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A Comprehensive Microstructural and Compositional Characterization of Allogenic and Xenogenic Bone: Application to Bone Grafts and Nanostructured Biomimetic Coatings. COATINGS 2020. [DOI: 10.3390/coatings10060522] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bone grafts and bone-based materials are widely used in orthopedic surgery. However, the selection of the bone type to be used is more focused on the biological properties of bone sources than physico-chemical ones. Moreover, although biogenic sources are increasingly used for deposition of biomimetic nanostructured coatings, the influence of specific precursors used on coating’s morphology and composition has not yet been explored. Therefore, in order to fill this gap, we provided a detailed characterization of the properties of the mineral phase of the most used bone sources for allografts, xenografts and coating deposition protocols, not currently available. To this aim, several bone apatite precursors are compared in terms of composition and morphology. Significant differences are assessed for the magnesium content between female and male human donors, and in terms of Ca/P ratio, magnesium content and carbonate substitution between human bone and different animal bone sources. Prospectively, based on these data, bone from different sources can be used to obtain bone grafts having slightly different properties, depending on the clinical need. Likewise, the suitability of coating-based biomimetic films for specific clinical musculoskeletal application may depend on the type of apatite precursor used, being differently able to tune surface morphology and nanostructuration, as shown in the proof of concepts of thin film manufacturing here presented.
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Pabst A, Ackermann M, Thiem D, Kämmerer P. Influence of Different Rehydration Protocols on Biomechanical Properties of Allogeneic Cortical Bone Plates: A Combined in-vitro/ in-vivo Study. J INVEST SURG 2020; 34:1158-1164. [PMID: 32441171 DOI: 10.1080/08941939.2020.1767735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Allogeneic cortical bone plates (CP) are used for alveolar ridge augmentation. Since CP are freeze-dried and dehydrated during processing, the breaking strength (BS) and the flexibility (FX) are reduced, resulting in a relevant risk for plate fractures during insertion. The aim of this study was to evaluate the influence of rehydration time on the biomechanical properties (BS & FX) of CP in-vitro and in vivo.Material and Methods: 40 CP were randomly divided into four experimental groups. (A) untreated control (n = 10), rehydration for 10 (B), 30 (C) and 60 (D) minutes in 0.9% saline solution (n = 10 each). BS [Newton, N] and FX [mm] (force till fracture and distance of deflection to the breaking point) were analyzed. Besides, architectural features of all CP groups were visualized and examined by scanning electron microscopy (SEM). In addition, the frequency of CP fractures of rehydrated- vs. non-rehydrated CP was retrospectively analyzed in 6 patients.Results: Compared to the control group, significantly increased BS and FX were demonstrated after 10, 30 and 60 minutes of rehydration (p each ≤ 0.035). After a rehydration time of 10 minutes, no additional increase of BS and FX was seen when compared to30 and 60 minutes (p each = 1.0). SEM scans demonstrated that the CP fracture characteristics were influenced by the different rehydration protocols. The frequency of CP fractures was reduced in patients by CP rehydration.Conclusion: The biomechanical properties of CP can be significantly improved by 10 min of rehydration, resulting in an increased BS and FX, that might be clinically relevant.
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Affiliation(s)
- Andreas Pabst
- Department of Oral- and Maxillofacial Surgery, Federal Armed Forces Hospital, Koblenz, Germany
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center, Mainz, Germany
| | - Daniel Thiem
- Department of Oral- and Maxillofacial Surgery, University Medical Center, Mainz, Germany
| | - Peer Kämmerer
- Department of Oral- and Maxillofacial Surgery, University Medical Center, Mainz, Germany
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Muñoz MA, Garín-Correa C, González-Arriagada W, Quintela Davila X, Häberle P, Bedran-Russo A, Luque-Martínez I. The adverse effects of radiotherapy on the structure of dental hard tissues and longevity of dental restoration. Int J Radiat Biol 2020; 96:910-918. [DOI: 10.1080/09553002.2020.1741718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Miguel Angel Muñoz
- Interoperative Research Center in Dental and Medical Sciences, Faculty of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
| | - Carolina Garín-Correa
- Nanobio-Corrosion Laboratory, Institute of Chemistry, Faculty of Sciences, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Wilfredo González-Arriagada
- Interoperative Research Center in Dental and Medical Sciences, Faculty of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
| | - Ximena Quintela Davila
- Radiotherapy Unit, Carlos Van Buren Hospital, Valparaíso - San Antonio Health Service, MINSAL, Valparaíso, Chile
| | - Patricio Häberle
- Department of Physics, Universidad Técnica Federico Santa Maria, Valparaíso, Chile
| | - Ana Bedran-Russo
- Department of Restorative Dentistry, Faculty of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - Issis Luque-Martínez
- Interoperative Research Center in Dental and Medical Sciences, Faculty of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
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Design Techniques to Optimize the Scaffold Performance: Freeze-dried Bone Custom-made Allografts for Maxillary Alveolar Horizontal Ridge Augmentation. MATERIALS 2020; 13:ma13061393. [PMID: 32204393 PMCID: PMC7142634 DOI: 10.3390/ma13061393] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
The purpose of the current investigation was to evaluate the clinical success of horizontal ridge augmentation in severely atrophic maxilla (Cawood and Howell class IV) using freeze-dried custom made bone harvested from the tibial hemiplateau of cadaver donors, and to analyze the marginal bone level gain prior to dental implant placement at nine months subsequent to bone grafting and before prosthetic rehabilitation. A 52-year-old woman received custom made bone grafts. The patient underwent CT scans two weeks prior and nine months after surgery for graft volume and density analysis. The clinical and radiographic bone observations showed a very low rate of resorption after bone graft and implant placement. The custom-made allograft material was a highly effective modality for restoring the alveolar horizontal ridge, resulting in a reduction of the need to obtain autogenous bone from a secondary site with predictable procedure. Further studies are needed to investigate its behavior at longer time periods.
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Hua KC, Feng JT, Yang XG, Wang F, Zhang H, Yang L, Zhang HR, Xu MY, Li JK, Qiao RQ, Lun DX, Hu YC. Assessment of the Defatting Efficacy of Mechanical and Chemical Treatment for Allograft Cancellous Bone and Its Effects on Biomechanics Properties of Bone. Orthop Surg 2020; 12:617-630. [PMID: 32189444 PMCID: PMC7189055 DOI: 10.1111/os.12639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the defatting efficacy of high pressure washing and gradient alcohol and biomechanical properties of defatted bone. Methods Fresh cancellous bone was obtained from the femoral condyle and divided into six groups according to different defatting treatments, which were: high pressure washing for 10 s (10S group), 20 s (20S group), and 30 s (30S group), gradient alcohol immersion (Alcohol group), acetone immersion (Acetone group), and non‐defatted (Fresh group). The appearance of six groups was observed, and the appearance of defatted bone and fresh bone was compared. The residual lipid content and infrared spectrum were used to compare the efficacy of defatting, the DNA content was used to compare the cell content after defatting, and the maximum stress and elastic modulus were used to compare the effects of defatting treatment on biomechanical properties. Results The fresh bone was yellow and the pores contained a lot of fat. The defatted bone was white and the porous network was clear. There was no difference in residual lipid content among the three groups with high pressure washing (1.45% ± 0.16%, 1.40% ± 0.13%, and 1.46% ± 0.11%, respectively) (P = 0.828). There was no difference in residual lipid content among the 10S, alcohol, and acetone groups (1.45% ± 0.16%, 1.28% ± 0.07%, and 1.13% ± 0.22%, respectively) (P = 0.125). Infrared spectra showed that the fat content of the five defatting groups was significantly lower than that of the fresh group. There was no difference in residual lipid content among the three groups with high pressure washing (4.53 ± 0.23 ug/mL, 4.61 ± 0.18 ug/mL, and 4.66 ± 0.25 ug/mL, respectively) (P = 0.645). There was no difference in residual lipid content among the 10S, alcohol, and acetone groups (4.53 ± 0.23 ug/mL, 4.29 ± 0.24 ug/mL, and 4.27 ± 0.29 ug/mL, respectively) (P = 0.247). The maximum stress of the bone decreased significantly with the increase of the washing time (9.95 ± 0.31 Mpa, 9.07 ± 0.45 Mpa, and 8.17 ± 0.35 Mpa, respectively) (P = 0.003). The elastic modulus of the bone decreased significantly with the increase of the washing time (116.40 ± 3.54 Mpa, 106.10 ± 5.29 Mpa, and 95.63 ± 4.08 Mpa, respectively) (P = 0.003). There was no statistical difference in the maximum stress between the fresh group, the 10S group, the alcohol group, and the acetone group (10.09 ± 0.67 Mpa, 9.95 ± 0.31 Mpa, 10.11 ± 0.07 Mpa, and 10.09 ± 0.39 Mpa, respectively) (P = 0.963). There was no statistical difference in the maximum stress between the fresh group, the 10S group, the alcohol group and the acetone group (119.93 ± 4.94 Mpa, 116.40 ± 3.54 Mpa, 118.27 ± 0.85 Mpa, 118.10 ± 4.52 Mpa, respectively) (P = 0.737). Conclusion The defatting efficiency was satisfactory at a time of 10 s under high pressure washing. In terms of defatting efficiency and its effect on biomechanical properties of bone, high pressure washing and gradient alcohol were similar to conventional acetone solvent extraction defatting.
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Affiliation(s)
- Kun-Chi Hua
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China.,Graduate School, Tianjin Medical University, Tianjin, China
| | - Jiang-Tao Feng
- Graduate School, Tianjin Medical University, Tianjin, China
| | | | - Feng Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Li Yang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao-Ran Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ming-You Xu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ji-Kai Li
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Rui-Qi Qiao
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Deng-Xing Lun
- Deng-xing Lun, MD, Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Yong-Cheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
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56
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Ku JK, Kim BJ, Park JY, Lee JH, Yun PY, Kim YM, Um IW. Effects of gamma irradiation on the measurement of hepatitis B virus DNA in dentin harvested from chronically infected patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:314. [PMID: 32355758 PMCID: PMC7186722 DOI: 10.21037/atm.2020.03.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The manufacturing of the demineralized dentin matrix (DDM) has been proven to extensively reduce the presence of human hepatitis B viral DNA (HBV DNA). This study measured and compared HBV DNA in fresh dentin to that in gamma radiation (GR)-sterilized dentin extracted from HBV-infected patients. The application of GR as a means of terminal sterilization is hypothesized to inactivate or eliminate HBV within the dentin matrix. Methods Dentin from 18 HBV-infected patients was collected and divided into three fragments. The first fragment was unaltered and used as the control group; the remaining two fragments were sterilized with gamma radiation doses of 15 or 25 kGy. DNA was extracted and purified from each fresh (control), and the GR-sterilized (experimental) dentin specimen and HBV DNA copy numbers were evaluated on the basis of the real-time polymerase chain reaction. The copy numbers were used to assess GR efficacy as a means of terminal sterilization for HBV inactivation or elimination. Results HBV DNA was detected in 66.67% of the fresh dentin specimens. The differences in HBV DNA levels between the fresh dentin and the GR-sterilized dentin were confirmed by the Wilcoxon signed-rank test for the doses of 15 and 25 kGy with P value of 0.012 and 0.010, respectively. Among the twelve HBV-DNA-positive fresh dentin samples, HBV DNA persisted in eleven after GR sterilization, yet the copy number was reduced to <10 (except for a single sample within each experimental group). Conclusions The results suggest that 15 and 25 kGy of GR significantly reduced the HBV DNA levels in the fresh dentin matrix. Expansion of the possible clinical applications of allogenic grafts with the irradiated DDM will require additional studies, including validation of viral load inactivation to prevent infectious transmission and examination of GR exposure effects on the osteoinductivity of the matrix.
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Affiliation(s)
- Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Seongnam, Korea
| | - Bong-Ju Kim
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
| | - Joo-Young Park
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Jong-Ho Lee
- Clinical Trial Center, Seoul National University Dental Hospital, Seoul, Korea
| | - Pil-Young Yun
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu-Mi Kim
- R&D Institute, Korea Tooth Bank, Seoul, Korea
| | - In-Woong Um
- R&D Institute, Korea Tooth Bank, Seoul, Korea
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57
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Sun Y, Lovric V, Wang T, Oliver RA, Walsh WR. Effects of SCCO 2, Gamma Irradiation, and Sodium Dodecyl Sulfate Treatments on the Initial Properties of Tendon Allografts. Int J Mol Sci 2020; 21:ijms21051565. [PMID: 32106592 PMCID: PMC7084268 DOI: 10.3390/ijms21051565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 01/05/2023] Open
Abstract
Sterile and decellularized allograft tendons are viable biomaterials used in reconstructive surgeries for dense connective tissue injuries. Established allograft processing techniques including gamma irradiation and sodium dodecyl sulfate (SDS) can affect tissue integrity. Supercritical carbon dioxide (SCCO2) represents a novel alternative that has the potential to decellularize and sterilize tendons with minimized exposure to denaturants, shortened treatment time, lack of toxic residues, and superior tissue penetration, and thus efficacy. This study attempted to develop a single-step hybrid decellularization and sterilization protocol for tendons that involved SCCO2 treatment with various chemical additives. The processed tendons were evaluated with mechanical testing, histology, scanning electron microscopy (SEM), and Fourier-transform infrared (FTIR) spectroscopy. Uniaxial mechanical testing showed that tendons treated with SCCO2 and additive NovaKillTM Gen2 and 0.1% SDS had significantly higher (p < 0.05) ultimate tensile stress (UTS) and Young's modulus compared to gamma-irradiated and standard-SDS-treated tendons. This was corroborated by the ultrastructural intactness of SCCO2-treated tendons as examined by SEM and FTIR spectroscopy, which was not preserved in gamma-irradiated and standard SDS-treated tendons. However, complete decellularization was not achieved by the experimented SCCO2-SDS protocols used in this study. The present study therefore serves as a concrete starting point for development of an SCCO2-based combined sterilization and decellularization protocol for allograft tendons, where additive choice is to be optimized.
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58
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Suhardi JV, Morgan DFA, Muratoglu OK, Oral E. Radioprotection and cross-linking of allograft bone in the presence of vitamin E. J Biomed Mater Res B Appl Biomater 2020; 108:2354-2367. [PMID: 31975566 DOI: 10.1002/jbm.b.34569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/11/2019] [Accepted: 01/06/2020] [Indexed: 11/08/2022]
Abstract
Bone allografts are the preferred method for bone augmentation in over 500,000 orthopedic surgical procedures in the US. Sterilization by ionizing radiation is the most effective method of minimizing the bioburden of bone allografts; however, radiation causes chain scission of collagen, resulting in the reduction of the allografts' mechanical strength. In this study, we doped bone allografts with vitamin E as radioprotectant using a novel two-step process to protect the collagen architecture against radiation damage and to preserve the mechanical strength of the construct. In addition, combining the radioprotectant with a cross-linking agent further minimized collagen degradation and further preserved the mechanical strength of the allografts. Both vitamin E and combined vitamin E/genipin-treated allograft were less cytotoxic to both osteoblasts and osteoclasts when compared to irradiated-only allografts. Host bone-allograft unionization was faster in a rat calvaria defect model with vitamin E-treated and combined vitamin E and genipin-treated allograft when compare to irradiated-only allografts. This method can enable the efficient and uniform radioprotective treatment of bone allograft of desired shapes for sterilization with improved mechanical strength and biointegration.
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Affiliation(s)
- Jeremy V Suhardi
- Harris Orthopedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medical Engineering and Medical Physics, Massachusetts Institute of Technology, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | | | - Orhun K Muratoglu
- Harris Orthopedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ebru Oral
- Harris Orthopedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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59
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Thong FY, Mansor A, Ramalingam S, Yusof N. Does bone marrow aspirate help enhance the integration of gamma irradiated allograft bone? Cell Tissue Bank 2020; 21:107-117. [PMID: 31894432 DOI: 10.1007/s10561-019-09804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
Bone allografts donated by other individuals offer a viable alternative to autograft. Risks of disease transmission are overcome by sterilizing the bone; unfortunately sterilization methods generally affect bone functional properties including osteogenic potential and biomechanical integrity. This study aimed to determine any enhancement effect when gamma sterilised allografts was impregnated with autologous bone marrow in improving the rate and quality of integration in metaphyseal-tibial defects of rabbits. Almost all subjects showed 50% of the defect being covered by new bones by the third week and smaller residual defect size in the treated group at the fifth week. Hounsfield units at the defect site showed increasing healing in all samples, with the treated group having an apparent advantage although insignificant (p > 0.05). In the histopathological score evaluating healing over cortical and cancellous bone at the fracture site showed only slight variations between the groups (p > 0.05). Therefore no enhanced healing by the autologous bone marrow was observed when added to the bone allografts in treating the unicortical defects.
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Affiliation(s)
- Fu Yuen Thong
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Azura Mansor
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Saravana Ramalingam
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Norimah Yusof
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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61
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Pendleton MM, Emerzian SR, Liu J, Tang SY, O'Connell GD, Alwood JS, Keaveny TM. Effects of ex vivo ionizing radiation on collagen structure and whole-bone mechanical properties of mouse vertebrae. Bone 2019; 128:115043. [PMID: 31445224 PMCID: PMC6813909 DOI: 10.1016/j.bone.2019.115043] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022]
Abstract
Bone can become brittle when exposed to ionizing radiation across a wide range of clinically relevant doses that span from radiotherapy (accumulative 50 Gy) to sterilization (~35,000 Gy). While irradiation-induced embrittlement has been attributed to changes in the collagen molecular structure, the relative role of collagen fragmentation versus non-enzymatic collagen crosslinking remains unclear. To better understand the effects of radiation on the bone material without cellular activity, we conducted an ex vivo x-ray radiation experiment on excised mouse lumbar vertebrae. Spinal tissue from twenty-week old, female, C57BL/6J mice were randomly assigned to a single x-ray radiation dose of either 0 (control), 50, 1000, 17,000, or 35,000 Gy. Measurements were made for collagen fragmentation, non-enzymatic collagen crosslinking, and both monotonic and cyclic-loading compressive mechanical properties. We found that the group differences for mechanical properties were more consistent with those for collagen fragmentation than for non-enzymatic collagen crosslinking. Monotonic strength at 17,000 and 35,000 Gy was lower than that of the control by 50% and 73% respectively, (p < 0.001) but at 50 and 1000 Gy was not different than the control. Consistent with those trends, collagen fragmentation only occurred at 17,000 and 35,000 Gy. By contrast, non-enzymatic collagen crosslinking was greater than control for all radiation doses (p < 0.001). All results were consistent both for monotonic and cyclic loading conditions. We conclude that the reductions in bone compressive monotonic strength and fatigue life due to ex vivo ionizing radiation are more likely caused by fragmentation of the collagen backbone than any increases in non-enzymatic collagen crosslinks.
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Affiliation(s)
- Megan M Pendleton
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Shannon R Emerzian
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Jennifer Liu
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Simon Y Tang
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA; Department of Material Science & Mechanical Engineering, Washington University, St. Louis, MO, USA
| | - Grace D O'Connell
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA; Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Joshua S Alwood
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Tony M Keaveny
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA; Department of Bioengineering, University of California, Berkeley, CA, USA.
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da Silva AF, Antebi U, Honda EK, Rudelli M, Guimarães RP. Comparative Study of the Osteointegration of Irradiated and Non-irradiated Bone Grafts Used in Patients with Revision Hip Arthroplasty. Rev Bras Ortop 2019; 54:477-482. [PMID: 31435118 PMCID: PMC6702030 DOI: 10.1055/s-0039-1694715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
Objective
To evaluate and compare the osteointegration of irradiated and non-irradiated frozen bone grafts used in 21 patients undergoing revision hip arthroplasty procedures with the Exeter technique.
Methods
A retrospective study of 21 patients undergoing revision hip arthroplasty with the Exeter technique using bone tissues treated or not with gamma radiation between 2013 and 2014. The patients were divided into two groups according to the use of grafts treated or not with ionizing radiation (gamma rays); as such, these groups were classified as irradiated or non-irradiated. The osteointegration results determined by radiographic analysis of these grafts were compared in the postoperative period of 6 and 12 months.
Results
Comparing the graft osteointegration in all patients at 6 and 12 months postoperatively, we noticed a significant difference in the radiographic evaluations in this period (
p
= 0.031). Out of the patients studied, 7 were from the irradiated group, and 14 belonged to the non-irradiated group. No statistically significant differences were observed (
p
= 0.804) regarding osteointegration when we compared the irradiated and non-irradiated groups.
Conclusion
There was no significant difference in the use of irradiated or non-irradiated grafts in revision hip arthroplasty procedures with the Exeter technique.
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Affiliation(s)
- André Ferreira da Silva
- Banco de Tecidos Musculoesquelético, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Uri Antebi
- Banco de Tecidos Musculoesquelético, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Emerson Kiyoshi Honda
- Departamento de Ortopedia e Traumatologia, Santa Casa de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Marco Rudelli
- Departamento de Ortopedia e Traumatologia, Santa Casa de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Rodrigo Pereira Guimarães
- Departamento de Ortopedia e Traumatologia, Santa Casa de São Paulo, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
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A review of materials for managing bone loss in revision total knee arthroplasty. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 104:109941. [PMID: 31500053 DOI: 10.1016/j.msec.2019.109941] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022]
Abstract
In 2014-2015, 61,421 total knee arthroplasties (TKAs) were performed in Canada; an increase of about 20% over 2000-2001. Revision total knee arthroplasties (rTKAs) accounted for 6.8% of TKAs performed between 2014 and 2015, and this is estimated to grow another 12% by 2025. rTKAs are typically more complicated than primary TKAs due to the significant loss of femoral and tibial bone stock. The escalating demand and limitations associated with total knee arthroplasty and their revision drives the development of novel treatments. A variety of materials have been utilized to facilitate regeneration of healthy bone around the site of a knee arthroplasty. The selection of these materials is based on the bone defect size and includes bone grafts, graft substitutes and cements. However, all these materials have certain disadvantages such as blood loss, disease transmission (bone grafts), inflammatory response, insufficient mechanical properties (bone graft substitutes) thermal necrosis and stress shielding (bone cement). Recently, the use of metal augments for large bone defects has attracted attention, however they can undergo fretting, corrosion, and stress shielding. All things considered, this review indicates the necessity of developing augments that have structural integrities and biodegradation rates similar to that of human bone. Therefore, the future of bone loss management may lie in fabricating novel bioactive glass augments as they can promote bone healing and implant stability and can degrade with time.
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Comparative Study between Laser Light Stereo-Lithography 3D-Printed and Traditionally Sintered Biphasic Calcium Phosphate Scaffolds by an Integrated Morphological, Morphometric and Mechanical Analysis. Int J Mol Sci 2019; 20:ijms20133118. [PMID: 31247936 PMCID: PMC6651383 DOI: 10.3390/ijms20133118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023] Open
Abstract
In dental districts, successful bone regeneration using biphasic calcium phosphate materials was recently explored. The present study aimed to perform a comparative study between 3D-printed scaffolds produced by laser light stereo-lithography (SLA) and traditionally sintered biphasic calcium phosphate scaffolds by an integrated morphological, morphometric and mechanical analysis. Methods: Biphasic calcium phosphate (30% HA/70% β-TCP) samples, produced by SLA-3D-printing or by traditional sintering methods, were tested. The experimental sequence included: (1) Microtomography (microCT) analyses, to serve as control-references for the 3D morphometric analysis; (2) loading tests in continuous mode, with compression up to fracture, to reconstruct their mechanical characteristics; and (3) microCT of the same samples after the loading tests, for the prediction of the morphometric changes induced by compressive loading of the selected materials. All the biomaterials were also studied by complementary scanning electron microscopy to evaluate fracture regions and surfaces. Results: The characterization of the 3D mineralized microarchitecture showed that the SLA-3D-printed biomaterials offer performances comparable to and in some cases better than the traditionally sintered ones, with higher mean thickness of struts and pores. Interestingly, the SLA-3D-printed samples had a higher ultimate strength than the sintered ones, with a smaller plastic region. Moreover, by SEM observation, it was observed that fractures in the SLA-3D-printed samples were localized in the structure nodes or on the external shells of the rods, while all the traditionally sintered samples revealed a ductile fracture surface. Conclusions: The reduction of the region of plastic deformation in the SLA-3D-printed samples with respect to traditionally sintered biomaterials is expected to positively influence, in vivo, the cell adhesion. Both microCT and SEM imaging revealed that the studied biomaterials exhibit a structure more similar to human jaw than the sintered biomaterials.
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Zhang Q, Wu W, Qian C, Xiao W, Zhu H, Guo J, Meng Z, Zhu J, Ge Z, Cui W. Advanced biomaterials for repairing and reconstruction of mandibular defects. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109858. [PMID: 31349473 DOI: 10.1016/j.msec.2019.109858] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/26/2019] [Accepted: 06/02/2019] [Indexed: 02/07/2023]
Abstract
Mandibles are the largest and strongest bone in the human face and are often severely compromised by mandibular defects, compromising the quality of life of patients. Mandibular defects may result from trauma, inflammatory disease and benign or malignant tumours. The reconstruction of mandibular defect has been a research hotspot in oral and maxillofacial surgery. Although the principles and techniques of mandibular reconstruction have made great progress in recent years, the development of biomedical materials is still facing technical bottleneck, and new materials directly affect technological breakthroughs in this field. This paper reviews the current status of research and application of various biomaterials in mandibular defects and systematically elaborates different allogeneic biomaterial-based approaches. It is expected that various biomaterials, in combination with new technologies such as digital navigation and 3D printing, could be tuned to build new types of scaffold with more precise structure and components, addressing needs of surgery and post-reconstruction. With the illustration and systematization of different solutions, aims to inspire the development of reconstruction biomaterials.
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Affiliation(s)
- Qiang Zhang
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China; Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Wei Wu
- Department of General Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Chunyu Qian
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Wanshu Xiao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Huajun Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Jun Guo
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Zhibing Meng
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Jinyue Zhu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Zili Ge
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China.
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China.
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Ribeiro N, Soares GC, Santos-Rosales V, Concheiro A, Alvarez-Lorenzo C, García-González CA, Oliveira AL. A new era for sterilization based on supercritical CO 2 technology. J Biomed Mater Res B Appl Biomater 2019; 108:399-428. [PMID: 31132221 DOI: 10.1002/jbm.b.34398] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/05/2019] [Accepted: 04/17/2019] [Indexed: 11/06/2022]
Abstract
The increasing complexity in morphology and composition of modern biomedical materials (e.g., soft and hard biological tissues, synthetic and natural-based scaffolds, technical textiles) and the high sensitivity to the processing environment requires the development of innovative but benign technologies for processing and treatment. This scenario is particularly applicable where current conventional techniques (steam/dry heat, ethylene oxide, and gamma irradiation) may not be able to preserve the functionality and integrity of the treated material. Sterilization using supercritical carbon dioxide emerges as a green and sustainable technology able to reach the sterility levels required by regulation without altering the original properties of even highly sensitive materials. In this review article, an updated survey of experimental protocols based on supercritical sterilization and of the efficacy results sorted by microbial strains and treated materials was carried out. The application of the supercritical sterilization process in materials used for biomedical, pharmaceutical, and food applications is assessed. The opportunity of supercritical sterilization of not only replace the above mentioned conventional techniques, but also of reach unmet needs for sterilization in highly sensitive materials (e.g., single-use medical devices, the next-generation biomaterials, and medical devices and graft tissues) is herein unveiled.
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Affiliation(s)
- Nilza Ribeiro
- CBQF - Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
| | - Gonçalo C Soares
- CBQF - Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
| | - Víctor Santos-Rosales
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos A García-González
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana L Oliveira
- CBQF - Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
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Attia T, Grynpas M, Willett T. Ribose pre-treatment can protect the fatigue life of γ-irradiation sterilized bone. Cell Tissue Bank 2019; 20:287-295. [PMID: 31020508 DOI: 10.1007/s10561-019-09767-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/16/2019] [Indexed: 11/27/2022]
Abstract
Structural bone allografts are often sterilized with γ-irradiation to decrease infection risk, which unfortunately degrades the bone collagen connectivity, making the bone weak and brittle. In previous studies, we successfully protected the quasi-static mechanical properties of human cortical bone by pre-treating with ribose, prior to irradiation. This study focused on the quasi-static and fatigue tensile properties of ribose treated irradiated sterilized bone allografts. Seventy-five samples were cut from the mid-shaft diaphysis of human femurs into standardized dog-bone shape geometries for quasi-static and fatigue tensile testing. Specimens were prepared in sets of three adjacent specimens. Each set was made of a normal (N), irradiated (I) and ribose pre-treated + irradiation (R) group. The R group was incubated in a 1.2 M ribose solution before γ-irradiation. The quasi-static tensile and decalcified tests were conducted to failure under displacement control. The fatigue samples were tested under cyclic loading (10 Hz, peak stress of 45MP, minimum-to-maximum stress ratio of 0.1) until failure or reaching 10 million cycles. Ribose pre-treatment significantly improved significantly the mechanical properties of irradiation sterilized human bone in the quasi-static tensile and decalcified tests. The fatigue life of the irradiated group was impaired by 99% in comparison to the normal control. Surprisingly, the R-group has significantly superior properties over the I-group and N-group (p < 0.01, p < 0.05) (> 100%). This study shows that incubating human cortical bone in a ribose solution prior to irradiation can indeed improve the fatigue life of irradiation-sterilized cortical bone allografts.
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Affiliation(s)
- Tarik Attia
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Marc Grynpas
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Thomas Willett
- Composite Biomaterial Systems Laboratory, Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Park SSH, Zhang L, Attia T, Salat P, Banks K, Willett T, Grynpas M. Pre-clinical evaluation of bone allograft toughened with a novel sterilization method: An in vivo rabbit study. J Orthop Res 2019; 37:832-844. [PMID: 30839120 DOI: 10.1002/jor.24269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 02/12/2019] [Indexed: 02/04/2023]
Abstract
Bone allografts often undergo γ-irradiation sterilization to decrease infection risk. However this consequently degrades bone collagen and makes the allograft brittle. Our laboratory has previously found that pre-treatment with ribose ex vivo protects the bone. However, it remains unclear whether or not ribose-treated γ-irradiated allografts are able to unite and remodel in vivo. Using New Zealand White rabbits (NZWr), we aimed to evaluate if ribose-treated allografts can unite with host bone (compared to untreated (fresh-frozen) and conventionally-irradiated allografts). A critically-sized defect was created in the radii of NZWr and reconstructed with allografts fixed with an intramedullary Kirschner wire. Healing and union were assessed at 2, 6, and 12 weeks post operation, with radiographs, µCT, static and dynamic histomorphometry, backscatter electron microscopy, and torsion testing. Intramedullary fixation achieved stable reconstructions and bony union in all groups and no differences were found in the radiographic and biomechanical parameters tested. Interestingly, γ-irradiated allografts had significantly less bone volume due to evident resorption of the grafts. In contrast, ribose pre-treatment protected γ-irradiated allografts from this bone loss, with results similar to the fresh frozen controls. In conclusion, ribose-pretreated γ-irradiated allografts were able to unite in vivo. In addition to achieving bony union with host bone, ribose pre-treatment may protect against allograft resorption. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Sam Si-Hyeong Park
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Lucia Zhang
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Tarik Attia
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Peter Salat
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Kate Banks
- Division of Comparative Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Willett
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Marc Grynpas
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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Nanomechanical characterization of time-dependent deformation/recovery on human dentin caused by radiation-induced glycation. J Mech Behav Biomed Mater 2019; 90:248-255. [DOI: 10.1016/j.jmbbm.2018.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 01/05/2023]
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Limirio PHJO, Soares PBF, Emi ETP, Lopes CDCA, Rocha FS, Batista JD, Rabelo GD, Dechichi P. Ionizing radiation and bone quality: time-dependent effects. Radiat Oncol 2019; 14:15. [PMID: 30670063 PMCID: PMC6343359 DOI: 10.1186/s13014-019-1219-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/14/2019] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study was to evaluate the ionizing radiation (IR) effects on rat bone 30 and 60 days after irradiation. Methods Wistar rats were submitted to IR (30 Gy) on the left leg and were euthanized after 30 and 60 days. The legs were divided into four groups according to the treatment and euthanization time: C30 and C60 (right leg–without IR), IR30 and IR60 (left leg-with IR). Results CT analysis showed more radiodensity in C60 compared with other groups, and IR60 showed more radiodensity than IR30. In histomorphometric analysis, C30 showed lower bone matrix values compared with IR30 and C60. Lacunarity analyses showed more homogeneous bone channel distribution in C30 than IR30. ATR-FTIR showed decrease in ratio of mature and immature crosslinks in IR30 compared with C30. Crystallinity Index was decrease in IR60 compared with C60. The Amide III + Collagen/HA ratio was increased in C60 compared with C30; however this ratio decreased in IR60 compared with IR30. Biomechanical analysis showed lower values in IR groups in both time. Conclusions IR damaged bone quality and decreased stiffness. Moreover, the results suggested that the deleterious effects of IR increased in the late time points.
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Affiliation(s)
- Pedro Henrique Justino Oliveira Limirio
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Priscilla Barbosa Ferreira Soares
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Eduardo Tadashi Pinto Emi
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Camila de Carvalho Almança Lopes
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Flaviana Soares Rocha
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Jonas Dantas Batista
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil
| | - Gustavo Davi Rabelo
- Faculty of Dentistry, Federal University of Juiz de Fora, Faculdade de Odontologia - Campus Universitário - Bairro Martelos -, Juiz de Fora, Minas Gerais, 36036-300, Brazil
| | - Paula Dechichi
- Integrated Dental Clinic Program, Faculty of Dentistry, Federal University of Uberlândia, Avenida Pará s/n°, Campus Umuarama, Bloco 4L, Bairro Umuarama, Uberlândia, Minas Gerais, 38.400-902, Brazil.
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Abstract
Allograft tissues are commonly used by orthopedic surgeons and are processed using a variety of technologies to increase safety and clinical use. For safety, although disease transmission is a tangible risk, this possibility has been dramatically minimized through modern tissue-processing methods. These include steps to prevent processing tissues with unacceptable bioburden through rigorous screening using donor medical and social histories along with microbial testing of recovered tissue and viral testing of donor serum. Potential bioburden is also controlled through aseptic recovery and processing methods and then reduced through disinfection steps that can include antibiotics, detergents, mechanical process, chemical solutions, and terminal sterilization. Processing steps may also include decellularization methods to lower immunogenic potential of some tissues. To enhance fusion potential of bone void fillers, demineralization steps may be used, and the resultant demineralized bone matrices may be combined with a carrier to improve handling. Bone void fillers and osteochondral allografts may also be specially processed to retain a living cellular component. To preserve relevant biological, biochemical, and physical properties of allografts for clinical use and ease of handling, a number of methods may be used which include: (1) refrigeration in media, (2) freeze-drying, (3) cryopreservation, (4) freezing, and (5) media storage at room temperature. As academic and industry research continue to drive advances, the future direction of allograft tissue likely includes injectables, coatings, cellular therapies, and combinations with other materials. The technology approaches outlined here will be further described along with future directions.
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Erivan R, Aubret S, Villatte G, Cueff R, Mulliez A, Descamps S, Boisgard S. Irradiation at 11 kGy conserves the biomechanical properties of fascia lata better than irradiation at 25 kGy. Clin Biomech (Bristol, Avon) 2018; 60:100-107. [PMID: 30340149 DOI: 10.1016/j.clinbiomech.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/24/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
The objective of this study was to determine the biomechanical properties of the fascia lata and the effects of three preservation methods: freezing, cryopreservation with dimethylsulfoxide solution and lyophilization; and to compare the effects of low-dose (11 kGy) and normal-dose (25 kGy) gamma-ray sterilization versus no irradiation. 248 samples from 14 fasciae latae were collected. Freezing samples were frozen at -80 °C. Cryopreservation with dimethylsulfoxide solution samples were frozen with 10 cl dimethylsulfoxide solution at -80 °C. Lyophilization samples were frozen at -22 °C and lyophilized. Each preservation group were then randomly divided into 3 irradiation groups. The cryopreservation with dimethylsulfoxide solution samples had significantly worse results in all 3 irradiation conditions. Young's modulus was lower for the freezing samples (p < 0.001) and lyophilization samples groups (p < 0.001). Tear deformation was lower for the freezing samples (p = 0.001) and lyophilization samples groups (p = 0.003), as was stress at break (p < 0.001 and p < 0.001). Taking all preservation methods together, samples irradiated at 25 kGy had worse results than the 0 kGy and 11 kGy groups in terms of Young's modulus (p = 0.007 and p = 0.13) and of stress at break (p = 0.006 and p = 0.06). The biomechanical properties of fascia lata allografts were significantly worse under dimethylsulfoxide cryopreservation. The deleterious effects of irradiation were dose-dependent.
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Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France.
| | - Sylvain Aubret
- Université Clermont Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Régis Cueff
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la Recherche Clinique et aux Innovations (DRCI), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
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Rahman N, Khan R, Badshah S. Effect of x-rays and gamma radiations on the bone mechanical properties: literature review. Cell Tissue Bank 2018; 19:457-472. [PMID: 30426337 DOI: 10.1007/s10561-018-9736-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022]
Abstract
The bone auto grafting, isografting, allografting and xenografting are used for defective bone replacement or treatment in almost all living species. The X-ray and Gamma (electromagnetic radiation) sterilization performed on the donor bone graft to prevent toxicity or migration of virus/bacterial infections from donors to reciver. Conversely, X-ray and Gamma radiation deteriorates the bone mechanical properties and bone become more susceptible to fracture. Fracture toughness as well as other mechanical properties of bone change with these radiations. In this literature review the effect of the X-rays and Gamma radiation on bone mechanical properties are discussed. All relevant literature was reviewed. After reviewing the literature only the research relating to the effect of X-rays and Gamma radiations on bone mechanical properties are included. Literature studies showed significant effect of the X-rays and Gamma radiations on the mechanical properties of the bones. In some studies the differences exists on the doses of radiations which were discussed in this study. The high energetic electromagnetic radiation (X-rays and Gamma radiations) changed/modify the collagen network of the bone, which reduced the mechanical properties of bone; however these changes depend on the radiation dose.
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Affiliation(s)
- Noor Rahman
- Department of Mechanical Engineering, Faculty of Engineering and Technology, International Islamic University, Islamabad, H-10, Pakistan.
| | - Rafiullah Khan
- Department of Mechanical Engineering, Faculty of Engineering and Technology, International Islamic University, Islamabad, H-10, Pakistan
| | - Saeed Badshah
- Department of Mechanical Engineering, Faculty of Engineering and Technology, International Islamic University, Islamabad, H-10, Pakistan
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Peña Fernández M, Dall'Ara E, Kao AP, Bodey AJ, Karali A, Blunn GW, Barber AH, Tozzi G. Preservation of Bone Tissue Integrity with Temperature Control for In Situ SR-MicroCT Experiments. MATERIALS 2018; 11:ma11112155. [PMID: 30388813 PMCID: PMC6266162 DOI: 10.3390/ma11112155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 01/08/2023]
Abstract
Digital volume correlation (DVC), combined with in situ synchrotron microcomputed tomography (SR-microCT) mechanics, allows for 3D full-field strain measurement in bone at the tissue level. However, long exposures to SR radiation are known to induce bone damage, and reliable experimental protocols able to preserve tissue properties are still lacking. This study aims to propose a proof-of-concept methodology to retain bone tissue integrity, based on residual strain determination using DVC, by decreasing the environmental temperature during in situ SR-microCT testing. Compact and trabecular bone specimens underwent five consecutive full tomographic data collections either at room temperature or 0 °C. Lowering the temperature seemed to reduce microdamage in trabecular bone but had minimal effect on compact bone. A consistent temperature gradient was measured at each exposure period, and its prolonged effect over time may induce localised collagen denaturation and subsequent damage. DVC provided useful information on irradiation-induced microcrack initiation and propagation. Future work is necessary to apply these findings to in situ SR-microCT mechanical tests, and to establish protocols aiming to minimise the SR irradiation-induced damage of bone.
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Affiliation(s)
- Marta Peña Fernández
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK.
| | - Enrico Dall'Ara
- Department of Oncology and Metabolism and INSIGNEO Institute for in Silico Medicine, University of Sheffield, S1 3DJ, Sheffield, UK.
| | - Alexander P Kao
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK.
| | | | - Aikaterina Karali
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK.
| | - Gordon W Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, PO1 2DT, Portsmouth, UK.
| | - Asa H Barber
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK.
- School of Engineering, London South Bank University, SE1 0AA, London, UK.
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK.
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Peña Fernández M, Cipiccia S, Dall'Ara E, Bodey AJ, Parwani R, Pani M, Blunn GW, Barber AH, Tozzi G. Effect of SR-microCT radiation on the mechanical integrity of trabecular bone using in situ mechanical testing and digital volume correlation. J Mech Behav Biomed Mater 2018; 88:109-119. [PMID: 30165258 DOI: 10.1016/j.jmbbm.2018.08.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/21/2018] [Accepted: 08/13/2018] [Indexed: 01/06/2023]
Abstract
The use of synchrotron radiation micro-computed tomography (SR-microCT) is becoming increasingly popular for studying the relationship between microstructure and bone mechanics subjected to in situ mechanical testing. However, it is well known that the effect of SR X-ray radiation can considerably alter the mechanical properties of bone tissue. Digital volume correlation (DVC) has been extensively used to compute full-field strain distributions in bone specimens subjected to step-wise mechanical loading, but tissue damage from sequential SR-microCT scans has not been previously addressed. Therefore, the aim of this study is to examine the influence of SR irradiation-induced microdamage on the apparent elastic properties of trabecular bone using DVC applied to in situ SR-microCT tomograms obtained with different exposure times. Results showed how DVC was able to identify high local strain levels (> 10,000 µε) corresponding to visible microcracks at high irradiation doses (~ 230 kGy), despite the apparent elastic properties remained unaltered. Microcracks were not detected and bone plasticity was preserved for low irradiation doses (~ 33 kGy), although image quality and consequently, DVC performance were reduced. DVC results suggested some local deterioration of tissue that might have resulted from mechanical strain concentration further enhanced by some level of local irradiation even for low accumulated dose.
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Affiliation(s)
- Marta Peña Fernández
- Zeiss Global Centre, School of Engineering, University of Portsmouth, Portsmouth, UK
| | | | - Enrico Dall'Ara
- Department of Oncology and Metabolism and INSIGNEO Institute For in Silico Medicine, University of Sheffield, Sheffield, UK
| | | | - Rachna Parwani
- Zeiss Global Centre, School of Engineering, University of Portsmouth, Portsmouth, UK
| | - Martino Pani
- Zeiss Global Centre, School of Engineering, University of Portsmouth, Portsmouth, UK
| | - Gordon W Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Asa H Barber
- Zeiss Global Centre, School of Engineering, University of Portsmouth, Portsmouth, UK; School of Engineering, London South Bank University, London, UK
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Engineering, University of Portsmouth, Portsmouth, UK.
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76
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Steam Sterilization of Equine Bone Block: Morphological and Collagen Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9853765. [PMID: 30186873 PMCID: PMC6109994 DOI: 10.1155/2018/9853765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022]
Abstract
Introduction The use of equine bone blocks is widely reported for bone augmentation techniques. The block must be shaped according to the form of the defect that should be regenerated. The shaping could be performed by hand before or during the surgery, in a sterile ambient, or using a CNC milling machine that could not be sterile. The aim of our study was to evaluate if a steam sterilization could provide a medical grade sterilization of the blocks and to evaluate if bone microstructure and collagen structures change after different steam sterilization protocols provided by mainstream autoclave. Materials and Method Two blocks of equine bone were divided into 16 samples. 1 sample was used as control and not submitted to any treatment. 15 samples were infected with a Streptococcus faecalis bacterial culture. The samples were singularly packed, randomly divided into 3 groups, and submitted to autoclave sterilization on the same device. The groups were submitted to a sterilization cycle (Gr. A: 121°C, 1,16 bar for 20'; Gr. B:134°C, 2,16 bar for 4'; Gr. C: 134°C, 2,16 bar for 3.30 min.). 2 samples for each group were evaluated for the sterility. 3 samples for each group were observed at SEM to notice the macro- and microstructure modification and to confocal microscope to observe the collagen. Results All samples were sterile. The SEM evaluation showed, in all groups, a preserved morphological structure. Confocal microscope evaluation shows that the collagen structure appears to be more uniform and preserved in group C. Conclusion Data show that autoclave steam sterilization could be reliable to obtain sterilization of equine bone blocks.
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77
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Sloff M, Janke HP, de Jonge PKJD, Tiemessen DM, Kortmann BBM, Mihaila SM, Geutjes PJ, Feitz WFJ, Oosterwijk E. The Impact of γ-Irradiation and EtO Degassing on Tissue Remodeling of Collagen-based Hybrid Tubular Templates. ACS Biomater Sci Eng 2018; 4:3282-3290. [PMID: 30221191 PMCID: PMC6134342 DOI: 10.1021/acsbiomaterials.8b00369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/25/2018] [Indexed: 12/16/2022]
Abstract
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Clinical
implementation of novel products for tissue engineering
and regenerative medicine requires a validated sterilization method.
In this study, we investigated the effect of γ-irradiation and
EtO degassing on material characteristics in vitro and the effect on template remodeling of hybrid tubular constructs
in a large animal model. Hybrid tubular templates were prepared from
type I collagen and Vicryl polymers and sterilized by 25 kGray of
γ-irradiation or EtO degassing. The in vitro characteristics were extensively studied, including tensile strength
analysis and degradation studies. For in vivo evaluation,
constructs were subcutaneously implanted in goats for 1 month to form
vascularized neo-tissue. Macroscopic and microscopic appearances of
the γ- and EtO-sterilized constructs slightly differed due to
additional processing required for the COL-Vicryl-EtO constructs.
Regardless of the sterilization method, incubation in urine resulted
in fast degradation of the Vicryl polymer and decreased strength (<7
days). Incubation in SBF was less invasive, and strength was maintained
for at least 14 days. The difference between the two sterilization
methods was otherwise limited. In contrast, subcutaneous implantation
showed that the effect of sterilization was considerable. A well-vascularized
tube was formed in both cases, but the γ-irradiated construct
showed an organized architecture of vasculature and was mechanically
more comparable to the native ureter. Moreover, the γ-irradiated
construct showed advanced tissue remodeling as shown by enhanced ECM
production. This study shows that the effect of sterilization on tissue
remodeling cannot be predicted by in vitro analyses
alone. Thus, validated sterilization methods should be incorporated
early in the development of tissue engineered products, and this requires
both in vitro and in vivo analyses.
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Affiliation(s)
- Marije Sloff
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Heinz P Janke
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Paul K J D de Jonge
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Dorien M Tiemessen
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Barbara B M Kortmann
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands.,Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein 10 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Silvia M Mihaila
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Paul J Geutjes
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Wout F J Feitz
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands.,Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein 10 Zuid, 6525 GA Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein 28 Zuid, 6525 GA Nijmegen, The Netherlands
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78
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Du T, Niu X, Li Z, Li P, Feng Q, Fan Y. Crosslinking induces high mineralization of apatite minerals on collagen fibers. Int J Biol Macromol 2018; 113:450-457. [DOI: 10.1016/j.ijbiomac.2018.02.136] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 10/18/2022]
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79
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Smith RA, Chua R, Carnachan SM, Tan CL, Sims IM, Hinkley SF, Nurcombe V, Cool SM. Retention of the Structure and Function of Heparan Sulfate Biomaterials After Gamma Irradiation. Tissue Eng Part A 2018; 24:729-739. [DOI: 10.1089/ten.tea.2017.0263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Raymond A.A. Smith
- Glycotherapeutics Group, Institute of Medical Biology, Agency for Science, Technology and Research, Singapore
| | - R.J.E. Chua
- Glycotherapeutics Group, Institute of Medical Biology, Agency for Science, Technology and Research, Singapore
| | - Susan M. Carnachan
- The Ferrier Research Institute, Victoria University of Wellington, Lower Hutt, New Zealand
| | - Clarissa L.L. Tan
- Glycotherapeutics Group, Institute of Medical Biology, Agency for Science, Technology and Research, Singapore
| | - Ian M. Sims
- The Ferrier Research Institute, Victoria University of Wellington, Lower Hutt, New Zealand
| | - Simon F.R. Hinkley
- The Ferrier Research Institute, Victoria University of Wellington, Lower Hutt, New Zealand
| | - Victor Nurcombe
- Glycotherapeutics Group, Institute of Medical Biology, Agency for Science, Technology and Research, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University-Imperial College London, Singapore
| | - Simon M. Cool
- Glycotherapeutics Group, Institute of Medical Biology, Agency for Science, Technology and Research, Singapore
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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80
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Harrell CR, Djonov V, Fellabaum C, Volarevic V. Risks of Using Sterilization by Gamma Radiation: The Other Side of the Coin. Int J Med Sci 2018; 15:274-279. [PMID: 29483819 PMCID: PMC5820857 DOI: 10.7150/ijms.22644] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/21/2017] [Indexed: 12/30/2022] Open
Abstract
The standard sterilization method for most medical devices over the past 40 years involves gamma irradiation. During sterilization, gamma rays efficiently eliminate microorganisms from the medical devices and tissue allografts, but also significantly change molecular structure of irradiated products, particularly fragile biologics such as cytokines, chemokines and growth factors. Accordingly, gamma radiation significantly alters biomechanical properties of bone, tendon, tracheal, skin, amnion tissue grafts and micronized amniotic membrane injectable products. Similarly, when polymer medical devices are sterilized by gamma radiation, their physico-chemical characteristics undergo modification significantly affecting their clinical use. Several animal studies demonstrated that consummation of irradiated food provoked genome instability raising serious concerns regarding oncogenic potential of irradiated consumables. These findings strongly suggest that new, long-term, prospective clinical studies should be conducted in near future to investigate whether irradiated food is safe for human consumption. In this review, we summarized current knowledge regarding molecular mechanisms responsible for deleterious effects of gamma radiation with focusing on its significance for food safety and biomechanical characteristics of medical devices, and tissue allografts, especially injectable biologics.
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Affiliation(s)
- C Randall Harrell
- Regenerative Processing Plant, LLC, Palm Harbor, Florida, United States of America
| | | | - Crissy Fellabaum
- Regenerative Processing Plant, LLC, Palm Harbor, Florida, United States of America
| | - Vladislav Volarevic
- Department of Microbiology and Immunology, Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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81
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Attia T, Tupy J, Asker D, Hatton B, Grynpas M, Willett T. The effect of ribose pre-treatment of cortical bone on γ-irradiation sterilization effectiveness. Cell Tissue Bank 2017; 18:555-560. [PMID: 29032461 DOI: 10.1007/s10561-017-9662-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
Reconstruction of large skeletal defects is a significant and challenging issue. Tissue banks often use γ-irradiation (15-35 kGy) to sterilize bone allografts, which, however, drastically impairs the post-yield mechanical properties. In previous studies, we reported the development of a method that protects human bone collagen connectivity through ribose crosslinking while still undergoing γ-irradiation. Given these promising results, the next step was to determine if the presence of ribose within the bone tissue would interfere with the effectiveness of the γ-irradiation sterilization against bacteria. This study had two stages. The aim of the first stage was to assess the protective effect of ribose in solution using a Bacillus pumilus spore strip model. The aim of the second stage was to assess the protective effect of ribose (R) on spores within a human cortical bone model in comparison to conventionally irradiated bone (I). Treatment of B. pumilus spore strips with ribose in solution led to temperature-dependent effects on spore viability versus spore strips treated with PBS alone. Ribose solution at 60 °C led to a notable two logs decrease in spore count relative to PBS at 60 °C. In the human bone model, the number of spores in the I and R groups were greatly decreased in comparison to the non-irradiated N group. No spore colonies were detected in the R group (n = 4) whereas two of the four plates of group I formed colonies. This study provides evidence that the method of pre-treating bone with ribose crosslinking prior to irradiation sterilization, while improving irradiation sterilized bone allograft quality, also may improve the effectiveness of the sterilization process.
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Affiliation(s)
- Tarik Attia
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jindra Tupy
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
| | - Dalal Asker
- Materials Science and Engineering, University of Toronto, Toronto, ON, Canada.,Alexandria University, Alexandria, Egypt
| | - Benjamin Hatton
- Materials Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Marc Grynpas
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Thomas Willett
- Biomedical Engineering Program, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.
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82
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Furuta M, Matsugaki A, Nakano T, Hirata I, Kato K, Oda T, Sato M, Okazaki M. Molecular level analyses of mechanical properties of PTFE sterilized by Co-60 γ-ray irradiation for clinical use. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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83
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Leow-Dyke SF, Rooney P, Kearney JN. The efficacy and sterilisation of human decellularised dermal allografts with combinations of cupric ions and hydrogen peroxide. Cell Tissue Bank 2017; 18:561-572. [PMID: 28952000 DOI: 10.1007/s10561-017-9660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
Decellularised tissue allografts have been used in reconstructive surgical applications and transplantation for many years. Some of the current methods of sterilisation have a detrimental effect on the tissue graft structure and function. The anti-microbial activity of cupric ions and hydrogen peroxide (H2O2) are well known however their combined application is not currently utilised as a decontamination agent in the tissue banking world sector. The aim of this study was to determine the combined concentrations of copper chloride (CuCl2) and H2O2 that have the optimal bactericidal and sporicidal activity on decellularised (dCELL) human dermis. The first part of this study established the decimal reduction time (D-value) of CuCl2 (0.1 mg/L and 1 mg/L) together with H2O2 (0.01, 0.1, 0.5 and 1%) for Staphylococcus epidermidis, Escherichia coli and Bacillus subtilis spores. The second part of this study identified the most effective CuCl2 and H2O2 concentration that decontaminated dCELL human dermis inoculated with these pathogens. Of all the concentrations tested, 0.1 mg/L CuCl2 in combination with 1% H2O2 had the shortest D-value; S. epidermidis D = 3.15 min, E. coli D = 2.62 min and B. subtilis spores D = 18.05 min. However when adsorbed onto dCELL dermis, S. epidermidis and E. coli were more susceptible to 1 mg/L CuCl2 together with 0.5% H2O2. These studies show promise of CuCl2-H2O2 formulations as potential sterilants for decellularised dermal allografts.
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Affiliation(s)
- S F Leow-Dyke
- NHS Blood and Transplant, Tissue Services R&D, Liverpool, UK. .,Public Health England, Manchester Medical Microbiology Partnership, Manchester, UK.
| | - P Rooney
- NHS Blood and Transplant, Tissue Services R&D, Liverpool, UK
| | - J N Kearney
- NHS Blood and Transplant, Tissue Services R&D, Liverpool, UK
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84
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Cai X, Peralta L, Giron A, Helfen L, Olivier C, Peyrin F, Laugier P, Grimal Q. Cortical bone elasticity measured by resonant ultrasound spectroscopy is not altered by defatting and synchrotron X-ray imaging. J Mech Behav Biomed Mater 2017; 72:241-245. [DOI: 10.1016/j.jmbbm.2017.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/25/2017] [Accepted: 05/05/2017] [Indexed: 11/15/2022]
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85
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Flanagan CD, Unal M, Akkus O, Rimnac CM. Raman spectral markers of collagen denaturation and hydration in human cortical bone tissue are affected by radiation sterilization and high cycle fatigue damage. J Mech Behav Biomed Mater 2017; 75:314-321. [PMID: 28772165 DOI: 10.1016/j.jmbbm.2017.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Thermal denaturation and monotonic mechanical damage alter the organic and water-related compartments of cortical bone. These changes can be detected using Raman spectroscopy. However, less is known regarding Raman sensitivity to detect the effects of cyclic fatigue damage and allograft sterilization doses of gamma radiation. OBJECTIVE To determine if Raman spectroscopic biomarkers of collagen denaturation and hydration are sensitive to the effects of (a) high cycle fatigue damage and (b) 25kGy irradiation. METHODS Unirradiated and gamma-radiation sterilized human cortical bone specimens previously tested in vitro under high-cycle (> 100,000 cycles) fatigue conditions at 15MPa, 25MPa, 35MPa, 45MPa, and 55MPa cyclic stress levels were studied. Cortical bone Raman spectral profiles from wavenumber ranges of 800-1750cm-1 and 2700-3800cm-1 were obtained and compared from: a) non-fatigue vs fatigue fracture sites and b) radiated vs. unirradiated states. Raman biomarker ratios 1670/1640 and 3220/2949, which reflect collagen denaturation and organic matrix (mainly collagen)-bound water, respectively, were assessed. One- and two-way ANOVA analyses were utilized to identify differences between groups along with interaction effects between cyclic fatigue and radiation-induced damage. RESULTS Cyclic fatigue damage resulted in increases in collagen denaturation (1670/1640: 1.517 ± 0.043 vs 1.579 ± 0.021, p < 0.001) and organic matrix-bound water (3220/2949: 0.109 ± 0.012 vs 0.131 ± 0.008, p < 0.001). Organic matrix-bound water increased secondary to 25kGy irradiation (3220/2949: 0.105 ± 0.010 vs 0.1161 ± 0.009, p = 0.003). Organic matrix-bound water was correlated positively with collagen denaturation (r = 0.514, p < 0.001). CONCLUSIONS Raman spectroscopy can detect the effects of cyclic fatigue damage and 25kGy irradiation via increases in organic matrix (mainly collagen)-bound water. A Raman measure of collagen denaturation was sensitive to cyclic fatigue damage but not 25kGy irradiation. Collagen denaturation was correlated with organic matrix-bound water, suggesting that denaturation of collagen to gelatinous form may expose more binding sites to water by unwinding the triple alpha chains. This research may eventually be useful to help identify allograft quality and more appropriately match donors to recipients.
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Affiliation(s)
- Christopher D Flanagan
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Mustafa Unal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ozan Akkus
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Clare M Rimnac
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA; Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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86
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Gauza-Włodarczyk M, Kubisz L, Włodarczyk D. Amino acid composition in determination of collagen origin and assessment of physical factors effects. Int J Biol Macromol 2017; 104:987-991. [PMID: 28687386 DOI: 10.1016/j.ijbiomac.2017.07.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/16/2022]
Abstract
The amino acid composition of collagen is a characteristic feature of this protein. Collagen, irrespective of its origin, contains 19 amino acids, including hydroxyproline which does not occur in other proteins. Its atypical amino acid composition is characterized by high content of proline and glycine, as well as the absence of cysteine. This paper shows the comparison of qualitative composition of amino acids of fish skin (FS) collagen, bovine Achilles tendon (BAT) collagen, and bone collagen. Results demonstrate that FS collagen as well as BAT collagen contains no cysteine and significantly different amount of hydroxyproline. In BAT collagen hydroxyproline content is 30% higher than hydroxyproline content of FS collagen. In bone collagen the amount of hydroxyproline is two times more than in FS collagen. Furthermore, it is shown that sensitivity to radiation of individual amino acids varies and depends on the absorbed dose of ionizing radiation. The changes observed in the amino acid composition become very intense for the doses of 500kGy and 1000kGy.
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Affiliation(s)
- Marlena Gauza-Włodarczyk
- Department of Biophysics, Poznań University of Medical Sciences, Grunwaldzka 6, 60-780 Poznań, Poland.
| | - Leszek Kubisz
- Department of Biophysics, Poznań University of Medical Sciences, Grunwaldzka 6, 60-780 Poznań, Poland
| | - Dariusz Włodarczyk
- Department of Biophysics, Poznań University of Medical Sciences, Grunwaldzka 6, 60-780 Poznań, Poland
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87
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Yeoh JC, Taylor BA. Osseous Healing in Foot and Ankle Surgery with Autograft, Allograft, and Other Orthobiologics. Orthop Clin North Am 2017; 48:359-369. [PMID: 28577785 DOI: 10.1016/j.ocl.2017.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the surgical treatment of foot and ankle abnormality, many problems require bone grafting for successful osseous union. Nonunion, reconstruction, and arthrodesis procedures pose specific challenges due to bony defects secondary to trauma, malunions, or previous surgery. Nonunion in foot and ankle arthrodesis is a significant risk and is well documented in recent literature. This article is a review of the recent literature regarding the use of bone graft and orthobiologics in foot and ankle surgery.
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Affiliation(s)
- Jane C Yeoh
- Campbell Clinic Foot & Ankle Department, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Brandon A Taylor
- Campbell Clinic Foot & Ankle Department, 1400 South Germantown Road, Germantown, TN 38138, USA.
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88
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Herteleer M, Ectors N, Duflou J, Van Calenbergh F. Complications of skull reconstruction after decompressive craniectomy. Acta Chir Belg 2017; 117:149-156. [PMID: 27931166 DOI: 10.1080/00015458.2016.1264730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Decompressive craniectomy can be a life-saving procedure. Later reconstruction of the skull using the stored bone flap ("cranioplasty") is often associated with complications. These complications require new procedures and often result in the reconstruction of the skull using an expensive patient-specific cranial implant. PATIENTS & METHODS All adult patients who underwent cranioplasty after decompressive craniectomy in the last 10 years in our center were included (74 patients). Bone flap size, duration of the procedure, age, and other clinical parameters were included in our analysis. RESULTS 29.7% of our patients who received in the first place an autologous cranioplasty developed a complication which necessitated removal of the bone flap and the implantation of a custom-made implant. Descriptive statistics demonstrate a significantly higher amount of complications in younger patients (20-40 years, p = 0.027). We also saw a trend toward lower complications when bone flaps were stored according to a biobank protocol (p = 0.075). CONCLUSIONS Cranioplasty using the stored bone flap after decompressive craniectomy is associated with a high percentage of complications. Selecting patients at risk could possibly indicate cases where an immediate custom-made implant technique would be required.
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Affiliation(s)
| | - Nadine Ectors
- Tissue Bank, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Joost Duflou
- Department of Mechanical Engineering, Katholieke Universiteit Leuven Groep Wetenschap and Technologie, Belgium
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89
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Attia T, Woodside M, Minhas G, Lu XZ, Josey DS, Burrow T, Grynpas M, Willett TL. Development of a novel method for the strengthening and toughening of irradiation-sterilized bone allografts. Cell Tissue Bank 2017; 18:323-334. [PMID: 28560495 DOI: 10.1007/s10561-017-9634-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/26/2017] [Indexed: 01/22/2023]
Abstract
Reconstruction of large skeletal defects is a significant and challenging issue. Bone allografts are often used for such reconstructions. However, sterilizing bone allografts by using γ-irradiation, damages collagen and causes the bone to become weak, brittle and less fatigue resistant. In a previous study, we successfully protected the mechanical properties of human cortical bone by conducting a pre-treatment with ribose, a natural and biocompatible agent. This study focuses on examining possible mechanisms by which ribose might protect the bone. We examined the mechanical properties, crosslinking, connectivity and free radical scavenging potentials of the ribose treatment. Human cortical bone beams were treated with varying concentration of ribose (0.06-1.2 M) and γ-irradiation before testing them in 3-point bending. The connectivity and amounts of crosslinking were determined with Hydrothermal-Isometric-Tension testing and High-Performance-Liquid-Chromatography, respectively. The free radical content was measured using Electron Paramagnetic Resonance. Ribose pre-treatment improved the mechanical properties of irradiation sterilized human bone in a pre-treatment concentration-dependent manner. The 1.2 M pre-treatment provided >100% of ultimate strength of normal controls and protected 76% of the work-to-fracture (toughness) lost in the irradiated controls. Similarly, the ribose pre-treatment improved the thermo-mechanical properties of irradiation-sterilized human bone collagen in a concentration-dependent manner. Greater free radical content and pentosidine content were modified in the ribose treated bone. This study shows that the mechanical properties of irradiation-sterilized cortical bone allografts can be protected by incubating the bone in a ribose solution prior to irradiation.
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Affiliation(s)
- Tarik Attia
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Mitchell Woodside
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
| | - Gagan Minhas
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
| | - Xing Ze Lu
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
| | - David S Josey
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
| | - Timothy Burrow
- Department of Chemistry, University of Toronto, Toronto, ON, Canada
| | - Marc Grynpas
- Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Thomas L Willett
- Biomedical Engineering Program, Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
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90
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Boriani F, Fazio N, Fotia C, Savarino L, Nicoli Aldini N, Martini L, Zini N, Bernardini M, Baldini N. A novel technique for decellularization of allogenic nerves and in vivo
study of their use for peripheral nerve reconstruction. J Biomed Mater Res A 2017; 105:2228-2240. [DOI: 10.1002/jbm.a.36090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/21/2017] [Accepted: 04/13/2017] [Indexed: 12/16/2022]
Affiliation(s)
- F. Boriani
- Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - N. Fazio
- Prometeo Laboratory; Rizzoli Orthopaedic Institute; Bologna Italy
| | - C. Fotia
- Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - L. Savarino
- Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - N. Nicoli Aldini
- Laboratory of Preclinical and Surgical Studies; Rizzoli Orthopaedic Institute; Bologna Italy
| | - L. Martini
- Laboratory of Preclinical and Surgical Studies; Rizzoli Orthopaedic Institute; Bologna Italy
| | - N. Zini
- CNR, National Research Council of Italy, Institute of Molecular Genetics; Bologna Italy
- Laboratory of Musculoskeletal Cell Biology; Rizzoli Orthopaedic Institute; Bologna Italy
| | - M. Bernardini
- Department of Animal Medicine; Production and Health, Padova University; Padua Italy
| | - N. Baldini
- Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
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91
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Johnson CM, Guo D, Ryals S, Postma GN, Weinberger PM. The feasibility of gamma radiation sterilization for decellularized tracheal grafts. Laryngoscope 2017; 127:E258-E264. [PMID: 28480504 DOI: 10.1002/lary.26367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/19/2016] [Accepted: 09/12/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES/HYPOTHESIS The most promising stem cell-derived tracheal transplantation approach is dependent upon the use of decellularized tracheal grafts. It has been assumed that a sterilization step, such as gamma radiation, would damage the delicate extracellular matrix of the graft, thus rendering it less viable for cellular repopulation, although this has not been thoroughly investigated. STUDY DESIGN Laboratory-based comparative analysis. METHODS Fifteen murine tracheas of strain C57/B-6 mice were obtained. Thirteen were subjected to a detergent-enzymatic decellularization process. Of these decellularized tracheas (DT), eight were irradiated, exposing five tracheas to a radiation level of 25 kGy (DT25) and three to 5 kGy (DT5). Two were left untreated. The two untreated tracheas, two DTs, and two DT25s were prepared and examined using both scanning and transmission electron microscopy. Bioburden calculations were obtained from three DTs, three DT25s, and three DT5s by homogenization, serial dilution, and streak plating. RESULTS Electron microscopy of untreated fresh tracheas and DTs showed a slight qualitative degradation of cartilage ultrastructure due to the decellularization process. In contrast, examination of DT25 shows significant degradation including poor overall preservation of cartilage architecture with disorganized collagen fibers. The nonirradiated DTs had a calculated bacterial bioburden of 7.8 × 107 to 3.4 × 108 colony-forming units per gram. Both the DT25 and DT5 specimens were found to have a bioburden of zero. CONCLUSIONS Gamma radiation at 25 kGy degrades the architecture of decellularized tracheal grafts. These ultrastructural changes may prove detrimental to graft viability; however, bioburden calculations suggest that a 5 kGy radiation dose may be sufficient for sterilization. LEVEL OF EVIDENCE NA Laryngoscope, 127:E258-E264, 2017.
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Affiliation(s)
- Christopher M Johnson
- Department of Otolaryngology-Head and Neck Surgery/Center for Voice Airway and Swallowing, Augusta University, Augusta, Georgia.,Department of Otolaryngology, Naval Medical Center, San Diego, California, U.S.A
| | - DeHuang Guo
- Department of Otolaryngology-Head and Neck Surgery/Center for Voice Airway and Swallowing, Augusta University, Augusta, Georgia.,Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, Georgia
| | - Stephanie Ryals
- Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Gregory N Postma
- Department of Otolaryngology-Head and Neck Surgery/Center for Voice Airway and Swallowing, Augusta University, Augusta, Georgia
| | - Paul M Weinberger
- Department of Otolaryngology-Head and Neck Surgery/Center for Voice Airway and Swallowing, Augusta University, Augusta, Georgia.,Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, Georgia.,Georgia Cancer Center, Augusta University, Augusta, Georgia
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92
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Ahmadi RS, Sayar F, Rakhshan V, Iranpour B, Jahanbani J, Toumaj A, Akhoondi N. Clinical and Histomorphometric Assessment of Lateral Alveolar Ridge Augmentation Using a Corticocancellous Freeze-Dried Allograft Bone Block. J ORAL IMPLANTOL 2017; 43:202-210. [PMID: 28326892 DOI: 10.1563/aaid-joi-d-16-00042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Horizontal ridge augmentation with allografts has attracted notable attention because of its proper success rate and the lack of disadvantages of autografts. Corticocancellous block allografts have not been adequately studied in humans. Therefore, this study clinically and histomorphometrically evaluated the increase in ridge width after horizontal ridge augmentation using corticocancellous block allografts as well as implant success after 12 to 18 months after implantation. In 10 patients receiving implants (3 women, 7 men; mean age = 45 years), defective maxillary alveolar ridges were horizontally augmented using freeze-dried bone allograft blocks. Ridge widths were measured before augmentation, immediately after augmentation, and ∼6 months later in the reentry surgery for implantation. This was done at points 2 mm (A) and 5 mm (B) apically to the crest. Biopsy cores were acquired from the implantation site. Implant success was assessed 15.1 ± 2.7 months after implantation (range = 12-18 months). Data were analyzed using Friedman and Dunn tests (α = 0.05). At point A, ridge widths were 2.77 ± 0.37, 8.02 ± 0.87, and 6.40 ± 0.66 mm, respectively, before surgery, immediately after surgery, and before implantation. At point B, ridge widths were 3.40 ± 0.39, 9.35 ± 1.16, and 7.40 ± 1.10 mm, respectively, before surgery, immediately after surgery, and before implantation. The Friedman test showed significant increases in ridge widths, both at point A and point B (both P = .0000). Postaugmentation resorption was about 1.5-2 mm and was statistically significant at points A and B (P < .05, Dunn). The percentage of newly formed bone, residual graft material, and soft tissue were 33.0% ± 11.35% (95% confidence interval [CI] = 24.88%-41.12%), 37.50% ± 19.04% (95% CI = 23.88%-51.12%), and 29.5%, respectively. The inflammation was limited to grades 1 or zero. Twelve to 18 months after implantation, no implants caused pain or showed exudates or pockets. Radiographic bone loss was 2.0 ± 0.7 mm (range = 1-3). It can be concluded that lateral ridge augmentation with corticocancellous allograft blocks might be successful both clinically and histologically. Implants might have a proper clinical success after a minimum of 12 months.
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Affiliation(s)
- Roya Shariatmadar Ahmadi
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Ferena Sayar
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Vahid Rakhshan
- 2 Department of Dental Anatomy, Dental Faculty, Islamic Azad University, Tehran, Iran
| | - Babak Iranpour
- 1 Department of Periodontics and Implant Research, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
| | - Jahanfar Jahanbani
- 3 Oral Pathology Department, Dental Branch Tehran, Islamic Azad University, Tehran, Iran
| | | | - Nasrin Akhoondi
- 5 Department of Mathematics, South Tehran Branch, Islamic Azad University, Tehran, Iran
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93
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No YJ, Li JJ, Zreiqat H. Doped Calcium Silicate Ceramics: A New Class of Candidates for Synthetic Bone Substitutes. MATERIALS (BASEL, SWITZERLAND) 2017; 10:E153. [PMID: 28772513 PMCID: PMC5459133 DOI: 10.3390/ma10020153] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/30/2017] [Accepted: 02/04/2017] [Indexed: 02/06/2023]
Abstract
Doped calcium silicate ceramics (DCSCs) have recently gained immense interest as a new class of candidates for the treatment of bone defects. Although calcium phosphates and bioactive glasses have remained the mainstream of ceramic bone substitutes, their clinical use is limited by suboptimal mechanical properties. DCSCs are a class of calcium silicate ceramics which are developed through the ionic substitution of calcium ions, the incorporation of metal oxides into the base binary xCaO-ySiO₂ system, or a combination of both. Due to their unique compositions and ability to release bioactive ions, DCSCs exhibit enhanced mechanical and biological properties. Such characteristics offer significant advantages over existing ceramic bone substitutes, and underline the future potential of adopting DCSCs for clinical use in bone reconstruction to produce improved outcomes. This review will discuss the effects of different dopant elements and oxides on the characteristics of DCSCs for applications in bone repair, including mechanical properties, degradation and ion release characteristics, radiopacity, and biological activity (in vitro and in vivo). Recent advances in the development of DCSCs for broader clinical applications will also be discussed, including DCSC composites, coated DCSC scaffolds and DCSC-coated metal implants.
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Affiliation(s)
- Young Jung No
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney 2006, Australia.
| | - Jiao Jiao Li
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney 2006, Australia.
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney 2006, Australia.
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94
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Zhao Y, Hu X, Li Z, Wang F, Xia Y, Hou S, Zhong H, Zhang F, Gu N. Use of polyvinylpyrrolidone-iodine solution for sterilisation and preservation improves mechanical properties and osteogenesis of allografts. Sci Rep 2016; 6:38669. [PMID: 27934929 PMCID: PMC5146663 DOI: 10.1038/srep38669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/11/2016] [Indexed: 11/09/2022] Open
Abstract
Allografts eliminate the disadvantages associated with autografts and synthetic scaffolds but are associated with a disease-transmission risk. Therefore, allograft sterilisation is crucial. We aimed to determine whether polyvinylpyrrolidone-iodine (PVP-I) can be used for sterilisation and as a new wet-preservation method. PVP-I-sterilised and preserved allografts demonstrated improved mechanical property, osteogenesis, and excellent microbial inhibition. A thigh muscle pouch model of nude mice showed that PVP-I-preserved allografts demonstrated better ectopic formation than Co60-sterilised allografts (control) in vivo (P < 0.05). Furthermore, the PVP-I-preserved group showed no difference between 24 h and 12 weeks of allograft preservation (P > 0.05). PVP-I-preserved allografts showed more hydrophilic surfaces and PVP-I-sterilised tendons showed higher mechanical strength than Co60-sterilised tendons (P < 0.05). The level of residual PVP-I was higher without washing and with prolonged preservation (P < 0.05). In vitro cellular tests showed that appropriate PVP-I concentration was nontoxic to preosteoblast cells, and cellular differentiation measured by alkaline phosphatase activity and osteogenic gene markers was enhanced (P < 0.05). Therefore, the improved biological performance of implanted allografts may be attributable to better surface properties and residual PVP-I, and PVP-I immersion can be a simple, easy method for allograft sterilisation and preservation.
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Affiliation(s)
- Yantao Zhao
- Beijing Engineering Research Center of Orthopaedic Implants, First Affiliated Hospital of CPLA General Hospital, Beijing 100048, P. R. China
| | - Xiantong Hu
- Beijing Engineering Research Center of Orthopaedic Implants, First Affiliated Hospital of CPLA General Hospital, Beijing 100048, P. R. China
| | - Zhonghai Li
- Beijing Engineering Research Center of Orthopaedic Implants, First Affiliated Hospital of CPLA General Hospital, Beijing 100048, P. R. China
| | - Fuli Wang
- Beijing Engineering Research Center of Orthopaedic Implants, First Affiliated Hospital of CPLA General Hospital, Beijing 100048, P. R. China
| | - Yang Xia
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing 210029, P. R. China.,State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory of Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - Shuxun Hou
- Beijing Engineering Research Center of Orthopaedic Implants, First Affiliated Hospital of CPLA General Hospital, Beijing 100048, P. R. China
| | - Hongbin Zhong
- Beijing Engineering Research Center of Orthopaedic Implants, First Affiliated Hospital of CPLA General Hospital, Beijing 100048, P. R. China
| | - Feimin Zhang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing 210029, P. R. China.,Suzhou Institute &Collaborative Innovation Center of Suzhou Nano Science and Technology, Southeast University, Suzhou 215000, P. R. China
| | - Ning Gu
- State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory of Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P. R. China.,Suzhou Institute &Collaborative Innovation Center of Suzhou Nano Science and Technology, Southeast University, Suzhou 215000, P. R. China
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95
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Motlagh MF, Bayat M, Naji S. Bone Allograft: An Option for Total Mandibular Reconstruction. Craniomaxillofac Trauma Reconstr 2016; 10:306-313. [PMID: 29114352 DOI: 10.1055/s-0036-1593474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/04/2016] [Indexed: 10/20/2022] Open
Abstract
Total mandibular reconstruction is one of the most challenging modalities in maxillofacial surgery. In this article, we try to introduce a method of total mandible reconstruction. We report a 25-year-old male patient with complete involvement of the mandible by Langerhans cell tumor. The patient underwent total mandibulectomy and reconstruction with bone allograft harvested from a donor who had died the day before. The patient has good functional and aesthetic results in a long time. It seems that bone allograft can be a good alternative to other methods in total mandibular reconstruction.
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Affiliation(s)
| | - Mohamad Bayat
- Department of Oral and Maxillofacial, Tehran University of Medical Science, Tehran, Iran
| | - Siamak Naji
- Department of Pathology, Urmia University of Medical Sciences Ringgold Standard Institution, Urmia, Iran
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96
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Kitala D, Klama-Baryła A, Kawecki M, Kraut M, Łabuś W, Glik J, Ples M, Tomanek E, Nowak M. Infections in the tissue material and their impact on the loss of transplants in the Laboratory of in vitro Cell and Tissue Culture with Tissue Bank in the years 2011-2015. Cell Tissue Bank 2016; 18:61-68. [PMID: 27796524 DOI: 10.1007/s10561-016-9597-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 10/24/2016] [Indexed: 12/20/2022]
Abstract
Radiation sterilization eliminates microbiological infections but causes the degradation of the cell factor. The negative result of microbiological examination for tissue transplants is one of the conditions for approval for distribution in patients. The study attempts to verify impact of the presence of microbes onto material for transplant loss. In the 2011-2015 period, we analyzed 293 donors of skin and amnion. Microbiological sampling was performed. The total of 21 strains of bacteria, molds and fungi was identified in collected tissue. The widest spectrum of strains was found in skin (17), followed by amnia (8). The total number of positive findings was 147 and was again highest in skin (129), while the number of positive findings in amnia was 18 only. The general percentage of fungal infections was very low. The presence of fungal strains was only observed in allogeneic skin (2%). Large number of microorganisms isolated from the skin before sterilization was observed, so it seems impossible to use allogeneic intravital skin. However, the intravital application of allogeneic amnion obtained from cesarean section remains to be considered.
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Affiliation(s)
- D Kitala
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland.
| | - A Klama-Baryła
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland
| | - M Kawecki
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland.,Department of Health Sciences, Technical-Humanistic Academy, Willowa 2, 43-309, Bielsko-Biała, Poland
| | - M Kraut
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland
| | - W Łabuś
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland
| | - J Glik
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland.,Department of Chronic Wounds Management Organization, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Ples
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland
| | - E Tomanek
- Non-Public Laboratory of Microbiology, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland
| | - M Nowak
- Dr Stanisław Sakiel Center for Burns Treatment, Jana Pawła II 2, 41-100, Siemianowice Śląskie, Poland
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97
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Nilsen TJ, Dasgupta A, Huang YC, Wilson H, Chnari E. Do Processing Methods Make a Difference in Acellular Dermal Matrix Properties? Aesthet Surg J 2016; 36:S7-S22. [PMID: 27697888 DOI: 10.1093/asj/sjw163] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of acellular dermal matrices (ADMs) has become the standard of practice in many reconstructive and aesthetic surgical applications. Different methods used to prepare the allograft tissue for surgical use can alter the ADMs natural properties. Aseptic processing has been shown to retain the natural properties of ADMs more favorably than terminally sterilized ADMs. Terminal sterilization has been historically linked to alteration of biological materials. In vitro work was conducted to compare ADM processing methods. OBJECTIVES Characterize aseptically processed ADMs and compare cell-matrix interaction characteristics to terminally sterilized ADMs. METHODS Two aseptically processed ADMs, FlexHD Pliable and BellaDerm, were characterized via histological evaluation, biomechanical integrity, enzymatic degradation, and in vitro cell studies. FlexHD Pliable was compared to Alloderm Ready-to-Use (RTU). RESULTS Histological evaluation revealed that FlexHD Pliable had a uniform, open structure compared to BellaDerm. Mechanical characterization demonstrated that BellaDerm had higher strength and stiffness compared to FlexHD Pliable, which maintained higher elasticity. Immunohistochemical analysis verified that key matrix proteins remained intact after aseptic processing. Cell studies found that fibroblasts attached more readily, and proliferated faster on FlexHD Pliable compared to BellaDerm. Additionally, fibroblasts infiltrated into FlexHD Pliable from both sides and on the dermal side in BellaDerm and produced an abundance of multi-layered matrix proteins (collagen, fibronectin) when compared to AlloDerm RTU which was sparse. CONCLUSIONS Aseptically processed FlexHD Pliable and BellaDerm provide a suitable, biocompatible option for tissue repair and regeneration in aesthetic and reconstructive surgical applications.
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Affiliation(s)
- Todd J Nilsen
- Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA
| | - Anouska Dasgupta
- Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA
| | - Yen-Chen Huang
- Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA
| | - Henry Wilson
- Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA
| | - Evangelia Chnari
- Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA
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98
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Effect of gamma radiation on the expression of mRNA growth factors in glycerol cryopreserved human amniotic membrane. Cell Tissue Bank 2016; 17:643-651. [PMID: 27535136 DOI: 10.1007/s10561-016-9576-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/04/2016] [Indexed: 02/07/2023]
Abstract
Human amniotic membrane (HAM) due to its high biocompatibility, low immunogenicity, anti-microbial, anti-viral properties as well as the presence of growth factors has been used in various clinical applications. The growth factors play an important role in wound healing. The current study aimed to explore the effect of 15 kGy gamma radiation dose on selected growth factors and receptors mRNA present in HAM. Eight growth factors, namely, EGF, HGF, KGF, TGF-α, TGF-β1, TGF-β2, TGF-β3 and bFGF and two growth factor receptors, HGFR and KGFR were evaluated in this study. The total RNA was extracted and converted to complimentary DNA using commercial kits. Subsequently, the mRNA expressions of these growth factors were evaluated using real-time PCR and the results were statistically analyzed using REST-MCS software. This study confirmed the presence of these mRNA growth factors and receptors in fresh, glycerol cryopreserved and irradiated glycerol cryopreserved HAM. In glycerol cryopreserved HAM, the results showed up-regulation of HGF and bFGF and down-regulation of EGF, HGFR, KGF, KGFR, TGF-α, TGF-β1, TGF-β2 and TGF-β3 relative to the fresh HAM which acted as the control, whereas in irradiated glycerol cryopreserved HAM, the results showed up-regulation of EGF, HGF, KGF, KGFR, TGF-β1, TGF-β2 and TGF-β3 and down-regulation of HGFR, TGF-α and bFGF relative to the glycerol cryopreserved HAM which acted as the control. However, these mRNA expressions did not show any statistical significant difference compared to the control groups. This study concluded that a dose of 15 kGy of gamma radiation did not affect the mRNA expression for the growth factors' and receptors' in the glycerol cryopreserved HAM.
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99
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Allaveisi F, Mirzaei M. Effects of high-dose gamma irradiation on tensile properties of human cortical bone: Comparison of different radioprotective treatment methods. J Mech Behav Biomed Mater 2016; 61:475-483. [DOI: 10.1016/j.jmbbm.2016.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/24/2016] [Accepted: 04/08/2016] [Indexed: 12/15/2022]
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100
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Woodside M, Willett TL. Elastic-plastic fracture toughness and rising JR-curve behavior of cortical bone is partially protected from irradiation-sterilization-induced degradation by ribose protectant. J Mech Behav Biomed Mater 2016; 64:53-64. [PMID: 27479894 DOI: 10.1016/j.jmbbm.2016.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/24/2016] [Accepted: 07/03/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study tested the hypothesis that pre-treating cortical bone with ribose would protect the rising fracture resistance curve behavior and crack initiation fracture toughness of both bovine and human cortical bone from the degrading effects of γ-irradiation sterilization. MATERIALS AND METHODS A ribose pre-treatment (1.8 M for bovine, and 1.2 M for human, in PBS at 60 °C for 24 h) was applied to single-edge notched bending fracture specimens prior to sterilization with a 33 kGy dose of γ-irradiation. Fracture resistance curves were generated with a single specimen method using an optical crack length measurement technique. The effect of the treatment on overall fracture resistance behavior, crack initiation fracture toughness, and tearing modulus was compared with non-irradiated and conventionally irradiation sterilized controls. Hydrothermal isometric tension testing was used to examine collagen network connectivity and thermal stability to explore relationships between collagen network quality and fracture resistance. RESULTS The ribose pre-treatment successfully protected the crack growth initiation fracture toughness of bovine and human bone by 32% and 63%, respectively. The rising JR-curve behavior was also partially protected. Furthermore, collagen connectivity and thermal stability followed similar patterns to those displayed by fracture toughness. CONCLUSIONS This paper demonstrates that the fracture toughness of irradiation-sterilized bone tissue can be partially protected with a ribose pre-treatment. This new approach shows potential for the production and clinical application of sterilized allografts with improved mechanical performance and durability.
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Affiliation(s)
- Mitchell Woodside
- Materials Science and Engineering, University of Toronto, Toronto, ON, Canada; Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Thomas L Willett
- Materials Science and Engineering, University of Toronto, Toronto, ON, Canada; Musculoskeletal Research Laboratory, Mount Sinai Hospital - Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, ON, Canada.
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