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Silk and silk derivatives have emerged as a possible alternative in surgical device development, offering mechanical strength, biocompatibility, and environmental sustainability. Through a systematic review following PRISMA guidelines, this study evaluated silk fibroin's application across pre-clinical and clinical settings, focusing on its role as screws and plates for osteofixation. A comprehensive search yielded 245 studies, with 33 subjected to full-text review and 15 ultimately included for qualitative analysis. The findings underscore silk fibroin's superior properties, including its tunable degradation rates and ability to be functionalized with therapeutic agents. In vivo and in vitro studies demonstrated its efficacy in enhancing bone healing, offering improved outcomes in osteofixation, particularly for craniofacial defects. Silk fibroin's remarkable attributes in biodegradation and drug release capabilities underscore its potential to enhance patient care. Ultimately, silk fibroin's integration into surgical practices promises a revolution in patient outcomes and environmental sustainability. Its versatility, coupled with the continuous progress in fabrication techniques, signals a promising horizon for its widespread acceptance in the medical field, potentially establishing a new benchmark in surgical treatment. Further research is expected to solidify the transition of silk products from basic science to patient care, paving the way for widespread use in various surgical applications. [ABSTRACT FROM AUTHOR]

Peripheral nerve repair is a common but challenging surgical treatment. Many artificial nerve grafts have been developed, including nerve guidance conduits (NGCs) with biocompatibility, suitable mechanical properties and topography to guide axon growth. However, there remains a need to promote nerve regeneration and accelerate functional recovery using NGCs for nerve reconstruction. Here, silk fibroin (SF) and magnesium (S/Mg) filaments were braided into an inner layer of NGC and freeze-dried with a solution of SF and chitosan (CS). The mechanical stress of these S/Mg-SF/CS conduits reached 2.8 ± 0.2 N and possessed high compression strength. The conduits were evaluated with subcutaneous implantation. Sustainable mechanical function was demonstrated when used to repair 10 mm sciatic nerve gaps in rats. The hollow NGCs improved neurochemotaxis from the damaged nerves. The wet weight ratio of the gastrocnemius muscle, a target muscle for the sciatic nerve related to motor and sensory functions in the NGC group, reached 83.5% of that in the autologous group in 8 weeks; the nerve ports at both ends of the NGC grew well. When the distal end of the regenerated nerve was observed by Transmission Electron Microscopy (TEM), there was no significance difference in the diameter and thickness of the myelin sheath of the distal nerve between the autograft and S/Mg-SF/CS group, indicating that S/Mg-SF/CS NGC in this study promoted the growth of damaged nerves and provided appropriate physio mechanical guidance, thus suggesting potential utility for this approach in artificial nerve transplantation. 1. Porous nerve guidance conduits (NGCs) is reinforced by a braided composite structure consisting of silk/magnesium filaments, which provides the NGC with appropriate physio-mechanical guidance as well as sufficient stability to support the biological micro-environment during early-stages of nerve regeneration and functional recovery. 2. Sufficient mechanical properties, biocompatibility with Schwan cells and good performance after sciatic nerve transplantation demonstrates that the S/Mg-SF/CS NGC in this study promotes the growth of damaged nerves and provides a suitable physio-mechanical guide for potential in artificial nerve transplantation. 3. A facile scalable manufacturing process is achieved by utilizing multidisciplinary engineering, such as textile technologies, biomaterial engineering and medical science. [Display omitted] [ABSTRACT FROM AUTHOR]

Periodic nanostructures provide the facility to control and manipulate the flow of light through their lattices. Three-dimensional photonic crystals enable the controlled design of structural colour, which can be varied by infiltrating the structure with different (typically liquid) fillers. Here, we report three-dimensional photonic crystals composed entirely of a purified natural protein (silk fibroin). The biocompatibility of this protein, as well as its favourable material properties and ease of biological functionalization, present opportunities for otherwise unattainable device applications such as bioresorbable integration of structural colour within living tissue or lattice functionalization by means of organic and inorganic material doping. We present a silk inverse opal that demonstrates a pseudo-photonic bandgap in the visible spectrum and show its associated structural colour beneath biological tissue. We also leverage silk's facile dopability to manufacture a gold nanoparticle silk inverse opal and demonstrate patterned heating mediated by enhancement of nanoparticle absorption at the band-edge frequency of the photonic crystal. [ABSTRACT FROM AUTHOR]

A novel seamless silk fibroin-based endovascular prosthesis (SFEPs) with bifurcated woven structure and anticoagulant function for the improvement of patency is described. The SFEPs were prepared from silk fibroin (SF) and polyester filaments using an installed weaving machine. The production processing parameters were optimized using orthogonal design methods. The inner surface of SFEPs was modified with polyethylenimine (PEI) and EDC/NHS-activated low-molecular-weight heparin (LMWH) to enhance anticoagulant function. The surface morphology and mechanical properties of the SFEPs were evaluated according to standard protocols. The thickness of modified SFEPs was lower than 0.085 ± 0.004 mm and water permeability was lower than 5.19 ± 0.30 mL/(cm2 × min). The results of mechanical properties showed that the diametral tensile strength and burst strength reached 61.6 ± 1.8 and 23.7 ± 2.2 MPa, respectively. Automatic coagulometer and energy-dispersive X-ray (EDX) confirmed LMWH immobilization on the surface of the SFEPs and the blood compatibility was improved with the heparin modification with PEI polymerization. In conclusion, the new prosthesis has potential applications in the blood vessel repairs where minimal thickness but superior mechanical strength and biocompatibility are important. [ABSTRACT FROM AUTHOR]

Abstract Injectable silk hydrogels are ideal carriers of therapeutic agents due to their biocompatibility and low immunogenicity. Injectable silk hydrogels for bone regeneration have been previously developed but often utilize expensive biologics. In this study, we have developed an injectable silk composite incorporated with a triphasic ceramic called MSM-10 (54 Mg 2 SiO 4 , 36 Si 3 Sr 5 and 10 MgO (wt%)) capable of simultaneously releasing magnesium, silicon, and strontium ions into its environment. These ions have been previously reported to possess therapeutic effects for bone regeneration. MSM-10 particles were incorporated into the silk hydrogels at various weight percentages [0.1 (SMH-0.1), 0.6 (SMH-0.6), 1 (SMH-1) and 2 (SMH-2)]. The effects of the released ions on the physicochemical and biological properties of the silk hydrogel were comprehensively evaluated. Increased MSM-10 loading was found to hinder the gelation kinetics of the silk hydrogel through the reduction of beta-sheet phase formation, which in turn affected the required sonication time for gelation, compressive strength, force of injection, microstructure and in vitro degradation rate. Primary human osteoblasts seeded on SMH-0.6 demonstrated increased proliferation and early alkaline phosphatase activity, as well as enhanced osteogenic gene expression compared to pure silk hydrogel and SMH-0.1. In vivo results in subcutaneous mouse models showed both decreased fibrous capsule formation and increased number of new blood vessels around the injected SMH-0.1 and SMH-0.6 implants compared to pure silk hydrogels. The results in this study indicate that the ions released from MSM-10 is able to influence the physicochemical and biological properties of silk hydrogels, and SMH-0.6 in particular shows promising properties for bone regeneration. Highlights • Silk hydrogels able to release bioactive Mg, Si and Sr ions were prepared by sonication and with novel ceramic particulates. • The release of Mg, Si and Sr ions markedly improved in vitro osteogenesis of silk hydrogels. • Incorporation of ceramic particulate changed physical, chemical and mechanical properties of silk hydrogels. • Modified hydrogels provided better environment for angiogenesis and reduced surrounding fibrous capsule formation in vivo. [ABSTRACT FROM AUTHOR]

Silk fibroin (SF) is a natural fibrous polymer with strong potential for many biomedical applications. SF has attracted interest in the field of bone tissue engineering due to its extraordinary characteristics in terms of elasticity, flexibility, biocompatibility and biodegradability. However, low osteogenic capacity has limited applications for SF in the orthopedic arena unless suitably functionalized. Hydroxyapatite (HAp) is a well-established bioceramic with biocompatibility and appropriate for constructing orthopedic and dental substitutes. However, HAp ceramics tend to be brittle which can restrict applications in the repair of load-bearing tissues such as bones. Therefore, blending SF and HAp combines the useful properties of both materials as bone constructs for tissue engineering, the subject of this review. [ABSTRACT FROM AUTHOR]

A silk-protein based reservoir rod was developed for zero-order and long-term sustained drug delivery applications. Silk reservoir rod formulations were processed in three steps. First, a regenerated silk fibroin solution, rich in random-coil content was transformed into a tubular silk film with controllable dimensions, uniform film morphology and a structure rich in silk II , β -sheet content via “film-spinning.” Second, the drug powder was loaded into swollen silk tubes followed by tube end clamping. Last, clamped silk tube ends were sealed completely via dip coating. Anastrozole, an FDA approved active ingredient for the treatment of breast cancer, was used as a model drug to investigate viability of the silk reservoir rod technology for sustained drug delivery. The in vitro and in vivo pharmacokinetic data (in a female Sprague–Dawley rat model) analyzed via liquid chromatography-tandem mass spectroscopy indicated zero-order release for 91 days. Both in vitro and in vivo anastrozole release rates could be controlled simply by varying silk rod dimensions. The swelling behavior of silk films and zero-order anastrozole release kinetics indicated practically immediate film hydration and formation of a linear anastrozole concentration gradient along the silk film thickness. The dependence of anastrozole release rate on the overall silk rod dimensions was in good agreement with an essentially diffusion-controlled sustained release from a reservoir cylindrical geometry. In vivo results highlighted a strong in vitro - in vivo pharmacokinetic correlation and a desirable biocompatibility profile of silk reservoir rods. During a 6-month implantation in rats, the apparent silk molecular weight values decreased gradually, while rod dry mass and β -sheet crystal content values remained essentially constant, providing a suitable timeframe for controlled, long-term sustained delivery applications. Overall, the silk reservoir rod may be a viable candidate for sustained delivery of breast cancer therapeutics. [ABSTRACT FROM AUTHOR]

Abstract: Blended polymers are used extensively in many critical medical conditions as components of permanently implanted devices. Hybrid protein polymers containing recombinant human tropoelastin and silk fibroin have favorable characteristics as implantable scaffolds in terms of mechanical and biological properties. A firefly luciferase transgenic mouse model was used to monitor real-time IL-1β production localized to the site of biomaterial implantation, to observe the acute immune response (up to 5 days) to these materials. Significantly reduced levels of IL-1β were observed in silk/tropoelastin implants compared to control silk only implants at 1, 2 and 3 days post-surgery. Subsequently, mice (n = 9) were euthanized at 10 days (10D) and 3 weeks (3W) post-surgery to assess inflammatory cell infiltration and collagen deposition, using histopathology and immunohistochemistry. Compared to control silk only implants, fewer total inflammatory cells were found in silk/tropoelastin (∼29% at 10D and ∼47% at 3W). Also fewer ingrowth cells (∼42% at 10D and ∼63% at 3W) were observed within the silk/tropoelastin implants compared to silk only. Lower IL-6 (∼52%) and MMP-2 (∼84%) (pro-inflammatory) were also detected for silk/tropoelastin at 10 days. After 3 weeks implantation, reduced neovascularization (vWF ∼43%), fewer proliferating cells (Ki67 ∼58% and PCNA ∼41%), macrophages (F4/80 ∼64%), lower IL-10 (∼47%) and MMP-9 (∼55%) were also observed in silk/tropoelastin materials compared to silk only. Together, these results suggest that incorporation of tropoelastin improves on the established biocompatibility of silk fibroin, uniquely measured here as a reduced foreign body inflammatory response. [Copyright &y& Elsevier]

Abstract: The goal of the presented study was to compare the biocompatibility and cellular responses to porous silk fibroin (SF) scaffolds produced in a water-based (UPW) or a solvent based process (HFIP) using two different SF sources. For that reason, four different SF scaffolds were implanted (n =6) into drill hole defects in the cancellous bone of the sheep tibia and humerus. The scaffolds were evaluated histologically for biocompatibility, cell–material interaction, and cellular ingrowth. New bone formation was observed macroscopically and histologically at 8weeks after implantation. For semiquantitative evaluation, the investigated parameters were scored and statistically analyzed (factorial ANOVA). All implants showed good biocompatibility as evident by low infiltration of inflammatory cells and the absent encapsulation of the scaffolds in connective tissue. Multinuclear foreign body giant cells (MFGCs) and macrophages were present in all parts of the scaffold at the material surface and actively degrading the SF material. Cell ingrowth and vascularization were uniform across the scaffold. However, in HFIP scaffolds, local regions of void pores were present throughout the scaffold, probably due to the low pore interconnectivity in this scaffold type in contrast to UPW scaffolds. The amount of newly formed bone was very low in both scaffold types but was more abundant in the periphery than in the center of the scaffolds and for HFIP scaffolds mainly restricted to single pores. [Copyright &y& Elsevier]

Proteins-polysaccharide scaffolds have been attracted extensive attentions in tissue engineering for decades. However, degradation of these biocomposites are still unknown owe to their difference in hydrophilicity, pore morphology, density and crystallinity, which obviously limits their applications. Here, we designed a silk fibroin/hyaluronic acid (SF/HA) nerve conduit with oriented channels, combining with different components and HA interpenetrating network to improve stability and biodegradation of the conduit. The conduit exhibited well-organized porous structure, remarkable flexibility, water absorption and stability (<8%), determined by morphology and solubility tests. The structure analysis showed that the silk I structures are dominant of the SF/HA conduits. The drug release behavior of the conduits demonstrated gradient release of rhodamine B with an attribute to the oriented channels. Further, by HA skeleton of interpenetrating network, the SF/HA conduits retained conduit and porous morphology in protease XIV solution for 21days. More importantly, the conduits showed good biocompatibility, which are verified by the growth and phenotype of mouse embryonic stem cell. This study broadening the understanding of the biodegradation behavior of protein-polysaccharide biocomposites and provides promising design strategy for nerve conduits. • Protein-polysaccharide conduits with multichannels were fabricated successfully by freezed drying technique. • Hyaluronic acid acted as skeleton of interpenetrating network against biodegradation of the conduits. • The conduits exhibited gradient drug release, good biocompatibility and potential for nerve tissue engineering. [ABSTRACT FROM AUTHOR]

Silk fibroin (SF) hydrogels are explored for diverse applications, ranging from cosmetic thickeners to support matrices for drug delivery and regenerative medicine. However, their utilities remain inherent challenges in inadequate mechanical properties and sophisticated process. Hyaluronic acid (HA) is a natural polysaccharide with outstanding physiological activities and superior water retaining capacity. In this study, HA was used as a skeleton of interpenetrating network to fabricate SF/HA hydrogel with high-flexibility and micro or nanofibers networks. The flexibility and water-absorbing quality of SF/HA hydrogels are improved dramatically due to super hydrophilicity of HA addition. By the synergistic effect of HA and solvent exchange, SF molecular conformation is induced efficiently to form β-sheet structures and assembling directly by physical crosslinking, which are determined by structure analysis. Moreover, the condense structure of the SF/HA hydrogel is mainly silk II, which contributes to their high thermal stability. The HA also plays a dominating role in formation of the micro or nanofibers networks on the wall of the SF/HA hydrogels, confirming by elements analysis. Investigation on fibroblast vitality and morphology showed that these SF/HA hydrogels can support cell adhesion, differentiation, and proliferation in vitro and present a better biocompatibility in comparison to pure SF hydrogel. Thus, it is believed that this work provides a facile way to fabricate protein-polysaccharide biomaterials and tissue engineering scaffolds. In this work, we report a new approach to assemble directly high-flexibility and biocompatible silk fibroin (SF)/hyaluronic acid (HA) hydrogel without chemical crosslinking. HA macromolecular chains and β-sheet content enriched contribute to the SF molecules conformational transitions and remarkable mechanical property in terms of physical crosslinking efficiently. Fibroblasts growth, morphology and viability on the hydrogels indicate good alternatives for tissue engineering. Image 1 • Composite hydrogels of silk fibroin and hyaluronic acid were fabricated by novel solvent exchange technique. • Hyaluronic acid acted as a skeleton of interpenetrating network to induce robust silk-based hydrogel formation without chemical agents. • Silk fibroin/hyaluronic acid hydrogels with nano or submicron fibers and good biocompatibility made them as expected candidates for soft tissue repair in future. [ABSTRACT FROM AUTHOR]