Comparative study of tissue reactions to calcium phosphate ceramics among cancellous, cortical, and medullar bone sites in rabbits

Evaluation of calcium phosphate and calcium sulfate as injectable bone cements in sheep vertebrae

STUDY DESIGN

An animal study.

OBJECTIVE

To compare the biomechanical and biometabolic properties between calcium phosphate (CaP), calcium sulfate (CaS), and polymethylmethacrylate (PMMA) as bone void fillers in a sheep model of lumbar vertebral defect.

SUMMARY OF BACKGROUND DATA

PMMA is commonly used as a bone void filler in vertebroplasty and kyphoplasty. However, it has certain intrinsic limitations. CaP and CaS are considered as potential PMMA substitutes, but further in vivo evaluations of their biomechanical and biometabolic properties are needed before they can be recommended for clinical use in routine vertebroplasty and kyphoplasty procedures.

METHODS

Bone voids were experimentally created on lumbar vertebrae L2-L5 with L6 left intact as a normal control in 24 adult female sheep. The defect vertebrae L2-L5 in each of the animals were randomized to receive no filler augmentation (controls) or augmentation with CaP, CaS, or PMMA. Animals were killed after 2, 12, and 24 weeks of the bone filler augmentation, respectively. Vertebrae L2-L6 were collected and their biomechanical strength/stiffness, osseointegration activity, and biodegradability were evaluated.

RESULTS

At all 3 time points tested, the PMMA-augmented lumbar vertebra had the highest biomechanical strength and stiffness, followed by the intact vertebra L6. CaP and CaS significantly improved the strength as compared with the sham augmentation, but did not yet restore it to the normal level. Osteogenesis occurred at low levels in the empty vertebrae, in the CaP-augmented defect vertebrae at 12 and 24 weeks, and in the CaS-augmented vertebrae at 12 weeks, but at a substantially high level after 24 weeks of CaS augmentation. The filler biodegradation rate was low in the CaP-augmented vertebrae, but was substantially high in the CaS-augmented vertebrae.

CONCLUSIONS

CaP and CaS are effective enough to strengthen the fractured lumbar vertebrae in a time-dependent manner, although not as good as PMMA. CaS has a much higher osseointegration capacity than CaP.

Biocompatibility of engineered nanoparticles for drug delivery

The rapid advancement of nanotechnology has raised the possibility of using engineered nanoparticles that interact within biological environments for treatment of diseases. Nanoparticles interacting with cells and the extracellular environment can trigger a sequence of biological effects. These effects largely depend on the dynamic physicochemical characteristics of nanoparticles, which determine the biocompatibility and efficacy of the intended outcomes. Understanding the mechanisms behind these different outcomes will allow prediction of the relationship between nanostructures and their interactions with the biological milieu. At present, almost no standard biocompatibility evaluation criteria have been established, in particular for nanoparticles used in drug delivery systems. Therefore, an appropriate safety guideline of nanoparticles on human health with assessable endpoints is needed. In this review, we discuss the data existing in the literature regarding biocompatibility of nanoparticles for drug delivery applications. We also review the various types of nanoparticles used in drug delivery systems while addressing new challenges and research directions. Presenting the aforementioned information will aid in getting one step closer to formulating compatibility criteria for biological systems under exposure to different nanoparticles.

Evaluation of BMP-2 tethered polyelectrolyte coatings on hydroxyapatite scaffolds in vivo

The goal of this in vivo study was to evaluate the osteoinductive and angio-inductive properties of a porous hydroxyapatite (HAp) scaffold with immobilized recombinant bone morphogenetic protein-2 (rhBMP-2) on the surface. It was hypothesized in this study that the use of a rhBMP-2 incorporated polyelectrolyte coating on the HAp scaffold would allow for controlled exposure of rhBMP-2 into the tissue and would provide a sound platform for tissue growth. The scaffolds were characterized for porosity and interconnectivity using pycnometry, scanning electron microscopy and micro-ct. These scaffolds were then divided into the following four groups: (a) HAp scaffold (n-HAp group), (b) rhBMP-2 physically adsorbed on HAp scaffold (HAp-BMP-2 Group), (c) polyelectrolyte coating on HAp scaffold without rhBMP-2 (HAp-PEI Scaffold Group), and (d) polyelectrolyte coating tethered with rhBMP-2 on HAp scaffold (HAp-PEI-BMP-2 Scaffold Group). Using 18 skeletally matured New Zealand white rabbits, these scaffolds were evaluated in a nonload bearing femoral condyle plug model. The negative controls for this study have defects that were left untreated and the positive controls have defects that were filled with autologous bone graft harvested from epsilateral iliac crest. Bone induction, vessel growth, and scaffold-bone contact were analyzed after 8-week implantation using micro-CT and histomorphometry. It was concluded from this study that the use of scaffold with an attached rhBMP-2 increased the vascularization around the implant when compared with the uncoated n-HAp scaffold, a necessary step of bone regeneration. The open-pore HAp scaffold was also concluded to provide a platform for tissue growth, drug loading, and tissue interaction.

Biocompatibility and bone tissue compatibility of alumina ceramics reinforced with carbon nanotubes

Aims: The addition of carbon nanotubes (CNTs) remarkably improves the mechanical characteristics of base materials. CNT/alumina ceramic composites are expected to be highly functional biomaterials useful in a variety of medical fields. Biocompatibility and bone tissue compatibility were studied for the application of CNT/alumina composites as biomaterials. Methods & results: Inflammation reactions in response to the composite were as mild as those of alumina ceramic alone in a subcutaneous implantation study. In bone implantation testing, the composite showed good bone tissue compatibility and connected directly to new bone. An in vitro cell attachment test was performed for osteoblasts, chondrocytes, fibroblasts and smooth muscle cells, and CNT/alumina composite showed cell attachment similar to that of alumina ceramic. Discussion & conclusion: Owing to proven good biocompatibility and bone tissue compatibility, the application of CNT/alumina composites as biomaterials that contact bone, such as prostheses in arthroplasty and devices for bone repair, are expected.

Original submitted 23 March 2011; Revised submitted 16 November 2011; Published online 8 March 2012

Ectopic study of calcium phosphate cement seeded with pBMP-2 modified canine bMSCs mediated by a non-viral PEI derivative

We have evaluated the ectopic new bone formation effects of CPC (calcium phosphate cement) seeded with pBMP-2 (plasmids containing bone morphogenetic protein-2 gene) transfected canine bMSCs (bone marrow stromal cells) mediated by a non-viral PEI (polyethylenimine) derivative (GenEscort™ II) in nude mice. Canine bMSCs were transfected with pBMP-2 or pEGFP (plasmids containing enhanced green fluorescent protein gene) mediated by GenEscort™ II in vitro, and the osteoblastic differentiation was explored by ALP (alkaline phosphatase) staining, ARS (alizarin red S) staining and RT-qPCR (real-time quantitative PCR) analysis. Ectopic bone formation effects of CPC/pBMP-2 transfected bMSCs were evaluated and compared with CPC/pEGFP transfected bMSCs or CPC/untransfected bMSCs through histological, histomorphological and immunohistochemical analysis 8 and 12 weeks post-operation in nude mice. Transfection efficiency was up ∼35% as demonstrated by EGFP (enhanced green fluorescent protein) expression. ALP and ARS staining were stronger with pBMP-2 gene transfection, and mRNA expression of BMP-2 (bone morphogenetic protein-2), Col 1 (collagen 1) and OCN (osteocalcin) in pBMP-2 group was significantly up-regulated at 6 and 9 days. Significantly higher NBV (new bone volume) was achieved in pBMP-2 group than in the control groups at 8 and 12 weeks (P<0.05). In addition, immunohistochemical analysis indicated higher OCN expression in pBMP-2 group (P<0.01). We conclude that CPC seeded with pBMP-2 transfected bMSCs mediated by GenEscort™ II could enhance ectopic new bone formation in nude mice, suggesting that GenEscort™ II mediated pBMP-2 gene transfer is an effective non-viral method and CPC is a suitable scaffold for gene enhanced bone tissue engineering.

The enhancement of bone regeneration by a combination of osteoconductivity and osteostimulation using β-CaSiO3/β-Ca3(PO4)2 composite bioceramics

β-Tricalcium phosphate (β-TCP) is osteoconductive, while β-calcium silicate (β-CS) is bioactive with osteostimulative properties. Porous β-CaSiO(3)/β-Ca(3)(PO(4))(2) composite bioceramic scaffolds with various β-TCP:β-CS ratios were designed to combine both osteoconductivity and osteostimulation in order to enhance bone regeneration. The composite scaffolds were implanted in critical sized femur defects (6×12 mm) for 4, 12 and 26weeks with pure β-TCP and β-CS scaffolds as the controls. The in vivo biodegradation and bone regeneration of the specimens were investigated using sequential histological evaluations, immunohistochemical examination and micro-computed tomography technology. The results showed that the scaffolds with 50 and 80 wt.% β-CS dramatically enhanced the amount of newly formed bone and reduced the degradation rate. In contrast, porous β-CS displayed poor new bone formation due to its rapid degradation, while porous β-TCP showed moderate bone regeneration starting on the surface of the implants, due to a lack of osteostimulation. More importantly, the scaffolds with 50 and 80 wt.% β-CS not only had excellent osteoconductivity, but also stimulated rapid bone formation, and they could degrade progressively at a rate matching the regeneration of new bone. In summary, our findings indicated that the degradation rate and bioactivity of β-CS/β-TCP composite bioceramic scaffolds could be adjusted by controlling the ratio of β-CS to β-TCP, suggesting the potential application of β-CS/β-TCP composite bioceramic scaffolds with 50 and 80 wt.% β-CS component in hard tissue regeneration and bone tissue engineering.

The influence of bone type on the gene expression in normal bone and at the bone-implant interface: experiments in animal model

BACKGROUND

Studies on the biological processes in different bone types and the reaction of different bone types to biomaterials are often hindered because of the difficulties in sampling procedures and lack of sensitive techniques.

PURPOSE

The purpose was to assess the suitability of quantitative polymerase chain reaction (qPCR) for investigation of the biological differences between cortical and trabecular bone types and their responses to biomaterials.

MATERIALS AND METHODS

Gene expression of selected markers in rat bone samples from different locations was evaluated. Samples were harvested by trephines from the trabecular femoral epiphysis, cortico-trabecular proximal tibial metaphysic, and the cortical distal tibial metaphysis. Gene expression was also evaluated at the surfaces of anodically oxidized implants retrieved from cortical and trabecular sites after 3 days of implantation. mRNA in the bone samples and in the tissue associated with the implant surfaces was extracted and quantified using qPCR. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), alkaline phosphatase (ALP), osteocalcin (OC), tartrate-resistant acid phosphatase (TRAP), cathepsin K (CATK), and 18S ribosomal subunits (18S) were analyzed.

RESULTS

In the bone samples, higher expression of ALP, OC, TRAP, and CATK was found in femoral epiphysis compared to proximal or distal tibial metaphysis, indicating a higher turnover in the trabecular bone. On the other hand, TNF-α and IL-1β showed higher expression in both tibia sites compared with the femur site, which suggests higher inflammatory potential in the cortical bone. In response to the oxidized implants trabecular bone expressed a higher level of IL-1β, whereas the implants in cortical bone were associated with higher expression of ALP and OC.

CONCLUSION

There are biological differences between cortical and trabecular bone types, both in the normal steady-state condition and in response to biomaterials. Such differences can be characterized and discriminated quantitatively using a sensitive technique such as qPCR.

In vivo performance of bilayer hydroxyapatite scaffolds for bone tissue regeneration in the rabbit radius

The objective of this study was to investigate the in vivo biomechanical performance of bone defects implanted with novel bilayer hydroxyapatite (HAp) scaffolds that mimic the cortical and cancellous organization of bone. The scaffolds maintained architectural continuity in a rabbit radius segmental defect model and were compared to an untreated defect group (negative control) and autologous bone grafts (positive control). Micro-CT evaluations indicated total bone and scaffold volume in the experimental group was significantly greater than the defect group but lesser than the autologous bone graft treatment. The flexural toughness of the scaffold and the autograft groups was significantly greater than the flexural toughness of the defect group. Interestingly, the absolute density of the bone mineral as well as calcium to phosphorus (Ca/P) ratio in that mineral for the scaffold and autograft contralateral bones was significantly higher than those for the defect contralaterals suggesting that the scaffolds contributed to calcium homeostasis. It was concluded from this study that new bone regenerated in the bilayer HAp scaffolds was comparable to the empty defects and while the HAp scaffolds provided significant increase in modulus when compared to empty defect and their flexural toughness was comparable to autografts after 8 weeks of implantation.

BMP-2 gene modified canine bMSCs promote ectopic bone formation mediated by a nonviral PEI derivative

The study was to explore the effects of BMP-2 gene modified canine bone marrow stromal cells (bMSCs) mediated by a nonviral PEI derivative (GenEscort™ II) in promoting bone formation in vitro and in vivo. Canine bMSCs were cultured and transfected with plasmids containing bone morphogenetic protein-2 gene (pBMP-2) or enhanced green fluorescent protein gene (pEGFP). Gene transfection conditions were initially optimized by varying GenEscort™ II/plasmid ratios. Osteogenic differentiation of gene modified bMSCs was investigated via alkaline phosphatase (ALP) activity analysis and real-time quantitative PCR (RT-qPCR) analysis in vitro. The bone formation ability of pBMP-2 transfected bMSCs combined with apatite-coated silk scaffolds (mSS) was explored and compared with pEGFP transfected bMSCs/mSS or untreated bMSCs/mSS at 8, 12 weeks after operation. Results showed that gene transfection efficiency reached up to 36.67 ± 4.12% as demonstrated by EGFP expression. ALP staining and activity assay were stronger with pBMP-2 gene transfection, and the mRNA expression of BMP-2, bone sialoprotein (BSP), Runt-related transcription factor 2 (Runx-2), and osteopontin (OPN) up-regulated in bMSCs 3, 6, 9 days in pBMP-2 group. Besides, the tissue-engineered bone complex with pBMP-2 modified bMSCs achieved significantly increased de novo bone formation compared with control groups (p < 0.01). We conclude that pBMP-2 transfection mediated by GenEscort™ II could enhance the osteogenic differentiation of canine bMSCs and promote the ectopic new bone formation in nude mice. GenEscort™ II mediated pBMP-2 gene transfer appears to be a safe and effective nonviral method for gene enhanced bone tissue engineering.

A novel sheep vertebral bone defect model for injectable bioactive vertebral augmentation materials

New injectable bone substitutes have been developed that are, unlike polymethylmethacrylate, biologically active and have an osteogenic effect leading to osteogenesis and bone remodeling for vertebroplasty or kyphoplasty. In this study, we developed a sheep vertebral bone defect model to evaluate the new bioactive materials and assessed the feasibility of the model in vivo. Bone voids were experimentally created on lumbar vertebrae L2-L5 with L1 and L6 left intact as a normal control in mature sheep. The defect vertebrae L2-L5 in each sheep were randomized to receive augmentation with calcium phosphate cement (CPC) or sham. Vertebrae (L1-L6) were collected after 2 and 24 weeks of the cement augmentation and their strength and stiffness, as well as osseointegration activity and biodegradability, were evaluated. Finally, CPC significantly improved the strength and stiffness of vertebrae but did not yet restore it to the normal level at 24 weeks. Osteogenesis occurred at a substantially high level after 24 weeks of CPC augmentation or sham. Therefore, the sheep vertebral model with one void, 6.0 mm in diameter and 15.0 mm in depth, is replicable and can be used for evaluating the new injectable bioactive materials in vertebral augmentation or reconstruction.

In vivo behaviour of low-temperature calcium-deficient hydroxyapatite: comparison with deproteinised bovine bone

This study aims to evaluate in detail the biological osteoconductive properties of the low-temperature synthetic porous calcium-deficient hydroxyapatite and to compare it with the biological apatite. Bone reactions to granules of similar sizes of the low-temperature hydroxyapatite and commercially available non-sintered deproteinized bovine bone were compared. Two different temperatures were used to fabricate two batches of newly developed porous hydroxyapatite with different carbonate groups content and specific surface area. The histological analysis of specimens with histomorphometry was performed at different time after in vivo implantation. Based on histological analysis, the level of bone formation in the spaces between the implanted granules and through the interconnected pores of all implanted materials within a cortical region (bone area ingrowth 72-85 %) was several-fold higher than within a cancellous bone site (bone area ingrowth 16-28 %) at three and six months after implantation. Within the cancellous bone site, bone coverage of the implanted material at six months was significantly higher in hydroxyapatite material fabricated using low-temperature synthesis and subsequent processing at 150°C than in hydroxyapatite scaffold developed using low-temperature synthesis with subsequent processing at 700°C or deproteinized bovine bone. According to our study, the bioactive properties of the low-temperature calcium-deficient hydroxyapatite are comparable with the biological apatite. The favourable influence of a high specific surface area of a low-temperature calcium-deficient hydroxyapatite on in vivo bone formation was emphasized.

Porous beta tricalcium phosphate scaffolds used as a BMP-2 delivery system for bone tissue engineering

Macroporous beta tricalcium phosphate (beta-TCP) scaffolds were evaluated as potential carriers and delivery systems for bone morphogenetic protein-2 (BMP-2). Chemical etching was performed to increase the available surface and thus the protein loading. X-ray diffraction and infrared spectrocopy analyses confirmed the preparation of pure beta-TCP scaffolds. Scanning electron microscopy revealed interconnected porosity (64%) and a microporous surface after chemical etching. Scaffolds loaded with 30 and 15 microg of BMP-2 were implanted respectively into the back muscles and into femoral defects (condyle and diaphysis) of rabbits for 4 weeks. Histological observations confirmed the activity of the BMP-2 released from the scaffolds. Intramuscularly, bone was formed within the BMP-2-loaded scaffold pores. In the bone defects, the effect of released BMP-2 was similarly noticeable, as evaluated by histomorphometry. The incorporation of BMP-2 resulted in an amount of newly formed bone that was 1.3 times higher than with unloaded scaffolds. The implant site, however, did not have an effect on bone formation as no statistical differences were measured between cortical (diaphysis) and trabecular (condyle) defects. These results indicate the suitability of chemically etched beta-TCP scaffolds as BMP-2 carriers, in the context of bone regeneration.

rhVEGF 165 delivered in a porous beta-tricalcium phosphate scaffold accelerates bridging of critical-sized defects in rabbit radii

Segmental bone defects are a common obstacle in major orthopedic procedures, and the treatment of these defects remains a challenging clinical problem. Bone tissue engineering has been attracting much attention in recent years. We evaluated the ability of the specific combination of 3 microg rhVEGF(165) with a novel porous beta-tricalcium phosphate (beta-TCP) scaffold coated with fibrin sealant (FS) to facilitate bone regeneration. Unilateral 15-mm long critical-sized defects were prepared in the radial diaphysis of rabbits and treated with rhVEGF(165)/FS/scaffold or FS/scaffold. Healing of the defects was assessed at 4, 8, and 12 weeks, radiologically, histologically, and biomechanically. The results of the study demonstrated that the critical-sized defects in the midshaft of the rabbit radius, treated with rhVEGF(165) incorporated in porous beta-TCP scaffold by FS, can be completely bridged by cortical bone in 12 weeks. The bone marrow space was also reformed histologically and radiologically at 12 weeks postsurgery in the rhVEGF(165)-treated group. Furthermore, biomechanical examination demonstrated that the segmental bone defects were not only radiologically and histologically repaired but were also mechanically repaired. Interestingly, none of the defects was completely repaired at 12 weeks following treatment with FS/scaffold without rhVEGF(165). A solution-driven process is likely the predominant mechanism of accelerating biodegradation of the beta-TCP scaffold in the presence of rhVEGF(165); furthermore, cell-mediated phagocytosis also contributes to biodegradation of the biomaterials.

Skeletal repair in rabbits using a novel biomimetic composite based on adipose-derived stem cells encapsulated in collagen I gel with PLGA-beta-TCP scaffold

In bone tissue engineering, the cell distribution mode in the scaffold may affect in vivo osteogenesis. Therefore, we fabricated a novel biomimetic construct based on a combination of rabbit adipose-derived stem cells (rASCs) encapsulated in collagen I gel with a PLGA-beta-TCP scaffold (rASCs-COL/PLGA-beta-TCP, group A), the combination of rASCs and PLGA-beta-TCP (rASCs/PLGA-beta-TCP, group B), the combination of collagen I gel and PLGA-beta-TCP (COL/PLGA-beta-TCP, group C), and PLGA-beta-TCP scaffold (group D). The composites were implanted into a 15-mm length critical-sized segmental radial defect. The results were assessed by histology, radiographs, bone mineral density (BMD), and mechanical testing. After 24 weeks, the medullary cavity recanalized, bone was rebuilt, and molding finished, the bone contour remodeled smoothly and the scaffold degraded completely in group A. The BMDs and mechanical properties were similar to normal. However, the bone defect remained unrepaired in groups B, C, and D. Moreover, the scaffold degradation rate in group A was significantly higher than the other groups. Thus, enhanced in vivo osteogenesis of rASCs wrapped in collagen I gel combined with PLGA-beta-TCP was achieved, and the bone defect was repaired. We hope this study provides new insights into ASCs-based bone tissue engineering.

beta-Tricalcium phosphate promotes cell proliferation, osteogenesis and bone regeneration in intrabony defects in dogs

OBJECTIVE

This study investigates the effect of the new synthetic bone grafting material, high pure-phase beta-tricalcium phosphate (Cerasorb(1) M, granule size 500-1000microm), on the osteogenesis process and proliferation marker in bone marrow stromal cells (BMSCs) and its regenerative effect in the periodontal intrabony defects in dogs.

DESIGN

The effect of Cerasorb(1) M (20 and 40mgml(-1) for 1 and 2 weeks) on the proliferation rate of BMSCs was assessed by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay on the proliferating cell nuclear antigen (PCNA) by immunoblotting and on alkaline phosphatase level by colourimetric assay. The regenerative effect of Cerasorb(1) M in the periodontal intrabony defects in dogs was investigated by histological and immunohistochemical analysis after 3 and 6 months of grafting.

RESULTS

Incubation of BMSCs with Cerasorb(1) M for 2 weeks led to significant increase in cell proliferation rate, which was associated with increased PCNA. Cerasorb(1) M significantly increased the production of alkaline phosphatase as a marker for the osteogenic stromal lineage and for differentiation and bone formation in BMSCs after 2 weeks. In the histological features and immunohistochemical analysis of PCNA of the intrabony defects in dogs augmented with Cerasorb(1) M, osteoid tissue with a plate-like structure and cellular mesenchymal proliferation besides osteoid islands joined by bridges were observed after 3 months. Six months after the implantation, the Cerasorb(1) M granules were replaced by abundant new plate-like bone besides PCNA-enriched, small, oval-shaped mononuclear cells and multinucleated-giant cells that were attached to newly formed bones. No remains of the Cerasorb(1) M granules could be seen after 3 and 6 months with the newly formed plate-like bones and no histological sign of inflammatory reaction or formation of foreign-body granulomas.

CONCLUSION

Cerasorb(1) M may induce cell proliferation via induction of PCNA that may induce early osteogenesis and bone formation. Cerasorb(1) M regenerated the bone completely in intrabony defects and that this regeneration was highly associated with PCNA expression in different cell lineage.

Clinical, radiological and histological evaluation of biphasic calcium phosphate bioceramic wedges filling medial high tibial valgisation osteotomies

We report clinical, radiological and histological findings following high tibial valgisation osteotomy (HTVO) using micro-macroporous biphasic calcium phosphate wedges fixed with a plate and locking screws. From 1999 to 2002, 43 knees were operated on and studied prospectively. All underwent clinical and radiological follow-up at days 1, 90, and 365 to evaluate consolidation and bone substitute interfaces. Additionally, biopsies were taken for histology at least 1 year after implantation from 10 patients who requested plate removal. Radiologically, consolidation was observed in 98% of cases. At 1 year, correction was unchanged in 95% of cases. Histological analysis revealed considerable MBCP resorption and bone ingrowth, both into the pores and replacing the bioceramic material. Polarised light microscopy confirmed normal bony architecture with trabecular and/or dense lamellar bone growth at the expense of the wedge implants. X-ray and micro-CT scan revealed a well organised and mineralised structure in the newly-formed bone. This study shows that using MBCP wedges in combination with orientable locking screws and a plate is a simple, safe and fast surgical technique for HTVO. The is the first study to examine the results by histological analysis, which confirmed good outcomes.

In vivo study on hydroxyapatite scaffolds with trabecular architecture for bone repair

The objective of this research was to investigate the bone formation and angio-conductive potential of hydroxyapatite (HA) scaffolds closely matched to trabecular bone in a canine segmental defect after 3 and 12 weeks post implantation. Histomorphometric comparisons were made between naturally forming trabecular bone (control) and defects implanted with scaffolds fabricated with micro-size (M-HA) and nano-size HA (N-HA) ceramic surfaces. Scaffold architecture was similar to trabecular bone formed in control defects at 3 weeks. No significant differences were identified between the two HA scaffolds; however, significant bone in-growth was observed by 12 weeks with 43.9 +/- 4.1% and 50.4 +/- 8.8% of the cross-sectional area filled with mineralized bone in M-HA and N-HA scaffolds, respectively. Partially organized, lamellar collagen fibrils were identified by birefringence under cross-polarized light at both 3 and 12 weeks post implantation. Substantial blood vessel infiltration was identified in the scaffolds and compared with the distribution and diameter of vessels in the surrounding cortical bone. Vessels were less numerous but significantly larger than native cortical Haversian and Volkmann canals reflecting the scaffold architecture where open spaces allowed interconnected channels of bone to form. This study demonstrated the potential of trabecular bone modeled, highly porous and interconnected, HA scaffolds for regenerative orthopedics.

A comparative study of proliferation and osteogenic differentiation of adipose-derived stem cells on akermanite and beta-TCP ceramics

This study investigated the in vitro effects of akermanite, a new kind of Ca-, Mg-, Si-containing bioceramic, on the attachment, proliferation and osteogenic differentiation of human adipose-derived stem cells (hASCs). Parallel comparison of the cellular behaviors of hASCs on the akermanite was made with those on beta-tricalcium phosphate (beta-TCP). Scanning electron microscope (SEM) observation and fluorescent DiO labeling were carried out to reveal the attachment and growth of hASCs on the two ceramic surfaces, while the quantitative assay of cell proliferation with time was detected by DNA assay. Osteogenic differentiation of hASCs cultured on the akermanite and beta-TCP was assayed by ALP expression and osteocalcin (OCN) deposition, which was further confirmed by Real-time PCR analysis for markers of osteogenic differentiation. It was shown that hASCs attached and spread well on the akermanite as those on beta-TCP, and similar proliferation behaviors of hASCs were observed on the two ceramics. Both of them exhibited good compatibility to hASCs with only minor cytotoxicity as compared with the tissue culture plates. Interestingly, the osteogenic differentiation of hASCs could be enhanced on the akermanite compared with that on the beta-TCP when the culture time was extended to approximately 10 days. Thus, it can be ascertained that akermanite ceramics may serve as a potential scaffold for bone tissue engineering.

Bone formation and resorption in patients after implantation of beta-tricalcium phosphate blocks with 60% and 75% porosity in opening-wedge high tibial osteotomy

Most of the implanted porous beta-tricalcium phosphate (beta-TCP) can be resorbed. However, beta-TCP block with 75% porosity is inadequate for weight-bearing sites until bone incorporation occurs. Thus, the authors have recently developed beta-TCP block with 60% porosity, which is approximately sevenfold greater in terms of compressive strength than that of beta-TCP with 75% porosity. The authors investigated bone formation and resorption of beta-TCP after implantation in patients of beta-TCP blocks with two different porosities. From May 2003 to November 2004, medial opening high tibial osteotomy was performed in 25 patients with a mean age of 66 years. The opened defect was fixed with a Puddu plate. Then 6-8 cm(3) of beta-TCP block with 75% porosity was used to fill the cancellous bone defect, except on the medial side where 2.83-3.18 cm(3) of wedge-shaped beta-TCP block with 60% porosity was implanted. At least 2 years after surgery, the 25 patients had no correction loss, and bone formation was noted in all cases. Complete or nearly complete resorption of beta-TCP with 60 and 75% porosity was obtained within 3.5 years. Thirteen biopsy samples obtained from the 60% porosity implantation sites showed good lamellar bone formation, and the percentage of beta-TCP remaining relative to the newly formed bone plus beta-TCP ranged from 0.3 to 14.5%, with a mean of 6.7%. The authors suspect that mechanical stress loading to the medial side of the tibia facilitated bone formation and resorption of beta-TCP with 60% porosity.

In vivo biocompatibility of ultra-short single-walled carbon nanotube/biodegradable polymer nanocomposites for bone tissue engineering

Scaffolds play a pivotal role in the tissue engineering paradigm by providing temporary structural support, guiding cells to grow, assisting the transport of essential nutrients and waste products, and facilitating the formation of functional tissues and organs. Single-walled carbon nanotubes (SWNTs), especially ultra-short SWNTs (US-tubes), have proven useful for reinforcing synthetic polymeric scaffold materials. In this article, we report on the in vivo biocompatibility of US-tube reinforced porous biodegradable scaffolds in a rabbit model. US-tube nanocomposite scaffolds and control polymer scaffolds were implanted in rabbit femoral condyles and in subcutaneous pockets. The hard and soft tissue response was analyzed with micro-computed tomography (micro CT), histology, and histomorphometry at 4 and 12 weeks after implantation. The porous US-tube nanocomposite scaffolds exhibited favorable hard and soft tissue responses at both time points. At 12 weeks, a three-fold greater bone tissue ingrowth was seen in defects containing US-tube nanocomposite scaffolds compared to control polymer scaffolds. Additionally, the 12 week samples showed reduced inflammatory cell density and increased connective tissue organization. No significant quantitative difference in polymer degradation was observed among the various groups; qualitative differences between the two time points were consistent with expected degradation due to the progression of time. Although no conclusions can be drawn from the present study concerning the osteoinductivity of US-tube nanocomposite scaffolds, the results suggest that the presence of US-tubes may render nanocomposite scaffolds bioactive assisting osteogenesis.

Fabrication of porous substrates: a review of processes using pore forming agents in the biomaterial field

This paper is a review of solid and casting manufacturing processes able to create porous materials, mainly in the biomaterial field. The considered methods are based on pore forming agents that are removed either by heating or by dissolution. All techniques lead to products presenting pores with amount, size, and shape are close to those of the initial pore formers. Porosities up to 90% with pores ranging from 1 to 2000 microm are reported. Major differences concern macrointerconnections that are more frequently obtained using foams, or porogens which undergo a melting stage during firing. Casting methods combined with solid free form fabrication are promising for the design of porous network through the manufacturing of 3D scaffolds corresponding to the desired porosity.

In vitro study of using calcium phosphate cement as immunoisolative device to enclose insulinoma/agarose microspheres as bioartificial pancreas

In this study, the feasibility of using calcium phosphate cement (CPC) as immunoisolative device to enclose insulinoma/agarose microspheres as bioartificial pancreas was evaluated. We fabricated a chamber by CPC and utilized X-ray diffraction, Scanning electron microscope and Mercury intrusion porosimetry to identify the characters of the CPC chamber. The nominal molecular weight cut-off and cytotoxicity of CPC chamber were also evaluated. An insulinoma cell line (RIN-m5F) was chosen as insulin source and encapsulated in agarose microspheres and then enclosed in preformed CPC chamber. Insulin secretion was analyzed by Enzyme-linked immunosorbant assay to evaluate the function of insulinoma enclosed in CPC chamber. Results showed that the CPC chamber was non-cytotoxicity to insulinoma and can block the penetration of molecules which molecular weight larger than 12.4 kDa. Insulinoma inside the CPC chamber can secrete insulin in stable level for 30 days. This study indicated that we may use CPC as immunoisolative material to enclose insulinoma/agarose microspheres as bioartificial pancreas.

Experimental study on reconstruction of segmental mandible defects using tissue engineered bone combined bone marrow stromal cells with three-dimensional tricalcium phosphate

Reconstructive procedures of segmental mandible defects often require bone graft harvesting, which results in donor site morbidity; the use of tissue-engineered bone might mitigate this problem. The aim of the present experimental pilot study was to produce three-dimensional (3D) autologous tissue-engineered constructs that combine autogenous cultivated bone marrow stromal cells with beta-tricalcium phosphate to reconstruct segmental mandible defects without donor site morbidity. Bone marrow stromal cells were isolated from a dog's caput femoris. After differentiation and proliferation in vitro, the cells were seeded into a 3D beta-tricalcium phosphate scaffold. The constructs were incubated under osteogenic culture conditions for 5 days. Segmental defects of 30 mm length were created unilaterally in the mandibles of the animals. Reconstruction was performed using the construct in three dogs and the scaffold only in three dogs as a control group. The specimens were retrieved 3 months later, and the reconstructed areas were processed for gross observation, radiographic examination, 3D computed tomographic (CT) imaging, biomechanical evaluations, and histologic observation. The construct implanted group (n = 3) showed an average height of the reconstructed area of 18.54 mm and the control group 9.16 mm (P < 0.05). Higher radiodensity was present in the construct group than in the control group, as shown by radiograph. 3D CT imaging showed nearly two-thirds absorption of the reconstructed area in the control group. The biomechanical examination of the construct and control groups showed a compression strength of 102.77 N and 42.90 N and stress of 3.504 N/mm and 1.930 N/mm, which demonstrates significant difference. Histologic micrographs showed new bone formation in the scaffolds in central sections of the defects in the construct group 3 months later, with osteoblast seams, osteoclastic resorption, and cartilage formation. The construct of morphologic, 3D beta-tricalcium phosphate scaffold seeded, autologous bone marrow stromal cells ensure bone formation and vascularization throughout the procedure of mandible segmental defect reconstruction, closely resembling how tissue engineering would be used to reconstruct a segmental mandible defect in the clinical setting.

Quantitative analysis of the resorption and osteoconduction of a macroporous calcium phosphate bone cement for the repair of a critical size defect in the femoral condyle

Clinical orthopaedic use of calcium phosphate cement has been limited due to its slow resorption rate, but a new macroporous alpha-tricalcium phosphate (alpha-TCP) bone cement has been designed to accelerate resorption and to increase bone ingrowth. To assess its clinical potential, the in vivo behaviour of alpha-TCP was evaluated in a critical-size defect drilled in the femoral condyles of 36 adult female New Zealand rabbits. Macroporous or standard cement was injected immediately after preparation of the defect. The foaming agent was albumen, which gave up to 75% porosity. The rabbits were divided into three groups and the lesions examined histopathologically at 1, 4 and 12 weeks. No inflammatory reaction was detected at any time period following implantation with either macroporous or standard cement. At 12 weeks, the area of the implanted macroporous cement was approximately 35% of the initial lesion size. Bone growth and revascularisation was observed inside the central pores of the macroporous cement, not only at the margins, as was found with standard calcium phosphate cement. The results indicated that both cements were osteoconductive, biocompatible and biodegradable but their different physicochemical and biological properties had a marked influence on their post-implant behaviour.

Effect of weight-bearing on bone-bonding behavior of strontium-containing hydroxyapatite bone cement

The purpose of this study was to investigate and compare the chemical composition and nanomechanical properties at the bone-cement interface under non-weight-bearing and weight-bearing conditions, in order to understand the effect of weight-bearing on the bone-bonding behavior of strontium-containing hydroxyapatite (Sr-HA) cement. In one group, Sr-HA cement was injected into rabbit ilium (under non-weight-bearing conditions). Unilateral hip replacement was performed with Sr-HA cement (under weight-bearing conditions) in the other group. Six months later, scanning electron microscopy (SEM) with energy-dispersive X-ray (EDX) analysis and nanoindentation tests were conducted on the interfaces between cancellous bone and the Sr-HA cement. The nanoindentation results revealed two different transitional behaviors under different conditions. nder weight-bearing conditions, both the Young modulus and hardness at the interface were considerably higher than those at either the Sr-HA cement or cancellous bone. On the contrary, under non-weight-bearing conditions, both the Young modulus and hardness values at the interface were lower than those at the cancellous bone, but were higher than the Sr-HA cement. In addition, EDX results showed that the calcium and phosphorus contents at the interface under weight-bearing conditions were considerably higher than those under non-weight-bearing conditions. The differences in chemical composition and nanomechanical properties at the cement-bone interface under two different conditions indicate that weight-bearing produces significant effects on the bone-bonding behavior of the Sr-HA cement.

Three-dimensional flow perfusion culture system for stem cell proliferation inside the critical-size beta-tricalcium phosphate scaffold

A 3-dimensional flow perfusion system has been created in our laboratory to provide continuous and homogeneous nutrient supply inside the critical-size beta-tricalcium phosphate (beta-TCP) scaffold and permit cell proliferation during long-term incubation. The critical-size porous cylindrical scaffold (14 mm in diameter, 30 mm in length) with a central tunnel was impregnated with sheep mesenchymal stem cells. In the flow perfusion group, the hybrid scaffolds were continuously perfused with complete alpha-minimum essential medium via a peristaltic pump for 7, 14, and 28 days. In the static culture group, the hybrid composites were immersed in the medium without perfusion for 14 and 28 days. The daily glucose consumption was much higher in the flow perfusion group than in the static group (p < 0.001). In the flow perfusion group, glucose consumption increased dramatically in the first 14 days, and the increase slowed in the last 14 days. In the static group, the increase occurred only in the first 14 days. Cell viability via MTT colorimetry increased with time, which coincided with the results of glucose consumption. Histological study showed that the cells proliferated through the whole scaffolds under the flow perfusion culture. While under the static culture, the cells survived and proliferated only inside the first to third rows of the macropores under the scaffold surface. The cell quantity increased with time under flow perfusion culture. The results suggest that flow perfusion culture is superior to static culture for mesenchymal stem cell proliferation in the critical-size porous scaffold. This perfusion culture system permits a constant nutrition supply into the center of a large-scale scaffold for at least 4 weeks. Determination of D-glucose in the culture medium is a noninvasive way to survey cell proliferation in this system.

Histological and histomorphometrical comparative study of the degradation and osteoconductive characteristics of α- and β-tricalcium phosphate in block grafts

The purpose of the present study was to compare alpha- and beta-tricalcium phosphate (TCP) as bone graft material for augmenting highly resorbed alveolar ridges. The cranial bones of 15 rabbits were used. Three titanium chambers filled with porous blocks of alpha-TCP, beta-TCP, or blood clots were placed in each slit. The two TCP blocks had similar inner/outer structures and purities. Animals were sacrificed after 2, 4, and 8 weeks. Specimens were embedded in polyester resin as nondecalcified specimens, and evaluated both histologically and histomorphometrically. In both TCP groups, blocks had hardly degraded at 2 weeks while in the alpha-TCP group, the block had notably started degrading after 4 weeks. In the beta-TCP group, degradation began at 4 weeks and this degradation had increased just slightly after 8 weeks. The alpha-TCP block degraded significantly more than the beta-TCP block. Residual alpha-TCP particles surrounded by newly formed bone decreased over time, and both particles and newly formed bone were simultaneously absorbed by osteoclast-like cells. These observations suggest that residual alpha-TCP particles surrounded by newly formed bone may disappear progressively from bone and could be incorporated into the bone remodeling cycle in combination with newly formed bone.

Biodegradable magnesium scaffolds: Part II: peri-implant bone remodeling

In this study, histomorphometrical parameters of the peri-implant bone remodeling around degrading open-porous scaffolds made of magnesium alloy AZ91D were investigated and compared with the peri-implant bone remodeling around an autologous bone transplant in the contralateral side in a rabbit model after 3 and 6 months. Osteoblast activity was displayed by collagen I (alpha 2) mRNA in situ hybridization. Major scaffold degradation was completed within 3 months after implantation showing no osteolysis around the scaffolds, both after 3 and 6 months. Enhanced formation of unmineralized extracellular matrix and an enhanced mineral apposition rate adjacent to the degrading magnesium scaffolds were accompanied by an increased osteoclastic bone surface, which resulted in higher bone mass and a tendency to a more mature trabecular bone structure around the magnesium scaffolds compared to the control. These results show that even fast-degrading magnesium scaffolds induce extended peri-implant bone remodeling with a good biocompatibility. In summary, this study shows that degrading magnesium scaffolds promote both bone formation and resorption in a rabbit model and are therefore very promising candidates for the development of novel implants in musculoskeletal surgery.

In vitro and in vivo performance of a novel surface treatment to enhance osseointegration of endosseous implants

OBJECTIVE

This article shows the in vitro and in vivo characterization of a new biomimetic treatment developed to enhance the osseointegration of titanium dental implants.

STUDY DESIGN

A novel biomimetic treatment of titanium was developed. Its physicochemical properties and biologic and in vivo performance were considered and studied. Mineralization capability was assessed by soaking test in simulated body fluid solution, and cytocompatibility was assessed using osteoblast-like MG63 cell culture. Histomorphometric analysis was performed at 3 time points using a sheep animal model.

RESULTS

In vitro tests confirmed the biomimetic potential of the considered novel treatment. Histomorphometric analysis indicated its potential for rapid and good-quality osseointegration.

CONCLUSION

The in vitro and in vivo test results indicated that the proposed novel treatment possesses a significant potential to increase the rate of osteointegration of titanium for endosseous dental implants.

Effects of trabecular calcium phosphate scaffolds on stress signaling in osteoblast precursor cells

The objective of this research was to investigate stress-signaling patterns in response to two-dimensional (2-D) and three-dimensional (3-D) calcium phosphate (CP) materials using human embryonic palatal mesenchyme cells (HEPM, CRL-1486, ATCC, Manassas, VA), an osteoblast precursor cell line. Control discs and scaffolds were fabricated from hydroxyapatite and beta tri-CP ceramics. Phospho-specific antibody cell-based ELISA technique was utilized on members of the mitogen-activated protein kinase cascade including; the extracellular signal-regulated kinases (ERK1/2), p38, c-Jun N-terminal kinase (JNK), and the anti-apoptosis mediator protein kinase B (AKT). Quantification of these signals was evaluated during the early attachment phase of osteoblast precursor cells. In this study, it was observed that 3-D CP scaffolds significantly activated the stress mediators p38 and JNK but not ERK1/2. This signal trend was matched with an up-regulation in AKT, suggesting the ability of cells to manage high stress signals in response to 3-D CP architecture and that 3-D CP scaffolds are necessary for studies simulating a natural trabecular bone organization. The absence of these signals in 2-D CP surfaces indicated the importance of local architecture conditions on cell stress response. It was concluded from this study that osteoblast precursor cells cultured in 3-D CP scaffolds experience greater stress-signaling patterns when compared to 2-D CP surfaces.

Comparison on the Osteogenesis Potential between Poly(lactide-Co-Glycolide) and Alginate as Bone Tissue Engineering Scaffold In Vivo

Poly(lactide-co-glycolide) (PLGA) and alginate(AG) are the most promising scaffolds in the bone tissue engineering for their stable mechanical characters and three-dimensional porous structure. This study aimed to assay the in vivo osteogenesis potentials by loading the autogenous bone marrow stromal cells (BMSCs) on PLGA or AG. The results suggested that PLGA and AG are both ideal bone tissue engineering scaffold. BMSCs/AG has stronger osteogenesis potentials in vivo than BMSCs/PLGA.

In vivo evaluation of an injectable Macroporous Calcium Phosphate Cement

Although Calcium Phosphate Cements (CPC) are highly biocompatible and osteconductive materials, its resorption rate still remains too slow for some applications. In this work the introduction of Macroporosity in an injectable CPC is evaluated as a way to accelerate resorption and to increase bone ingrowth. A Macroporous and a standard CPC were injected just after preparation in a defect drilled in rabbit femur for their in vivo evaluation. The foaming agent used was Albumen, which gave up to a 75% porosity. Sodium Alginate was added to promote the cohesion of the foamed paste after implantation. In the case of the Macroporous Cement, bone growth and neovascularisation was observed inside the pores of the material, not only at the margins of the cement but also in some central pores. After 12 weeks of implantation, the residual material volume of the Macroporous Cement was approximately 35% of the initial value, whereas only the outer layers of non-Macroporous CPC were resorbed, being the residual material volume close to 100%. The higher resorption rate was due to the higher surface contact with body fluids which increased the dissolution rate, and to the enhancement of the cellular activity.

Treatment of osteonecrosis of the femoral head with hBMP-2-gene-modified tissue-engineered bone in goats

The efficacy of β-tricalcium phosphate (β-TCP) loaded with bone morphogenetic protein-2 (BMP-2)-gene-modified bone-marrow mesenchymal stem cells (BMSCs) was evaluated for the repair of experimentally-induced osteonecrosis of the femoral head in goats.

Bilateral early-stage osteonecrosis was induced in adult goats three weeks after ligation of the lateral and medial circumflex arteries and delivery of liquid nitrogen into the femoral head. After core decompression, porous β-TCP loaded with BMP-2 gene- or β-galactosidase (gal)-gene-transduced BMSCs was implanted into the left and right femoral heads, respectively. At 16 weeks after implantation, there was collapse of the femoral head in the untreated group but not in the BMP-2 or β-gal groups. The femoral heads in the BMP-2 group had a normal density and surface, while those in the β-gal group presented with a low density and an irregular surface. Histologically, new bone and fibrous tissue were formed in the macropores of the β-TCP. Sixteen weeks after implantation, lamellar bone had formed in the BMP-2 group, but there were some empty cavities and residual fibrous tissue in the β-gal group. The new bone volume in the BMP-2 group was significantly higher than that in the β-gal group. The maximum compressive strength and Young’s modulus of the repaired tissue in the BMP-2 group were similar to those of normal bone and significantly higher than those in the β-gal group.

Our findings indicate that porous β-TCP loaded with BMP-2-gene-transduced BMSCs are capable of repairing early-stage, experimentally-induced osteonecrosis of the femoral head and of restoring its mechanical function.

In vivo evaluation of a porous hydroxyapatite/poly-DL-lactide composite for bone tissue engineering

As reported previously, a porous composite of uncalcined hydroxyapatite (u-HA) and poly-DL-lactide (PDLLA) showed excellent osteoconductivity and biodegradability as a bone substitute in rabbit model. In this study, to investigate the usefulness of this composite as a scaffold loaded with cells, we estimated whether this material showed osteogenesis on implantation to extraosseous site. On loading with syngeneic bone marrow cells and implantation into rat dorsal subcutaneous tissue, osteogenesis with enchondral ossification was seen both on and in the material at 3 weeks after implantation. The osteogenesis in the u-HA/PDLLA had progressed, and newly formed bone tissue was found in the material by 6 weeks. To investigate the osteoinductive properties of the material, we implanted this porous composite material into extraosseous canine dorsal muscle. At 8 weeks, osteogenesis was seen in the pores of the material. Newly formed bone could be observed adjacent to the material. In addition, cuboidal osteoblasts adjacent to the newly formed bone were evident. Neither cartilage nor chondrocytes were found. These results might indicate that the material induced osteogenesis by intramembranous ossification. Conversely, similar porous PDLLA did not induce osteogenesis during the observation period. Therefore, porous HA/PDLLA, which has osteoconductive and osteoinductive properties, might be a useful material for use as a bone substitute and cellular scaffold.

Evaluation of an injectable bone substitute (betaTCP/hydroxyapatite/hydroxy-propyl-methyl-cellulose) in severely osteopenic and aged rats

The use of injectable biomaterials is of interest in osteoporotic patients to locally restore bone mass in sites at risk of fracture. An injectable bone substitute (IBS1 made of betaTCP/hydroxyapatite as a calcium phosphate substitute and hydroxy-propyl-methyl-cellulose as a polymer carrier) was used in a severely osteopenic rat model obtained by combining orchidectomy (ORX) and disuse (paralysis induced by botulinum toxin - BTX). Fifty-six aged male rats were randomized into three groups: 18 were SHAM operated; 38 were ORX and BTX injected in the right hindlimb; they constituted the OP (osteoporotic) group. One month after ORX-BTX surgery, 20 of these OP rats received a IBS1 injection in the right femur (OP-IBS1 rats). Animals were studied at the time of IBS1 injection 1 month post ORX-BTX (M1), 1 month (M2) and 2 months (M3) after IBS1 injection. Bone mass (BV/TV) and microarchitectural parameters were measured by microCT. BV/TV was decreased after ORX-BTX; ORX and BTX had cumulative effects on bone loss (differences maximized on the right femur). BV/TV (combining the volume of both bone and material in OP-IBS1 rats) was elevated at M1 but decreased at M2. Marked bone formation was found onto the biomaterial granules but bone had a woven texture. A marked increase in the number of nonosteoclastic TRAcP+ cells was found in the implanted area. IBS1 induced new bone formation shortly after implantation but both IBS1 and woven bone were resorbed without inducing lamellar bone. Biomaterial trials must be conducted with long-term implantation periods, in aged osteoporotic animals.

Repair of segmental bone defects in rabbit tibiae using a complex of beta-tricalcium phosphate, type I collagen, and fibroblast growth factor-2

The objective of this study was to evaluate the effects of a complex of beta-tricalcium phosphate (beta-TCP) granules, collagen, and fibroblast growth factor-2 (FGF-2) on cortical bone repair in rabbits. Segmental bone defects of 5 mm in length were created in the middle of the tibial shaft. The defect was stabilized with a plate and screws, and was filled with 0.3 ml of a complex of beta-TCP granules and 5% collagen, with or without 200 microg of recombinant human fibroblast growth factor-2 (rhFGF-2). Bone regeneration and beta-TCP resorption were assessed by X-ray and micro-CT scanner. A three-point bending test was also performed. The results showed that the segmental bone defect was not only radiologically, but also mechanically healed with cortical bone 12 weeks after implantation of the complex with rhFGF-2. In contrast, after implantation of the complex without rhFGF-2, most of the defect was filled with beta-TCP and only a small amount of bone formation was found. These results suggest that resorption of beta-TCP is important for bone formation and may be promoted by FGF-2 in the beta-TCP implantation site. In addition, the complex of beta-TCP granules and collagen combined with rhFGF-2 provides a paste-like material that is easy to handle. This material may be of considerable use in the treatment of cortical bone defects.

Biodegradation process of alpha-TCP particles and new bone formation in a rabbit cranial defect model

The purpose of the present study was to observe the biodegradation process of pure alpha-tricalcium phosphate (alpha-TCP) particles and to determine the efficacy of alpha-TCP as a space maintainer in a bone defect. We used 14 rabbits and prepared two cranial bone defects in each rabbit. One defect was left empty as a control, whereas the other was filled with alpha-TCP particles about 300 mum in diameter. Animals were sacrificed at 1 week, 4 weeks, and 8 weeks. The cranial bone was then embedded either in paraffin wax for the preparation of decalcified specimens, or in polyester resin for the preparation of nondecalcified specimens. All specimens were evaluated histologically and histomorphometrically. As a consequence of the degradation of alpha-TCP, a "reticulate structure" appeared in the particles at 1 week and new bone was observed in this structure at 8 weeks. The amount of new bone between the control and experimental groups was not significantly different at any of the time points. However, in the experimental group, new bone at the surface of alpha-TCP was evident even in the center of the defect whereas fibrous connective tissue was dominant in the control group. These results indicate that alpha-TCP is a degradable osteoconductive material that is able to act as a space maintainer for bone regeneration when applied to a bone defect. While there was no significant difference in total bone formation between the experimental and negative control groups, the space-maintaining and osteoconductive properties of the particles may result in more complete bone formation in longer-term studies.