Table 4.
The bone protecting effects of CPC enhanced by polysaccharides.
| Enhancer | Characteristics of Enhanced CPC |
Type of Study | Type of Cell, Sample, and Animal Model | Outcomes Observed in Animals | Reference |
|---|---|---|---|---|---|
| Bacterial cellulose | Thermal stability: ↑, compressive strength: ↑ | In vitro | MC3T3-E1 cells | Cell growth and proliferation: ↑ | [50] |
| Chitosan | - | In vitro | Osteoblastic cells | ALP: ↑ | [51] |
| Chitosan | Flexural strength: ↑, elastic modulus: ↑ | In vitro | Rat bone marrow mesenchymal stem cells | ALP: ↑ | [52] |
| Chitosan | Compressive strength: ↑ | In vivo | Bone defect at radius of mature dogs | Amount of implant debris: ↓, new bone callus formation: ↑ | [53] |
| Hyaluronic acid | - | In vitro | Osteoblastic cells | ALP: ↑ | [51] |
| Hyaluronic acid | Compressive strength: ↑ | In vitro | Human bone marrow mesenchymal stromal cells | ALP: ↑, OPN: ↑, Runx-2: ↑ | [54] |
| In vivo | Bone defect at metaphyseal region of medial tibia in female Sprague-Dawley rats | BV/TV: ↑, Tb.Pf: ↑, BMD: ↑, bone and vessel formation: ↑, mineralisation: ↑, OCN: ↑, COL1: ↑, BMP-2: ↑ | |||
| Alginate | Injectability: ↑, cohesion: ↑, compressive strength: ↑, Young’s modulus: ↑, setting time: ↔ | In vitro | Human osteoblast-like cells | Viable cells: ↑ | [55] |
| Alginate hydrogel microbeads | Flexural strength: ↑, work of failure: ↑ | In vitro | Human umbilical cord mesenchymal stem cells | ALP: ↑, OCN: ↑, COL1: ↑, OSX: ↑ | [56] |
Abbreviations: ALP, alkaline phosphatase; BMD, bone mineral density; BMP-2, bone morphogenetic protein-2; BV/TV, bone volume/total volume; COL1, type I collagen; CPC, calcium phosphate cement; OCN, osteocalcin; OPN, osteopontin; OSX, osterix; Runx-2, Runt-related transcription factor 2; Tb.Pf, trabecular pattern factor; ↑, increase/improve; ↓, decrease/inhibit; ↔, no change.