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Shanbhag S, Kampleitner C, Sanz-Esporrin J, Lie SA, Gruber R, Mustafa K, Sanz M. Regeneration of alveolar bone defects in the experimental pig model: A systematic review and meta-analysis. Clin Oral Implants Res 2024; 35:467-486. [PMID: 38450852 DOI: 10.1111/clr.14253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Pigs are emerging as a preferred experimental in vivo model for bone regeneration. The study objective was to answer the focused PEO question: in the pig model (P), what is the capacity of experimental alveolar bone defects (E) for spontaneous regeneration in terms of new bone formation (O)? METHODS Following PRISMA guidelines, electronic databases were searched for studies reporting experimental bone defects or extraction socket healing in the maxillae or mandibles of pigs. The main inclusion criteria were the presence of a control group of untreated defects/sockets and the assessment of regeneration via 3D tomography [radiographic defect fill (RDF)] or 2D histomorphometry [new bone formation (NBF)]. Random effects meta-analyses were performed for the outcomes RDF and NBF. RESULTS Overall, 45 studies were included reporting on alveolar bone defects or extraction sockets, most frequently in the mandibles of minipigs. Based on morphology, defects were broadly classified as 'box-defects' (BD) or 'cylinder-defects' (CD) with a wide range of healing times (10 days to 52 weeks). Meta-analyses revealed pooled estimates (with 95% confidence intervals) of 50% RDF (36.87%-63.15%) and 43.74% NBF (30.47%-57%) in BD, and 44% RDF (16.48%-71.61%) and 39.67% NBF (31.53%-47.81%) in CD, which were similar to estimates of socket-healing [48.74% RDF (40.35%-57.13%) and 38.73% NBF (28.57%-48.89%)]. Heterogeneity in the meta-analysis was high (I2 > 90%). CONCLUSION A substantial body of literature revealed a high capacity for spontaneous regeneration in experimental alveolar bone defects of (mini)pigs, which should be considered in future studies of bone regeneration in this animal model.
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Affiliation(s)
- Siddharth Shanbhag
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Carina Kampleitner
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Javier Sanz-Esporrin
- ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - Stein-Atle Lie
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Reinhard Gruber
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Kamal Mustafa
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mariano Sanz
- ETEP Research Group, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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The effect of polyethylenglycol gel on the delivery and osteogenic differentiation of homologous tooth germ-derived stem cells in a porcine model. Clin Oral Investig 2020; 25:3043-3057. [PMID: 33104929 DOI: 10.1007/s00784-020-03625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate if bone regeneration can be promoted by homologous transplantation of STRO-1 sorted (STRO-1+) porcine tooth germ mesenchymal stem cells (TGSCs) with the combination of polyethylenglycol (PEG)-based hydrogel and biphasic calcium phosphate (BCP) scaffolds. MATERIAL AND METHODS TGSCs were isolated from impacted third molars of domestic pigs. Nine critical-sized defects were created as (1) untreated defect; filled with (2) autogenous bone; (3) BCP + PEG; (4) BCP + PEG + unsorted TGSCs; (5) BCP + unsorted TGSCs; (6) BCP + PEG + STRO-1-sorted TGSCs; (7) BCP + STRO-1-sorted TGSCs; (8) BCP + PEG + osteogenic induced unsorted TGSCs; and (9) BCP + PEG + osteogenic induced STRO-1-sorted TGSCs in 20 domestic pigs. CM-DiI labelling was used to track cells in vivo. Histomorphometric assessment of new bone formation was achieved by toluidine blue O staining and microradiography after 1, 2, 4 and 12 weeks posttransplantation. RESULTS Complete healing was achieved in all defects although defects with PEG hydrogel presented better bone formation while STRO-1+ and unsorted TGSCs showed similar ability to form new bone after 12 weeks. Transplanted cells were seen in defects where PEG hydrogel was used as carriers in contrast to defects treated with cells and only bone grafts. CONCLUSIONS PEG hydrogel is an efficient carrier for homologous stem cell transplantation. TGSCs are capable of promoting bone healing in critical-sized defects in combination with bone graft and PEG hydrogel. CLINICAL RELEVANCE This study provides information about the importance of the delivery vehicle for future translational stem cell delivery approaches.
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Pelled G, Lieber R, Avalos P, Cohn-Yakubovich D, Tawackoli W, Roth J, Knapp E, Schwarz EM, Awad HA, Gazit D, Gazit Z. Teriparatide (recombinant parathyroid hormone 1-34) enhances bone allograft integration in a clinically relevant pig model of segmental mandibulectomy. J Tissue Eng Regen Med 2020; 14:1037-1049. [PMID: 32483878 PMCID: PMC7429307 DOI: 10.1002/term.3075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
Massive craniofacial bone loss poses a clinical challenge to maxillofacial surgeons. Structural bone allografts are readily available at tissue banks but are rarely used due to a high failure rate. Previous studies showed that intermittent administration of recombinant parathyroid hormone (rPTH) enhanced integration of allografts in a murine model of calvarial bone defect. To evaluate its translational potential, the hypothesis that rPTH would enhance healing of a mandibular allograft in a clinically relevant large animal model of mandibulectomy was tested. Porcine bone allografts were implanted into a 5-cm-long continuous mandible bone defect in six adult Yucatan minipigs, which were randomized to daily intramuscular injections of rPTH (1.75 μg/kg) and placebo (n = 3). Blood tests were performed on Day 56 preoperation, Day 0 and on Day 56 postoperation. Eight weeks after the surgery, bone healing was analyzed using high-resolution X-ray imaging (Faxitron and micro computed tomography [CT]) and three-point bending biomechanical testing. The results showed a significant 2.6-fold rPTH-induced increase in bone formation (p = 0.02). Biomechanically, the yield failure properties of the healed mandibles were significantly higher in the rPTH group (yield load: p < 0.05; energy to yield: p < 0.01), and the post-yield displacement and energy were higher in the placebo group (p < 0.05), suggesting increased mineralized integration of the allograft in the rPTH group. In contrast to similar rPTH therapy studies in dogs, no signs of hypercalcemia, hyperphosphatemia, or inflammation were detected. Taken together, we provide initial evidence that rPTH treatment enhances mandibular allograft healing in a clinically relevant large animal model.
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Affiliation(s)
- Gadi Pelled
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raphael Lieber
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
| | - Pablo Avalos
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Doron Cohn-Yakubovich
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
| | - Wafa Tawackoli
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joseph Roth
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Emma Knapp
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Edward M. Schwarz
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Hani A. Awad
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Dan Gazit
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zulma Gazit
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Li Y, Zhang X, Dai C, Yin Y, Gong L, Pan W, Huang R, Bu Y, Liao X, Guo K, Gao F. Bioactive Three-Dimensional Graphene Oxide Foam/Polydimethylsiloxane/Zinc Silicate Scaffolds with Enhanced Osteoinductivity for Bone Regeneration. ACS Biomater Sci Eng 2020; 6:3015-3025. [PMID: 33463276 DOI: 10.1021/acsbiomaterials.9b01931] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Nanocomposite scaffold materials have shown great prospect in promoting bone integration and bone regeneration. A three-dimensional graphene oxide foam/polydimethylsiloxane/zinc silicate (GF/PDMS/ZS) scaffold for bone tissue engineering was synthesized via dip coating and hydrothermal synthesis processes, resulting in the interconnected macroporous structure. The scaffold was characterized with scanning electron microscopy (SEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and thermogravimetric (TG) analysis. The result showed that scaffolds exhibiting a porous characteristic had organic-inorganic components similar to natural bone tissue. Moreover, the scaffolds possessed suitable pore size, high porosity, and good mechanical properties. In vitro experiments with mouse bone marrow mesenchymal stem cells (mBMSCs) revealed that the composite scaffold not only has great biocompatibility but also has the ability to induce mBMSC proliferation and preferential osteogentic differentiation. Thereafter, the expression of critical genes, ALP, RUNX2, VEGFA, and OPN, was activated. In vivo analysis of critical bone defect in rabbits demonstrated superior bone formation in defect sites in the GF/PDMS/ZS scaffold group at 12 weeks of post implantation without no significant inflammatory response. All the results validated that the GF/PDMS/ZS scaffold is a promising alternative for applications in bone regeneration.
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Affiliation(s)
- Yang Li
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China.,Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, China
| | - Xing Zhang
- Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Chengbai Dai
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China.,Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, China
| | - Yiming Yin
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China
| | - Ling Gong
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China
| | - Wenzhen Pan
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China.,Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, China
| | - Ruqi Huang
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China.,Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, China
| | - Yeyang Bu
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China.,Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, China
| | - Xianjiu Liao
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China
| | - Kaijin Guo
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China.,Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, 221002, Xuzhou, China
| | - Fenglei Gao
- School of Pharmacy, Xuzhou Medical University, 221004, Xuzhou, China
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Nam JW, Kim HJ. Stepwise verification of bone regeneration using recombinant human bone morphogenetic protein-2 in rat fibula model. J Korean Assoc Oral Maxillofac Surg 2017; 43:373-387. [PMID: 29333367 PMCID: PMC5756794 DOI: 10.5125/jkaoms.2017.43.6.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 11/07/2022] Open
Abstract
Objectives The purpose of this study was to introduce our three experiments on bone morphogenetic protein (BMP) and its carriers performed using the critical sized segmental defect (CSD) model in rat fibula and to investigate development of animal models and carriers for more effective bone regeneration. Materials and Methods For the experiments, 14, 16, and 24 rats with CSDs on both fibulae were used in Experiments 1, 2, and 3, respectively. BMP-2 with absorbable collagen sponge (ACS) (Experiments 1 and 2), autoclaved autogenous bone (AAB) and fibrin glue (FG) (Experiment 3), and xenogenic bone (Experiment 2) were used in the experimental groups. Radiographic and histomorphological evaluations were performed during the follow-up period of each experiment. Results Significant new bone formation was commonly observed in all experimental groups using BMP-2 compared to control and xenograft (porcine bone) groups. Although there was some difference based on BMP carrier, regenerated bone volume was typically reduced by remodeling after initially forming excessive bone. Conclusion BMP-2 demonstrates excellent ability for bone regeneration because of its osteoinductivity, but efficacy can be significantly different depending on its delivery system. ACS and FG showed relatively good bone regeneration capacity, satisfying the essential conditions of localization and release-control when used as BMP carriers. AAB could not provide release-control as a BMP carrier, but its space-maintenance role was remarkable. Carriers and scaffolds that can provide sufficient support to the BMP/carrier complex are necessary for large bone defects, and AAB is thought to be able to act as an effective scaffold. The CSD model of rat fibula is simple and useful for initial estimate of bone regeneration by agents including BMPs.
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Affiliation(s)
- Jung-Woo Nam
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Department of Oral and Maxillofacial Surgery, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Hyung-Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.,Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea.,Research Institute for Dental Biomaterials & Bioengineering, Yonsei University College of Dentistry, Seoul, Korea
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The recycling of autoclaved autografts in mandibular reconstruction: case report and review of literature. J Maxillofac Oral Surg 2013; 14:308-12. [PMID: 25838715 DOI: 10.1007/s12663-013-0508-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/20/2013] [Indexed: 10/27/2022] Open
Abstract
Removal of pathological lesions from the mandible can leave a disfiguring appearance in addition to compromising the function of speech and mastication. It therefore becomes imperative to replace the lost part with bone grafts. Autogenous bone grafts-vascularised and non-vascularised, have been in vogue for the same. The probability of using the same resected bone after removal of all pathology has been done for a long time with mixed results in terms of uptake and viability. This paper presents a case of the use of autoclaved resected bone being used for reconstructing the mandible.
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Implants in bone: part I. A current overview about tissue response, surface modifications and future perspectives. Oral Maxillofac Surg 2013; 18:243-57. [PMID: 23435578 DOI: 10.1007/s10006-013-0398-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/04/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of study paper is to present an overview of osseointegration of dental implants, focusing on tissue response, surface modifications and future perspective. DISCUSSION Great progress has been made over the decades in the understanding of osseous peri-implant healing of dental implants, leading to the development of new implant materials and surfaces. However, failures and losses of implants are an indicator that there is room for improvement. Of particular importance is the understanding of the biological interaction between the implant and its surrounding bone. CONCLUSION The survival rates of dental implants in bone of over 90 % after 10 years show that they are an effective and well-established therapy option. However, new implant materials and surface modifications may be able to improve osseointegration of medical implants especially when the wound healing is compromised. Advanced techniques of evaluation are necessary to understand and validate osseointegration in these cases. An overview regarding the current state of the art in experimental evaluation of osseointegration of implants and implant material modifications will be given in Part II.
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von Wilmowsky C, Moest T, Nkenke E, Stelzle F, Schlegel KA. Implants in bone: part II. Research on implant osseointegration: material testing, mechanical testing, imaging and histoanalytical methods. Oral Maxillofac Surg 2013; 18:355-72. [PMID: 23430020 DOI: 10.1007/s10006-013-0397-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/04/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE In order to determine whether a newly developed implant material conforms to the requirements of biocompatibility, it must undergo rigorous testing. To correctly interpret the results of studies on implant material osseointegration, it is necessary to have a sound understanding of all the testing methods. The aim of this overview is to elucidate the methods that are used for the experimental evaluation of the osseointegration of implant materials. DISCUSSION In recent decades, there has been a constant proliferation of new materials and surface modifications in the field of dental implants. This continuous development of innovative biomaterials requires a precise and detailed evaluation in terms of biocompatibility and implant healing before clinical use. The current gold standard is in vivo animal testing on well validated animal models. However, long-term outcome studies on patients have to follow to finally validate and show patient benefit. CONCLUSION No experimental set-up can provide answers for all possible research questions. However, a certain transferability of the results to humans might be possible if the experimental set-up is carefully chosen for the aspects and questions being investigated. To enhance the implant survival rate in the rising number of patients with chronic diseases which compromise wound healing and osseointegration, dental implant research on compromised animal models will further gain importance in future.
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Affiliation(s)
- Cornelius von Wilmowsky
- Mund-,Kiefer- und Gesichtschirurgische Klinik Universitätsklinikum Erlangen, Glückstrasse 11, 91054, Erlangen, Germany,
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Abstract
Defects requiring reconstruction in the mandible are commonly encountered and may result from resection of benign or malignant lesions, trauma, or osteoradionecrosis. Mandibular defects can be classified according to location and extent, as well as involvement of mucosa, skin, and tongue. Vascularized bone flaps, in general, provide the best functional and aesthetic outcome, with the fibula flap remaining the gold standard for mandible reconstruction. In this review, we discuss classification and approach to reconstruction of mandibular defects. We also elaborate upon four commonly used free osteocutaneous flaps, inclusive of fibula, iliac crest, scapula, and radial forearm. Finally, we discuss indications and use of osseointegrated implants as well as recent advances in mandibular reconstruction.
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Hollister SJ, Murphy WL. Scaffold translation: barriers between concept and clinic. TISSUE ENGINEERING. PART B, REVIEWS 2011; 17:459-74. [PMID: 21902613 PMCID: PMC3223015 DOI: 10.1089/ten.teb.2011.0251] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/26/2011] [Indexed: 01/29/2023]
Abstract
Translation of scaffold-based bone tissue engineering (BTE) therapies to clinical use remains, bluntly, a failure. This dearth of translated tissue engineering therapies (including scaffolds) remains despite 25 years of research, research funding totaling hundreds of millions of dollars, over 12,000 papers on BTE and over 2000 papers on BTE scaffolds alone in the past 10 years (PubMed search). Enabling scaffold translation requires first an understanding of the challenges, and second, addressing the complete range of these challenges. There are the obvious technical challenges of designing, manufacturing, and functionalizing scaffolds to fill the Form, Fixation, Function, and Formation needs of bone defect repair. However, these technical solutions should be targeted to specific clinical indications (e.g., mandibular defects, spine fusion, long bone defects, etc.). Further, technical solutions should also address business challenges, including the need to obtain regulatory approval, meet specific market needs, and obtain private investment to develop products, again for specific clinical indications. Finally, these business and technical challenges present a much different model than the typical research paradigm, presenting the field with philosophical challenges in terms of publishing and funding priorities that should be addressed as well. In this article, we review in detail the technical, business, and philosophical barriers of translating scaffolds from Concept to Clinic. We argue that envisioning and engineering scaffolds as modular systems with a sliding scale of complexity offers the best path to addressing these translational challenges.
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Affiliation(s)
- Scott J Hollister
- Scaffold Tissue Engineering Group, Department of Biomedical Engineering, The University of Michigan, Ann Arbor, Michigan 48109, USA.
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