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Saul D, Khosla S. Fracture Healing in the Setting of Endocrine Diseases, Aging, and Cellular Senescence. Endocr Rev 2022; 43:984-1002. [PMID: 35182420 PMCID: PMC9695115 DOI: 10.1210/endrev/bnac008] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 11/19/2022]
Abstract
More than 2.1 million age-related fractures occur in the United States annually, resulting in an immense socioeconomic burden. Importantly, the age-related deterioration of bone structure is associated with impaired bone healing. Fracture healing is a dynamic process which can be divided into four stages. While the initial hematoma generates an inflammatory environment in which mesenchymal stem cells and macrophages orchestrate the framework for repair, angiogenesis and cartilage formation mark the second healing period. In the central region, endochondral ossification favors soft callus development while next to the fractured bony ends, intramembranous ossification directly forms woven bone. The third stage is characterized by removal and calcification of the endochondral cartilage. Finally, the chronic remodeling phase concludes the healing process. Impaired fracture healing due to aging is related to detrimental changes at the cellular level. Macrophages, osteocytes, and chondrocytes express markers of senescence, leading to reduced self-renewal and proliferative capacity. A prolonged phase of "inflammaging" results in an extended remodeling phase, characterized by a senescent microenvironment and deteriorating healing capacity. Although there is evidence that in the setting of injury, at least in some tissues, senescent cells may play a beneficial role in facilitating tissue repair, recent data demonstrate that clearing senescent cells enhances fracture repair. In this review, we summarize the physiological as well as pathological processes during fracture healing in endocrine disease and aging in order to establish a broad understanding of the biomechanical as well as molecular mechanisms involved in bone repair.
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Affiliation(s)
- Dominik Saul
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905, USA.,Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, 37073 Goettingen, Germany
| | - Sundeep Khosla
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905, USA
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2
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Yildiz E, Ersen A, Yener E, Comunoglu N, Sen C. The Effect of Intraarticular Insulin on Chondral Defect Repair. Cartilage 2021; 13:684S-691S. [PMID: 32613847 PMCID: PMC8804716 DOI: 10.1177/1947603520938462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of intraarticular insulin on the treatment of chondral defects. DESIGN Twenty-four mature New Zealand rabbits were randomly divided into 3 groups as control (Group 1), microfracture (Group 2), and microfracture and insulin (Group 3). Four-millimeter full-thickness cartilage defects were created to the weight-bearing surface on the medial femoral condyles of each rabbit. In the first group, any additional interventions were not performed. Microfracture was performed on defects in groups 2 and 3. Additionally, 10 IU of insulin glargine was administrated into the knee joints of the third group. Three months after surgery, the knee joints were harvested and cartilage quality was assessed according to Wakitani and ICRS (International Cartilage Repair Society) scores histopathologically. Insulin injections were performed into the knees of 2 additional rabbits without creating a cartilage defect to evaluate the potential adverse effects of insulin on healthy cartilage (Group 4). RESULTS The total ICRS and Wakitani scores of the insulin group were found to be significantly lower than the microfracture group but similar to the control group. No negative effects of insulin on healthy cartilage were detected. Intraarticular insulin after surgery has led to a statistically significant decrease in systemic blood sugar levels whereas the decrease observed after administration to intact tissues was not statistically significant. CONCLUSIONS Insulin had a negative influence on the quality of cartilage regeneration and had no effect on healthy cartilage. Intraarticular insulin administration does not cause significant systemic effects in intact tissue.
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Affiliation(s)
- Eren Yildiz
- Department of Orthopaedics, Hatay State
Hospital, Antakya, Turkey
| | - Ali Ersen
- Department of Orthopaedics, School of
Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Yener
- Department of Pathology, Mehmet Akif
Inan Training and Research Hospital, School of Medicine, University of Health
Sciences, Şanlıurfa, Turkey
| | - Nil Comunoglu
- Department of Pathology, School of
Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Cengiz Sen
- Department of Orthopaedics, School of
Medicine, Istanbul University, Istanbul, Turkey
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3
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Abraham S, Vives M, Cottrell JA, Mitchell A, Lin HN, Effiong L, Iqbal E, Jingar N, Kim B, Shah N, Munoz W, Chaudhary SB, Lin SS, Benevenia J, O'Connor JP. Local insulin application has a dose-dependent effect on lumbar fusion in a rabbit model. J Tissue Eng Regen Med 2021; 15:442-452. [PMID: 33608970 DOI: 10.1002/term.3182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to determine if locally applied insulin has a dose-responsive effect on posterolateral lumbar fusion. Adult male New Zealand White rabbits underwent posterolateral intertransverse spinal fusions (PLFs) at L5-L6 using suboptimal amounts of autograft. Fusion sites were treated with collagen sponge soaked in saline (control, n = 11), or with insulin at low (5 or 10 units, n = 13), mid (20 units, n = 11), and high (40 units, n = 11) doses. Rabbits were euthanized at 6 weeks. The L5-L6 spine segment underwent manual palpation and radiographic evaluation performed by two fellowship trained spine surgeons blinded to treatment. Differences between groups were evaluated by analysis of variance on ranks followed by post-hoc Dunn's tests. Forty-three rabbits were euthanized at the planned 6 weeks endpoint, while three died or were euthanized prior to the endpoint. Radiographic evaluation found bilateral solid fusion in 10%, 31%, 60%, and 60% of the rabbits from the control and low, mid, and high-dose insulin-treated groups, respectively (p < 0.05). As per manual palpation, 7 of 10 rabbits in the mid-dose insulin group were fused as compared to 1 of 10 rabbits in the control group (p < 0.05). This study demonstrates that insulin enhanced the effectiveness of autograft to increase fusion success in the rabbit PLF model. The study indicates that insulin or insulin-mimetic compounds can be used to promote bone regeneration.
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Affiliation(s)
- Sangeeta Abraham
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Michael Vives
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Jessica A Cottrell
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Ashley Mitchell
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Hsuan-Ni Lin
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Linda Effiong
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Emaad Iqbal
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Neel Jingar
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Brian Kim
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Neel Shah
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - William Munoz
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Saad B Chaudhary
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Sheldon S Lin
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Joseph Benevenia
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - J Patrick O'Connor
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Newark, NJ, USA
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Khader A, Arinzeh TL. Biodegradable zinc oxide composite scaffolds promote osteochondral differentiation of mesenchymal stem cells. Biotechnol Bioeng 2019; 117:194-209. [PMID: 31544962 DOI: 10.1002/bit.27173] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/26/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
Osteoarthritis (OA) involves the degeneration of articular cartilage and subchondral bone. The capacity of articular cartilage to repair and regenerate is limited. A biodegradable, fibrous scaffold containing zinc oxide (ZnO) was fabricated and evaluated for osteochondral tissue engineering applications. ZnO has shown promise for a variety of biomedical applications but has had limited use in tissue engineering. Composite scaffolds consisted of ZnO nanoparticles embedded in slow degrading, polycaprolactone to allow for dissolution of zinc ions over time. Zinc has well-known insulin-mimetic properties and can be beneficial for cartilage and bone regeneration. Fibrous ZnO composite scaffolds, having varying concentrations of 1-10 wt.% ZnO, were fabricated using the electrospinning technique and evaluated for human mesenchymal stem cell (MSC) differentiation along chondrocyte and osteoblast lineages. Slow release of the zinc was observed for all ZnO composite scaffolds. MSC chondrogenic differentiation was promoted on low percentage ZnO composite scaffolds as indicated by the highest collagen type II production and expression of cartilage-specific genes, while osteogenic differentiation was promoted on high percentage ZnO composite scaffolds as indicated by the highest alkaline phosphatase activity, collagen production, and expression of bone-specific genes. This study demonstrates the feasibility of ZnO-containing composites as a potential scaffold for osteochondral tissue engineering.
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Affiliation(s)
- Ateka Khader
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
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5
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Henderson S, Ibe I, Cahill S, Chung YH, Lee FY. Bone Quality and Fracture-Healing in Type-1 and Type-2 Diabetes Mellitus. J Bone Joint Surg Am 2019; 101:1399-1410. [PMID: 31393433 DOI: 10.2106/jbjs.18.01297] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Shasta Henderson
- Department of Orthopaedics, Pennsylvania State University, Hershey, Pennsylvania
| | - Izuchukwu Ibe
- Department of Orthopaedics and Rehabilitation (I.I.), Yale School of Medicine (S.C., Y.-H.C., and F.Y.L.), New Haven, Connecticut
| | - Sean Cahill
- Department of Orthopaedics and Rehabilitation (I.I.), Yale School of Medicine (S.C., Y.-H.C., and F.Y.L.), New Haven, Connecticut
| | - Yeon-Ho Chung
- Department of Orthopaedics and Rehabilitation (I.I.), Yale School of Medicine (S.C., Y.-H.C., and F.Y.L.), New Haven, Connecticut
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation (I.I.), Yale School of Medicine (S.C., Y.-H.C., and F.Y.L.), New Haven, Connecticut
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6
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Liu Q, Wang X, Huang Z, Liu J, Ding J, Xu X, Kong G, Wu X, Yang Z, Zhu Q. Ketogenic diet delays spinal fusion and decreases bone mass in posterolateral lumbar spinal fusion: an in vivo rat model. Acta Neurochir (Wien) 2018; 160:1909-1916. [PMID: 29982887 DOI: 10.1007/s00701-018-3616-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/27/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ketogenic diet (KD), a low-carbohydrate-and-high-fat diet, causes a metabolic state of ketogenesis and has been used to treat drug-resistance epilepsy. Our recent studies showed KD neuroprotective after spinal cord injury and causing bone loss. Effects of KD on spinal fusion were still unknown. This study was aimed to evaluate effects of KD on spinal fusion in rats. METHODS Thirty-two Sprague-Dawley rats were randomly divided into KD and standard diet (SD) groups. The KD group was fed with food of 1:4 carbohydrates to fat. All rats were subjected to L4/5 posterolateral lumbar spinal fusion. The blood ketone, and serum calcium, phosphorus, and insulin-like growth factor-1 (IGF-1) were measured, as well as the fusion rates, bone mass (BV), and bone mineral contents (BMC) of fusion sites were estimated at 4 and 8 weeks. RESULTS There was no significant difference in serum calcium or phosphorus levels between groups at 4 or 8 weeks. However, there was a significant increase of blood ketone (1.02 mmol/L vs 0.38 mmol/L at 4 weeks; 0.83 mmol/L vs 0.32 mmol/L, at 8 weeks) and decrease of serum IGF-1 (339.4 ng/mL vs 630.6 ng/mL at 4 weeks; 418.8 ng/mL vs 628.6 ng/mL, at 8 weeks) in the KD group compared with the SD group. The spinal fusion occurred less in the KD group (1/16 vs 6/16 at 4 weeks; 7/16 vs 10/16, at 8 weeks), particularly at 4 weeks after surgery. The BV and BMC were lower in the KD group than that in the SD group at 4 weeks, but not different between groups at 8 weeks. CONCLUSIONS This study demonstrated that KD delayed spinal fusion and decreased bone mass in posterolateral lumbar spinal fusion in rats.
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Cao GL, Tian FM, Liu GY, Song HP, Yuan LL, Geng LD, Bei MJ, Zheng ZY, Zhang L. Strontium Ranelate Combined with Insulin Is as Beneficial as Insulin Alone in Treatment of Fracture Healing in Ovariectomized Diabetic Rats. Med Sci Monit 2018; 24:6525-6536. [PMID: 30221634 PMCID: PMC6154119 DOI: 10.12659/msm.911573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) and estrogen deficiency both predispose fracture patients to increased risk of delayed union or nonunion. The present study investigated the effects of strontium ranelate (SR) on fracture healing in ovariectomized (OVX) diabetic rats. Material/Methods A mid-shaft fracture was established in female normal control (CF), diabetic (DF), and OVX diabetic (DOF) rats. Treated DOF rats received either insulin alone (DOFI) or combined with SR (DOFIS). All rats were euthanized at 2 or 3 weeks after fracture. Fracture healing was evaluated using radiological, histological, immunohistochemical, and micro-computed tomography analyses. Results At 3 weeks after fracture, radiological and histological evaluations demonstrated delayed fracture healing in the DF group compared with the CF group, which was exacerbated by OVX, as indicated by the significantly lower X-ray score, BMD, BV/TV, and Md.Ar/Ps.Cl.Ar, and the markedly decreased OCN and Col I expression in the DOF group. All these changes were prevented by insulin alone or combined with SR treatment. In comparison with the DOFI group, DOFIS rats displayed markedly higher OCN expression at 2 weeks after fracture and Col I expression at 2 and 3 weeks after fracture. Conclusions These results demonstrated delayed fracture healing with preexisting estrogen deficiency and T2DM. While insulin alone and combined with SR were both effective in promoting bone fracture healing in this model, their combined treatment showed significant improvement in promoting osteogenic marker expression, but not of the radiological appearance, compared with insulin alone.
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Affiliation(s)
- Guo-Long Cao
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, Hebei, China (mainland).,International Science and Technology Cooperation Base of Geriatric Medicine, Department of International Cooperation, Ministry of Science and Technology of China, Tangshan, Hebei, China (mainland)
| | - Guang-Yuan Liu
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Hui-Ping Song
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Lei-Liang Yuan
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Lin-Dan Geng
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Ming-Jian Bei
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Zhi-Yuan Zheng
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Mine Medical Security Center, Meitan General Hospital, Beijing, China (mainland)
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8
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Bennett PM, Stewart SK, Dretzke J, Bem D, Penn-Barwell JG. Preclinical therapies to prevent or treat fracture non-union: A systematic review. PLoS One 2018; 13:e0201077. [PMID: 30067783 PMCID: PMC6070249 DOI: 10.1371/journal.pone.0201077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/08/2018] [Indexed: 12/22/2022] Open
Abstract
Background Non-union affects up to 10% of fractures and is associated with substantial morbidity. There is currently no single effective therapy for the treatment or prevention of non-union. Potential treatments are currently selected for clinical trials based on results from limited animal studies, with no attempt to compare results between therapies to determine which have the greatest potential to treat non-union. Aim The aim of this systematic review was to define the range of therapies under investigation at the preclinical stage for the prevention or treatment of fracture non-union. Additionally, through meta-analysis, it aimed to identify the most promising therapies for progression to clinical investigation. Methods MEDLINE and Embase were searched from 1St January 2004 to 10th April 2017 for controlled trials evaluating an intervention to prevent or treat fracture non-union. Data regarding the model used, study intervention and outcome measures were extracted, and risk of bias assessed. Results Of 5,171 records identified, 197 papers describing 204 therapies were included. Of these, the majority were only evaluated once (179/204, 88%), with chitosan tested most commonly (6/204, 3%). Substantial variation existed in model design, length of survival and duration of treatment, with results poorly reported. These factors, as well as a lack of consistently used objective outcome measures, precluded meta-analysis. Conclusion This review highlights the variability and poor methodological reporting of current non-union research. The authors call for a consensus on the standardisation of animal models investigating non-union, and suggest journals apply stringent criteria when considering animal work for publication.
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Affiliation(s)
- Philippa M. Bennett
- Institute of Naval Medicine, Crescent Road, Alverstoke, Hampshire, United Kingdom
- * E-mail:
| | - Sarah K. Stewart
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Janine Dretzke
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Danai Bem
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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9
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Malekzadeh BÖ, Erlandsson MC, Tengvall P, Palmquist A, Ransjo M, Bokarewa MI, Westerlund A. Effects of implant-delivered insulin on bone formation in osteoporotic rats. J Biomed Mater Res A 2018; 106:2472-2480. [PMID: 29673097 DOI: 10.1002/jbm.a.36442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 02/05/2023]
Abstract
Osteoporosis is a major cause of age-related fractures. Healing complications in osteoporotic patients are often associated with increased mortality and morbidity. Stimulation of the implant-adjacent bone could be beneficial in terms of the surgical outcome. Over the past decade, numerous investigations have implicated insulin in normal bone growth, and recent studies have described the advantages of administering insulin locally to increase bone formation. Therefore, we hypothesized that insulin-coated titanium implants would increase bone formation in osteoporotic animals. The aim of this study was to evaluate the effects of insulin delivered from an implant surface on bone-related gene expression and bone formation in osteoporotic rats. Characterizations of the surfaces of insulin-coated and control implants were performed using ellipsometry and interferometry. Forty ovariectomized and four healthy Sprague Dawley rats were used and implants were inserted in the tibias. The systemic effect of insulin was assessed by measuring the blood glucose levels and total body weight. The animals were sacrificed either 1 day or 3 weeks postimplantation. Implant-adherent cells were analyzed by quantitative real-time PCR, and the bone adjacent to the implants was examined by microcomputed tomography and histomorphometry. The insulin-coated implants had no systemic effects. The insulin-coated samples demonstrated significantly lower expression of the gene for interleukin 1β (p = 0.019) at 1 day, and significantly exhibited more periosteal callus (p = 0.029) at 3 weeks. Locally delivered insulin has potential for promoting bone formation and it exerts potentially anti-inflammatory effects in osteoporotic rats. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A:2472-2480, 2018.
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Affiliation(s)
- Behnosh Ö Malekzadeh
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Biomaterials, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin C Erlandsson
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pentti Tengvall
- Department of Biomaterials, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- Department of Biomaterials, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Ransjo
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria I Bokarewa
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Westerlund
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Glenske K, Donkiewicz P, Köwitsch A, Milosevic-Oljaca N, Rider P, Rofall S, Franke J, Jung O, Smeets R, Schnettler R, Wenisch S, Barbeck M. Applications of Metals for Bone Regeneration. Int J Mol Sci 2018; 19:E826. [PMID: 29534546 PMCID: PMC5877687 DOI: 10.3390/ijms19030826] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 02/06/2023] Open
Abstract
The regeneration of bone tissue is the main purpose of most therapies in dental medicine. For bone regeneration, calcium phosphate (CaP)-based substitute materials based on natural (allo- and xenografts) and synthetic origins (alloplastic materials) are applied for guiding the regeneration processes. The optimal bone substitute has to act as a substrate for bone ingrowth into a defect, as well as resorb in the time frame needed for complete regeneration up to the condition of restitution ad integrum. In this context, the modes of action of CaP-based substitute materials have been frequently investigated, where it has been shown that such materials strongly influence regenerative processes such as osteoblast growth or differentiation and also osteoclastic resorption due to different physicochemical properties of the materials. However, the material characteristics needed for the required ratio between new bone tissue formation and material degradation has not been found, until now. The addition of different substances such as collagen or growth factors and also of different cell types has already been tested but did not allow for sufficient or prompt application. Moreover, metals or metal ions are used differently as a basis or as supplement for different materials in the field of bone regeneration. Moreover, it has already been shown that different metal ions are integral components of bone tissue, playing functional roles in the physiological cellular environment as well as in the course of bone healing. The present review focuses on frequently used metals as integral parts of materials designed for bone regeneration, with the aim to provide an overview of currently existing knowledge about the effects of metals in the field of bone regeneration.
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Affiliation(s)
- Kristina Glenske
- Clinic of Small Animals, c/o Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University of Giessen, D-35392 Giessen, Germany.
| | | | | | - Nada Milosevic-Oljaca
- Clinic of Small Animals, c/o Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University of Giessen, D-35392 Giessen, Germany.
| | | | - Sven Rofall
- Botiss Biomaterials, D-12109 Berlin, Germany.
| | - Jörg Franke
- Clinic for Trauma Surgery and Orthopedics, Elbe Kliniken Stade-Buxtehude, D-21682 Stade, Germany.
| | - Ole Jung
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, D-20246 Hamburg, Germany.
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, D-20246 Hamburg, Germany.
| | | | - Sabine Wenisch
- Clinic of Small Animals, c/o Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University of Giessen, D-35392 Giessen, Germany.
| | - Mike Barbeck
- Botiss Biomaterials, D-12109 Berlin, Germany.
- Department of Oral and Maxillofacial Surgery, University Hospital Hamburg- Eppendorf, D-20246 Hamburg, Germany.
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11
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Wang X, Zhang G, Qi F, Cheng Y, Lu X, Wang L, Zhao J, Zhao B. Enhanced bone regeneration using an insulin-loaded nano-hydroxyapatite/collagen/PLGA composite scaffold. Int J Nanomedicine 2017; 13:117-127. [PMID: 29317820 PMCID: PMC5743129 DOI: 10.2147/ijn.s150818] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Insulin is widely considered as a classical hormone and drug in maintaining energy and glucose homeostasis. Recently, insulin has been increasingly recognized as an indispensable factor for osteogenesis and bone turnover, but its applications in bone regeneration have been restricted because of the short periods of activity and uncontrolled release. In this study, we incorporated insulin-loaded poly lactic-co-glycolic-acid (PLGA) nanospheres into nano-hydroxyapatite/collagen (nHAC) scaffolds and investigated the bioactivity of the composite scaffolds in vitro and in vivo. Bioactive insulin was successfully released from the nanospheres within the scaffold, and the release kinetics of insulin could be efficiently controlled by uniform-sized nanospheres. The physical characterizations of the composite scaffolds demonstrated that incorporation of nanospheres in nHAC scaffolds using this method did not significantly change the porosity, pore diameters, and compressive strengths of nHAC. In vitro, the insulin-loaded nHAC/PLGA composite scaffolds possessed favorable biological function for bone marrow mesenchymal stem cells adhesion and proliferation, as well as the differentiation into osteoblasts. In vivo, the optimized bone regenerative capability of this composite scaffold was confirmed in rabbit mandible critical size defects. These results demonstrated successful development of a functional insulin-PLGA-nHAC composite scaffold that enhances the bone regeneration capability of nHAC.
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Affiliation(s)
- Xing Wang
- Shanxi Medical University Stomatological Hospital, Taiyuan
| | - Guilan Zhang
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Feng Qi
- Department of Mechanical and Aerospace Engineering, University of Missouri, Columbia, MO, USA
| | - Yongfeng Cheng
- Shanxi Medical University Stomatological Hospital, Taiyuan
| | - Xuguang Lu
- Shanxi Medical University Stomatological Hospital, Taiyuan
| | - Lu Wang
- Shanxi Medical University Stomatological Hospital, Taiyuan
| | - Jing Zhao
- Shanxi Medical University Stomatological Hospital, Taiyuan
| | - Bin Zhao
- Shanxi Medical University Stomatological Hospital, Taiyuan
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12
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Ippolito JA, Krell ES, Cottrell J, Meyer R, Clark D, Nguyen D, Sudah S, Muñoz M, Lim E, Lin A, Lee TJH, O'Connor JP, Benevenia J, Lin SS. Effects of local vanadium delivery on diabetic fracture healing. J Orthop Res 2017; 35:2174-2180. [PMID: 28084655 DOI: 10.1002/jor.23521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/09/2017] [Indexed: 02/04/2023]
Abstract
This study evaluated the effect of local vanadyl acetylacetonate (VAC), an insulin mimetic agent, upon the early and late parameters of fracture healing in rats using a standard femur fracture model. Mechanical testing, and radiographic scoring were performed, as well as histomorphometry, including percent bone, percent cartilage, and osteoclast numbers. Fractures treated with local 1.5 mg/kg VAC possessed significantly increased mechanical properties compared to controls at 6 weeks post-fracture, including increased torque to failure (15%; p = 0.046), shear modulus (89%; p = 0.043), and shear stress (81%; p = 0.009). The radiographic scoring analysis showed increased cortical bridging at 4 weeks and 6 weeks (119%; p = 0.036 and 209%; p = 0.002) in 1.5 mg/kg VAC treated groups. Histomorphometry of the fracture callus at days 10 and 14 showed increased percent cartilage (121%; p = 0.009 and 45%; p = 0.035) and percent mineralized tissue (66%; p = 0.035 and 58%; p = 0.006) with local VAC treated groups compared to control. Additionally, fewer osteoclasts were observed in the local VAC treated animals as compared to controls at day 14 (0.45% ± 0.29% vs. 0.83% ± 0.36% of callus area; p = 0.032). The results suggest local administration of VAC acts to modulate osteoclast activity and increase percentage of early callus cartilage, ultimately enhancing mechanical properties comparably to non-diabetic animals treated with local VAC. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2174-2180, 2017.
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Affiliation(s)
- Joseph A Ippolito
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Ethan S Krell
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Jessica Cottrell
- Department of Biological Sciences, Seton Hall University, South Orange, New Jersey
| | - Ryan Meyer
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Devin Clark
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Daniel Nguyen
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Suleiman Sudah
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Maximillian Muñoz
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Elisha Lim
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Anthony Lin
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Thomas Jae Hoon Lee
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - James Patrick O'Connor
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Joseph Benevenia
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
| | - Sheldon S Lin
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07101
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13
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Wang X, Wu X, Xing H, Zhang G, Shi Q, E L, Liu N, Yang T, Wang D, Qi F, Wang L, Liu H. Porous Nanohydroxyapatite/Collagen Scaffolds Loading Insulin PLGA Particles for Restoration of Critical Size Bone Defect. ACS APPLIED MATERIALS & INTERFACES 2017; 9:11380-11391. [PMID: 28256126 DOI: 10.1021/acsami.6b13566] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Insulin is considered to be a classical central regulator of energy homeostasis. Recently, the effect of insulin on bone has gained a lot of attention, but little attention has been paid to the application in bone tissue engineering. In this study, porous nanohydroxyapatite/collagen (nHAC) scaffolds incorporating poly lactic-co-glycolic acid (PLGA) particles were successfully developed as an insulin delivery platform for bone regeneration. Bioactive insulin was successfully released from the PLGA particles within the scaffold, and the size of the particles as well as the release kinetics of the insulin could be efficiently controlled through Shirasu porous glass premix membrane emulsification technology. It was indicated that the nHAC/PLGA composite scaffolds possessed favorable mechanical and structural properties for cell adhesion and proliferation, as well as the differentiation into osteoblasts. It was also demonstrated that the nHAC/PLGA scaffolds implanted into a rabbit critical-size mandible defect possessed tissue compatibility and higher bone restoration capacity compared with the defects that were filled with or without nHAC scaffolds. Furthermore, the in vivo results showed that the nHAC/PLGA scaffolds which incorporated insulin-loaded microspheres with a size of 1.61 μm significantly accelerated bone healing compared with two other composite scaffolds. Our study indicated that the local insulin released at the optimal time could substantially and reproducibly improve bone repair.
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Affiliation(s)
- Xing Wang
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
- Hospital of Stomatology, Shanxi Medical University , Taiyuan, 030001, China
| | - Xia Wu
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Helin Xing
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Guilan Zhang
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Quan Shi
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Lingling E
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Na Liu
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Tingyuan Yang
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences , Beijing, 100190, China
| | - Dongsheng Wang
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Feng Qi
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences , Beijing, 100190, China
| | - Lianyan Wang
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences , Beijing, 100190, China
| | - Hongchen Liu
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
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14
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Abstract
BACKGROUND This study examined the efficacy of calcium sulfate (CaSO4) as a carrier for intramedullary delivery of zinc chloride (ZnCl2) to treat fracture healing in a BB Wistar rat model. A non-carrier-mediated injection of 3.0 mg/kg of ZnCl2 has previously been shown to enhance fracture healing. METHODS A heterogeneous mixture of ZnCl2 and CaSO4 was administered into the intramedullary femoral canal and a mid-diaphyseal femur fracture was created unilaterally. Early and late parameters of fracture healing were assessed using biomechanical testing, radiographic scoring, quantitative histomorphometry (for percentage of new cartilage and bone within the fracture callus), and long-term histologic evaluation. RESULTS Fractures treated with 1.0 mg/kg of ZnCl2/CaSO4 demonstrated a significantly higher maximum torque to failure compared with both CaSO4 (P = 0.048) and saline (P = 0.005) controls at 4 weeks postfracture (396.4 versus 251.3 versus 178.7 N mm, respectively). Statistically significant increases in torsional rigidity, effective shear modulus, and effective shear stress were also found, as well as a 3.5 times increase in radiographic score (based on bone union). Histologic examination of the fracture callus indicated enhanced chondrogenesis at day 14 postfracture, with increased percent cartilage for the ZnCl2/CaSO4 group compared with saline (P = 0.0004) and CaSO4 (P = 0.0453) controls. Long-term radiographic and histologic evaluation revealed no abnormal bone formation or infection up to 12 weeks postoperatively. CONCLUSIONS The effective dose of ZnCl2 augmentation for the enhancement of fracture healing in rats was reduced 3-fold in this study compared with previous findings. Furthermore, CaSO4 acted synergistically with ZnCl2 to increase the mechanical strength and stability at the fracture site.
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15
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Khader A, Sherman LS, Rameshwar P, Arinzeh TL. Sodium Tungstate for Promoting Mesenchymal Stem Cell Chondrogenesis. Stem Cells Dev 2016; 25:1909-1918. [PMID: 27615276 PMCID: PMC5165671 DOI: 10.1089/scd.2016.0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/09/2016] [Indexed: 02/07/2023] Open
Abstract
Articular cartilage has a limited ability to heal. Mesenchymal stem cells (MSCs) derived from the bone marrow have shown promise as a cell type for cartilage regeneration strategies. In this study, sodium tungstate (Na2WO4), which is an insulin mimetic, was evaluated for the first time as an inductive factor to enhance human MSC chondrogenesis. MSCs were seeded onto three-dimensional electrospun scaffolds in growth medium (GM), complete chondrogenic induction medium (CCM) containing insulin, and CCM without insulin. Na2WO4 was added to the media leading to final concentrations of 0, 0.01, 0.1, and 1 mM. Chondrogenic differentiation was assessed by biochemical analyses, immunostaining, and gene expression. Cytotoxicity using human peripheral blood mononuclear cells (PBMCS) was also investigated. The chondrogenic differentiation of MSCs was enhanced in the presence of low concentrations of Na2WO4 compared to control, without Na2WO4. In the induction medium containing insulin, cells in 0.01 mM Na2WO4 produced significantly higher sulfated glycosaminoglycans, collagen type II, and chondrogenic gene expression than all other groups at day 28. Cells in 0.1 mM Na2WO4 had significantly higher collagen II production and significantly higher sox-9 and aggrecan gene expression compared to control at day 28. Cells in GM and induction medium without insulin containing low concentrations of Na2WO4 also expressed chondrogenic markers. Na2WO4 did not stimulate PBMC proliferation or apoptosis. The results demonstrate that Na2WO4 enhances chondrogenic differentiation of MSCs, does not have a toxic effect, and may be useful for MSC-based approaches for cartilage repair.
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Affiliation(s)
- Ateka Khader
- 1 Department of Biomedical Engineering, New Jersey Institute of Technology , Newark, New Jersey
| | - Lauren S Sherman
- 2 Department of Medicine-Hematology/Oncology, Rutgers-New Jersey Medical School , Newark, New Jersey
| | - Pranela Rameshwar
- 2 Department of Medicine-Hematology/Oncology, Rutgers-New Jersey Medical School , Newark, New Jersey
| | - Treena L Arinzeh
- 1 Department of Biomedical Engineering, New Jersey Institute of Technology , Newark, New Jersey
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16
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Malekzadeh BÖ, Ransjo M, Tengvall P, Mladenovic Z, Westerlund A. Insulin released from titanium discs with insulin coatings-Kinetics and biological activity. J Biomed Mater Res B Appl Biomater 2016; 105:1847-1854. [DOI: 10.1002/jbm.b.33717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 02/01/2023]
Affiliation(s)
- B. Ö. Malekzadeh
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
- Department of Oral and Maxillofacial Surgery; Mölndal Hospital; Sweden
- Department of Biomaterials; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - M. Ransjo
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - P. Tengvall
- Department of Biomaterials; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - Z. Mladenovic
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - A. Westerlund
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
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17
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Abstract
Diabetes mellitus is a metabolic disorder that increases fracture risk, interferes with bone formation, and impairs fracture healing. Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) both increase fracture risk and have several common features that affect the bone including hyperglycemia and increased advanced glycation end product (AGE) formation, reactive oxygen species (ROS) generation, and inflammation. These factors affect both osteoblasts and osteoclasts leading to increased osteoclasts and reduced numbers of osteoblasts and bone formation. In addition to fracture healing, T1DM and T2DM impair bone formation under conditions of perturbation such as bacteria-induced periodontal bone loss by increasing osteoblast apoptosis and reducing expression of factors that stimulate osteoblasts such as BMPs and growth factors.
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Affiliation(s)
- Hongli Jiao
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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18
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Kömürcü E, Özyalvaçlı G, Kaymaz B, Gölge UH, Göksel F, Cevizci S, Adam G, Ozden R. Effects of Local Administration of Boric Acid on Posterolateral Spinal Fusion with Autogenous Bone Grafting in a Rodent Model. Biol Trace Elem Res 2015; 167:77-83. [PMID: 25728510 DOI: 10.1007/s12011-015-0274-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 11/29/2022]
Abstract
Spinal fusion is among the most frequently applied spinal surgical procedures. The goal of the present study was to evaluate whether the local administration of boric acid (BA) improves spinal fusion in an experimental spinal fusion model in rats. Currently, there is no published data that evaluates the possible positive effects if the local administration of BA on posterolateral spinal fusion. Thirty-two rats were randomly divided into four independent groups: no material was added at the fusion area for group 1; an autogenous morselized corticocancellous bone graft was used for group 2; an autogenous morselized corticocancellous bone graft with boric acid (8.7 mg/kg) for group 3; and only boric acid was placed into the fusion area for group 4. The L4-L6 spinal segments were collected at week 6, and the assessments included radiography, manual palpation, and histomorphometry. A statistically significant difference was determined between the groups with regard to the mean histopathological scores (p = 0.002), and a paired comparison was made with the Mann-Whitney U test to detect the group/groups from which the difference originated. It was determined that only the graft + BA practice increased the histopathological score significantly with regard to the control group (p = 0.002). Whereas, there was no statistically significant difference between the groups in terms of the manual assessment of fusion and radiographic analysis (respectively p = 0.328 and p = 0.196). This preliminary study suggests that BA may clearly be useful as a therapeutic agent in spinal fusion. However, further research is required to show the most effective dosage of BA on spinal fusion, and should indicate whether BA effects spinal fusion in the human body.
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Affiliation(s)
- Erkam Kömürcü
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey,
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19
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Ruiz-Ibán MA, Gonzalez-Lizán F, Diaz-Heredia J, Elías-Martin ME, Correa Gorospe C. Effect of VEGF-A165 addition on the integration of a cortical allograft in a tibial segmental defect in rabbits. Knee Surg Sports Traumatol Arthrosc 2015; 23:1393-1400. [PMID: 24296989 DOI: 10.1007/s00167-013-2785-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 11/17/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Long-bone segmental defects caused by infection, fracture, or tumour are a challenge for orthopaedic surgeons. Structural allografts are sometimes used in their treatment but their poor biological characteristics are a liability. The objective of this study was to determine whether the addition of recombinant vascular endothelial growth factor-A (VEGF) to a structural allograft improved its integration into a rabbit tibial segmental defect in a non-union model. METHODS Tibial segmental defects were filled with heat sterilized allogenic tubular tibiae sections and then stabilized with a screw plate. In the VEGF treatment group (n = 6 tibiae), 2 μg of VEGF added to a 50 μl matrigel solution was inserted into the allograft cavity. In the control group (n = 6 tibiae), only matrigel was added. After 12 weeks, macroscopic and microscopic analysis, radiographs, and computerized micro-tomography (micro-CT) were performed. If allograft consolidation was present, a torsional resistance analysis was performed. RESULTS Addition of VEGF to the allograft decreased the rate of osteosynthesis failure compared with the control group (1/6 vs. 5/6, p = 0.08), increased trabecular continuity evaluated by micro-CT in the bone-allograft interphases (8/12 vs. 2/12, p = 0.036) and histological trabecular continuity (7/12 vs. 0/12, p = 0.0046). Full consolidation was observed in three tibiae of the VEGF group and one in the control group (differences not significant); however, torsional resistance showed no significant differences (n.s.). CONCLUSION Addition of VEGF to a structural allograph inserted into a rabbit tibial segmental defect increased allograft integration rate. Further research in this direction might help clinicians in dealing with large bone defects.
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Affiliation(s)
- Miguel Angel Ruiz-Ibán
- Department of Orthopaedic Surgery and Trauma, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9.100, 28034, Madrid, Spain.
| | - Fausto Gonzalez-Lizán
- Department of Orthopaedic Surgery and Trauma, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9.100, 28034, Madrid, Spain
| | - Jorge Diaz-Heredia
- Department of Orthopaedic Surgery and Trauma, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9.100, 28034, Madrid, Spain
| | - Maria Elena Elías-Martin
- Department of Anesthesiology and Reanimation, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9.100, 28034, Madrid, Spain
| | - Carlos Correa Gorospe
- Experimental Surgery Unit, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9.100, 28034, Madrid, Spain
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20
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Chen QQ, Wang WM. Expression of FGF-2 and IGF-1 in diabetic rats with fracture. ASIAN PAC J TROP MED 2014; 7:71-5. [PMID: 24418087 DOI: 10.1016/s1995-7645(13)60195-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/15/2013] [Accepted: 12/15/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To observe the change of fibroblast growth factor-2 (FGF-2), insulin-like growth factor-1 (IGF-1) in serum and bone callus after fracture in diabetic rats, and to explore molecular biological mechanism of healing of diabetic fracture. METHODS Thirty male SD rats were designed into normal (n=15) and control (n=15) groups randomly. Venous blood was extracted on the lst, 2nd, 4th, 6th, 8th week after surgery. It was certificated and the serum was obtained. Left lower extremity was observed by X- ray. Bone callus at broken ends was observed under light microscope. Expressions of FGF-2 and IGF-1 in tissue were detected by immunohistochemistry method, and ELISA was used to detect expression of FGF-2 and IGF-1 in serum. RESULTS The results showed a significant increase in the density and area of newly formed bone in the distraction gaps of normal rats compared to control rats. Increased cell proliferation was also found in the distraction gaps of normal rats versus control rats. There was significant difference in serum levels of FGF-2 and IGF-1 between two groups. CONCLUSIONS The decrease of FGF-2 and IGF-1 both in the serum and in the fracture region is one of the reasons for bad bone healing or delayed union in rats' fracture with diabetes. There are some synergistic effects possibly between FGF-2 and IGF-1.
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Affiliation(s)
- Qing-Quan Chen
- Department of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area, Fuzhou 350025, China
| | - Wan-Ming Wang
- Department of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area, Fuzhou 350025, China
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21
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Wey A, Cunningham C, Hreha J, Breitbart E, Cottrell J, Ippolito J, Clark D, Lin HN, Benevenia J, O'Connor JP, Lin SS, Paglia DN. Local ZnCl2 accelerates fracture healing. J Orthop Res 2014; 32:834-41. [PMID: 24574139 DOI: 10.1002/jor.22593] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/13/2014] [Indexed: 02/04/2023]
Abstract
This study evaluated the effect of local zinc chloride (ZnCl2 ), an insulin mimetic agent, upon the early and late parameters of fracture healing in rats using a standard femur fracture model. Mechanical testing, radiographic scoring, histomorphometry, qualitative histological scoring, PCNA immunohistochemistry, and local growth factor analysis were performed. Fractures treated with local ZnCl2 possessed significantly increased mechanical properties compared to controls at 4 weeks post fracture. The radiographic scoring analysis showed increased cortical bridging at 4 weeks in the 1.0 (p=0.0015) and 3.0 (p<0.0001) mg/kg ZnCl2 treated groups. Histomorphometry of the fracture callus at day 7 showed 177% increase (p=0.036) in percent cartilage and 133% increase (p=0.002) in percent mineralized tissue with local ZnCl2 treatment compared to controls. Qualitative histological scoring showed a 2.1× higher value at day 7 in the ZnCl2 treated group compared to control (p = 0.004). Cell proliferation and growth factors, VEGF and IGF-I, within fracture calluses treated with local ZnCl2 were increased at day 7. The results suggest local administration of ZnCl2 increases cell proliferation, causing increased growth factor production which yields improved chondrogenesis and endochondral ossification. Ultimately, these events lead to accelerated fracture healing as early as 4 weeks post fracture.
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Affiliation(s)
- Aaron Wey
- Rutgers New Jersey Medical School, Department of Orthopaedics, 90 Bergen Street, Suite 7300, Newark, New Jersey, 07103
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22
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Paglia DN, Wey A, Hreha J, Park AG, Cunningham C, Uko L, Benevenia J, O'Connor JP, Lin SS. Local vanadium release from a calcium sulfate carrier accelerates fracture healing. J Orthop Res 2014; 32:727-34. [PMID: 24375684 DOI: 10.1002/jor.22570] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 12/05/2013] [Indexed: 02/04/2023]
Abstract
This study evaluated the efficacy of using calcium sulfate (CaSO4 ) as a carrier for intramedullary delivery of an organic vanadium salt, vanadyl acetylacetonate (VAC) after femoral fracture. VAC can act as an insulin-mimetic and can be used to accelerate fracture healing in rats. A heterogenous mixture of VAC and CaSO4 was delivered to the fracture site of BB Wistar rats, and mechanical testing, histomorphometry, micro-computed tomography (micro-CT) were performed to measure healing. At 4 weeks after fracture, maximum torque to failure, effective shear modulus, and effective shear stress were all significantly higher (p < 0.05) in rats treated with 0.25 mg/kg VAC-CaSO4 as compared to carrier control rats. Histomorphometry found a 71% increase in percent cartilage matrix (p < 0.05) and a 64% decrease in percent mineralized tissue (p < 0.05) at 2 weeks after fracture in rats treated with 0.25 mg/kg of VAC-CaSO4 . Micro-CT analyses at 4 weeks found a more organized callus structure and higher trending maximum connected z-ray. fraction for VAC-CaSO4 groups. Evaluation of radiographs and serial histological sections at 12 weeks did not show any evidence of ectopic bone formation. As compared to previous studies, CaSO4 was an effective carrier for reducing the dose of VAC required to accelerate femoral fracture healing in rats.
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Affiliation(s)
- David N Paglia
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey, 07103
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23
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Park AG, Paglia DN, Al-Zube L, Hreha J, Vaidya S, Breitbart E, Benevenia J, O'Connor JP, Lin SS. Local insulin therapy affects fracture healing in a rat model. J Orthop Res 2013; 31:776-82. [PMID: 23238765 DOI: 10.1002/jor.22287] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 11/08/2012] [Indexed: 02/04/2023]
Abstract
A significant number of lower extremity fractures result in mal-union necessitating effective treatments to restore ambulation. Prior research in diabetic animal fracture models demonstrated improved healing following local insulin application to the fracture site and indicated that local insulin therapy can aid bone regeneration, at least within an insulin-dependent diabetic animal model. This study tested whether local insulin therapy could accelerate femur fracture repair in normal, non-diabetic rats. High (20 units) and low (10 units) doses of insulin were delivered in a calcium sulfate carrier which provided sustained release of the exogenous insulin for 7 days after fracture. Histomorphometry, radiographic scoring, and torsional mechanical testing were used to measure fracture healing. The fracture calluses from rats treated with high-dose insulin had significantly more cartilage than untreated rats after 7 and 14 days of healing. After 4 weeks of healing, femurs from rats treated with low-dose insulin had significantly higher radiographic scores and mechanical strength (p < 0.05), compared to the no treatment control groups. The results of this study suggest that locally delivered insulin is a potential therapeutic agent for treating bone fractures. Further studies are necessary, such as large animal proof of concepts, prior to the clinical use of insulin for bone fracture treatment.
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Affiliation(s)
- Andrew G Park
- Department of Orthopaedics, University of Medicine, Dentistry of New Jersey-New Jersey Medical School, 185 South Orange Avenue, 90 Bergen Street, Suite 7300, Newark, NJ 07103, USA
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24
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Paglia DN, Wey A, Breitbart EA, Faiwiszewski J, Mehta SK, Al-Zube L, Vaidya S, Cottrell JA, Graves D, Benevenia J, O’Connor JP, Lin SS. Effects of local insulin delivery on subperiosteal angiogenesis and mineralized tissue formation during fracture healing. J Orthop Res 2013; 31:783-91. [PMID: 23238777 PMCID: PMC6446235 DOI: 10.1002/jor.22288] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/08/2012] [Indexed: 02/04/2023]
Abstract
Local insulin delivery has been shown to improve osseous healing in diabetic animals. The purpose of this study was to quantify the effects of local intramedullary delivery of saline or Ultralente insulin (UL) on various fracture healing parameters using an in vivo non-diabetic BB Wistar rat model. Quantitation of local insulin levels showed a rapid release of insulin from the fractured femora, demonstrating complete release at 2 days. RT-PCR analysis revealed that the expression of early osteogenic markers (Col1α2, osteopontin) was significantly enhanced with UL treatment when compared with saline controls (p < 0.05). Significant differences in VEGF + cells and vascularity were evident between the treatment and control groups at day 7 (p < 0.05). At day 21, histomorphometric analysis demonstrated a significant increase in percent mineralized tissue in the UL-treated animals compared with controls (p < 0.05), particularly within the subperiosteal region of the fracture callus. Mechanical testing at 4 weeks showed significantly greater mechanical strength for UL-treated animals (p < 0.05), but healing in control animals caught up at 6 weeks post-fracture. These results suggest that the primary osteogenic effect of UL during the early stages of fracture healing (1-3 weeks) is through an increase in osteogenic gene expression, subperiosteal angiogenesis, and mineralized tissue formation.
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Affiliation(s)
- David N. Paglia
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103
| | - Aaron Wey
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103
| | - Eric A. Breitbart
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103
| | - Jonathan Faiwiszewski
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103
| | - Siddhant K. Mehta
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103
| | - Loay Al-Zube
- Department of Biochemistry and Molecular Biology, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey,Department of Biomedical Engineering, The Hashemite University, Zarqa 13115, Jordan
| | - Swaroopa Vaidya
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103,Department of Biochemistry and Molecular Biology, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey
| | - Jessica A. Cottrell
- Department of Biochemistry and Molecular Biology, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey
| | - Dana Graves
- Department of Periodontics, University of Pennsylvania, 240 South 40 Street, Philadelphia, PA, 19104
| | - Joseph Benevenia
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103
| | - J. Patrick O’Connor
- Department of Biochemistry and Molecular Biology, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey
| | - Sheldon S. Lin
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103
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The BB Wistar Rat as a Diabetic Model for Fracture Healing. ISRN ENDOCRINOLOGY 2013; 2013:349604. [PMID: 23606982 PMCID: PMC3628493 DOI: 10.1155/2013/349604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 03/11/2013] [Indexed: 11/22/2022]
Abstract
The advent of improved glucose control with insulin and oral medications has allowed for the diabetic population to live longer and healthier lives. Unfortunately diabetes remains a worldwide epidemic with multiple health implications. Specifically, its affects upon fracture healing have been well studied and shown to have negative effects on bone mineral density, biomechanical integrity, and fracture healing. Multiple animal models have been used for research purposes to gain further insight into the effects and potential treatments of this disease process. The diabetic BB Wistar rat is one model that replicates a close homology to human type-1 diabetes and has been used as a fracture model to study the effects of diabetes on bone integrity and healing. In particular, the effects of tight glucose control, ultrasound therapy, platelet-rich plasma (PRP), platelet-derived growth factor (PDGF), bone morphogenetic protein 2 (BMP-2), and allograft bone incorporation have been studied extensively. We present a review of the literature using the BB Wistar rat to elucidate the implications of diabetes on fracture healing.
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Koerner JD, Yalamanchili P, Munoz W, Uko L, Chaudhary SB, Lin SS, Vives MJ. The effects of local insulin application to lumbar spinal fusions in a rat model. Spine J 2013; 13:22-31. [PMID: 23295034 DOI: 10.1016/j.spinee.2012.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 09/25/2012] [Accepted: 11/08/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The rates of pseudoarthrosis after a single-level spinal fusion have been reported up to 35%, and the agents that increase the rate of fusion have an important role in decreasing pseudoarthrosis after spinal fusion. Previous studies have analyzed the effects of local insulin application to an autograft in a rat segmental defect model. Defects treated with a time-released insulin implant had significantly more new bone formation and greater quality of bone compared with controls based on histology and histomorphometry. A time-released insulin implant may have similar effects when applied in a lumbar spinal fusion model. PURPOSE This study analyzes the effects of a local time-released insulin implant applied to the fusion bed in a rat posterolateral lumbar spinal fusion model. Our hypothesis was twofold: first, a time-released insulin implant applied to the autograft bed in a rat posterolateral lumbar fusion will increase the rate of successful fusion and second, will alter the local environment of the fusion site by increasing the levels of local growth factors. STUDY DESIGN Animal model (Institutional Animal Care and Use Committee approved) using 40 adult male Sprague-Dawley rats. METHODS Forty skeletally mature Sprague-Dawley rats weighing approximately 500 g each underwent posterolateral intertransverse lumbar fusions with iliac crest autograft from L4 to L5 using a Wiltse-type approach. After exposure of the transverse processes and high-speed burr decortication, a Linplant (Linshin Canada, Inc., ON, Canada) consisting of 95% microrecrystalized palmitic acid and 5% bovine insulin (experimental group) or a sham implant consisting of only palmitic acid (control group) was implanted on the fusion bed with iliac crest autograft. As per the manufacturer, the Linplant has a release rate of 2 U/day for a minimum of 40 days. The transverse processes and autograft beds of 10 animals from the experimental and 10 from the control group were harvested at Day 4 and analyzed for growth factors. The remaining 20 spines were harvested at 8 weeks and underwent a radiographic examination, manual palpation, and microcomputed tomographic (micro-CT) examination. RESULTS One of the 8-week control animals died on postoperative Day 1, likely due to anesthesia. In the groups sacrificed at Day 4, there was a significant increase in insulinlike growth factor-I (IGF-I) in the insulin treatment group compared with the controls (0.185 vs. 0.129; p=.001). No significant differences were demonstrated in the levels of transforming growth factor beta-1, platelet-derived growth factor-AB, and vascular endothelial growth factor between the groups (p=.461, .452, and .767 respectively). Based on the radiographs, 1 of 9 controls had a solid bilateral fusion mass, 2 of 9 had unilateral fusion mass, 3 of 9 had small fusion mass bilaterally, and 3 of 9 had graft resorption. The treatment group had solid bilateral fusion mass in 6 of 10 and unilateral fusion mass in 4 of 10, whereas a small bilateral fusion mass and graft resorption were not observed. The difference between the groups was significant (p=.0067). Based on manual palpation, only 1 of 9 controls was considered fused, 4 of 9 were partially fused, and 4 of 9 were not fused. In the treatment group, there were 6 of 10 fusions, 3 of 10 partial fusions, and 1 of 10 were not fused. The difference between the groups was significant (p=.0084). Based on the micro-CT, the mean bone volume of the control group was 126.7 mm(3) and 203.8 mm(3) in the insulin treatment group. The difference between the groups was significant (p=.0007). CONCLUSIONS This study demonstrates the potential role of a time-released insulin implant as a bone graft enhancer using a rat posterolateral intertransverse lumbar fusion model. The insulin-treatment group had significantly higher fusion rates based on the radiographs and manual palpation and had significantly higher levels of IGF-I and significantly more bone volume on micro-CT.
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Affiliation(s)
- John D Koerner
- Department of Orthopaedics, UMDNJ-New Jersey Medical School, 90 Bergen St, DOC 7300, Newark, NJ 07101, USA.
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Paglia DN, Wey A, Park AG, Breitbart EA, Mehta SK, Bogden JD, Kemp FW, Benevenia J, O'Connor JP, Lin SS. The effects of local vanadium treatment on angiogenesis and chondrogenesis during fracture healing. J Orthop Res 2012; 30:1971-8. [PMID: 22653614 DOI: 10.1002/jor.22159] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 05/09/2012] [Indexed: 02/04/2023]
Abstract
This study quantified the effects of local intramedullary delivery of an organic vanadium salt, which may act as an insulin-mimetic on fracture healing. Using a BB Wistar rat femoral fracture model, local vanadyl acetylacetonate (VAC) was delivered to the fracture site and histomorphometry, mechanical testing, and immunohistochemistry were performed. Callus percent cartilage was 200% higher at day 7 (p < 0.05) and 88% higher at day 10 (p < 0.05) in the animals treated with 1.5 mg/kg of VAC. Callus percent mineralized tissue was 37% higher at day 14 (p < 0.05) and 31% higher at day 21 (p < 0.05) in the animals treated with 1.5 mg/kg of VAC. Maximum torque to failure was 104% and 154% higher at 4 weeks post-fracture (p < 0.05) for the healing femurs from the VAC-treated (1.5 and 3.0 mg/kg) animals. Animals treated with other VAC doses demonstrated increased mechanical parameters at 4 weeks (p < 0.05). Immunohistochemistry detected 62% more proliferating cells at days 7 (p < 0.05) and 94% more at day 10 (p < 0.05) in the animals treated with 1.5 mg/kg VAC. Results showed 100% more vascular endothelial growth factor-C (VEGF-C) positive cells and 80% more blood vessels at day 7 (p < 0.05) within the callus subperiosteal region of VAC-treated animals (1.5 mg/kg) compared to controls. The results suggest that local VAC treatment affects chondrogenesis and angiogenesis within the first 7-10 days post-fracture, which leads to enhanced mineralized tissue formation and accelerated fracture repair as early as 3-4 weeks post-fracture.
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Affiliation(s)
- David N Paglia
- Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103, USA.
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Malekzadeh B, Tengvall P, Öhrnell LO, Wennerberg A, Westerlund A. Effects of locally administered insulin on bone formation in non-diabetic rats. J Biomed Mater Res A 2012; 101:132-7. [DOI: 10.1002/jbm.a.34313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 05/10/2012] [Accepted: 05/25/2012] [Indexed: 11/12/2022]
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Graves DT, Alblowi J, Paglia DN, O’Connor JP, Lin S. Impact of Diabetes on Fracture Healing. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jecm.2010.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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