Natural composites, in particular nacre, often combine high strength and toughness thanks to highly ordered architectures and controlled geometries of the reinforcement components. However, combining strength, toughness and resorbability in synthetic materials remains a challenge in particular in the field of bone graft substitutes. In the present study, calcium phosphate-(CaP-)based materials with designed architectures inspired from natural composite materials were achieved. CaP platelets obtained by precipitation in organic medium were first aligned in chitosan matrices by solvent casting in ambient conditions. Efficient strengthening was obtained with 15 vol-% ceramic, reaching cortical bone strength (150 MPa) and preserving good ductility (5 % deformation). In a weak magnetic field, high spatial arrangement without percolation was maintained up to 20 vol-%. With directional freezing, good alignment of the platelets could be pushed up to 50 vol-%. In parallel, in situ recrystallization of CaP blocks in hydrothermal conditions led to hierarchical structures. The strength and the work-of-fracture were enhanced (300%) thanks to a change of failure mode.

Natural composites, in particular nacre, often combine high strength and toughness thanks to highly ordered architectures and controlled geometries of the reinforcement components. However, combining strength, toughness and resorbability in synthetic materials remains a challenge in particular in the field of bone graft substitutes. In the present study, calcium phosphate-(CaP-)based materials with designed architectures inspired from natural composite materials were achieved. CaP platelets obtained by precipitation in organic medium were first aligned in chitosan matrices by solvent casting in ambient conditions. Efficient strengthening was obtained with 15 vol-% ceramic, reaching cortical bone strength (150 MPa) and preserving good ductility (5 % deformation). In a weak magnetic field, high spatial arrangement without percolation was maintained up to 20 vol-%. With directional freezing, good alignment of the platelets could be pushed up to 50 vol-%. In parallel, in situ recrystallization of CaP blocks in hydrothermal conditions led to hierarchical structures. The strength and the work-of-fracture were enhanced (300%) thanks to a change of failure mode.:Acknowledgements v Summary vii Background vii Thesis outline viii Part I: “Brick-and-mortar” structures with discrete reinforcement components ix Part II: “Textured” structures with continuous reinforcement components x Zusammenfassung xi Hintergrund xi Doktorarbeit Gliederung xii Teil I: “Ziegelmauer-Architektur” mit diskreten Verstärkungskomponenten xiii Teil II: “ Texturierte” Strukturen mit kontinuierlichen Verstärkungskomponenten xiv Chapter 1: General introduction 1 Bone grafting 1 CaP ceramics 1 How to improve toughness of CaP ceramics? 2 Importance of structure design: bio-inspiration 2 What mechanical properties should be reached? 5 Specific aims 5 Two general approaches to reach the goal 6 Nacre-inspired “brick-and mortar” structures (Part I) 6 Textured ceramic monoliths (Part II) 6 References 7 Chapter 2: Theoretical calculations 11 Introduction 12 Theoretical tensile strength of β-TCP platelets and critical size for flaw tolerance 13 Optimal aspect ratio 15 Composite strength and stiffness 17 Limitations 19 References 19 PART I: NACRE-INSPIRED “BRICK-AND-MORTAR” STRUCTURES Chapter 3: Synthesis of sub-micrometer calcium phosphate platelets 23 Introduction 24 ii Materials and Methods 25 Precipitation method 25 Reaction parameters 25 Characterization 26 Statistical analysis of results 28 Results 28 Reproducibility of standard experiments 28 Increase of the reagent volume to increase the productivity 30 Increase of the precursors concentration to increase the productivity and modify the particles 30 Increase of titration rate to simplify the process 32 Influence of temperature on the particles 35 Effect of the pH value on the particles 37 Effect of a longer reaction time on the particle stability 40 Study of the influence of variations of the Ca/P molar ratio 42 Discussion 43 Reproducibility 43 Productivity 44 CaP crystal shape 45 Crystal purity 47 Aspect ratio 48 Critical thickness 49 Uniformity of primary particles 50 Non agglomerated 51 General points 52 Conclusions 52 References 53 Chapter 4: Kinetics study of the calcium phosphate platelets growth 57 Introduction 58 Theory 58 Materials and methods 60 Materials and sample preparation 60 Characterization methods 61 Results 62 Visual observations during manipulations 62 SEM observations 62 XRD results 66 Size measurements 68 Kinetics calculations 70 Discussion 74 Nucleation and assembly mechanism 74 Reaction kinetics 76 Control of size and aspect ratio 76 Conclusions 77 References 78 Chapter 5: Structural design of bio-inspired composites by solvent casting 81 Foreword 82 Introduction 82 Experimental section 84 iii Synthesis of resorbable ceramic platelets 84 Solvent casting to prove the reinforcement efficiency of DCP platelets 84 Magnetization of the platelets 85 Maintaining the orientation during drying of an hydrogel matrix 86 Results 87 Synthesis of resorbable ceramic platelets 87 Solvent casting to prove the reinforcement efficiency of CaP platelets 87 Magnetization of the platelets 91 Maintaining the orientation during drying of an hydrogel matrix 93 Discussion 95 Detrimental effect of β-TCP platelets in chitosan 95 Efficient reinforcement with DCP platelets up to a given volume fraction 96 Threshold value for strength improvement 97 Fitting the experimental results with theoretical equations 98 Conclusions 101 References 101 Chapter 6: Biodegradable, strong and tough nacre-inspired structures obtained by freezecasting 105 Introduction 106 Experimental section 108 Synthesis of resorbable ceramic platelets 108 Preliminary freeze-casting tests with β-TCP-based slurries 108 Determination of adequate freeze-casting parameters for hydrogels-CaP slurries 108 Integration of CaP platelets and local planar alignment 109 Attempts to globally align porosity in two directions 109 Densification and consolidation 110 Tensile testing 110 Results 111 Preliminary freeze-casting tests with β-TCP-based slurries 111 Determination of adequate freeze-casting parameters for hydrogels-CaP slurries 112 Integration of CaP platelets and local planar alignment 113 Attempts to globally align porosity in two directions 119 Densification and consolidation 121 Tensile testing 121 Discussion 122 Conclusions 124 References 125 PART II: TEXTURED CERAMIC MONOLITHS Chapter 7: Micro-texturing by recrystallization of calcium phosphate blocks in hydrothermal conditions 127 Introduction 128 Materials and Methods 130 Samples characterization 132 Results 133 Macroscopic observations 133 Microstructural changes (SEM) 133 Crystalline phase conversion (XRD) 139 iv Mechanical properties 142 Fractured surfaces 142 Discussion 145 Conclusions 150 References 150 Chapter 8: Toughening of textured calcium phosphate blocks by polymer impregnation 155 Foreword 156 Introduction 156 Materials and Methods 157 Samples preparation 157 Characterization 158 Results 158 Porosity and microstructure 158 Composition 161 Mechanical properties 161 Discussion 162 Conclusions 164 References 164 Chapter 9: Synthesis and outlook 167 Curriculum Vitae 171

Die Behandlung entzündlicher, tumorbedingter, dysmorphischer oder posttraumatischer Defekte des menschlichen Skeletts hat besonders in den letzten drei Jahrzehnten neben dem Standard der Behandlung, der Übertragung von körpereigenen Hartgeweben und in konserviertem Zustand übertragenem Spendermaterial, auch Knochenersatzmittel in der Therapie etabliert und in Qualität und Quantität der Eingriffe an Bedeutung gewonnen. Die Diskussion über die Übertragbarkeit von Infektionskrankheiten durch Gewebe aus Knochenbanken hat den Einsatz von konserviertem Spenderknochen in den Hintergrund treten lassen. Aus diesem Grunde wird immer wieder nach geeigneten Knochenersatzmaterialien gesucht. Zahlreiche Implantate aus verschiedenen physikalisch und chemisch differenten Stoffgruppen wurden auf ihre Eignung zum Knochenersatz getestet. Ein ideales Material wurde bislang nicht gefunden. Im Tierversuchsmodell und in der klinischen Anwendung beim Menschen wurden verschiedene Knochenersatzmaterialien hinsichtlich der Dynamik der Knochenumbauprozesse mittels nuklearmedizinscher und röntgenologischer Verfahren evaluiert und im Ergebnis des knöchernen Substitues histologisch bezüglich ihrer Wertigkeit für den funktionellen Knochenersatz untersucht. Im Vergleich zum autogenen Knochentransplantat entstanden im Ergebnis der Implantation osteoinduktiver und osteokonduktiv wirkender Knochenersatzmaterialien Substitute, die ausnahmslos und vor allem bei den keramischen Implantaten als unvollständige Restitution zu werten waren. / Alongside the standard donor bone transfer, bone substitutes have established themselves, improved in quality and are being increasingly used in the surgical treatment of dysmorphic defects or defects following inflammation, tumor surgery or trauma, particularly in the last three decades. With the discussion about infectious disease transmission through tissue from bone banks, the use of donor bone has receded into the background. For this reason, suitable bone substitutes are being sought constantly. Implants of many different physical and chemical substance groups have been tested for their suitability as bone substitutes, but an ideal material has yet to be found. In animal experiment models and their clinical application in humans, various bone substitutes have been evaluated for the dynamic of the resulting bone formation using nuclear medical and radiological procedures and have been examined histologically for their value as functional bone substitutes. Compared to autogenous bone grafts, the bone substitutes which have emerged as the result of the implantation of osteoinductive and osteoconductive materials have, without exception and particularly in the case the ceramic implants, shown incomplete restitution.

Both platelet-rich plasma (PRP) and vascular endothelial growth factor (VEGF) can promote regeneration. The aim of this study was to compare the effects of these two elements on bone formation and vascularization in combination with bone marrow stromal cells (BMSC) in a critical-size bone defect in rabbits. The critical-size defects of the radius were filled with: (1) a calcium-deficient hydroxyapatite (CDHA) scaffold + phVEGF165-transfected BMSC (VEGF group), (2) CDHA and PRP, or (3) CDHA, autogenous BMSC, and PRP. As controls served: (4) the CDHA scaffold alone and (5) the CDHA scaffold and autogenous BMSC. The volume of new bone was measured by means of micro-CT scans, and vascularization was assessed in histology after 16 weeks. Bone formation was higher in the PRP + CDHA, BMSC + CDHA, and PRP + BMSC + CDHA groups than in the VEGF group (p < 0.05). VEGF transfection significantly promoted vascularization of the scaffolds in contrast to BMSC and PRP (p < 0.05), but was similar to the result of the CDHA + PRP + BMSC group. The results show that VEGF-transfected BMSC as well as the combination of PRP and BMSC improve vascularization, but bone healing was better with the combination of BMSC and PRP than with VEGF-transfected BMSC. Expression of VEGF in BMSC as a single growth factor does not seem to be as effective for bone formation as expanded BMSC alone or PRP which contains a mixture of growth factors. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Both platelet-rich plasma (PRP) and vascular endothelial growth factor (VEGF) can promote regeneration. The aim of this study was to compare the effects of these two elements on bone formation and vascularization in combination with bone marrow stromal cells (BMSC) in a critical-size bone defect in rabbits. The critical-size defects of the radius were filled with: (1) a calcium-deficient hydroxyapatite (CDHA) scaffold + phVEGF165-transfected BMSC (VEGF group), (2) CDHA and PRP, or (3) CDHA, autogenous BMSC, and PRP. As controls served: (4) the CDHA scaffold alone and (5) the CDHA scaffold and autogenous BMSC. The volume of new bone was measured by means of micro-CT scans, and vascularization was assessed in histology after 16 weeks. Bone formation was higher in the PRP + CDHA, BMSC + CDHA, and PRP + BMSC + CDHA groups than in the VEGF group (p < 0.05). VEGF transfection significantly promoted vascularization of the scaffolds in contrast to BMSC and PRP (p < 0.05), but was similar to the result of the CDHA + PRP + BMSC group. The results show that VEGF-transfected BMSC as well as the combination of PRP and BMSC improve vascularization, but bone healing was better with the combination of BMSC and PRP than with VEGF-transfected BMSC. Expression of VEGF in BMSC as a single growth factor does not seem to be as effective for bone formation as expanded BMSC alone or PRP which contains a mixture of growth factors. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.