Table 3.
The bone protecting effects of CPC enhanced by proteins.
| Enhancer | Characteristics of Enhanced CPC |
Type of Study | Type of Cell, Sample, and Animal Model | Outcomes Observed in Animals | Reference |
|---|---|---|---|---|---|
| Alkaline-treated silk fibroin | Compressive strength: ↑, setting time: ↓, anti-washout: ↑, injectability: ↑ | Ex vivo | Sheep vertebra | Compressive strength: ↑, stiffness: ↑ | [17] |
| In vitro | MC3T3-E1 cells | No cytotoxicity, good cell morphology | |||
| Lysine | Compressive strength: ↑, apparent porosity: ↑ | In vitro | Bone mesenchymal stem cells | ALP: ↑, Runx-2: ↑, COL1: ↑, OCN: ↑ | [18] |
| Arginine-glycine-aspartate | Flexural strength: ↔, elastic modulus: ↔, work of fracture: ↔ | In vitro | Human umbilical cord mesenchymal stem cells | Viable cells: ↑, ALP: ↑, COL1: ↑, OCN: ↑, Runx-2: ↑, mineralisation: ↑ | [19] |
| Arginine-glycine-aspartate | Setting time: ↔, flexural strength: ↔, elastic modulus: ↔ | In vitro | Human umbilical cord mesenchymal stem cells | Cell density: ↑, ALP: ↑, OCN: ↑, COL1: ↑, mineralisation: ↑ | [20] |
| N-acetyl cysteine loaded silk fibroin | - | Ex vivo | Sheep vertebra | Compressive strength: ↑, stiffness: ↑ | [21] |
| In vivo | Bone defect at distal femoral metaphysis of male Sprague-Dawley rats | Maximum force: ↑, BV/TV: ↑, remaining material in bone: ↓ | |||
| In vitro | Rat bone marrow mesenchymal stromal cells | ALP: ↑, mineralisation: ↑, Runx-2: ↑, OSX: ↑, OCN: ↑, β-catenin: ↑ | |||
| Collagen | Flexural strength: ↑ | In vitro | Human umbilical cord mesenchymal stem cells | Mineral nodules: ↑, extracellular matrix formation: ↑, cell number: ↑, ALP: ↑, OCN: ↑, COL1: ↑, Runx-2: ↑, mineralisation: ↑ | [22] |
| Collagen microsphere | - | In vivo | Bone defect at femoral condyles of female New Zealand rabbits | New bone formation: ↑ | [23] |
| Gelatine | Initial and final setting time: ↓, compressive strength: ↑, elastic displacement: ↑ | In vitro | Human osteosarcoma (G-292) cells | Cell number: ↑, ALP: ↑ | [24] |
| Gelatine | Setting time: ↓, compressive strength: ↑ | In vitro | Human osteoblast-like (MG63) cells | Cell proliferation: ↑, ALP: ↑, type 1 pro-collagen: ↑, TGF-β1: ↑ | [25] |
| Elastin-like polypeptide | Micro-hardness: ↑, compressive strength: ↑, initial and final setting time: ↑, anti-washout, denser microstructure with fewer pores, crystallite formation: ↑ | In vitro | NIH3T3 cells | Viable cells, normal cell morphology, normal spreading pattern, normal cell distribution, no nuclear condensation in cells | [26] |
| CGRP | Pore size distribution: ↔, compressive strength: ↔ | In vitro | Rat bone marrow mesenchymal stromal cells | Cell proliferation: ↑, ALP: ↑, BMP-2: ↑, osteonectin: ↑, Runx-2: ↑ | [27] |
| Bone sialoprotein | - | In vitro | Human primary osteoblasts | Cell number: ↑, ALP: ↔, OPN: ↔, OSX: ↑, Runx-2: ↔, osteonectin: ↑ | [28] |
| Bone sialoprotein | - | In vivo | Bone defect at femoral condyles of male Wistar rats | BV/TV: ↔, bone ingrowth: ↔ | [29] |
Abbreviations: ALP, alkaline phosphatase; BMP-2, bone morphogenetic protein-2; BV/TV, bone volume/total volume; CGRP, calcitonin gene-related peptide; COL1, type I collagen; CPC, calcium phosphate cement; OCN, osteocalcin; OPN, osteopontin; OSX, osterix; Runx-2, runt-related transcription factor 2; ↑, increase/improve; ↓, decrease/inhibit; ↔, no change.