Biomaterial surface energy, chemical composition, charge, wettability and roughness all play an important role in determining the degree of the direct bone-to-implant interface, termed osseointegration. Surface chemistry, which is influenced by surface energy, wettability, and composition, is another factor that determines osteoblast phenotype and regulates osteoblast maturation. Increased surface energy is desirable for bone implants due to enhanced interaction between the implant surface and the biological environment. The extent of bone formation in vivo is also increased with increasing water wettability of implants. The physiological role of implant surface chemistry is important in determining the success of implant osseointegration because of molecular rearrangements, surface reactions, contamination, and release of toxic or biologically active ions that are determined by the starting chemistry. However, the role of surface chemistry on osteoblast response is not fully studied. Therefore, the overall goal of this dissertation is to understand how the surface chemistry, including wettability, chemical composition, and charge density, of titanium biomaterials impacts osteoblast maturation (in vitro). This study focuses on the general hypothesis that modifications of surface chemistry of titanium surfaces with sterilization or polyelectrolyte coating on titanium surfaces regulate osteoblast response.

Los cementos de fosfato de calcio son biomateriales utilizados para la regeneración ósea. En esta tesis doctoral se estudia la influencia de la microestructura y la macroporosidad en el comportamiento biológico de un cemento de fosfato de calcio. En la primera parte, se caracterizaron las propiedades físico-químicas y superficiales de dos sustratos de apatita deficiente en calcio con diferente microestructura obtenidos a partir de un cemento de fosfato de calcio (CPC) cuyo principalmente componente es el fosfato tricálcico en fase $\alpha$. % con dos distribuciones de tamaño de partícula distintos. Se estudió la influencia de la microestructura en el comportamiento celular y la adsorción de proteínas como la albúmina, la fibronectina y la lisozima. El uso de dos agentes desorción (EDTA y SDS) permitió evidenciar la influencia de la morfología y tamaño de los cristales de apatita en la fuerza de adhesión de las proteínas estudiadas. Los cultivos celulares con la línea MG-63 mostraron el efecto de la microestructura y el intercambio iónico sobre la proliferación celular. Se observó asimismo una estimulación en la diferenciación celular en uno de los sustratos que fue atribuido a un efecto de la topografía. En la segunda parte, se desarrolló un cemento macroporoso inyectable para aplicaciones médicas, utilizando como agente espumante una solución proteica de albumen. Se optimizó la obtención de la macroporosidad a partir de variables como: la distribución del tamaño de partícula, la relación entre la fase sólida y la fase líquida, la cantidad de agente espumante y la adición de un agente de cohesión como el alginato de sodio para posibilitar su inyección directa en el lugar de implantación. Por último, se demostró mediante estudios \emph{in vivo} en fémur de conejos un mayor potencial de regeneración ósea por parte del cemento macroporoso en comparación con su homólogo microporoso, al obtenerse una mayor cantidad de tejido óseo y una mayor reabsorción en el cemento macroporoso.

Patients with inflammatory or infectious conditions such as periodontitis, peri-implantitis, osteomyelitis, rheumatoid arthritis, septic arthritis and loosened joint prosthesis display varying severity of destruction in the adjacent bone tissue. Bone loss in inflammatory diseases is considered a consequence of cytokine induced RANKL and subsequent enhanced osteoclast formation. Hence, osteotropic cytokines and their receptors have been suggested to be important for the pathogenesis of inflammation-induced osteolysis. It is, here, suggested that bacterial components, so called “pathogen associated molecular patterns=PAMPs”, may also be involved. Varieties of cells express receptors for PAMPs, including Toll-like receptors (TLRs) which are the first line of defence in the innate immune system. LPS (lipopolysaccharide), fimbria and lipoproteins from pathogenic bacteria such as P. gingivalis, S. aureus are ligands for TLR2 and flagellin from pathogenic flagellated bacteria like S. typhimurium is a ligand for TLR5.   Since the susceptibility to, or the severity of inflammation-associated bone diseases are likely related to differences in the tissue response, and the mechanisms by which PAMPs interact with bone cells are not fully understood, we aimed to elucidate the importance of different TLRs for inflammation induced bone loss by conducting in vitro and in vivo investigations. Activation of TLR2 and TLR5 in organ cultured mouse parietal bones increased bone resorption in a time- and concentration-dependent manner by a process inhibited by OPG and bisphosphonate, showing the crucial role of RANKL-induced osteoclast formation. In addition, the number of osteoclasts, expression of osteoclastic genes and osteoclastogenic transcription factors were increased. In the bones and in osteoblasts isolated from the bones, TLR2 agonists increased the expression of RANKL without affecting OPG, while TLR5 activation resulted in enhanced RANKL and decreased OPG. Activation of both TLR2 and TLR5 stimulated the expression in both bones and osteoblasts of prostaglandins and pro-inflammatory cytokines, known to stimulate RANKL. By blocking the cytokines and prostaglandin, we showed that TLR2 and TLR5 induced bone resorption and RANKL expression are independent of these molecules. Activation of TLR2, but not TLR5, in mouse bone marrow macrophage cultures inhibited RANKL-induced osteoclast formation, an effect not observed in committed pre-osteoclasts. Local administration in vivo of TLR2 and TLR5 agonists on the top of mouse skull bones enhanced local and systemic osteoclast formation and bone resorption. Using knockout mice, we showed that the effects by LPS from P. gingivalis (used as TLR2 agonist) and flagellins (used as TLR5 agonists) are explicit for TLR2 and TLR5 ex vivo and in vivo, respectively. These data show that stimulation of TLR2 and TLR5 results in bone resorption in vitro and in vivo mediated by increased RANKL in osteoblasts and thus may be one mechanism for developing inflammatory bone loss. Interestingly, histological analyses of skull bones of mice treated locally with TLR2 and TLR5 agonists revealed that the bones not only reacted with locally increased osteoclastogenesis (osteoclast formation), but also with locally increased new bone formation. This was observed on both periosteal and endosteal sides of the bones, as well as in the bone marrow compartment. The formation of new bone was seen close to osteoclasts in some parts, but also in other areas, distant from these cells. The response was associated with active, cuboidal osteoblasts, extensive cell proliferation and increased expression of genes coding for bone matrix proteins and osteoblastic transcription factors. In conclusion, activation of TLR2 and TLR5 in osteoblasts results in bone loss associated with enhanced osteoclast formation and bone resorption, as well as with increased osteoblast differentiation and new bone formation, indicating that inflammation causes bone modeling. The data provide an explanation why LPS from P. gingivalis and flagellin from flagella-expressing bacteria can stimulate bone loss. Since TLR2 and TLR5 can be activated not only by bacterial components, but also by endogenous ligands produced in inflammatory processes, the data also contribute to the understanding of inflammation induced bone loss in autoimmune diseases. Hopefully, these findings will contribute to the development of treatment strategies for inflammation induced bone loss.

Bone consists of collagen/hydroxyapatite (HA) composites in which poorly crystalline carbonated calcium phosphate is intercalated within the fibrillar structure. Normal bone mineral is a carbonated-apatite, but there are limited data on the effect of mineral containing carbonate on cell response. Although the exact biological role of silicate in bone formation is unclear, silicate has been identified at trace levels in immature bone and is believed to play a metabolic role in new bone formation. To mimic the inorganic and organic composition of bone we have developed a variety of bone graft substitutes. In the present body of research, we characterized the surface composition of human cortical and trabecular bone. When then characterized the surface compositions of the following potential bone substitutes: carbonated hydroxyapatite (CO₃²-HA), silicated hydroxyapatite (Si-HA), and collagen sponges mineralized with calcium phosphate using the polymer-induced liquid-precursor (PILP) process. In the latter substitutes, the PILP process leads to type I collagen fibrils infiltrated with an amorphous mineral precursor upon which crystallization leads to intrafibrillar HA closely mimicking physiological bone mineral. We then determined the osteoblast-like cell response to each bone substitute to characterize the substrate’s effect on osteoblast differentiation. The observations collectively indicate that cells are sensitive to the formatting of the mineral phase of a bone substitute and that this format can be altered to modulate cell behavior.

Dental and orthopaedic implants are currently the solutions of choice for teeth and joint replacements with success rates continually improving, but they still have undesirable failure rates in patients who are compromised by disease or age, and who in many cases are the ones most in need. The success of titanium (Ti) implants depends on their ability to osseointegrate with the surrounding bone and this, in turn, is greatly dependent on the surface characteristics of the device. Advancements in surface analysis and surface modification techniques have improved the biological performance of metallic implants by mimicking the hierarchical structure of bone associated with regular bone remodeling. In this process, damaged bone is resorbed by osteoclasts, which produce resorption lacunae containing high microroughness generated after mineral dissolution under the ruffled border, as well as superimposed nanoscale features created by the collagen fibers left at the surface. Indeed, increasing Ti surface roughness at the micro and sub-microscale level has been shown to increase osteoblast differentiation in vitro, increase bone-to-implant contact in vivo, and accelerate healing times clinically. Recently, the clinical application of surface nanomodification of implants has been evaluated. Still, most clinically-available devices remain smooth at the nanoscale and fundamental questions remain to be elucidated about the effect of nanoroughness on the initial response of osteoblast lineage cells. Another property that could be used to control osteoblast development and the process of osseointegration is the electrical surface charge of implants. The presence of endogenous electrical signals in bone has been implicated in the processes of bone remodeling and repair. The existence of these native signals has prompted the use of external electrical stimulation to enhance bone growth in cases of fractures with delayed union or nonunion, with several in vitro and in vivo reports confirming its beneficial effects on bone formation. However, the use of electrical stimulation on Ti implants to enhance osseointegration is less understood, in part because of the lack of in vitro models that truly represent the in vivo environment. In addition, an aspect that has not been thoroughly examined is the electrical implication of implant corrosion and its effect on the surrounding tissue. Implants are exposed to extreme conditions in the body such as high pH during inflammation, and cyclic loads. These circumstances may lead to corrosion events that generate large electrochemical currents and potentials, and may cause abnormal cell and tissue responses that could be partly responsible for complications such as aseptic loosening of implants. Consequently, Ti implants with tailored surface characteristics such as nanotopography and electrical polarization, could promote bone healing and osseointegration to ensure successful outcomes for patients by mimicking the biological environment of bone without the use of systemic drugs. The objective of this thesis is to understand how surface nanostructural and electrical characteristics of Ti and Ti alloy surfaces may affect osteoblast lineage cell response in vitro for normal tissue regeneration and repair. Our central hypothesis is that combined micro/nanostructured surfaces, as well as direct stimulation of Ti surfaces with fixed direct current (DC) potentials, can enhance osteoblast differentiation.

Paget’s disease is characterised by focal regions of accelerated bone turnover. The aetiology is unknown, but genetic and environmental factors have been implicated. Pagetic lesions contain increased numbers of osteoclasts with abnormal morphology, so an osteoclast defect has been considered central to the pathogenesis. However, given osteoblasts regulate osteoclast differentiation and activity; osteoblast abnormalities may be important in the disease. This study aimed to identify features of pagetic osteoblasts that could clarify their role in Paget’s disease. Gene expression in osteoblasts and bone marrow cultured from pagetic lesions of 23 patients was compared to cells from unaffected tissue using both microarrays and real time RT-PCR. The results indicated global changes in gene expression in pagetic osteoblasts. A number of genes that can stimulate osteoclastogenesis, including interleukins 6 and 1β, and monocyte chemotactic factor 1 were up-regulated, but the RANKL/OPG ratio tended to be decreased. Genes involved in osteoblast differentiation were down-regulated, including the transcription factors RUNX2, DLX5 and SATB2, the osteogenic factor BMP2, and the matrix proteins osteocalcin and bone sialoprotein. Markers of less mature osteoblastic cells, alkaline phosphatase and matrix gla protein were up-regulated. The intermediate filament, keratin 18, was very significantly up-regulated in pagetic cells. Over-expression of this protein in osteoblasts using an adenoviral vector produced some changes in gene expression, but did not produce an overtly pagetic phenotype. Over-expression of SQSTM1 mutants found in some patients with Paget’s disease also produced only minor changes in osteoblast phenotype. The RNA from the primary cell cultures was also used to investigate the presence of measles virus and somatic mutations in SQSTM1 in the disease, but neither were identified in any of the patients. These results suggest that there are important changes in pagetic osteoblasts that are maintained when the cells are removed from the affected bone microenvironment. These include enhanced production of factors to stimulate osteoclastogenesis, while osteoblast differentiation and activity may be impaired. We were unable to identify genetic or environmental factors that could trigger these changes. The pagetic osteoblast is distinct from control cells, and is likely to contribute to the development of Paget’s disease.

Paget’s disease is characterised by focal regions of accelerated bone turnover. The aetiology is unknown, but genetic and environmental factors have been implicated. Pagetic lesions contain increased numbers of osteoclasts with abnormal morphology, so an osteoclast defect has been considered central to the pathogenesis. However, given osteoblasts regulate osteoclast differentiation and activity; osteoblast abnormalities may be important in the disease. This study aimed to identify features of pagetic osteoblasts that could clarify their role in Paget’s disease. Gene expression in osteoblasts and bone marrow cultured from pagetic lesions of 23 patients was compared to cells from unaffected tissue using both microarrays and real time RT-PCR. The results indicated global changes in gene expression in pagetic osteoblasts. A number of genes that can stimulate osteoclastogenesis, including interleukins 6 and 1β, and monocyte chemotactic factor 1 were up-regulated, but the RANKL/OPG ratio tended to be decreased. Genes involved in osteoblast differentiation were down-regulated, including the transcription factors RUNX2, DLX5 and SATB2, the osteogenic factor BMP2, and the matrix proteins osteocalcin and bone sialoprotein. Markers of less mature osteoblastic cells, alkaline phosphatase and matrix gla protein were up-regulated. The intermediate filament, keratin 18, was very significantly up-regulated in pagetic cells. Over-expression of this protein in osteoblasts using an adenoviral vector produced some changes in gene expression, but did not produce an overtly pagetic phenotype. Over-expression of SQSTM1 mutants found in some patients with Paget’s disease also produced only minor changes in osteoblast phenotype. The RNA from the primary cell cultures was also used to investigate the presence of measles virus and somatic mutations in SQSTM1 in the disease, but neither were identified in any of the patients. These results suggest that there are important changes in pagetic osteoblasts that are maintained when the cells are removed from the affected bone microenvironment. These include enhanced production of factors to stimulate osteoclastogenesis, while osteoblast differentiation and activity may be impaired. We were unable to identify genetic or environmental factors that could trigger these changes. The pagetic osteoblast is distinct from control cells, and is likely to contribute to the development of Paget’s disease.

Paget’s disease is characterised by focal regions of accelerated bone turnover. The aetiology is unknown, but genetic and environmental factors have been implicated. Pagetic lesions contain increased numbers of osteoclasts with abnormal morphology, so an osteoclast defect has been considered central to the pathogenesis. However, given osteoblasts regulate osteoclast differentiation and activity; osteoblast abnormalities may be important in the disease. This study aimed to identify features of pagetic osteoblasts that could clarify their role in Paget’s disease. Gene expression in osteoblasts and bone marrow cultured from pagetic lesions of 23 patients was compared to cells from unaffected tissue using both microarrays and real time RT-PCR. The results indicated global changes in gene expression in pagetic osteoblasts. A number of genes that can stimulate osteoclastogenesis, including interleukins 6 and 1β, and monocyte chemotactic factor 1 were up-regulated, but the RANKL/OPG ratio tended to be decreased. Genes involved in osteoblast differentiation were down-regulated, including the transcription factors RUNX2, DLX5 and SATB2, the osteogenic factor BMP2, and the matrix proteins osteocalcin and bone sialoprotein. Markers of less mature osteoblastic cells, alkaline phosphatase and matrix gla protein were up-regulated. The intermediate filament, keratin 18, was very significantly up-regulated in pagetic cells. Over-expression of this protein in osteoblasts using an adenoviral vector produced some changes in gene expression, but did not produce an overtly pagetic phenotype. Over-expression of SQSTM1 mutants found in some patients with Paget’s disease also produced only minor changes in osteoblast phenotype. The RNA from the primary cell cultures was also used to investigate the presence of measles virus and somatic mutations in SQSTM1 in the disease, but neither were identified in any of the patients. These results suggest that there are important changes in pagetic osteoblasts that are maintained when the cells are removed from the affected bone microenvironment. These include enhanced production of factors to stimulate osteoclastogenesis, while osteoblast differentiation and activity may be impaired. We were unable to identify genetic or environmental factors that could trigger these changes. The pagetic osteoblast is distinct from control cells, and is likely to contribute to the development of Paget’s disease.

This thesis focuses on surface science and bioengineering investigations, first for the development of an improved biomaterial for orthopaedic implant applications, and second, for the development of a biosensor device for biomedical diagnostics. A key component considered in this thesis was the covalent linkage of proteins to the material’s surface for retaining the protein’s immunological and biological activities and for generating a functional interface. Part 1 of this thesis investigated surface modification procedures for improving the bioactivity of titanium substrates. Titanium is first coated with a bioactive silica film grown by plasma enhanced chemical vapour deposition (PECVD), referred to as PECVD-Si-Ti. In previous studies, the bone-implant integration process was enhanced 1.6-fold for titanium implants coated with PECVD-Si films compared to uncoated titanium implants in vivo. However, in vitro studies carried out in this thesis showed that the growth of MG63 osteoblast-like cells was 7-fold higher on uncoated titanium compared to PECVD-Si coated titanium. Therefore, to improve cell growth on the surface and, by inference, the integration of PECVD-Si-Ti implants into bone tissue, the implant’s surface was functionalised with a mitogenic factor, insulin-like growth factor-1 (IGF-1). This was accomplished by modifying the PECVD-Si-Ti surface with an alkoxysilane, 3-isocyanatopropyl triethoxysilane (IPTES), and then by covalent bioconjugation of IGF-1 through isocyanate-amino chemistry. After 72 h of in vitro cell culture in serum-free medium, the growth of MG63 cells was enhanced 1.9-fold on IPTES functionalised PECVD-Si-Ti, which was loaded with covalently immobilised IGF-1 compared to IPTES functionalised PECVD-Si-Ti without IGF-1 (isocyanate reactive groups were quenched with ethanolamine hydrochloride). The attachment and adhesion of MG63 cells were also enhanced on PECVD-Si-Ti by the covalently immobilised IGF-1 in serum-free cell culture conditions. Therefore, the bioactivity of PECVD-Si-Ti was improved by covalently linking IGF-1 to the substrate surface through isocyanate-amino chemistry. Part 2 of this thesis involved the development of a new optical interferometric biosensor. The biosensor platform was constructed from electrochemically-prepared thin films of porous silicon that acted as a sensing matrix and transducer element. By reflective interferometry using white light, an enzyme-catalysed reaction was discovered (horseradish peroxidase (HRP) mediated oxidation of 3,3’,5,5’-tetramethylbenzidine (TMB)), which led to an acceleration in the rate of porous silicon corrosion and represented the biosensor’s readout signal. We discovered that another substrate, which is also oxidised by HRP, OPD, produces an even more pronounced readout signal. The HRP-OPD system was used in an immunoassay for detecting human IgG from an Intragam solution. An important part in the design of the biosensor was the surface functionalisation approach where anti-human IgG, referred to as the capture antibody, is immobilised on the porous silicon surface. The readout signal (produced from the capture of human IgG) was enhanced 4-fold on the porous silicon biosensing platform functionalised with covalently linked anti-human IgG through isocyanate-amino chemistry compared to the porous silicon biosensing platform functionalised with adsorbed anti-human IgG. The optimised biosensor was used to detect IgG from a total human protein concentration of Intragam to a sensitivity of 100 ng/ml. In summary, isocyanate-amino bioconjugate chemistry was used to covalently link either IGF-1 to PECVD-Si-Ti for improving the biological activity of the orthopaedic implant and to covalently link IgG to porous silicon for developing a sensitive biosensor for the detection of proteins. This surface chemistry approach is very useful for biomaterial and biosensing applications.

RNA interference (RNAi) is a post-transcriptional gene silencing process elicited by double-stranded RNA, such as micro-RNA (miRNA) and small interfering RNA (siRNA). They are 18-25 nucleotide long, small non-coding RNAs acting as critical regulators in eukaryotic genome expression. They play an important role in regulating a wide range of biological processes such as cell cycle control, differentiation, aging and apoptosis. However, their role in supporting skeletal development and bone homeostasis is still poorly understood. Osteoporotic fractures constitute a tremendous and growing problem in our ageing populations, with an annual incidence of approximately 60000 osteoporotic fractures in Sweden. Osteoporosis is referred as the “Silent epidemic” because bone loss is gradual and a basically symptomless development until a fracture occurs. Results presented in this thesis provide a novel insight into crucial roles of   miRNAs in regulating bone homeostasis. The initial aim for the thesis was to perform global miRNA expression profiling in human bone cells, and to correlate these levels to global mRNA levels. We identified and functionally characterized several miRNAs that were differentially expressed and acted in important bone signaling pathways such as the Wnt and BMP pathways. These miRNAs included hsa-miR-29b, hsa-miR-30c2 and hsa-miR-125b, which we found targeting genes highly relevant to bone metabolism e.g. COL1A1, SPARC, RUNX2, BGLAP and FRZB. Thereafter, the effect on the microRNAome upon external stimuli (e.g., Dexamethasone and Parathyroid hormone) was assessed by SOLiD sequencing. We observed a substantial difference in the expression of miRNAs between PTH and DEX treated cells. Understanding the changes in miRNAome in human bone cells under different conditions could provide new insight in bone remodeling, specifically differentiation and functional properties of osteoblasts. Based on these studies, we furthermore identified Dlx5 as potential common target of miR-203 and miR-320b and these miRNAs negatively regulate BMP-2-induced osteoblast differentiation. To activate the RNAi pathway, siRNA or miRNA molecules must be conveyed into the cytoplasm of target cells. Since challenges in cellular delivery of these small silencing RNA molecules so far have limited their clinical utility, we developed a new siRNA design that demonstrates a novel carrier-free cellular delivery. This development could potentially have a major impact in RNAi therapeutics. In conclusion, this thesis provides novel insight of miRNAs that play a major role in the regulation of bone remodeling and differentiation and functional properties of osteoblasts. Our findings may have diagnostic and/or therapeutic implications in disorders of bone metabolism.