151
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Zhang H, Yang L, Yang XG, Wang F, Feng JT, Hua KC, Li Q, Hu YC. Demineralized Bone Matrix Carriers and their Clinical Applications: An Overview. Orthop Surg 2019; 11:725-737. [PMID: 31496049 PMCID: PMC6819172 DOI: 10.1111/os.12509] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 01/06/2023] Open
Abstract
Reconstruction of massive bone defects is challenging for orthopaedic clinicians, especially in cases of severe trauma and resection of tumors in various locales. Autologous iliac crest bone graft (ICBG) is the “gold standard” for bone grafting. However, the limited availability and complications at donor sites resulted in seeking other options like allografts and bone graft substitutes. Demineralized bone matrix (DBM) is a form of allograft using acidic solution to remove mineral components, while leaving much of the proteinaceous components native to bone, with small amounts of calcium‐based solids, inorganic phosphates, and some trace cell debris. It is an osteoconductive and osteoinductive biomaterial and is approved as a medical device for use in bone defects and spinal fusion. To pack consistently into the defect sites and stay firmly in the filling parts, DBM products have various forms combined with biocompatible viscous carriers, including sponges, strips, injectable putty, paste, and paste infused with chips. The present review aims to summarize the properties of various kind of viscous carriers and their clinical use combined with DBM in commercially available products. Given DBM'mercially available products. Given DBM;s long clinical track record and commercial accessibility in standard forms, opportunities to further develop and validate DBM as a versatile bone biomaterial in orthopaedic repair and regenerative medicine contexts are attractive.
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Affiliation(s)
- Hao Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China.,Graduate School, Tianjin Medical University, Tianjin, China
| | - Li Yang
- Graduate School, Tianjin Medical University, Tianjin, China
| | | | - Feng Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Jiang-Tao Feng
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Kun-Chi Hua
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Qi Li
- Beijing Wonderful Medical Biomaterial Co. Ltd., Beijing, China
| | - Yong-Cheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
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152
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Chang YL, Hsieh CY, Yeh CY, Lin FH. The Development of Gelatin/Hyaluronate Copolymer Mixed with Calcium Sulfate, Hydroxyapatite, and Stromal-Cell-Derived Factor-1 for Bone Regeneration Enhancement. Polymers (Basel) 2019; 11:polym11091454. [PMID: 31491928 PMCID: PMC6780272 DOI: 10.3390/polym11091454] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022] Open
Abstract
In clinical practice, bone defects still remain a challenge. In recent years, apart from the osteoconductivity that most bone void fillers already provide, osteoinductivity has also been emphasized to promote bone healing. Stromal-cell-derived factor-1 (SDF-1) has been shown to have the ability to recruit mesenchymal stem cells (MSCs), which play an important role in the bone regeneration process. In this study, we developed a gelatin–hyaluronate (Gel-HA) copolymer mixed with calcium sulfate (CS), hydroxyapatite (HAP), and SDF-1 in order to enhance bone regeneration in a bone defect model. The composites were tested in vitro for biocompatibility and their ability to recruit MSCs after material characterization. For the in vivo test, a rat femoral condyle bone defect model was used. Micro computed tomography (Micro-CT), two-photon excitation microscopy, and histology analysis were performed to assess bone regeneration. As expected, enhanced bone regeneration was well observed in the group filled with Gel-HA/CS/HAP/SDF-1 composites compared with the control group in our animal model. Furthermore, detailed blood analysis of rats showed no obvious systemic toxicity or side effects after material implantation. In conclusion, the Gel-HA/CS/HAP/SDF-1 composite may be a safe and applicable material to enhance bone regeneration in bone defects.
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Affiliation(s)
- Yun-Liang Chang
- Department of Biomedical Engineering, National Taiwan University, No. 1, Sec.1, Jen-Ai Road, Taipei City 10051, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei City 10002, Taiwan
| | - Chia-Ying Hsieh
- Department of Biomedical Engineering, National Taiwan University, No. 1, Sec.1, Jen-Ai Road, Taipei City 10051, Taiwan
| | - Chao-Yuan Yeh
- Integrative Stem Cell Center, China Medical University, No. 2, Yude Road, Taichung City 40447, Taiwan
| | - Feng-Huei Lin
- Department of Biomedical Engineering, National Taiwan University, No. 1, Sec.1, Jen-Ai Road, Taipei City 10051, Taiwan.
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153
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Zeng Y, Hoque J, Varghese S. Biomaterial-assisted local and systemic delivery of bioactive agents for bone repair. Acta Biomater 2019; 93:152-168. [PMID: 30711659 PMCID: PMC6615988 DOI: 10.1016/j.actbio.2019.01.060] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 01/05/2023]
Abstract
Although bone tissues possess an intrinsic capacity for repair, there are cases where bone healing is either impaired or insufficient, such as fracture non-union, osteoporosis, osteomyelitis, and cancers. In these cases, treatments like surgical interventions are used, either alone or in combination with bioactive agents, to promote tissue repair and manage associated clinical complications. Improving the efficacy of bioactive agents often requires carriers, with biomaterials being a pivotal player. In this review, we discuss the role of biomaterials in realizing the local and systemic delivery of biomolecules to the bone tissue. The versatility of biomaterials enables design of carriers with the desired loading efficiency, release profile, and on-demand delivery. Besides local administration, systemic administration of drugs is necessary to combat diseases like osteoporosis, warranting bone-targeting drug delivery systems. Thus, chemical moieties with the affinity towards bone extracellular matrix components like apatite minerals have been widely utilized to create bone-targeting carriers with better biodistribution, which cannot be achieved by the drugs alone. Bone-targeting carriers combined with the desired drugs or bioactive agents have been extensively investigated to enhance bone healing while minimizing off-target effects. Herein, these advancements in the field have been systematically reviewed. STATEMENT OF SIGNIFICANCE: Drug delivery is imperative when surgical interventions are not sufficient to address various bone diseases/defects. Biomaterial-assisted delivery systems have been designed to provide drugs with the desired loading efficiency, sustained release, and on-demand delivery to enhance bone healing. By surveying recent advances in the field, this review outlines the design of biomaterials as carriers for the local and systemic delivery of bioactive agents to the bone tissue. Particularly, biomaterials that bear chemical moieties with affinity to bone are attractive, as they can present the desired bioactive agents to the bone tissue efficiently and thus enhance the drug efficacy for bone repair.
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Affiliation(s)
- Yuze Zeng
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27710, USA
| | - Jiaul Hoque
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Shyni Varghese
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27710, USA.
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154
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Peterson JR, Chen F, Nwankwo E, Dekker TJ, Adams SB. The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419849019. [PMID: 35097327 PMCID: PMC8500392 DOI: 10.1177/2473011419849019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments.
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Affiliation(s)
- Jonathan R. Peterson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Fangyu Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eugene Nwankwo
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Travis J. Dekker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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155
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Geetha B, Premkumar J, Pradeep JP, Krishnakumar S. Synthesis and characterization of bioscaffolds using freeze drying technique for bone regeneration. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2019. [DOI: 10.1016/j.bcab.2019.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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156
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Sun M, Feng W, Wang B, Han B, Zou J, Yang C, Liu Z. Studies on Surface Properties and Cell Adhesion Properties of BSA Modified DBM Scaffold. Chem Res Chin Univ 2019. [DOI: 10.1007/s40242-019-9020-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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157
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Lobb DC, DeGeorge BR, Chhabra AB. Bone Graft Substitutes: Current Concepts and Future Expectations. J Hand Surg Am 2019; 44:497-505.e2. [PMID: 30704784 DOI: 10.1016/j.jhsa.2018.10.032] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/25/2018] [Accepted: 10/23/2018] [Indexed: 02/02/2023]
Abstract
Owing to its osteoinductive and osteoconductive properties and the presence of osteogenic cells, freshly harvested autologous bone graft is the gold standard for skeletal reconstruction where there is inadequate native bone. Whereas these characteristics are difficult to replicate, engineered, commercially available bone graft substitutes aim to achieve a comparable osseoregenerative profile. This work furnishes the reader with an understanding of the predominant classes of bone graft substitutes available for reconstruction of upper extremity bone defects following trauma or oncological surgery. We review bone graft substitutes with respect to their mechanisms of action, their advantages and disadvantages, and their indications and contraindications. We provide examples of bone graft substitutes in clinical use and outline comparative costs. We also describe the future directions for this specific aspect of reconstructive surgery with a focus on the role of bioactive glass.
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Affiliation(s)
- David C Lobb
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA.
| | - Brent R DeGeorge
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, VA
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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158
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Boys AJ, Zhou H, Harrod JB, McCorry MC, Estroff LA, Bonassar LJ. Top-down Fabrication of Spatially Controlled Mineral-Gradient Scaffolds for Interfacial Tissue Engineering. ACS Biomater Sci Eng 2019; 5:2988-2997. [PMID: 31211246 DOI: 10.1021/acsbiomaterials.9b00176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Materials engineering can generally be divided into "bottom-up" and "top-down" approaches, where current state-of-the-art methodologies are bottom-up, relying on the advent of atomic-scale technologies. Applying bottom-up approaches to biological tissues is challenging due to the inherent complexity of these systems. Top-down methodologies provide many advantages over bottom-up approaches for biological tissues, given that some of the complexity is already built into the system. Here, we generate interfacial scaffolds by the spatially controlled removal of mineral content from trabecular bone using a chelating solution. We controlled the degree and location of the mineral interface, producing scaffolds that support cell growth, while maintaining the hierarchical structure of these tissues. We characterized the structural and compositional gradients across the scaffold using X-ray diffraction, microcomputed tomography (μCT), and Raman microscopy, revealing the presence of mineral gradients on the scale of 20 - 40 μm. Using these data, we generated a model showing the dependence of mineral removal as function of time in the chelating solution and initial bone morphology, specifically trabecular density. These scaffolds will be useful for interfacial tissue engineering, with application in the fields of orthopedics, developmental biology, and cancer metastasis to bone.
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Affiliation(s)
- Alexander J Boys
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY
| | - Hao Zhou
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY
| | - Jordan B Harrod
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY
| | | | - Lara A Estroff
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY.,Kavli Institute for Nanoscale Science at Cornell, Cornell University, Ithaca, NY
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY
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159
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Lin H, Sohn J, Shen H, Langhans MT, Tuan RS. Bone marrow mesenchymal stem cells: Aging and tissue engineering applications to enhance bone healing. Biomaterials 2019; 203:96-110. [PMID: 29980291 PMCID: PMC6733253 DOI: 10.1016/j.biomaterials.2018.06.026] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/11/2022]
Abstract
Bone has well documented natural healing capacity that normally is sufficient to repair fractures and other common injuries. However, the properties of bone change throughout life, and aging is accompanied by increased incidence of bone diseases and compromised fracture healing capacity, which necessitate effective therapies capable of enhancing bone regeneration. The therapeutic potential of adult mesenchymal stem cells (MSCs) for bone repair has been long proposed and examined. Actions of MSCs may include direct differentiation to become bone cells, attraction and recruitment of other cells, or creation of a regenerative environment via production of trophic growth factors. With systemic aging, MSCs also undergo functional decline, which has been well investigated in a number of recent studies. In this review, we first describe the changes in MSCs during aging and discuss how these alterations can affect bone regeneration. We next review current research findings on bone tissue engineering, which is considered a promising and viable therapeutic solution for structural and functional restoration of bone. In particular, the importance of MSCs and bioscaffolds is highlighted. Finally, potential approaches for the prevention of MSC aging and the rejuvenation of aged MSC are discussed.
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Affiliation(s)
- Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jihee Sohn
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - He Shen
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Division of Nanobiomedicine, Suzhou Institute of Nano-tech and Nano-bionics, Chinese Academy of Sciences, China
| | - Mark T Langhans
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; The Chinese University of Hong Kong, Hong Kong SAR, China.
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160
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Ghosh M, Halperin-Sternfeld M, Grinberg I, Adler-Abramovich L. Injectable Alginate-Peptide Composite Hydrogel as a Scaffold for Bone Tissue Regeneration. NANOMATERIALS (BASEL, SWITZERLAND) 2019; 9:E497. [PMID: 30939729 PMCID: PMC6523611 DOI: 10.3390/nano9040497] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/17/2019] [Accepted: 03/23/2019] [Indexed: 12/19/2022]
Abstract
The high demand for tissue engineering scaffolds capable of inducing bone regeneration using minimally invasive techniques prompts the need for the development of new biomaterials. Herein, we investigate the ability of Alginate incorporated with the fluorenylmethoxycarbonyl-diphenylalanine (FmocFF) peptide composite hydrogel to serve as a potential biomaterial for bone regeneration. We demonstrate that the incorporation of the self-assembling peptide, FmocFF, in sodium alginate leads to the production of a rigid, yet injectable, hydrogel without the addition of cross-linking agents. Scanning electron microscopy reveals a nanofibrous structure which mimics the natural bone extracellular matrix. The formed composite hydrogel exhibits thixotropic behavior and a high storage modulus of approximately 10 kPA, as observed in rheological measurements. The in vitro biocompatibility tests carried out with MC3T3-E1 preosteoblast cells demonstrate good cell viability and adhesion to the hydrogel fibers. This composite scaffold can induce osteogenic differentiation and facilitate calcium mineralization, as shown by Alizarin red staining, alkaline phosphatase activity and RT-PCR analysis. The high biocompatibility, excellent mechanical properties and similarity to the native extracellular matrix suggest the utilization of this hydrogel as a temporary three-dimensional cellular microenvironment promoting bone regeneration.
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Affiliation(s)
- Moumita Ghosh
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Michal Halperin-Sternfeld
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Itzhak Grinberg
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Lihi Adler-Abramovich
- Department of Oral Biology, The Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
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161
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Townsend JM, Beck EC, Gehrke SH, Berkland CJ, Detamore MS. Flow Behavior Prior to Crosslinking: The Need for Precursor Rheology for Placement of Hydrogels in Medical Applications and for 3D Bioprinting. Prog Polym Sci 2019; 91:126-140. [PMID: 31571701 PMCID: PMC6768569 DOI: 10.1016/j.progpolymsci.2019.01.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hydrogels - water swollen cross-linked networks - have demonstrated considerable promise in tissue engineering and regenerative medicine applications. However, ambiguity over which rheological properties are needed to characterize these gels before crosslinking still exists. Most hydrogel research focuses on the performance of the hydrogel construct after implantation, but for clinical practice, and for related applications such as bioinks for 3D bioprinting, the behavior of the pre-gelled state is also critical. Therefore, the goal of this review is to emphasize the need for better rheological characterization of hydrogel precursor formulations, and standardized testing for surgical placement or 3D bioprinting. In particular, we consider engineering paste or putty precursor solutions (i.e., suspensions with a yield stress), and distinguish between these differences to ease the path to clinical translation. The connection between rheology and surgical application as well as how the use of paste and putty nomenclature can help to qualitatively identify material properties are explained. Quantitative rheological properties for defining materials as either pastes or putties are proposed to enable easier adoption to current methods. Specifically, the three-parameter Herschel-Bulkley model is proposed as a suitable model to correlate experimental data and provide a basis for meaningful comparison between different materials. This model combines a yield stress, the critical parameter distinguishing solutions from pastes (100-2000 Pa) and from putties (>2000 Pa), with power law fluid behavior once the yield stress is exceeded. Overall, successful implementation of paste or putty handling properties to the hydrogel precursor may minimize the surgeon-technology learning time and ultimately ease incorporation into current practice. Furthermore, improved understanding and reporting of rheological properties will lead to better theoretical explanations of how materials affect rheological performances, to better predict and design the next generation of biomaterials.
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Affiliation(s)
- Jakob M. Townsend
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Emily C. Beck
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA
| | - Stevin H. Gehrke
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA
| | - Cory J. Berkland
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66045, USA
| | - Michael S. Detamore
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
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162
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Heath DE. A Review of Decellularized Extracellular Matrix Biomaterials for Regenerative Engineering Applications. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019. [DOI: 10.1007/s40883-018-0080-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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163
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Sargolzaei Aval F, Arab MR, Sargolzaei N, Barfrushan S, Mir M, Sargazi GH, Sargolzaeiaval F, Arab M. Histomorphometric Analysis of Newly-formed Bone Using Octacalcium Phosphate and Bone Matrix Gelatin in Rat Tibial Defects. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:182-190. [PMID: 31211197 PMCID: PMC6510914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Repair of bone defects is challenging for reconstructive and orthopedic surgeons. In this study, we aimed to histomorphometrically assess new bone formation in tibial bone defects filled with octacalcium phosphate (OCP), bone matrix gelatin (BMG), and a combination of both. METHODS A total of 96 male Sprague Dawley rats aged 6-8 weeks weighing 120-150 g were randomly allocated into three experimental (OCP, BMG, and OCP/BMG) and one control group (n=24 in each group). The defects in experimental groups were filled with OCP (6 mg), BMG (6 mg), or a combination of OCP and BMG (6 mg, 2:1 ratio). No material was used to fill the defects in the control group and the defect was only covered with Surgicel. Samples were taken on days 7, 14, 21, and 56 after the surgery. The sections were stained with hematoxylin-eosin (H&E) and assessed using light microscopy. RESULTS In our experimental groups, bone formation was started from the margins of the defect towards the center with an increasing rate during the study period. Moreover, the formed bone was more mature. Bone formation in our control group was only limited to the margins of the defect. The newly formed bone mass was significantly higher in the experimental groups (P=0.001). CONCLUSION OCP, BMG, and OCP/BMG compound enhanced osteoinduction in long bones.
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Affiliation(s)
- Fereydoon Sargolzaei Aval
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
| | - Mohammad R Arab
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
| | - Narjes Sargolzaei
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
| | - Sanam Barfrushan
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
| | - Mohsen Mir
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
| | - Gholam H Sargazi
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
| | - Forough Sargolzaeiaval
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
| | - Maryam Arab
- Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Research performed at Animals Research Center, Zahedan University of Medical Ssciences, Zahedan, Iran
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164
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Multiple integrin ligands provide a highly adhesive and osteoinductive surface that improves selective cell retention technology. Acta Biomater 2019; 85:106-116. [PMID: 30557698 DOI: 10.1016/j.actbio.2018.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/01/2023]
Abstract
Among various bone tissue engineering strategies, selective cell retention (SCR) technology has been used as a practical clinical method for bone graft manufacturing in real time. The more mesenchymal stem cells (MSCs) are retained, the better the osteoinductive microenvironment provided by the scaffold, which in turn promotes the osteogenesis of the SCR-fabricated bone grafts. Integrin receptors are crucial to cell-matrix adhesion and signal transduction. We designed a collagen-binding domain (CBD)-containing IKVAV-cRGD peptide (CBD-IKVAV-cRGD peptide) to complement the collagen-based demineralized bone matrix (DBM) with a functionalized surface containing multiple integrin ligands, which correspond to the highly expressed integrin subtypes on MSCs. This DBM/CBD-IKVAV-cRGD composite exhibited superior in vitro adhesion capacity to cultured MSCs, as determined by oscillatory cell adhesion assay, centrifugal cell adhesion assay and mimetic SCR. Moreover, it promoted the retention of MSC-like CD271+ cells and MSC-like CD90+/CD105+ cells in the clinical SCR method. Furthermore, the DBM/CBD-IKVAV-cRGD composite induced robust MSC osteogenesis, coupled with the activation of the downstream FAK-ERK1/2 signaling pathway of integrins. The SCR-prepared DBM/CBD-IKVAV-cRGD composite displayed superior in vivo osteogenesis, indicating that it may be potentially utilized as a biomaterial in SCR-mediated bone transplantation. STATEMENT OF SIGNIFICANCE: Selective cell retention technology (SCR) has been utilized in clinical settings to manufacture bioactive bone grafts. Specifically, demineralized bone matrix (DBM) is a widely-used SCR clinical biomaterial but it displays poor adhesion performance and osteoinduction. Improvements of the DBM that promote cell adhesion and osteoinduction will benefit SCR-prepared implants. In this work, we developed a novel peptide that complements the DBM with a functionalized surface of multiple integrin ligands, which are corresponding to integrin subtypes available on human bone marrow-derived mesenchymal stem cells (MSCs). Our results indicate this novel functionalized bioscaffold greatly increases SCR-mediated MSC adhesion and in vivo osteogenesis. Overall, this novel material has promising SCR applications and may likely provide highly bioactive bone implants in clinical settings.
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Iaquinta MR, Mazzoni E, Manfrini M, D'Agostino A, Trevisiol L, Nocini R, Trombelli L, Barbanti-Brodano G, Martini F, Tognon M. Innovative Biomaterials for Bone Regrowth. Int J Mol Sci 2019; 20:E618. [PMID: 30709008 PMCID: PMC6387157 DOI: 10.3390/ijms20030618] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022] Open
Abstract
The regenerative medicine, a new discipline that merges biological sciences and the fundamental of engineering to develop biological substitutes, has greatly benefited from recent advances in the material engineering and the role of stem cells in tissue regeneration. Regenerative medicine strategies, involving the combination of biomaterials/scaffolds, cells, and bioactive agents, have been of great interest especially for the repair of damaged bone and bone regrowth. In the last few years, the life expectancy of our population has progressively increased. Aging has highlighted the need for intervention on human bone with biocompatible materials that show high performance for the regeneration of the bone, efficiently and in a short time. In this review, the different aspects of tissue engineering applied to bone engineering were taken into consideration. The first part of this review introduces the bone cellular biology/molecular genetics. Data on biomaterials, stem cells, and specific growth factors for the bone regrowth are reported in this review.
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Affiliation(s)
- Maria Rosa Iaquinta
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | - Elisa Mazzoni
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | - Marco Manfrini
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | | | | | - Riccardo Nocini
- Department of Surgery, University of Verona, 37129 Verona, Italy.
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, 44121 Ferrara, Italy.
| | | | - Fernanda Martini
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
| | - Mauro Tognon
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.
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166
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Kim YS, Majid M, Melchiorri AJ, Mikos AG. Applications of decellularized extracellular matrix in bone and cartilage tissue engineering. Bioeng Transl Med 2019; 4:83-95. [PMID: 30680321 PMCID: PMC6336671 DOI: 10.1002/btm2.10110] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/12/2022] Open
Abstract
Regenerative therapies for bone and cartilage injuries are currently unable to replicate the complex microenvironment of native tissue. There are many tissue engineering approaches attempting to address this issue through the use of synthetic materials. Although synthetic materials can be modified to simulate the mechanical and biochemical properties of the cell microenvironment, they do not mimic in full the multitude of interactions that take place within tissue. Decellularized extracellular matrix (dECM) has been established as a biomaterial that preserves a tissue's native environment, promotes cell proliferation, and provides cues for cell differentiation. The potential of dECM as a therapeutic agent is rising, but there are many limitations of dECM restricting its use. This review discusses the recent progress in the utilization of bone and cartilage dECM through applications as scaffolds, particles, and supplementary factors in bone and cartilage tissue engineering.
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Affiliation(s)
- Yu Seon Kim
- Dept. of BioengineeringRice UniversityHoustonTX 77005
| | - Marjan Majid
- Dept. of BioengineeringRice UniversityHoustonTX 77005
| | | | - Antonios G. Mikos
- Dept. of BioengineeringRice UniversityHoustonTX 77005
- Biomaterials LabRice UniversityHoustonTX 77005
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167
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White KA, Olabisi RM. Spatiotemporal Control Strategies for Bone Formation through Tissue Engineering and Regenerative Medicine Approaches. Adv Healthc Mater 2019; 8:e1801044. [PMID: 30556328 DOI: 10.1002/adhm.201801044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/06/2018] [Indexed: 02/06/2023]
Abstract
Global increases in life expectancy drive increasing demands for bone regeneration. The gold standard for surgical bone repair is autografting, which enjoys excellent clinical outcomes; however, it possesses significant drawbacks including donor site morbidity and limited availability. Although collagen sponges delivered with bone morphogenetic protein, type 2 (BMP2) are a common alternative or supplement, they do not efficiently retain BMP2, necessitating extremely high doses to elicit bone formation. Hence, reports of BMP2 complications are rising, including cancer promotion and ectopic bone formation, the latter inducing complications such as breathing difficulties and neurologic impairments. Thus, efforts to exert spatial control over bone formation are increasing. Several tissue engineering approaches have demonstrated the potential for targeted and controlled bone formation. These approaches include biomaterial scaffolds derived from synthetic sources, e.g., calcium phosphates or polymers; natural sources, e.g., bone or seashell; and immobilized biofactors, e.g., BMP2. Although BMP2 is the only protein clinically approved for use in a surgical device, there are several proteins, small molecules, and growth factors that show promise in tissue engineering applications. This review profiles the tissue engineering advances in achieving control over the location and onset of bone formation (spatiotemporal control) toward avoiding the complications associated with BMP2.
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Affiliation(s)
- Kristopher A. White
- Department of Chemical and Biochemical Engineering; Rutgers University; 98 Brett Road Piscataway NJ 08854 USA
| | - Ronke M. Olabisi
- Department of Biomedical Engineering; Rutgers University; 599 Taylor Road Piscataway NJ 08854 USA
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168
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Homayounfar N, Khan MM, Ji Y, Khoury ZH, Oates TW, Goodlett DR, Chellaiah M, Masri R. The effect of embryonic origin on the osteoinductive potential of bone allografts. J Prosthet Dent 2018; 121:651-658. [PMID: 30598313 DOI: 10.1016/j.prosdent.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
Abstract
STATEMENT OF PROBLEM Allografts with osteoinduction potential are widely used to augment bone in surgical and prosthetic rehabilitations. However, osteoinduction potential varies among commercially available allografts. Donor bones are derived from different embryonic origins, either the neural crest or mesoderm. Whether the origin of the bones affects the osteoinductivity of allograftsis is unclear. PURPOSE The purpose of this ex vivo study was to investigate the osteoinduction potential of allografts derived from bones with distinct embryonic origins. MATERIAL AND METHODS Allografts were obtained from human frontal and parietal bones at 2 different ages (fetal and adult). The specimens were divided into 4 groups: adult frontal (n=5), adult parietal (n=5), fetal frontal (n=10), and fetal parietal (n=10). Two investigations were conducted to assess the osteoinductive potential of these allografts. First, the osteogenesis of human osteoblasts exposed to these allografts were evaluated by analyzing the expression of runt-related transcription factor 2 (RUNX2), collagen type 1 alpha 2 chain (COL1A2), and bone gamma-carboxyglutamate protein (BGLAP) genes using quantitative real-time polymerase chain reaction (qRT-PCR). Second, the protein content of the adult frontal and parietal bone matrices was analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS). One-way ANOVA and the t test were used for statistical analyses of the gene and protein expression of the groups (α=.05). RESULTS No difference was found in the gene expression of the cells exposed to frontal or parietal bones. However, all 3 genes were significantly overexpressed in cells treated with fetal bones compared with adult bones. No difference was found in protein expression between adult frontal and adult parietal bones. CONCLUSIONS No difference was found in the osteoinductive capacity of frontal and parietal bones used as allografts. However, the osteoinductivity of fetal bones can be higher than that of adult bones. Further microanalyses are needed to determine the protein content of fetal bones.
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Affiliation(s)
- Negar Homayounfar
- Assistant Professor, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Md.
| | - Mohd M Khan
- Graduate student, University of Maryland School of Medicine, Baltimore, Md
| | - Yadong Ji
- Research Scientist, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Md
| | - Zaid H Khoury
- Graduate student, Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Md
| | - Thomas W Oates
- Professor, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Md
| | - David R Goodlett
- Professor, Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Md
| | - Meenakshi Chellaiah
- Professor, Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Md
| | - Radi Masri
- Associate Professor, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Md
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169
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Kim JM, Kim JH, Lee BH, Choi SH. Vertical Bone Augmentation Using Three-dimensionally Printed Cap in the Rat Calvarial Partial Defect. In Vivo 2018; 32:1111-1117. [PMID: 30150433 DOI: 10.21873/invivo.11353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIM Lost alveolar bone is commonly restored by distraction osteogenesis or bone blocks for substantial vertical bone augmentation (VBA), that is applied in conjunction with a barrier system. This study was performed to determine whether volume control of a three-dimensional (3D) printed nylon cap in the rat calvarial partial thickness bone defect would induce qualitative and quantitative differences in vertical bone regeneration. MATERIALS AND METHODS A rat calvarial partial thickness bone defect was prepared and the 3D cap covered the defect to induce VBA, while the control group was left without cap placement. After six weeks the animals were sacrificed, and the calvaria were prepared for micro-CT (μCT) and histology. RESULTS Quantitative μCT results showed that our cap system has significant osteoconductive properties, and the histology slide revealed new bone filled inside the cap. CONCLUSION The results clearly showed that this system was successful for VBA in a research animal model.
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Affiliation(s)
- Joong-Min Kim
- e-Well Dental Hospital, Seoul, Republic of Korea.,Department of Dentistry, Graduate School of Medicine, Korea University, Seoul, Republic of Korea
| | - Joong-Hyun Kim
- Laboratory Animal Center, Osong Medical Innovation Foundation, Cheongju, Republic of Korea.,Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, Republic of Korea
| | - Byeong-Han Lee
- Laboratory Animal Center, Osong Medical Innovation Foundation, Cheongju, Republic of Korea
| | - Seok Hwa Choi
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
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170
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Liu M, Lv Y. Reconstructing Bone with Natural Bone Graft: A Review of In Vivo Studies in Bone Defect Animal Model. NANOMATERIALS (BASEL, SWITZERLAND) 2018; 8:E999. [PMID: 30513940 PMCID: PMC6315600 DOI: 10.3390/nano8120999] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022]
Abstract
Bone defects caused by fracture, disease or congenital defect remains a medically important problem to be solved. Bone tissue engineering (BTE) is a promising approach by providing scaffolds to guide and support the treatment of bone defects. However, the autologous bone graft has many defects such as limited sources and long surgical procedures. Therefore, xenograft bone graft is considered as one of the best substitutions and has been effectively used in clinical practice. Due to better preserved natural bone structure, suitable mechanical properties, low immunogenicity, good osteoinductivity and osteoconductivity in natural bone graft, decellularized and demineralized bone matrix (DBM) scaffolds were selected and discussed in the present review. In vivo animal models provide a complex physiological environment for understanding and evaluating material properties and provide important reference data for clinical trials. The purpose of this review is to outline the in vivo bone regeneration and remodeling capabilities of decellularized and DBM scaffolds in bone defect models to better evaluate the potential of these two types of scaffolds in BTE. Taking into account the limitations of the state-of-the-art technology, the results of the animal bone defect model also provide important information for future design of natural bone composite scaffolds.
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Affiliation(s)
- Mengying Liu
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China.
- Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College, Chongqing University, Chongqing 400044, China.
| | - Yonggang Lv
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China.
- Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College, Chongqing University, Chongqing 400044, China.
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171
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Shahmoradi SR, Kabir Salmani M, Soleimanpour HR, Tavakoli AH, Hosaini K, Haghighipour N, Bonakdar S. Induction of Chondrogenic Differentiation in Human Mesenchymal Stem Cells Cultured on Human Demineralized Bone Matrix Scaffold under Hydrostatic Pressure. Tissue Eng Regen Med 2018; 16:69-80. [PMID: 30815352 DOI: 10.1007/s13770-018-0164-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 02/03/2023] Open
Abstract
Background Articular cartilage damage is still a troublesome problem. Hence, several researches have been performed for cartilage repair. The aim of this study was to evaluate the chondrogenicity of demineralized bone matrix (DBM) scaffolds under cyclic hydrostatic pressure (CHP) in vitro. Methods In this study, CHP was applied to human bone marrow mesenchymal stem cells (hBMSCs) seeded on DBM scaffolds at a pressure of 5 MPa with a frequency of 0.5 Hz and 4 h per day for 1 week. Changes in chondrogenic and osteogenic gene expressions were analyzed by quantifying mRNA signal level of Sox9, collagen type I, collagen type II, aggrecan (ACAN), Osteocalcin, and Runx2. Histological analysis was carried out by hematoxylin and eosin, and Alcian blue staining. Moreover, DMMB and immunofluorescence staining were used for glycosaminoglycan (GAG) and collagen type II detection, respectively. Results Real-time PCR demonstrated that applying CHP to hBMSCs in DBM scaffolds increased mRNA levels by 1.3-fold, 1.2-fold, and 1.7-fold (p < 0.005) for Sox9, Col2, and ACAN, respectively by day 21, whereas it decreased mRNA levels by 0.7-fold and 0.8-fold (p < 0.05) for Runx2 and osteocalcin, respectively. Additionally, in the presence of TGF-β1 growth factor (10 ng/ml), CHP further increased mRNA levels for the mentioned genes (Sox9, Col2, and ACAN) by 1.4-fold, 1.3-fold and 2.5-fold (p < 0.005), respectively. Furthermore, in histological assessment, it was observed that the extracellular matrix contained GAG and type II collagen in scaffolds under CHP and CHP with TGF-β1, respectively. Conclusion The osteo-inductive DBM scaffolds showed chondrogenic characteristics under hydrostatic pressure. Our study can be a fundamental study for the use of DBM in articular cartilage defects in vivo and lead to production of novel scaffolds with two different characteristics to regenerate both bone and cartilage simultaneously. Graphical abstract
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Affiliation(s)
- Saeid Reza Shahmoradi
- 1Biomaterials and Tissue Engineering Department, Stem Cell Division, National Institute of Genetic Engineering and Biotechnology, Shahrak-e Pajoohesh, km 15, Tehran - Karaj Highway, Tehran, 1497716316 Iran
| | - Maryam Kabir Salmani
- 1Biomaterials and Tissue Engineering Department, Stem Cell Division, National Institute of Genetic Engineering and Biotechnology, Shahrak-e Pajoohesh, km 15, Tehran - Karaj Highway, Tehran, 1497716316 Iran
| | - Hamid Reza Soleimanpour
- 1Biomaterials and Tissue Engineering Department, Stem Cell Division, National Institute of Genetic Engineering and Biotechnology, Shahrak-e Pajoohesh, km 15, Tehran - Karaj Highway, Tehran, 1497716316 Iran
| | - Amir Hossein Tavakoli
- 2Iranian Tissue Bank, Imam khomani Hospital, University of Medical Sciences, Keshavarz Blvd, Tehran, 1419733141 Iran
| | - Kazem Hosaini
- 2Iranian Tissue Bank, Imam khomani Hospital, University of Medical Sciences, Keshavarz Blvd, Tehran, 1419733141 Iran
| | - Nooshin Haghighipour
- 3National Cell Bank Department, Pasteur Institute of Iran (IPI), No. 69, Pasteur Ave, Tehran, 1316943551 Iran
| | - Shahin Bonakdar
- 3National Cell Bank Department, Pasteur Institute of Iran (IPI), No. 69, Pasteur Ave, Tehran, 1316943551 Iran
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He W, Fan Y, Li X. [Recent research progress of bioactivity mechanism and application of bone repair materials]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1107-1115. [PMID: 30129343 DOI: 10.7507/1002-1892.201807039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Large bone defect repair is a difficult problem to be solved urgently in orthopaedic field, and the application of bone repair materials is a feasible method to solve this problem. Therefore, bone repair materials have been continuously developed, and have evolved from autogenous bone grafts, allograft bone grafts, and inert materials to highly active and multifunctional bone tissue engineering scaffold materials. In this paper, the related mechanism of bone repair materials, the application of bone repair materials, and the exploration of new bone repair materials are introduced to present the research status and advance of the bone repair materials, and the development direction is also prospected.
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Affiliation(s)
- Wei He
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, P.R.China;Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, P.R.China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, P.R.China;Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083,
| | - Xiaoming Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, P.R.China;Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083,
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173
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Strauss FJ, Stähli A, Beer L, Mitulović G, Gilmozzi V, Haspel N, Schwab G, Gruber R. Acid bone lysate activates TGFβ signalling in human oral fibroblasts. Sci Rep 2018; 8:16065. [PMID: 30375456 PMCID: PMC6207660 DOI: 10.1038/s41598-018-34418-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023] Open
Abstract
Demineralized bone matrix is a widely used allograft from which not only the inorganic mineral but also embedded growth factors are removed by hydrochloric acid (HCl). The cellular response to the growth factors released during the preparation of demineralized bone matrix, however, has not been studied. Here we investigated the in vitro impact of acid bone lysate (ABL) prepared from porcine cortical bone chips on oral fibroblasts. Proteomic analysis of ABL revealed a large spectrum of bone-derived proteins including TGF-β1. Whole genome microarrays and RT-PCR together with the pharmacologic blocking of TGF-β receptor type I kinase with SB431542 showed that ABL activates the TGF-β target genes interleukin 11, proteoglycan 4, and NADPH oxidase 4. Interleukin 11 expression was confirmed at the protein level by ELISA. Immunofluorescence and Western blot showed the nuclear localization of Smad2/3 and increased phosphorylation of Smad3 with ABL, respectively. This effect was independent of whether ABL was prepared from mandible, calvaria or tibia. These results demonstrate that TGF-β is a major growth factor that is removed upon the preparation of demineralized bone matrix.
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Affiliation(s)
- Franz Josef Strauss
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
- Department of Conservative Dentistry, School of Dentistry, University of Chile, Sergio Livingstone 943, Santiago, Chile
| | - Alexandra Stähli
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Lucian Beer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Goran Mitulović
- Clinical Department of Laboratory Medicine Proteomics Core Facility, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Valentina Gilmozzi
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Nina Haspel
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Gerhild Schwab
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Reinhard Gruber
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria.
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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Zielak JC, Neto DG, Cazella Zielak MA, Savaris LB, Esteban Florez FL, Deliberador TM. In vivo regeneration functionalities of experimental organo-biomaterials containing water-soluble nacre extract. Heliyon 2018; 4:e00776. [PMID: 30229137 PMCID: PMC6141258 DOI: 10.1016/j.heliyon.2018.e00776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/08/2018] [Accepted: 09/05/2018] [Indexed: 12/01/2022] Open
Abstract
Background Novel multifunctional biomaterials were recently designed to allow for an optimized tissue regeneration process. Purpose To comprehensively assess (photographic, radiographic and histological) the in vivo functionality of demineralized bovine bone matrix (DBM) associated with an experimental marine organic extract (MOE) from nacre in a sheep ectopic grafting model. Materials and methods Synthesis of MOE was based on mixing powdered nacre (0.05 g, particles average size <0.1 mm) with acetic acid (5 mL, pH 7) under constant stirring for 72 hours (25 °C). Polyethylene tubes (3/animal, n = 4, diameter: 5.0 mm × length: 10.0 mm) from the control (empty) or experimental groups (DBM or DBM + MOE) were then intramuscularly implanted into the lumbar regions of sheep (n = 8, 2-years old, ≈45 kg). Animals were euthanized at 3 and 6 months to allow for the collection of tissue samples. Tissue samples were fixed in formalin 10% (buffered, 7 days) in preparation for photographic, radiographic and histological assessments. Acquired images were then analyzed using digital image analysis software to quantify the amount of neoformed tissues, whereas radiographic and histological analyses were performed to determine radiopacity and classification of tissues deposited inside of the tubes. Results Photographic and radiographic analyses have shown that both pure (unaltered) and MOE-modified DBM were capable of depositing neoformed tissues (at 3 and 6 months), where higher levels of deposition and radiopacity were observed on groups treated with experimental materials. Histological results, however, demonstrated that tissues formed from both unaltered and MOE-modified DBM were only fibrous connective in origin. Conclusions As an ectopic grafting in sheep, the experimental organo-biomaterial association applied did not reveal any osteoinductive property but led to a fibrous tissue repair only.
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Affiliation(s)
- João César Zielak
- Graduate Program in Dentistry, Universidade Positivo, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, Paraná, 81280-330, Brazil
| | - David Gulin Neto
- Graduate Program in Dentistry, Universidade Positivo, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, Paraná, 81280-330, Brazil
| | - Makeli Aparecida Cazella Zielak
- Graduate Program in Dentistry, Universidade Positivo, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, Paraná, 81280-330, Brazil
| | - Leonardo Brunet Savaris
- Graduate Program in Dentistry, Universidade Positivo, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, Paraná, 81280-330, Brazil
| | - Fernando Luis Esteban Florez
- Department of Restorative Sciences, Division of Dental Biomaterials, The University of Oklahoma Health Sciences Center, 1201 N. Stonewall Ave., Oklahoma City, OK, 73117, USA
| | - Tatiana Miranda Deliberador
- Graduate Program in Dentistry, Universidade Positivo, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, Paraná, 81280-330, Brazil
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Cui Y, Lu C, Chen B, Han J, Zhao Y, Xiao Z, Han S, Pan J, Dai J. Restoration of mandibular bone defects with demineralized bone matrix combined with three-dimensional cultured bone marrow-derived mesenchymal stem cells in minipig models. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:147. [PMID: 30171486 DOI: 10.1007/s10856-018-6152-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/19/2018] [Indexed: 06/08/2023]
Abstract
Mandibular defects, caused by congenital, pathological or iatrogenic insults, can significantly affect patient quality of life. The reconstruction of mandible has recently gained the interest of clinical and tissue engineering researchers. The purpose of this study was to evaluate the effectiveness of three-dimensional (3-D) cultured autologous grafts prepared using bone marrow-derived mesenchymal stem cells (BMSCs) combined with demineralized bone matrix (DBM) scaffolds for the restoration of mandibular defects. Cylindrical defects were created in the mandibular body of minipigs and filled with 3D-cultured BMSCs/DBM autografts, 2D-cultured BMSCs/DBM autografts, DBM material (without cells), or were left unfilled (blank). Using computed tomographic (CT) imaging and histological staining, we found that treatment of mandibular defects using 3-D cultured BMSCs/DBM autografts offered improvements in bone formation over both 2-D cultured autografts and cell-free DBM scaffolds. We found increased osteoid formation in 3D and 2D cultures, with more osteogenic cells present in the 3D constructs. We suggest that 3-D cultured homograft BMSCs combined with DBM scaffolds represents a new strategy for bone reconstruction, with potential future clinical applicability.
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Affiliation(s)
- Yi Cui
- Reproductive and Genetic Center of National Research Institute for Family Planning, Beijing, 100081, P.R. China
| | - Chao Lu
- Department of Oral & Maxillofacial Surgery, Beijing Chongwen Hospital of Stomatology, Beijing, 100062, China
| | - Bing Chen
- Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100080, China
| | - Jin Han
- Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100080, China
| | - Yannan Zhao
- Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100080, China
| | - Zhifeng Xiao
- Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100080, China
| | - Sufang Han
- Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100080, China
| | - Juli Pan
- Department of VIP Service, School of Stomatology, Capital Medical University, Beijing, China.
| | - Jianwu Dai
- Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100080, China.
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176
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杨 波, 常 彦, 凌 鸣, 李 思, 曹 峻. [Demineralized cancellous bone seeded with allogeneic chondrocytes for repairing articular osteochondral defects in rabbits]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1039-1044. [PMID: 30377114 PMCID: PMC6744196 DOI: 10.12122/j.issn.1673-4254.2018.09.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effect of demineralized cancellous bone (DCB) seeded with allogeneic chondrocytes for repairing articular osteochondral defects in rabbits. METHODS Articular chondrocytes were isolated from a 1-month-old male New Zealand rabbit for primary culture. The passage 1 chondrocytes were seeded onto prepared rabbit DCB scaffold to construct tissue-engineered cartilage and cultured in vitro for 2 weeks. Full-thickness articular osteochondral defects (3 mm both in diameter and depth) were created on both sides of the femoral medial condyles in 30 New Zealand white rabbits (age 4- 5 months). In 20 of the rabbits, the defects were filled with the tissue-engineered cartilage on the right side (group A) and with DCB only on the left side (group B); the remaining 10 rabbits did not receive any implantation in the defects to serve as the control (group C). At 1, 3, and 6 months after the implantation, tissue samples were collected from the defects for macroscopic observation and histological examination with Toluidine blue (TB) and collagen type Ⅱ staining. The effect of defect repair using the tissue-engineered cartilage was assessed at 6 months based on the histological scores. RESULTS The prepared DCB had a spongy 3D structure with open and interconnected micropores of various sizes and showed good plasticity and mechanical strength. DCB began to degrade within 1 month after implantation and was totally absorbed at 3 months. At 6 months after implantation, the defects filled with the chondrocyte-seeded DCB were repaired mainly by hyaline-like cartilage tissues, which were well integrated to the adjacent cartilage without clear boundaries and difficult to recognize. The chondrocytes were located in the lacunate and arranged in vertical columns in the deep repaired tissue, where matrix proteoglycans and collagen type Ⅱ were distributed homogeneously close to the normal cartilage. The subchondral bone plate was reconstructed completely. The defects implanted with DCB only were filled with fibrocartilage tissue, as compared with fibrous tissue in the control defects. The histological scores in group A were significantly superior to those in group B and C (P < 0.05), but the scores for subchondral bone plate reconstruction were comparable between groups A and B at 6 months. CONCLUSIONS DCB is a good scaffold material for preparing tissue-engineered cartilage, and chondrocyte- seeded DCB can repair articular osteochondral defects by inducing the generation of hayline-like cartilage.
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Affiliation(s)
- 波 杨
- 陕西省人民医院骨科//西安交通大学第三附属医院,陕西 西安 710068Department of Orthopedics, Shannxi Provincial People's Hospital/Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, China
| | - 彦海 常
- 陕西省人民医院骨科//西安交通大学第三附属医院,陕西 西安 710068Department of Orthopedics, Shannxi Provincial People's Hospital/Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, China
| | - 鸣 凌
- 陕西省人民医院骨科//西安交通大学第三附属医院,陕西 西安 710068Department of Orthopedics, Shannxi Provincial People's Hospital/Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, China
| | - 思远 李
- 西安交通大学第二附属医院麻醉科,陕西 西安 710004Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - 峻岭 曹
- 西安交通大学医学部地方病研究所,环境与疾病相关基因教育部重点实验室,陕西 西安 710061Xi'an Jiaotong University Health Science Center, Institute of Endemic Diseases, Key Laboratory of Environment and Genes Related to Diseases, Xi'an 710061, China
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177
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Manjubala I, Basu P, Narendrakumar U. In situ synthesis of hydroxyapatite/carboxymethyl cellulose composites for bone regeneration applications. Colloid Polym Sci 2018. [DOI: 10.1007/s00396-018-4393-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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178
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Hu Q, Liu M, Chen G, Xu Z, Lv Y. Demineralized Bone Scaffolds with Tunable Matrix Stiffness for Efficient Bone Integration. ACS APPLIED MATERIALS & INTERFACES 2018; 10:27669-27680. [PMID: 30063134 DOI: 10.1021/acsami.8b08668] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As a biophysical cue, matrix stiffness can decide the stem cell fate. However, most methods to construct three-dimensional (3D) scaffolds may change the 3D microstructure while altering their mechanical properties. In this study, demineralized bone matrix scaffolds with different compressive modulus (66.06 ± 27.83 MPa (high), 26.90 ± 13.16 MPa (medium), and 0.67 ± 0.14 MPa (low)) were constructed by controlling the decalcification duration (1 h, 12 h, and 5 days), respectively. The pore size and porosity have no significant difference between the scaffolds before and after decalcification. Cell experiments indicated that the low scaffolds could promote the osteogenic differentiation of bone marrow mesenchymal stem cells (MSCs) in vitro. Rat subcutaneous implantation experiments further demonstrated that the low scaffolds could efficiently improve the cell infiltration, deposition of collagen fibers, and positive osteocalcin and osteopontin expression of endogenous cells as well as angiogenesis. Finally, rabbit femoral condylar defect experiments proved that the low scaffolds could significantly promote the bone repair and integration and stromal cell derived factor-1α/CXC chemokine receptor signal pathway was essential for the stiffness-mediated bone repair. These investigations provided a novel method for fabricating 3D bone grafts with different stiffness, which is also of great significance for studying the effect of stiffness on the biological behavior of MSCs in three dimensions.
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Affiliation(s)
- Qingxia Hu
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College and Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College , Chongqing University , Chongqing 400044 , P. R. China
| | - Mengying Liu
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College and Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College , Chongqing University , Chongqing 400044 , P. R. China
| | - Guobao Chen
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College and Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College , Chongqing University , Chongqing 400044 , P. R. China
| | - Zhiling Xu
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College and Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College , Chongqing University , Chongqing 400044 , P. R. China
| | - Yonggang Lv
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Bioengineering College and Mechanobiology and Regenerative Medicine Laboratory, Bioengineering College , Chongqing University , Chongqing 400044 , P. R. China
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179
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Kim Y, Kang BJ, Kim WH, Yun HS, Kweon OK. Evaluation of Mesenchymal Stem Cell Sheets Overexpressing BMP-7 in Canine Critical-Sized Bone Defects. Int J Mol Sci 2018; 19:ijms19072073. [PMID: 30018197 PMCID: PMC6073206 DOI: 10.3390/ijms19072073] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/13/2018] [Accepted: 07/15/2018] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to investigate the in vitro osteogenic capacity of bone morphogenetic protein 7 (BMP-7) overexpressing adipose-derived (Ad-) mesenchymal stem cells (MSCs) sheets (BMP-7-CS). In addition, BMP-7-CS were transplanted into critical-sized bone defects and osteogenesis was assessed. BMP-7 gene expressing lentivirus particles were transduced into Ad-MSCs. BMP-7, at the mRNA and protein level, was up-regulated in BMP-7-MSCs compared to expression in Ad-MSCs. Osteogenic and vascular-related gene expressions were up-regulated in BMP-7-CS compared to Ad-MSCs and Ad-MSC sheets. In a segmental bone-defect model, newly formed bone and neovascularization were enhanced with BMP-7-CS, or with a combination of BMP-7-CS and demineralized bone matrix (DBM), compared to those in control groups. These results demonstrate that lentiviral-mediated gene transfer of BMP-7 into Ad-MSCs allows for stable BMP-7 production. BMP-7-CS displayed higher osteogenic capacity than Ad-MSCs and Ad-MSC sheets. In addition, BMP-7-CS combined with demineralized bone matrix (DBM) stimulated new bone and blood vessel formation in a canine critical-sized bone defect. The BMP-7-CS not only provides BMP-7 producing MSCs but also produce osteogenic and vascular trophic factors. Thus, BMP-7-CS and DBM have therapeutic potential for the treatment of critical-sized bone defects and could be used to further enhance clinical outcomes during bone-defect treatment.
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Affiliation(s)
- Yongsun Kim
- BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea.
| | - Byung-Jae Kang
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon 24341, Korea.
| | - Wan Hee Kim
- BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea.
| | - Hui-Suk Yun
- Powder and Ceramics Division, Korea Institute of Materials Science, Changwon 51508, Korea.
| | - Oh-Kyeong Kweon
- BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea.
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180
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Bracey DN, Seyler TM, Jinnah AH, Lively MO, Willey JS, Smith TL, Van Dyke ME, Whitlock PW. A Decellularized Porcine Xenograft-Derived Bone Scaffold for Clinical Use as a Bone Graft Substitute: A Critical Evaluation of Processing and Structure. J Funct Biomater 2018; 9:jfb9030045. [PMID: 30002336 PMCID: PMC6164666 DOI: 10.3390/jfb9030045] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Bone grafts are used in approximately one half of all musculoskeletal surgeries. Autograft bone is the historic gold standard but is limited in supply and its harvest imparts significant morbidity to the patient. Alternative sources of bone graft include allografts, synthetics and, less commonly, xenografts which are taken from animal species. Xenografts are available in unlimited supply from healthy animal donors with controlled biology, avoiding the risk of human disease transmission, and may satisfy current demand for bone graft products. METHODS In the current study, cancellous bone was harvested from porcine femurs and subjected to a novel decellularization protocol to derive a bone scaffold. RESULTS The scaffold was devoid of donor cellular material on histology and DNA sampling (p < 0.01). Microarchitectural properties important for osteoconductive potential were preserved after decellularization as shown by high resolution imaging modalities. Proteomics data demonstrated similar profiles when comparing the porcine bone scaffold against commercially available human demineralized bone matrix approved for clinical use. CONCLUSION We are unaware of any porcine-derived bone graft products currently used in orthopaedic surgery practice. Results from the current study suggest that porcine-derived bone scaffolds warrant further consideration to serve as a potential bone graft substitute.
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Affiliation(s)
- Daniel N Bracey
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Alexander H Jinnah
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Mark O Lively
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Jeffrey S Willey
- Department of Radiation Oncology, Wake Forest School of Medicine Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
| | - Mark E Van Dyke
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
| | - Patrick W Whitlock
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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181
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Zhang N, Ma L, Liu X, Jiang X, Yu Z, Zhao D, Zhang L, Zhang C, Huang F. In vitro and in vivo evaluation of xenogeneic bone putty with the carrier of hydrogel derived from demineralized bone matrix. Cell Tissue Bank 2018; 19:591-601. [PMID: 29974309 DOI: 10.1007/s10561-018-9708-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
The demineralized bone matrix (DBM) putty is a traditional bone graft utilized to facilitate the repair and reconstruction of bone. Recent studies indicated the DBM putties with the various carriers were different in bone repairing ability. In order to prepare a kind of DBM putty with a good biocompatibility and bioactivity, the DBM gel was processed from the DBM and the feasibility as a carrier for the DBM putty was evaluated. After the bovine DBM gel was prepared, the BMPs content as well as the ability to promote osteogenic differentiation of MC3T3-E1 cells in vitro were investigated. Then the DBM putty was prepared and filled into the rat calvarial defect model to evaluate the bone repairing ability by micro-CT and histology. The result showed there was 2.953 ± 0.054 ng BMP contained in per gram of the DBM gel. And the ALP production of MC3T3-E1 cells in the DBM gels group increased with prolonged culturing, the mineralized nodules formed in MC3T3-E1 cells on 14th day after co-culture. The putty prepared by DBM gel was easy to handle without loss of DBM particles at room temperature. In the rat calvarial bone defect experiment, histological observation showed more mature bone formed in the DBM putty group than that in the type I collagen group at 12 weeks, which indicated the bone putty prepared by DBM gel exhibited a better bone repair capability.
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Affiliation(s)
- Naili Zhang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Lina Ma
- Department of Diagnostics, School of Medicine, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Xiaowei Liu
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Xiaorui Jiang
- Department of Hand and Foot Surgery, Yuhuangding Hospital, 20 Yuhuangding East Road, Zhifu, Yantai, 264000, China
| | - Zhenhai Yu
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Dongmei Zhao
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Luping Zhang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Chunlei Zhang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China
| | - Fei Huang
- Department of Human Anatomy, School of Basic Medical Science, Binzhou Medical University, 346 Guanhai Road, Laishan, Yantai, 264003, Shandong, China.
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182
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de Vries S, Doeselaar MV, Meij B, Tryfonidou M, Ito K. Notochordal Cell Matrix As a Therapeutic Agent for Intervertebral Disc Regeneration. Tissue Eng Part A 2018; 25:830-841. [PMID: 29739272 DOI: 10.1089/ten.tea.2018.0026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Notochordal cells (NCs) reside in the core of the healthy disc and produce soluble factors that can stimulate nucleus pulposus cells (NPCs). These NC-derived factors may be applied in intervertebral disc regeneration for treatment of low-back pain. However, identification of the active soluble factors is challenging. Therefore a novel approach to directly use porcine NC-rich NP matrix (NCM) is introduced. We explored porcine NCM's anabolic effects on bovine NPCs harvested from caudal discs of adolescent and adult (2-2.5 vs. 4-6 year old) cows. NC-conditioned medium (NCCM) and NCM were produced from porcine NC-rich NP tissue. Bovine NPCs were cultured in alginate beads for 4 weeks in base medium (BM), NCCM, and NCM to investigate NCM's regenerative potential. Porcine NCM increased glycosaminoglycan (GAG) content of both adolescent and adult bovine NPCs. This was through increased proliferation of adolescent bovine NPCs, whereas in adult bovine NPCs, it was mostly through increased GAG production per NPC. Furthermore, adolescent bovine NPCs were cultured in BM and porcine NCM treated with interleukin (IL)-1β to investigate NCM's potential in an inflammatory environment. Addition of IL-1β enhanced IL1β and CXCL8 (IL8) gene expression, while NCM diminished IL1β gene expression. IL-1β reduced GAG and DNA content, but the addition of NCM relative to BM improved GAG and DNA content. Altogether, porcine NCM exerts bovine NPC-age dependent effects, and NCM's anabolic effect on adult NPCs is stronger compared with NCCM. Furthermore, porcine NCM induced an anabolic response of bovine NPCs in an inflammatory environment and may have anti-inflammatory properties. Therefore, NCM has potential in a regenerative therapy for disc degeneration, and warrants additional in vivo studies.
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Affiliation(s)
- Stefan de Vries
- 1 Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marina van Doeselaar
- 1 Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Björn Meij
- 2 Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marianna Tryfonidou
- 2 Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Keita Ito
- 1 Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,3 Department of Orthopaedics, University Medical Center, Utrecht, The Netherlands
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183
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Meimandi-Parizi A, Oryan A, Sayahi E, Bigham-Sadegh A. Propolis extract a new reinforcement material in improving bone healing: An in vivo study. Int J Surg 2018; 56:94-101. [PMID: 29902525 DOI: 10.1016/j.ijsu.2018.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/27/2018] [Accepted: 06/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Propolis is known for its antioxidant, immune response modulating, and wound healing effects. In the present study in order to determine the bone healing capacity of the propolis extract, a critical sized, nonunion, radial bone defect model was repaired in rat, using chitosan and demineralized bone matrix (DBM) scaffolds along with propolis extract. MATERIALS AND METHODS Seventy-two radial bone defects in 36 healthy male rats were randomly divided into 6 groups (n = 12/group). The groups included autograft, defect or untreated group, chitosan, DBM, chitosan and propolis (chitosan-propolis), and DBM and propolis (DBM-propolis). The bone repairing capability was characterized using radiography at 28th, 42nd and 56th postoperative days. Gross morphologic, histopathologic, histomorphometric and biomechanical examinations were performed following euthanasia at the 56th post-operative day. RESULTS The DBM-propolis group, showed better structural and biomechanical properties compared to the untreated, DBM, chitosan and chitosan-propolis groups. The defect site in the chitosan and untreated groups were mainly restored by fibrous connective tissue while the lesions in the autograft group were mostly filled by cartilage and a lesser amount of woven bone. The woven bone, and the hyaline cartilage were the main constituents of the newly formed tissues in the DBM-propolis group, at the 56th day after injury. CONCLUSION The results of this study showed that percutaneous injection of diluted aqueous propolis extract in the bone defect (25 mg/defect) can improve bone formation in the critical radial bone defect in rat. Since there was no significant difference between the autograft and DBM-propolis group, probably this therapeutic strategy has high potential in augmentation of autologous bone grafting.
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Affiliation(s)
| | - Ahmad Oryan
- Clinical Sciences Department, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Emad Sayahi
- Clinical Sciences Department, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Amin Bigham-Sadegh
- Department of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
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184
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Kowalczewski CJ, Saul JM. Biomaterials for the Delivery of Growth Factors and Other Therapeutic Agents in Tissue Engineering Approaches to Bone Regeneration. Front Pharmacol 2018; 9:513. [PMID: 29896102 PMCID: PMC5986909 DOI: 10.3389/fphar.2018.00513] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/27/2018] [Indexed: 12/14/2022] Open
Abstract
Bone fracture followed by delayed or non-union typically requires bone graft intervention. Autologous bone grafts remain the clinical "gold standard". Recently, synthetic bone grafts such as Medtronic's Infuse Bone Graft have opened the possibility to pharmacological and tissue engineering strategies to bone repair following fracture. This clinically-available strategy uses an absorbable collagen sponge as a carrier material for recombinant human bone morphogenetic protein 2 (rhBMP-2) and a similar strategy has been employed by Stryker with BMP-7, also known as osteogenic protein-1 (OP-1). A key advantage to this approach is its "off-the-shelf" nature, but there are clear drawbacks to these products such as edema, inflammation, and ectopic bone growth. While there are clinical challenges associated with a lack of controlled release of rhBMP-2 and OP-1, these are among the first clinical examples to wed understanding of biological principles with biochemical production of proteins and pharmacological principles to promote tissue regeneration (known as regenerative pharmacology). After considering the clinical challenges with such synthetic bone grafts, this review considers the various biomaterial carriers under investigation to promote bone regeneration. This is followed by a survey of the literature where various pharmacological approaches and molecular targets are considered as future strategies to promote more rapid and mature bone regeneration. From the review, it should be clear that pharmacological understanding is a key aspect to developing these strategies.
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Affiliation(s)
| | - Justin M Saul
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, OH, United States
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185
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Biologic canine and human intervertebral disc repair by notochordal cell-derived matrix: from bench towards bedside. Oncotarget 2018; 9:26507-26526. [PMID: 29899873 PMCID: PMC5995168 DOI: 10.18632/oncotarget.25476] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/28/2018] [Indexed: 12/19/2022] Open
Abstract
The socioeconomic burden of chronic back pain related to intervertebral disc (IVD) disease is high and current treatments are only symptomatic. Minimally invasive strategies that promote biological IVD repair should address this unmet need. Notochordal cells (NCs) are replaced by chondrocyte-like cells (CLCs) during IVD maturation and degeneration. The regenerative potential of NC-secreted substances on CLCs and mesenchymal stromal cells (MSCs) has already been demonstrated. However, identification of these substances remains elusive. Innovatively, this study exploits the regenerative NC potential by using healthy porcine NC-derived matrix (NCM) and employs the dog as a clinically relevant translational model. NCM increased the glycosaminoglycan and DNA content of human and canine CLC aggregates and facilitated chondrogenic differentiation of canine MSCs in vitro. Based on these results, NCM, MSCs and NCM+MSCs were injected in mildly (spontaneously) and moderately (induced) degenerated canine IVDs in vivo and, after six months of treatment, were analyzed. NCM injected in moderately (induced) degenerated canine IVDs exerted beneficial effects at the macroscopic and MRI level, induced collagen type II-rich extracellular matrix production, improved the disc height, and ameliorated local inflammation. MSCs exerted no (additive) effects. In conclusion, NCM induced in vivo regenerative effects on degenerated canine IVDs. NCM may, comparable to demineralized bone matrix in bone regeneration, serve as ‘instructive matrix’, by locally releasing growth factors and facilitating tissue repair. Therefore, intradiscal NCM injection could be a promising regenerative treatment for IVD disease, circumventing the cumbersome identification of bioactive NC-secreted substances.
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186
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Hasan A, Byambaa B, Morshed M, Cheikh MI, Shakoor RA, Mustafy T, Marei HE. Advances in osteobiologic materials for bone substitutes. J Tissue Eng Regen Med 2018; 12:1448-1468. [DOI: 10.1002/term.2677] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 02/04/2018] [Accepted: 04/12/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Anwarul Hasan
- Department of Mechanical and Industrial Engineering, College of Engineering; Qatar University; Doha Qatar
| | - Batzaya Byambaa
- Center for Biomedical Engineering, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA USA
| | - Mahboob Morshed
- School of Life Sciences; Independent University, Bangladesh (IUB); Dhaka Bangladesh
| | - Mohammad Ibrahim Cheikh
- Department of Mechanical Engineering, Faculty of Engineering and Architecture; American University of Beirut; Beirut Lebanon
| | | | - Tanvir Mustafy
- Department of Mechanical Engineering; Ecole Polytechnique de Montreal; Quebec Canada
| | - Hany E. Marei
- Biomedical Research Center; Qatar University; Doha Qatar
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187
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Chen Y, Ye SH, Sato H, Zhu Y, Shanov V, Tiasha T, D'Amore A, Luketich S, Wan G, Wagner WR. Hybrid scaffolds of Mg alloy mesh reinforced polymer/extracellular matrix composite for critical-sized calvarial defect reconstruction. J Tissue Eng Regen Med 2018; 12:1374-1388. [DOI: 10.1002/term.2668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/07/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Yingqi Chen
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh PA USA
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, College of Materials Science and Engineering; Southwest Jiaotong University; Chengdu China
| | - Sang-Ho Ye
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh PA USA
| | - Hideyoshi Sato
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh PA USA
| | - Yang Zhu
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh PA USA
| | - Vesselin Shanov
- College of Engineering and Applied Science; University of Cincinnati; Cincinnati OH USA
| | - Tarannum Tiasha
- College of Engineering and Applied Science; University of Cincinnati; Cincinnati OH USA
| | - Antonio D'Amore
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh PA USA
| | - Samuel Luketich
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh PA USA
| | - Guojiang Wan
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, College of Materials Science and Engineering; Southwest Jiaotong University; Chengdu China
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh PA USA
- Department of Surgery; University of Pittsburgh; Pittsburgh PA USA
- Department of Chemical Engineering; University of Pittsburgh; Pittsburgh PA USA
- Department of Bioengineering; University of Pittsburgh; Pittsburgh PA USA
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188
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Vas WJ, Shah M, Blacker TS, Duchen MR, Sibbons P, Roberts SJ. Decellularized Cartilage Directs Chondrogenic Differentiation: Creation of a Fracture Callus Mimetic. Tissue Eng Part A 2018; 24:1364-1376. [PMID: 29580181 DOI: 10.1089/ten.tea.2017.0450] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Complications that arise from impaired fracture healing have considerable socioeconomic implications. Current research in the field of bone tissue engineering predominantly aims to mimic the mature bone tissue microenvironment. This approach, however, may produce implants that are intrinsically unresponsive to the cues present during the initiation of fracture repair. As such, this study describes the development of decellularized xenogeneic hyaline cartilage matrix in an attempt to mimic the initial reparative phase of fracture repair. Three approaches based on vacuum-assisted osmotic shock (Vac-OS), Triton X-100 (Vac-STx), and sodium dodecyl sulfate (Vac-SDS) were investigated. The Vac-OS methodology reduced DNA content below 50 ng/mg of tissue, while retaining 85% of the sulfate glycosaminoglycan content, and as such was selected as the optimal methodology for decellularization. The resultant Vac-OS scaffolds (decellularized extracellular matrix [dcECM]) were also devoid of the immunogenic alpha-Gal epitope. Furthermore, minimal disruption to the structural integrity of the dcECM was demonstrated using differential scanning calorimetry and fluorescence lifetime imaging microscopy. The biological integrity of the dcECM was confirmed by its ability to drive the chondrogenic commitment and differentiation of human chondrocytes and periosteum-derived cells, respectively. Furthermore, histological examination of dcECM constructs implanted in immunocompetent mice revealed a predominantly M2 macrophage-driven regenerative response both at 2 and 8 weeks postimplantation. These findings contrasted with the implanted native costal cartilage that elicited a predominantly M1 macrophage-mediated inflammatory response. This study highlights the capacity of dcECM from the Vac-OS methodology to direct the key biological processes of endochondral ossification, thus potentially recapitulating the callus phase of fracture repair.
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Affiliation(s)
- Wollis J Vas
- 1 Department of Materials and Tissue, Institute of Orthopaedics and Musculoskeletal Science, University College London , Stanmore, United Kingdom
| | - Mittal Shah
- 1 Department of Materials and Tissue, Institute of Orthopaedics and Musculoskeletal Science, University College London , Stanmore, United Kingdom
| | - Thomas S Blacker
- 2 Department of Cell and Developmental Biology, University College London , London, United Kingdom .,3 Department of Physics and Astronomy, University College London , London, United Kingdom
| | - Michael R Duchen
- 2 Department of Cell and Developmental Biology, University College London , London, United Kingdom
| | - Paul Sibbons
- 4 Northwick Park Institute for Medical Research , Northwick Park Hospital, London, United Kingdom
| | - Scott J Roberts
- 1 Department of Materials and Tissue, Institute of Orthopaedics and Musculoskeletal Science, University College London , Stanmore, United Kingdom
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189
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Spinal Biologics in Minimally Invasive Lumbar Surgery. Minim Invasive Surg 2018; 2018:5230350. [PMID: 29850240 PMCID: PMC5907390 DOI: 10.1155/2018/5230350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/25/2018] [Indexed: 12/28/2022] Open
Abstract
As the use of minimally invasive spine (MIS) fusion approaches continues to grow, increased scrutiny is being placed on its outcomes and efficacies against traditional open fusion surgeries. While there are many factors that contribute to the success of achieving spinal arthrodesis, selecting the optimal fusion biologic remains a top priority. With an ever-expanding market of bone graft substitutes, it is important to evaluate each of their use as it pertains to MIS techniques. This review will summarize the important characteristics and properties of various spinal biologics used in minimally invasive lumbar surgeries and compare their fusion rates via a systematic review of published literature.
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190
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Townsend JM, Zabel TA, Feng Y, Wang J, Andrews BT, Nudo RJ, Berkland CJ, Detamore MS. Effects of tissue processing on bioactivity of cartilage matrix-based hydrogels encapsulating osteoconductive particles. ACTA ACUST UNITED AC 2018; 13:034108. [PMID: 29411714 DOI: 10.1088/1748-605x/aaad77] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In the treatment of severe traumatic brain injury (TBI), decompressive craniectomy is commonly used to remove a large portion of calvarial bone to allow unimpeded brain swelling. Hydrogels have the potential to revolutionize TBI treatment by permitting a single-surgical intervention, remaining pliable during brain swelling, and tuned to regenerate bone after swelling has subsided. With this motivation, our goal is to present a pliable material capable of regenerating calvarial bone across a critical size defect. We therefore proposed the use of a methacrylated solubilized decellularized cartilage (MeSDCC) hydrogel encapsulating synthetic osteogenic particles of hydroxyapatite nanofibers, bioglass microparticles, or added rat bone marrow-derived mesenchymal stem cells (rMSCs) for bone regeneration in critical-size rat calvarial defects. Fibrin hydrogels were employed as a control material for the study. MeSDCC hydrogels exhibited sufficient rheological performance for material placement before crosslinking ([Formula: see text] > 500 Pa), and sufficient compressive moduli post-crosslinking (E > 150 kPa). In vitro experiments suggested increased calcium deposition for cells seeded on the MeSDCC material; however, in vivo bone regeneration was minimal in both MeSDCC and fibrin groups, even with colloidal materials or added rMSCs. Minimal bone regeneration in the MeSDCC test groups may potentially be attributed to cartilage solubilization after decellularization, in which material signals may have degraded from enzymatic treatment. Looking to the future, an improvement in the bioactivity of the material will be crucial to the success of bone regeneration strategies for TBI treatment.
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Affiliation(s)
- Jakob M Townsend
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, United States of America
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191
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Efficacy of rhBMP-2 Loaded PCL/ β-TCP/bdECM Scaffold Fabricated by 3D Printing Technology on Bone Regeneration. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2876135. [PMID: 29682530 PMCID: PMC5848108 DOI: 10.1155/2018/2876135] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 11/23/2022]
Abstract
This study was undertaken to evaluate the effect of 3D printed polycaprolactone (PCL)/β-tricalcium phosphate (β-TCP) scaffold containing bone demineralized and decellularized extracellular matrix (bdECM) and human recombinant bone morphogenetic protein-2 (rhBMP-2) on bone regeneration. Scaffolds were divided into PCL/β-TCP, PCL/β-TCP/bdECM, and PCL/β-TCP/bdECM/BMP groups. In vitro release kinetics of rhBMP-2 were determined with respect to cell proliferation and osteogenic differentiation. These three reconstructive materials were implanted into 8 mm diameter calvarial bone defect in male Sprague-Dawley rats. Animals were sacrificed four weeks after implantation for micro-CT, histologic, and histomorphometric analyses. The findings obtained were used to calculate new bone volumes (mm3) and new bone areas (%). Excellent cell bioactivity was observed in the PCL/β-TCP/bdECM and PCL/β-TCP/bdECM/BMP groups, and new bone volume and area were significantly higher in the PCL/β-TCP/bdECM/BMP group than in the other groups (p < .05). Within the limitations of this study, bdECM printed PCL/β-TCP scaffolds can reproduce microenvironment for cells and promote adhering and proliferating the cells onto scaffolds. Furthermore, in the rat calvarial defect model, the scaffold which printed rhBMP-2 loaded bdECM stably carries rhBMP-2 and enhances bone regeneration confirming the possibility of bdECM as rhBMP-2 carrier.
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192
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Hydrophilicity, Viscoelastic, and Physicochemical Properties Variations in Dental Bone Grafting Substitutes. MATERIALS 2018; 11:ma11020215. [PMID: 29385747 PMCID: PMC5848912 DOI: 10.3390/ma11020215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 12/23/2022]
Abstract
The indication-oriented Dental Bone Graft Substitutes (DBGS) selection, the correct bone defects classification, and appropriate treatment planning are very crucial for obtaining successful clinical results. However, hydrophilic, viscoelastic, and physicochemical properties’ influence on the DBGS regenerative potential has poorly been studied. For that reason, we investigated the dimensional changes and molecular mobility by Dynamic Mechanical Analysis (DMA) of xenograft (cerabone®), synthetic (maxresorb®), and allograft (maxgraft®, Puros®) blocks in a wet and dry state. While no significant differences could be seen in dry state, cerabone® and maxresorb® blocks showed a slight height decrease in wet state, whereas both maxgraft® and Puros® had an almost identical height increase. In addition, cerabone® and maxresorb® blocks remained highly rigid and their damping behaviour was not influenced by the water. On the other hand, both maxgraft® and Puros® had a strong increase in their molecular mobility with different damping behaviour profiles during the wet state. A high-speed microscopical imaging system was used to analyze the hydrophilicity in several naturally derived (cerabone®, Bio-Oss®, NuOss®, SIC® nature graft) and synthetic DBGS granules (maxresorb®, BoneCeramic®, NanoBone®, Ceros®). The highest level of hydrophilicity was detected in cerabone® and maxresorb®, while Bio-Oss® and BoneCeramic® had the lowest level of hydrophilicity among both naturally derived and synthetic DBGS groups. Deviations among the DBGS were also addressed via physicochemical differences recorded by Micro Computed Tomography, Scanning Electron Microscopy, Fourier Transform Infrared Spectroscopy, X-ray powder Diffractometry, and Thermogravimetric Analysis. Such DBGS variations could influence the volume stability at the grafting site, handling as well as the speed of vascularization and bone regeneration. Therefore, this study initiates a new insight into the DBGS differences and their importance for successful clinical results.
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193
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Pharaon SK, Schoch S, Marchand L, Mirza A, Mayberry J. Orthopaedic traumatology: fundamental principles and current controversies for the acute care surgeon. Trauma Surg Acute Care Open 2018; 3:e000117. [PMID: 29766123 PMCID: PMC5887772 DOI: 10.1136/tsaco-2017-000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/20/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
Multiply injured patients with fractures are co-managed by acute care surgeons and orthopaedic surgeons. In most centers, orthopaedic surgeons definitively manage fractures, but preliminary management, including washouts, splinting, reductions, and external fixations, may be performed by selected acute care surgeons. The acute care surgeon should have a working knowledge of orthopaedic terminology to communicate with colleagues effectively. They should have an understanding of the composition of bone, periosteum, and cartilage, and their reaction when there is an injury. Fractures are usually fixed urgently, but some multiply injured patients are better served with a damage control strategy. Extremity compartment syndrome should be suspected in all critically injured patients with or without fractures and a low threshold for compartment pressure measurements or empiric fasciotomy maintained. Acute care surgeons performing rib fracture fixation and other chest wall injury reconstructions should follow the principles of open fracture reduction and stabilization.
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Affiliation(s)
- Shad K Pharaon
- Trauma and Acute Care Surgery, PeaceHealth Southwest Medical Center, Vancouver, Washington, USA
| | - Shawn Schoch
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Lucas Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Amer Mirza
- Orthopaedic Trauma Surgery, Legacy Emanuel Medical Center, Portland, Oregon, USA
| | - John Mayberry
- Trauma and Acute Care Surgery, Saint Alphonsus Regional Medical Center, Boise, Idaho, USA.,Department of Surgery, WWAMI Regional Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
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194
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Kim H, Kim Y, Fendereski M, Hwang NS, Hwang Y. Recent Advancements in Decellularized Matrix-Based Biomaterials for Musculoskeletal Tissue Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1077:149-162. [DOI: 10.1007/978-981-13-0947-2_9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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195
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Le BQ, Nurcombe V, Cool SM, van Blitterswijk CA, de Boer J, LaPointe VLS. The Components of Bone and What They Can Teach Us about Regeneration. MATERIALS (BASEL, SWITZERLAND) 2017; 11:E14. [PMID: 29271933 PMCID: PMC5793512 DOI: 10.3390/ma11010014] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022]
Abstract
The problem of bone regeneration has engaged both physicians and scientists since the beginning of medicine. Not only can bone heal itself following most injuries, but when it does, the regenerated tissue is often indistinguishable from healthy bone. Problems arise, however, when bone does not heal properly, or when new tissue is needed, such as when two vertebrae are required to fuse to stabilize adjacent spine segments. Despite centuries of research, such procedures still require improved therapeutic methods to be devised. Autologous bone harvesting and grafting is currently still the accepted benchmark, despite drawbacks for clinicians and patients that include limited amounts, donor site morbidity, and variable quality. The necessity for an alternative to this "gold standard" has given rise to a bone-graft and substitute industry, with its central conundrum: what is the best way to regenerate bone? In this review, we dissect bone anatomy to summarize our current understanding of its constituents. We then look at how various components have been employed to improve bone regeneration. Evolving strategies for bone regeneration are then considered.
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Affiliation(s)
- Bach Quang Le
- Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, #6-06 Immunos, Singapore 138648, Singapore.
| | - Victor Nurcombe
- Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, #6-06 Immunos, Singapore 138648, Singapore.
| | - Simon McKenzie Cool
- Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, #6-06 Immunos, Singapore 138648, Singapore.
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119288, Singapore.
| | - Clemens A van Blitterswijk
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Jan de Boer
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Vanessa Lydia Simone LaPointe
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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196
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Simkin J, Seifert AW. Concise Review: Translating Regenerative Biology into Clinically Relevant Therapies: Are We on the Right Path? Stem Cells Transl Med 2017; 7:220-231. [PMID: 29271610 PMCID: PMC5788874 DOI: 10.1002/sctm.17-0213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023] Open
Abstract
Despite approaches in regenerative medicine using stem cells, bio‐engineered scaffolds, and targeted drug delivery to enhance human tissue repair, clinicians remain unable to regenerate large‐scale, multi‐tissue defects in situ. The study of regenerative biology using mammalian models of complex tissue regeneration offers an opportunity to discover key factors that stimulate a regenerative rather than fibrotic response to injury. For example, although primates and rodents can regenerate their distal digit tips, they heal more proximal amputations with scar tissue. Rabbits and African spiny mice re‐grow tissue to fill large musculoskeletal defects through their ear pinna, while other mammals fail to regenerate identical defects and instead heal ear holes through fibrotic repair. This Review explores the utility of these comparative healing models using the spiny mouse ear pinna and the mouse digit tip to consider how mechanistic insight into reparative regeneration might serve to advance regenerative medicine. Specifically, we consider how inflammation and immunity, extracellular matrix composition, and controlled cell proliferation intersect to establish a pro‐regenerative microenvironment in response to injuries. Understanding how some mammals naturally regenerate complex tissue can provide a blueprint for how we might manipulate the injury microenvironment to enhance regenerative abilities in humans. Stem Cells Translational Medicine2018;7:220–231
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Affiliation(s)
- Jennifer Simkin
- Department of Biology, University of Kentucky, Lexington, Kentucky, USA
| | - Ashley W Seifert
- Department of Biology, University of Kentucky, Lexington, Kentucky, USA
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197
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Thrivikraman G, Athirasala A, Twohig C, Boda SK, Bertassoni LE. Biomaterials for Craniofacial Bone Regeneration. Dent Clin North Am 2017; 61:835-856. [PMID: 28886771 PMCID: PMC5663293 DOI: 10.1016/j.cden.2017.06.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Functional reconstruction of craniofacial defects is a major clinical challenge in craniofacial sciences. The advent of biomaterials is a potential alternative to standard autologous/allogenic grafting procedures to achieve clinically successful bone regeneration. This article discusses various classes of biomaterials currently used in craniofacial reconstruction. Also reviewed are clinical applications of biomaterials as delivery agents for sustained release of stem cells, genes, and growth factors. Recent promising advancements in 3D printing and bioprinting techniques that seem to be promising for future clinical treatments for craniofacial reconstruction are covered. Relevant topics in the bone regeneration literature exemplifying the potential of biomaterials to repair bone defects are highlighted.
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Affiliation(s)
- Greeshma Thrivikraman
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, OHSU School of Dentistry, 2730 SW Moody Avenue, Portland, OR 97201, USA
| | - Avathamsa Athirasala
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, OHSU School of Dentistry, 2730 SW Moody Avenue, Portland, OR 97201, USA
| | - Chelsea Twohig
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, OHSU School of Dentistry, 2730 SW Moody Avenue, Portland, OR 97201, USA
| | - Sunil Kumar Boda
- Mary and Dick Holland Regenerative Medicine Program, Department of Surgery-Transplant, University of Nebraska Medical Center, Omaha, NE 68198-5965, USA
| | - Luiz E Bertassoni
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, OHSU School of Dentistry, 2730 SW Moody Avenue, Portland, OR 97201, USA; Department of Biomedical Engineering, OHSU School of Medicine, 3303 SW Bond Avenue, Portland, OR 97239, USA; OHSU Center for Regenerative Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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198
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Pacelli S, Basu S, Whitlow J, Chakravarti A, Acosta F, Varshney A, Modaresi S, Berkland C, Paul A. Strategies to develop endogenous stem cell-recruiting bioactive materials for tissue repair and regeneration. Adv Drug Deliv Rev 2017; 120:50-70. [PMID: 28734899 PMCID: PMC5705585 DOI: 10.1016/j.addr.2017.07.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/05/2017] [Accepted: 07/16/2017] [Indexed: 02/07/2023]
Abstract
A leading strategy in tissue engineering is the design of biomimetic scaffolds that stimulate the body's repair mechanisms through the recruitment of endogenous stem cells to sites of injury. Approaches that employ the use of chemoattractant gradients to guide tissue regeneration without external cell sources are favored over traditional cell-based therapies that have limited potential for clinical translation. Following this concept, bioactive scaffolds can be engineered to provide a temporally and spatially controlled release of biological cues, with the possibility to mimic the complex signaling patterns of endogenous tissue regeneration. Another effective way to regulate stem cell activity is to leverage the inherent chemotactic properties of extracellular matrix (ECM)-based materials to build versatile cell-instructive platforms. This review introduces the concept of endogenous stem cell recruitment, and provides a comprehensive overview of the strategies available to achieve effective cardiovascular and bone tissue regeneration.
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Affiliation(s)
- Settimio Pacelli
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.
| | - Sayantani Basu
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.
| | - Jonathan Whitlow
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.
| | - Aparna Chakravarti
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.
| | - Francisca Acosta
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.
| | - Arushi Varshney
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
| | - Saman Modaresi
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.
| | - Cory Berkland
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA; Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, USA.
| | - Arghya Paul
- Department of Chemical and Petroleum Engineering, Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.
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199
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Jakus AE, Laronda MM, Rashedi AS, Robinson CM, Lee C, Jordan SW, Orwig KE, Woodruff TK, Shah RN. "Tissue Papers" from Organ-Specific Decellularized Extracellular Matrices. ADVANCED FUNCTIONAL MATERIALS 2017; 27:1700992. [PMID: 29104526 PMCID: PMC5665058 DOI: 10.1002/adfm.201700992] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Using an innovative, tissue-independent approach to decellularized tissue processing and biomaterial fabrication, the development of a series of "tissue papers" derived from native porcine tissues/organs (heart, kidney, liver, muscle), native bovine tissue/organ (ovary and uterus), and purified bovine Achilles tendon collagen as a control from decellularized extracellular matrix particle ink suspensions cast into molds is described. Each tissue paper type has distinct microstructural characteristics as well as physical and mechanical properties, is capable of absorbing up to 300% of its own weight in liquid, and remains mechanically robust (E = 1-18 MPa) when hydrated; permitting it to be cut, rolled, folded, and sutured, as needed. In vitro characterization with human mesenchymal stem cells reveals that all tissue paper types support cell adhesion, viability, and proliferation over four weeks. Ovarian tissue papers support mouse ovarian follicle adhesion, viability, and health in vitro, as well as support, and maintain the viability and hormonal function of nonhuman primate and human follicle-containing, live ovarian cortical tissues ex vivo for eight weeks postmortem. "Tissue papers" can be further augmented with additional synthetic and natural biomaterials, as well as integrated with recently developed, advanced 3D-printable biomaterials, providing a versatile platform for future multi-biomaterial construct manufacturing.
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Affiliation(s)
- Adam E Jakus
- Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA. Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, USA
| | - Monica M Laronda
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Alexandra S Rashedi
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Christina M Robinson
- Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA. Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, USA
| | - Chris Lee
- Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA. Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, USA
| | - Sumanas W Jordan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kyle E Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences and Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Teresa K Woodruff
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ramille N Shah
- Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA. Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL 60611, USA. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA. Divsion of Organ Transplantation, Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abstract
In a quest to provide best-quality treatment, results, and long-term prognosis, physicians must be well versed in emerging sciences and discoveries to more favorably provide suitable options to patients. Bioengineering and regeneration have rapidly developed, and with them, the options afforded to surgeons are ever-expanding. Grafting techniques can be modified according to evolving knowledge. The basic principles of bioengineering are discussed in this article to provide a solid foundation for favorable treatment and a comprehensive understanding of the reasons why each particular treatment available can be the most adequate for each particular case.
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