Efficacy of the biomaterials 3 wt%-nanostrontium-hydroxyapatite-enhanced calcium phosphate cement (nanoSr-CPC) and nanoSr-CPC-incorporated simvastatin-loaded poly(lactic-co-glycolic-acid) microspheres in osteogenesis improvement: An explorative multi-phas

• The addition of nanostrontium can enhance the chemophysical and biological properties of CPC.
• Higher P/L ratios of nano-Sr-CPC might improve the chemomechanical properties and reduce the setting time.
• Nano-Sr-CPC composited with simvastatin-incorporated PLGA microspheres can boost the osteogenesis considerably.

AimsThe purpose of this multi-phase explorative in vivo animal/surgical and in vitro multi-test experimental study was to (1) create a 3 wt%-nanostrontium hydroxyapatite-enhanced calcium phosphate cement (Sr-HA/CPC) for increasing bone formation and (2) creating a simvastatin-loaded poly(lactic-co-glycolic acid) (SIM-loaded PLGA) microspheres plus CPC composite (SIM-loaded PLGA + nanostrontium-CPC). The third goal was the extensive assessment of multiple in vitro and in vivo characteristics of the above experimental explorative products in vitro and in vivo (animal and surgical studies).Methods and results pertaining to Sr-HA/CPCPhysical and chemical properties of the prepared Sr-HA/CPC were evaluated. MTT assay and alkaline phosphatase activities, and radiological and histological examinations of Sr-HA/CPC, CPC and negative control were compared. X-ray diffraction (XRD) indicated that crystallinity of the prepared cement increased by increasing the powder-to-liquid ratio. Incorporation of Sr-HA into CPC increased MTT assay (biocompatibility) and ALP activity (P < 0.05). Histomorphometry showed greater bone formation after 4 weeks, after implantation of Sr-HA/CPC in 10 rats compared to implantations of CPC or empty defects in the same rats (n = 30, ANOVA P < 0.05).Methods and results pertaining to SIM-loaded PLGA microspheres + nanostrontium-CPC compositeAfter SEM assessment, the produced composite of microspheres and enhanced CPC were implanted for 8 weeks in 10 rabbits, along with positive and negative controls, enhanced CPC, and enhanced CPC plus SIM (n = 50). In the control group, only a small amount of bone had been regenerated (localized at the boundary of the defect); whereas, other groups showed new bone formation within and around the materials. A significant difference was found in the osteogenesis induced by the groups sham control (16.96 ± 1.01), bone materials (32.28 ± 4.03), nanostrontium-CPC (24.84 ± 2.6), nanostrontium-CPC-simvastatin (40.12 ± 3.29), and SIM-loaded PLGA + nanostrontium-CPC (44.8 ± 6.45) (ANOVA P < 0.001). All the pairwise comparisons were significant (Tukey P < 0.01), except that of nanostrontium-CPC-simvastatin and SIM-loaded PLGA + nanostrontium-CPC. This confirmed the efficacy of the SIM-loaded PLGA + nanostrontium-CPC composite, and its superiority over all materials except SIM-containing nanostrontium-CPC.