The Osteo-inductive and Osteo-conductive Potential of Nano-Chitosan-Based Composites in Bone Tissue Regeneration: A Systematic Review of In-vitro Studies Analysed by Quinn Tool

Abstract

Background: Chitosan-based composites have gained significant attention in bone tissue engineering due to their biocompatibility, biodegradability, and intrinsic bioactivity. These materials are increasingly explored for their potential to enhance bone regeneration, particularly through their osteoconductive and osteoinductive properties. This systematic review aims to critically assess the current evidence on the effectiveness of nano chitosan-based composites in promoting bone tissue regeneration.
Methodology: A comprehensive literature search was performed across multiple electronic databases, including PubMed, Google Scholar, the Trip Medical Database, and EBSCO. The search was conducted from November 2023 to July 2024, and it includes studies published till November 2023. The search terms were carefully selected using the MeSH Browser and tailored for each database. Inclusion criteria were focused on in vitro studies investigating the osteoconductive and osteoinductive properties of chitosan-based composites in bone regeneration. Systematic reviews, meta-analyses, and in vivo studies that did not specifically address the role of chitosan in bone healing were excluded. The quality and risk of bias of the included studies were assessed using the QUINN assessment tool.
Results: Twelve studies met the inclusion criteria and were included in the qualitative analysis. These studies explored various nano-chitosan-based composites, often combined with osteoconductive materials like hydroxyapatite or bioactive glass, etc. The findings across these studies consistently demonstrated that chitosan-based composites enhance osteogenic differentiation of precursor cells and promote bone matrix deposition. Additionally, the osteoinductive capacity of these composites were evident by their ability to induce mesenchymal stem cell differentiation into osteoblasts and facilitate new bone formation in animal models. However, the methodological quality of the included studies varied, with most studies exhibiting a moderate risk of bias. The key challenges identified included issues with randomization, blinding, and sample size calculations, which may affect the generalizability of the findings. Despite these limitations, the results suggest that nano chitosan-based composites hold significant potential as biomaterials for bone tissue regeneration.
Conclusion: This systematic review underscores the potential of chitosan-based composites in bone tissue engineering, particularly for their osteoconductive and osteoinductive properties. While the current evidence is promising, further high-quality research is necessary to confirm these findings and facilitate the translation of these materials into clinical practice. Addressing the methodological limitations identified in this review will be crucial for advancing the field and improving patient outcomes in bone regeneration therapies.