Abstract
   Implant materials for bone regeneration necessitate a barrier function
   to block bacterial adhesion and fibroblast infiltration, while
   maintaining a delicate equilibrium between material degradation and
   osteogenesis. Here, a spatiotemporally and hierarchically‐guided bone
   regeneration hydrogel with a Janus structure is engineered through a
   sequential photocuring protocol, which features full barrier protection
   by the outer dense phase and superior osteoconductivity within the
   inner loose phase. The Janus hydrogel exhibits stable spatiotemporal
   layering, adaptable degradation, asymmetrical combination of network
   structures, and mechanical strength. The dense phase, with space
   maintenance capacity, completely covers the defective area,
   continuously blocking fibroblast infiltration, and preventing bacterial
   adhesion. In addition, the loose phase is shape‐adapted to the
   defective cavity, allowing osteoblast‐associated cells to migrate and
   create a favorable osteogenic microenvironment. In situ implantation of
   this Janus hydrogel effectively promoted osteogenesis, angiogenesis,
   and neurogenesis in both mouse calvarial and rat periodontal bone
   defect models. Furthermore, the osteogenic efficiency achieved by the
   Janus hydrogel implanted in mouse calvarial defects and rat periodontal
   defects is increased by 42% and 13.7%, respectively, as compared with
   previous studies. These findings thus demonstrated the synergy of
   protective barrier function, osteoconductive properties, and adaptive
   degradation within a single scaffold, which is conducive to bone
   regeneration.
   Keywords: adaptable degradation, integrated Janus hydrogel,
   osteoconductive, protective barrier
     __________________________________________________________________
   The filler‐barrier hydrogel system developed by dual‐network Janus
   structural strategy breaks through the difficulty of a single hydrogel
   to combine barrier protection with bone regeneration, and realizes the
   regeneration‐material degradation adaptation for the field of
   mandibular regeneration. Multi‐omics analysis elucidates the underlying
   mechanisms by which the material regulates tissue regeneration and
   lipid metabolism pathway.
   graphic file with name ADVS-12-e06736-g009.jpg
1. Introduction
   The goal of bone regenerative medicine is to restore the normal
   physiological activities and functions of injured or diseased bone
   tissues. The optimal strategy for implant biomaterials to achieve this
   requires maintaining the delicate balance between material degradation
   and tissue regrowth to maximize material function during bone repair^[
   [52]^1 ^] However, most studies often only consider the biological
   function of the implant material itself to promote bone regeneration.
   The infiltration of non‐osteogenic cells and tissues into the bone
   defect will upset the degradative–regenerative balance.^[ [53]^2 ,
   [54]^3 ^] If bone tissue is infected, the bacterial invasion will cause
   further complications, which could result in failed repair or delayed
   healing.^[ [55]^4 , [56]^5 ^] Hence, precise coupling of different or
   even contradictory material properties and biological characteristics,
   such as barrier protection and guided regeneration, as well as
   preventing bacterial adhesion and promoting cell‐activation, is much
   desired in the field of bone tissue engineering but remains challenging
   to achieve.
   Hydrogels have been widely used in tissue regeneration due to their
   advantages such as, amenability to on‐demand injection, in situ
   gelation, and minimally invasive implantation.^[ [57]^6 , [58]^7 ^]
   Moreover, hydrogels can also provide a conducive physical
   microenvironment for cell growth and differentiation due to their
   suitable network structure.^[ [59]^8 , [60]^9 ^] In recent years,
   injectable hydrogels with in situ gel‐forming properties upon exposure
   to chemical, temperature, pH or light stimuli were designed to simulate
   the anisotropic functional and structural characteristics of bone and
   have achieved progressive results in promoting osteogenesis, thereby
   attracting extensive attention among orthopedic researchers.^[ [61]^10
   , [62]^11 ^] Jiang et al. developed a novel injectable in situ forming
   composite hydrogel system with physico‐chemical properties and
   excellent osteogenic/angiogenic function by introducing fibroin and
   sodium alginate for minimally invasive treatment of jaw regeneration.^[
   [63]^12 ^] It was reported that a co‐assembly system that integrates
   hyaluronic acid tyramine, bioactive peptide amphiphiles, and Laponite
   to engineer hydrogels can be fine‐tuned to enhance bone regeneration.^[
   [64]^13 ^] However, currently available hydrogels are limited in
   clinical application for bone regeneration under physiological
   conditions, and in particular, lack the ability of resistance to
   fibrous tissue infiltration and bacterial adhesion and adaptable
   degradation. Therefore, it is necessary to develop an advanced
   hydrogel‐based scaffold with distinct functionalities on opposite
   sides, referred to as a Janus hydrogel‐based scaffold to meet the needs
   of bone repair under both physiological and pathological conditions.
   Silk fibroin (SF) and chondroitin sulfate (CS) are biocompatible and
   have been approved by the Food and Drug Administration (FDA) for
   biomedical applications.^[ [65]^14 , [66]^15 ^] Here, based on multiple
   adaptations including mechanics and pore structure, a spatiotemporally
   Janus hydrogel through a simple sequential photocuring was developed,
   which can comprehensively overcome various challenging issues during
   the regeneration processes (Scheme [67]1 ). The silk‐methacrylate
   (SF‐MA) phase exhibits a microporous structure and adhesion to seal the
   edge of the defect cavity, so it has a sufficient space maintenance
   capacity. The chondroitin sulfate‐methacrylate (CS‐MA) phase exhibits a
   macroporous structure and shape plasticity that can adapt to various
   bone surface morphologies. Based on the above asymmetric design, we
   integrate the framework with plasticity to meet the desirable space
   properties of the regeneration proccess. In terms of the hierarchical
   function, the SF‐MA dense phase can continuously act as a barrier
   against both fibroblasts and bacteria, while the CS‐MA phase is
   conducive to the ingrowth of osteogenesis‐associated cells.
   Furthermore, we demonstrated that this integrated osteoconductive Janus
   hydrogel achieved adaptive degradation with new bone formation in both
   mouse calvarial defect and rat periodontal defect models. Mechanistic
   study revealed that various signaling pathways associated with cell
   proliferation, differentiation, and tissue regeneration were
   significantly activated during bone regeneration, with lipid metabolism
   being observed to be the most enriched among multiple metabolic
   pathways. Combined LC‐MS/MS analysis suggested that the integrated
   Janus hydrogel orchestrated cellular lipid metabolism that promoted the
   osteogenic differentiation of Rat Bone Marrow Mesenchymal Stem Cells
   (rBMSCs). Based on our results, our integrated Janus hydrogel scaffold
   achieves both barrier protection and osteogenic enhancement, which
   offers much promise in clinical bone regeneration.
Scheme 1.
   Scheme 1
   [68]Open in a new tab
   Schematic diagram of the integrated osteoconductive Janus hydrogel in
   bone regeneration. a) This integrated osteoconductive Janus hydrogel
   was fabricated by sequential application of photocuring, comprising
   methacrylated silk fibroin (SF‐MA) hydrogel with barrier protection
   properties and methacrylated chondroitin sulfate (CS‐MA) hydrogel with
   osteoconductive property. b) After implantation to fill the bone
   defect, the integrated osteoconductive Janus hydrogel facilitated
   improved new bone formation with adaptable degradation.
2. Results and Discussion
2.1. Design Principles and Application Scenarios of the Integrated
Osteoconductive Janus Hydrogel Scaffold
   Functional chemical modifications of injectable hydrogels by grafting
   groups or ions, is a reliable method for regulating the physical
   properties of injectable hydrogels.^[ [69]^16 ^] To realize the
   integration of osteoconductive and protective barrier functions for
   synergistically promoting bone defect repair, an integrated
   osteoconductive Janus hydrogel was fabricated, which was composed of
   SF‐MA hydrogel and CS‐MA hydrogel. Previous studies have shown that CS
   is a biologically active polysaccharide that enhances the expression of
   osteogenic genes and repair of bone microstructure.^[ [70]^17 ^]
   Moreover, CS polymer chains contain a number of sulfate and carboxyl
   groups that regulate cytokine recruitment and promote cell adhesion,
   migration, proliferation, and differentiation.^[ [71]^18 , [72]^19 ^]
   SF is a natural fiber polymer extracted for wound dressings, cartilage
   regeneration, and other tissue engineering because of its
   biocompatibility, biodegradability, and high strength.^[ [73]^20 ,
   [74]^21 , [75]^22 ^] SF can also be used as an important material
   source for guiding bone regeneration membranes in bone tissue
   reconstruction.^[ [76]^23 , [77]^24 ^] Additionally, a previous study
   demonstrated that owing to the presence of carboxyl groups within the
   amorphous region of the SF molecular chains, the SF coating increased
   the polarity and water contact angle of the materials.^[ [78]^25 ^] The
   successful introduction of carbon–carbon double bonds into the
   molecular chains of CS and SF through chemical modification techniques
   achieves the synthesis of photocurable hydrogel (CS‐MA and SF‐MA)
   (Figure [79]1a). Due to the presence of gingival fibroblasts and the
   high microbial density of the oral environment, periodontal defect
   healing often has a poor prognosis. To overcome the aforementioned
   clinical challenges, the integrated osteoconductive Janus hydrogel was
   obtained by sequential injection and photocuring (Figure [80]1b). The
   chemical structures of CS‐MA and SF‐MA were confirmed by ^1H NMR
   spectrum (Figure [81]S1a, Supporting Information), which clearly
   exhibited the signals of vinyl protons at 5.6 and 6.2 ppm (─CH[2]). In
   this study, the CS‐MA hydrogel was designed with two concentrations of
   5% w/v (LCS) and 10% w/v (HCS), which was aimed at investigating the
   effects of bonding and regulating cytokines and growth factors involved
   in osteogenesis. For the SF‐MA hydrogel, we designed three hydrogels
   with concentrations of 5% w/v (SF‐MA 5%), 10% w/v (SF‐MA 10%), and 30%
   w/v (SF‐MA) respectively. When the concentration was 30% w/v, the
   cross‐section of the SF‐MA hydrogel exhibited a microporous structure
   with a smooth and dense outer surface (Figure [82]S1b,c, Supporting
   Information), as observed under scanning electron microscopy.
   Therefore, we chose 30% (w/v) SF‐MA hydrogel for one phase of the
   integrated osteoconductive Janus hydrogel in subsequent experiments.
Figure 1.
   Figure 1
   [83]Open in a new tab
   Design principles and application scenarios of the integrated
   osteoconductive Janus hydrogel. a) Schematic diagram of the fabrication
   process of the SF‐MA and CS‐MA phases. b) The design principles of the
   integrated osteoconductive Janus hydrogel.
2.2. Structural and Mechanical Characteristics of the Integrated
Osteoconductive Janus Hydrogel
   Owing to the introduction of carbon–carbon double bonds, the hydrogel
   exhibited the properties of injectability and rapid photocuring, which
   can be adjusted by irradiation time, thus enabling convenient
   application. As shown in Figures [84]2a and [85]S1d (Supporting
   Information), the precursor solution was able to pass through a
   26‐gauge needle and displayed quick curing in molds with various shapes
   upon irradiation. By sequentially adding CS‐MA precursor solution to
   SF‐MA precursor solution and photocuring respectively, the integrated
   osteoconductive Janus hydrogel was thus fabricated (Figure [86]2b),
   with the SF‐MA precursor solution displaying fluidity, and being able
   to partially penetrate the CS‐MA hydrogel, to form a mechanical
   interlock with chemical bonding after photocuring. To investigate the
   internal structure of the integrated osteoconductive Janus hydrogel and
   the interface bonding between the SF‐MA hydrogel phase and CS‐MA
   hydrogel phase, we found that the LCS hydrogel and the HCS hydrogel had
   a homogeneous, porous structure, with the pore size of the LCS hydrogel
   being 102.78±2.13 µm and that of the HCS hydrogel being 66.72±2.01 µm.
   By contrast, the structure of the SF‐MA hydrogel was relatively
   microporous with a pore size of just 5.06±0.19 µm (Figure [87]2c;
   Figure [88]S1e, Supporting Information). Additionally, the SF‐MA
   hydrogel and the CS‐MA hydrogel were closely integrated with no obvious
   gap being observed. Longitudinal‐sectional scanning showed a
   well‐integrated interface between the SF‐MA hydrogel phase and the
   CS‐MA hydrogel phase, with the SF‐MA hydrogel penetrating the CS‐MA
   hydrogel such that mechanical interlocking and cohesion could be
   observed, which further confirmed the physical integrity of the
   integrated osteoconductive Janus hydrogel (Figure [89]2d). Sufficient
   mechanical strength and stability of the hydrogel are very important
   for functional stability and for creating a conducive pro‐osteogenic
   microenvironment.^[ [90]^26 , [91]^27 ^] As shown in Figure [92]2e, all
   hydrogels exhibited similar non‐linear rheological behavior. In the
   angular frequency range (0.1–10 rad s^−1), the storage modulus (G') is
   higher than the loss modulus (G''). This indicated that all hydrogels
   had stable 3D network structures, in which they could be able to
   maintain the original hydrogel network structure during the functional
   state. Hydrogels are thought to better mimic the natural bone ECM in
   complex bone defects microenvironments, providing mechanical signals to
   promote cell adhesion, proliferation, and osteogenic differentiation.^[
   [93]^28 ^] The results in Figure [94]2f and Figure [95]S1f,g
   (Supporting Information) showed that the contents of CS‐MA in the
   hydrogel matrix exerted a significant effect on the rheological and
   mechanical properties of the hydrogel. With an increase of CS‐MA
   content, the mechanical properties of the integrated osteoconductive
   Janus hydrogel were improved, which could be attributed to their higher
   cross‐linking density. Moreover, the SF‐MA hydrogel showed stronger
   mechanical properties compared with the CS‐MA hydrogel or the GelMA
   (Control). The mechanical strength of our hydrogels greatly exceeded
   that of the natural hematoma fibrin clot, which was regarded as the
   minimum strength during the bone healing process.^[ [96]^29 , [97]^30
   ^] These results suggested that the Janus hydrogel met the requirements
   in the complex mechanical environment of bone defect sites. Together,
   we successfully fabricated an integrated osteoconductive Janus
   hydrogel, which exhibited a stable 3D network structure and
   considerable mechanical properties.
Figure 2.
   Figure 2
   [98]Open in a new tab
   Structural and mechanical characterization of the integrated
   osteoconductive Janus hydrogel. a) The injectability and in‐situ
   gelation of the integrated osteoconductive Janus hydrogel. b) The
   fabrication process of the integrated osteoconductive Janus hydrogel.
   c) Representative SEM images of the integrated osteoconductive Janus
   hydrogel. The area between the red dotted lines denotes the fusion of
   the CS‐MA hydrogel phase with the SF‐MA hydrogel phase. d)
   Representative CLSM images of the integrated osteoconductive Janus
   hydrogel. The area between the white dotted lines shows the fusion of
   the CS‐MA hydrogel phase and SF‐MA hydrogel phase. e) Rheological
   properties of the hydrogels after photocuring as measured by the
   frequency sweep test at a constant strain of 1% at 25 °C. f)
   Stress‐strain curve of the integrated osteoconductive Janus hydrogel.
2.3. In Vitro Swelling Behavior, Degradation Performance and Structural
Stability
   The swelling properties of the hydrogel within the in vivo environment
   affect its function.^[ [99]^31 , [100]^32 ^] Hydrogels in contact with
   blood will rapidly swell without dissolving in vivo, which can mimic
   the natural tissue environment to provide support for the defects.
   However, too much swelling performance can lead to its original
   function and structure being affected. By evaluating the swelling
   behavior of the integrated osteoconductive Janus hydrogel within
   modified simulated body fluid (SBF), we found that both the LCS‐SF‐MA
   (LCS‐SF) hydrogel and the HCS‐SF‐MA (HCS‐SF) integrated osteoconductive
   Janus hydrogel rapidly swelled during the 1 h, and gradually reached
   swelling equilibrium after 5 h (Figure [101]3a; Figure [102]S2a,
   Supporting Information). Hydrogels with high concentrations have been
   reported to exhibit higher cross‐linking densities due to having more
   carbon–carbon double bonds.^[ [103]^33 ^] As expected, the HCS‐SF
   integrated osteoconductive Janus hydrogel displayed less swelling
   capacity with an equilibrium swelling percentage of 120% compared to
   the LCS‐SF integrated osteoconductive Janus hydrogel, which was mainly
   attributed to its higher concentration of CS (Figure [104]3a). Notably,
   both the LCS‐SF and HCS‐SF integrated Janus hydrogel stably maintained
   the combination during the swelling process, which proved the organic
   binding of the two phases (Figure [105]3b). The degradation performance
   of the hydrogels in vitro was conducted in SBF over 25 days to mimic
   degradation in the biosystem.^[ [106]^34 , [107]^35 ^] Upon exposure to
   SBF, all the hydrogels displayed partial degradation behavior in the
   first 5 days with different degradation rates. The GelMA hydrogel
   showed the fastest degradation rate while the HCS‐SF integrated
   osteoconductive Janus hydrogel exhibited the slowest degradation rate
   (≈72% remaining after 25 days), which was also attributed to
   light‐induced crosslinking of carbon–carbon double bonds and high
   concentrations of CS (Figure [108]3c). Moreover, it was revealed that
   the integrated osteoconductive Janus hydrogel interfacial bonding
   remained stable during the 25‐day in vitro degradation process. With
   the prolongation of degradation time, the pores of the CS‐MA hydrogel
   gradually increased and the structure disintegrated, while the SF‐MA
   hydrogel still maintained a stable structure when the pores increased
   (Figure [109]3d; Figure [110]S2b, Supporting Information). Notably, the
   average pore size of the SF‐MA hydrogel was still less than 35 µm on
   the 25^th day of degradation (Figure [111]3e). Additionally, we also
   found that the in vitro weight loss of the SF‐MA hydrogel was only 30%
   on the 25^th day, while the in vivo weight loss of SF‐MA hydrogel was
   only 50% on the 35^th day (Figure [112]3f; Figure [113]S2c, Supporting
   Information). As shown in Figure [114]3g, we observed the adhesion of
   SF‐MA hydrogel to the tissue. Early removal of biological barrier
   membrane or premature loss of barrier structure due to rapid absorption
   will lead to poor osteogenesis.^[ [115]^36 , [116]^37 ^] The above
   results demonstrated that the integrated osteoconductive Janus
   hydrogels have a relatively stable structure in SBF solution with rapid
   swelling equilibrium and appropriate degradation rate adapted to the
   needs of neo‐natal bone repair, which are critical for bone
   regeneration.
Figure 3.
   Figure 3
   [117]Open in a new tab
   The integrated osteoconductive Janus hydrogel maintained a relatively
   stable structure in vitro. a) Swelling ratio of the integrated
   osteoconductive Janus hydrogel in PBS solution at 37 °C for 25 h (n =
   3). b) Representative real‐time images of the integrated
   osteoconductive Janus hydrogel swelling over 25 h. c) Degradation of
   the integrated osteoconductive Janus hydrogel in vitro (n = 3). d)
   Representative SEM images after 1, 5 and 15 days of hydrogel
   degradation. The area between the red dotted lines denoted the fusion
   of the CS‐MA hydrogel phase with the SF‐MA hydrogel phase. e)
   Quantitative analysis of pore size within the integrated
   osteoconductive Janus hydrogel after degradation. f) In vitro
   degradation properties of the SF‐MA hydrogel. g) Tissue adhesion of the
   SF‐MA hydrogel. The black arrow indicated that the SF‐MA adhered to the
   tissue. (ns, not significant; ^*** p < 0.001 and ^**** p < 0.0001).
2.4. In Vitro Assessment of the Barrier Protection Functions of the SF‐MA
Hydrogel Phase and In Vitro Assessment of the Pro‐Osteogenic Activity of the
CS‐MA Hydrogel Phase
   Figure [118]S3a,b (Supporting Information) showed that the SF‐MA
   hydrogel phase was mildly hydrophobic, which made it difficult for
   bacteria and cells to form local adhesion sites, as the air layer
   formed on the surface kept out bacteria.^[ [119]^38 , [120]^39 ^]
   Subsequently, we measured the surface zeta potential of the SF‐MA
   hydrogel. We found that the surface potential of the SF‐MA hydrogel
   decreased significantly with increasing concentration (Figure [121]S3c,
   Supporting Information), factors that are unfavorable for bacterial
   adhesion. It was reported that SF has low immunogenicity and causes
   mild inflammation during the initial stages of trauma repair, favoring
   the destruction of pathogens present at the site of injury.^[ [122]^40
   ^] As the predominant etiological microbe implicated in oral
   infections, Staphylococcus aureus (S. aureus) and Escherichia coli
   (E.coli) were selected for in vitro experiments. The results showed
   that the activity and proliferation of both S. aureus and E. coli were
   inhibited with decreasing surface zeta potential when co‐cultured with
   the SF‐MA hydrogel (Figure [123]S3d,e, Supporting Information). As
   shown in Figures [124]4a and [125]S3f (Supporting Information), the
   bacterial colony‐forming units of S. aureus and E. coli decreased with
   decreasing surface potential, as assessed by confocal laser scanning
   microscope (CLSM). With the extension of co‐culture time, the number of
   bacteria on SF‐MA increased, but it must be noted that the proportion
   of dead bacteria also increased (Figure [126]4b,c; Figure [127]S3g,h,
   Supporting Information). Biofilm formation is a key mechanism for
   bacteria to resist harsh environments and enable drug resistance.^[
   [128]^41 ^] We therefore assessed biofilm formation by crystal violet
   staining and the same trend was confirmed (Figure [129]4d; Figure
   [130]S3i,j, Supporting Information). In brief, the above results
   suggested that the dense SF phase was effective in resisting bacterial
   adhesion. To verify the feasibility of in vivo applications of the
   integrated osteoconductive Janus hydrogel, we first conducted
   biocompatibility assays by culturing rBMSCs in the CS‐MA hydrogel and
   human gingival fibroblasts (HGFs) in the SF‐MA hydrogel. The cell
   viability was assessed by CCK‐8 assay and the results showed that all
   groups of hydrogels exhibited biocompatibility, with rBMSCs in the
   CS‐MA hydrogels and HGFs in the SF‐MA hydrogel proliferating normally
   when cultured for 1, 3, 7 and 14 days (Figure [131]S4a, Supporting
   Information). Moreover, for clinical GBR treatment, a protective
   barrier to prevent fibroblasts infiltration is of great significance
   for occupying the bone defect space and preventing fibroblast
   infiltration from the surrounding soft tissue.^[ [132]^42 , [133]^43 ,
   [134]^44 ^] Considering the mechanical properties and microporous
   structure of the SF‐MA hydrogel, we next assessed the function of
   preventing fibroblast infiltration within a simulated in vivo
   environment by culturing HGFs on the surface of the SF‐MA hydrogel. The
   results showed that HGFs hardly penetrated the SF‐MA hydrogel with a
   growth depth of only 12 µm after 14 days of culture (Figure [135]4e,f;
   Figure [136]S4b,c, Supporting Information). For comparison, we also
   constructed a hydrogel scaffold with a GelMA‐SF‐MA‐GelMA sandwich
   structure, and cultured HGFs on the surface of the GelMA hydrogel. HGFs
   gradually infiltrated into the GelMA hydrogel, and the depth of growth
   reached 38 µm after 14 days, which further proved that the SF‐MA
   hydrogel had the effective function of preventing fibroblasts
   infiltration (Figure [137]4g). Hence, our data demonstrated that the
   SF‐MA hydrogel phase exhibited a protective barrier function, which
   provided structural and biological protection for the bone regeneration
   process.
Figure 4.
   Figure 4
   [138]Open in a new tab
   In vitro barrier protection functions of the SF‐MA hydrogel phase and
   in vitro pro‐osteogenic activity of the CS‐MA hydrogel phase. a) The
   representative live & dead staining images of S. aureus and E.coli
   after 24 h of co‐culture with SF‐MA. b) Quantification of the
   fluorescence area based on the live/dead fluorescence staining images
   of S. aureus. c) Quantification of the fluorescence area based on the
   live/dead fluorescence staining images of E.coli. d)
   Semi‐quantification of crystal violet staining after 48 h of co‐culture
   with S. aureus and E.coli. e) Representative immunocytochemical
   staining images of gingival fibroblasts cultured on the SF hydrogel and
   GelMA‐SF‐MA‐GelMA sandwich structure for 1, 7 and 14 days. The red
   arrow indicated that the gingival fibroblasts penetrated through GelMA
   to the surface of the SF hydrogel. f,g) Quantitative analysis of the
   growth depth of gingival fibroblasts cultured on the. SF hydrogel and
   GelMA‐SF‐MA‐ GelMA sandwich structure for 1, 7 and 14 days (n = 3). h)
   RT‐qPCR quantification of genes related to osteogenic differentiation
   (Runx2, Bmp2 and Ocn, Col1al) in rBMSCs cultured on LCS, HCS and GelMA
   for 3 days (n = 3). i) RT‐qPCR quantification of genes related to
   osteogenic differentiation (Runx2, Bmp2 and Ocn, Col1al) in rBMSCs
   cultured on LCS, HCS and GelMA for 7 days (n = 3). j) Representative
   immunofluorescence images of osteogenic differentiation protein (RUNX2
   green), actin network (Phalloidin, red), and cell nuclei (DAPI, blue)
   in rBMSCs cultured on the LCS and HCS for 3 days. k) Representative
   immunocytochemical staining images of osteogenic marker protein (BMP2
   green), actin network (Phalloidin, red), and cell nuclei (DAPI, blue)
   in rBMSCs cultured on the LCS and HCS for 7 days. l,m) The mean
   fluorescence intensities were calculated to evaluate protein (RUNX2
   and BMP2) expression levels (n = 3). n) Western blot analysis of RUNX2,
   BMP2 and OCN in rBMSCs cultured on LCS, HCS and GelMA for 7 days. Error
   bars represent the standard error of the mean. (ns, not significant; ^*
   p < 0.05, ^** p < 0.01, ^*** p < 0.001 and ^**** p < 0.0001).
   To assess the pro‐osteogenic functions of the LCS hydrogel and HCS
   hydrogel on rBMSCs, we co‐cultured rBMSCs with hydrogels for 3 and 7
   days and measured the expression of osteogenesis‐related genes (Col1al,
   Ocn, Bmp2, Runx2) by RT‐qPCR. Compared with the control group,
   osteogenesis‐related genes were upregulated in cells cultured in both
   the LCS hydrogel and HCS hydrogel (Figure [139]4h,i). Notably,
   transcription levels of these genes were much higher in the HCS groups,
   thus suggesting the significant stimulatory role of high concentrations
   of CS within the hydrogels in promoting osteogenesis.
   Immunofluorescence staining (RUNX2 and BMP2) was performed to analyze
   the localization and quantity of osteogenic markers in rBMSCs on day 7.
   As demonstrated in Figure [140]4j,k, upregulation of RUNX2 and BMP2 was
   observed in both the LCS hydrogel and HCS hydrogel, within the nucleus
   and cytoplasm, respectively, indicating that the main switch of
   osteogenic differentiation was turned on, especially in the HCS
   hydrogel. The quantitative analyses of RUNX2 and BMP2 protein
   expression shown in Figure [141]4l,m also confirmed the trend. Western
   blotting further confirmed the enhancing effects of LCS and HCS on the
   osteogenic differentiation of rBMSCs, with upregulated expression of
   early osteogenic differentiation‐related markers RUNX2, BMP2, and OCN
   in rBMSCs after 7 days of culture (Figure [142]4n). Taken together, our
   results revealed that the CS‐MA hydrogel phase can activate osteogenic
   differentiation of rBMSCs in vitro.
2.5. Dynamic Adaptation of Material Degradation with New Bone Formation
   The adaptive degradation of scaffold materials with new bone formation
   is a key indicator in biodegradable material‐mediated bone
   regeneration.^[ [143]^45 , [144]^46 , [145]^47 ^] To further evaluate
   the degradation behavior of the integrated osteoconductive Janus
   hydrogel in vivo, we labeled the hydrogels with fluorescent dyes and
   implanted the scaffold into the calvarial defect of mice (Figure
   [146]5a). The first stage of bone defect reconstruction is the growth
   of periosteum. The complete periosteum covering the defect area is
   helpful in preventing the ingrowth of gingival fibrous tissues, thereby
   preserving space for new bone generation.^[ [147]^48 , [148]^49 ^]
   Before the periosteum is fully repaired, the SF‐MA hydrogel phase needs
   to function as a barrier to protect the bone defect from soft tissue
   ingrowth. The SF‐MA hydrogel degraded slowly in vivo during the first
   28 days, effectively protecting the bone defect area and promoting
   periosteal repair, followed by being gradually degraded, with more than
   50% remaining at 35 days (Figure [149]S5a,b, Supporting Information).
   After the implantation of the materials, the integrated osteoconductive
   Janus hydrogel also started to display osteogenic repair function at
   the same time. As shown in Figure [150]S5b (Supporting Information),
   HCS‐SF and LCS‐SF were gradually degraded after implantation, and the
   degradation rate of the HCS‐SF integrated Janus hydrogel was slower
   than that of the LCS‐SF integrated Janus hydrogel, with HCS‐SF and
   LCS‐SF degrading by 35.8% and 49.6% on the 28th day respectively. In
   addition, the periosteum had formed and covered the entire defect area
   by 28 days, and new bone had been generated in the bone defect area,
   while the integrated osteoconductive Janus hydrogel had been partially
   degraded based on micro‐CT scanning and histological analysis (Figure
   [151]S5c, Supporting Information). In contrast, the GelMA group was
   completely degraded by 21 days with ineffective bone regeneration
   (Figure [152]S5b, Supporting Information; Figure [153]5b–d,j), which
   indicated that the integrated osteoconductive Janus hydrogel had a more
   stable structure and could sustain a longer‐lasting pro‐osteogenic role
   in vivo. Moreover, through analysis by synthesis of calvaria neogenesis
   and material degradation at 4 weeks post‐implantation, we found that
   the bone regeneration and material degradation rate matched better in
   the HCS‐SF group, as compared with the GelMA control group
   (Figure [154]5e,f). Although the in vivo degradation rate of materials
   in the LCS‐SF group was slightly faster than that of bone regeneration,
   it still supported bone growth during the early stages of bone
   regeneration. At 12 weeks post‐implantation, the defects were almost
   completely filled with new bone in the HCS‐SF, LCS‐SF and Bio‐Gide
   groups (Figure [155]5g). The new bone volume/total volume (BV/TV) of
   the group implanted with HCS‐SF was higher than the control groups
   (Figure [156]5h) at 12 weeks post‐implantation. Bone mineral density
   (BMD) was also measured and there was a significant difference between
   the HCS‐SF group and the Bio‐Gide group at 12 weeks post‐implantation
   (Figure [157]5i). These results thus suggested that the integrated
   osteoconductive Janus hydrogel mainly played a role in osteogenic
   stimulation during the early‐middle process of bone regeneration.
   Subsequent H&E staining and Masson's trichrome staining were used to
   histologically analyze the osteogenic process (Figure [158]5j; Figure
   [159]S5d, Supporting Information). At 12 weeks post‐implantation,
   HCS‐SF led to complete healing with flat and consecutive bone‐structure
   formation that is characteristic of full bone maturation. Masson's
   trichrome staining also revealed mature osteoid tissue after 12 weeks
   of implantation of HCS‐SF. In contrast, a small amount of newly‐formed
   bone was observed in the GelMA control group, without any complete and
   contiguous healing with host tissues, with only fibrous tissues being
   detected in the Blank group when observation time was extended to 12
   weeks post‐implantation. These results thus indicated that the
   coordination of the barrier function of the SF‐MA hydrogel phase and
   the osteoconductive function of the CS‐MA hydrogel phase together with
   adaptive degradation, contributed to the regeneration of the mouse
   calvarial defect. In summary, the integrated osteoconductive Janus
   hydrogel has a degradation rate compatible with bone regeneration,
   which promoted healing of bone defects and subsequent bone maturation.
Figure 5.
   Figure 5
   [160]Open in a new tab
   The integrated osteoconductive Janus hydrogel achieved adaptive
   degradation of materials with new bone formation. a) Schematic
   representation of adaptation between hydrogel degradation and bone
   regeneration within the mouse calvarial defect area. b) Representative
   micro‐CT images of mouse calvarial full‐thickness defects at 4 weeks
   post‐implantation. Red dotted lines denote the boundaries between the
   nascent bone and the host bone. c,d) Quantitative analysis of the bone
   volume/ tissue volume and bone mineral density (BMD) at 4 weeks
   post‐implantation (n = 4). e) Representative micro‐CT images of mouse
   calvarial full‐thickness defects at 4 weeks post‐implantation and
   degradation images of the integrated osteoconductive Janus hydrogel in
   vivo at 4 weeks post‐implantation. f) Quantification analysis of the
   degradation ratio of the integrated osteoconductive Janus hydrogel in
   vivo and new bone formation ratio at 4 weeks post‐implantation (n = 4).
   g) Representative micro‐CT images of mouse calvarial full‐thickness
   defects at 12 weeks post‐implantation. The red dotted lines denote the
   boundaries between the nascent bone and the host bone. h,i)
   Quantitative analysis of bone volume/ tissue volume and bone mineral
   density (BMD) at 12 weeks post‐implantation (n = 4). j) H&E staining
   and Masson's trichrome staining of histological sections at 4 & 12
   weeks after implantation. (FT, fibrous tissue; NB, nascent bone; OT,
   osteoid tissue; MT, mineralized tissue; M, residual materials; P,
   periosteum). Error bars represent the standard error of the mean. (ns,
   not significant; ^* p < 0.05, ^** p < 0.01, ^*** p < 0.001 and ^**** p
   < 0.0001).
2.6. The Integrated Osteoconductive Janus Hydrogel Enhanced Rat Periodontal
Bone Regeneration
   To further investigate the osteoconductive functions of the integrated
   osteoconductive Janus hydrogel for clinical GBR therapy, a rat
   mandibular complete periodontal defect model (with a 3 mm × 1 mm‐sized
   defect) was established (Figure [161]6a). Rats treated with Bio‐Gide
   and Bio‐Oss (Bio) were assigned as controls; while untreated rats were
   assigned as the Blank group. Through micro‐CT and histological
   analysis, we found that there was almost no new bone formation in the
   Blank group, at 4 weeks and even 12 weeks post‐implantation (Figure
   [162]S6a, Supporting Information; Figure [163]6b), thus indicating the
   weak self‐regenerative capacity of periodontal tissue. At 4 weeks after
   implantation, relatively contiguous and intact newly‐formed bone in the
   periodontal defect area was observed in the HCS‐SF group (Figure
   [164]S6a, Supporting Information). In contrast, only a small amount of
   new bone was formed in the Bio group with much Bio‐Oss residues (Figure
   [165]S6a, Supporting Information). The results presented in Figure
   [166]S6b–e (Supporting Information) indicated that the bone volume and
   mean thickness of the newly formed bone were significantly greater in
   the HCS‐SF group versus other groups. The abovementioned results thus
   indicated that the integrated osteoconductive Janus hydrogel could
   promote stem cell osteogenic differentiation, which was consistent with
   the in vitro cell regulation results.
Figure 6.
   Figure 6
   [167]Open in a new tab
   The integrated osteoconductive Janus hydrogel enhanced rat periodontal
   bone regeneration. a) Schematic representation of the integrated
   osteoconductive Janus hydrogel implantation within the rat periodontal
   defect area. b) Representative micro‐CT images of rat periodontal
   defects at 12 weeks post‐implantation. Red dotted lines denote the
   boundary between nascent bone and host bone. The green fake color
   denotes nascent bone. H&E staining and Masson's trichrome staining of
   histological sections at 12 weeks after post‐implantation. The parts
   circled by the yellow dotted line denote the new bone in the defect
   area. (FT, fibrous tissue; NB: nascent bone; OT, osteoid tissue; MT,
   mineralized tissue; MC, marrow cavity; D, dentin; PM, periodontium).
   c–f) Quantitative analysis of bone volume/ tissue volume, bone mineral
   density (BMD), bone thickness and bone coverage at 12 weeks
   post‐implantation (n = 5). g) Immunofluorescence images of OCN (Green)
   and NF200 (Pink) expression within the rat mandible defect after
   implantation of the integrated osteoconductive Janus hydrogel at 12
   weeks post‐implantation. DAPI stained cell nuclei (Blue). h,i) The mean
   fluorescence intensities were calculated to evaluate protein expression
   levels (n = 5). j) Osteogenesis efficiency of HCS‐SF hydrogel (red
   asterisk), as compared with hydrogel materials (purple circles),
   scaffold materials (green triangles) and membrane materials (orange
   rhomboids) within the mouse calvarial defect model and rat periodontal
   defect model. Materials are classified according to the material
   morphology. The osteogenesis efficiency is represented by the ratio of
   bone volume to the total volume (BV/TV). Details and values of the
   aforementioned materials are listed in Table [168]S1 (Supporting
   Information). Error bars represent the standard error of the mean. (ns,
   not significant; ^* p < 0.05, ^** p < 0.01, ^*** p < 0.001 and ^**** p
   < 0.0001).
   To achieve complete osseous tissue regeneration, the implantation time
   was extended to 12 weeks. The micro‐CT results showed that the
   newly‐formed jaw bone in the HCS‐SF group was similar to the natural
   jaw bone, without an obvious boundary between the defect area and tooth
   area (Figure [169]6b). In marked contrast, abundant high‐density
   undegraded materials were observed in the Bio group (Figure [170]6b).
   The results presented in Figure [171]6c–f indicated that the bone
   volume, mean thickness, and coverage of newly‐formed bone were
   significantly greater in the HCS‐SF group than in the other groups and
   close to complete healing at 12 weeks post‐implantation. The
   microstructure of the regenerated osseous tissues after 12 weeks
   post‐implantation was further evaluated with H&E and Masson's trichrome
   staining (Figure [172]6b). The results showed that HCS‐SF implantation
   led to complete healing with contiguous bone‐structure formation at
   bone maturity without any hydrogel residue. In contrast, in the Bio
   groups, a small amount of newly‐formed bone was observed, but there
   were still a lot of Bio‐Oss residues. Masson's trichrome staining
   showed that the mature bone in the defect area of the HCS‐SF group was
   more than that in the Bio and Blank groups. These results thus
   demonstrated that complete regeneration of the jaw bone could be
   achieved through HCS‐SF integrated osteoconductive Janus hydrogel
   treatment. Furthermore, the canonical osteogenic differentiation marker
   OCN, vascular differentiation marker CD31, and early neural
   differentiation marker PAX6, were all detectable by immunocytochemical
   staining at 4 weeks post‐implantation, with the confocal microscopy
   images indicating that HCS‐SF promoted osteogenic differentiation,
   vascular differentiation, and neural differentiation at the same time
   (Figure [173]S6f–i, Supporting Information). Additionally, as compared
   with the control groups, OCN and the mature neural differentiation
   marker NF200, were highly expressed in the HCS‐SF group at 12 weeks
   post‐implantation (Figure [174]6g–i), which validated mineralization of
   bone extracellular matrix and neural maturation respectively. Numerous
   studies have been conducted to develop a diverse array of materials for
   facilitating bone defect repair, which can induce bone regeneration to
   varying degrees. Compared with the performance of previous implant
   materials such as hydrogels and scaffolds, HCS‐SF exhibited higher
   osteogenic efficiency in the mouse calvarial defect model and in the
   rat periodontal defect model, increasing by 42% and 13.7% respectively,
   thus demonstrating that the integrated osteoconductive Janus hydrogel
   can achieve synergistic osteogenic effects for clinical applications
   under normal conditions. (Figure [175]6j; Table [176]S1, Supporting
   Information). Additionally, an infected rat periodontal defect model
   was employed to further validate the effects of HCS‐SF on bone
   regeneration under pathological conditions^[ [177]^50 ^] (Figure
   [178]7a). After 4 weeks of implantation, the micro‐CT data clearly
   showed increased mass and improved parameters of new bone formation in
   the HCS‐SF versus Blank group (Figure [179]7b–d). Notably, the
   regenerated bone within the Blank group of the infected periodontal
   defect model was much less than that in the normal healthy model,
   confirming that the defect site was indeed infected, which inhibited
   bone regeneration (Figure [180]7e–j). In sharp contrast, the amount of
   newly formed bone in the HCS‐SF group of the infected periodontal
   defect model was at the same level as that in the normal healthy model,
   suggesting that HCS‐SF can effectively impede bacterial infection and
   provide a conducive microenvironment for bone regeneration (Figure
   [181]S7a–f, Supporting Information). Moreover, SF and CS used in the
   preparation of the integrated osteoconductive Janus hydrogel are
   biocompatible and have been approved by FDA for biomedical
   applications. Hence, these results demonstrated that the integrated
   osteoconductive Janus hydrogel is an effective implant biomaterial with
   broad clinical prospects for facilitating craniomaxillofacial bone
   repair due to its technical simplicity and convenience of application.
Figure 7.
   Figure 7
   [182]Open in a new tab
   The integrated osteoconductive Janus hydrogel enhanced infected rat
   periodontal bone regeneration. a) Schematic representation showing the
   creation of rat periodontal defects to assess in vivo osteogenic
   ability under pathological conditions. b) Representative micro‐CT
   images of infected rat periodontal defects at 4 weeks
   post‐implantation. Red dotted lines denote the boundary between nascent
   bone and host bone. c) Quantitative analysis of bone volume/ tissue
   volume (BV/TV) at 4 weeks post‐implantation (n = 7). d) Quantitative
   analysis of bone mineral density (BMD) at 4 weeks post‐implantation (n
   = 7). e) Representative micro‐CT images of infected rat periodontal
   defects at 8 weeks post‐implantation. Red dotted lines denote the
   boundary between nascent bone and host bone. f) Quantitative analysis
   of bone volume/ tissue volume (BV/TV) at 8 weeks post‐implantation (n =
   7). g) Quantitative analysis of bone mineral density (BMD) at 8 weeks
   post‐implantation (n = 7). h) Representative micro‐CT images of
   infected rat periodontal defects at 12 weeks post‐implantation. Red
   dotted lines denote the boundary between nascent bone and host bone. i)
   Quantitative analysis of bone volume/ tissue volume (BV/TV) at 12 weeks
   post‐implantation (n = 7). j) Quantitative analysis of bone mineral
   density (BMD) at 12 weeks post‐implantation (n = 7). (ns, not
   significant; ^* p < 0.05, ^** p < 0.01, ^*** p < 0.001 and ^**** p <
   0.0001).
2.7. The Integrated Osteoconductive Janus Hydrogel Promotes Osteogenesis by
Regulating Lipid Metabolism
   To further elucidate the the underlying mechanisms driving osteogenesis
   within the HCS‐SF integrated osteoconductive Janus hydrogel upon
   implantation in situ, we collected healing samples from the rat
   periodontal defect for RNA‐seq analysis, at 1 and 4 weeks
   post‐implantation. As expected, we found that many genes associated
   with tissue regeneration were upregulated in the differential gene
   expression volcano map and heat map (Figures [183]S8a,b and [184]S9a,b,
   Supporting Information). The Gene Ontology (GO) enrichment analysis and
   the Kyoto Encyclopedia Genes and Genomes (KEGG) enrichment analysis of
   the functions of differentially expressed genes indicated that the
   HCS‐SF mainly had an impact on lipid metabolism and tissue
   regeneration‐related pathways, such as “extracellular matrix
   organization”, “positive regulation of MSC proliferation” and
   “ECM‐receptor interaction” at 1 week post‐implantation, and
   “collagen‐containing extracellular matrix”, “PI3K‐Akt signaling
   pathway” and “Hippo signaling pathway” at 4 weeks post‐implantation
   (Figure [185]S8c–e, Supporting Information; Figure [186]8a–c). The GSEA
   analysis of the transcriptional results at 1 week post‐implantation
   mainly focused on cell proliferation and protein synthesis (Figure
   [187]S8f, Supporting Information). The gene expression heatmap showed
   that the levels of Col8a1, Itgb7, and Comp were enhanced after 1 week
   of treatment with HCS‐SF (Figure [188]S8g, Supporting Information).
   Moreover, the GSEA of the RNA‐Seq results revealed that genes
   associated with tissue regeneration including “Wnt signaling pathway
   and pluripotency” and “collagen fibril organization” were enriched in
   the HCS‐SF group at 4 weeks post‐implantation (Figure [189]8d). The
   gene expression heatmap showed that the mRNA levels of Wnt3, Bmpr2, and
   Yap1 were increased after 4‐weeks of treatment. These signaling
   pathways are crucial for regulating cell proliferation,
   differentiation, and migration, which together constituted a complex
   cascade of biological processes involved in tissue repair and
   regeneration.
Figure 8.
   Figure 8
   [190]Open in a new tab
   The integrated osteoconductive Janus hydrogel promoted osteogenesis at
   4 weeks post‐implantation by regulating lipid metabolism. a) The
   enriched GO terms of upregulated genes in the HCS‐SF group compared
   with the Blank group. The red spectrum denotes osteogenesis‐related
   biological processes. b) Representative KEGG pathways of significant
   DEGs from the HCS‐SF group versus the Blank group (p ≤ 0.05, |log fold
   change| ≥1). c) Enrichment of metabolically related KEGG pathways by
   RNA‐seq analysis. d) GSEA analysis of significant DEGs in the HCS‐SF
   and Blank groups. e) Gene cluster analysis of osteogenesis‐related
   genes in the HCS‐SF and Blank groups. f) Circle plot of differential
   metabolite by KEGG enrichment analysis. g) Circle plot of
   metabolism‐related pathways by KEGG enrichment analysis.
   In addition, RNA‐seq analysis suggested a role for metabolic processes
   in the mechanism of bone regeneration promoted by HCS‐SF. To further
   explore the characteristics of metabolites in this process, we used
   LC‐MS/MS technology to analyze various metabolic components and
   enrichment pathways. Clustered heatmaps showed significant differences
   in metabolite levels between the HCS‐SF and Blank groups at both 1 and
   4 weeks post‐implantation (Figures [191]S8h and [192]S9c, Supporting
   Information). KEGG enrichment analysis of differential metabolite
   levels showed that metabolic pathways were significantly enriched in
   the HCS‐SF group (Figure [193]S8i, Supporting Information;
   Figure [194]8f). Further analysis of metabolic pathways indicated that
   lipid metabolism accounted for the largest proportion among all
   metabolic pathways at both 1 week and 4 weeks post‐implantation (Figure
   [195]S8j, Supporting Information; Figure [196]8g), which was consistent
   with the enrichment results of differentially expressed genes in the
   RNA‐seq analysis, thus revealing the key role of lipid metabolism in
   HCS‐SF‐mediated bone regeneration. Previous studies have shown that the
   regulation of lipid metabolism contributed to osteogenesis by affecting
   several biological processes, including cellular energy supply,
   signaling, and cell growth and differentiation.^[ [197]^51 , [198]^52
   ^] Therefore, the HCS‐SF integrated osteoconductive Janus hydrogel may
   promote rBMSCs osteogenic differentiation by modulating lipid
   metabolism‐related enzyme molecules or transcription factors.
3. Conclusion
   An integrated osteoconductive Janus hydrogel comprising of a SF‐MA
   hydrogel phase and a CS‐MA hydrogel phase to promote intensive bone
   ingrowth was fabricated by sequential photocuring. The SF‐MA hydrogel
   phase with barrier protection function prevented the infiltration and
   ingrowth of gingival fibroblasts, and inhibited S. aureus and E.coli
   adhesion, thereby providing a relatively closed biological environment
   for bone regeneration. Additionally, the CS‐MA hydrogel phase
   orchestrated lipid metabolism and thus enhanced osteogenesis,
   angiogenesis, and neurogenesis, thereby enhancing extensive bone
   regeneration, with osteogenic efficiencies of more than 60% in both the
   mouse calvarial defect and rat periodontal defect models. Furthermore,
   this integrated osteoconductive Janus hydrogel achieved adaptive
   material degradation and facilitated new bone formation with
   considerable mechanical strength and early structural stability in
   vivo, which might provide an innovative and well‐suited strategy for
   bone regeneration therapies. Hence, by combining the advantages of
   stability, applicability, and simple fabrication techniques, the
   integrated osteoconductive Janus hydrogel has much promising potential
   to provide an innovative and well‐suited strategy for bone repair,
   thereby maximizing therapeutic efficacy in promoting osteogenesis.
4. Experimental Section
Synthesis of Chondroitin Sulfate‐Methacrylate (CS‐MA)
   CS was dissolved in deionized water. After full dissolution, the
   methacrylic anhydride (MA) was added dropwise into the CS solution. The
   molar ratio of MA versus the hydroxyl groups of CS was 20‐fold. Then,
   NaOH solution was carefully added to adjust the pH to ≈8. The reaction
   solution was stirred in an ice bath for 24 h. After the reaction
   period, the reaction mixture was subjected to dialysis against
   deionized water to remove the remaining unreacted MA and any
   by‐products. The CS‐MA was then lyophilized and stored at −20 °C.
Synthesis of Silk‐Methacrylate (SF‐MA)
   SF‐MA solutions were prepared as previously described. Briefly, 5 g of
   sliced cocoons were boiled in 1 L of 0.02 m Na[2]CO[3] solution for
   30 min at 100 °C to remove the sericin, and then washed and stirred for
   20 min with distilled water several times. Subsequently, the degummed
   silk was dried at room temperature and then dissolved in 5 mL of 4.03 g
   lithium bromide (LiBr) solution at 60 °C for 1 h. Immediately after the
   SF was dissolved by LiBr, 0.3 mL (424 mm) of glycidyl methacrylate
   (GMA) solution (Sigma–Aldrich, St. Louis, USA) was added to the mixture
   with stirring at 300 rpm for 3 h at 60 °C to create a high‐yield
   reaction between GMA and SF. Then, the resulting solution was
   centrifuged and dialyzed against distilled water using Slide‐A‐Lyzer
   dialysis cassettes (MWCOs of 14000 Da for methacrylated SF solutions)
   for 3 days. Finally, those solutions were frozen at ‐20 °C for 12 h and
   freeze‐dried for 48 h. The lyophilized SF‐MA powder was stored at
   −20 °C before further use.
Fabrication of the Integrated Osteoconductive Janus Hydrogel
   Photo‐curable SF‐MA hydrogels were fabricated as follows. Lyophilized
   SF‐MA was dissolved in deionized water at a concentration of 30% (w/v),
   and the photoinitiator lithium phenyl(2,4,6‐trimethylbenzoyl)
   phosphinate (LAP) (0.2% w/v) (Tokyo Chemical Industry, Tokyo, Japan)
   was added and mixed. The mixed solution was kept at 4 °C overnight to
   ensure complete dissolution. The fabrication of photocurable CS‐MA
   hydrogels was prepared as follows. Lyophilized CS‐MA was dissolved in
   deionized water and formulated at concentrations of 5% (w/v) and 10%
   (w/v), and the LAP (0.2% w/v) (Tokyo Chemical Industry, Tokyo, Japan)
   was added and mixed. The mixed solution was then kept at 4 °C overnight
   for full dissolution. After the material was completely dissolved,
   250 µL of CS‐MA was added into a mold with a diameter of 10 mm, and
   then subjected to photocuring via exposure to 30 mW cm^−2 UV light for
   5 s at a distance of 1 cm using Architect SV003 (Regenovo). Then 100 µL
   of SF‐MA was added, and then photocured via exposure to 30 mW cm^−2 UV
   light for 30 s at a distance of 1 cm using Architect SV003 (Regenovo),
   to obtain the integrated osteoconductive Janus hydrogel.
Characterization of the Integrated Structure
   To determine the molecular structure, CS‐MA and SF‐MA were examined
   through ^1H nuclear magnetic resonance (^1H‐NMR) at a frequency of
   400 MHz using a Bruker DPX FT‐NMR spectrometer (9.4 T, Bruker, Germany)
   and 700 µL of deuterium oxide (D[2]O, Sigma‐Aldrich) as the solvent per
   5 mg of sample. The SF‐MA solution was filtered using a 0.45 µm filter
   before analysis. To assess the injectability and photocuring property
   of the hydrogel, different dyes were added into the precursor solution
   of CS‐MA and SF‐MA and then the solution was added to syringes and
   extruded through 26‐gauge needles (φ ≈ 260 µm) to observe the
   injectability of the hydrogel. The hydrogel was photocured via exposure
   to UV light for 30 s at a distance of 1 cm respectively. The gelation
   state and the fabrication of the integrated osteoconductive Janus
   structure were observed and imaged with a digital camera (Canon
   camera). To compare the microstructure and pore characteristics among
   the different hydrogels, field emission scanning electron microscopy
   (FE‐SEM, S‐4800, HITACHI) was performed after the samples were
   embrittled with liquid nitrogen, lyophilized, and gold‐coated. For
   further observation of the interface structure, the CS‐MA solution and
   SF‐MA solution were mixed with fluorescent dyes of different colors,
   and the fabricated integrated osteoconductive Janus hydrogel was
   examined with CLSM (Leica).
Mechanical Behavior, Swelling and Degradation of the Integrated
Osteoconductive Janus Hydrogel
   Mechanical properties of these cylindrical hydrogels with dimensions of
   5 mm in height and 10 mm in diameter were assessed using a universal
   mechanical testing machine (WDW3020, China) with a 1 kN load cell at a
   cross‐head speed of 5 mm min^−1. Compressive strength and compressive
   modulus were determined from stress‐strain curves. Compressive strength
   was the stress at which the sample breaks or the stress at a strain of
   90% for highly ductile samples, which do not break until very high
   strains. Compressive modulus was determined as the slope of the
   stress‐strain curve within the initial linear region at low strains
   (0–10%). Otherwise, the dynamic mechanical properties of different
   hydrogel systems were assessed with a rheometer (TA Instruments‐waters
   LLC), and all measurement plates were used with a constant gap (1 mm)
   at room temperature. The loss modulus represents the viscous capacities
   of the gel, and the resistance of the substance against deformation
   under shear was measured by the elastic modulus. Cylindrical hydrogels
   were individually weighted (S[0]) and incubated in PBS solution at
   37 °C for 24 h. At predetermined intervals, the hydrogels were
   carefully taken out, and the residual water on the hydrogel surface was
   drained with filter papers and weighed (S[1]). The swelling percentage
   (SP) was determined with Equation ([199]1).
   [MATH: SP=S1S0×100% :MATH]
   (1)
   The in vitro degradation of hydrogels was evaluated in a modified
   simulated body (SBF) solution (pH = 7.4) at 37 °C for 35 days. The SBF
   solution was refreshed daily. At predetermined intervals, the residual
   hydrogels were taken out from the solution, carefully washed with
   deionized water, and weighed. The weight remaining ratio (WRR) was
   determined with Equation ([200]2).
   [MATH: WRR=WtW0×100% :MATH]
   (2)
   Where W[0] and W[t] are the weights of samples before and after
   degradation for a specific duration time (t) respectively. To assess
   the in vivo degradation rate of the hydrogel, the CS‐MA and SF‐MA
   labeled with fluorescent protein were injected into the 3 mm diameter
   calvarial defect of C57BL/6J mice. The in vivo degradation of the
   hydrogel was tracked and quantified by the in vivo image system
   (PerkinElmer).
Bacterial Adhesion‐Related Surface Property Tests
   To further examine the properties related to bacterial adhesion, SF‐MA
   hydrogels were subjected to water contact angle and surface zeta
   potential analyses. The water contact angle was measured by a Kruss
   DSC100 (Germany) instrument via a drop of 2 µL on each hydrogel.
   Surface zeta potential was measured by a ZETASIZE NANO instrument. The
   samples were dispersed in ultrapure water and then filtered through a
   filter. The filtered samples were injected into a polystyrene cuvette
   and the ZETASIZE NANO instrument automatically calculated the zeta
   potential for electrophoretic migration.
Protective Barrier Function Assessment of the SF‐MA Hydrogel
   The Gram‐positive bacteria (S. aureus, ATCC 25923) and Gram‐negative
   bacteria (E.coli, ATCC 25922) were cultured on SF‐MA hydrogel at 37 °C
   for 12 and 24 h respectively. To evaluate bacterial adhesion and
   antibacterial activity, the bacteria were stained with SYT09 and PI
   fluorescent staining solution (ThermoFisher Scientific) after
   co‐culture for 15 min, followed by imaging with CLSM (Leica). MTT assay
   was performed according to the manufacturer's protocol (Solarbio) for
   the detection of bacterial proliferation. Quantitative analysis of
   biofilm formation was carried out by crystal violet (Solarbio)
   staining. Briefly, the samples were washed with PBS, stained with 0.1%
   (w/v) crystal violet for 20 min, and then washed with deionized water.
   The crystal violet granules were eluted with 33% (v/v) acetic acid and
   the absorbance at 595 nm was measured. To evaluate the barrier function
   of the SF‐MA hydrogel against HGFs, 20 µL aliquots of HGF suspension
   were seeded onto the surface of each sample at each time point. After
   culturing for 1, 7, and 14 days, cells on the hydrogels were stained
   with 4′,6‐diamidino‐2‐phenylindole (DAPI; Sigma) and Phalloidin
   (Sigma), and observed under CLSM.
Quantitative Real‐Time Polymerase Chain Reaction (RT‐PCR)
   To investigate cell osteogenic differentiation on the integrated
   osteoconductive Janus hydrogel in vitro, rBMSCs were cultured
   three‐dimensionally onto the CS‐MA hydrogel for 3 and 7 days
   separately. Quantitative RT‐PCR was applied to evaluate the expression
   of osteogenic differentiation gene markers (BMP‐2, Runx2, Col1a1, and
   OCN). Total RNA was extracted with Trizol reagent (Invitrogen) and
   synthesis of cDNA was performed using SuperScript III One‐Step RT‐PCR
   System with Platinum Taq High Fidelity (Invitrogen). Quantitative
   RT‐PCR was performed on a 7500HT Fast Real‐Time PCR using SYBR Green
   (Invitrogen). The primer sequences utilized for RT‐PCR were as follows:
   Primers          Forward             Reverse
   Rat‐Gapdh  TCTCTGCTCCTCCCTGTTC ACACCGACCTTCACCATCT
   Rat‐Runx‐2 CTTCCCAAAGCCAGAGCG  CAGCGTCAACACCATCATTC
   Rat‐Bmp‐2   GAAGCCAGGTGTCTCCA  AGTCCACATACAAAGGGTG
   Rat‐Col1a1 AGGCAACAGTCGATTCACC  GTCCAAGGGAGCCACATC
   Rat‐Ocn     AGTCTGACAAAGCCTTC   AAGCAGGGTTAAGCTCAC
   [201]Open in a new tab
Biocompatibility Assessment
   The prepared hydrogels were placed in the wells of standard 96‐well
   culture plates, and 2 × 10^4 rBMSCs were seeded per well with LCS, HCS
   or GelMA, and 2 × 10^4 HGFs were seeded per well with SF‐MA after
   ethanol/UV sterilization, and allowed to grow for 14 days. Hydrogel
   cytocompatibility was analyzed using a Cell Counting Kit 8 (CCK‐8)
   assay, following the manufacturer's instructions (Bimake). The 96‐well
   plate was incubated at 37 °C for 20 min in a 5% CO[2] incubator.
Immunocytochemistry
   To investigate the biological effects of the CS‐MA hydrogel, CS‐MA was
   dissolved and sterilized through a 0.45 µm filter. A condensed cell
   suspension at a density of 2 × 10^6 rBMSCs was seeded into each sample.
   Subsequently, the samples were slowly added to micro‐tissue 3D petri
   dishes (Sigma) and photocured. The samples were cultured in an
   incubator for 3 and 7 days, followed by rinsing with phosphate‐buffered
   saline (PBS) and fixation with 4% (w/v) paraformaldehyde for 30 min at
   room temperature. Then, the samples were permeabilized with 0.1% (w/v)
   Triton X‐100 (diluted with PBS) for 10 min and then blocked with 3%
   (v/v) bovine serum albumin (BSA; diluted with PBS) for 1 h at room
   temperature. The permeabilization solution was removed and the samples
   were rinsed with PBS for 5 min at room temperature. The samples were
   then incubated respectively with the following primary antibodies in 5%
   (w/v) BSA in PBS overnight at 4 °C: polyclonal rabbit anti‐RUNX‐2
   (1:100; Abcam), polyclonal rabbit anti‐BMP2 (1:200; Abcam). After
   thorough rinsing to remove excess antibodies, the cells were incubated
   with the following secondary antibodies for 1 h in the dark: goat
   anti‐rabbit IgG H&L Alexa Fluor 488 pre‐adsorbed (1:500; Abcam).
   Phalloidin (Sigma) was used for cytoskeletal staining. Cell nuclei were
   stained using 4′,6‐diamidino‐2‐phenylindole (DAPI; Sigma). Images were
   captured using CLSM (Leica). To investigate the barrier effects of the
   SF‐MA hydrogel, SF‐MA and GelMA were dissolved separately, and
   sterilized through a 0.45 µm filter. GelMA and SF‐MA were added into
   micro‐tissue 3D petri dishes, and a sandwich structure of
   GelMA‐SF‐MA‐GelMA, as well as a simple SF‐MA monolayer structure, were
   fabricated, which were then subjected to layered photocuring. A
   condensed cell suspension at a density of 2 × 10^4 human gingival
   fibroblasts was seeded into each sample and the samples were cultured
   in an incubator for 1, 7, and 14 days. The samples were rinsed with
   phosphate‐buffered saline (PBS) and fixed in 4% (w/v) paraformaldehyde
   for 30 min at room temperature. Then, the samples were permeabilized
   with 0.1% (w/v) Triton X‐100 (diluted with PBS) for 10 min and blocked
   with 3% (w/v) bovine serum albumin (BSA; diluted with PBS) for 1 h at
   room temperature. The permeabilization solution was removed and the
   samples were rinsed with PBS for 5 min at room temperature. Blocking
   with 3% (wv) BSA was used for minimizing non‐specific staining.
   Phalloidin (Sigma) was used for cytoskeletal staining, while cell
   nuclei were stained using DAPI (Sigma). Images were captured with CLSM
   (Leica).
Western Blotting
   Briefly, cell lysate proteins were harvested by RIPA Buffer (Thermo
   Fisher Scientific), separated by 10% (w/v) SDS–polyacrylamide gel
   electrophoresis, and then transferred to polyvinylidene difluoride
   membranes and blocked in 5% (w/v) non‐fat milk. The blotted membranes
   were separately probed with corresponding primary antibodies against
   GAPDH (1:5000, RayAntibody), RUNX‐2 (1:1000, Abcam), BMP‐2 (1:500,
   Affinity), or OCN (1:1000, Abcam) overnight at 4 °C. Then the blotted
   membranes were washed three times in TBS with 0.1% (v/v) Tween‐20,
   incubated with a HRP‐conjugated secondary antibody for 1 h, and imaged
   with an Odyssey Imaging System. Quantitative analysis was performed
   with the Image J software.
Animals and Surgical Procedures
   The experimental protocol was approved by the Animal Care and Use
   Committee of Peking University (IACUC number: LA2022604). All the
   Sprague‐Dawley rats (280–310 g) were randomly divided into three
   groups: HCS‐SF hydrogel (HCS‐SF), Bio‐Oss+Bio‐Gide (Bio), and Blank (n
   = 5 for each group). After anesthesia via intravenous injection of 1%
   (w/v) pentobarbital sodium (1 mg kg^−1), a 3 mm diameter periodontal
   defect was created using a saline‐cooled trephine drill and a 3 mm
   outer diameter treble. Then, the materials of each group were implanted
   into the defects and the CS‐MA hydrogel and SF‐MA hydrogel were
   photocured with UV light for 5 and 30 s respectively. The wound was
   closed by suturing the muscle and the skin layer by layer in the normal
   healthy model, while those in the infected model were sutured after
   inoculation with S. aureus suspension (2 µL, 10^7 CFU·mL^−1) was added
   onto the surface of the SF‐MA hydrogel. For establishing the calvarial
   defect model, all the C57BL/6J mice (20–25 g) were randomly divided
   into five groups: HCS‐SF hydrogel (HCS‐SF), LCS‐SF hydrogel (LCS‐SF),
   Bio‐Oss+Bio‐Gide (Bio), GelMA, and Blank (n = 5 for each group). The
   mice were anesthetized via intravenous injection of 1% (w/v)
   pentobarbital sodium (1 mg kg^−1) and then two bone defects (3 mm
   diameter) were prepared in each mouse. Materials were randomly injected
   into each calvarial defect and then photocured.
Micro‐CT Scanning Evaluation
   At 4, 8, and 12 weeks postimplantation, mandible samples and calvaria
   samples were harvested and fixed in 4% (w/v) paraformaldehyde for 24 h
   at 4 °C, and the specimens were examined using micro‐CT scanning. After
   3D visualization, bone morphometric analyses, including calculation of
   BV/TV and BMD measurements, were carried out on the region of interest.
Histological Analysis
   Briefly, tissue samples were fixed in 10% (w/v) neutral buffered
   formalin for 7 days, decalcified and dehydrated according to standard
   protocols, embedded in paraffin, and sectioned at 5 µm thickness. H&E
   staining and Masson's trichrome staining were performed separately on
   tissue sections, according to the manufacturer's protocols, and images
   were captured under a light microscope (CX21, Olympus, Japan). CD31,
   OCN, NF200, and PAX6 expression and distribution were observed using
   immunocytochemical staining.
RNA Sequencing, LC‐MS/MS Sequencing and Analysis
   Periodontal bone defects were created in rats for RNA‐Seq and LC‐MS/MS
   analysis. The integrated osteoconductive Janus HCS‐SF hydrogel was
   injected to fill into the defects of the HCS‐SF group. Subsequently,
   the periodontal bone defects were sampled at 1 and 4 weeks
   post‐implantation. For the RNA‐seq analysis, total RNA was extracted
   using the Trizol reagent (Invitrogen, CA, USA) according to the
   manufacturer's protocol. RNA purity and quantification were evaluated
   using the NanoDrop 2000 spectrophotometer (Thermo Scientific, USA). The
   RNA integrity was assessed using the Agilent 2100 Bioanalyzer (Agilent
   Technologies, Santa Clara, CA, USA). Then the libraries were
   constructed using the VAHTS Universal V6 RNA‐seq Library Prep Kit
   according to the manufacturer's instructions. This was followed by
   sequencing of the libraries on an Illumina Novaseq 6000 platform and
   150 bp paired‐end reads were generated. All genes with |log fold
   change|>1 and a p‐value of <0.05 were selected as DEGs. Based on the
   hypergeometric distribution, GO, KEGG pathway, Reactome and
   WikiPathways enrichment analysis of DEGs were performed to screen the
   significant enriched term using R (v 3.2.0), respectively. The Gene Set
   Enrichment Analysis (GSEA) was performed using the GSEA software. For
   the LC‐MS/MS Sequencing, 30 mg of sample was added to a 1.5 mL
   Eppendorf tube with 400 µL of methanol‐water (V:V = 4:1) as internal
   standard. The mixtures were stored at −40 °C for 2 min and placed in a
   grinder (60 Hz, 2 min). The whole samples were extracted by ultrasonic
   treatment for 10 min in an ice‐water bath, and stored at −40 °C for
   120 min. The extract was then centrifuged at 4 °C (13000 rpm) for
   20 min. The supernatants (150 µL) from each tube were collected using
   crystal syringes and transferred to LC vials. The vials were stored at
   −80 °C until LC‐MS analysis. QC samples were prepared by mixing
   aliquots of the samples to form a pooled sample. The metabolomic data
   analytical instrument utilized was the ACQUITY UPLC I‐Class plus
   instrument (Waters Corporation, Milford, USA). The original LC‐MS data
   were processed by the Progenesis QI V2.3 (Nonlinear, Dynamics,
   Newcastle, UK) software for baseline filtering, peak identification,
   integration, retention time correction, peak alignment, and
   normalization. A two‐tailed Student's T‐test was further used to verify
   whether the differential metabolite levels between groups were
   significantly different. Differential metabolites were selected with
   p‐values less than 0.05 and were further used for KEGG pathway
   enrichment analysis.
Statistical Analysis
   All quantitative data were expressed as mean ± standard deviation (SD)
   of at least three independent replicate experiments. The Shapiro‐Wilk
   test was used to assess the normality of distributions. Statistical
   analyses were carried out using One‐Way analysis of variance (ANOVA)
   combined with the Student‐Newman‐Keuls (SNK) multiple comparison
   post‐hoc test. The thresholds of statistical significance were set at
   ^* p < 0.05, ^** p < 0.01, ^*** p < 0.001, and ^**** p < 0.0001.
Conflict of Interest
   The authors declare no conflict of interest.
Supporting information
   Supporting Information
   [202]ADVS-12-e06736-s001.pdf^ (1.8MB, pdf)
Acknowledgements