title: Optimizing surface characteristics for cell adhesion and proliferation on titanium plasma spray coatings on polyetheretherketone.
abstract: Titanium plasma spray coating on polyetheretherketone (PEEK) is a recent innovation to interbody spacer technology. The inherent hydrophobic properties of standard, uncoated PEEK implants can hamper cell attachment and bone healing during fusion. The addition of titanium coating not only offers initial stability due to increased surface roughness but also long-term stability due to bony ongrowth created from osteoconductive microenvironment on the device surface. The previously established hydrophilic and osteophilic properties of commercially pure titanium (CPTi) can potentially provide an ideal environment promoting cell attachment and bony ongrowth when applied at the end plate level of the fusion site. Because the surface material composition and topography is what seems to directly affect cell adhesion, it is important to determine the ideal titanium coating for the highest effectiveness.
  
  
  
  The purpose of the study is to determine whether there is an optimal surface roughness for the titanium coatings and whether different polishing methods have a greater effect than roughness or topography in mediating cell adhesion to the surface.
  
  
  
  The study was divided into two phases. In Phase 1, the effects of varying surface roughnesses on identical polishing method were compared. In Phase 2, the effect of varying polishing methods was compared on identical surface roughnesses.
  
  
  
  Coating thickness, porosity, and surface roughness were characterized using an optical microscope as per ASTM F 1854 standards. For both phases, PEEK coupons with plasma-sprayed CPTi were used, and human mesenchymal stem cells (hMSCs) at an initial density of 25,000 cells/cm2were seeded and cultured for 24 hours before fixation in 10% formalin. The cultured hMSCs were visualized by 4',6-diamidino-2-phenylindole (DAPI) staining, a fluorescent stain that binds to the DNA of living cells. Samples were imaged using an environmental scanning electron microscope (eSEM) (Carl Zeiss Microscopy, Thornwood, NY, USA) using a backscattered detector.
  
  
  
  Image analysis of the CPTi coatings showed uniform and rough surfaces. For Phase 1, roughness was evaluated as fine, medium, and coarse. The eSEM image analysis and cell counting by DAPI demonstrated that hMSCs have a tendency to form stronger adhesion and greater pseudopodia extensions on fine roughness surfaces. Individual hMSCs were seen forming cytoplasmic processes extending across the width of a pore. There was a 4- and 20-fold reduction in adhered hMSCs with an increase to medium and coarse roughnesses, respectively. For Phase 2, studied groups are (1) medium CPTi coating with zirconia polishing, (2) medium CPTi coating with CPTi polishing, and (3) fine CPTi coating with CPTi polishing. The eSEM image analysis and cell counting by DAPI demonstrated that hMSCs have a tendency to form stronger adhesion and greater pseudopodia extensions on Group 3 over the other two groups. There was a twofold reduction in adhered hMSCs on medium roughness relative to fine. No difference in cell adhesion was found between Groups 1 and 2. Individual hMSCs were seen forming cytoplasmic processes extending across the width of a pore.
  
  
  
  Previously, it was accepted without much scrutiny that surface coatings were beneficial. This study begins to discover that surface topography directly affects the potential for cells to adhere and proliferate and lead to greater surgical efficacy.
authors.affiliation: Integrated Spine Research Program, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Byung Jo Victor
authors.initials: BJ
authors.lastname: Yoon
authors.affiliation: Integrated Spine Research Program, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Xavier
authors.affiliation: Integrated Spine Research Program, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Brendon R
authors.initials: BR
authors.lastname: Walker
authors.affiliation: Integrated Spine Research Program, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Grinberg
authors.affiliation: Integrated Spine Research Program, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
authors.affiliation: Integrated Spine Research Program, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA. Electronic address: AbjornsonC@hss.edu.
authors.forename: Celeste
authors.initials: C
authors.lastname: Abjornson
mesh_terms: D001577:Benzophenones; D002448:Cell Adhesion; D049109:Cell Proliferation; D002478:Cells, Cultured; D020099:Coated Materials, Biocompatible / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D007659:Ketones / Q000009:adverse effects / Q000737:chemistry*; D059630:Mesenchymal Stem Cells / Q000187:drug effects* / Q000502:physiology; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000737:chemistry*; D011108:Polymers; D013499:Surface Properties; D014025:Titanium / Q000009:adverse effects / Q000737:chemistry*
chemical_list: D001577:Benzophenones; D020099:Coated Materials, Biocompatible; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols; D014025:Titanium
keywords: Cell adhesion; Instrumentation; PEEK; Polyetheretherketone; Surface coating; Titanium