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Ribeiro M, Grotheer VC, Nicolini LF, Latz D, Pishnamaz M, Greven J, Taday R, Wergen NM, Hildebrand F, Windolf J, Jungbluth P. Biomechanical validation of a tibial critical-size defect model in minipigs. Clin Biomech (Bristol, Avon) 2024; 120:106336. [PMID: 39276502 DOI: 10.1016/j.clinbiomech.2024.106336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Autologous cancellous bone grafting still represents the gold standard for the therapy of non-healing bone defects. However, donor site morbidity and the restricted availability of autologous bone grafts have initiated scientists to look for promising alternatives to heal even large defects. The present study aimed to evaluate the biomechanical potential and failure properties of a previously developed metaphyseal critical-size defect model of the proximal tibia in minipigs for future comparisons of bone substitute materials. METHODS Fresh-frozen minipig tibiae were divided into two groups, with half undergoing the creation of critical-size defects. Specimens were subjected to biomechanical fatigue tests and load-to-failure tests. CT scans post-test verified bone damage. Statistical analysis compared the properties of defected and intact specimens. FINDINGS In this model, it was demonstrated that under uniaxial cyclic compression within the loading axis, the intact tibiae specimens (8708 ± 202 N) provided a significant (p = 0.014) higher compressive force to failure than the tibiae with the defect (6566 ± 1653 N). INTERPRETATION Thus, the used minipig model is suitable for comparing bone substitute materials regarding their biomechanical forces and bone regeneration capacity.
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Affiliation(s)
- Marx Ribeiro
- Department of Orthopedics, Trauma and Reconstructive Surgery University Hospital RWTH Aachen, Pauwelstr. 30, 52074 Aachen, Germany; Department of Trauma and Reconstructive Surgery University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany.
| | - Vera Cora Grotheer
- Department of Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Luis Fernando Nicolini
- Department of Mechanical Engineering, Federal University of Santa Maria UFSM, Av. Roraima n° 1000 Cidade Universitária Bairro - Camobi, 97105 - 900 Santa Maria, Brazil.
| | - David Latz
- Department of Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Miguel Pishnamaz
- Department of Orthopedics, Trauma and Reconstructive Surgery University Hospital RWTH Aachen, Pauwelstr. 30, 52074 Aachen, Germany.
| | - Johannes Greven
- Department of Thorax Surgery, University Hospital RWTH Aachen, Pauwelstr. 30, 52074 Aachen, Germany.
| | - Roman Taday
- Department of Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Niklas Markus Wergen
- Department of Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery University Hospital RWTH Aachen, Pauwelstr. 30, 52074 Aachen, Germany.
| | - Joachim Windolf
- Department of Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Pascal Jungbluth
- Department of Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
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Bacevich BM, Smith RDJ, Reihl AM, Mazzocca AD, Hutchinson ID. Advances with Platelet-Rich Plasma for Bone Healing. Biologics 2024; 18:29-59. [PMID: 38299120 PMCID: PMC10827634 DOI: 10.2147/btt.s290341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
Despite significant advances in the understanding and delivery of osteosynthesis, fracture non-union remains a challenging clinical problem in orthopaedic surgery. To bridge the gap, basic science characterization of fracture healing provides a platform to identify and target biological strategies to enhance fracture healing. Of immense interest, Platelet-rich plasma (PRP) is a point of care orthobiologic that has been extensively studied in bone and soft tissue healing given its relative ease of translation from the benchtop to the clinic. The aim of this narrative review is to describe and relate pre-clinical in-vitro and in-vivo findings to clinical observations investigating the efficacy of PRP to enhance bone healing for primary fracture management and non-union treatment. A particular emphasis is placed on the heterogeneity of PRP preparation techniques, composition, activation strategies, and delivery. In the context of existing data, the routine use of PRP to enhance primary fracture healing and non-union management cannot be supported. However, it is acknowledged that extensive heterogeneity of PRP treatments in clinical studies adds obscurity; ultimately, refinement (and consensus) of PRP treatments for specific clinical indications, including repetition studies are warranted.
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Affiliation(s)
- Blake M Bacevich
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Richard David James Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Alec M Reihl
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Augustus D Mazzocca
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
- Medical Director, Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Brigham, Boston, MA, USA
| | - Ian D Hutchinson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
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The Epidemiology of Platelet-Rich Plasma Injections From 2010 to 2020 in a Large US Commercial Insurance Claims Database: A Recent Update. J Am Acad Orthop Surg 2023; 31:e135-e147. [PMID: 36584347 DOI: 10.5435/jaaos-d-22-00397] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/19/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The popularity of platelet-rich plasma (PRP) injections for the treatment of orthopaedic conditions has grown markedly. We sought to better define the trends in the usage of orthopaedic PRP injections across an insured US population over the past decade. METHODS The PearlDiver M91Ortho commercial administrative claims database was queried for all patients receiving PRP injections for orthopaedic conditions from 2010 through the first quarter of 2020 (Q1.2020). Trends in PRP use, reimbursement charges, demographics, joints injected, and administering physicians were assessed over time and reported as year-over-year (YOY) changes. RESULTS Over the study period, 14,096 unique patients had 17,759 orthopaedic PRP injections. The number of PRP injections administered had a YOY increase of 7.1% (144 injections/year, 95% confidence interval [CI] = 89 to 199, Ptrend = 0.0009). A YOY increase of 895% was observed in total nonsurgical charges ($683,974/yr, 95% CI 441,504 to 926,444, Ptrend = 0.0009). The median age of PRP recipients increased (YOY change = +0.6 years, 95% CI 0.4 to 0.8, Ptrend = 0.0005). Injections to the elbow (YOY change = -0.8%, 95% CI -0.10% to [-0.06%], Ptrend = 0.005) and foot/ankle (YOY change = -1.0%, 95% CI -1.4% to [-0.06%], Ptrend = 0.002) decreased, whereas hip (YOY change = +0.4%, 95% CI 0.2% to 0.6%, Ptrend = 0.019), knee (YOY change = +0.9%, 95% CI 0.3% to 1.2%, Ptrend = 0.016), and spine (YOY change = +0.2%, 95% CI 0.0% to 0.4%, Ptrend = 0.033) injections increased. PRP injections given by sports medicine orthopaedic surgeons (YOY change = +0.8%, 95% CI 0.6% to 1.2%, Ptrend <0.0001) increased over time, whereas those by general orthopaedic surgeons decreased (YOY change = -0.9, 95% CI -1.2 to [-0.6%], Ptrend = 0.001). CONCLUSION PRP injections quadrupled in prevalence from 2010 to Q1.2020, with a projected increase in annual usage in this data set of 66% by 2030. As greater evidence-based indications for PRP use are identified, more specialists and insurance providers may consider expanding their involvement in this growing field. LEVEL OF EVIDENCE III, retrospective cohort study.
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Cinar IC, Gultekin BA, Saglanmak A, Yalcin S, Olgac V, Mijiritsky E. Histologic, Histomorphometric, and Clinical Analysis of the Effects of Growth Factors in a Fibrin Network Used in Maxillary Sinus Augmentation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061918. [PMID: 32183498 PMCID: PMC7142822 DOI: 10.3390/ijerph17061918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/15/2022]
Abstract
This randomized controlled clinical trial evaluated the effect of mineralized plasmatic matrix (MPM), comprised of synthetic graft and platelet concentrates, on new bone formation and volume stability over time in maxillary sinus lifting (MSL). Unilateral MSL was performed in 20 patients with either beta-tricalcium phosphate (β-TCP) or MPM grafts (10 sinuses each). Six months postsurgery, specimens were obtained with a trephine bur prior to implant placement in 39 cases. Volumetric changes in sinus augmentation were analyzed between 1 week (T-I) and 6 months (T-II) postsurgery. Histomorphometric and histological analyses of biopsy samples revealed mean new bone percentages of 35.40% ± 9.09% and 26.92% ± 7.26% and residual graft particle areas of 23.13% ± 6.16% and 32.25% ± 8.48% in the MPM and β-TCP groups, respectively (p < 0.05). The mean soft-tissue areas in the MPM and β-TCP groups were 41.48% ± 8.41% and 40.83% ± 8.86%, respectively (p > 0.05). Graft reductions between baseline and 6-months postprocedure in the β-TCP and MPM groups were 17.12% ± 13.55% and 14.41% ± 12.87%, respectively, with significant graft volume reduction observed in both groups (p < 0.05) while there is no significant difference between MPM and β-TCP groups (p > 0.05). Thus, MPM, representing growth factors in a fibrin network, increases new bone formation and has acceptable volume stability in MSL procedures
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Affiliation(s)
- Ihsan Caglar Cinar
- Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul, 34093 Fatih, Turkey; (I.C.C.); (A.S.); (S.Y.)
| | - Bahattin Alper Gultekin
- Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul, 34093 Fatih, Turkey; (I.C.C.); (A.S.); (S.Y.)
- Correspondence: ; Tel.: +90-5326757236; Fax: +90-212-5323254
| | - Alper Saglanmak
- Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul, 34093 Fatih, Turkey; (I.C.C.); (A.S.); (S.Y.)
| | - Serdar Yalcin
- Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul, 34093 Fatih, Turkey; (I.C.C.); (A.S.); (S.Y.)
| | - Vakur Olgac
- Pathology and Oncology Cytology Department of Institute of Oncology, Istanbul University, 34093 Fatih, Turkey;
| | - Eitan Mijiritsky
- Department of Otolaryngology, Head and Neck and Maxilllofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 5219100 Ramat Aviv, Israel;
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Human iPSC-derived iMSCs improve bone regeneration in mini-pigs. Bone Res 2019; 7:32. [PMID: 31667001 PMCID: PMC6813363 DOI: 10.1038/s41413-019-0069-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 06/04/2019] [Accepted: 07/22/2019] [Indexed: 01/15/2023] Open
Abstract
Autologous bone marrow concentrate (BMC) and mesenchymal stem cells (MSCs) have beneficial effects on the healing of bone defects. To address the shortcomings associated with the use of primary MSCs, induced pluripotent stem cell (iPSC)-derived MSCs (iMSCs) have been proposed as an alternative. The aim of this study was to investigate the bone regeneration potential of human iMSCs combined with calcium phosphate granules (CPG) in critical-size defects in the proximal tibias of mini-pigs in the early phase of bone healing compared to that of a previously reported autograft treatment and treatment with a composite made of either a combination of autologous BMC and CPG or CPG alone. iMSCs were derived from iPSCs originating from human fetal foreskin fibroblasts (HFFs). They were able to differentiate into osteoblasts in vitro, express a plethora of bone morphogenic proteins (BMPs) and secrete paracrine signaling-associated cytokines such as PDGF-AA and osteopontin. Radiologically and histomorphometrically, HFF-iMSC + CPG transplantation resulted in significantly better osseous consolidation than the transplantation of CPG alone and produced no significantly different outcomes compared to the transplantation of autologous BMC + CPG after 6 weeks. The results of this translational study imply that iMSCs represent a valuable future treatment option for load-bearing bone defects in humans.
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Szponder T, Wessely-Szponder J, Sobczyńska-Rak A, Żylińska B, Radzki RP, Polkowska I. Application of Platelet-rich Plasma and Tricalcium Phosphate in the Treatment of Comminuted Fractures in Animals. In Vivo 2019; 32:1449-1455. [PMID: 30348700 DOI: 10.21873/invivo.11398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 12/11/2022]
Abstract
AIM To assess the applicability of β-tri-calcium phosphate (TCP) and platelet-rich plasma (PRP) in the treatment of comminuted fractures in small animals. MATERIAL AND METHODS The experimental study was carried out on 16 New Zealand White rabbits. After creating the bone defect and performing tibial osteotomy, TCP implants containing activated PRP were introduced into the fracture and the defect. The fracture was stabilised using external fixators or intramedullary nails. After 12 weeks, the animals were euthanised, and radiological, histological, scanning electron microscopy and peripheral quantitative computed tomography examinations were performed. The analysis also covered the results of fracture treatment in 37 small animals (cats and dogs) in which treatment with TCP containing PRP was used as an alternative to cancellous bone implantation. RESULTS Correct bone union was observed in the experimental groups, TCP remained visible at the site of the fracture after 12 weeks. In the clinical application in small animals, bone union was observed in over 91% of treated animals. CONCLUSION β-TCP and activated PRP may be an effective method of bone union enhancement in the treatment of comminuted fractures in small animals.
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Affiliation(s)
- Tomasz Szponder
- Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland .,Department of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - Joanna Wessely-Szponder
- Department of Pathophysiology, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - Aleksandra Sobczyńska-Rak
- Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland.,Department of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - Beata Żylińska
- Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland.,Department of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - Radosław P Radzki
- Department of Animal Physiology, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - Izabella Polkowska
- Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland.,Department of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
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Alsousou J, Harrison P. Therapeutic Platelet-Rich Plasma in Wound Healing. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Growth Factors Release From Concentrated Growth Factors: Effect of β-Tricalcium Phosphate Addition. J Craniofac Surg 2018; 29:2291-2295. [DOI: 10.1097/scs.0000000000004607] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Marcazzan S, Taschieri S, Weinstein RL, Del Fabbro M. Efficacy of platelet concentrates in bone healing: A systematic review on animal studies - Part B: Large-size animal models. Platelets 2017; 29:338-346. [PMID: 29206070 DOI: 10.1080/09537104.2017.1384537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the presence of large bone defects, delayed bone union, or nonunion and fractures, bone reconstruction may be necessary. Different strategies have been employed to enhance bone healing among which the use of autologous platelet concentrates (APCs). Due to the high content of platelets and platelet-derived bioactive molecules (e.g., growth factors, antimicrobial peptides), they are promising candidates to enhance bone healing. However, both preclinical and clinical studies produced contrasting results, mainly due to a high heterogeneity in study design, objectives, techniques adopted, and outcomes assessed. The aim of the present systematic review was to evaluate the efficacy of APCs in animal models of bone regeneration, considering the possible factors that might affect the outcome. An electronic search was performed on MEDLINE and Scopus databases. Comparative animal studies with a minimum follow up of 2 weeks, at least five subjects per group and using APCs for regeneration of bone defects were included. Articles underwent risk of bias assessment and quality evaluation. Fifty studies performed on six animal species (rat, rabbit, dog, sheep, goat, mini-pig) were included. The present part of the review considers studies performed on small ruminants, dogs, and mini-pigs (14 articles). The majority of the studies were considered at low risk of bias. In general, APCs' adjunct positively affected bone regeneration. Animal species, platelet and growth factors concentration, type of bone defect and of platelet concentrate used seemed to influence their efficacy in bone healing. However, sound conclusions were not drawn since too few studies for each large-size animal model were included. In addition, characterization of APCs' content was performed only in a few studies. Further studies with a standardized protocol including characterization of the final products will provide useful information for translating the results to clinical application of APCs in bone surgery.
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Affiliation(s)
- Sabrina Marcazzan
- a Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche , Università degli Studi di Milano , Milan , Italy.,b Department of Nanomedicine, Houston Methodist Research Institute , Houston, TX, USA
| | - Silvio Taschieri
- a Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche , Università degli Studi di Milano , Milan , Italy.,c Dental Clinic, IRCCS (Scientific Institute for Care and Clinical Research) Istituto Ortopedico Galeazzi, Milan , Italy
| | | | - Massimo Del Fabbro
- a Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche , Università degli Studi di Milano , Milan , Italy
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Babo PS, Cai X, Plachokova AS, Reis RL, Jansen J, Gomes ME, Walboomers XF. Evaluation of a platelet lysate bilayered system for periodontal regeneration in a rat intrabony three‐wall periodontal defect. J Tissue Eng Regen Med 2017; 12:e1277-e1288. [DOI: 10.1002/term.2535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 07/06/2017] [Accepted: 08/11/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Pedro S. Babo
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineUniversity of Minho Guimarães Portugal
- ICVS/3B's—PT Government Associate Laboratory Guimarães Portugal
| | - Xinjie Cai
- Department of BiomaterialsRadboud University Medical Center Nijmegen The Netherlands
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei‐MOST), Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of StomatologyWuhan University Wuhan China
| | - Adelina S. Plachokova
- Department of Implantology and PeriodontologyRadboud University Medical Center Nijmegen The Netherlands
| | - Rui L. Reis
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineUniversity of Minho Guimarães Portugal
- ICVS/3B's—PT Government Associate Laboratory Guimarães Portugal
- The Discoveries Centre for Regenerative and Precision MedicineHeadquarters at University of Minho Guimarães Portugal
| | - John Jansen
- Department of BiomaterialsRadboud University Medical Center Nijmegen The Netherlands
| | - Manuela E. Gomes
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineUniversity of Minho Guimarães Portugal
- ICVS/3B's—PT Government Associate Laboratory Guimarães Portugal
- The Discoveries Centre for Regenerative and Precision MedicineHeadquarters at University of Minho Guimarães Portugal
| | - X. Frank Walboomers
- Department of BiomaterialsRadboud University Medical Center Nijmegen The Netherlands
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Duramaz A, Ursavaş HT, Bilgili MG, Bayrak A, Bayram B, Avkan MC. Platelet-rich plasma versus exchange intramedullary nailing in treatment of long bone oligotrophic nonunions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:131-137. [DOI: 10.1007/s00590-017-2024-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/17/2017] [Indexed: 12/31/2022]
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Qiu G, Shi Z, Xu HH, Yang B, Weir MD, Li G, Song Y, Wang J, Hu K, Wang P, Zhao L. Bone regeneration in minipigs via calcium phosphate cement scaffold delivering autologous bone marrow mesenchymal stem cells and platelet‐rich plasma. J Tissue Eng Regen Med 2017; 12:e937-e948. [PMID: 28102000 DOI: 10.1002/term.2416] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Gengtao Qiu
- Department of Orthopaedic SurgeryNanfang Hospital, Southern Medical University Guangzhou Guangdong China
- Department of Orthopaedic SurgeryShunde First People Hospital Shunde Guangdong China
| | - Zhanjun Shi
- Department of Orthopaedic SurgeryNanfang Hospital, Southern Medical University Guangzhou Guangdong China
| | - Hockin H.K. Xu
- Biomaterials & Tissue Engineering Division, Department of Endodontics, Periodontics and ProsthodonticsUniversity of Maryland Dental School Baltimore MD USA
- Center for Stem Cell Biology and Regenerative MedicineUniversity of Maryland School of Medicine Baltimore MD USA
- University of Maryland Marlene and Stewart Greenebaum Cancer CenterUniversity of Maryland School of Medicine Baltimore MD USA
| | - Bo Yang
- State Key Laboratory of Oral Diseases and Department of Oral Implantology, West China Hospital of StomatologySichuan University Chengdu China
| | - Michael D. Weir
- Biomaterials & Tissue Engineering Division, Department of Endodontics, Periodontics and ProsthodonticsUniversity of Maryland Dental School Baltimore MD USA
| | - Guangjun Li
- Department of Spinal SurgeryNanfang Hospital, Southern Medical University Guangzhou Guangdong China
- Department of Orthopaedic SurgeryDeqing Hospital Huzhou Zhejiang China
| | - Yang Song
- Biomaterials & Tissue Engineering Division, Department of Endodontics, Periodontics and ProsthodonticsUniversity of Maryland Dental School Baltimore MD USA
| | - Jixing Wang
- Department of Spinal SurgeryNanfang Hospital, Southern Medical University Guangzhou Guangdong China
| | - Kevin Hu
- Biomaterials & Tissue Engineering Division, Department of Endodontics, Periodontics and ProsthodonticsUniversity of Maryland Dental School Baltimore MD USA
| | - Ping Wang
- Biomaterials & Tissue Engineering Division, Department of Endodontics, Periodontics and ProsthodonticsUniversity of Maryland Dental School Baltimore MD USA
| | - Liang Zhao
- Department of Orthopaedic SurgeryNanfang Hospital, Southern Medical University Guangzhou Guangdong China
- Biomaterials & Tissue Engineering Division, Department of Endodontics, Periodontics and ProsthodonticsUniversity of Maryland Dental School Baltimore MD USA
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Schneppendahl J, Jungbluth P, Sager M, Benga L, Herten M, Scholz A, Wild M, Hakimi M, Windolf J, Grassmann JP. Synergistic effects of HBO and PRP improve bone regeneration with autologous bone grafting. Injury 2016; 47:2718-2725. [PMID: 27817884 DOI: 10.1016/j.injury.2016.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/29/2016] [Indexed: 02/02/2023]
Abstract
Bone defects remain a challenge for patients and orthopaedic surgeons. Autologous transfer of cancellous bone grafts remains the standard of care. However, in recent years various osteoinductive substitute materials, such as platelet rich plasma (PRP) and hyperbaric oxygen therapy (HBO) have been shown to improve bone healing. This study evaluates the effects of a combined application of PRP and HBO with autologous bone grafting in an animal model. In 48 New Zealand White rabbits bone defects at the radius were filled with autologous bone harvested at the iliac crest. This was combined with application of autologous PRP and/or HBO treatment for the duration of this study. After 3 and 6 weeks histomorphometric, immunohistochemical and radiologic evaluations were performed. All animals tolerated the treatment well. Improved bone regeneration was shown in all groups at 6 weeks compared to 3 weeks. Additional application of PRP and HBO resulted in an increase in new bone formation and increased neovascularization at 3 and 6 weeks. There was no statistical significant difference between PRP and HBO application in these regards. A combinatory use of PRP and HBO resulted in an increased bone regeneration and neovascularization compared to all other groups. This study provides evidence for an improvement of bone regeneration with the combinatory application of PRP and HBO to autologous cancellous bone grafts in a model of weight bearing bone defects in rabbits. Also synergistic effects of these two measures on angiogenesis were evident.
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Affiliation(s)
- Johannes Schneppendahl
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Pascal Jungbluth
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany.
| | - Martin Sager
- Heinrich Heine University Hospital Duesseldorf, Animal Research Institute, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Laurentiu Benga
- Heinrich Heine University Hospital Duesseldorf, Animal Research Institute, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Monika Herten
- University Hospital Muenster, Department for Vascular and Endovascular Surgery, Waldeyerstraße 30, 48149 Münster, Germany
| | - Armin Scholz
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Michael Wild
- Department of Orthopaedic, Trauma, and Hand Surgery, Klinikum Darmstadt, Grafenstraße 9, 64283 Darmstadt, Germany
| | - Mohssen Hakimi
- Department of Trauma, Orthopaedic, and Hand Surgery, Vivantes Klinikum am Urban, Dieffenbachstraße 1, 10967 Berlin, Germany
| | - Joachim Windolf
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Jan-Peter Grassmann
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Platelet-rich plasma for the treatment of bone defects: from pre-clinical rational to evidence in the clinical practice. A systematic review. INTERNATIONAL ORTHOPAEDICS 2016; 41:221-237. [PMID: 27888295 DOI: 10.1007/s00264-016-3342-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE The treatment of large bone defects represents a significant challenge for orthopaedic surgeons. In recent years, biologic agents have also been used to further improve bone healing. Among these, platelet-rich plasma (PRP) is the most exploited strategy. The aim of the present study was to systematically review the available literature to identify: 1) preclinical in-vivo results supporting the rational of PRP use for bone healing; 2) evidence from the clinical practice on the actual clinical benefit of PRP for the treatment of fractures and complications such as delayed unions and non-unions. METHODS A systematic review of the literature was performed on the application of PRP in bone healing, using the following inclusion criteria: pre-clinical and clinical reports of any level of evidence, written in English language, published in the last 20 years (1996-2016), on the use of PRP to stimulate long-bone defect treatment, with focus on fracture and delayed/non-unions healing. RESULTS The search in the Pubmed database identified 64 articles eligible for inclusion: 45 were preclinical in-vivo studies and 19 were clinical studies. Despite the fact that the overall pre-clinical results seem to support the benefit of PRP in 91.1 % of the studies, a more in depth analysis underlined a lower success rate, with a positive outcome of 84.4 % in terms of histological analysis, and even lower values considering radiological and biomechanical results (75.0 % and 72.7 % positive outcome respectively). This was also mirrored in the clinical literature, where the real benefit of PRP use to treat fractures and non-unions is still under debate. CONCLUSION Overall, the available literature presents major limitations in terms of low quality and extreme heterogeneity, which hamper the possibility to optimize PRP treatment and translate it into a real clinical benefit despite positive preclinical findings on its biological potential to favour bone healing.
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Babo PS, Carvalho PP, Santo VE, Faria S, Gomes ME, Reis RL. Assessment of bone healing ability of calcium phosphate cements loaded with platelet lysate in rat calvarial defects. J Biomater Appl 2016; 31:637-649. [DOI: 10.1177/0885328216669474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Injectable calcium phosphate cements have been used as a valid alternative to autologous bone grafts for bone augmentation with the additional advantage of enabling minimally invasive implantation procedures and for perfectly fitting the tissue defect. Nevertheless, they have low biodegradability and lack adequate biochemical signaling to promote bone healing and remodeling. In previous in vitro studies, we observed that the incorporation of platelet lysate directly into the cement paste or loaded in hyaluronic acid microspheres allowed to modulate the cement degradation and the in vitro expression of osteogenic markers in seeded human adipose derived stem cells. The present study aimed at investigating the possible effect of this system in new bone formation when implanted in calvarial bilateral defects in rats. Different formulations were assessed, namely plain calcium phosphate cements, calcium phosphate cements loaded with human platelet lysate, hybrid injectable formulations composed of the calcium phosphate cement incorporating hyaluronin acid non-loaded microparticles (20% hyaluronin acid) or with particles loaded with platelet lysate. The degradability and new bone regrowth were evaluated in terms of mineral volume in the defect, measured by micro-computed tomography and histomorphometric analysis upon 4, 8 and 12 weeks of implantation. We observed that the incorporation of hyaluronin acid microspheres induced an overly rapid cement degradation, impairing the osteoconductive properties of the cement composites. Moreover, the incorporation of platelet lysate induced higher bone healing than the materials without platelet lysate, up to four weeks after surgery. Nevertheless, this effect was not found to be significant when compared to the one observed in the sham-treated group.
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Affiliation(s)
- Pedro S Babo
- 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro P Carvalho
- 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Vítor E Santo
- 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Susana Faria
- CMAT – Centre of Mathematics, Department of Mathematics and Applications, University of Minho, Guimarães, Portugal
| | - Manuela E Gomes
- 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
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16
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Babo PS, Santo VE, Gomes ME, Reis RL. Development of an Injectable Calcium Phosphate/Hyaluronic Acid Microparticles System for Platelet Lysate Sustained Delivery Aiming Bone Regeneration. Macromol Biosci 2016; 16:1662-1677. [DOI: 10.1002/mabi.201600141] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/24/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Pedro S. Babo
- 3B's Research Group; Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark Zona Industrial da Gandra 4805-017 Barco GMR Portugal
| | - Vítor E. Santo
- 3B's Research Group; Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark Zona Industrial da Gandra 4805-017 Barco GMR Portugal
| | - Manuela E. Gomes
- 3B's Research Group; Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark Zona Industrial da Gandra 4805-017 Barco GMR Portugal
| | - Rui L. Reis
- 3B's Research Group; Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; AvePark Zona Industrial da Gandra 4805-017 Barco GMR Portugal
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17
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Abstract
OBJECTIVES Long bone fractures that fail to heal or show a delay in healing can lead to increased morbidity. Bone marrow aspirate concentrate (BMAC) containing bone mesenchymal stem cells (BMSCs) has been suggested as an autologous biologic adjunct to aid long bone healing. The purpose of this study was to systematically review the basic science in vivo evidence for the use of BMAC with BMSCs in the treatment of segmental defects in animal long bones. DATA SOURCES The PubMed/MEDLINE and EMBASE databases were screened in July 14-25, 2014. STUDY SELECTION The following search criteria were used: [("bmac" OR "bone marrow aspirate concentrate" OR "bmc" OR "bone marrow concentrate" OR "mesenchymal stem cells") AND ("bone" OR "osteogenesis" OR "fracture healing" OR "nonunion" OR "delayed union")]. DATA EXTRACTION Three authors extracted data and analyzed for trends. Quality of evidence score was given to each study. DATA SYNTHESIS Results are presented as Hedge G standardized effect sizes with 95% confidence intervals. RESULTS The search yielded 35 articles for inclusion. Of studies reporting statistics, 100% showed significant increase in bone formation in the BMAC group on radiograph. Ninety percent reported significant improvement in earlier bone healing on histologic/histomorphometric assessment. Eighty-one percent reported a significant increase in bone area on micro-computed tomography. Seventy-eight percent showed a higher torsional stiffness for the BMAC-treated defects. CONCLUSION In the in vivo studies evaluated, BMAC confer beneficial effects on the healing of segmental defects in animal long bone models when compared with a control. Proof-of-concept has been established for BMAC in the treatment of animal segmental bone defects.
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18
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Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther 2015; 16:213-32. [DOI: 10.1517/14712598.2016.1118458] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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19
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Gianakos A, Zambrana L, Savage-Elliott I, Lane JM, Kennedy JG. Platelet-Rich Plasma in the Animal Long-Bone Model: An Analysis of Basic Science Evidence. Orthopedics 2015; 38:e1079-90. [PMID: 26652328 DOI: 10.3928/01477447-20151120-04] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/20/2015] [Indexed: 02/03/2023]
Abstract
Platelet-rich plasma (PRP) has been suggested as an adjunct to aid in long-bone healing. The purpose of this study was to systematically review the basic science in vivo evidence for the use of PRP in the treatment of bone pathology. The PubMed/MEDLINE and EMBASE databases were screened using the following search criteria: "(Platelet-rich plasma OR PRP OR autologous conditioned plasma OR ACP) AND (bone OR osteocytes OR osteogenesis OR nonunion OR delayed union)." Studies were included if they fulfilled the following criteria: (1) studied the effect of PRP or a similar concentrated platelet product, defined as a blood product with platelet concentration elevated to higher than baseline; (2) established a control with which to compare PRP; (3) were published in a peer-reviewed journal; and (4) looked specifically at animal long-bone models. All review articles and clinical studies, including randomized controlled trials and case series, were excluded from the review. Studies examining the effects of PRP on bones of animals with confounding pathology were excluded. In studies that contained additional treatment variables, only the portion of the experiment that compared PRP directly with the control were evaluated. Data were then extracted with a standardized table. The search yielded 29 articles for inclusion. Seventy-two percent of the studies reported platelet concentrations. Eighty-nine percent of studies reported significant improvement in earlier bone healing on histologic/histomorphometric assessment. One hundred percent showed significant increase in bone formation on radiographs in the PRP group. Eighty percent of studies reported a significant increase in bone area on microcomputed tomography. One hundred percent of studies showed a higher torsional stiffness for the PRP-treated defects. In the in vivo studies evaluated, PRP confers several beneficial effects on animal long-bone models. Proof of concept for PRP as a biologic adjunct in long-bone models has been determined.
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20
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Abstract
Bone defects do not heal in 5-10% of the fractures. In order to enhance bone regeneration, drug delivery systems are needed. They comprise a scaffold with or without inducing factors and/or cells. To test these drug delivery systems before application in patients, they finally need to be tested in animal models. The choice of animal model depends on the main research question; is a functional or mechanistic evaluation needed? Furthermore, which type of bone defects are investigated: load-bearing (i.e. orthopedic) or non-load-bearing (i.e. craniomaxillofacial)? This determines the type of model and in which type of animal. The experiments need to be set-up using the 3R principle and must be reported following the ARRIVE guidelines.
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21
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New and emerging strategies in platelet-rich plasma application in musculoskeletal regenerative procedures: general overview on still open questions and outlook. BIOMED RESEARCH INTERNATIONAL 2015; 2015:846045. [PMID: 26075269 PMCID: PMC4436449 DOI: 10.1155/2015/846045] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 02/07/2023]
Abstract
Despite its pervasive use, the clinical efficacy of platelet-rich plasma (PRP) therapy and the different mechanisms of action have yet to be established. This overview of the literature is focused on the role of PRP in bone, tendon, cartilage, and ligament tissue regeneration considering basic science literature deriving from in vitro and in vivo studies. Although this work provides evidence that numerous preclinical studies published within the last 10 years showed promising results concerning the application of PRP, many key questions remain unanswered and controversial results have arisen. Additional preclinical studies are needed to define the dosing, timing, and frequency of PRP injections, different techniques for delivery and location of delivery, optimal physiologic conditions for injections, and the concomitant use of recombinant proteins, cytokines, additional growth factors, biological scaffolds, and stems cells to develop optimal treatment protocols that can effectively treat various musculoskeletal conditions.
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22
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Healing of massive segmental femoral bone defects in minipigs by allogenic ASCs engineered with FLPo/Frt-based baculovirus vectors. Biomaterials 2015; 50:98-106. [DOI: 10.1016/j.biomaterials.2015.01.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/08/2015] [Accepted: 01/20/2015] [Indexed: 12/25/2022]
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Grassmann JP, Schneppendahl J, Hakimi AR, Herten M, Betsch M, Lögters TT, Thelen S, Sager M, Wild M, Windolf J, Jungbluth P, Hakimi M. Hyperbaric oxygen therapy improves angiogenesis and bone formation in critical sized diaphyseal defects. J Orthop Res 2015; 33:513-20. [PMID: 25640997 DOI: 10.1002/jor.22805] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 12/03/2014] [Indexed: 02/04/2023]
Abstract
Besides the use of autologous bone grafting several osteoconductive and osteoinductive methods have been reported to improve bone healing. However, persistent non-union occurs in a considerable number of cases and compromised angiogenesis is suspected to impede bone regeneration. Hyperbaric oxygen therapy (HBO) improves angiogenesis. This study evaluates the effects of HBO on bone defects treated with autologous bone grafting in a bone defect model in rabbits. Twenty-four New-Zealand White Rabbits were subjected to a unilateral critical sized diaphyseal radius bone defect and treated with autologous cancellous bone transplantation. The study groups were exposed to an additional HBO treatment regimen. Bone regeneration was evaluated radiologically and histologically at 3 and 6 weeks, angiogenesis was assessed by immunohistochemistry at three and six weeks. The additional administration of HBO resulted in a significantly increased new bone formation and angiogenesis compared to the sole treatment with autologous bone grafting. These results were apparent after three and six weeks of treatment. The addition of HBO therapy to autologous bone grafts leads to significantly improved bone regeneration. The increase in angiogenesis observed could play a crucial role for the results observed.
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Affiliation(s)
- J P Grassmann
- Heinrich Heine University Hospital D, uesseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, D-40225 Duesseldorf, Germany
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24
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Grassmann JP, Schneppendahl J, Sager M, Hakimi AR, Herten M, Loegters TT, Wild M, Hakimi M, Windolf J, Jungbluth P. The effect of bone marrow concentrate and hyperbaric oxygen therapy on bone repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5331. [PMID: 25577213 DOI: 10.1007/s10856-014-5331-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 07/27/2014] [Indexed: 06/04/2023]
Abstract
Neoangiogenesis represents an essential part of bone regeneration. Therefore the improvement of neovascularization is the subject of various research approaches. In addition autologous mesenchymal stem cells concentrate in combination with bone substitute materials have been shown to support bone regeneration. In a rabbit model we examined the proposed synergistic effect of hyperbaric oxygen therapy (HBOT) and bone marrow concentrate (BMC) with porous calcium phosphate granules (CPG) on neoangiogenesis and osseous consolidation of a critical- size defect. The animal groups treated with HBOT showed a significantly higher microvessel density (MVD) by immunhistochemistry. Furthermore HBOT groups presented a significantly larger amount of new bone formation histomorphometrically as well as radiologically. We conclude that the increase in perfusion as a result of increased angiogenesis may play a key role in the effects of HBOT and consequently promotes bone healing.
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Affiliation(s)
- J P Grassmann
- Department of Trauma and Handsurgery, Heinrich Heine University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
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25
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Malhotra A, Pelletier M, Oliver R, Christou C, Walsh WR. Platelet-Rich Plasma and Bone Defect Healing. Tissue Eng Part A 2014; 20:2614-33. [DOI: 10.1089/ten.tea.2013.0737] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Angad Malhotra
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Matthew Pelletier
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Rema Oliver
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Chris Christou
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - William R. Walsh
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
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26
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Bone formation with deproteinized bovine bone mineral or biphasic calcium phosphate in the presence of autologous platelet lysate: comparative investigation in rabbit. Int J Biomater 2014; 2014:367265. [PMID: 24982676 PMCID: PMC4058493 DOI: 10.1155/2014/367265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 12/20/2022] Open
Abstract
Bone substitutes alone or supplemented with platelet-derived concentrates are widely used to promote bone regeneration but their potency remains controversial. The aim of this study was, therefore, to compare the regenerative potential of preparations containing autologous platelet lysate (APL) and particles of either deproteinized bovine bone mineral (DBBM) or biphasic calcium phosphate (BCP), two bone substitutes with different resorption patterns. Rabbit APL was prepared by freeze-thawing a platelet suspension. Critical-size defects in rabbit femoral condyle were filled with DBBM or DBBM+APL and BCP or BCP+APL. Rabbits were sacrificed after six weeks and newly formed bone and residual implanted material were evaluated using nondemineralized histology and histomorphometry. New bone was observed around particles of all fillers tested. In the defects filled with BCP, the newly formed bone area was greater (70%; P < 0.001) while the residual material area was lower (60%; P < 0.001) than that observed in those filled with DBBM. New bone and residual material area of defects filled with either APL+DBBM or APL+BCP were similar to those observed in those filled with the material alone. In summary, osteoconductivity and resorption of BCP were greater than those of DBBM, while APL associated with either DBBM or BCP did not have an additional benefit.
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27
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Jungbluth P, Hakimi AR, Grassmann JP, Schneppendahl J, Betsch M, Kröpil P, Thelen S, Sager M, Herten M, Wild M, Windolf J, Hakimi M. The early phase influence of bone marrow concentrate on metaphyseal bone healing. Injury 2013; 44:1285-94. [PMID: 23684350 DOI: 10.1016/j.injury.2013.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/30/2013] [Accepted: 04/14/2013] [Indexed: 02/02/2023]
Abstract
Bone marrow concentrate (BMC) contains high densities of progenitor cells. Therefore, in critical size defects BMC may have the potency to support bone healing. The aim of this study was to investigate the effect of BMC in combination with calcium phosphate granules (CPG) on bone defect healing in a metaphyseal long bone defect in mini-pigs. A metaphyseal critical-size bone defect at the proximal tibia of 24 mini-pigs was filled with CPG combined with BMC, CPG solely (control group) or with an autograft. Radiological and histomorphometrical evaluations after 6 weeks (42 days) showed significantly more bone formation in the BMC group in the central area of the defect zone and the cortical defect zone compared to the CPG group. At the same time the resorption rate of CPG increased significantly in the BMC group. Nevertheless, compared to the BMC group the autograft group showed a significantly higher new bone formation radiologically and histomorphometrically. In BMC the count of mononuclear cells was significantly higher compared to the bone marrow aspirate (3.5-fold). The mesenchymal progenitor cell characteristics of the cells in BMC were confirmed by flow cytometry. Cells from BMC created significantly larger colonies of alkaline phosphatase-positive colony forming units (CFU-ALP) (4.4-fold) compared to cells from bone marrow aspirate. Nevertheless, even in the BMC group complete osseous bridging was only detectable in isolated instances of the bone defects. Within the limitations of this study the BMC+CPG composite promotes bone regeneration in the early phase of bone healing significantly better than the isolated application of CPG. However, the addition of BMC does not lead to a solid fusion of the defect in the early phase of bone healing an still does not represent an equal alternative to autologous bone.
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Affiliation(s)
- P Jungbluth
- Heinrich Heine University Hospital Duesseldorf, Department of Trauma and Handsurgery, Moorenstr. 5, 40225 Duesseldorf, Germany
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28
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El Backly RM, Zaky SH, Canciani B, Saad MM, Eweida AM, Brun F, Tromba G, Komlev VS, Mastrogiacomo M, Marei MK, Cancedda R. Platelet rich plasma enhances osteoconductive properties of a hydroxyapatite-β-tricalcium phosphate scaffold (Skelite) for late healing of critical size rabbit calvarial defects. J Craniomaxillofac Surg 2013; 42:e70-9. [PMID: 23932544 DOI: 10.1016/j.jcms.2013.06.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 12/19/2022] Open
Abstract
The use of platelet rich plasma (PRP) in bone repair remains highly controversial. In this work, we evaluated the effect of lyophilized PRP on bone regeneration when associated with a silicon stabilized hydroxyapatite tricalcium phosphate scaffold in a rabbit calvarial defect (Skelite). Critical defects were created in the calvaria of twenty-four rabbits. The periosteum was removed and the defects were either left empty or filled with allogeneic PRP gel; Skelite particles; Skelite and PRP gel. Four animals were killed after 4 weeks, 10 animals after 8 and 10 after 16 weeks. Specimens were processed for X-ray microtomography (μCT) and for resin embedded histology. μCT analysis revealed significant osteoid-like matrix and new bone deposition in PRP + Skelite group at both 8 and 16 weeks in respect to Skelite alone. Histologically, PRP + Skelite defects were highly cellular with more abundant osteoid deposition and more regular collagen fibres. Moreover, in vitro migration assays confirmed the chemotactic effect of PRP to endothelial and osteoprogenitor cells. We conclude that the addition of PRP influenced the local tissue microenvironment by providing key cryptic factors for regeneration, thereby enhancing progenitor cell recruitment, collagen and bone matrix deposition, and by creating a bridging interface between the scaffold and bone.
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Affiliation(s)
- Rania M El Backly
- Dipartimento di Medicina Sperimentale (D.I.M.E.S.) (Head: Prof. Maria Adelaide Pronzato), Università di Genova & AOU San Martino - Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genova, Italy; Tissue Engineering Labs, Faculty of Dentistry (Dean: Prof. Dr. Ihab Hammad), Alexandria University, El-Guish Road, El-Shatby, 21526 Alexandria, Egypt
| | - Samer H Zaky
- Dipartimento di Medicina Sperimentale (D.I.M.E.S.) (Head: Prof. Maria Adelaide Pronzato), Università di Genova & AOU San Martino - Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genova, Italy; Tissue Engineering Labs, Faculty of Dentistry (Dean: Prof. Dr. Ihab Hammad), Alexandria University, El-Guish Road, El-Shatby, 21526 Alexandria, Egypt
| | - Barbara Canciani
- Dipartimento di Medicina Sperimentale (D.I.M.E.S.) (Head: Prof. Maria Adelaide Pronzato), Università di Genova & AOU San Martino - Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genova, Italy
| | - Manal M Saad
- Tissue Engineering Labs, Faculty of Dentistry (Dean: Prof. Dr. Ihab Hammad), Alexandria University, El-Guish Road, El-Shatby, 21526 Alexandria, Egypt; Pharos University (Dean of Faculty: Prof. Dr. Yehia Ashour), Canal El Mahmoudia Street, Alexandria, Egypt
| | - Ahmed M Eweida
- Tissue Engineering Labs, Faculty of Dentistry (Dean: Prof. Dr. Ihab Hammad), Alexandria University, El-Guish Road, El-Shatby, 21526 Alexandria, Egypt; Faculty of Medicine (Dean: Prof. Dr. Mohammed Ashraf Galal), Alexandria University, El-Guish Road, El-Shatby, 21526 Alexandria, Egypt
| | - Francesco Brun
- Department of Industrial Engineering and Information Technology (Head: Prof. Maurizio Fermeglia), University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy; Sincrotrone Trieste S.C.p.A. (President: Prof. Carlo Rizzuto), Elettra, Strada Statale 14 - km 163,5 in AREA Science Park, 34149 Basovizza, Trieste, Italy
| | - Giuliana Tromba
- Sincrotrone Trieste S.C.p.A. (President: Prof. Carlo Rizzuto), Elettra, Strada Statale 14 - km 163,5 in AREA Science Park, 34149 Basovizza, Trieste, Italy
| | - Vladimir S Komlev
- A.A. Baikov Institute of Metallurgy and Materials Science (Head: Prof. Konstantin Aleksandrovich Solntsev), Russian Academy of Sciences, Leninskii Avenue 14, 119991 Moscow, Russia
| | - Maddalena Mastrogiacomo
- Dipartimento di Medicina Sperimentale (D.I.M.E.S.) (Head: Prof. Maria Adelaide Pronzato), Università di Genova & AOU San Martino - Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genova, Italy.
| | - Mona K Marei
- Tissue Engineering Labs, Faculty of Dentistry (Dean: Prof. Dr. Ihab Hammad), Alexandria University, El-Guish Road, El-Shatby, 21526 Alexandria, Egypt
| | - Ranieri Cancedda
- Dipartimento di Medicina Sperimentale (D.I.M.E.S.) (Head: Prof. Maria Adelaide Pronzato), Università di Genova & AOU San Martino - Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genova, Italy
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Smith JD, Weiss LE, Burgess JE, West AI, Campbell PG. Biologically Active Blood Plasma-Based Biomaterials as a New Paradigm for Tissue Repair Therapies. ACTA ACUST UNITED AC 2013. [DOI: 10.1089/dst.2012.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bausset O, Giraudo L, Veran J, Magalon J, Coudreuse JM, Magalon G, Dubois C, Serratrice N, Dignat-George F, Sabatier F. Formulation and storage of platelet-rich plasma homemade product. Biores Open Access 2013; 1:115-23. [PMID: 23516671 PMCID: PMC3559222 DOI: 10.1089/biores.2012.0225] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The platelet-rich plasma (PRP) is an autologous biotherapy based on platelet-healing properties. Here, we developed a simple and reproducible PRP purification protocol based on two successive centrifugations. We evaluated different centrifugation speeds and time-storage durations on the platelet quantity and quality. Sterility and stability of our PRP homemade product were also performed. We prepared PRP from 54 healthy volunteers. We tested activation state, reactivity, and stability of platelets by flow cytometry using basal and adenosine diphosphate (ADP)-induced P-selectin expression markers; growth factor release after platelet activation by an enzyme-linked immunosorbent assay (ELISA); platelet aggregation capacity by aggregrometry assays; clot formation and retraction by thromboelastography; and platelet morphology by ultrastructural analysis. About 130 and 250 g successive speed centrifugations further concentrated platelets while preserving their bioactivity during 6 h (after that, platelet functions were significantly altered). In these conditions, we obtained a highly concentrated pure PRP product (with a low leukocyte count) suitable to study platelet properties. To avoid the loss of efficacy, we recommend injecting PRP under 3 h after preparation.
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Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH. A novel hypothesis: the application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears. Med Sci Monit 2012; 18:HY47-50. [PMID: 22847210 PMCID: PMC3560705 DOI: 10.12659/msm.883254] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The white-white tears (meniscus lesion completely in the avascular zone) are without blood supply and theoretically cannot heal. Basal research has demonstrated that menisci are unquestionably important in load bearing, load redistribution, shock absorption, joint lubrication and the stabilization of the knee joint. It has been proven that partial or all-meniscusectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing. Some preliminary approaches have progressed to improve meniscal healing. However, the problem of promoting meniscal healing in the avascular area has not yet been resolved. The demanding nature of the approach as well as its low utility and efficacy has impeded the progress of these enhancement techniques. Platelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery.
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Affiliation(s)
- Li-Cheng Wei
- Department of Orthopaedics, Xiangya Hospital, Central South University, ChangSha, Hunan, China
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32
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Bone marrow concentrate for autologous transplantation in minipigs. Characterization and osteogenic potential of mesenchymal stem cells. Vet Comp Orthop Traumatol 2012; 26:34-41. [PMID: 23171924 DOI: 10.3415/vcot-11-11-0165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 07/16/2012] [Indexed: 12/31/2022]
Abstract
Autologous bone marrow plays an increasing role in the treatment of bone, cartilage and tendon healing disorders. Cell-based therapies display promising results in the support of local regeneration, especially therapies using intra-operative one-step treatments with autologous progenitor cells. In the present study, bone marrow-derived cells were concentrated in a point-of-care device and investigated for their mesenchymal stem cell (MSC) characteristics and their osteogenic potential. Bone marrow was harvested from the iliac crest of 16 minipigs. The mononucleated cells (MNC) were concentrated by gradient density centrifugation, cultivated, characterized by flow cytometry and stimulated into osteoblasts, adipocytes, and chondrocytes. Cell differentiation was investigated by histological and immunohistological staining of relevant lineage markers. The proliferation capacity was determined via colony forming units of fibroblast and of osteogenic alkaline-phosphatase-positive-cells. The MNC could be enriched 3.5-fold in nucleated cell concentrate in comparison to bone marrow. Flow cytometry analysis revealed a positive signal for the MSC markers. Cells could be differentiated into the three lines confirming the MSC character. The cellular osteogenic potential correlated significantly with the percentage of newly formed bone in vivo in a porcine metaphyseal long-bone defect model. This study demonstrates that bone marrow concentrate from minipigs display cells with MSC character and their osteogenic differentiation potential can be used for osseous defect repair in autologous transplantations.
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Kasten P, Beverungen M, Lorenz H, Wieland J, Fehr M, Geiger F. Comparison of platelet-rich plasma and VEGF-transfected mesenchymal stem cells on vascularization and bone formation in a critical-size bone defect. Cells Tissues Organs 2012; 196:523-33. [PMID: 22796828 DOI: 10.1159/000337490] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 12/27/2022] Open
Abstract
Both platelet-rich plasma (PRP) and vascular endothelial growth factor (VEGF) can promote regeneration. The aim of this study was to compare the effects of these two elements on bone formation and vascularization in combination with bone marrow stromal cells (BMSC) in a critical-size bone defect in rabbits. The critical-size defects of the radius were filled with: (1) a calcium-deficient hydroxyapatite (CDHA) scaffold + phVEGF(165)-transfected BMSC (VEGF group), (2) CDHA and PRP, or (3) CDHA, autogenous BMSC, and PRP. As controls served: (4) the CDHA scaffold alone and (5) the CDHA scaffold and autogenous BMSC. The volume of new bone was measured by means of micro-CT scans, and vascularization was assessed in histology after 16 weeks. Bone formation was higher in the PRP + CDHA, BMSC + CDHA, and PRP + BMSC + CDHA groups than in the VEGF group (p < 0.05). VEGF transfection significantly promoted vascularization of the scaffolds in contrast to BMSC and PRP (p < 0.05), but was similar to the result of the CDHA + PRP + BMSC group. The results show that VEGF-transfected BMSC as well as the combination of PRP and BMSC improve vascularization, but bone healing was better with the combination of BMSC and PRP than with VEGF-transfected BMSC. Expression of VEGF in BMSC as a single growth factor does not seem to be as effective for bone formation as expanded BMSC alone or PRP which contains a mixture of growth factors.
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Affiliation(s)
- P Kasten
- Division of Experimental Orthopaedics, Orthopaedic University Hospital of Heidelberg, Heidelberg, Germany
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Metzler P, von Wilmowsky C, Zimmermann R, Wiltfang J, Schlegel KA. The effect of current used bone substitution materials and platelet-rich plasma on periosteal cells by ectopic site implantation: An in-vivo pilot study. J Craniomaxillofac Surg 2012; 40:409-15. [DOI: 10.1016/j.jcms.2011.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 07/19/2011] [Accepted: 07/23/2011] [Indexed: 11/26/2022] Open
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Alsousou J, Ali A, Willett K, Harrison P. The role of platelet-rich plasma in tissue regeneration. Platelets 2012; 24:173-82. [DOI: 10.3109/09537104.2012.684730] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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36
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Riegger C, Kröpil P, Jungbluth P, Lanzman RS, Miese FR, Hakimi AR, Hakimi M, Wild M, Antoch G, Scherer A. Quantitative assessment of bone defect healing by multidetector CT in a pig model. Skeletal Radiol 2012; 41:531-7. [PMID: 21701952 DOI: 10.1007/s00256-011-1203-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 05/03/2011] [Accepted: 05/09/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate multidetector CT volumetry in the assessment of bone defect healing in comparison to histopathological findings in an animal model. MATERIALS AND METHODS In 16 mini-pigs, a circumscribed tibial bone defect was created. Multidetector CT (MDCT) of the tibia was performed on a 64-row scanner 42 days after the operation. The extent of bone healing was estimated quantitatively by MDCT volumetry using a commercially available software programme (syngo Volume, Siemens, Germany).The volume of the entire defect (including all pixels from -100 to 3,000 HU), the nonconsolidated areas (-100 to 500 HU), and areas of osseous consolidation (500 to 3,000 HU) were assessed and the extent of consolidation was calculated. Histomorphometry served as the reference standard. RESULTS The extent of osseous consolidation in MDCT volumetry ranged from 19 to 92% (mean 65.4 ± 18.5%). There was a significant correlation between histologically visible newly formed bone and the extent of osseous consolidation on MDCT volumetry (r = 0.82, P < 0.0001). A significant negative correlation was detected between osseous consolidation on MDCT and histological areas of persisting defect (r = -0.9, P < 0.0001). CONCLUSION MDCT volumetry is a promising tool for noninvasive monitoring of bone healing, showing excellent correlation with histomorphometry.
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Affiliation(s)
- Carolin Riegger
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Duesseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Xie C, Lu H, Li W, Chen FM, Zhao YM. The use of calcium phosphate-based biomaterials in implant dentistry. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:853-862. [PMID: 22201031 DOI: 10.1007/s10856-011-4535-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 12/12/2011] [Indexed: 05/31/2023]
Abstract
Since calcium phosphates (CaPs) were first proposed, a wide variety of formulations have been developed and continuously optimized, some of which (e.g. calcium phosphate cements, CPCs) have been successfully commercialized for clinical applications. These CaP-based biomaterials have been shown to be very attractive bone substitutes and efficient drug delivery vehicles across diverse biomedical applications. In this article, CaP biomaterials, principally CPCs, are addressed as alternatives/complements to autogenous bone for grafting in implant dentistry and as coating materials for enhancing the osteoinductivity of titanium implants, highlighting their performance benefits simultaneously as carriers for growth factors and as scaffolds for cell proliferation, differentiation and penetration. Different strategies for employing CaP biomaterials in dental implantology aim to ultimately reach the same goal, namely to enhance the osseointegration process for dental implants in the context of immediate loading and to augment the formation of surrounding bone to guarantee long-term success.
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Affiliation(s)
- Cheng Xie
- Department of Prosthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
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Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy 2012; 28:429-39. [PMID: 22284405 DOI: 10.1016/j.arthro.2011.10.018] [Citation(s) in RCA: 351] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/21/2011] [Accepted: 10/19/2011] [Indexed: 02/02/2023]
Abstract
Platelet concentrates such as platelet-rich plasma (PRP) have gained popularity in sports medicine and orthopaedics to promote accelerated physiologic healing and return to function. Each PRP product varies depending on patient factors and the system used to generate it. Blood from some patients may fail to make PRP, and most clinicians use PRP without performing cell counts on either the blood or the preparation to confirm that the solution is truly PRP. Components in this milieu have bioactive functions that affect musculoskeletal tissue regeneration and healing. Platelets are activated by collagen or other molecules and release growth factors from alpha granules. Additional substances are released from dense bodies and lysosomes. Soluble proteins also present in PRP function in hemostasis, whereas others serve as biomarkers of musculoskeletal injury. Electrolytes and soluble plasma hormones are required for cellular signaling and regulation. Leukocytes and erythrocytes are present in PRP and function in inflammation, immunity, and additional cellular signaling pathways. This article supports the emerging paradigm that more than just platelets are playing a role in clinical responses to PRP. Depending on the specific constituents of a PRP preparation, the clinical use can theoretically be matched to the pathology being treated in an effort to improve clinical efficacy.
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Affiliation(s)
- Stacie G Boswell
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Kröpil P, Hakimi AR, Jungbluth P, Riegger C, Rubbert C, Miese F, Lanzman RS, Wild M, Schek A, Scherer A, Windolf J, Antoch G, Becker J, Hakimi M. Cone beam CT in assessment of tibial bone defect healing: an animal study. Acad Radiol 2012; 19:320-5. [PMID: 22173320 DOI: 10.1016/j.acra.2011.10.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 10/11/2011] [Accepted: 10/14/2011] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate cone beam computed tomography (CBCT) for monitoring of tibial bone defect healing in comparison to histopathological findings. MATERIALS AND METHODS Circumscribed tibial bone defects were created in 16 mini-pigs and imaging of the tibia was performed on day 42 using a modern CBCT scanner with flat panel detector (PaX-Duo3D, Vatech, Korea). The extent of osseous consolidation including remaining calcium phosphate granules was measured quantitatively by a CBCT volumetry tool using commercially available software (Osirix Imaging software, Pixmeo, Geneva, Switzerland). Volumes of the entire defect (including all pixels), areas of osseous consolidation (density values >2350) and nonmineralized areas (density values <2350) of the defect were determined. The extent of bone regeneration was determined and correlated with the histomorphometrical reference standard. Independently, a visual semiquantitative CBCT-score was applied (4-point scale) to assess bone defect healing. RESULTS The extent of osseous consolidation in CBCT volumetry ranged from 14% to 92% (mean, 63.4 ± 17.6%). There was a significant positive correlation between histologically visible newly formed bone and the extent of bone regeneration on CBCT volumetry (r = 0.74-0.79, P < .001). The visual score matched with the volumetric results in 75% of the cases. CONCLUSION CBCT volumetry allows for reliable, noninvasive quantitative monitoring of bone defect healing and correlates significantly with histological findings. CBCT is a promising technique for imaging of peripheral bones suggesting further evaluation in clinical trials.
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Hansen GM, Lawler ME, Williams WB, Troulis MJ, Kaban LB. BMP4 localization and PCNA expression during distraction osteogenesis of the porcine mandible. Int J Oral Maxillofac Surg 2012; 41:867-73. [PMID: 22285012 DOI: 10.1016/j.ijom.2011.12.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 12/22/2011] [Indexed: 10/14/2022]
Abstract
This study characterized sequential molecular and cellular events in the porcine mandibular distraction osteogenesis (DO) wound. Nineteen Yucatan minipigs were divided into three treatment groups: Group A, unilateral mandibular distraction with 0 day latency, 1mm/day rate for 12 days, 24 days fixation (n=16); Group B, acute lengthening 12 mm (n=2); Group C, sham control (n=1). Group A was further divided by death date: mid-DO (n=5), end-DO (n=4), mid-fixation (n=5) and end-fixation (n=2). Groups B and C were killed on postoperative day 36, corresponding to end-fixation. Specimens were stained for proliferating cell nuclear antigen (PCNA) and bone morphogenetic protein-4 (BMP4). Cellular proliferation (PCNA) was assessed quantitatively and BMP4 staining was assessed on a semi-quantitative scale. Progenitor cell proliferation was greatest during mid-DO and decreased from end-DO through end-fixation. Proliferation in the acute lengthening group was elevated relative to sham control and comparable to end-DO. BMP4 staining intensity (localized to the periosteal cambium layer) was greatest during mid- and end-DO, decreased at mid-fixation and was undetectable at end-fixation. Progenitor cell proliferation and BMP4 expression are greatest during mid-DO and decrease progressively thereafter. At the time of death of the acute lengthening group, only increased cell proliferation was demonstrated.
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Affiliation(s)
- G M Hansen
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
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Mietsch A, Neidlinger-Wilke C, Schrezenmeier H, Mauer UM, Friemert B, Wilke HJ, Ignatius A. Evaluation of platelet-rich plasma and hydrostatic pressure regarding cell differentiation in nucleus pulposus tissue engineering. J Tissue Eng Regen Med 2011; 7:244-52. [DOI: 10.1002/term.524] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/17/2011] [Accepted: 09/21/2011] [Indexed: 01/24/2023]
Affiliation(s)
- Antje Mietsch
- Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research; Ulm University; Germany
| | - Cornelia Neidlinger-Wilke
- Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research; Ulm University; Germany
| | - Hubert Schrezenmeier
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm; German Red Cross Blood Transfusion Service Baden-Württemberg, Center of Musculoskeletal Research; Ulm University; Germany
| | - Uwe Max Mauer
- Department of Neurosurgery; German Armed Forces Hospital of Ulm; Germany
| | - Benedikt Friemert
- Department of Trauma Surgery and Orthopaedics; German Armed Forces Hospital of Ulm; Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research; Ulm University; Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research; Ulm University; Germany
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