Design of biodegradable, implantable devices towards clinical translation

Biodegradable materials, including natural and synthetic polymers and hydrolyzable metals, constitute the main components of temporary, implantable medical devices. Besides the intrinsic properties of the materials, the most critical factor determining the successful clinical outcome of implantable and degradable devices is the host response, particularly the immune response, which largely depends on the material features and degradation mechanisms. In this Review, we first survey the state of the art in terms of materials options for use in biodegradable medical devices, focusing on degradation mechanisms and their control. In particular, we highlight silk, which is emerging as an important polymer, owing to its mechanical robustness, bioactive component sequestration, degradability without problematic metabolic products and biocompatibility. We then discuss the host response to these biodegradable materials in terms of dynamic tissue–implant interfaces. Next, we examine the clinical translation of three leading biodegradable material systems — natural and synthetic biodegradable polymers and biodegradable metals — and the related challenges in the context of orthopaedic fixation devices, cardiovascular stents and biodegradable electronic devices. Looking to the future, we propose updated material design strategies to improve the clinical outcomes for these biodegradable medical devices. Clinical outcomes with implantable and degradable devices largely depend on host response. This Review surveys material options and degradation mechanisms relevant to host responses to biodegradable devices, examines clinical translation of leading biodegradable materials and proposes updated material-design strategies to improve device performance.