nerve guidance channel • Skin Grafts • Bone Replacements
  • 31. Biomaterials - An Emerging Industry • Next generation of medical implants and therapeutic modalities • Interface of biotechnology and traditional engineering • Significant industrial growth in the next 15 years -- potential of a multi-billion dollar industry
  • 32. Biomaterials Companies • BioForma Research & Consulting, Inc., fibrinolytic systems, protein-material interactions • Baxter International develops technologies related to the blood and circulatory system. • Biocompatibles Ltd. develops commercial applications for technology in the field of biocompatibility. • Carmeda makes a biologically active surface that interacts with and supports the bodys own control mechanisms • Collagen Aesthetics Inc. bovine and human placental sourced collagens, recombinant collagens, and PEG-polymers • Endura-Tec Systems Corp. bio-mechanical endurance testing ofstents, grafts, and cardiovascular materials • Howmedica develops and manufactures products in orthopaedics. • MATECH Biomedical Technologies, development of biomaterials by chemical polymerization methods. • Medtronic, Inc. is a medical technology company specializing in implantable and invasive therapies. • Molecular Geodesics Inc., biomimetic materials for biomedical, industrial, and military applications • Polymer Technology Group is involved in the synthesis, characterization, and manufacture of new polymer products. • SurModics, offers PhotoLink(R) surface modification technology that can be used to immobilize biomolecules • W.L. Gore Medical Products Division, PTFE microstructures configured to exclude or accept tissue ingrowth. • Zimmer, design, manufacture and distribution of orthopaedic implants and related equipment and supplies
  • 33. What are some of the Challenges? • To more closely replicate complex tissue architecture and arrangement in vitro • To better understand extracellular and intracellular modulators of cell function • To develop novel materials and processing techniques that are compatible with biological interfaces • To find better strategies for immune acceptance