Biomaterials 29 (2008) 3047–3052
Contents lists available at ScienceDirect
Biomaterials
journal homepage: www.elsevier.com/locate/biomaterials
Editorial
Trends in biomaterials research: An analysis of the scientific programme
of the World Biomaterials Congress 2008
1. Introduction
The use of artificial biomaterials for the treatment of diseased
tissues traces back to more than 2000 years ago, when heavy
metals such as gold were extensively used in dentistry [1]. Other
early examples of biomaterials include wooden teeth and glass
eyes, but generally, this first generation of biomaterials as devel-
oped before 1960 had low success rates due to a poor understand-
ing of biocompatibility. A major change came with the ending of
World War II, when materials that were originally developed for
military purposes became available for general use. Durable, inert
metals, ceramics and especially polymers such as PMMA were
taken off-the-shelf by surgeons and applied for clinical use. One
of the most inspiring examples of this transition from general to
specific use of high-performance materials is the development of
the first successful total hip replacement by Charnley in 1961,
who adopted the use of high-molecular weight polyethylene and
PMMA cement from the plastics industry and dentistry, respec-
tively [2]. Generally, however, these industrial materials were not
intentionally redesigned for biomedical purposes, and optimal bio-
compatibility was still considered to be the absence of cytotoxicity
[3]. Following these developments, an entirely new field of research
was initiated in the 1960s which focused on the design of new
biomaterials with improved biological performance. During the
second consensus conference on definitions in biomaterials,
biomaterials were defined as [4]:
‘‘Materials intended to interface with biological systems to evalu-
ate, treat, augment, or replace any tissue, organ or function of
the body.’’
Although the focus of biomaterials research was gradually shift-
ing from materials science and engineering towards an integrated
approach involving material scientists as well as biologists and sur-
geons, a major paradigm shift occurred around the early 1990s. By
that time, the term Tissue Engineering was introduced as [5]:
‘‘A scientific discipline dedicated to the generation of new tissue us-
ing the principles of engineering in combination with an under-
standing and application of the biologic sciences’’
By combining cells, biologically active molecules and carrier
materials called scaffolds (the three key elements of tissue engi-
neering), research efforts became aimed at improving and replac-
ing biological functions. This definition clearly expresses the
growing appreciation of the need to integrate biomaterial design
with new insights emerging from studies of cell–matrix
0142-9612/$ – see front matter Ó 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.biomaterials.2008.04.032
interactions, cell-signalling pathways, and developmental/
systems biology. The focus on interdisciplinarity has created
unforeseen crossover between areas of research that were previ-
ously unconnected.
A third, major step in the development was heralded by the con-
vergence of stem cell research with tissue engineering during the
early 2000s, resulting into the even broader field of regenerative
medicine as defined recently by Mason and Dunnill [6]:
‘‘Regenerative medicine replaces or regenerates human cells, tissue
or organs, to restore or establish normal function’’
The focal point of regenerative medicine lies within human cells,
which contrasts the more prominent role of artificial biomaterials
during the ages of biomaterials and tissue engineering. Shastri [7]
discerned two divergent approaches in regenerative medicine: (i)
external creation of tissue architecture and (ii) minimal interven-
tion through design of materials that evoke specific wound healing
responses. As such, regenerative medicine yields a new generation
of instructive materials that are intended to orchestrate local cellu-
lar processes by implementing signalling functions derived from
biological processes. One step further would be to question if scaf-
folds are still needed in regenerative medicine, as many aspects of
regenerative medicine could be accomplished by applying biologi-
cal principles without consideration of engineering principles [3,5].
Regenerative medicine can thus be regarded as the culmination of
regeneration strategies that are increasingly inspired by fundamen-
tal knowledge of human biology.
This paradigm shift from basic materials science towards the
highly interdisciplinary nature of current biomaterials research is
also reflected in the evolution of the major event in the field, i.e.,
the quadrennial World Biomaterials Congress (WBC). In 2008, the
WBC was entitled ‘‘Crossing frontiers in biomaterials and regener-
ative medicine’’. This article analyzes scientific and geographical
trends of the WBC 2008 in Amsterdam, especially compared to
the previous WBC in 2004 in Sydney, thereby providing an insight
into the current state of biomaterials research during its transfor-
mation from technologically towards biologically inspired engi-
neering strategies.
2. Congress details
Since 1980, the WBC has been held every four years, and the
congress venue has been equally distributed among the various
continents (Vienna 1980, Washington 1984, Kyoto 1996, Berlin
1992, Toronto 1996, Honolulu 2000, Sydney 2004, and Amsterdam
3048 S.C.G. Leeuwenburgh et al. / Biomaterials 29 (2008) 3047–3052
3000
Poster
2500
Oral
2000
1500
1000
500
0 search focus of the biomaterials community is aimed at under-
1980 1984 1988 1992 1996 2000 2004 2008
Fig. 1. Number of accepted oral and poster presentations on World Biomaterials Con-
gresses since 1980.
2008). Due to convergence with related fields of research such as
tissue engineering and regenerative medicine, this congress has
grown to become the major event of the biomaterials’ community,
attracting an increasing number of scientific presentations (Fig. 1)
and up to 3000 attendees. Accordingly, the percentage of oral pre-
sentations has considerably decreased from 67% in 1980 to 26% in
2008.
3. Geographical trends
Generally, the number of accepted abstracts increased from less
than 2000 in 2004 to more than 2500 in 2008, while the number of
submitting countries increased from 38 to 52 (Fig. 2A). The highest
number of abstracts for the Amsterdam meeting was received from
Europe (42%), followed by Asia (28%) and North America (23%),
whereas only a low number of abstracts were received from Oce-
ania and Latin America (below 5%) (Fig. 2A). The high number of Eu-
ropean submissions is directly related to the fact that Amsterdam is
easily accessible in Europe, whereas the large travelling distance
from Oceania and Latin America explains the low number of sub-
missions from these regions. Interestingly, as compared to the
WBC 2004 in Sydney, emerging countries are mainly located in
Asia (China and India) and Latin America (most notably Brazil)
(Fig. 2B), which reflects the general trend of increasing
globalization.
During the abstract submission process of the WBC 2008, au-
thors could indicate a presentation type preference for a poster
or an oral presentation (in general sessions or predefined sym-
posia; Fig. 3). The vast majority of authors from North America,
Europe and Oceania communicated a preference for an oral pre-
sentation, with a comparable percentage opting for a presenta-
tion in a general session or symposium. On the contrary, Asian
and especially Latin-American authors preferred a poster presen-
tation, which could be related to the relatively large language
barrier and/or a lower number of long-term research programs
in these emerging countries. The latter is also reflected in
Fig. 4, which demonstrates that best-scoring abstracts were
mainly submitted from countries with high investments in
R&D [8].
4. Scientific trends
In contrast to the high number of keywords for the 2004
meeting in Sydney (284), authors of contributions to the WBC
2008 could link their abstract to a reduced number of 29 general
keywords. Fig. 5A shows the incidence of these keywords for all
accepted abstracts for the WBC in 2008. In addition, Fig. 5B is
a similar representation, but derived from the accepted abstracts
at the previous WBC in 2004. To allow a proper comparison be-
tween the two conferences, the specific WBC 2004 keywords
were linked to their encompassing WBC 2008 keywords. Al-
though this is an arbitrary process in some cases (Degradation
was not a separate keyword in 2008, whereas Bioreactors was
not a keyword in 2004), general scientific trends can still be
observed.
The high scores of the keywords Biomaterial surfaces, Cell/pro-
tein-material interactions, and Tissue engineering and regenerative
medicine for both WBC 2004 and 2008 indicate that the current re-
standing the fundamental processes at the interface between
implant surfaces and surrounding living tissues. This confirms
that the above-mentioned paradigm shift from technologically to-
wards biologically inspired design of biomaterials is no longer a vi-
sion for the future, but is actually occurring. In other words, human
biology and nature in general have indeed become a starting point
for the design of instructive, functionalized biomaterials, as op-
posed to the traditional concept of the human body as passive
recipient of implants.
Interestingly, the separation between the three traditional ma-
terial classes (i.e., metals, ceramics, and polymers) is gradually
being replaced by keywords such as Scaffolds and Composite bioma-
terials. This might be explained by the realization that a single ma-
terial class does not reflect the complexity of highly structured
human tissues, and necessitates the use of advanced biomimetic
processing techniques to create intelligent biomaterials of similar
(nano)functionality [3]. In that respect, the increasing score of
Nanotechnology/nanostructured biomaterials is no surprise since
nanotechnology is a powerful tool in modern materials science,
which is able to incorporate biomimicry on the nanoscale into
materials engineering.
Finally, keywords that are related to tissues or organs as well
as translational and clinical research are generally low scoring,
which confirms that biomaterials researchers are still struggling
to translate basic knowledge towards clinical applications. This
concern is shared by many opinion leaders, and the general con-
sensus is that high expectations in press should be tempered in
order to ensure that the great promise of regenerative medicine
will not suffer the same fate as tissue engineering in the 1990s
[3,7,9]. Despite the huge set of data on tissue response to
biomaterials, the exact mechanisms behind inflammatory and im-
munological response or intriguing phenomena such as osteocon-
duction/osteoinduction are still essentially unknown [3]. It cannot
be expected that the complexity of tissue regeneration can be
solved by stem cells, bioactive agents or artificial biomaterials
on their own [10], which stresses the need for continuing inter-
disciplinary efforts to cross the gap between applied and basic
sciences.
Mason and Dunnill [6], however, recognized that a distinc-
tion currently exists between biomaterials scientists tending to
focus on man-made devices, and those focused on cell-based
therapies that envisage future regenerative medicine based
on nature’s own regenerative capacity with a minimum of ar-
tificial material present. Moreover, the keyword analysis of the
WBCs in 2004 and 2008 demonstrates that researchers in-
volved in clinical and translational research do not regard
the WBC as the proper platform for dissemination of their re-
search. In spite of the obvious fact that the biomaterials com-
munity would most certainly gain from developmental
biology/clinicians (and vice versa), researchers in each of these
fields still publish in their own journals and attend their own
meetings [10].
 S.C.G. Leeuwenburgh et al. / Biomaterials 29 (2008) 3047–3052 3049

Fig. 2. (A) Percentage of submitted abstracts per continent at WBC 2008 in Amsterdam. (B) Number of accepted abstracts per country for the WBC 2008 in Amsterdam (orange) and
the WBC 2004 in Sydney (green). A: North America, B: Latin America, C: Asia, D: Europe, E: Oceania.

Interaction between biomaterials scientists, clinicians, and de-
velopmental/system biologists should therefore be stimulated in
order to enable a fully integrated approach towards biomaterials
design. Accordingly, attracting surgeons and fundamental biolo-
gists to conferences like the WBC will become a key priority in
order to pave the way for a future generation of bio-inspired bio-
materials. It is interesting to note that in the journal Biomaterials
there has been an increasing trend towards the publication of pa-
pers that are more associated with translational research (in re-
cently introduced sections on Biomaterials and Biotechnology
and Biomaterials and Nanotechnology, for example) and of papers
that discuss the clinical performance of devices from biomaterials
perspectives.
5. Conclusions
Despite the high speed of transformation and expansion of the
field of biomaterials, the significant promise of regenerative medi-
cine has not yet resulted in large-scale translation of basic science
towards novel and revolutionary clinical concepts. To this end, in-
terdisciplinary communication between previously unconnected
fields of relevant basic and applied research has now become
3050 S.C.G. Leeuwenburgh et al. / Biomaterials 29 (2008) 3047–3052

Fig. 3. Presentation type preferences of the abstract authors from different regions. Poster ¼ poster presentation, Oral G ¼ oral presentation in a general session, Oral S ¼ oral pre-
sentation in a symposium.

Fig. 4. Average abstract review scores of the 10 best-scoring countries with more than 20 submitted abstracts. Each abstract was scored by 3 independent referees on a scale of 1
(worst) to 10 (best).
 S.C.G. Leeuwenburgh et al. / Biomaterials 29 (2008) 3047–3052 3051

Fig. 5. Occurrence of master keywords for abstracts at the WBC in (A) 2008 and (B) 2004.

a major challenge. It is essential that the WBC remains a primary Acknowledgements

focus of such communication and interdisciplinarity, which will in-
deed be a major goal for the next WBC in Chengdu, China in 2012, The authors thank Dr. Ramshaw and Dr. Werkmeister for the
and that these trends are fairly reflected in the key journals of the discussions on the manuscript. Dr. Leeuwenburgh and Dr. Malda
field of biomaterials science. are supported by a VENI fellowship from the Dutch Technology
3052 S.C.G. Leeuwenburgh et al. / Biomaterials 29 (2008) 3047–3052

Foundation STW, Applied Science Division of NWO and the Tech- Sander C.G. Leeuwenburgh1
nology Program of the Ministry of Economic Affairs. John A. Jansen
Department of Periodontology and Biomaterials, Radboud University
Nijmegen Medical Center, Nijmegen, The Netherlands
References
Jos Malda1
[1] Ratner BD, Hoffman AS, Schoen FJ, Lemons JE. Biomaterials science: an intro- Wouter A. Dhert
duction to materials in medicine. Orlando: Academic Press; 2004.
[2] Charnley J. Arthroplasty of the hip: a new operation. Lancet 1961:1129–32. Department of Orthopaedics, University Medical Center Utrecht,
[3] Kirkpatrick CJ, Fuchs S, Peters K, Brochhausen C, Hermanns MI, Unger RE. Vi- The Netherlands
sions for regenerative medicine: interface between scientific fact and science
fiction. Artif Organs 2006;30:822–7. Jeroen Rouwkema1
[4] Williams DF, Black J, Doherty PJ. Second consensus conference on definitions Clemens A. van Blitterswijk
in biomaterials, Chester, England. In: Doherty PJ, Williams RF, Williams DF,
Lee AJC, editors. Biomaterial–tissue interfaces. Advances in biomaterials,
Department of Tissue Regeneration, Institute for Biomedical
vol. 10. Amsterdam: Elsevier; 1992. Technology, University of Twente, Enschede, The Netherlands
[5] Vacanti CA. Tissue Eng 2006;12:1137–42.
[6] Mason C, Dunnill P. A brief definition of regenerative medicine. Regen Med C. James Kirkpatrick
2008;3:1–5. Institute of Pathology, Johannes Gutenberg University, Mainz,
[7] Shastri VP. Future of regenerative medicine: challenges and hurdles. Artif
Germany
Organs 2006;30:828–34.
[8] Courtland R. How the world invests in R&D: the changing face of public and
David F. Williams, Editor-in-Chief, Biomaterials*
private funding. Nature 2008;451:378.
 Corresponding author.
[9] Petit-Zeman S. Regenerative medicine: the regeneration of tissues and organs
offers a radical new approach to the treatment of injury and disease. It’s a new E-mail address: biomaterials@online.be (D.F. Williams)
medicine for a new millennium, but does the reality match the hype? Nat Bio-
technol 2001;19:201–6.
[10] Ingber DE, Levin M. What lies at the interface of regenerative medicine and 21 April 2008
developmental biology? Development 2007;134:2541–7. Available online 6 May 2008

1
Equally contributed.