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Miceli ALC, Pereira LC, Torres TDS, Calasans-Maia MD, Louro RS. Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery. Craniomaxillofac Trauma Reconstr 2016; 10:292-298. [PMID: 29109841 DOI: 10.1055/s-0036-1593475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/30/2016] [Indexed: 10/20/2022] Open
Abstract
Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.
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Affiliation(s)
- Ana Lucia Carpi Miceli
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Livia Costa Pereira
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thiago da Silva Torres
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rafael Seabra Louro
- Department of Oral and Maxillofacial Surgery, Servidores do Estado Federal Hospital, Rio de Janeiro, Rio de Janeiro, Brazil.,Oral Surgery Department, Dentistry School, Fluminense Federal University, Niterói, Rio de Janeiro
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102
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Li G, Wang L, Pan W, Yang F, Jiang W, Wu X, Kong X, Dai K, Hao Y. In vitro and in vivo study of additive manufactured porous Ti6Al4V scaffolds for repairing bone defects. Sci Rep 2016; 6:34072. [PMID: 27667204 PMCID: PMC5036184 DOI: 10.1038/srep34072] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/07/2016] [Indexed: 01/12/2023] Open
Abstract
Metallic implants with a low effective modulus can provide early load-bearing and reduce stress shielding, which is favorable for increasing in vivo life-span. In this research, porous Ti6Al4V scaffolds with three pore sizes (300~400, 400~500, and 500~700 μm) were manufactured by Electron Beam Melting, with an elastic modulus range of 3.7 to 1.7 GPa. Cytocompatibility in vitro and osseointegration ability in vivo of scaffolds were assessed. hBMSCs numbers increased on all porous scaffolds over time. The group with intended pore sizes of 300 to 400 μm was significantly higher than that of the other two porous scaffolds at days 5 and 7. This group also had higher ALP activity at day 7 in osteogenic differentiation experiment. The scaffold with pore size of 300 to 400 μm was implanted into a 30-mm segmental defect of goat metatarsus. In vivo evaluations indicated that the depth of bone ingrowth increased over time and no implant dislocation occurred during the experiment. Based on its better cytocompatibility and favorable bone ingrowth, the present data showed the capability of the additive manufactured porous Ti6Al4V scaffold with an intended pore size of 300 to 400 μm for large segmental bone defects.
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Affiliation(s)
- Guoyuan Li
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Lei Wang
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Wei Pan
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Fei Yang
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Wenbo Jiang
- Research and Development Center of Medical Implant Engineering Technology, Engineering Research Center of Digital Medical and Clinical Translation Ministry of Education, 1954 Huashan Road, Shanghai 200011, People's Republic of China
| | - Xianbo Wu
- Research and Development Department, Thytec Shanghai Co.,Ltd, 320 Xingda Road, Shanghai 201100, People's Republic of China
| | - Xiangdong Kong
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Kerong Dai
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.,Research and Development Center of Medical Implant Engineering Technology, Engineering Research Center of Digital Medical and Clinical Translation Ministry of Education, 1954 Huashan Road, Shanghai 200011, People's Republic of China
| | - Yongqiang Hao
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.,Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
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103
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Synergistic Effect of Mesoporous Silica and Hydroxyapatite in Loaded Poly(DL-lactic-co-glycolic acid) Microspheres on the Regeneration of Bone Defects. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9824827. [PMID: 27652269 PMCID: PMC5019907 DOI: 10.1155/2016/9824827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023]
Abstract
A microsphere composite made of poly(DL-lactic-co-glycolic acid) (PLGA), mesoporous silica nanoparticle (MSN), and nanohydroxyapatite (nHA) (PLGA-MSN/nHA) was prepared and evaluated as bone tissue engineering materials. The objective of this study was to investigate the synergistic effect of MSN/nHA on biocompatibility as well as its potential ability for bone formation. First, we found that this PLGA-MSN/nHA composite performed good characteristics on microstructure, mechanical strength, and wettability. By cell culture experiments, the adhesion and proliferation rate of the cells seeded on PLGA-MSN/nHA composite was higher than those of the controls and high levels of osteogenetic factors such as ALP and Runx-2 were detected by reverse transcriptase polymerase chain reaction. Finally, this PLGA-MSN/nHA composite was implanted into the femur bone defect in a rabbit model, and its ability to induce bone regeneration was observed by histological examinations. Twelve weeks after implantation, the bone defects had significantly more formation of mature bone and less residual materials than in the controls. These results demonstrate that this PLGA-MSN/nHA composite, introducing both MSN and nHA into PLGA microspheres, can improve the biocompatibility and osteoinductivity of composite in vitro and in vivo and had potential application in bone regeneration.
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104
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Salem D, Natto Z, Elangovan S, Karimbux N. Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence — A Systematic Assessment. J Periodontol 2016; 87:872-9. [DOI: 10.1902/jop.2016.150512] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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105
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Behrend C, Carmouche J, Millhouse PW, Ritter L, Moskal J, Rubery P, Puzas E. Allogeneic and Autogenous Bone Grafts Are Affected by Historical Donor Environmental Exposure. Clin Orthop Relat Res 2016; 474:1405-9. [PMID: 26511634 PMCID: PMC4868162 DOI: 10.1007/s11999-015-4572-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone graft materials are routinely evaluated for infectious agents; however, data regarding contamination of bone graft from environmental exposure of the donors to osteotoxic substances such as lead are not routinely available. In animal models, stored lead in bone has been shown to impair fracture healing and osteocyte function. In clinical studies, lead is linked to skeletal disease at relatively low concentrations. Presumably the levels of lead in allografts mirror the level of lead in bone in the population; however, the degree to which processing might decrease this and the frequency with which potentially osteotoxic levels appear in bone grafts have not been studied. QUESTIONS/PURPOSES (1) Does processing of donor bone for allografts result in lower concentrations of lead in commercial allograft when compared with autologous bone graft; and (2) what proportion of bone grafts contain potentially osteotoxic levels of lead from > 2.0 to 20.0 µg/g corresponding to environmental exposure? METHODS Allograft from commercial sources and autologous bone graft materials were examined for lead content using ICP- atomic absorption spectrophotometric analysis. We analyzed bone graft specimens from 42 donors, including 26 corticocancellous tibial specimens from commercially available bone graft materials and 16 autograft corticocancellous tibial specimens. Lead levels were determined for the cortical (n = 42) and cancellous (n = 42) portions of each specimen. For quality control, all instruments, plastic and glassware, were regularly tested for lead contamination by atomic absorption spectrophotometry throughout the experiments. In addition, spectrophotometer calibration was verified using Standard Reference Material 1486 bone meal (NIST, Gaithersburg, MD, USA). Descriptive statistical analysis was performed using SPSS 20 (SPSS Inc, Chicago, IL, USA). Using these techniques, a lead level > 2 µg/g to 20 µg/g corresponds to some degree of environmental exposure to lead. RESULTS With the numbers available in the present study, there were no differences in mean lead level between commercial bone graft materials and autogenous bone graft, 2.1 µg/g (95% confidence interval [CI], 1.6-3.3 µg/g) versus 2.0 µg/g (95% CI, 1.0-4.5 µg/g; p = 0.86). The range for all tested samples varied from < 0.1 to 5.0 µg/g. Likewise, there were no differences in mean lead level between cortical bone grafts, which contained 2.2 µg/g (95% CI, 1.5-3.7 µg/g), and cancellous grafts, which contained 1.9 µg/g (95% CI, 1.2-3.4 µg/g; p = 0.58). Thirty-eight percent (16 of 42) of the specimens had levels between 2.0 µg/g and 20 µg/g within a range expected for individuals with known environmental exposure to lead. CONCLUSIONS This study demonstrates that lead is present in up to one-third of tibial allograft and autograft bone specimens at potentially osteotoxic levels regardless of the source or screening. Further research is needed to delineate the relationship with nonunion or pseudoarthrosis after procedures in which allograft is used. In addition, further study would examine concentrations of lead and other environmental contaminants in other graft types. CLINICAL RELEVANCE Comparable levels of lead exposure have been associated with toxic effects on skeletal tissue. Further study of bone graft used in fusion procedures and other procedures is necessary to define the magnitude of osteotoxic effects in the setting of fracture care or fusion procedures.
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Affiliation(s)
- Caleb Behrend
- Department of Orthopedic Surgery, Carilion Clinic, Virginia Tech Carilion School of Medicine and Research Institute, 3 Riverside Circle, Roanoke, VA, 24016, USA.
| | - Jonathon Carmouche
- Department of Orthopedic Surgery, Carilion Clinic, Virginia Tech Carilion School of Medicine and Research Institute, 3 Riverside Circle, Roanoke, VA, 24016, USA
| | - Paul W Millhouse
- Department of Orthopaedic Research, Rothman Institute, Philadelphia, PA, USA
| | | | - Joseph Moskal
- Department of Orthopedic Surgery, Carilion Clinic, Virginia Tech Carilion School of Medicine and Research Institute, 3 Riverside Circle, Roanoke, VA, 24016, USA
| | - Paul Rubery
- School of Medicine and Research Institute, University of Rochester, Rochester, NY, USA
| | - Edward Puzas
- School of Medicine and Research Institute, University of Rochester, Rochester, NY, USA
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106
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Galanis V, Fiska A, Kapetanakis S, Kazakos K, Demetriou T. Effect of platelet-rich plasma combined with demineralised bone matrix on bone healing in rabbit ulnar defects. Singapore Med J 2016; 58:551-556. [PMID: 27193079 DOI: 10.11622/smedj.2016095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study evaluates the effect of autologous platelet-rich plasma (PRP) combined with xenogeneic demineralised bone matrix (DBM) on bone healing of critical-size ulnar defects (2-2.5 times the ulnar diameter) in New Zealand White rabbits. METHODS Critical-size defects were created unilaterally in the ulna of 36 rabbits, while keeping the contralateral limb intact. They were divided into three groups. In Group A, the defect was filled with autologous PRP and in Group B, with autologous PRP combined with DBM; in Group C, the defect remained empty. The rabbits were euthanised 12 weeks postoperatively. Radiological, biomechanical and histological assessments were carried out and statistical analysis of the results was performed. RESULTS Group B had significantly higher radiological and histological scores than Groups A and C. Defects in Group B showed significant new bone formation, whereas there was minimal or no new bone formation in Groups A and C. Only specimens in Group B showed macroscopic bone union. Biomechanical evaluation of the treated and intact contralateral limbs in Group B showed significant differences. CONCLUSION In this study, statistically significant enhancement of bone healing was found in critical-size defects treated with PRP and DBM, as shown by radiological findings, gross assessment, and biomechanical and histopathological results. Defects in the two other groups remained unbridged. Therefore, PRP was effective only when it was used in combination with a bone graft.
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Affiliation(s)
- Vasilios Galanis
- Department of Orthopaedics, University Hospital of Alexandroupolis, Greece
| | - Alice Fiska
- Department of Anatomy, Medical School, Democritus University of Thrace, Greece
| | | | | | - Thespis Demetriou
- Department of Anatomy, Medical School, Democritus University of Thrace, Greece
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107
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Abstract
The continual cycle of bone formation and resorption is carried out by osteoblasts, osteocytes, and osteoclasts under the direction of the bone-signaling pathway. In certain situations the host cycle of bone repair is insufficient and requires the assistance of bone grafts and their substitutes. The fundamental properties of a bone graft are osteoconduction, osteoinduction, osteogenesis, and structural support. Options for bone grafting include autogenous and allograft bone and the various isolated or combined substitutes of calcium sulphate, calcium phosphate, tricalcium phosphate, and coralline hydroxyapatite. Not all bone grafts will have the same properties. As a result, understanding the requirements of the clinical situation and specific properties of the various types of bone grafts is necessary to identify the ideal graft. We present a review of the bone repair process and properties of bone grafts and their substitutes to help guide the clinician in the decision making process.
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Affiliation(s)
- Y Fillingham
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, 60612, Illinois, USA
| | - J Jacobs
- Rush University Medical Center, 1611 West Harrison Street, Suite 300, 60612, Illinois, USA
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108
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Efficacy and safety of porous hydroxyapatite/type 1 collagen composite implantation for bone regeneration: A randomized controlled study. J Orthop Sci 2016; 21:373-80. [PMID: 26961287 DOI: 10.1016/j.jos.2016.01.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Porous hydroxyapatite/collagen composite (HAp/Col) is a bioresorbable bone substitute composed of nano-scale HAp and porcine type 1 collagen. In this study, the efficacy and safety were assessed in comparison to commercially available porous β-tricalcium phosphate (β-TCP). METHODS Patients with bone defects caused by benign bone tumors, fractures, or harvesting of autografts were randomly allocated for implantation of porous HAp/Col (n = 63) or porous β-TCP (n = 63). X-ray images were scored and used to evaluate the efficacy of the implantation until 24 weeks after surgery. Blood tests and observation of the surgical site were also performed to evaluate the safety of the implants. In total, 59 and 60 cases were analyzed in the porous HAp/Col and β-TCP groups, respectively. RESULTS At 18 and 24 weeks after surgery, the highest grade of bone regeneration was more frequent in the porous HAp/Col group than in the porous β-TCP group (p = 0.0004 and 0.0254 respectively). Wilcoxon's rank sum test confirmed the superiority of porous HAp/Col from early time points onward (p = 0.0084, 4 w; p = 0.0037, 8 w; p = 0.0030, 12 w; p < 0.0001, 18 w; and p = 0.0316, 24 w). The incidence of adverse effects was higher in the porous HAp/Col group than in the β-TCP group. However, no serious adverse events were reported and no cases needed to drop out of the clinical trial. CONCLUSIONS The superiority of porous HAp/Col for bone regeneration in comparison to an established porous β-TCP was confirmed. Although the incidence of side effects associated with the porous HAp/Col implant was higher than that in the β-TCP group, no serious adverse events occurred that resulted in rejection of the implants.
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109
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Puvaneswary S, Raghavendran HB, Talebian S, Murali MR, A Mahmod S, Singh S, Kamarul T. Incorporation of Fucoidan in β-Tricalcium phosphate-Chitosan scaffold prompts the differentiation of human bone marrow stromal cells into osteogenic lineage. Sci Rep 2016; 6:24202. [PMID: 27068453 PMCID: PMC4828646 DOI: 10.1038/srep24202] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/21/2016] [Indexed: 12/31/2022] Open
Abstract
In our previous study, we reported the fabrication and characterization of a novel tricalcium phosphate-fucoidan-chitosan (TCP-Fu-Ch) biocomposite scaffold. However, the previous report did not show whether the biocomposite scaffold can exhibit osteogenic differentiation of human bone marrow stromal cells in osteogenic media and normal media supplemented with platelet-derived growth factor (PDGF-BB). On day 15, the release of osteocalcin, was significant in the TCP-Fu-Ch scaffold, when compared with that in the TCP-Ch scaffold, and the level of release was approximately 8 and 6 ng/ml in osteogenic and normal media supplemented with PDGF-BB, respectively. Scanning electron microscopy of the TCP-Fu-Ch scaffold demonstrated mineralization and apatite layer formation on day 14, while the addition of PDGF-BB also improved the osteogenic differentiation of the scaffold. An array of gene expression analysis demonstrated that TCP-Fu-Ch scaffold cultured in osteogenic and normal media supplemented with PDGF-BB showed significant improvement in the expression of collagen 1, Runt-related transcription factor 2, osteonectin, bone gamma-carboxyglutamate protein, alkaline phosphatase, and PPA2, but a decline in the expression of integrin. Altogether, the present study demonstrated that fucoidan-incorporated TCP-Ch scaffold could be used in the differentiation of bone marrow stromal cells and can be a potential candidate for the treatment of bone-related ailments through tissue engineering technology.
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Affiliation(s)
- Subramaniam Puvaneswary
- Tissue Engineering Group (TEG), Department of Orthopaedic Surgery, NOCERAL, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hanumantharao Balaji Raghavendran
- Tissue Engineering Group (TEG), Department of Orthopaedic Surgery, NOCERAL, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sepehr Talebian
- Department of Mechanical engineering, Engineering Faculty, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Malliga Raman Murali
- Tissue Engineering Group (TEG), Department of Orthopaedic Surgery, NOCERAL, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Suhaeb A Mahmod
- Tissue Engineering Group (TEG), Department of Orthopaedic Surgery, NOCERAL, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Simmrat Singh
- Tissue Engineering Group (TEG), Department of Orthopaedic Surgery, NOCERAL, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Tunku Kamarul
- Tissue Engineering Group (TEG), Department of Orthopaedic Surgery, NOCERAL, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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110
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He B, Ou Y, Zhou A, Chen S, Zhao W, Zhao J, Li H, Zhu Y, Zhao Z, Jiang D. Functionalized d-form self-assembling peptide hydrogels for bone regeneration. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1379-88. [PMID: 27114701 PMCID: PMC4833366 DOI: 10.2147/dddt.s97530] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bone defects are very common in orthopedics, and there is great need to develop suitable bone grafts for transplantation in vivo. However, current bone grafts still encounter some limitations, including limited availability, immune rejection, poor osteoinduction and osteoconduction, poor biocompatibility and degradation properties, etc. Self-assembling peptide nanofiber scaffolds have emerged as an important substrate for cell culture and bone regeneration. We report on the structural features (eg, Congo red staining, circular dichroism spectroscopy, transmission electron microscopy, and rheometry assays) and osteogenic ability of d-RADA16-RGD peptide hydrogels (with or without basic fibroblast growth factor) due to the better stability of peptide bonds formed by these peptides compared with those formed by l-form peptides, and use them to fill the femoral condyle defect of Sprague Dawley rat model. The bone morphology change, two-dimensional reconstructions using microcomputed tomography, quantification of the microcomputed tomography analyses as well as histological analyses have demonstrated that RGD-modified d-form peptide scaffolds are able to enhance extensive bone regeneration.
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Affiliation(s)
- Bin He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ao Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Shuo Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Weikang Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jinqiu Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Hong Li
- School of Physical Science and Technology, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zenghui Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Dianming Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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111
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El‐Jawhari JJ, Sanjurjo‐Rodríguez C, Jones E, Giannoudis PV. Collagen-containing scaffolds enhance attachment and proliferation of non-cultured bone marrow multipotential stromal cells. J Orthop Res 2016; 34:597-606. [PMID: 26466765 PMCID: PMC5063164 DOI: 10.1002/jor.23070] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/12/2015] [Indexed: 02/04/2023]
Abstract
Large bone defects are ideally treated with autografts, which have many limitations. Therefore, osteoconductive scaffolds loaded with autologous bone marrow (BM) aspirate are increasingly used as alternatives. The purpose of this study was to compare the growth of multipotential stromal cells (MSCs) from unprocessed BM on a collagen-containing bovine bone scaffold (Orthoss(®) Collagen) with a non-collagen-containing bovine bone scaffold, Orthoss(®) . Another collagen-containing synthetic scaffold, Vitoss(®) was included in the comparison. Colonization of scaffolds by BM MSCs (n = 23 donors) was evaluated using microscopy, colony forming unit-fibroblast assay and flow-cytometry. The number of BM MSCs initially attached to Orthoss(®) Collagen and Vitoss(®) was similar but greater than Orthoss(®) (p = 0.001 and p = 0.041, respectively). Furthermore, the number of MSCs released from Orthoss(®) Collagen and Vitoss(®) after 2-week culture was also higher compared to Orthoss(®) (p = 0.010 and p = 0.023, respectively). Interestingly, collagen-containing scaffolds accommodated larger numbers of lymphocytic and myelomonocytic cells. Additionally, the proliferation of culture-expanded MSCs on Orthoss(®) collagen and Vitoss(®) was greater compared to Orthoss(®) (p = 0.047 and p = 0.004, respectively). Collectively, collagen-containing scaffolds were superior in supporting the attachment and proliferation of MSCs when they were loaded with unprocessed BM aspirates. This highlights the benefit of collagen incorporation into bone scaffolds for use with autologous bone marrow aspirates as autograft substitutes.
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Affiliation(s)
- Jehan J. El‐Jawhari
- Academic Unit of Musculoskeletal DiseaseLeeds Institute of Rheumatic and Musculoskeletal MedicineSt. James University HospitalUniversity of LeedsLS9 7TFLeedsUnited Kingdom,NIHRLeeds Biomedical Research UnitChapel Allerton HospitalUniversity of LeedsLS7 4SALeedsUnited Kingdom
| | - Clara Sanjurjo‐Rodríguez
- Academic Unit of Musculoskeletal DiseaseLeeds Institute of Rheumatic and Musculoskeletal MedicineSt. James University HospitalUniversity of LeedsLS9 7TFLeedsUnited Kingdom
| | - Elena Jones
- Academic Unit of Musculoskeletal DiseaseLeeds Institute of Rheumatic and Musculoskeletal MedicineSt. James University HospitalUniversity of LeedsLS9 7TFLeedsUnited Kingdom,NIHRLeeds Biomedical Research UnitChapel Allerton HospitalUniversity of LeedsLS7 4SALeedsUnited Kingdom
| | - Peter V. Giannoudis
- Academic Unit of Musculoskeletal DiseaseLeeds Institute of Rheumatic and Musculoskeletal MedicineSt. James University HospitalUniversity of LeedsLS9 7TFLeedsUnited Kingdom,NIHRLeeds Biomedical Research UnitChapel Allerton HospitalUniversity of LeedsLS7 4SALeedsUnited Kingdom
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112
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Yang N, Zhong Q, Zhou Y, Kundu SC, Yao J, Cai Y. Controlled degradation pattern of hydroxyapatite/calcium carbonate composite microspheres. Microsc Res Tech 2016; 79:518-24. [DOI: 10.1002/jemt.22661] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/12/2016] [Accepted: 03/09/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Ning Yang
- The Key Laboratory of Advanced Textile Materials and Manufacturing Technology of Ministry of Education, National Engineering Lab for Textile Fiber Materials and Processing Technology(Zhejiang), College of Materials and Textiles, Zhejiang Sci-Tech University; Hangzhou 310018 China
| | - Qiwei Zhong
- The Key Laboratory of Advanced Textile Materials and Manufacturing Technology of Ministry of Education, National Engineering Lab for Textile Fiber Materials and Processing Technology(Zhejiang), College of Materials and Textiles, Zhejiang Sci-Tech University; Hangzhou 310018 China
| | - Ying Zhou
- The Key Laboratory of Advanced Textile Materials and Manufacturing Technology of Ministry of Education, National Engineering Lab for Textile Fiber Materials and Processing Technology(Zhejiang), College of Materials and Textiles, Zhejiang Sci-Tech University; Hangzhou 310018 China
| | - Subhas C. Kundu
- Department of Biotechnology; Indian Institute of Technology (IIT); Kharagpur West Bengal 721302 India
| | - Juming Yao
- The Key Laboratory of Advanced Textile Materials and Manufacturing Technology of Ministry of Education, National Engineering Lab for Textile Fiber Materials and Processing Technology(Zhejiang), College of Materials and Textiles, Zhejiang Sci-Tech University; Hangzhou 310018 China
| | - Yurong Cai
- The Key Laboratory of Advanced Textile Materials and Manufacturing Technology of Ministry of Education, National Engineering Lab for Textile Fiber Materials and Processing Technology(Zhejiang), College of Materials and Textiles, Zhejiang Sci-Tech University; Hangzhou 310018 China
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113
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Makhni MC, Caldwell JME, Saifi C, Fischer CR, Lehman RA, Lenke LG, Lee FY. Tissue engineering advances in spine surgery. Regen Med 2016; 11:211-22. [DOI: 10.2217/rme.16.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Autograft, while currently the gold standard for bone grafting, has several significant disadvantages including limited supply, donor site pain, hematoma formation, nerve and vascular injury, and fracture. Bone allografts have their own disadvantages including reduced osteoinductive capability, lack of osteoprogenitor cells, immunogenicity and risk of disease transmission. Thus demand exists for tissue-engineered constructs that can produce viable bone while avoiding the complications associated with human tissue grafts. This review will focus on recent advancements in tissue-engineered bone graft substitutes utilizing nanoscale technology in spine surgery applications. An evaluation will be performed of bone graft substitutes, biomimetic 3D scaffolds, bone morphogenetic protein, mesenchymal stem cells and intervertebral disc regeneration strategies.
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Affiliation(s)
- Melvin C Makhni
- Department of Orthopedic Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | - Jon-Michael E Caldwell
- Department of Orthopedic Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | - Comron Saifi
- The Spine Hospital, Department of Orthopedic Surgery, New York-Presbyterian Healthcare System, Columbia University Medical Center, 5141 Broadway, New York, NY 10034, USA
| | - Charla R Fischer
- The Spine Hospital, Department of Orthopedic Surgery, New York-Presbyterian Healthcare System, Columbia University Medical Center, 5141 Broadway, New York, NY 10034, USA
| | - Ronald A Lehman
- Department of Orthopedic Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | - Lawrence G Lenke
- The Spine Hospital, Department of Orthopedic Surgery, New York-Presbyterian Healthcare System, Columbia University Medical Center, 5141 Broadway, New York, NY 10034, USA
| | - Francis Y Lee
- Department of Orthopedic Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
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114
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Masaoka T, Yamada T, Yuasa M, Yoshii T, Okawa A, Morita S, Kozaka Y, Hirano M, Sotome S. Biomechanical evaluation of the rabbit tibia after implantation of porous hydroxyapatite/collagen in a rabbit model. J Orthop Sci 2016; 21:230-6. [PMID: 26778623 DOI: 10.1016/j.jos.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/05/2015] [Accepted: 11/30/2015] [Indexed: 02/09/2023]
Abstract
PURPOSE Porous hydroxyapatite/collagen composite (HAp/Col) is an artificial bone substitute with excellent osteoconduction and sponge-like elasticity. However, the porosity of porous HAp/Col is as high as 95% and its mechanical strength is very poor. The aim of this study was to biomechanically analyze sites implanted with porous HAp/Col. METHODS Rectangular cortical bone defects (3 × 8 mm) were made in the tibia of rabbits and filled with porous HAp/Col or porous β-tricalcium phosphate or left vacant. The tibia was harvested at 4 or 12 weeks after surgery. The harvested specimens were analyzed using a micro-CT system, and the mechanical strength of the specimens was examined by torsion testing. RESULTS Quantitative micro-CT analysis of the regenerated bone revealed that both bone substitutes equally facilitated bone regeneration. Biomechanical testing demonstrated that the torsional strength of HAp/Col-implanted sites was higher than that of the control (vs control: p = 0.030 and vs β-TCP: p = 0.056). CONCLUSIONS The results indicate that porous HAp/Col implantation is an effective strategy for recovery of the mechanical strength of bone defects.
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Affiliation(s)
- Tomokazu Masaoka
- Department of Orthopaedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan; Department of Rehabilitation Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopaedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan
| | - Masato Yuasa
- Department of Orthopaedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan
| | - Sadao Morita
- Department of Rehabilitation Medicine, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, Japan
| | - Yuko Kozaka
- HOYA Technosurgical Corporation, 4-28-4 Yotsuya Shinjuku-ku, Tokyo, Japan
| | - Masahiro Hirano
- HOYA Technosurgical Corporation, 4-28-4 Yotsuya Shinjuku-ku, Tokyo, Japan
| | - Shinichi Sotome
- Department of Orthopaedic Research and Development, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-8519, Japan.
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115
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Mullan CJ, Pagoti R, Davison H, McAlinden MG. An audit of consent for allograft use in elective orthopaedic surgery. Ann R Coll Surg Engl 2016; 98:254-7. [PMID: 26924483 DOI: 10.1308/rcsann.2016.0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons.
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Affiliation(s)
| | - R Pagoti
- Musgrave Park Hospital , Belfast , UK
| | - H Davison
- Musgrave Park Hospital , Belfast , UK
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116
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Komatsu K, Shibata T, Shimada A, Ideno H, Nakashima K, Tabata Y, Nifuji A. Cationized gelatin hydrogels mixed with plasmid DNA induce stronger and more sustained gene expression than atelocollagen at calvarial bone defects in vivo. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2016; 27:419-30. [PMID: 26848778 DOI: 10.1080/09205063.2016.1139486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gene transduction of exogenous factors at local sites in vivo is a promising approach to promote regeneration of tissue defects owing to its simplicity and capacity for expression of a variety of genes. Gene transduction by viral vectors is highly efficient; however, there are safety concerns associated with viruses. As a method for nonviral gene transduction, plasmid DNA delivery is safer and simpler, but requires an efficient carrier substance. Here, we aimed to develop a simple, efficient method for bone regeneration by gene transduction and to identify optimal conditions for plasmid DNA delivery at bone defect sites. We focused on carrier substances and compared the efficiencies of two collagen derivatives, atelocollagen, and gelatin hydrogel, as substrates for plasmid DNA delivery in vivo. To assess the efficiencies of these substrates, we examined exogenous expression of green fluorescence protein (GFP) by fluorescence microscopy, polymerase chain reaction, and immunohistochemistry. GFP expression at the bone defect site was higher when gelatin hydrogel was used as a substrate to deliver plasmids than when atelocollagen was used. Moreover, the gelatin hydrogel was almost completely absorbed at the defect site, whereas some atelocollagen remained. When a plasmid harboring bone morphogenic protein 2 was delivered with the substrate to bony defect sites, more new bone formation was observed in the gelatin group than in the atelocollagen group. These results suggested that the gelatin hydrogel was more efficient than atelocollagen as a substrate for local gene delivery and may be a superior material for induction of bone regeneration.
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Affiliation(s)
- K Komatsu
- a Department of Pharmacology , Tsurumi University School of Dental Medicine , Yokohama , Japan
| | - T Shibata
- a Department of Pharmacology , Tsurumi University School of Dental Medicine , Yokohama , Japan
| | - A Shimada
- a Department of Pharmacology , Tsurumi University School of Dental Medicine , Yokohama , Japan
| | - H Ideno
- a Department of Pharmacology , Tsurumi University School of Dental Medicine , Yokohama , Japan
| | - K Nakashima
- a Department of Pharmacology , Tsurumi University School of Dental Medicine , Yokohama , Japan
| | - Y Tabata
- b Department of Biomaterials, Field of Tissue Engineering, Institute for Frontier Medical Sciences , Kyoto University , Kyoto , Japan
| | - A Nifuji
- a Department of Pharmacology , Tsurumi University School of Dental Medicine , Yokohama , Japan
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Montazerolghaem M, Ning Y, Engqvist H, Karlsson Ott M, Tenje M, Mestres G. Simvastatin and zinc synergistically enhance osteoblasts activity and decrease the acute response of inflammatory cells. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:23. [PMID: 26704540 DOI: 10.1007/s10856-015-5639-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/27/2015] [Indexed: 06/05/2023]
Abstract
Several ceramic biomaterials have been suggested as promising alternatives to autologous bone to replace or restore bone after trauma or disease. The osteoinductive potential of most scaffolds is often rather low by themselves and for this reason growth factors or drugs have been supplemented to these synthetic materials. Although some growth factors show good osteoinductive potential their drawback is their high cost and potential severe side effects. In this work the combination of the well-known drug simvastatin (SVA) and the inorganic element Zinc (Zn) is suggested as a potential additive to bone grafts in order to increase their bone regeneration/formation. MC3T3-E1 cells were cultured with Zn (10 and 25 µM) and SVA (0.25 and 0.4 µM) for 10 days to evaluate proliferation and differentiation, and for 22 days to evaluate secretion of calcium deposits. The combination of Zn (10 µM) and SVA (0.25 µM) significantly enhanced cell differentiation and mineralization in a synergetic manner. In addition, the release of reactive oxygen species (ROS) from primary human monocytes in contact with the same concentrations of Zn and SVA was evaluated by chemiluminescence. The combination of the additives decreased the release of ROS, although Zn and SVA separately caused opposite effects. This work shows that a new combination of additives can be used to increase the osteoinductive capacity of porous bioceramics.
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Affiliation(s)
| | - Yi Ning
- Department Engineering Sciences, Uppsala University, Uppsala, Sweden
| | - Håkan Engqvist
- Department Engineering Sciences, Uppsala University, Uppsala, Sweden
| | - Marjam Karlsson Ott
- Department Engineering Sciences, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Uppsala, Sweden
| | - Maria Tenje
- Department Engineering Sciences, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Uppsala, Sweden
- Department Biomedical Engineering, Lund University, Lund, Sweden
| | - Gemma Mestres
- Department Engineering Sciences, Uppsala University, Uppsala, Sweden.
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118
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Mondal D, Griffith M, Venkatraman SS. Polycaprolactone-based biomaterials for tissue engineering and drug delivery: Current scenario and challenges. INT J POLYM MATER PO 2016. [DOI: 10.1080/00914037.2015.1103241] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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119
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Zhao F, Zhang W, Fu X, Xie W, Chen X. Fabrication and characterization of bioactive glass/alginate composite scaffolds by a self-crosslinking processing for bone regeneration. RSC Adv 2016. [DOI: 10.1039/c6ra18309c] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Bioactive glass/alginate composite scaffolds were fabricated through a self-crosslinking process by bioactive glass microspheres provided Ca2+completely.
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Affiliation(s)
- Fujian Zhao
- Department of Biomedical Engineering
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Wen Zhang
- Department of Biomedical Engineering
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Xiaoling Fu
- Department of Biomedical Engineering
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Weihan Xie
- Department of Biomedical Engineering
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
| | - Xiaofeng Chen
- Department of Biomedical Engineering
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
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120
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Van Lieshout EMM, Alt V. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence? Injury 2016; 47 Suppl 1:S43-6. [PMID: 26768291 DOI: 10.1016/s0020-1383(16)30011-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substitutes are often used for stabilizing the implant and for providing a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials are available. Products generally contain hydroxyapatite, tricalcium phosphate, dicalcium phosphate, calcium phosphate cement, calcium sulfate (plaster of Paris), or combinations of the above. Products have been used for the treatment of osteoporotic fractures of the proximal humerus, distal radius, vertebra, hip, and tibia plateau. Although there is generally consensus that screw augmentation increased the biomechanical properties and implant stability, the results of using these products for void filling are not unequivocal. In osteoporotic patients, Bone Morphogenetic Proteins (BMPs) have the potential impact to improve fracture healing by augmenting the impaired molecular and cellular mechanisms. However, the clinical evidence on the use of BMPs in patients with osteoporotic fractures is poor as there are no published clinical trials, case series or case studies. Even pre-clinical literature on in vitro and in vivo data is weak as most articles focus on the beneficial role for BMPs for restoration of the underlying pathophysiological factors of osteoporosis but do not look at the specific effects on osteoporotic fracture healing. Limited data on animal experiments suggest stimulation of fracture healing in ovariectomized rats by the use of BMPs. In conclusion, there is only limited data on the clinical relevance and optimal indications for the use of bone graft substitute materials and BMPs on the treatment of osteoporotic fractures despite the clinical benefits of these materials in other clinical indications. Given the general compromised outcome in osteoporotic fractures and limited alternatives for enhancement of fracture healing, clinicians and researchers should focus on this important topic and provide more data in this field in order to enable a sound clinical use of these materials in osteoporotic fractures.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Volker Alt
- Department of Trauma, Hand and Reconstructive Surgery Giessen University Hospital Giessen-Marburg, Campus Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany.
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121
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Jia W, Lau GY, Huang W, Zhang C, Tomsia AP, Fu Q. Bioactive Glass for Large Bone Repair. Adv Healthc Mater 2015; 4:2842-8. [PMID: 26582584 DOI: 10.1002/adhm.201500447] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/12/2015] [Indexed: 12/11/2022]
Abstract
There has been an ongoing quest for new biomedical materials for the repair and regeneration of large segmental bone defects caused by disease or trauma. Autologous bone graft (ABG) remains the gold standard for bone repair despite their limited supply and donor-site morbidity. The current tissue engineering approach with synthetically derived bone grafts requires a bioactive ceramic or polymeric scaffold loaded with growth factors for osteoinduction and angiogenesis, and bone marrow stromal cells (BMSCs) for osteogenic properties. Unfortunately, this approach has serious drawbacks: the low mechanical strength of scaffolds, the high cost of growth factors, and a lack of optimal strategies for growth-factor delivery. Here, it is shown that, for the first time, a synthetic material alone can repair large bone defects as efficiently as the gold standard ABG. Through the use of strong and resorbable bioactive glass scaffolds, complete bone healing, and defect bridging can be achieved in a rabbit femur segmental defect model without growth factors or BMSCs. New bone and blood vessel formation, in both inner and peripheral scaffolds, demonstrates the excellent osteoinductive and osteogenic properties of these scaffolds similar as ABG.
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Affiliation(s)
- Weitao Jia
- Department of Orthopaedic Surgery; Shanghai Jiaotong University; Affiliated Sixth People's Hospital; Shanghai 200233 China
| | - Grace Y. Lau
- Materials Sciences Division; Lawrence Berkeley National Laboratory; Berkeley CA 94720 USA
| | - Wenhai Huang
- Department of Materials Science and Engineering; Institute of Bioengineering and Information Technology Materials; Tongji University; Shanghai 200092 China
| | - Changqing Zhang
- Department of Orthopaedic Surgery; Shanghai Jiaotong University; Affiliated Sixth People's Hospital; Shanghai 200233 China
| | - Antoni P. Tomsia
- Materials Sciences Division; Lawrence Berkeley National Laboratory; Berkeley CA 94720 USA
| | - Qiang Fu
- Materials Sciences Division; Lawrence Berkeley National Laboratory; Berkeley CA 94720 USA
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122
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Fountain S, Windolf M, Henkel J, Tavakoli A, Schuetz MA, Hutmacher DW, Epari DR. Monitoring Healing Progression and Characterizing the Mechanical Environment in Preclinical Models for Bone Tissue Engineering. TISSUE ENGINEERING PART B-REVIEWS 2015; 22:47-57. [PMID: 26507933 DOI: 10.1089/ten.teb.2015.0123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The treatment of large segmental bone defects remains a significant clinical challenge. Due to limitations surrounding the use of bone grafts, tissue-engineered constructs for the repair of large bone defects could offer an alternative. Before translation of any newly developed tissue engineering (TE) approach to the clinic, efficacy of the treatment must be shown in a validated preclinical large animal model. Currently, biomechanical testing, histology, and microcomputed tomography are performed to assess the quality and quantity of the regenerated bone. However, in vivo monitoring of the progression of healing is seldom performed, which could reveal important information regarding time to restoration of mechanical function and acceleration of regeneration. Furthermore, since the mechanical environment is known to influence bone regeneration, and limb loading of the animals can poorly be controlled, characterizing activity and load history could provide the ability to explain variability in the acquired data sets and potentially outliers based on abnormal loading. Many approaches have been devised to monitor the progression of healing and characterize the mechanical environment in fracture healing studies. In this article, we review previous methods and share results of recent work of our group toward developing and implementing a comprehensive biomechanical monitoring system to study bone regeneration in preclinical TE studies.
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Affiliation(s)
| | - Markus Windolf
- 1 Queensland University of Technology , Brisbane, Australia .,2 AO Research Institute Davos , Davos, Switzerland
| | - Jan Henkel
- 1 Queensland University of Technology , Brisbane, Australia
| | | | - Michael A Schuetz
- 1 Queensland University of Technology , Brisbane, Australia .,3 Trauma Service, Princess Alexandra Hospital , Brisbane, Australia
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Longo F, Finotti L, Bellini L, Zavan B, Busetto R, Isola M. Bovine xenograft application for treatment of a metatarsal nonunion fracture in an alpaca (Vicugna pacos). N Z Vet J 2015; 64:188-92. [PMID: 26617346 DOI: 10.1080/00480169.2015.1125810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CASE HISTORY A 15-year-old female huacaya alpaca (Vicugna pacos) was referred because of a non-weight-bearing lameness (4/4) in the left pelvic limb caused by a grade three open metatarsal fracture. The referring veterinarian treated the fracture with conservative management using bandages, but it progressively evolved to a non-union. CLINICAL FINDINGS AND DIAGNOSIS Clinical examination revealed external wounds on the medial and lateral surfaces of the metatarsus. Radiographs confirmed an open, nonarticular, displaced, diaphyseal fracture of the left metatarsus. TREATMENT AND OUTCOME Cancellous bone was sourced from bovine proximal and distal femur epiphyses, followed by a thermal shock procedure to achieve decellularisation, to produce a xenograft. Open reduction and internal fixation of the fracture using locking plates was performed. Alignment of the fracture fragments was corrected and the xenograft was placed at the debrided fracture site to stimulate and harness osteogenesis in situ. Clinical and radiographic follow-up was performed up to 40 weeks postoperatively. Clinical evaluations revealed that the alpaca gradually increased weight bearing following bandage removal 10 days after surgery. Serial radiographs showed correct alignment of the left metatarsus, progressive bone modelling and, complete bone union at 12 weeks. Ten months postoperatively the alpaca showed no signs of lameness and resumed normal activity. CLINICAL RELEVANCE For management of a metatarsal non-union, a combination of bovine xenograft application and angular stable internal fixation progressed toward an excellent long-term recovery.
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Affiliation(s)
- F Longo
- a Department of Animal Medicine, Productions and Health , Institute of Veterinary Medicine, University of Padova , Agripolis (Padova) 35020 , Italy
| | - L Finotti
- a Department of Animal Medicine, Productions and Health , Institute of Veterinary Medicine, University of Padova , Agripolis (Padova) 35020 , Italy
| | - L Bellini
- a Department of Animal Medicine, Productions and Health , Institute of Veterinary Medicine, University of Padova , Agripolis (Padova) 35020 , Italy
| | - B Zavan
- b Department of Biomedical Sciences , Institute of Biology, University of Padova , Padova 35129 , Italy
| | - R Busetto
- a Department of Animal Medicine, Productions and Health , Institute of Veterinary Medicine, University of Padova , Agripolis (Padova) 35020 , Italy
| | - M Isola
- a Department of Animal Medicine, Productions and Health , Institute of Veterinary Medicine, University of Padova , Agripolis (Padova) 35020 , Italy
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Fu YC, Wang YH, Chen CH, Wang CK, Wang GJ, Ho ML. Combination of calcium sulfate and simvastatin-controlled release microspheres enhances bone repair in critical-sized rat calvarial bone defects. Int J Nanomedicine 2015; 10:7231-40. [PMID: 26664114 PMCID: PMC4671780 DOI: 10.2147/ijn.s88134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Most allogenic bone graft substitutes have only osteoconductive properties. Developing new strategies to improve the osteoinductive activity of bone graft substitutes is both critical and practical for clinical application. Previously, we developed novel simvastatin-encapsulating poly(lactic-co-glycolic acid) microspheres (SIM/PLGA) that slowly release simvastatin and enhance fracture healing. In this study, we combined SIM/PLGA with a rapidly absorbable calcium sulfate (CS) bone substitute and studied the effect on bone healing in critical-sized calvarial bone defects in a rat model. The cytotoxicity and cytocompatibility of this combination was tested in vitro using lactate dehydrogenase leakage and a cell attachment assay, respectively. Combination treatment with SIM/PLGA and the CS bone substitute had no cytotoxic effect on bone marrow stem cells. Compared with the control, cell adhesion was substantially enhanced following combination treatment with SIM/PLGA and the CS bone substitute. In vivo, implantation of the combination bone substitute promoted healing of critical-sized calvarial bone defects in rats; furthermore, production of bone morphogenetic protein-2 and neovascularization were enhanced in the area of the defect. In summary, the combination of SIM/PLGA and a CS bone substitute has osteoconductive and osteoinductive properties, indicating that it could be used for regeneration of bone in the clinical setting.
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Affiliation(s)
- Yin-Chih Fu
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan ; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Orthopaedics, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yan-Hsiung Wang
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan ; School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hwan Chen
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Orthopaedics, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Kuang Wang
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gwo-Jaw Wang
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Orthopaedics, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Ling Ho
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Orthopaedics, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Physiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
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Calori GM, Colombo M, Bucci M, Mazza EL, Fadigati P, Mazzola S. Clinical effectiveness of Osigraft in long-bones non-unions. Injury 2015; 46 Suppl 8:S55-64. [PMID: 26747920 DOI: 10.1016/s0020-1383(15)30056-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Current evidence, based primarily on case series, suggest that the eptotermin alfa (recombinant bone morphogenetic protein-7 (rhBM-7)), which is commercialized as Osigraft with an indication for tibial non-union, used in monotherapy or polytherapy, is a safe and effective therapy for long bones non-unions of lower and upper limbs. No previous study has compared the safety and the efficacy of Osigraft and the "gold standard" treatment for recalcitrant long-bones non-union, autologous bone graft (ABG). This study aims to compare the effectiveness of Osigraft and ABG in the treatment of post-traumatic, persistent long bone non-unions. In particular, the present study will focus exclusively on complex persistent non-unions, excluding simpler cases, in which it is likely that a simple revision of the osteosynthesis will be sufficient to promote union, and extremely severe cases in which there is an indication for amputation and prosthesis. The study addresses the following research question: 1. Is the effectiveness of eptotermin alfa comparable to that of ABG in the treatment of complex long bone non-unions? 2. Are there significant differences in the prevalence of adverse events between patients treated with eptotermin alfa and those treated with ABG? The study is an observational, retrospective study, located in one Experimental Recruiting Center (Ospedale Universitario G. PINI - Milano). The study was conducted with ethics approval and according with the existing Italian law. Demographic and clinical data were collected from patients Clinical Medical Records and other existing documentation, through a web based eCRF. The treatment (surgery with Osigraft or ABG) effectiveness was evaluated comparing the number of success cases (primary endpoint) and the length for clinical and radiological healing (secondary end-points). The treatment safety was evaluating comparing the prevalence of Adverse Events. Osigraft was demonstrated to be statistically equivalent to ABG with respect to the primary and secondary end point of surgical success. The treatment success was statistically comparable across all the anatomical regions considered, both in patients treated with Osigraft and in patients treated with ABG. The use of Osigraft when compared to autograft was associated with statistically lower intraoperative blood loss and shorter operative times. In addition patients treated with Osigraft developed statistically less peri-operative and late onset adverse events, compared to ABG. The difference was substantially due to the occurrence of pain at donor site in patients treated with ABG.
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Affiliation(s)
- Giorgio Maria Calori
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy.
| | - Massimiliano Colombo
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Miguel Bucci
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Emilio Luigi Mazza
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Piero Fadigati
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Simone Mazzola
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
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Cecchinato F, Agha NA, Martinez-Sanchez AH, Luthringer BJC, Feyerabend F, Jimbo R, Willumeit-Römer R, Wennerberg A. Influence of Magnesium Alloy Degradation on Undifferentiated Human Cells. PLoS One 2015; 10:e0142117. [PMID: 26600388 PMCID: PMC4658158 DOI: 10.1371/journal.pone.0142117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/16/2015] [Indexed: 01/11/2023] Open
Abstract
Background Magnesium alloys are of particular interest in medical science since they provide compatible mechanical properties with those of the cortical bone and, depending on the alloying elements, they have the capability to tailor the degradation rate in physiological conditions, providing alternative bioresorbable materials for bone applications. The present study investigates the in vitro short-term response of human undifferentiated cells on three magnesium alloys and high-purity magnesium (Mg). Materials and Methods The degradation parameters of magnesium-silver (Mg2Ag), magnesium-gadolinium (Mg10Gd) and magnesium-rare-earth (Mg4Y3RE) alloys were analysed after 1, 2, and 3 days of incubation in cell culture medium under cell culture condition. Changes in cell viability and cell adhesion were evaluated by culturing human umbilical cord perivascular cells on corroded Mg materials to examine how the degradation influences the cellular development. Results and Conclusions The pH and osmolality of the medium increased with increasing degradation rate and it was found to be most pronounced for Mg4Y3RE alloy. The biological observations showed that HUCPV exhibited a more homogeneous cell growth on Mg alloys compared to high-purity Mg, where they showed a clustered morphology. Moreover, cells exhibited a slightly higher density on Mg2Ag and Mg10Gd in comparison to Mg4Y3RE, due to the lower alkalinisation and osmolality of the incubation medium. However, cells grown on Mg10Gd and Mg4Y3RE generated more developed and healthy cellular structures that allowed them to better adhere to the surface. This can be attributable to a more stable and homogeneous degradation of the outer surface with respect to the incubation time.
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Affiliation(s)
| | | | | | | | | | - Ryo Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö, Sweden
| | | | - Ann Wennerberg
- Department of Prosthodontics, Faculty of Odontology, Malmö, Sweden
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127
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The Effect of Alendronate Loaded Biphasic Calcium Phosphate Scaffolds on Bone Regeneration in a Rat Tibial Defect Model. Int J Mol Sci 2015; 16:26738-53. [PMID: 26561810 PMCID: PMC4661841 DOI: 10.3390/ijms161125982] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 10/22/2015] [Accepted: 10/27/2015] [Indexed: 01/02/2023] Open
Abstract
This study investigated the effect of alendronate (Aln) released from biphasic calcium phosphate (BCP) scaffolds. We evaluated the in vitro osteogenic differentiation of Aln/BCP scaffolds using MG-63 cells and the in vivo bone regenerative capability of Aln/BCP scaffolds using a rat tibial defect model with radiography, micro-computed tomography (CT), and histological examination. In vitro studies included the surface morphology of BCP and Aln-loaded BCP scaffolds visualized using field-emission scanning electron microscope, release kinetics of Aln from BCP scaffolds, alkaline phosphatase (ALP) activity, calcium deposition, and gene expression. The in vitro studies showed that sustained release of Aln from the BCP scaffolds consisted of porous microstructures, and revealed that MG-63 cells cultured on Aln-loaded BCP scaffolds showed significantly increased ALP activity, calcium deposition, and gene expression compared to cells cultured on BCP scaffolds. The in vivo studies using radiograph and histology examination revealed abundant callus formation and bone maturation at the site in the Aln/BCP groups compared to the control group. However, solid bony bridge formation was not observed at plain radiographs until 8 weeks. Micro-CT analysis revealed that bone mineral density and bone formation volume were increased over time in an Aln concentration-dependent manner. These results suggested that Aln/BCP scaffolds have the potential for controlling the release of Aln and enhance bone formation and mineralization.
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128
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Tao ZS, Zhou WS, Tu KK, Huang ZL, Zhou Q, Sun T, Lv YX, Cui W, Yang L. Effect exerted by Teriparatide upon Repair Function of β-tricalcium phosphate to ovariectomised rat's femoral metaphysis defect caused by osteoporosis. Injury 2015; 46:2134-41. [PMID: 26306803 DOI: 10.1016/j.injury.2015.07.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/11/2015] [Accepted: 07/28/2015] [Indexed: 02/02/2023]
Abstract
In this study, we tested the effect of Teriparatide (PTH) in combination with β-tricalcium phosphate (β-TCP) as a bone void filler in an ovariectomised rat distal femoral metaphysis model.β-TCP is a completely resorbable synthetic calcium phosphate and the Teriparatide is a drug that can promote bone formation in the condition of osteoporosis. A critical size defect of 3mm in diameter, a through-hole bone defect, was drilled into each distal femur of the ovariectomised rats. The hole was filled with β-TCP and the rat was injected PTH Teriparatide (30μg/kg) in peritoneum 5 times per week. After 4and 8 weeks the animals were killed and the degree of bone healing analysed. In total, 60 animals were investigated. When the β-TCP and PTH were used, histological, biochemistry and histomor-phometric evaluations revealed significantly better bone healing in terms of quantity and quality of the newly formed bone. The Ovariectomised rats which suffer from femur metaphysis defect are cured by embedding β-tricalcuim phosphate and intermittently cured by parathyroid hormone (PTH).
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Affiliation(s)
- Zhou-Shan Tao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou 325027, Zhejiang, China
| | - Wan-Shu Zhou
- Endocrine & Metabolic Diseases Unit, Affiliated Hospital of Guizhou Medcial University, Guizhou 550001, China
| | - Kai-kai Tu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou 325027, Zhejiang, China
| | - Zheng-Liang Huang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou 325027, Zhejiang, China
| | - Qiang Zhou
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou 325027, Zhejiang, China
| | - Tao Sun
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou 325027, Zhejiang, China
| | - Yang-Xun Lv
- Department of Orthopaedic Surgery, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang, China
| | - Wei Cui
- Sichuan Provincial Orthopedics Hospital, No. 132 West First Section First Ring Road, Chengdu 610000, Sichuan, China
| | - Lei Yang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou 325027, Zhejiang, China.
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129
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Combined treatment with parathyroid hormone (1–34) and beta-tricalcium phosphate had an additive effect on local bone formation in a rat defect model. Med Biol Eng Comput 2015; 54:1353-62. [DOI: 10.1007/s11517-015-1402-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
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130
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Cerci DX, Portela GS, Cunha EJ, Grossi JRDA, Zielak JC, Araújo MR, Scariot R, Deliberador TM, Giovanini AF. Leukocyte-platelet-rich plasma diminishes bone matrix deposition in rat calvaria treated with autograft due to simultaneous increase in immunohistochemical expression of Indian Hedgehog, transforming growth factor-β, and parathyroid-1 receptor. J Craniomaxillofac Surg 2015. [DOI: 10.1016/j.jcms.2015.06.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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131
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Tao ZS, Zhou WS, Tu KK, Huang ZL, Zhou Q, Sun T, Lv YX, Cui W, Yang L. Treatment study of distal femur for parathyroid hormone (1-34) and β-tricalcium phosphate on bone formation in critical-sized defects in osteopenic rats. J Craniomaxillofac Surg 2015; 43:2136-43. [PMID: 26507646 DOI: 10.1016/j.jcms.2015.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/12/2015] [Accepted: 09/17/2015] [Indexed: 12/11/2022] Open
Abstract
The objective of this study was to evaluate the effect of following combined treatment with parathyroid hormone (1-34) (PTH) and β-tricalcium phosphate (β-TCP) on local bone formation in a rat 3-mm critical-sized defect at the distal femur. Fourteen weeks were allowed to pass before defect surgery for the establishment of osteopenic animal models chronically fed a low-protein diet. All animals were randomly divided into four groups: group PTH; group β-TCP, group PTH + β-TCP, and a control group. All rats then underwent a surgical procedure to create bone defects in the bilateral distal femurs, and β-TCP was implanted into critical-sized defects for the groups designated as β-TCP and group PTH + β-TCP. After the defect operation, all animals from group PTH and group PTH + β-TCP received following subcutaneous injections with PTH (60 μg/kg, three times per week) until euthanasia at 4 and 8 weeks. The distal femurs and blood were collected for evaluation. The results of study showed the strongest effect on accelerating the local bone formation with treatment β-TCP and PTH at 4 weeks and 8 weeks. The results from our study demonstrate that a combination of PTH and β-TCP had an additive effect on local bone formation in osteopenic rats chronically fed a low-protein diet.
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Affiliation(s)
- Zhou-Shan Tao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou, Zhejiang, 325027, China
| | - Wan-Shu Zhou
- Endocrine & Metabolic Diseases Unit, Affiliated Hospital of Guizhou Medical University, Guizhou, 550001, China
| | - Kai-kai Tu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou, Zhejiang, 325027, China
| | - Zheng-Liang Huang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou, Zhejiang, 325027, China
| | - Qiang Zhou
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou, Zhejiang, 325027, China
| | - Tao Sun
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou, Zhejiang, 325027, China
| | - Yang-Xun Lv
- Department of Orthopaedic Surgery, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China
| | - Wei Cui
- Sichuan Provincial Orthopedics Hospital, NO. 132 West First Section First Ring Road, Chengdu, Sichuan, 610000, China
| | - Lei Yang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Xi Road, Wenzhou, Zhejiang, 325027, China.
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Repair of Cranial Bone Defects Using rhBMP2 and Submicron Particle of Biphasic Calcium Phosphate Ceramics with Through-Hole. BIOMED RESEARCH INTERNATIONAL 2015; 2015:926291. [PMID: 26491693 PMCID: PMC4600556 DOI: 10.1155/2015/926291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/24/2015] [Indexed: 11/17/2022]
Abstract
Recently a submicron particle of biphasic calcium phosphate ceramic (BCP) with through-hole (donut-shaped BCP (d-BCP)) was developed for improving the osteoconductivity. This study was performed to examine the usefulness of d-BCP for the delivery of osteoinductive rhBMP2 and the effectiveness on cranial bone regeneration. The d-BCP was soaked in rhBMP2 solution and then freeze-dried. Scanning electron microscope (SEM), energy dispersive spectroscopy (EDS), and Raman spectroscopy analyses confirmed that rhBMP2 was well delivered onto the d-BCP surface and the through-hole. The bioactivity of the rhBMP2/d-BCP composite was validated in MC3T3-E1 cells as an in vitro model and in critical-sized cranial defects in C57BL/6 mice. When freeze-dried d-BCPs with rhBMP2 were placed in transwell inserts and suspended above MC3T3-E1, alkaline phosphatase activity and osteoblast-specific gene expression were increased compared to non-rhBMP2-containing d-BCPs. For evaluating in vivo effectiveness, freeze-dried d-BCPs with or without rhBMP2 were implanted into critical-sized cranial defects. Microcomputed tomography and histologic analysis showed that rhBMP2-containing d-BCPs significantly enhanced cranial bone regeneration compared to non-rhBMP2-containing control. These results suggest that a combination of d-BCP and rhBMP2 can accelerate bone regeneration, and this could be used to develop therapeutic strategies in hard tissue healing.
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133
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Mattioli-Belmonte M, Teti G, Salvatore V, Focaroli S, Orciani M, Dicarlo M, Fini M, Orsini G, Di Primio R, Falconi M. Stem cell origin differently affects bone tissue engineering strategies. Front Physiol 2015; 6:266. [PMID: 26441682 PMCID: PMC4585109 DOI: 10.3389/fphys.2015.00266] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/09/2015] [Indexed: 12/22/2022] Open
Abstract
Bone tissue engineering approaches are encouraging for the improvement of conventional bone grafting technique drawbacks. Thanks to their self-renewal and multi-lineage differentiation ability, stem cells are one of the major actors in tissue engineering approaches, and among these adult mesenchymal stem cells (MSCs) hold a great promise for regenerative medicine strategies. Bone marrow MSCs (BM-MSCs) are the first- identified and well-recognized stem cell population used in bone tissue engineering. Nevertheless, several factors hamper BM-MSC clinical application and subsequently, new stem cell sources have been investigated for these purposes. The fruitful selection and combination of tissue engineered scaffold, progenitor cells, and physiologic signaling molecules allowed the surgeon to reconstruct the missing natural tissue. On the basis of these considerations, we analyzed the capability of two different scaffolds, planned for osteochondral tissue regeneration, to modulate differentiation of adult stem cells of dissimilar local sources (i.e., periodontal ligament, maxillary periosteum) as well as adipose-derived stem cells (ASCs), in view of possible craniofacial tissue engineering strategies. We demonstrated that cells are differently committed toward the osteoblastic phenotype and therefore, taking into account their specific features, they could be intriguing cell sources in different stem cell-based bone/periodontal tissue regeneration approaches.
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Affiliation(s)
- Monica Mattioli-Belmonte
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche Ancona, Italy
| | - Gabriella Teti
- Department of Biomedical and Neuromotor Sciences, University of Bologna Bologna, Italy
| | - Viviana Salvatore
- Department of Biomedical and Neuromotor Sciences, University of Bologna Bologna, Italy
| | - Stefano Focaroli
- Department of Biomedical and Neuromotor Sciences, University of Bologna Bologna, Italy
| | - Monia Orciani
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche Ancona, Italy
| | - Manuela Dicarlo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche Ancona, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute Bologna, Italy
| | - Giovanna Orsini
- Department of Clinical Sciences and Stomatology, Università Politecnica delle Marche Ancona, Italy
| | - Roberto Di Primio
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche Ancona, Italy
| | - Mirella Falconi
- Department of Biomedical and Neuromotor Sciences, University of Bologna Bologna, Italy
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134
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Papanagiotou M, Dailiana ZH, Karachalios T, Varitimidis S, Vlychou M, Hantes M, Malizos KN. RhBMP-7 for the treatment of nonunion of fractures of long bones. Bone Joint J 2015; 97-B:997-1003. [PMID: 26130359 DOI: 10.1302/0301-620x.97b7.35089] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report the outcome of 84 nonunions involving long bones which were treated with rhBMP-7, in 84 patients (60 men: 24 women) with a mean age 46 years (18 to 81) between 2003 and 2011. The patients had undergone a mean of three previous operations (one to 11) for nonunion which had been present for a mean of 17 months (4 months to 20 years). The nonunions involved the lower limb in 71 patients and the remainder involved the upper limb. A total of 30 nonunions were septic. Treatment was considered successful when the nonunion healed without additional procedures. The relationship between successful union and the time to union was investigated and various factors including age and gender, the nature of the nonunion (location, size, type, chronicity, previous procedures, infection, the condition of the soft tissues) and type of index procedure (revision of fixation, type of graft, amount of rhBMP-7) were analysed. The improvement of the patients' quality of life was estimated using the Short Form (SF) 12 score. A total of 68 nonunions (80.9%) healed with no need for further procedures at a mean of 5.4 months (3 to 10) post-operatively. Multivariate logistic regression analysis of the factors affecting union suggested that only infection significantly affected the rate of union (p = 0.004).Time to union was only affected by the number of previous failed procedures (p = 0.006). An improvement of 79% and 32.2% in SF-12 physical and mental score, respectively, was noted within the first post-operative year. Rh-BMP-7 combined with bone grafts, enabled healing of the nonunion and improved quality of life in about 80% of patients. Aseptic nonunions were much more likely to unite than septic ones. The number of previous failed operations significantly delayed the time to union.
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Affiliation(s)
- M Papanagiotou
- University of Thessalia, 3 Panepistimiou Street, Biopolis 41500 Larissa, Greece
| | - Z H Dailiana
- University of Thessalia, 3 Panepistimiou Street, Biopolis 41500 Larissa, Greece
| | - T Karachalios
- University of Thessalia, 3 Panepistimiou Street, Biopolis 41500 Larissa, Greece
| | - S Varitimidis
- University of Thessalia, 3 Panepistimiou Street, Biopolis 41500 Larissa, Greece
| | - M Vlychou
- University of Thessalia, 3 Panepistimiou Street, Biopolis 41500 Larissa, Greece
| | - M Hantes
- University of Thessalia, 3 Panepistimiou Street, Biopolis 41500 Larissa, Greece
| | - K N Malizos
- University of Thessalia, 3 Panepistimiou Street, Biopolis 41500 Larissa, Greece
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135
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Alves E, Serakides R, Rosado I, Varon J, Paez O, Machado F, Fukushima F, Pereira M, Rezende C. Matriz porosa do BV60S no tratamento de defeitos ósseos críticosem rádios de cães. ARQ BRAS MED VET ZOO 2015. [DOI: 10.1590/1678-4162-7744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi avaliar o efeito da matriz porosa do biovidro de composição molar 60% SiO2 - 36% CaO - 4% P2O5 (BV60S) no tratamento de defeitos ósseos críticos de cães. Foram utilizados 20 cães, machos, sem raça definida, com dois anos e massa corporal média de 25kg. Foram constituídos três grupos experimentais: defeitos ósseos preenchidos com BV60S (BV), com osso autógeno (C+) e defeitos não preenchidos (C-). A regeneração óssea foi avaliada por meio de exames radiográficos, densitométricos e histomorfométricos ao longo de 90 dias. A matriz do BV60S mostrou rápida reabsorção com redução média de 12,62% a cada 15 dias. A regeneração foi completa no grupo C+ e incompleta nos grupos BV e C-, aos 90 dias. A área de neoformação óssea foi semelhante entre os grupos BV e C-, em todos os tempos estudados. Conclui-se que a matriz porosa do BV60S possui rápida reabsorção, não sendo eficiente no tratamento de defeitos ósseos críticos em rádios de cães.
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Affiliation(s)
- E.G.L. Alves
- Universidade de Uberaba, Brazil; Universidade Federal de Minas Gerais, Brazil
| | | | - I.R. Rosado
- Universidade de Uberaba, Brazil; Universidade Federal de Minas Gerais, Brazil
| | | | - O.L.A. Paez
- Universidade Federal de Minas Gerais, Brazil
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136
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Schlickewei CW, Laaff G, Andresen A, Klatte TO, Rueger JM, Ruesing J, Epple M, Lehmann W. Bone augmentation using a new injectable bone graft substitute by combining calcium phosphate and bisphosphonate as composite--an animal model. J Orthop Surg Res 2015. [PMID: 26205381 PMCID: PMC4513618 DOI: 10.1186/s13018-015-0263-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective The aim of this study was to create a new injectable bone graft substitute by combining the features of calcium phosphate and bisphosphonate as a composite bone graft to support bone healing and to evaluate the effect of alendronate to the bone healing process in an animal model. Material and method In this study, 24 New Zealand white rabbits were randomly divided into two groups: a calcium phosphate alendronate group and a calcium phosphate control group. A defect was created at the proximal medial tibia and filled with the new created injectable bone graft substitute calcium phosphate alendronate or with calcium phosphate. Healing process was documented by fluoroscopy. To evaluate the potential of the bone graft substitute, the proximal tibia was harvested 2, 4, and 12 weeks after operation. Histomorphological analysis was focused on the evaluation of the dynamic bone parameters using the Osteomeasure system. Results Radiologically, the bone graft materials were equally absorbed. No fracture was documented. The bones healed normally. After 2 weeks, the histological analysis showed an increased new bone formation for both materials. The osteoid volume per bone volume (OV/BV) was significantly higher for the calcium phosphate group. After 4 weeks, the results were almost equal. The trabecular thickness (Tb.Th) increased in comparison to week 2 in both groups with a slight advantage for the calcium phosphate group. The total mass of the bone graft (KEM.Ar) and the bone graft substitute surface density (KEM.Pm) were consistently decreasing. After 12 weeks, the new bone volume per tissue volume (BV/TV) was still constantly growing. Both bone grafts show a good integration. New bone was formed on the surface of both bone grafts. The calcium phosphate as well as the calcium phosphate alendronate paste had been enclosed by the bone. The trabecular thickness was higher in both groups compared to the first time point. Conclusion Calcium phosphate proved its good potential as a bone graft substitute. Initially, the diagrams seem to show a tendency that alendronate improves the known properties of calcium phosphate as a bone graft substitute. The composite graft induced a good and constant new bone formation. Not only the graft was incorporated into the bone but also a new bone was formed on its surface. But we could not prove a significant difference between the grafts. Both implants proved their function as a bone graft substitute, but the bisphosphonate alendronate does not support the bone healing process sufficiently that the known properties of calcium phosphate as a bone graft substitute were improved in the sense of a composite graft. In this study, alendronate used as a bone graft in a healthy bony environment did not influence the bone healing process in a positive or negative way.
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Affiliation(s)
- Carsten W Schlickewei
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Georg Laaff
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Anne Andresen
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Till O Klatte
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes M Rueger
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Ruesing
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Universitaetsstr. 5-7, 45117, Essen, Germany
| | - Matthias Epple
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Universitaetsstr. 5-7, 45117, Essen, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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137
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Abstract
BACKGROUND The treatment of fracture nonunion (pseudarthrosis) is often lengthy and debilitating for the patient. There are operative and conservative therapies available. RESEARCH QUESTION Does the systemic use of osteoanabolic acting substances (osteoanabolics) lead to an acceleration of the delayed fracture healing and/or strengthening of the fracture? Which types of pseudarthrosis are suitable for this treatment option? MATERIALS AND METHODS A literature review was carried out focusing on the systemic anabolic therapy options for the treatment of delayed healing of fractures or pseudarthrosis. Additionally, our own case studies are presented. RESULTS Teriparatide and strontium ranelate have a positive effect on the healing of fractures in animal studies and in humans. There are also case studies on the use of both substances in delayed fracture healing or pseudarthrosis. The scientific knowledge regarding teriparatide is significantly more comprehensive. However, prospective randomized trials are lacking so far. CONCLUSION The systemic use of anabolics can be a therapeutic option, especially for biological reactive pseudarthrosis. However, these are off-label treatments and contraindications should be especially well heeded. Because of the numerous positive results, from the point of view of teriparatide treatment, a multicentric, prospective randomized study on the treatment of aseptic pseudarthrosis should be initiated.
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Affiliation(s)
- K M Peters
- Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland.
| | - T Tuncel
- Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland
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138
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Ollivier M, Gay AM, Cerlier A, Lunebourg A, Argenson JN, Parratte S. Can we achieve bone healing using the diamond concept without bone grafting for recalcitrant tibial nonunions? Injury 2015; 46:1383-8. [PMID: 25933808 DOI: 10.1016/j.injury.2015.03.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/17/2015] [Accepted: 03/30/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to evaluate the efficacy and safety of a combination of recombinant human bone morphogenetic protein 7 (rhBMP-7) and resorbable calcium phosphate bone substitute (rCPBS) as a salvage solution for recalcitrant tibial fracture nonunions. Twenty consecutive patients, 16 male and four female, with a mean age of 46.8±15.7 years (21-78) and a mean body mass index (BMI) of 24.2±5.3kgm(-2) (21.5-28.5), suffering from 20 recalcitrant tibial fracture nonunions were included. The mean number of operations performed prior to the procedure was 3.3, with homolateral iliac crest bone grafts being used for all of the patients. All patients were treated with a procedure including debridement and decortications of the bone ends, nonunion fixation with a locking plate, and filling of the bony defect with a combined graft of rhBMP-7 (as osteoinductor) with an rCPBS (as scaffold). The mean follow-up was 14±2.7 months. Both clinical and radiological union occurred in 18 cases, within a mean time of 4.7±3.2 months. A recurrence of deep infection was diagnosed for one of the non-consolidated patients. No specific complication of rCPBS or rhBMP-7 was encountered. This study supports the view that the application of rCPBS combined with rhBMP-7, without any bone grafting, is safe and efficient in the treatment of recalcitrant bone union.
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Affiliation(s)
- M Ollivier
- Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
| | - A M Gay
- Department of Hand Surgery and Limb Reconstruction, Aix-Marseille University, Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - A Cerlier
- Department of Hand Surgery and Limb Reconstruction, Aix-Marseille University, Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France
| | - A Lunebourg
- Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - J N Argenson
- Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - S Parratte
- Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
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139
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Das A, Segar CE, Chu Y, Wang TW, Lin Y, Yang C, Du X, Ogle RC, Cui Q, Botchwey EA. Bioactive lipid coating of bone allografts directs engraftment and fate determination of bone marrow-derived cells in rat GFP chimeras. Biomaterials 2015; 64:98-107. [PMID: 26125501 DOI: 10.1016/j.biomaterials.2015.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 12/31/2022]
Abstract
Bone grafting procedures are performed to treat wounds incurred during wartime trauma, accidents, and tumor resections. Endogenous mechanisms of repair are often insufficient to ensure integration between host and donor bone and subsequent restoration of function. We investigated the role that bone marrow-derived cells play in bone regeneration and sought to increase their contributions by functionalizing bone allografts with bioactive lipid coatings. Polymer-coated allografts were used to locally deliver the immunomodulatory small molecule FTY720 in tibial defects created in rat bone marrow chimeras containing genetically-labeled bone marrow for monitoring cell origin and fate. Donor bone marrow contributed significantly to both myeloid and osteogenic cells in remodeling tissue surrounding allografts. FTY720 coatings altered the phenotype of immune cells two weeks post-injury, which was associated with increased vascularization and bone formation surrounding allografts. Consequently, degradable polymer coating strategies that deliver small molecule growth factors such as FTY720 represent a novel therapeutic strategy for harnessing endogenous bone marrow-derived progenitors and enhancing healing in load-bearing bone defects.
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Affiliation(s)
- Anusuya Das
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Claire E Segar
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Yihsuan Chu
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Tiffany W Wang
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Yong Lin
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Chunxi Yang
- Department of Orthopaedic Surgery, Tenth People's Hospital of Tongji University, Shanghai 200072, China
| | - Xeujun Du
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453100, China
| | - Roy C Ogle
- School of Medical Diagnostic and Translational Sciences, Old Dominion University, Norfolk, VA, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Edward A Botchwey
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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140
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Abstract
Normal bone healing is a complex process that eventually restores original structure and function to the site of trauma. However, clinical circumstances such as nonunion, critical-sized defects, systemic bone disease, and fusion procedures have stimulated a search for ways to enhance this normal healing process. Biologics are an important part of this search and many, including bone marrow aspirate concentrate, demineralized bone matrix, platelet-rich plasma, bone morphogenic proteins, and platelet-derived growth factor, are currently in clinical use. Many others, including mesenchymal stem cells, parathyroid hormone, and Nel-like molecule-1 (NELL-1) will likely be in use in the future depending on the results of preclinical and clinical trials.
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Affiliation(s)
- Benjamin Smith
- Department of Orthopedic Surgery and Orthopedic Research Laboratory, Feinstein Institute for Medical Research and North Shore-LIJ Health System, Manhasset, NY, USA,
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141
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Jariwala SH, Lewis GS, Bushman ZJ, Adair JH, Donahue HJ. 3D Printing of Personalized Artificial Bone Scaffolds. 3D PRINTING AND ADDITIVE MANUFACTURING 2015; 2:56-64. [PMID: 28804734 PMCID: PMC4981149 DOI: 10.1089/3dp.2015.0001] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Additive manufacturing technologies, including three-dimensional printing (3DP), have unlocked new possibilities for bone tissue engineering. Long-term regeneration of normal anatomic structure, shape, and function is clinically important subsequent to bone trauma, tumor, infection, nonunion after fracture, or congenital abnormality. Due to the great complexity in structure and properties of bone across the population, along with variation in the type of injury or defect, currently available treatments for larger bone defects that support load often fail in replicating the anatomic shape and structure of the lost bone tissue. 3DP could provide the ability to print bone substitute materials with a controlled chemistry, shape, porosity, and topography, thus allowing printing of personalized bone grafts customized to the patient and the specific clinical condition. 3DP and related fabrication approaches of bone grafts may one day revolutionize the way clinicians currently treat bone defects. This article gives a brief overview of the current advances in 3DP and existing materials with an emphasis on ceramics used for 3DP of bone scaffolds. Furthermore, it addresses some of the current limitations of this technique and discusses potential future directions and strategies for improving fabrication of personalized artificial bone constructs.
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Affiliation(s)
- Shailly H. Jariwala
- Division of Musculoskeletal Sciences, Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Gregory S. Lewis
- Division of Musculoskeletal Sciences, Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Biomedical Engineering, Penn State College of Engineering, University Park, Pennsylvania
| | - Zachary J. Bushman
- Chemistry Department, Eberly College of Science, Pennsylvania State University, University Park, Pennsylvania
| | - James H. Adair
- Materials Science and Engineering, College of Earth and Mineral Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Henry J. Donahue
- Division of Musculoskeletal Sciences, Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Biomedical Engineering, Penn State College of Engineering, University Park, Pennsylvania
- Department of Cellular and Molecular Physiology, Penn State College of Medicine, Hershey, Pennsylvania
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142
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Anisimova NY, Kiselevsky MV, Sukhorukova IV, Shvindina NV, Shtansky DV. Fabrication method, structure, mechanical, and biological properties of decellularized extracellular matrix for replacement of wide bone tissue defects. J Mech Behav Biomed Mater 2015; 49:255-68. [PMID: 26051225 DOI: 10.1016/j.jmbbm.2015.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/27/2015] [Accepted: 05/08/2015] [Indexed: 01/07/2023]
Abstract
The present paper was focused on the development of a new method of decellularized extracellular matrix (DECM) fabrication via a chemical treatment of a native bone tissue. Particular attention was paid to the influence of chemical treatment on the mechanical properties of native bones, sterility, and biological performance in vivo using the syngeneic heterotopic and orthotopic implantation models. The obtained data indicated that after a chemical decellularization treatment in 4% aqueous sodium chlorite, no noticeable signs of the erosion of compact cortical bone surface or destruction of trabeculae of spongy bone in spinal channel were observed. The histological studies showed that the chemical treatment resulted in the decellularization of both bone and cartilage tissues. The DECM samples demonstrated no signs of chemical and biological degradation in vivo. Thorough structural characterization revealed that after decellularization, the mineral frame retained its integrity with the organic phase; however clotting and destruction of organic molecules and fibers were observed. FTIR studies revealed several structural changes associated with the destruction of organic molecules, although all organic components typical of intact bone were preserved. The decellularization-induced structural changes in the collagen constituent resulted changed the deformation under compression mechanism: from the major fracture by crack propagation throughout the sample to the predominantly brittle fracture. Although the mechanical properties of radius bones subjected to decellularization were observed to degrade, the mechanical properties of ulna bones in compression and humerus bones in bending remained unchanged. The compressive strength of both the intact and decellularized ulna bones was 125-130 MPa and the flexural strength of humerus bones was 156 and 145 MPa for the intact and decellularized samples, respectively. These results open new avenues for the use of DECM samples as the replacement of wide bone tissue defects.
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Affiliation(s)
- N Y Anisimova
- Blokhin Russian Cancer Research Center of the Russian Academy of Medical Sciences, Kashirskoe Shosse 24, Moscow 115478, Russia
| | - M V Kiselevsky
- Blokhin Russian Cancer Research Center of the Russian Academy of Medical Sciences, Kashirskoe Shosse 24, Moscow 115478, Russia
| | - I V Sukhorukova
- National University of Science and Technology "MISIS", Leninsky Prospect 4, Moscow 119049, Russia.
| | - N V Shvindina
- National University of Science and Technology "MISIS", Leninsky Prospect 4, Moscow 119049, Russia
| | - D V Shtansky
- National University of Science and Technology "MISIS", Leninsky Prospect 4, Moscow 119049, Russia.
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143
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Wei Q, Pohl TLM, Seckinger A, Spatz JP, Cavalcanti-Adam EA. Regulation of integrin and growth factor signaling in biomaterials for osteodifferentiation. Beilstein J Org Chem 2015; 11:773-83. [PMID: 26124879 PMCID: PMC4464188 DOI: 10.3762/bjoc.11.87] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/07/2015] [Indexed: 12/21/2022] Open
Abstract
Stem cells respond to the microenvironment (niche) they are located in. Under natural conditions, the extracellular matrix (ECM) is the essential component the in stem cell niche, in which both integrin ligands and growth factors are important regulators to directly or indirectly modulate the cell behavior. In this review, we summarize the current knowledge about the potential of integrin ligands and growth factors to induce osteogenic differentiation of stem cells, and discuss the signaling pathways that are initiated by both individual and cooperative parameters. The joint effect of integrin ligands and growth factors is highlighted as the multivalent interactions for bone therapy.
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Affiliation(s)
- Qiang Wei
- Department of Biophysical Chemistry, Institute for Physical Chemistry, University of Heidelberg, INF 253, 69120 Heidelberg, Germany ; Department of New Materials and Biosystems, Max-Planck Institute for Intelligent Systems, Stuttgart, Germany
| | - Theresa L M Pohl
- Department of Biophysical Chemistry, Institute for Physical Chemistry, University of Heidelberg, INF 253, 69120 Heidelberg, Germany ; Department of New Materials and Biosystems, Max-Planck Institute for Intelligent Systems, Stuttgart, Germany
| | - Anja Seckinger
- Department of Internal Medicine V, Oncology, Hematology, and Rheumatology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Joachim P Spatz
- Department of Biophysical Chemistry, Institute for Physical Chemistry, University of Heidelberg, INF 253, 69120 Heidelberg, Germany ; Department of New Materials and Biosystems, Max-Planck Institute for Intelligent Systems, Stuttgart, Germany
| | - Elisabetta A Cavalcanti-Adam
- Department of Biophysical Chemistry, Institute for Physical Chemistry, University of Heidelberg, INF 253, 69120 Heidelberg, Germany ; Department of New Materials and Biosystems, Max-Planck Institute for Intelligent Systems, Stuttgart, Germany
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144
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Posnick JC, Sami A. Is It Safe and Effective to Lengthen a Chin With Interpositional Allogenic (Iliac) Graft? J Oral Maxillofac Surg 2015; 73:1583-91. [PMID: 25930958 DOI: 10.1016/j.joms.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/10/2015] [Accepted: 02/04/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE This is a retrospective review of a consecutive series of patients undergoing chin lengthening at the time of orthognathic surgery over a 3-year timeframe. MATERIALS AND METHODS The genioplasty procedures studied included lengthening to the extent that an interpositional graft was deemed necessary (n = 19). Allogenic (iliac) corticocancellous bone was used in all cases. Each patient underwent lateral cephalometric radiography within 2 months before and 5 weeks after surgery. From the radiographs, quantitative measurements (millimeters) were made to document the vertical lengthening and horizontal advancement achieved. Chin region wound healing parameters were reviewed to document evidence of infection, sequestra, need for reoperation, and evidence of fibrous union. Inpatient hospital and outpatient office records were reviewed for any evidence of sepsis or viral transmission. RESULTS The patients' mean age at operation was 35 years (range, 15 to 58 yr). Analysis of preoperative and 5-week postoperative radiographs documented a mean vertical lengthening of 7 mm (range, 4 to 10 mm). The mean horizontal advancement at the pogonion was confirmed to be 2 mm (range, 1 to 3 mm). None of the study patients sustained chin region infection graft sequestra, fibrous union, or need for reoperation. There were no cases of postoperative sepsis or viral illness to indicate systemic infectious sequelae. CONCLUSION The study confirms the safety of allogenic (iliac) corticocancellous grafting to fill interpositional defects associated with a transverse symphyseal lengthening osteotomy.
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Affiliation(s)
- Jeffrey C Posnick
- Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor, Departments of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor, Department of Orthodontics, University of Maryland, School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC.
| | - Ali Sami
- Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC
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145
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Sarkar SK, Lee BT. Hard tissue regeneration using bone substitutes: an update on innovations in materials. Korean J Intern Med 2015; 30:279-93. [PMID: 25995658 PMCID: PMC4438282 DOI: 10.3904/kjim.2015.30.3.279] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/05/2015] [Indexed: 12/15/2022] Open
Abstract
Bone is a unique organ composed of mineralized hard tissue, unlike any other body part. The unique manner in which bone can constantly undergo self-remodeling has created interesting clinical approaches to the healing of damaged bone. Healing of large bone defects is achieved using implant materials that gradually integrate with the body after healing is completed. Such strategies require a multidisciplinary approach by material scientists, biological scientists, and clinicians. Development of materials for bone healing and exploration of the interactions thereof with the body are active research areas. In this review, we explore ongoing developments in the creation of materials for regenerating hard tissues.
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Affiliation(s)
- Swapan Kumar Sarkar
- Institute of Tissue Regeneration, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Byong Taek Lee
- Institute of Tissue Regeneration, Soonchunhyang University College of Medicine, Cheonan, Korea
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146
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Kane RJ, Weiss-Bilka HE, Meagher MJ, Liu Y, Gargac JA, Niebur GL, Wagner DR, Roeder RK. Hydroxyapatite reinforced collagen scaffolds with improved architecture and mechanical properties. Acta Biomater 2015; 17:16-25. [PMID: 25644451 DOI: 10.1016/j.actbio.2015.01.031] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/09/2015] [Accepted: 01/15/2015] [Indexed: 11/26/2022]
Abstract
Hydroxyapatite (HA) reinforced collagen scaffolds have shown promise for synthetic bone graft substitutes and tissue engineering scaffolds. Freeze-dried HA-collagen scaffolds are readily fabricated and have exhibited osteogenicity in vivo, but are limited by an inherent scaffold architecture that results in a relatively small pore size and weak mechanical properties. In order to overcome these limitations, HA-collagen scaffolds were prepared by compression molding HA reinforcements and paraffin microspheres within a suspension of concentrated collagen fibrils (∼ 180 mg/mL), cross-linking the collagen matrix, and leaching the paraffin porogen. HA-collagen scaffolds exhibited an architecture with high porosity (85-90%), interconnected pores ∼ 300-400 μm in size, and struts ∼ 3-100 μm in thickness containing 0-80 vol% HA whisker or powder reinforcements. HA reinforcement enabled a compressive modulus of up to ∼ 1 MPa, which was an order of magnitude greater than unreinforced collagen scaffolds. The compressive modulus was also at least one order of magnitude greater than comparable freeze-dried HA-collagen scaffolds and two orders of magnitude greater than absorbable collagen sponges used clinically. Moreover, scaffolds reinforced with up to 60 vol% HA exhibited fully recoverable elastic deformation upon loading to 50% compressive strain for at least 100,000 cycles. Thus, the scaffold mechanical properties were well-suited for surgical handling, fixation, and bearing osteogenic loads during bone regeneration. The scaffold architecture, permeability, and composition were shown to be conducive to the infiltration and differentiation of adipose-derive stromal cells in vitro. Acellular scaffolds were demonstrated to induce angiogenesis and osteogenesis after subcutaneous ectopic implantation by recruiting endogenous cell populations, suggesting that the scaffolds were osteoinductive.
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147
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Wen C, Yan H, Fu S, Qian Y, Wang D, Wang C. Allogeneic adipose-derived stem cells regenerate bone in a critical-sized ulna segmental defect. Exp Biol Med (Maywood) 2015; 241:1401-9. [PMID: 25819682 DOI: 10.1177/1535370215576298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 01/28/2015] [Indexed: 12/17/2022] Open
Abstract
Adipose-derived stem cells (ASCs) with multilineage potential can be induced into osteoblasts, adipocytes and chondrocytes. ASCs as seed cell are widely used in the field of tissue engineering, but most studies either use autologous cells as the source or an immunodeficient animal as the host. In our present study, we explored the feasibility of applying allogeneic ASCs and demineralized bone matrix (DBM) scaffolds for repairing tubular bone defects without using immunosuppressive therapy. Allogeneic ASCs were expanded and seeded on DBM scaffolds and induced to differentiate along the osteogenic lineage. Eight Sprague-Dawley (SD) rats were used in this study and bilateral critical-sized defects (8 mm) of the ulna were created and divided into two groups: with ASC-DBM constructs or DBM alone. The systemic immune response and the extent of bone healing were evaluated post-operatively. Twenty-four weeks after implantation, digital radiography (DR) testing showed that new bones had formed in the experimental group. By contrast, no bone tissue formation was observed in the control group. This study demonstrated that allogeneic ASCs could promote bone regeneration and repair tubular bone defects combined with DBM by histologically typical bone without systemic immune response.
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Affiliation(s)
- Congji Wen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China Department of Plastic Surgery, Yancheng First Peoples' Hospital, 16 Yue He Road, People's Republic of China. 224000
| | - Hai Yan
- Department of Orthepedics, Nantong Rich Hospital, No. 2000 Lake Avenue, Nantong, 226010, People's Republic of China
| | - Shibo Fu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China
| | - Yunliang Qian
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China
| | - Danru Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China
| | - Chen Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China
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148
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Lee MH, You C, Kim KH. Combined Effect of a Microporous Layer and Type I Collagen Coating on a Biphasic Calcium Phosphate Scaffold for Bone Tissue Engineering. MATERIALS 2015; 8:1150-1161. [PMID: 28787993 PMCID: PMC5455448 DOI: 10.3390/ma8031150] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 11/16/2022]
Abstract
In this study, type I collagen was coated onto unmodified and modified microporous biphasic calcium phosphate (BCP) scaffolds. Surface characterization using a scanning electron microscope (SEM) and a surface goniometer confirmed the modification of the BCP coating. The quantity of the collagen coating was investigated using Sirius Red staining, and quantitative assessment of the collagen coating showed no significant differences between the two groups. MG63 cells were used to evaluate cell proliferation and ALP activity on the modified BCP scaffolds. The modified microporous surfaces showed low contact angles and large surface areas, which enhanced cell spreading and proliferation. Coating of the BCP scaffolds with type I collagen led to enhanced cell-material interactions and improved MG63 functions, such as spreading, proliferation, and differentiation. The micropore/collagen-coated scaffold showed the highest rate of cell response. These results indicate that a combination of micropores and collagen enhances cellular function on bioengineered bone allograft tissue.
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Affiliation(s)
- Mun-Hwan Lee
- Department of Medical & Biological Engineering, Graduate School, Kyungpook National University, 2-188-1 Samduk-dong, Jung-gu, Daegu 700-412, Korea.
| | - Changkook You
- Department of Medical & Biological Engineering, Graduate School, Kyungpook National University, 2-188-1 Samduk-dong, Jung-gu, Daegu 700-412, Korea.
| | - Kyo-Han Kim
- Department of Dental Biomaterials, School of Dentistry, Kyungpook National University, 2-188-1 Samduk-dong, Jung-gu, Daegu 700-412, Korea.
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149
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Is DBM beneficial for the enhancement of bony consolidation in distraction osteogenesis? A randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2015; 2015:281738. [PMID: 25705653 PMCID: PMC4326219 DOI: 10.1155/2015/281738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/11/2014] [Indexed: 01/28/2023]
Abstract
The aim of the present study was to compare the radiographic and clinical outcomes of DBM injection and conventional treatment during tibial lengthening over an intramedullary nail in adult patients with short stature. Twenty-nine patients were randomized to receive DBM injection (n = 14) or conventional treatment without any injection (n = 15) and evaluated. The outcome was measured on the basis of the pixel value ratio (PVR) in the digital radiographs during the consolidation period; healing index; clinical assessment; and the rate of complications. In the DBM group, the mean PVR of 1 (mineral density of the callus is comparable to the adjacent bone) was reached by 40 weeks in anterior and medial cortices which was significantly different than that in the control group (P = 0.03 for anterior cortex; P = 0.04 for medial cortex). The average healing index in the DBM group was 39.8 ± 5.3 days/cm compared to 44.3 ± 5.8 days/cm in the control group (P = 0.05). There were no significant differences in clinical outcomes (P = 0.23) and functional status (P = 0.47) including complications (P = 0.72) between two groups. In this randomized clinical trial, injection of DBM at the time of initial operation enhanced consolidation of regenerate callus without interfering with clinical outcomes compared to that with conventional treatment.
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150
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Bencharit S, Byrd WC, Hosseini B. Immediate placement of a porous-tantalum, trabecular metal-enhanced titanium dental implant with demineralized bone matrix into a socket with deficient buccal bone: a clinical report. J Prosthet Dent 2015; 113:262-9. [PMID: 25702965 DOI: 10.1016/j.prosdent.2014.09.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
Abstract
A missing or deficient buccal alveolar bone plate is often an important limiting factor for immediate implant placement. Titanium dental implants enhanced with porous tantalum-based trabecular metal material (PTTM) are designed for osseoincorporation, a combination of vascularized bone ingrowth and osseointegration (bone on-growth). Demineralized bone matrix (DBM) contains growth factors with good handling characteristics. However, the combination of these 2 materials in facial alveolar bone regeneration associated with immediate implant therapy has not been reported. A 65-year-old Asian woman presented with a failing central incisor. Most of the buccal alveolar bone plate of the socket was missing. A PTTM enhanced implant was immediately placed with DBM. Cone beam computed tomography scans 12 months after the insertion of the definitive restoration showed regeneration of buccal alveolar bone. A combination of a PTTM enhanced implant, DBM, and a custom healing abutment may have an advantage in retaining biologically active molecules and form a scaffold for neovascularization and osteogenesis. This treatment protocol may be a viable option for immediate implant therapy in a failed tooth with deficient buccal alveolar bone.
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Affiliation(s)
- Sompop Bencharit
- Assistant Professor, Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC.
| | - Warren C Byrd
- Research Fellow, Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Bashir Hosseini
- Former Resident, Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
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