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Jia W, Zhou Z, Zhan W. Musculoskeletal Biomaterials: Stimulated and Synergized with Low Intensity Pulsed Ultrasound. J Funct Biomater 2023; 14:504. [PMID: 37888169 PMCID: PMC10607075 DOI: 10.3390/jfb14100504] [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: 08/11/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical biophysical stimulating strategies, which have significant effects on improving the function of organs or treating diseases by causing the salutary response of body, have shown many advantages, such as non-invasiveness, few side effects, and controllable treatment process. As a critical technique for stimulation, the low intensity pulsed ultrasound (LIPUS) has been explored in regulating osteogenesis, which has presented great promise in bone repair by delivering a combined effect with biomaterials. This review summarizes the musculoskeletal biomaterials that can be synergized with LIPUS for enhanced biomedical application, including bone regeneration, spinal fusion, osteonecrosis/osteolysis, cartilage repair, and nerve regeneration. Different types of biomaterials are categorized for summary and evaluation. In each subtype, the verified biological mechanisms are listed in a table or graphs to prove how LIPUS was effective in improving musculoskeletal tissue regeneration. Meanwhile, the acoustic excitation parameters of LIPUS that were promising to be effective for further musculoskeletal tissue engineering are discussed, as well as their limitations and some perspectives for future research. Overall, coupled with biomimetic scaffolds and platforms, LIPUS may be a powerful therapeutic approach to accelerate musculoskeletal tissue repair and even in other regenerative medicine applications.
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Affiliation(s)
- Wanru Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Zifei Zhou
- Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
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Low-intensity pulsed ultrasound stimulation facilitates in vitro osteogenic differentiation of human adipose-derived stem cells via up-regulation of heat shock protein (HSP)70, HSP90, and bone morphogenetic protein (BMP) signaling pathway. Biosci Rep 2018; 38:BSR20180087. [PMID: 29789443 PMCID: PMC6048203 DOI: 10.1042/bsr20180087] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023] Open
Abstract
Low-intensity pulsed ultrasound (LIPUS) has positive effects on osteogenic differentiation. However, the effect of LIPUS on osteogenic differentiation of human adipose-derived stem cells (hASCs) is unclear. In the present study, we investigated whether LIPUS could promote the proliferation and osteogenic differentiation of hASCs. hASCs were isolated and osteogenically induced with LIPUS stimulation at 20 and 30 mW cm-2 for 30 min day-1 Cell proliferation and osteogenic differentiation potential of hASCs were respectively analyzed by cell counting kit-8 assay, Alizarin Red S staining, real-time polymerase chain reaction, and Western blotting. The results indicated that LIPUS stimulation did not significantly affect the proliferation of hASCs, but significantly increased their alkaline phosphatase activity on day 6 of culture and markedly promoted the formation of mineralized nodules on day 21 of culture. The mRNA expression levels of runt-related transcription factor, osteopontin, and osteocalcin were significantly up-regulated by LIPUS stimulation. LIPUS stimulation did not affect the expression of heat shock protein (HSP) 27, HSP40, bone morphogenetic protein (BMP)-6 and BMP-9, but significantly up-regulated the protein levels of HSP70, HSP90, BMP-2, and BMP-7 in the hASCs. Further studies found that LIPUS increased the mRNA levels of Smad 1 and Smad 5, elevated the phosphorylation of Smad 1/5, and suppressed the expression of BMP antagonist Noggin. These findings indicated that LIPUS stimulation enhanced osteogenic differentiation of hASCs possibly through the up-regulation of HSP70 and HSP90 expression and activation of BMP signaling pathway. Therefore, LIPUS might have the potential to promote the repair of bone defect.
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Zaky SH, Lee KW, Gao J, Jensen A, Verdelis K, Wang Y, Almarza AJ, Sfeir C. Poly (glycerol sebacate) elastomer supports bone regeneration by its mechanical properties being closer to osteoid tissue rather than to mature bone. Acta Biomater 2017; 54:95-106. [PMID: 28110067 DOI: 10.1016/j.actbio.2017.01.053] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/10/2017] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
Mechanical load influences bone structure and mass. Arguing the importance of load-transduction, we investigated the mechanisms inducing bone formation using an elastomeric substrate. We characterized Poly (glycerol sebacate) (PGS) in vitro for its mechanical properties, compatibility with osteoprogenitor cells regarding adhesion, proliferation, differentiation under compression versus static cultures and in vivo for the regeneration of a rabbit ulna critical size defect. The load-transducing properties of PGS were compared in vitro to a stiffer poly lactic-co-glycolic-acid (PLA/PGA) scaffold of similar porosity and interconnectivity. Under cyclic compression for 7days, we report focal adhesion kinase overexpression on the less stiff PGS and upregulation of the transcription factor Runx2 and late osteogenic markers osteocalcin and bone sialoprotein (1.7, 4.0 and 10.0 folds increase respectively). Upon implanting PGS in the rabbit ulna defect, histology and micro-computed tomography analysis showed complete gap bridging with new bone by the PGS elastomer by 8weeks while minimal bone formation was seen in empty controls. Immunohistochemical analysis demonstrated the new bone to be primarily regenerated by recruited osteoprogenitors cells expressing periostin protein during early phase of maturation similar to physiological endochondral bone development. This study confirms PGS to be osteoconductive contributing to bone regeneration by recruiting host progenitor/stem cell populations and as a load-transducing substrate, transmits mechanical signals to the populated cells promoting differentiation and matrix maturation toward proper bone remodeling. We hence conclude that the material properties of PGS being closer to osteoid tissue rather than to mineralized bone, allows bone maturation on a substrate mechanically closer to where osteoprogenitor/stem cells differentiate to develop mature load-bearing bone. SIGNIFICANCE OF SIGNIFICANCE The development of effective therapies for bone and craniofacial regeneration is a foremost clinical priority in the mineralized tissue engineering field. Currently at risk are patients seeking treatment for craniofacial diseases, traumas and disorders including birth defects such as cleft lip and palate, (1 in 525 to 714 live births), craniosynostosis (300-500 per 1,000,000 live births), injuries to the head and face (20 million ER visits per year), and devastating head and neck cancers (8000 deaths and over 30,000 new cases per year). In addition, approximately 6.2 million fractures occur annually in the United States, of which 5-10% fail to heal properly, due to delayed or non-union [1], and nearly half of adults aged 45-65 have moderate to advanced periodontitis with associated alveolar bone loss, which, if not reversed, will lead to the loss of approximately 6.5 teeth/individual [2]. The strategies currently available for bone loss treatment largely suffer from limitations in efficacy or feasibility, necessitating further development and material innovation. Contemporary materials systems themselves are indeed limited in their ability to facilitate mechanical stimuli and provide an appropriate microenvironment for the cells they are designed to support. We propose a strategy which aims to leverage biocompatibility, biodegradability and material elasticity in the creation of a cellular niche. Within this niche, cells are mechanically stimulated to produce their own extracellular matrix. The hypothesis that mechanical stimuli will enhance bone regeneration is supported by a wealth of literature showing the effect of mechanical stimuli on bone cell differentiation and matrix formation. Using mechanical stimuli, to our knowledge, has not been explored in vivo in bone tissue engineering applications. We thus propose to use an elastomeric platform, based on poly(glycerol sebacate (PGS), to mimic the natural biochemical environment of bone while enabling the transmission of mechanical forces. In this study we report the material's load-transducing ability as well as falling mechanically closer to bone marrow and osteoid tissue rather than to mature bone, allowed osteogenesis and bone maturation. Defying the notion of selecting bone regeneration scaffolds based on their relative mechanical comparability to mature bone, we consider our results in part novel for the new application of this elastomer and in another fostering for reassessment of the current selection criteria for bone scaffolds.
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Affiliation(s)
- S H Zaky
- Center for Craniofacial Regeneration, Department of Oral Biology, University of Pittsburgh, USA
| | - K W Lee
- Department of Bioengineering, University of Pittsburgh, USA
| | - J Gao
- Department of Bioengineering, University of Pittsburgh, USA
| | - A Jensen
- Department of Chemistry, University of Pittsburgh Dietrich School of Arts and Sciences, USA
| | - K Verdelis
- Center for Craniofacial Regeneration, Department of Oral Biology, University of Pittsburgh, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, USA
| | - Y Wang
- Department of Bioengineering, University of Pittsburgh, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, USA
| | - A J Almarza
- Center for Craniofacial Regeneration, Department of Oral Biology, University of Pittsburgh, USA; Department of Bioengineering, University of Pittsburgh, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, USA
| | - C Sfeir
- Center for Craniofacial Regeneration, Department of Oral Biology, University of Pittsburgh, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, USA.
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Sasaki H, Monden K, Yoshinari M, Yajima Y. Comparison of Angiogenesis in Bone Defect Healing Process due to the Difference in the Frequency of Low-Intensity Pulsed Ultrasound (LIPUS). J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hodaka Sasaki
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
| | - Kazuya Monden
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College
| | | | - Yasutomo Yajima
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College
- Oral Health Science Center, Tokyo Dental College
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Takebe H, Nakanishi Y, Hirose Y, Wang PL, Irie K, Ochi M. Effects of Low-intensity Pulsed Ultrasound on Healing after Maxillary Sinus Augmentation in Rabbits. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hiroaki Takebe
- Division of Histology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido
| | - Yasuhiro Nakanishi
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido
| | - Yukito Hirose
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido
| | - Pao-Li Wang
- Department of Bacteriology, Osaka Dental University
| | - Kazuharu Irie
- Division of Histology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido
| | - Morio Ochi
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido
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Repair of segmental ulna defects using a β-TCP implant in combination with a heparan sulfate glycosaminoglycan variant. Acta Biomater 2015; 28:193-204. [PMID: 26384700 DOI: 10.1016/j.actbio.2015.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/06/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
Given the wide spread clinical use of ceramic-based bone void fillers, we sought to determine the efficacy of an FDA-approved β-tricalcium phosphate bone graft substitute (JAX™) in combination with a carboxymethyl cellulose (CMC) handling agent that included a particular heparan glycosaminoglycan (GAG) variant, herein referred to as HS3. Having recently demonstrated efficacy of a combination collagen/HS3 device, we further aimed to determine the support that HS3 could offer a handling agent used to administer a more tissue-relevant bone void filler. This study evaluated the JAX™-HS3 combination device in 1.5 cm critical-sized defects in the ulna bones of 27 male New Zealand White rabbits. Treatment groups consisted of JAX™ applied with CMC alone, or JAX™ with CMC containing either 30 μg or 100 μg of the HS3 GAG. Data based on radiographic, μCT, mechanical, and histological analyses at 4 and 8 weeks post-surgery, clearly demonstrate enhanced new bone formation in the JAX™-HS3 combination treated defects compared to treatment with JAX™ alone. The efficacy of such a combination advocates for inclusion of HS3 in handling agents used in the preparation of various bone void fillers being used in orthopaedic surgery. STATEMENT OF SIGNIFICANCE Synthetic bone grafts and demineralized bone matrices are gaining prominence as alternatives to autologous and allogeneic bone grafts and are frequently administered in granular form, necessitating their combination with a handling agent. Typical handling agents include glycerol, gelatin, cellulose, hyaluronic acid and lecithin, formulated as hydrogels, which can be further enhanced by the addition of heparan sulfate (HS) glycosaminoglycans that augment the osteostimulatory properties of the graft. Here we assessed the efficacy of β-TCP granules combined with a hydrogel consisting of carboxymethyl cellulose and the HS variant (HS3) previously shown to enhance osteogenic healing. The data advocates for HS3 to be included during the formulation of hydrogel-based carriers that support the various bone void fillers being used in orthopaedic surgery.
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Chang W, Kim R, Park SI, Jung YJ, Ham O, Lee J, Kim JH, Oh S, Lee MY, Kim J, Park MS, Chung YA, Hwang KC, Maeng LS. Enhanced Healing of Rat Calvarial Bone Defects with Hypoxic Conditioned Medium from Mesenchymal Stem Cells through Increased Endogenous Stem Cell Migration via Regulation of ICAM-1 Targeted-microRNA-221. Mol Cells 2015; 38:643-50. [PMID: 26062554 PMCID: PMC4507031 DOI: 10.14348/molcells.2015.0050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 01/08/2023] Open
Abstract
The use of conditioned medium from mesenchymal stem cells may be a feasible approach for regeneration of bone defects through secretion of various components of mesenchymal stem cells such as cytokines, chemokines, and growth factors. Mesenchymal stem cells secrete and accumulate multiple factors in conditioned medium under specific physiological conditions. In this study, we investigated whether the conditioned medium collected under hypoxic condition could effectively influence bone regeneration through enhanced migration and adhesion of endogenous mesenchymal stem cells. Cell migration and adhesion abilities were increased through overexpression of intercellular adhesion molecule-1 in hypoxic conditioned medium treated group. Intercellular adhesion molecule-1 was upregulated by microRNA-221 in mesenchymal stem cells because microRNAs are key regulators of various biological functions via gene expression. To investigate the effects in vivo, evaluation of bone regeneration by computed tomography and histological assays revealed that osteogenesis was enhanced in the hypoxic conditioned medium group relative to the other groups. These results suggest that behavioral changes of endogenous mesenchymal stem cells through microRNA-221 targeted-intercellular adhesion molecule-1 expression under hypoxic conditions may be a potential treatment for patients with bone defects.
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Affiliation(s)
- Woochul Chang
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735,
Korea
| | - Ran Kim
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735,
Korea
| | - Sang In Park
- Institute of Catholic Integrative Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Incheon 403-720,
Korea
| | - Yu Jin Jung
- EIT/LOFUS Research Center, International St. Mary’s Hospital, Catholic Kwandong University, Incheon 404-834,
Korea
| | - Onju Ham
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 120-752,
Korea
| | - Jihyun Lee
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735,
Korea
| | - Ji Hyeong Kim
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735,
Korea
| | - Sekyung Oh
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305,
USA
| | - Min Young Lee
- Department of Molecular Physiology, College of Pharmacy, Kyungpook National University, Daegu 702-701,
Korea
| | - Jongmin Kim
- Department of Life Systems, Sookmyung Women’s University, Seoul 140-742,
Korea
| | - Moon-Seo Park
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735,
Korea
| | - Yong-An Chung
- Institute of Catholic Integrative Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Incheon 403-720,
Korea
| | - Ki-Chul Hwang
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangwon 210-701,
Korea
- Catholic Kwandong University International, St. Mary’s Hospital, Incheon 404-834,
Korea
| | - Lee-So Maeng
- Institute of Catholic Integrative Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Incheon 403-720,
Korea
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Jung YJ, Kim R, Ham HJ, Park SI, Lee MY, Kim J, Hwang J, Park MS, Yoo SS, Maeng LS, Chang W, Chung YA. Focused low-intensity pulsed ultrasound enhances bone regeneration in rat calvarial bone defect through enhancement of cell proliferation. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:999-1007. [PMID: 25701528 DOI: 10.1016/j.ultrasmedbio.2014.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 09/25/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
A number of studies have reported the therapeutic potential of low-intensity pulsed ultrasound (LIPUS) for induction of bone repair. This study investigated whether bone regeneration might be enhanced by application of focused LIPUS to selectively stimulate fractured calvarial bone. To accomplish this, bone defects were surgically created in the middle of the skull of rats that were subsequently exposed to focused LIPUS. Bone regeneration was assessed by repeated computed tomography imaging after the operation, as well as histologic analysis with calcein, hematoxylin and eosin and proliferating cell nuclear antigen assay. At 6 wk after surgery, bone formation in the focused LIPUS-treated group improved significantly relative to the control. Interestingly, new bone tissue sprouted from focused LIPUS target points. Histologic analysis after exposure to focused LIPUS revealed that proliferating cells were significantly increased relative to the control. Taken together, these results suggest that focused LIPUS can improve re-ossification through enhancement of cell proliferation in calvarial defect sites.
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Affiliation(s)
- Yu Jin Jung
- Institute of Catholic Integrative Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea
| | - Ran Kim
- Department of Biology Education, College of Education, Pusan National University, Busan, Republic of Korea
| | - Hyun-Joo Ham
- Institute of Catholic Integrative Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea
| | - Sang In Park
- Institute of Catholic Integrative Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea
| | - Min Young Lee
- Department of Molecular Physiology, College of Pharmacy, Kyungpook National University, Daegu, Republic of Korea
| | - Jongmin Kim
- Department of Life Systems, Sookmyung Women's University, Yongsan-gu Seoul, Republic of Korea
| | - Jihwan Hwang
- Department of Microbiology, College of Natural Science, Pusan National University, Busan, Republic of Korea
| | - Moon-Seo Park
- Institute of Catholic Integrative Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee-So Maeng
- Institute of Catholic Integrative Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea
| | - Woochul Chang
- Department of Biology Education, College of Education, Pusan National University, Busan, Republic of Korea.
| | - Yong-An Chung
- Institute of Catholic Integrative Medicine, Incheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea.
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Yilmaz D, Dogan N, Ozkan A, Sencimen M, Ora BE, Mutlu I. Effect of platelet rich fibrin and beta tricalcium phosphate on bone healing. A histological study in pigs. Acta Cir Bras 2014; 29:59-65. [PMID: 24474179 DOI: 10.1590/s0102-86502014000100009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/12/2013] [Indexed: 03/10/2023] Open
Abstract
PURPOSE To investigate the effect of platelet rich fibrin (PRF) and beta tricalcium phosphate (β-TCP), alone or in combination, on bone regeneration in pig tibial defects. METHODS Four standardized defects were prepared in both tibias of three adult male pigs. The first defect was left unfilled as a control; the others were grafted with either PRF, β-TCP or PRF mixed with β-TCP. All animals were sacrificed on the 12th postoperative week and the tibial bones were removed, histologic sections were prepared and the experimental sites were examined microscopically and stereologically. RESULTS Histologic and stereologic examination revealed more new bone formation in the defects filled with PRF mixed β-TCP than in the defects grafted with either β-TCP or PRF alone. CONCLUSION The platelet rich fibrin and beta tricalcium phosphate combination effectively induces new bone formation.
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Affiliation(s)
| | - Necdet Dogan
- Gulhane Military Medical Academy, Dental Sciences Center, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | | | - Metin Sencimen
- Gulhane Military Medical Academy, Dental Sciences Center, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Baris Eren Ora
- Gulhane Military Medical Academy, Dental Sciences Center, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Ibrahim Mutlu
- Gulhane Military Medical Academy, Dental Sciences Center, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
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Fındık Y, Baykul T. Effects of low-intensity pulsed ultrasound on autogenous bone graft healing. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:e255-60. [DOI: 10.1016/j.oooo.2012.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/26/2012] [Accepted: 05/29/2012] [Indexed: 12/22/2022]
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Adverse reactions of artificial bone graft substitutes: lessons learned from using tricalcium phosphate geneX®. Clin Orthop Relat Res 2014; 472:976-82. [PMID: 24078171 PMCID: PMC3916599 DOI: 10.1007/s11999-013-3305-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 09/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Artificial bone graft substitutes are widely used to fill bony defects after curettage of benign tumors. We sought to evaluate the efficacy of one such bone graft substitute, geneX®, which contains tricalcium phosphate and calcium sulphate; however, during the course of this study we observed a high number of complications. QUESTIONS/PURPOSES The primary aim of this prospective series was assessment of the effectiveness of geneX® concerning resorption profile and bone healing and remodeling after surgery. We present the types and frequencies of complications observed in patients treated for bone tumors by curettage and filling the defect using geneX®. METHODS We planned to study 40 patients; however, after enrollment of the first 31 patients, the study was stopped as a result of serious complications. There were 20 female and 11 male patients with a mean age at surgery of 40 years (range, 6–71 years). Plain radiographs were obtained at different intervals during followup and CT scans were obtained 6 and 12 months postoperatively. Complications were assessed using a 5-point scale according to Goslings and Gouma. RESULTS Five of the 31 patients (16%) had complications develop after surgery. In three cases, a sterile inflammation adjacent to the geneX® occurred, with delayed wound healing in two patients and local pain. In the third patient, geneX® produced moderate to severe skin damage in the area of the scar, needing revision surgery. In two other patients, inflammatory cystic formations developed in the soft tissues with sizes up to 15 cm, which gradually reduced in size with time. Overall, there were four Grade 1 complications and one Grade 2 according to Goslings and Gouma. CONCLUSIONS We concluded from this series of patients that geneX® causes soft tissue inflammation and pain with its use. Based on this experience we believe that this type of bone substitute should not be used in the treatment of bony defects. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Zaky SH, Lee KW, Gao J, Jensen A, Close J, Wang Y, Almarza AJ, Sfeir C. Poly(Glycerol Sebacate) Elastomer: A Novel Material for Mechanically Loaded Bone Regeneration. Tissue Eng Part A 2014; 20:45-53. [DOI: 10.1089/ten.tea.2013.0172] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samer Helal Zaky
- Department of Oral Biology, Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kee-Won Lee
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jin Gao
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adrianna Jensen
- Department of Chemistry, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Close
- Department of Dental Public Health and Information Management, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yadong Wang
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alejandro J. Almarza
- Department of Oral Biology, Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charles Sfeir
- Department of Oral Biology, Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Genes responsive to low-intensity pulsed ultrasound in MC3T3-E1 preosteoblast cells. Int J Mol Sci 2013; 14:22721-40. [PMID: 24252911 PMCID: PMC3856087 DOI: 10.3390/ijms141122721] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/04/2013] [Accepted: 08/06/2013] [Indexed: 12/12/2022] Open
Abstract
Although low-intensity pulsed ultrasound (LIPUS) has been shown to enhance bone fracture healing, the underlying mechanism of LIPUS remains to be fully elucidated. Here, to better understand the molecular mechanism underlying cellular responses to LIPUS, we investigated gene expression profiles in mouse MC3T3-E1 preosteoblast cells exposed to LIPUS using high-density oligonucleotide microarrays and computational gene expression analysis tools. Although treatment of the cells with a single 20-min LIPUS (1.5 MHz, 30 mW/cm(2)) did not affect the cell growth or alkaline phosphatase activity, the treatment significantly increased the mRNA level of Bglap. Microarray analysis demonstrated that 38 genes were upregulated and 37 genes were downregulated by 1.5-fold or more in the cells at 24-h post-treatment. Ingenuity pathway analysis demonstrated that the gene network U (up) contained many upregulated genes that were mainly associated with bone morphology in the category of biological functions of skeletal and muscular system development and function. Moreover, the biological function of the gene network D (down), which contained downregulated genes, was associated with gene expression, the cell cycle and connective tissue development and function. These results should help to further clarify the molecular basis of the mechanisms of the LIPUS response in osteoblast cells.
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Kang KS, Hong JM, Kang JA, Rhie JW, Cho DW. Osteogenic differentiation of human adipose-derived stem cells can be accelerated by controlling the frequency of continuous ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1461-1470. [PMID: 23887957 DOI: 10.7863/ultra.32.8.1461] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to demonstrate that the effects of continuous ultrasound on the osteogenic differentiation of human adipose-derived stem cells (hASCs) are dependent on the frequency in vitro. METHODS Before stimulation, we characterized the hASCs using cluster of differentiation marker profiles and tridifferentiation. Then we selected effective frequencies in the range of 0.5 to 1.5 MHz (with a peak negative pressure of 52 kPa), which upregulated runt-related transcription factor 2 messenger RNA expression. Next, the effects of ultrasound at the selected frequencies on the osteogenic differentiation were evaluated at the protein level. Alkaline phosphatase activity and the formation of mineralized nodules were measured. We additionally identified the cellular mechanisms underlying the effects of ultrasound stimulation using Western blotting. RESULTS The hASCs showed general cluster of differentiation marker profiles of stem cells and confirmed their potentials to yield adipogenic, chondrogenic, and osteogenic differentiation. Frequencies of 0.5, 1.0, and 1.5 MHz were selected for higher runt-related transcription factor 2 expression in the range of 0.5 to 1.5 MHz. Among the 3 groups, alkaline phosphatase activity and the formation of mineralized nodules were increased in cells exposed to 1.5-MHz ultrasound compared with cells exposed to 0.5-or 1.0-MHz ultrasound and nontreated control cells. We additionally confirmed that this acceleration of osteogenic differentiation was related to p38 and protein kinase B signaling pathways. CONCLUSIONS In this study, we found that, in the selected range, 1.5 MHz was the most effective frequency for inducing the osteogenic differentiation of hASCs.
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Affiliation(s)
- Kyung Shin Kang
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Korea
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15
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de Ávila Santana L, Alves JM, Andrade TAM, Kajiwara JK, Garcia SB, Gomes FG, Frade MAC. Clinical and immunohistopathological aspects of venous ulcers treatment by Low-Intensity Pulsed Ultrasound (LIPUS). ULTRASONICS 2013; 53:870-879. [PMID: 23294989 DOI: 10.1016/j.ultras.2012.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 11/11/2012] [Accepted: 12/16/2012] [Indexed: 06/01/2023]
Abstract
The immunological mechanisms that are triggered by Low-Intensity Pulsed Ultrasound (LIPUS) in wound healing are unknown. In the present study, experimental groups were used to assess the treatment of chronic venous ulcers with 30mW/cm(2) SATA peripheral LIPUS three times per week compared to a daily treatment of 1% silver sulfadiazine (SDZ). The ulcers of the SDZ group (n=7) (G1) and LIPUS group (n=9) (G2) were photographed five times three months, and the images were analyzed using ImageJ software to quantify the total area (S), fibrin/sphacel area (yellow) and granulation area (red). The healing process was evaluated by the wound healing rate (WHR), granulation tissue rate (GTR) and fibrin/sphacel tissue rate (FTR). The ulcers were biopsied on days 1 and 45 and stained for collagen fiber quantification (picrosirius) and CD68(+) protein and VEGF (vascular endothelial growth factor) expression using HRP-streptavidin (horseradish peroxidase-streptavidin). On day 90, G2 had a mean 41% decrease in the ulcer area, while no decrease was observed in G1 (p<0.05). An increased tendency toward positive labeling of collagen fibers and VEGF (p>0.05) was observed in G2 compared to G1, and the number of CD68(+) cells was greater in G2 than in G1 (p<0.05). LIPUS presents superior activity compared to SDZ in stimulating the inflammatory and proliferative (angiogenesis and collagenesis, respectively) phases of chronic venous wound healing.
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Affiliation(s)
- Luísiane de Ávila Santana
- Bioengineering Post-Graduate Program (EESC-IQSC-FMRP-USP), Trabalhador São-carlense Avenue, 400 Arnold Schimidt, São Carlos, São Paulo 13566-590, Brazil.
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16
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Takebe H, Nakanishi Y, Hirose Y, Ochi M. Effect of low intensity pulsed ultrasound stimulation on sinus augmentation in rabbits. Clin Oral Implants Res 2013; 25:735-41. [PMID: 23442146 PMCID: PMC4232324 DOI: 10.1111/clr.12136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
Abstract
Objectives The objective of the present study was to evaluate the efficacy of low intensity pulsed ultrasound stimulation (LIPUS) and to determine the optimal frequency for enhancing bone regeneration in sinus augmentation using a rabbit model. Material and methods Thirty male rabbits underwent sinus augmentation. Two rectangular nasal bone windows were outlined bilaterally. LIPUS was applied at two different frequencies (1 MHz and 3 MHz) on experimental sites daily for 2, 4 and 8 weeks. Each histological area of the experimental and control sites was divided into upper and lower parts from the parietal region to a depth of 5 mm. Each area of new bone was measured. Results At 2, 4 and 8 weeks, the experimental sites in the 1 MHz group exhibited significantly more new bone growth than the control sites in both the upper and lower parts. When the upper and lower parts of each area were measured in combination there was a statistical difference between the test and control sites in the 1 MHz group at 2, 4 and 8 weeks; however, there were no statistical differences between the test and control sites in the 3 MHz group. Conclusions The results suggest that clinical application of LIPUS for sinus augmentation may promote new bone formation, and that the effect of LIPUS for sinus augmentation at a frequency of 1 MHz was greater than at 3 MHz until 8 weeks after sinus augmentation.
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Affiliation(s)
- Hiroaki Takebe
- Department of Oral Rehabilitation, Division of Fixed Prosthodontics and Oral Implantology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan
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Yang HL, Zhu XS, Chen L, Chen CM, Mangham DC, Coulton LA, Aiken SS. Bone healing response to a synthetic calcium sulfate/β-tricalcium phosphate graft material in a sheep vertebral body defect model. J Biomed Mater Res B Appl Biomater 2012; 100:1911-21. [PMID: 22847979 PMCID: PMC3531612 DOI: 10.1002/jbm.b.32758] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/22/2012] [Accepted: 05/26/2012] [Indexed: 11/08/2022]
Abstract
The introduction of a material able to promote osteogenesis and remodelling activity in a clinically relevant time frame in vertebroplasty and kyphoplasty procedures may have patient benefit. We report the in-vivo performance of a biphasic synthetic bone graft material (Genex Paste, Biocomposites, UK) [test material], composed of calcium sulfate and β-tricalcium phosphate, implanted into a sheep vertebral defect model. Cavities drilled into 4 adjacent vertebrae (L2 to L5) of 24 skeletally mature sheep were; (1) filled with the test material; (2) filled with commercially available polymethylmethacrylate [PMMA] cement; (3) remained empty [sham]. Analysis was performed immediately after implantation and at 8, 16, and 36 weeks post implantation. Sites were evaluated for bone growth with microCT analysis, histological examination, and mechanical testing under compression. The test material exhibited an improved tissue response over the PMMA, indicating a superior biological tolerance. MicroCT and histology indicated marked osteoregenerative capacity of the test material when compared with sham and the PMMA. The percentage of new bone formation was higher for the test material than sham at 16 and 36 weeks post implantation, with bone regeneration almost complete at 36 weeks in this group. Resorption of test material and the integration into new bone tissue were demonstrated. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2012.
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Affiliation(s)
- H L Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Omata K, Matsuno T, Asano K, Hashimoto Y, Tabata Y, Satoh T. Enhanced bone regeneration by gelatin-β-tricalcium phosphate composites enabling controlled release of bFGF. J Tissue Eng Regen Med 2012; 8:604-11. [DOI: 10.1002/term.1553] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/23/2012] [Accepted: 05/25/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Kazuhiko Omata
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Tokyo; Nippon Dental University; Tokyo Japan
| | - Tomonori Matsuno
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Tokyo; Nippon Dental University; Tokyo Japan
| | - Kazunari Asano
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Tokyo; Nippon Dental University; Tokyo Japan
- Department of Biomaterials, Institute for Frontier Medical Sciences; Kyoto University; Japan
| | | | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences; Kyoto University; Japan
| | - Tazuko Satoh
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Tokyo; Nippon Dental University; Tokyo Japan
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Zhao X, Cai XZ, Shi ZL, Zhu FB, Zhao GS, Yan SG. Low-intensity pulsed ultrasound (LIPUS) may prevent polyethylene induced periprosthetic osteolysis in vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:238-246. [PMID: 22230133 DOI: 10.1016/j.ultrasmedbio.2011.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 11/09/2011] [Accepted: 11/13/2011] [Indexed: 05/31/2023]
Abstract
We investigated the effect of local low-intensity pulsed ultrasound (LIPUS) on polyethylene debris induced periprosthetic osteolysis. The periprosthetic osteolysis model was made by injecting endotoxin-free pure polyethylene particles into the distal part of the femur canal and inserting a stainless steel plug into this femur. The effects of polyethylene and LIPUS were assessed histologically and by the shear strength test and periprosthetic bone mineral density (BMD) test. Sixteen rabbits received a stainless steel plug on one side and both polyethylene and a stainless steel plug on the other side. Three months later, the side that received polyethylene showed periprosthetic osteolysis. Subsequently, another 16 rabbits received polyethylene plus local LIPUS (200 mW/cm(2) for 20 min daily) on one side and polyethylene alone on the other side. Three months later, LIPUS effectively prevented the periprosthetic osteolysis caused by polyethylene in this rabbit model.
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Affiliation(s)
- Xiang Zhao
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
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Cai XZ, Chen XZ, Yan SG, Ruan ZR, Yan RJ, Ji K, Xu J. Intermittent watt-level ultrasonication facilitates vancomycin release from therapeutic acrylic bone cement. J Biomed Mater Res B Appl Biomater 2009; 90:11-7. [PMID: 19090490 DOI: 10.1002/jbm.b.31288] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasound holds promise for enhancing the vancomycin release from cement though the length of time when local drug level exceeded the minimum inhibitory concentration (T(>MIC)) was not prolonged by the previous protocol of milliwatt-level ultrasonication. Here vancomycin-loaded cements were subjected to continuous watt-level ultrasonication (CUG), intermittent watt-level ultrasonication (IUG) or no ultrasonication (NUG) for 14 d during immersion in 40-ml phosphate buffered saline (PBS) for 28 d. The T(>MIC) for IUG was more than three times that for NUG. In contrast, T(>MIC) for CUG was slightly shortened. The subtherapeutic release of vancomycin between 15 d and 28 d for IUG was one-ninth that for NUG. The fitting equations indicated a significant enhancement on the burst release and the slow release for IUG; however, the continuous ultrasonication hampered the slow release. SEM images exhibited denser craters and pores with larger diameters and less residual drug in specimens from IUG relative to those from both CUG and NUG. Intermittent watt-level ultrasonication improved the ultrasound-enhanced vancomycin release from cement in view of the prolonged T(>MIC) and the inhibited subtherapeutic release compared with continuous ultrasonication. The mechanisms may be associated with the distinctive effects of detaching forces and pushing forces by acoustic microstreams.
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Affiliation(s)
- Xun-Zi Cai
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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