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Giedraitis A, Arnoczky SP, Bedi A. Allografts in soft tissue reconstructive procedures: important considerations. Sports Health 2014; 6:256-64. [PMID: 24790696 PMCID: PMC4000469 DOI: 10.1177/1941738113503442] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
CONTEXT Allografts offer several important advantages over autografts in musculoskeletal reconstructive procedures, such as anterior cruciate ligament reconstruction. Despite growing widespread use of allograft tissue, serious concerns regarding safety and functionality remain. We discuss the latest knowledge of the potential benefits and risks of allograft use and offer a critical review of allograft tissue regulation, management, and sterilization to enable the surgeon to better inform athletes considering reconstructive surgery options. EVIDENCE ACQUISITION A review of sources published in the past 10 years is the primary basis of this research. STUDY DESIGN Observational analysis (cohort study). LEVEL OF EVIDENCE Level 3. RESULTS Comparable outcome data for autografts and allografts do not support universal standards for anterior cruciate ligament reconstruction, and physician recommendation and bias appear to significantly influence patient preference and satisfaction. Sterilization by gamma and electron-beam irradiation diminishes the biomechanical integrity of allograft tissue, but radioprotective agents such as collagen cross-linking and free radical scavengers appear to have potential in mitigating the deleterious effects of irradiation and preserving tissue strength and stability. CONCLUSION Allografts offer greater graft availability and reduced morbidity in orthopaedic reconstructive procedures, but greater expansion of their use by surgeons is challenged by the need to maintain tissue sterility and biomechanical functionality. Advances in the radioprotection of irradiated tissue may lessen concerns regarding allograft safety and structural stability.
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Affiliation(s)
- Andrius Giedraitis
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven P Arnoczky
- Laboratory for Comparative Orthopaedic Research, Michigan State University, East Lansing, Michigan
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Murphy MV, Du DT, Hua W, Cortez KJ, Butler MG, Davis RL, DeCoster T, Johnson L, Li L, Nakasato C, Nordin JD, Ramesh M, Schum M, Von Worley A, Zinderman C, Platt R, Klompas M. The utility of claims data for infection surveillance following anterior cruciate ligament reconstruction. Infect Control Hosp Epidemiol 2014; 35:652-9. [PMID: 24799641 DOI: 10.1086/676430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the feasibility of identifying anterior cruciate ligament (ACL) allograft implantations and infections using claims. DESIGN Retrospective cohort study. METHODS We identified ACL reconstructions using procedure codes at 6 health plans from 2000 to 2008. We then identified potential infections using claims-based indicators of infection, including diagnoses, procedures, antibiotic dispensings, specialty consultations, emergency department visits, and hospitalizations. Patients' medical records were reviewed to determine graft type, validate infection status, and calculate sensitivity and positive predictive value (PPV) for indicators of ACL allografts and infections. RESULTS A total of 11,778 patients with codes for ACL reconstruction were identified. After chart review, PPV for ACL reconstruction was 96% (95% confidence interval [CI], 94%-97%). Of the confirmed ACL reconstructions, 39% (95% CI, 35%-42%) used allograft tissues. The deep infection rate after ACL reconstruction was 1.0% (95% CI, 0.7%-1.4%). The odds ratio of infection for allografts versus autografts was 0.41 (95% CI, 0.19-0.78). Sensitivity of individual claims-based indicators for deep infection after ACL reconstruction ranged from 0% to 75% and PPV from 0% to 100%. Claims-based infection indicators could be combined to enhance sensitivity or PPV but not both. CONCLUSIONS While claims data accurately identify ACL reconstructions, they poorly distinguish between allografts and autografts and identify infections with variable accuracy. Claims data could be useful to monitor infection trends after ACL reconstruction, with different algorithms optimized for different surveillance goals.
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Affiliation(s)
- Michael V Murphy
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Pascarella R, Commessatti M, Politano R, Maresca A, Del Torto M, Chehrassan M, Fantasia R. Bone graft from greater trochanter in posterior wall fractures with impacted fragments. J Orthop Traumatol 2014; 15:181-7. [PMID: 24671489 PMCID: PMC4182615 DOI: 10.1007/s10195-014-0291-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/05/2014] [Indexed: 11/20/2022] Open
Abstract
Background Posterior wall fracture is the most common acetabular fracture. Comminuted fractures with an impacted segment represent a subtype of this injury. The subchondral bone of the articular zone is compressed and causes a bone defect. The impacted fragment should be isolated, mobilized, and then reduced. A bone graft should be used to fill the gap. The other fragments are fixed following the reduction of the impacted segment. Materials and methods Ten patients with comminuted fractures and impacted segments with bone defects were enrolled in our study, from January 2010 to July 2012. Autogenous bone grafts from the greater trochanter were used to fill the gap in all patients. The reduction was achieved through the insertion of the graft above the impacted fracture, and plate fixation was performed subsequently. Merle d’Aubigne and Postel scoring, modified by Matta, was applied to evaluate the patients during follow-up. The mean follow-up was 12 months. Results The clinical results included one “excellent”, four “very good”, four “good” and one “poor”. Pain in the zone of graft harvesting was not detected in any patient. Femoral head necrosis was observed in one case. No other severe complications were detected. Conclusions Using an autogenous bone graft to fill the bone defect supplies excellent mechanical stability without any severe complications at the donor site. This surgical technique seems to be effective and safe in treating a comminuted fracture of the posterior wall in association with an impacted segment. Level of evidence Level IV.
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Affiliation(s)
- R Pascarella
- Orthopedic and Traumatology Department, Riuniti Hospital, Ancona, Italy,
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Wang Q, Zhang C, Zhang L, Guo W, Feng G, Zhou S, Zhang Y, Tian T, Li Z, Huang F. The preparation and comparison of decellularized nerve scaffold of tissue engineering. J Biomed Mater Res A 2014; 102:4301-8. [PMID: 24497414 DOI: 10.1002/jbm.a.35103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/13/2014] [Accepted: 01/30/2014] [Indexed: 12/27/2022]
Abstract
To integrate tissue engineering concepts into strategies to repair spinal cord injury (SCI) has been a hotspot in recent years, and the choice of scaffolding material is crucial to tissue engineering. Recently, decellularized nerve scaffold becomes a central concern due to its peculiar superiority. In this study, the decellularized nerve scaffold was prepared with three different methods and a comparison was made to acquire an ideal scaffold materials. All sciatic nerves from Sprague-Dawley (SD) rats were randomly divided into four groups: A: normal control group, B: TritonX-100 with sodium deoxycholate group, C: TritonX-100 with enzyme group and D: freezing-thawing with enzyme group. Histology and transmission electron microscope were exploited to evaluate the effect of removing cells and immunological histological chemistry was exploited to evaluate immunogenicity. Meanwhile the mechanical properties were evaluated by mechanics index. Hematoxylin and eosin (HE) staining and electron microscopic examinations reveal that the cell components and myelin sheaths are the least in the freezing-thawing with enzyme group. Immunohistochemistry shows that the immunogenicity is lower in group B, C, and D than the control group, and the group D has the lowest immunogenicity. Mechanical testing shows that there is no significant difference after acellular processing. Sciatic nerve, cell-extracted by freezing-thawing with enzyme, could obtain the ideal scaffold materials which has no cells and myelin sheaths. In addition, the decellularized nerve scaffold has no immunogenicity and the mechanical property of normal sciatic nerve is preserved.
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Affiliation(s)
- Qingbo Wang
- Department of Neurosurgery, Affiliated Hospital of Binzhou Medical University, Binzhou, 256603, China
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Comparative biomechanical and microstructural analysis of native versus peracetic acid-ethanol treated cancellous bone graft. BIOMED RESEARCH INTERNATIONAL 2014; 2014:784702. [PMID: 24678514 PMCID: PMC3942278 DOI: 10.1155/2014/784702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/10/2013] [Accepted: 12/23/2013] [Indexed: 01/29/2023]
Abstract
Bone transplantation is frequently used for the treatment of large osseous defects. The availability of autologous bone grafts as the current biological gold standard is limited and there is a risk of donor site morbidity. Allogenic bone grafts are an appealing alternative, but disinfection should be considered to reduce transmission of infection disorders. Peracetic acid-ethanol (PE) treatment has been proven reliable and effective for disinfection of human bone allografts. The purpose of this study was to evaluate the effects of PE treatment on the biomechanical properties and microstructure of cancellous bone grafts (CBG). Forty-eight human CBG cylinders were either treated by PE or frozen at −20°C and subjected to compression testing and histological and scanning electron microscopy (SEM) analysis. The levels of compressive strength, stiffness (Young's modulus), and fracture energy were significantly decreased upon PE treatment by 54%, 59%, and 36%, respectively. Furthermore, PE-treated CBG demonstrated a 42% increase in ultimate strain. SEM revealed a modified microstructure of CBG with an exposed collagen fiber network after PE treatment. We conclude that the observed reduced compressive strength and reduced stiffness may be beneficial during tissue remodeling thereby explaining the excellent clinical performance of PE-treated CBG.
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Chaudhury S, Wanivenhaus F, Fox AJ, Warren RF, Doyle M, Rodeo SA. Allograft replacement for absent native tissue. Sports Health 2014; 5:175-82. [PMID: 24427387 PMCID: PMC3658384 DOI: 10.1177/1941738112456668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Context: Structural instability due to poor soft tissue quality often requires augmentation. Allografts are important biological substitutes that are used for the symptomatic patient in the reconstruction of deficient ligaments, tendons, menisci, and osteochondral defects. Interest in the clinical application of allografts has arisen from the demand to obtain stable anatomy with restoration of function and protection against additional injury, particularly for high-demand patients who participate in sports. Traditionally, allografts were employed to reinforce weakened tissue. However, they can also be employed to substitute deficient or functionally absent tissue, particularly in the sports medicine setting. Objective: This article presents a series of 6 cases that utilized allografts to restore functionally deficient anatomic architecture, rather than just simply augmenting the degenerated or damaged native tissue. Detailed discussions are presented of the use of allografts as a successful treatment strategy to replace functionally weakened tissue, often after failed primary repairs.
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Affiliation(s)
| | | | - Alice J Fox
- Hospital for Special Surgery, New York, New York
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57
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Reich MS, Kishore V, Iglesias R, Akkus O. Genipin as a sporicidal agent for the treatment of cortical bone allografts. J Biomater Appl 2013; 28:1336-42. [DOI: 10.1177/0885328213507799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Microbial bioburden in bone allografts can be reduced by gamma radiation; however, the radiation compromises collagen and increases the risk of graft failure. Genipin is an agent that may reduce bioburden by chemical crosslinking without causing mechanical detriment or cytotoxicity. Methods To evaluate genipin’s ability to penetrate cortical bone while maintaining sporicidal activity, Bacillus subtilis spore strips were isolated between slices of bovine femoral cortical bone and immersed in genipin solutions for up to one week; spore viability was assessed with media-based assays. The mechanical effects of genipin treatment were assessed by performing three-point bending tests on genipin-treated cortical beams. Cytotoxicity studies were conducted by evaluating the adhesion and proliferation of murine MC3T3-E1 (P21) preosteoblasts on cortical bone slices which were treated with genipin and rinsed to different extents. Results Genipin successfully penetrated cortical bone slices and sterilized B. subtilis populations after 48 hours ( p > 0.05) and one week ( p < 0.05). Genipin-treated cortical beams demonstrated dose-dependent increases in yield strain ( p = 0.02) and resilience ( p < 0.01), whereas other mechanical properties were not affected by genipin treatment. Seeding cells onto inadequately rinsed genipin-treated bones proved cytotoxic. However, with adequate post-treatment rinsing of the residual genipin, cell adhesion and proliferation was comparable to phosphate-buffered saline-treated controls (no genipin). Conclusions Genipin solutions can sterilize bacterial spore populations entrapped within the continuum of bone tissue while preserving mechanical properties of bone and allowing cell adhesion and proliferation. Provided that antimicrobial effects seen with bacterial spores extend broadly to all microbial and viral species, genipin holds strong potential for bone allograft sterilization.
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Affiliation(s)
- Michael S Reich
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Vipuil Kishore
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Rodrigo Iglesias
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Ozan Akkus
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Aronoff DM. Clostridium novyi, sordellii, and tetani: mechanisms of disease. Anaerobe 2013; 24:98-101. [PMID: 24036420 DOI: 10.1016/j.anaerobe.2013.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 04/15/2013] [Accepted: 08/27/2013] [Indexed: 01/09/2023]
Abstract
Clostridia represent a diverse group of spore-forming gram positive anaerobes that include several pathogenic species. In general, diseases caused by clostridia are a result of intoxication of the infected host. Thus, clostridial toxins have been targeted for diagnostic, therapeutic, and preventive strategies against infection. Studying the mechanisms of action of clostridial toxins has not only shed light on the pathogenesis of infection but has provided important new insights into cell biology and immunology. A primary purpose of this manuscript is to provide a succinct review on the mechanisms of disease caused by intoxication by the pathogens Clostridium tetani, Clostridium novyi, and Clostridium sordellii.
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Affiliation(s)
- David M Aronoff
- Division of Infectious Diseases, Department of Internal Medicine, The University of Michigan Health System, Ann Arbor, MI 48109, United States; Department of Microbiology and Immunology, The University of Michigan Health System, Ann Arbor, MI 48109, United States; Reproductive Sciences Program, The University of Michigan Health System, Ann Arbor, MI 48109, United States.
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59
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Hassanzadeh H, Jain A, Kebaish KM, Neubauer PR, Mesfin A, Stein BE, Ain MC. Prevalence of Allograft Contamination During Intraoperative Processing for Spinal Deformity Correction Surgery. Spine Deform 2013; 1:348-351. [PMID: 27927391 DOI: 10.1016/j.jspd.2013.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 06/10/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Prospective study. OBJECTIVES To prospectively evaluate bone allografts during spinal fusion surgery for 1) the rate of contamination as a result of perioperative preparation, and 2) the types of bacterial organisms that may be transmitted through the contaminated bone allograft. SUMMARY OF BACKGROUND DATA Bone allografts are routinely used to enhance spinal arthrodesis procedures. Ready availability and lack of donor site morbidity make them valuable alternatives to iliac crest bone grafts. Reports of disease transmission of such organisms as hepatitis C, the human immunodeficiency virus, and a variety of bacterial pathogens through allograft bone implants raise concerns for patient and practitioner safety. METHODS Our study population consisted of 50 consecutive (20 male and 30 female) patients (mean age at surgery, 15 years; range, 3-51 years) undergoing spinal deformity correction from May 2010 through October 2010, by 1 surgeon at 1 institution. The mean operative time was 297 minutes (range, 81-444 minutes), and the most commonly fused spinal levels were T5 to L4. During the procedure, the researchers prospectively obtained intraoperative microbial culture swabs from a container with freeze-dried allograft and from an empty identical control container. Aerobic and anaerobic bacterial culture growth was assessed for 7 days postoperatively. Each patient was observed for 6 weeks after surgery to ascertain any evidence of surgical-site infection. RESULTS Microbial cultures showed bacterial growth in 4 cases: 1 allograft specimen (day 4, very light Staphylococcus aureus) and 3 control specimens (day 3, very light Enterococcus; day 4, very light S aureus; and day 6, Propionibacterium acnes). No patient showed signs of infection in the perioperative or 6-week postoperative period. CONCLUSIONS Intraoperative allograft preparation is not a major source of bone allograft contamination during spinal surgery.
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Affiliation(s)
- Hamid Hassanzadeh
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Philip R Neubauer
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Benjamin E Stein
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - Michael C Ain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
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Comparative studies on ectopic bone formation in porous hydroxyapatite scaffolds with complementary pore structures. Acta Biomater 2013; 9:8413-21. [PMID: 23732684 DOI: 10.1016/j.actbio.2013.05.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/21/2022]
Abstract
Vascularized bone grafts were constructed by implanting hydroxyapatite (HA) scaffolds with complementary macro-pore structures into the dorsal muscle of dogs. The relationship between pore structures and ectopic bone formation properties was investigated. Two types of scaffolds with complementary porous structures were fabricated by spherulite-accumulating and porogen-preparing methods, and were named spherulite HA-positive and porogen HA-negative, respectively. After implantation for 1 month, histological observation showed that all the scaffolds were encapsulated by normal muscle tissue and multiple vascular net with cells, indicating excellent biocompatibility and pore interconnectivity of the scaffolds. In the spherulite HA-positive scaffolds, a number of osteoclasts and osteoblasts coupled with new bone tissues were found after 3 and 6 months' implantations, which was better than those in the porogen HA-negative scaffolds. Similarly, the improvement of mechanical properties and the reconstruction of materials in the spherulite HA-positive scaffolds were superior to those in the porogen HA-negative scaffolds. The different ectopic bone formation induced by different macro-pore structures after intramuscular implantation demonstrated the significant effect of macro-pore structures of scaffolds on osteoinduction and vascularization.
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61
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Assessment of tissue allograft safety monitoring with administrative healthcare databases: a pilot project using Medicare data. Cell Tissue Bank 2013; 15:75-84. [PMID: 23824508 DOI: 10.1007/s10561-013-9376-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/29/2013] [Indexed: 12/22/2022]
Abstract
Assess whether Medicare data are useful for monitoring tissue allograft safety and utilization. We used health care claims (billing) data from 2007 for 35 million fee-for-service Medicare beneficiaries, a predominantly elderly population. Using search terms for transplant-related procedures, we generated lists of ICD-9-CM and CPT(®) codes and assessed the frequency of selected allograft procedures. Step 1 used inpatient data and ICD-9-CM procedure codes. Step 2 added non-institutional provider (e.g., physician) claims, outpatient institutional claims, and CPT codes. We assembled preliminary lists of diagnosis codes for infections after selected allograft procedures. Many ICD-9-CM codes were ambiguous as to whether the procedure involved an allograft. Among 1.3 million persons with a procedure ascertained using the list of ICD-9-CM codes, only 1,886 claims clearly involved an allograft. CPT codes enabled better ascertainment of some allograft procedures (over 17,000 persons had corneal transplants and over 2,700 had allograft skin transplants). For spinal fusion procedures, CPT codes improved specificity for allografts; of nearly 100,000 patients with ICD-9-CM codes for spinal fusions, more than 34,000 had CPT codes indicating allograft use. Monitoring infrequent events (infections) after infrequent exposures (tissue allografts) requires large study populations. A strength of the large Medicare databases is the substantial number of certain allograft procedures. Limitations include lack of clinical detail and donor information. Medicare data can potentially augment passive reporting systems and may be useful for monitoring tissue allograft safety and utilization where codes clearly identify allograft use and coding algorithms can effectively screen for infections.
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Irradiated allograft bone in spine surgery: to culture or not? A single center retrospective study. Spine (Phila Pa 1976) 2013; 38:558-63. [PMID: 23026873 DOI: 10.1097/brs.0b013e3182761109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE We aimed to document the rate of infection in our institution after the use of irradiated cancellous allograft or iliac crest bone autograft in vertebral fusion procedures. We also reviewed the pertinence of microbiological culture of cadaveric allograft bone prior to its implantation. SUMMARY OF BACKGROUND DATA Recent studies have shown similar postoperative infection rates between allograft and autograft. The pertinence of microbiological culture of allograft bone prior to its implantation is currently controversial. METHODS Retrospectively, we identified 338 patients who underwent spine fusion procedures for which there was a minimum of a 1-year follow-up. Files from both the neurosurgery and orthopedics divisions of the Centre hospitalier universitaire de Sherbrooke were reviewed during 1999 to 2009. Irradiated allografts were used in 164 patients and autografts were used in 174 patients. Of the 164 allografts implanted, 53 were cultured peroperatively. Postoperative spinal infection was based on documented positive spine cultures at the time of re-exploration for presumed infection. Infection rates were compared using Fisher exact test. RESULTS From the 53 peroperative cultures, 5 were positive (9.4%) and none of them led to antibiotherapy or surgical revision at 1 year. No significant difference was observed in the rate of surgical site infection at 1 year, after the use of irradiated allografts (1.8%) or autografts (1.7%), P = 1.0. CONCLUSION Perceived association with infection should not influence the surgeon in bone graft choice for spinal fusion. There is a lack of scientific evidence to recommend for or against routine cultures on allograft implantation in the literature. Our results strongly underline the pertinence of larger multicenter clinical trials to assess the pertinence of peroperative allograft bone culture.
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63
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Yanke AB, Bell R, Lee A, Kang RW, Mather RC, Shewman EF, Wang VM, Bach BR. The biomechanical effects of 1.0 to 1.2 Mrad of γ irradiation on human bone-patellar tendon-bone allografts. Am J Sports Med 2013; 41:835-40. [PMID: 23388672 DOI: 10.1177/0363546512473816] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent data suggest that anterior cruciate ligament (ACL) reconstruction with irradiated allograft tissue may lead to increased failure rates. HYPOTHESIS Low-dose (1.0-1.2 Mrad) gamma irradiation does not significantly alter the preimplantation biomechanical properties of bone-patellar tendon-bone (BTB) allografts. STUDY DESIGN Controlled laboratory study. METHODS Cyclic and failure mechanical properties were evaluated for 20 paired central-third human BTB allografts, with and without 1.0 to 1.2 Mrad of gamma irradiation. Testing included cyclic loading at 0.5 Hz for 100 cycles from 50 to 200 N and failure testing at a strain rate of 10% per second. RESULTS Cyclic elongation did not change significantly (P = .151) with irradiation, increasing from a mean ± SD of 9.4 ± 2.1 mm to 11.3 ± 3.4 mm. Cyclic creep strain approached a significant increase with irradiation (1.3% ± 0.8% to 2.6% ± 1.5%; P = .076). Failure testing was not affected with irradiation with regard to maximum load (1680 ± 417 mm to 1494 ± 435 mm), maximum stress (40.8 ± 10.6 MPa to 37.5 ± 15.7 MPa), elongation (7.85 ± 1.35 mm to 8.67 ± 2.05 mm), or strain at maximum stress (0.158 ± 0.03 to 0.175 ± 0.03). Graft stiffness significantly decreased by 20% with irradiation (278 ± 67 N/mm to 221 ± 50 N/mm; P = .035). CONCLUSION Low-dose (1.0-1.2 Mrad) gamma irradiation decreases BTB graft stiffness by 20%, but it does not affect other failure or cyclic parameters. CLINICAL RELEVANCE Aside from graft stiffness during load to failure testing, low-dose (1.0-1.2 Mrad) gamma irradiation of central-third human BTB allografts is not deleterious to preimplantation biomechanical properties.
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Affiliation(s)
- Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60617, USA
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64
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Nandakumar A, Cruz C, Mentink A, Tahmasebi Birgani Z, Moroni L, van Blitterswijk C, Habibovic P. Monolithic and assembled polymer-ceramic composites for bone regeneration. Acta Biomater 2013; 9:5708-17. [PMID: 23142480 DOI: 10.1016/j.actbio.2012.10.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 02/05/2023]
Abstract
The rationale for the use of polymer-ceramic composites for bone regeneration stems from the natural composition of bone, with collagen type I and biological apatite as the main organic and inorganic constituents, respectively. In the present study composite materials of PolyActive™ (PA), a poly(ethylene oxide terephthalate)/poly(butylene terephtalate) co-polymer, and hydroxyapatite (HA) at a weight ratio of 85:15 were prepared by rapid prototyping (RP) using two routes. In the first approach pre-extruded composite filaments of PA-HA were processed using three-dimensional fibre deposition (3DF) (conventional composite scaffolds). In the second approach PA scaffolds were fabricated using 3DF and combined with HA pillars produced inside stereolithographic moulds that fitted inside the pores of the PA three-dimensional structure (assembled composite scaffolds). Analysis of calcium and phosphate release in a simulated physiological solution, not containing calcium or phosphate, revealed significantly higher values for the HA pillars compared with other scaffolds. Release in simulated body fluid saturated with respect to HA did not show significant differences among the different scaffolds. Human mesenchymal stromal cells were cultured on polymer (3DF), conventional composite (3DF-HA) and assembled composite (HA assembled in 3DF) scaffolds and assessed for morphology, metabolic activity, DNA amount and gene expression of osteogenic markers using real time quantitative polymerase chain reaction (PCR). Scanning electron microscopy images showed that the cells attached to and infiltrated all the scaffolds. Assembled composites had a higher metabolic activity compared with 3DF-HA scaffolds while no significant differences were observed in DNA amounts. Gene expression of osteopontin in the assembled composite was significantly higher compared with the conventional composites. The strategy of composite fabrication by assembly appears to be a promising alternative to the conventional composite fabrication route for scaffolds for bone regeneration.
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Affiliation(s)
- Anandkumar Nandakumar
- Department of Tissue Regeneration, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, The Netherlands
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65
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Huang Q, Ingham E, Rooney P, Kearney JN. Production of a sterilised decellularised tendon allograft for clinical use. Cell Tissue Bank 2013; 14:645-54. [PMID: 23443409 DOI: 10.1007/s10561-013-9366-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/14/2013] [Indexed: 01/05/2023]
Abstract
Application of a high-level decontamination or sterilisation procedure and cell removal technique to tendon allograft can reduce the concerns of disease transmission, immune reaction, and may improve remodelling of the graft after implantation. The decellularised matrix can also be used as a matrix for tendon tissue engineering. One such sterilisation factor, Peracetic acid (PAA) has the advantage of not producing harmful reaction residues. The aim of this study was to evaluate the effects of PAA treatment and a cell removal procedure on the production of tendon matrix. Human patellar tendons, thawed from frozen were treated respectively as: Group 1, control with no treatment; Group 2, sterilised with PAA (0.1 % (w/v) PAA for 3 h) Group 3, decellularised (incubation successively in hypotonic buffer, 0.1 % (w/v) sodium dodecyl sulphate, and a nuclease solution); Group 4, decellularised and PAA sterilised. Histological analysis showed that no cells were visible after the decellularisation treatment. The integrity of tendon structure was maintained after decellularisation and PAA sterilisation, however, the collagen waveform was slightly loosened. No contact cytotoxicity was found in any of the groups. Determination of de-natured collagen showed no significant increase when compared with the control. This suggested that the decellularisation and sterilisation processing procedures did not compromise the major properties of the tendon. The sterilised, decellularised tendon could be suitable for clinical use.
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Affiliation(s)
- Q Huang
- Tissue Development Laboratory, NHS Blood and Transplant, Estuary Banks, Speke, Liverpool, L24 8RB, UK
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66
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Bi L, Li DC, Huang ZS, Yuan Z. Effects of sodium hydroxide, sodium hypochlorite, and gaseous hydrogen peroxide on the natural properties of cancellous bone. Artif Organs 2013; 37:629-36. [PMID: 23373516 DOI: 10.1111/aor.12048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Processed xenegeneic cancellous bone represents an alternative to bone autograft. In order to observe the effects of present prion inactivation treatments on the natural properties of xenogeneic cancellous bones, we treated bovine bone granules with sodium hydroxide (NaOH), sodium hypochlorite (NaOCl), and gaseous hydrogen peroxide (gH2 O2 ) respectively in this study. The microstructure, composition, and mineral content of the granules were evaluated by scanning electron micrograph, energy dispersive X-ray spectroscopy, ash analysis, and micro-computed tomography. The biomechanical property was analyzed by a materials testing machine. The cytocompatibility was evaluated by using a mouse fibroblast cell line (3T3). The microstructure, organic content, and mechanical strength were dramatically altered at the surface of bone in both NaOH- and NaOCl-treated groups, but not in the gH2 O2 -treated group. Compared with the gH2 O2 -treated group, attachment and proliferation of 3T3 were reduced in either NaOH- or NaOCl-treated groups. As the consequence, gH2 O2 treatment may be a useful approach of disinfection for the preparation of natural cancellous bone with well-preserved structural, mechanical, and biological properties.
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Affiliation(s)
- Long Bi
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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67
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Varettas K. Micro-organisms isolated from cadaveric samples of allograft musculoskeletal tissue. Cell Tissue Bank 2013; 14:621-5. [PMID: 23340929 DOI: 10.1007/s10561-013-9363-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
Abstract
Allograft musculoskeletal tissue is commonly used in orthopaedic surgical procedures. Cadaveric donors of musculoskeletal tissue supply multiple allografts such as tendons, ligaments and bone. The microbiology laboratory of the South Eastern Area Laboratory Services (SEALS, Australia) has cultured cadaveric allograft musculoskeletal tissue samples for bacterial and fungal isolates since 2006. This study will retrospectively review the micro-organisms isolated over a 6-year period, 2006-2011. Swab and tissue samples were received for bioburden testing and were inoculated onto agar and/or broth culture media. Growth was obtained from 25.1 % of cadaveric allograft musculoskeletal tissue samples received. The predominant organisms isolated were coagulase-negative staphylococci and coliforms, with the heaviest bioburden recovered from the hemipelvis. The rate of bacterial and fungal isolates from cadaveric allograft musculoskeletal tissue samples is higher than that from living donors. The type of organism isolated may influence the suitability of the allograft for transplant.
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Affiliation(s)
- Kerry Varettas
- Microbiology Department, South Eastern Area Laboratory Services, CSB Level 3, St. George Public Hospital, Gray St., Kogarah, Sydney, NSW, 2217, Australia,
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68
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Greenwald MA, Kuehnert MJ, Fishman JA. Infectious disease transmission during organ and tissue transplantation. Emerg Infect Dis 2013; 18:e1. [PMID: 22840823 PMCID: PMC3414044 DOI: 10.3201/eid1808.120277] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Transplantation of organs and tissues (bone, tendon, skin, cornea) will always be associated with some risk for transmission of infectious diseases from donor to recipient. Understanding and minimizing this risk is difficult for many reasons: donor screening processes vary, screening for every infectious organism is not possible, and assessment of recipient health after transplantation to determine possibility of disease transmission is often not adequate. In May 2010, the US Food and Drug Administration held a meeting to address these challenges and establish a research agenda for minimizing these transplant transmission risks. Attendees agreed that the focus should be on standardizing donor screening, compiling disease transmissibility data, monitoring of transplant recipients’ health, and assessing effectiveness of measures to minimize disease transmission. Collaboration and sharing of perspectives, experiences, and resources of all stakeholders in the transplantation process (government, private industry, and health care providers) can improve the safety of organ and tissue transplantation. Infectious disease transmission through organ and tissue transplantation has been associated with severe complications in recipients. Determination of donor-derived infectious risk associated with organ and tissue transplantation is challenging and limited by availability and performance characteristics of current donor epidemiologic screening (e.g., questionnaire) and laboratory testing tools. Common methods and standards for evaluating potential donors of organs and tissues are needed to facilitate effective data collection for assessing the risk for infectious disease transmission. Research programs can use advanced microbiological technologies to define infectious risks posed by pathogens that are known to be transplant transmissible and provide insights into transmission potential of emerging infectious diseases for which transmission characteristics are unknown. Key research needs are explored. Stakeholder collaboration for surveillance and research infrastructure is required to enhance transplant safety.
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Affiliation(s)
- Melissa A Greenwald
- Division of Human Tissues, Food and Drug Administration, 1401 Rockville Pike, Rockville, MD 20852, USA
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69
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Bach JS, Cherkaoui M, Corté L, Cantournet S, Ku DN. Design Considerations for a Prosthetic Anterior Cruciate Ligament. J Med Device 2012. [DOI: 10.1115/1.4007945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Anterior cruciate ligament (ACL) tearing is a common knee injury often requiring reconstruction with an autograft or an allograft. A prosthetic ligament replacement with off-the-shelf availability could potentially provide significant advantages over the current options for both patients and surgeons. Limitations of previous prosthetics include lack of biocompatibility and susceptibility to fatigue, creep, and failure of bony incorporation. This paper describes design considerations and possible improvements for the next generation prosthetic ACL. Design controls, as mandated by the FDA, are a systematic set of practices within the design and development process used to ensure that a new medical device meets the needs of the intended users. The specified requirements, called the design inputs, for a prosthetic ACL are discussed pertaining to material and structural properties, resistance to creep and fatigue, ability to support secure initial fixation, biocompatibility, and long-term osseointegration. Design innovations to satisfy the design inputs are discussed with regards to material selection, textile pattern, bone tunnel features, and short term fixation. A risk analysis is presented along with descriptions of proposed testing. Design control methodology and tissue engineering may be used to develop a next generation prosthetic ligament, solving multiple problems, simultaneously, on a holistic level, providing major improvements over earlier devices and current treatment options.
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Affiliation(s)
| | - Mohammed Cherkaoui
- e-mail: George W. Woodruff School of Mechanical Engineering, Georgia Tech Lorraine, 2 Rue Marconi, 57070 Metz, France
| | | | - Sabine Cantournet
- e-mail: Centre des Matériaux, Mines Paris, Paristech, CNRS UMR 7633, BP 87, F-91003 Evry Cedex, France
| | - David N. Ku
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 e-mail:
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70
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Evans ND, Swain RJ, Gentleman E, Gentleman MM, Stevens MM. Gene-expression analysis reveals that embryonic stem cells cultured under osteogenic conditions produce mineral non-specifically compared to marrow stromal cells or osteoblasts. Eur Cell Mater 2012; 24:211-23. [PMID: 23007907 PMCID: PMC5833941 DOI: 10.22203/ecm.v024a15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Pluripotent cells, such as embryonic stem cells (ESCs), divide indefinitely and can differentiate to form mineralised nodules in response to osteogenic supplements. This suggests that they may be used as a cell source for bone replacement strategies. Here, we related the expression of osteogenic and chondrogenic genes in cultures of murine ESCs, marrow stromal cells (MSCs) and calvarial osteoblasts (OBs) cultured under osteogenic conditions to the biochemical composition and quantity of mineral formed. Mineralisation, measured by calcium sequestration, was >2-fold greater in ESC cultures than in either MSCs or OBs. Micro-Raman spectroscopy and spectral mapping revealed a lower mineral-to-matrix ratio and confirmed a more diffuse pattern of mineralisation in ESCs compared to MSCs and OBs. Baseline expression of chondrogenic and osteogenic genes was between 1 and 4 orders of magnitude greater in MSCs and OBs than in ESCs. Osteogenic culture of MSCs and OBs was accompanied by increases in osteogenic gene expression by factors of ~100 compared to only ~10 in ESCs. Consequentially, peak expression of osteogenic and chondrogenic genes was greater in MSCs and OBs than ESCs by factors of 100-1000, despite the fact that mineralisation was more extensive in ESCs than either MSCs or OBs. We also observed significant cell death in ESC nodules. We conclude that the mineralised material observed in cultures of murine ESCs during osteogenic differentiation may accumulate non-specifically, perhaps in necrotic cell layers, and that thorough characterisation of the tissue formed by ESCs must be achieved before these cells can be considered as a cell source for clinical applications.
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Affiliation(s)
- Nicholas D. Evans
- Department of Materials, Imperial College London, South Kensington, London SW7 2AZ, UK,Institute of Biomedical Engineering, Imperial College London, South Kensington, London SW7 2AZ, UK
| | - Robin J. Swain
- Department of Materials, Imperial College London, South Kensington, London SW7 2AZ, UK,Institute of Biomedical Engineering, Imperial College London, South Kensington, London SW7 2AZ, UK
| | - Eileen Gentleman
- Department of Materials, Imperial College London, South Kensington, London SW7 2AZ, UK,Institute of Biomedical Engineering, Imperial College London, South Kensington, London SW7 2AZ, UK
| | - Molly M. Gentleman
- Mechanical Engineering Department, Texas A&M University, College Station TX 77843, USA
| | - Molly M. Stevens
- Department of Materials, Imperial College London, South Kensington, London SW7 2AZ, UK,Institute of Biomedical Engineering, Imperial College London, South Kensington, London SW7 2AZ, UK,To whom correspondence should be addressed.
Tel: +44 (0)20 7594 6804; Fax: +44 (0)20 7594 6757.
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71
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The effect of sterilization on mechanical properties of soft tissue allografts. Cell Tissue Bank 2012; 14:359-66. [PMID: 22972164 DOI: 10.1007/s10561-012-9340-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
Abstract
One major concern regarding soft tissue allograft use in surgical procedures is the risk of disease transmission. Current techniques of tissue sterilization, such as irradiation have been shown to adversely affect the mechanical properties of soft tissues. Grafts processed using Biocleanse processing (a proprietary technique developed by Regeneration Technologies to sterilize human tissues) will have better biomechanical characteristics than tissues that have been irradiated. Fifteen pairs of cadaveric Achilles tendon allografts were obtained and separated into three groups of 10 each. Three treatment groups were: Biocleanse, Irradiated, and Control (untreated). Each specimen was tested to determine the biomechanical properties of the tissue. Specimens were cyclically preloaded and then loaded to failure in tension. During testing, load, displacement, and optical strain data were captured. Following testing, the cross sectional area of the tendons was determined. Tendons in the control group were found to have a higher extrinsic stiffness (slope of the load-deformation curve, p = .005), have a higher ultimate stress (force/cross sectional area, p = .006) and higher ultimate failure load (p = .003) than irradiated grafts. Biocleanse grafts were also found to be stiffer than irradiated grafts (p = .014) yet were not found to be statistically different from either irradiated or non-irradiated grafts in terms of load to failure. Biocleanse processing seems to be a viable alternative to irradiation for Achilles tendon allografts sterilization in terms of their biomechanical properties.
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72
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In Response. Anesth Analg 2012. [DOI: 10.1213/ane.0b013e318263c911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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73
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Abstract
Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.
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Affiliation(s)
- Marco Demange
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Andreas H. Gomoll
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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74
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Marcos-Campos I, Marolt D, Petridis P, Bhumiratana S, Schmidt D, Vunjak-Novakovic G. Bone scaffold architecture modulates the development of mineralized bone matrix by human embryonic stem cells. Biomaterials 2012; 33:8329-42. [PMID: 22901965 DOI: 10.1016/j.biomaterials.2012.08.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 08/05/2012] [Indexed: 01/25/2023]
Abstract
Decellularized bone has been widely used as a scaffold for bone formation, due to its similarity to the native bone matrix and excellent osteoinductive and biomechanical properties. We have previously shown that human mesenchymal and embryonic stem cells form functional bone matrix on such scaffolds, without the use of growth factors. In this study, we focused on differences in bone matrix that exist even among identical harvesting sites, and the effects of the matrix architecture and mineral content on bone formation by human embryonic stem cells (hESC). Mesenchymal progenitors derived from hESCs were cultured for 5 weeks in decellularized bone scaffolds with three different densities: low (0.281 ± 0.018 mg/mm(3)), medium (0.434 ± 0.015 mg/mm(3)) and high (0.618 ± 0.027 mg/mm(3)). The medium-density group yielded highest densities of cells and newly assembled bone matrix, presumably due to the best balance between the transport of nutrients and metabolites to and from the cells, space for cell infiltration, surface for cell attachment and the mechanical strength of the scaffolds, all of which depend on the scaffold density. Bone mineral was beneficial for the higher expression of bone markers in cultured cells and more robust accumulation of the new bone matrix.
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Affiliation(s)
- Ivan Marcos-Campos
- Department of Biomedical Engineering, Columbia University, NY 10032, USA
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75
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Fishman JA, Greenwald MA, Grossi PA. Transmission of infection with human allografts: essential considerations in donor screening. Clin Infect Dis 2012; 55:720-7. [PMID: 22670038 DOI: 10.1093/cid/cis519] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Transmission of infection via transplantation of allografts including solid organs, eyes, and tissues are uncommon but potentially life-threatening events. Donor-derived infections have been documented following organ, tissue, and ocular transplants. Each year, more than 70 000 organs, 100 000 corneas, and 2 million human tissue allografts are implanted worldwide. Single donors may provide allografts for >100 organ and tissue recipients; each allograft carries some, largely unquantifiable, risk of disease transmission. Protocols for screening of organ or tissue donors for infectious risk are nonuniform, varying with the type of allograft, national standards, and availability of screening assays. In the absence of routine, active surveillance, coupled with the common failure to recognize or report transmission events, few data are available on the incidence of allograft-associated disease transmission. Research is needed to define the optimal screening assays and the transmissibility of infection with allografts. Approaches are reviewed that may contribute to safety in allograft transplantation.
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Affiliation(s)
- Jay A Fishman
- Transplant Infectious Disease Program, Infectious Disease Division, MGH Transplantation Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
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76
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Abstract
Bone graft substitutes have become progressively more widely used, and are currently heavily marketed. To make intelligent decisions, a complete knowledge of autograaft and allograft bone healing is essential, including the definition of "sterile". Differences in donor selection and tissue processing may confound the user not familiar with the implications of these different approaches. Specific products include demineralized bone matrix (DBM), specific growth factors (recombinant BMP's), ceramic grafts, and platelet-rich plasma (PRP). There are a number of useful applications of bone graft substitues for pediatric orthopaedists, but the data base is evolving. This paper describes the current status of these products.
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77
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Long B, Dan L, Jian L, Yunyu H, Shu H, Zhi Y. Evaluation of a novel reconstituted bone xenograft using processed bovine cancellous bone in combination with purified bovine bone morphogenetic protein. Xenotransplantation 2012; 19:122-32. [DOI: 10.1111/j.1399-3089.2012.00694.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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78
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Schmidt T, Hoburg A, Broziat C, Smith MD, Gohs U, Pruss A, Scheffler S. Sterilization with electron beam irradiation influences the biomechanical properties and the early remodeling of tendon allografts for reconstruction of the anterior cruciate ligament (ACL). Cell Tissue Bank 2012; 13:387-400. [PMID: 22311070 DOI: 10.1007/s10561-011-9289-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 12/20/2011] [Indexed: 12/21/2022]
Abstract
Although allografts for anterior cruciate ligament (ACL) replacement have shown advantages compared to autografts, their use is limited due to the risk of disease transmission and the limitations of available sterilization methods. Gamma sterilization has shown detrimental effects on graft properties at the high doses required for sufficient pathogen inactivation. In our previous in vitro study on human patellar tendon allografts, Electron beam (Ebeam) irradiation showed less detrimental effects compared to gamma sterilization (Hoburg et al. in Am J Sports Med 38(6):1134-1140, 2010). To investigate the biological healing and restoration of the mechanical properties of a 34 kGy Ebeam treated tendon allograft twenty-four sheep underwent ACL replacement with either a 34 kGy Ebeam treated allograft or a non-sterilized fresh frozen allograft. Biomechanical testing of stiffness, ultimate failure load and AP-laxity as well as histological analysis to investigate cell, vessel and myofibroblast-density were performed after 6 and 12 weeks. Native sheep ACL and hamstring tendons (HAT, each n = 9) served as controls. The results of a previous study analyzing the remodeling of fresh frozen allografts (n = 12) and autografts (Auto, n = 18) with the same study design were also included in the analysis. Statistics were performed using Mann-Whitney U test followed by Bonferroni-Holm correction. Results showed significantly decreased biomechanical properties during the early remodeling period in Ebeam treated grafts and this was accompanied with an increased remodeling activity. There was no recovery of biomechanical function from 6 to 12 weeks in this group in contrast to the results observed in fresh frozen allografts and autografts. Therefore, high dose Ebeam irradiation investigated in this paper cannot be recommended for soft tissue allograft sterilization.
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Affiliation(s)
- Tanja Schmidt
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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79
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Schmidt T, Hoburg AT, Gohs U, Schumann W, Sim-Brandenburg JW, Nitsche A, Scheffler S, Pruss A. Inactivation Effect of Standard and Fractionated Electron Beam Irradiation on Enveloped and Non-Enveloped Viruses in a Tendon Transplant Model. ACTA ACUST UNITED AC 2012; 39:29-35. [PMID: 22896764 DOI: 10.1159/000336380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 01/12/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND: For increasing allograft tendon safety in reconstructive surgery, an effective sterilization method achieving sterility assurance including viruses without impairing the grafts properties is needed. Fractionated Electron Beam (Ebeam) has shown promising in vitro results. The proof of sufficient virus inactivation is a central part of the process validation. METHODS: The Ebeam irradiation of the investigated viruses was performed in an optimized manner (oxygen content < 0.1%, -78 °C). Using principles of a tendon model the virus inactivation kinetics for HIV-2, HAV, pseudorabies virus (PRV) and porcine parvovirus (PPV) were calculated as TCID(50)/ml and D(10) value (kGy) for the fractionated (10 × 3.4 kGy) and the standard (1 × 34 kGy) Ebeam irradiation. RESULTS: All viruses showed comparable D(10) values for both Ebeam treatments. For sufficient virus titer reduction of 4 log(10) TCID(50)/ml, a dose of 34 kGy of the fractionated Ebeam irradiation was necessary in case of HIV-2, which was the most resistant virus investigated in this study. CONCLUSION: The fractionated and the standard Ebeam irradiation procedure revealed comparable and sufficient virus inactivation capacities. In combination with the known good biomechanical properties of fractionated Ebeam irradiated tendons, this method could be a safe and effective option for the terminal sterilization of soft tissue allografts.
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Affiliation(s)
- Tanja Schmidt
- Julius Wolff Institute, Center for Musculoskeletal Surgery, Germany
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80
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81
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Bilousova G, Jun DH, King KB, De Langhe S, Chick WS, Torchia EC, Chow KS, Klemm DJ, Roop DR, Majka SM. Osteoblasts derived from induced pluripotent stem cells form calcified structures in scaffolds both in vitro and in vivo. Stem Cells 2011; 29:206-16. [PMID: 21732479 DOI: 10.1002/stem.566] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reprogramming somatic cells into an ESC-like state, or induced pluripotent stem (iPS) cells, has emerged as a promising new venue for customized cell therapies. In this study, we performed directed differentiation to assess the ability of murine iPS cells to differentiate into bone, cartilage, and fat in vitro and to maintain an osteoblast phenotype on a scaffold in vitro and in vivo. Embryoid bodies derived from murine iPS cells were cultured in differentiation medium for 8–12 weeks. Differentiation was assessed by lineage-specific morphology, gene expression, histological stain, and immunostaining to detect matrix deposition. After 12 weeks of expansion, iPS-derived osteoblasts were seeded in a gelfoam matrix followed by subcutaneous implantation in syngenic imprinting control region (ICR) mice. Implants were harvested at 12 weeks, histological analyses of cell and mineral and matrix content were performed. Differentiation of iPS cells into mesenchymal lineages of bone, cartilage, and fat was confirmed by morphology and expression of lineage-specific genes. Isolated implants of iPS cell-derived osteoblasts expressed matrices characteristic of bone, including osteocalcin and bone sialoprotein. Implants were also stained with alizarin red and von Kossa, demonstrating mineralization and persistence of an osteoblast phenotype. Recruitment of vasculature and microvascularization of the implant was also detected. Taken together, these data demonstrate functional osteoblast differentiation from iPS cells both in vitro and in vivo and reveal a source of cells, which merit evaluation for their potential uses in orthopedic medicine and understanding of molecular mechanisms of orthopedic disease.
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Affiliation(s)
- Ganna Bilousova
- Charles C. Gates Regenerative Medicine and Stem Cell Biology Program, University of Colorado Denver, Aurora, Colorado 80045, USA
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82
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Archibald LK, Jarvis WR. Health care-associated infection outbreak investigations by the Centers for Disease Control and Prevention, 1946-2005. Am J Epidemiol 2011; 174:S47-64. [PMID: 22135394 DOI: 10.1093/aje/kwr310] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Since 1946, Centers for Disease Control and Prevention (CDC) personnel have investigated outbreaks of infections and adverse events associated with delivery of health care. CDC Epidemic Intelligence Service officers have led onsite investigations of these outbreaks by systematically applying epidemiology, statistics, and laboratory science. During 1946-2005, CDC Epidemic Intelligence Service officers conducted 531 outbreak investigations in facilities across the United States and abroad. Initially, the majority of outbreaks involved gastrointestinal tract infections; however, in later years, bloodstream, respiratory tract, and surgical wound infections predominated. Among pathogens implicated in CDC outbreak investigations, Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, nonfermentative Gram-negative bacteria, or yeasts predominated, but unusual organisms (e.g., the atypical mycobacteria) were often included. Outbreak types varied and often were linked to transfer of colonized patients or health care personnel between facilities (multihospital outbreaks), national distribution of contaminated products, use of invasive medical devices, or variances in practices and procedures in health care environments (e.g., intensive care units, water reservoirs, or hemodialysis units). Through partnerships with health care facilities and local and state health departments, outbreaks were terminated and lives saved. Data from investigations invariably contributed to CDC-generated guidelines for prevention and control of health care-associated infections.
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Affiliation(s)
- Lennox K Archibald
- Division of Infectious Diseases, College of Medicine, University of Florida, 1600 SWArcher Road, Room R2-124, PO Box 100277, Gainesville, FL 32610-0277, USA.
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83
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Adverse reactions and events related to musculoskeletal allografts: reviewed by the World Health Organisation Project NOTIFY. INTERNATIONAL ORTHOPAEDICS 2011; 36:633-41. [PMID: 22048753 DOI: 10.1007/s00264-011-1391-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 10/06/2011] [Indexed: 01/24/2023]
Abstract
PURPOSE The use of bone and connective tissue allografts has grown rapidly and surpassed the use of autografts in many countries. Being of human origin, bone and tendon allografts carry the risk of disease transmission and complications have been reported. As part of the Project NOTIFY led by the World Health Organisation, an effort to improve recognition, reporting, tracking and investigation of adverse outcomes of allografts was initiated, achieving a comprehensive review of associated disease transmission and failures. Those involving the use of musculoskeletal allografts are reported here. A major objective is to involve orthopaedic surgeons in the improvement of the safe use of the musculoskeletal allografts. METHODS We reviewed the medical literature, requested reports from surgeons in selected professional organisations and informally surveyed tissue bank organisations and selected tissue bank professionals to discover reported and unreported cases of adverse outcomes. We analysed each case to decide the likelihood that the complication was truly allograft related. RESULTS The efficiency of the procedures involved in bone banking and bone and tendon allograft has improved significantly during the last three decades. The evolution of the incidence of reported adverse reactions and events reflects positively on the safety of transplanted tissues. Cases of bacterial and viral transmission by bone and tendon allografts occurred mainly with those that contained viable cells, were not processed to remove cells, or were not disinfected or sterilised. We documented cases of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), human T-lymphotropic virus (HTLV), unspecified hepatitis, tuberculosis and other bacteria. Reporting of these adverse outcomes has led to corrective actions and has significantly improved the safety of allograft use. However, it is probable that not all cases have been reported and investigated. CONCLUSIONS Considering the high quality standards achieved in many countries, the best approach for further improvement in the safety of allografts is through a systematic reporting of all serious adverse reactions and events in the context of a global biovigilance programme.
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Antkowiak TT, Polage CR, Wiedeman JA, Meehan JP, Jamali AA. Chondrolysis of the tibial plateau caused by articular aspergillosis after ACL autograft reconstruction: management with a fresh osteochondral allograft: a case report. J Bone Joint Surg Am 2011; 93:e1241-6. [PMID: 22048103 DOI: 10.2106/jbjs.j.00782] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Tomasz T Antkowiak
- Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, CA 95817, USA
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85
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Frick CG, Fink H, Blobner M, Martyn J. A single injection of botulinum toxin decreases the margin of safety of neurotransmission at local and distant sites. Anesth Analg 2011; 114:102-9. [PMID: 22003222 DOI: 10.1213/ane.0b013e31823526bf] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We tested the hypothesis that a single injection of botulinum toxin not only has local, but also distant effects on muscle function, biochemistry, and pharmacodynamics of atracurium. METHODS Botulinum toxin (2.5 U) was injected into the tibialis muscle of anesthetized rats (n = 26). The contralateral side with no injection served to study distant effects. Control animals (n = 25) received a saline injection. Neuromuscular function, pharmacology, and expression of acetylcholine receptors (nAChRs) were evaluated in the tibialis at 0, 4, and 16 days after injection and in comparison with saline- injected controls. RESULTS On day 4, botulinum toxin caused complete paralysis of the tibialis, while its contralateral side showed a decrease in absolute twitch tension (1.8 N [1.6; 1.9] vs 3.0 N [2.8; 3.1], Newton, P < 0.05). On day 16, muscle weakness was only present on the toxin-injected side where absolute twitch tension was decreased (0.6 N [0.6, 0.7] vs 3.4 N [3.1, 3.7], P < 0.05). Tibialis mass was decreased on the toxin-injected side at day 4 (1.46 mg/g [1.43, 1.48] vs 1.74 mg/g [1.72; 1.75], P < 0.05) and on day 16 (0.78 mg/g [0.76, 0.79] vs 1.73 mg/g [1.69; 1.77], P < 0.05). Effects distant from the site of injection were seen on day 16, when muscle atrophy was also present in the adjacent gastrocnemius and soleus muscles. Normalized to tibialis mass, specific twitch tension (tension/g muscle) was reduced on the contralateral side at day 4 and on the toxin-injected side at day 16 in relation to saline controls. At day 16, an increased sensitivity to atracurium was seen on the toxin-injected side, evidenced as a decreased ED(50) (0.23 mg/kg [0.13, 0.33] vs 0.72 mg/kg [0.63, 0.82], P < 0.05) and a lower infusion rate (38 μL/kg/min [32, 43] vs135 μL/kg/min [126, 144], P < 0.05), together with a reduced plasma concentration requirement of atracurium (0.5 μg/mL [0.4, 0.7] vs 4.5 μg/mL [3.8, 5.2], P < 0.05) to achieve a steady state 50% reduction in baseline (absolute) twitch tension. ED(50) of atracurium was also decreased on the contralateral side at day 16 in relation to saline controls. The nAChRs in the tibialis were increased on the toxin-injected side to 123 fmol/mg [115, 131] vs 28 fmol/mg [25, 29] (P < 0.05) in time-matched saline-injected controls at day 4 and to 378 [341, 413] vs 27 fmol/mg [25, 29] (P < 0.05) at day 16. CONCLUSIONS Botulinum toxin has local and distant effects on muscle. The decrease in specific twitch tension indicates that the muscle atrophy alone cannot explain the functional changes; neuromuscular transmission is also impaired. An increased sensitivity to atracurium on the toxin-injected side, despite up-regulation of nAChRs, seems unique to botulinum toxin.
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Affiliation(s)
- Christiane G Frick
- Department of Anesthesia & Critical Care, Massachusetts General Hospital, Boston, USA.
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86
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Maitta RW, Avery L, Champion M, Vaughn D, Baillargeon C, Lederer J, Snyder EL. How do we ... integrate transfusion medicine and tissue dispensing programs in an academic medical center: response to a changing regulatory environment. Transfusion 2011; 52:1172-81. [PMID: 21981598 DOI: 10.1111/j.1537-2995.2011.03363.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Robert W Maitta
- Department of Laboratory Medicine, Anesthesiology and Perioperative Services, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut 06510, USA
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87
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Jost PW, Dy CJ, Robertson CM, Kelly AM. Allograft use in anterior cruciate ligament reconstruction. HSS J 2011; 7:251-6. [PMID: 23024622 PMCID: PMC3192899 DOI: 10.1007/s11420-011-9212-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 06/13/2011] [Indexed: 02/07/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopedic surgeons. While autograft reconstruction remains the gold standard, allograft tissues have become a controversial option for ACL reconstruction. No data currently exist regarding recent trends in graft choices, and no consensus exists over which graft type is most appropriate for which patient. In this article, we examine trends in ACL graft choice at our institution, and review the pertinent information a surgeon must consider when making this decision. We reviewed operating room records from 2002 to 2008 to determine trends in graft choice for primary single bundle ACL reconstruction. Total number of procedures performed, graft choices, and patient ages were recorded. Patients were divided into the following age groups: less than 16, 16 to 20, 21 to 30, 31 to 40, 41 to 50, and over 50. Percent of ACL reconstructions using allograft was calculated for each year, as well as for each age group. Data were analyzed for trends in ACL graft choice over this time period as well as for trends in graft choice by age. We hypothesized that the rate of allograft use in primary ACL reconstruction had increased over time and that allograft use was associated with higher patient age. We also review the risks, safety, and standards for tissue procurement. Allograft use increased significantly (p < 0.001) from 2002 (17%) to 2008 (46%). There was also a significant difference (p < 0.001) in average age of patients receiving allografts (40.4 years) and autografts (26.4 years). Allograft use was significantly associated with higher patient age (p < 0.05) and increased with each successive age group from a rate of 9.9% in patients under 16 to 79.9% in patients over 50. Our study found that allograft use in primary ACL reconstruction has significantly increased from 2002 to 2008 and is significantly more common in older patients.
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Affiliation(s)
- Patrick W. Jost
- grid.239915.50000000122858823Hospital for Special Surgery, 535 E. 70th St.,
New York, NY 10021 USA
| | - Christopher J. Dy
- grid.239915.50000000122858823Hospital for Special Surgery, 535 E. 70th St.,
New York, NY 10021 USA
| | - Catherine M. Robertson
- grid.239915.50000000122858823Hospital for Special Surgery, 535 E. 70th St.,
New York, NY 10021 USA
| | - Anne M. Kelly
- grid.239915.50000000122858823Hospital for Special Surgery, 535 E. 70th St.,
New York, NY 10021 USA
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88
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Abstract
The use of artificial bone grafts has been developed over recent years and is expected to increase further, for some indications even replacing the gold standard, autograft, in trauma and reconstructive surgery. However, the effectiveness of these materials is still a subject of debate, mostly because of unclear definitions or limited market surveillance. In this overview several facts and myths regarding bone-graft substitutes are summarized.
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Affiliation(s)
- T J Blokhuis
- University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, Utrecht, The Netherlands.
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89
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Inactivation of enveloped and non-enveloped viruses on seeded human tissues by gamma irradiation. Cell Tissue Bank 2011; 13:401-7. [PMID: 21809182 PMCID: PMC3432196 DOI: 10.1007/s10561-011-9266-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/25/2011] [Indexed: 12/11/2022]
Abstract
Human tissue allografts are widely used in a variety of clinical applications with over 1.5 million implants annually in the US alone. Since the 1990s, most clinically available allografts have been disinfected to minimize risk of disease transmission. Additional safety assurance can be provided by terminal sterilization using low dose gamma irradiation. The impact of such irradiation processing at low temperatures on viruses was the subject of this study. In particular, both human tendon and cortical bone samples were seeded with a designed array of viruses and the ability of gamma irradiation to inactivate those viruses was tested. The irradiation exposures for the samples packed in dry ice were 11.6–12.9 kGy for tendon and 11.6–12.3 kGy for bone, respectively. The viruses, virus types, and log reductions on seeded tendon and bone tissue, respectively, were as follows: Human Immunodeficiency Virus (RNA, enveloped), >2.90 and >3.20; Porcine Parvovirus (DNA, non-enveloped), 1.90 and 1.58; Pseudorabies Virus (DNA, enveloped), 3.80 and 3.79; Bovine Viral Diarrhea Virus (RNA, enveloped), 2.57 and 4.56; and Hepatitis A Virus (RNA, non-enveloped), 2.54 and 2.49, respectively. While proper donor screening, aseptic technique, and current disinfection practices all help reduce the risk of viral transmission from human allograft tissues, data presented here indicate that terminal sterilization using a low temperature, low dose gamma irradiation process inactivates both enveloped and non-enveloped viruses containing either DNA or RNA, thus providing additional assurance of safety from viral transmission.
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90
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Walk ST, Jain R, Trivedi I, Grossman S, Newton DW, Thelen T, Hao Y, Songer JG, Carter GP, Lyras D, Young VB, Aronoff DM. Non-toxigenic Clostridium sordellii: clinical and microbiological features of a case of cholangitis-associated bacteremia. Anaerobe 2011; 17:252-6. [PMID: 21726656 DOI: 10.1016/j.anaerobe.2011.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 06/13/2011] [Accepted: 06/15/2011] [Indexed: 10/18/2022]
Abstract
Toxigenic Clostridium sordellii strains are increasingly recognized to cause highly lethal infections in humans that are typified by a toxic shock syndrome (TSS). Two glucosylating toxins, lethal toxin (TcsL) and hemorrhagic toxin (TcsH) are believed to be important in the pathogenesis of TSS. While non-toxigenic strains of C. sordellii demonstrate reduced cytotoxicity in vitro and lower virulence in animal models of infection, there are few data regarding their behavior in humans. Here we report a non-TSS C. sordellii infection in the context of a polymicrobial bacterial cholangitis. The C. sordellii strain associated with this infection did not carry either the TcsL-encoding tcsL gene or the tcsH gene for TcsH. In addition, the strain was neither cytotoxic in vitro nor lethal in a murine sepsis model. These results provide additional correlative evidence that TcsL and TcsH increase the risk of mortality during C. sordellii infections.
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Affiliation(s)
- Seth T Walk
- The Department of Internal Medicine, University of Michigan Health System, Ann Arbor, 48109, USA
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91
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Ye JH, Xu YJ, Gao J, Yan SG, Zhao J, Tu Q, Zhang J, Duan XJ, Sommer CA, Mostoslavsky G, Kaplan DL, Wu YN, Zhang CP, Wang L, Chen J. Critical-size calvarial bone defects healing in a mouse model with silk scaffolds and SATB2-modified iPSCs. Biomaterials 2011; 32:5065-76. [PMID: 21492931 DOI: 10.1016/j.biomaterials.2011.03.053] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/21/2011] [Indexed: 12/16/2022]
Abstract
Induced pluripotent stem cells (iPSCs) can differentiate into mineralizing cells and thus have a great potential in application in engineered bone substitutes with bioactive scaffolds in regeneration medicine. In the current study we characterized and demonstrated the pluripotency and osteogenic differentiation of mouse iPSCs. To enhance the osteogenic differentiation of iPSCs, we then transduced the iPSCs with the potent transcription factor, nuclear matrix protein SATB2. We observed that in SATB2-overexpressing iPSCs there were increased mineral nodule formation and elevated mRNA levels of key osteogenic genes, osterix (OSX), Runx2, bone sialoprotein (BSP) and osteocalcin (OCN). Moreover, the mRNA levels of HoxA2 was reduced after SATB2 overexpression in iPSCs. The SATB2-overexpressing iPSCs were then combined with silk scaffolds and transplanted into critical-size calvarial bone defects created in nude mice. Five weeks post-surgery, radiological and micro-CT analysis revealed enhanced new bone formation in calvarial defects in SATB2 group. Histological analysis also showed increased new bone formation and mineralization in the SATB2 group. In conclusion, the results demonstrate that SATB2 facilitates the differentiation of iPSCs towards osteoblast-lineage cells by repressing HoxA2 and augmenting the functions of the osteoblast determinants Runx2, BSP and OCN.
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Affiliation(s)
- Jin-Hai Ye
- Division of Oral Biology, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA 02111, USA
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92
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Mallick TK, Mosquera A, Zinderman CE, St Martin L, Wise RP. Reported infections after human tissue transplantation before and after new Food and Drug Administration (FDA) regulations, United States, 2001 through June, 2010. Cell Tissue Bank 2011; 13:259-67. [PMID: 21479712 DOI: 10.1007/s10561-011-9253-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 03/18/2011] [Indexed: 01/26/2023]
Abstract
Processors distributed about 1.5 million human tissue allografts in the U.S. in 2007. The potential for transmitting infections through allografts concerns clinicians and patients. In 2005, FDA implemented Current Good Tissue Practice (CGTP) rules requiring tissue establishments to report to FDA certain serious infections after allograft transplantations. We describe infection reports following tissue transplants received by FDA from 2005 through June, 2010, and compare reporting before and after implementation of CGTP rules. We identified reports received by FDA from January 2001 through June, 2010, for infections in human tissue recipients, examining the reports by tissue type, organism, time to onset, severity, and reporter characteristics. Among 562 reports, 83 (20.8/year) were received from 2001-2004, before the CGTP rules, 43 in the 2005 transition year, and 436 (96.9/year) from 2006 through June, 2010, after the rules. Tissue processors accounted for 84.2% of reports submitted after the rules, compared to 26.5% previously. Bacterial infections were the most commonly reported organisms before (64.6%) and after (62.2%) the new rules. Afterward, 2.5% (11) of reports described deaths, and 33.7% (147) involved hospitalizations. Before the rules, 13% (11) described deaths, and another 72% involved hospitalizations. Reports received by the FDA quadrupled since 2005, suggesting that CGTP regulations have contributed to increased reporting and improved tissue safety surveillance. However, these data do not confirm that the reported infections were caused by suspect tissues; most reports may represent routine post-surgical infections not actually due to allografts.
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Affiliation(s)
- Tarun K Mallick
- Office of Biostatistics and Epidemiology, FDA/CBER, 1401 Rockville Pike, Suite 400 S, Rockville, MD 20852, USA
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93
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Herberts CA, Kwa MSG, Hermsen HPH. Risk factors in the development of stem cell therapy. J Transl Med 2011; 9:29. [PMID: 21418664 PMCID: PMC3070641 DOI: 10.1186/1479-5876-9-29] [Citation(s) in RCA: 461] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 03/22/2011] [Indexed: 02/06/2023] Open
Abstract
Stem cell therapy holds the promise to treat degenerative diseases, cancer and repair of damaged tissues for which there are currently no or limited therapeutic options. The potential of stem cell therapies has long been recognised and the creation of induced pluripotent stem cells (iPSC) has boosted the stem cell field leading to increasing development and scientific knowledge. Despite the clinical potential of stem cell based medicinal products there are also potential and unanticipated risks. These risks deserve a thorough discussion within the perspective of current scientific knowledge and experience. Evaluation of potential risks should be a prerequisite step before clinical use of stem cell based medicinal products. The risk profile of stem cell based medicinal products depends on many risk factors, which include the type of stem cells, their differentiation status and proliferation capacity, the route of administration, the intended location, in vitro culture and/or other manipulation steps, irreversibility of treatment, need/possibility for concurrent tissue regeneration in case of irreversible tissue loss, and long-term survival of engrafted cells. Together these factors determine the risk profile associated with a stem cell based medicinal product. The identified risks (i.e. risks identified in clinical experience) or potential/theoretical risks (i.e. risks observed in animal studies) include tumour formation, unwanted immune responses and the transmission of adventitious agents. Currently, there is no clinical experience with pluripotent stem cells (i.e. embryonal stem cells and iPSC). Based on their characteristics of unlimited self-renewal and high proliferation rate the risks associated with a product containing these cells (e.g. risk on tumour formation) are considered high, if not perceived to be unacceptable. In contrast, the vast majority of small-sized clinical trials conducted with mesenchymal stem/stromal cells (MSC) in regenerative medicine applications has not reported major health concerns, suggesting that MSC therapies could be relatively safe. However, in some clinical trials serious adverse events have been reported, which emphasizes the need for additional knowledge, particularly with regard to biological mechanisms and long term safety.
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Affiliation(s)
- Carla A Herberts
- Centre for Biological Medicines and Medical Technology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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94
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Srinivasan A. Influential outbreaks of healthcare‐associated infections in the past decade. Infect Control Hosp Epidemiol 2011; 31 Suppl 1:S70-2. [PMID: 20929377 DOI: 10.1086/655987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Outbreaks of healthcare‐associated infections have long played a critical role in both identification and mitigation of emerging challenges in health care. This article describes some of the most influential outbreaks of healthcare‐associated infections in the past decade that serve as excellent illustrations of this point.
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Affiliation(s)
- Arjun Srinivasan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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95
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Greenberg DD, Robertson M, Vallurupalli S, White RA, Allen WC. Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2010; 92:2402-8. [PMID: 20962190 DOI: 10.2106/jbjs.i.00456] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Injuries to the anterior cruciate ligament are the most common surgically treated knee ligament injury. There is no consensus regarding the optimal graft choice between allograft and autograft tissue. Postoperative septic arthritis is an uncommon complication after anterior cruciate ligament reconstruction. The purpose of this study was to compare infection rates between procedures with use of allograft and autograft tissue in primary anterior cruciate ligament reconstruction. METHODS A combined prospective and retrospective multicenter cohort study was performed over a three-year period. Graft selection was determined by the individual surgeon. Inclusion and exclusion criteria were equivalent for the two groups (allograft and autograft tissue). Data collected included demographic characteristics, clinical information, and graft details. Patients were followed for a minimum of 5.5 months postoperatively. Our primary outcome was intra-articular infection following anterior cruciate ligament reconstruction. RESULTS Of the 1298 patients who had anterior cruciate ligament reconstruction during the study period, 861 met the criteria for inclusion and formed the final study group. Two hundred and twenty-one patients (25.6%) received an autograft, and 640 (74.3%) received an allograft. There were no cases of septic arthritis in either group. The 95% confidence interval was 0% to 0.57% for the allograft group and 0% to 1.66% for the autograft group. The rate of superficial infections in the entire study group was 2.32%. We did not identify a significant difference in the rate of superficial infections between autograft and allograft reconstruction in our study group. CONCLUSIONS While the theoretical risk of disease transmission inherent with allograft tissue cannot be eliminated, we found no increased clinical risk of infection with the use of allograft tissue compared with autologous tissue for primary anterior cruciate ligament reconstruction.
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Affiliation(s)
- David D Greenberg
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri, USA
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96
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Chung EJ, Qiu H, Kodali P, Yang S, Sprague SM, Hwong J, Koh J, Ameer GA. Early tissue response to citric acid-based micro- and nanocomposites. J Biomed Mater Res A 2010; 96:29-37. [PMID: 20949482 DOI: 10.1002/jbm.a.32953] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 08/11/2010] [Accepted: 08/13/2010] [Indexed: 12/20/2022]
Abstract
Composites based on calcium phosphates and biodegradable polymers are desirable for orthopedic applications because of their potential to mimic bone. Herein, we describe the fabrication, characterization, and in vivo response of novel citric acid-based microcomposites and nanocomposites. Poly(1,8-octanediol-co-citrate) (POC) was mixed with increasing amounts of hydroxyapatite (HA) nanoparticles or microparticles (up to 60 wt %), and the morphology and mechanical properties of the resulting composites were assessed. To investigate tissue response, nanocomposites, microcomposites, POC, and poly(L-lactide) were implanted in osteochondral defects in rabbits and harvested at 6 weeks for histological evaluation. Scanning electron microscopy confirmed increased surface roughness of microcomposites relative to nanocomposites. The mechanical properties of both types of composites increased with increasing amounts of HA (8-328 MPa), although nanocomposites with 60 wt % HA displayed the highest strength and stiffness. Based on tissue-implant interfacial assessments, all implants integrated well with the surrounding bone and cartilage with no evidence of inflammation. Both nanocomposites and microcomposites supported bone remodeling; however, nanocomposites induced more trabecular bone formation at the tissue-implant interface. The mechanical properties of citric acid-based composites are within the range of human trabecular bone (1-1524 MPa, 211 ± 78 MPa mean modulus), and tissue response was dependent on the size and content of HA, providing new perspectives of design and fabrication criteria for orthopedic devices such as interference screws and fixation pins.
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Affiliation(s)
- Eun Ji Chung
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208, USA
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97
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Kemper N, Davison N, Fitzpatrick D, Marshall R, Lin A, Mundy K, Cobb RR. Characterization of the mechanical properties of bovine cortical bone treated with a novel tissue sterilization process. Cell Tissue Bank 2010; 12:273-9. [DOI: 10.1007/s10561-010-9191-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 06/26/2010] [Indexed: 11/25/2022]
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98
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Cartwright EJ, Prabhu RM, Zinderman CE, Schobert WE, Jensen B, Noble-Wang J, Church K, Welsh C, Kuehnert M, Burke TL, Srinivasan A. Transmission of Elizabethkingia meningoseptica (formerly Chryseobacterium meningosepticum) to tissue-allograft recipients: a report of two cases. J Bone Joint Surg Am 2010; 92:1501-6. [PMID: 20516326 DOI: 10.2106/jbjs.i.00502] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Emily J Cartwright
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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99
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Evans ND, Gentleman E, Chen X, Roberts CJ, Polak JM, Stevens MM. Extracellular matrix-mediated osteogenic differentiation of murine embryonic stem cells. Biomaterials 2010; 31:3244-52. [DOI: 10.1016/j.biomaterials.2010.01.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/10/2010] [Indexed: 10/19/2022]
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100
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Hao Y, Senn T, Opp J, Young VB, Thiele T, Srinivas G, Huang SK, Aronoff DM. Lethal toxin is a critical determinant of rapid mortality in rodent models of Clostridium sordellii endometritis. Anaerobe 2010; 16:155-60. [PMID: 19527792 PMCID: PMC2856776 DOI: 10.1016/j.anaerobe.2009.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/16/2009] [Accepted: 06/04/2009] [Indexed: 12/22/2022]
Abstract
The toxigenic anaerobe Clostridium sordellii is an uncommon but highly lethal cause of human infection and toxic shock syndrome, yet few studies have addressed its pathogenetic mechanisms. To better characterize the microbial determinants of rapid death from infection both in vitro and in vivo studies were performed to compare a clinical strain of C. sordellii (DA-108), isolated from a patient who survived a disseminated infection unaccompanied by toxic shock syndrome, to a virulent reference strain (ATCC9714). Rodent models of endometrial and peritoneal infection with C. sordellii ATCC9714 were rapidly lethal, while infections with DA-108 were not. Extensive genetic and functional comparisons of virulence factor and toxin expression between these two bacterial strains yielded many similarities, with the noted exception that strain DA-108 lacked the tcsL gene, which encodes the large clostridial glucosyltransferase enzyme lethal toxin (TcsL). The targeted removal by immunoprecipitation of TcsL protected animals from death following injection of crude culture supernatants from strain ATCC9714. Injections of a monoclonal anti-TcsL IgG protected animals from death during C. sordellii ATCC9714 infection, suggesting that such an approach might improve the treatment of patients with C. sordellii-induced toxic shock syndrome.
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Affiliation(s)
- Yibai Hao
- Division of Infectious Diseases, Department of Internal Medicine, the University of Michigan Health System, Ann Arbor, MI, USA
| | - Tennille Senn
- Division of Infectious Diseases, Department of Internal Medicine, the University of Michigan Health System, Ann Arbor, MI, USA
| | - Judy Opp
- Division of Infectious Diseases, Department of Internal Medicine, the University of Michigan Health System, Ann Arbor, MI, USA
| | - Vincent B. Young
- Division of Infectious Diseases, Department of Internal Medicine, the University of Michigan Health System, Ann Arbor, MI, USA
| | - Teri Thiele
- United States Department of Agriculture, Center for Veterinary Biologics, Ames, IA, USA
| | - Geetha Srinivas
- United States Department of Agriculture, Center for Veterinary Biologics, Ames, IA, USA
| | - Steven K. Huang
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, the University of Michigan Health System, Ann Arbor, MI, USA
| | - David M. Aronoff
- Division of Infectious Diseases, Department of Internal Medicine, the University of Michigan Health System, Ann Arbor, MI, USA
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