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Harrer JA, Fulton TM, Sangadala S, Kaiser J, Devereaux EJ, Oliver C, Presciutti SM, Boden SD, Willett NJ. Local FK506 delivery induces osteogenesis in in vivo rat bone defect and rabbit spine fusion models. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.08.584163. [PMID: 38559240 PMCID: PMC10979893 DOI: 10.1101/2024.03.08.584163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Bone grafting procedures are commonly used for the repair, regeneration, and fusion of bones in in a wide range of orthopaedic surgeries, including large bone defects and spine fusion procedures. Autografts are the clinical gold standard, though recombinant human bone morphogenetic proteins (rhBMPs) are often used, particularly in difficult clinical situations. However, treatment with rhBMPs can have off-target effects and significantly increase surgical costs, adding to patients' already high economic and mental burden. Recent studies have identified that FDA-approved immunosuppressant drug, FK506 (Tacrolimus), can also activate the BMP pathway by binding to its inhibitors. This study tested the hypothesis that FK506, as a standalone treatment, could induce osteogenic differentiation of human mesenchymal stromal cells (hMSCs), as well as functional bone formation in a rat segmental bone defect model and rabbit spinal fusion model. FK506 potentiated the effect of low dose BMP-2 to enhance osteogenic differentiation and mineralization of hMSCs in vitro. Standalone treatment with FK506 delivered on a collagen sponge, produced consistent bone bridging of a rat critically-sized femoral defect with functional mechanical properties comparable to naïve bone. In a rabbit single level posterolateral spine fusion model, treatment with FK506 delivered on a collagen sponge successfully fused the L5-L6 vertebrae at rates comparable to rhBMP-2 treatment. These data demonstrate the ability of FK506 to induce bone formation in human cells and two challenging in vivo models, and indicate FK506 can be utilized either as a standalone treatment or in conjunction with rhBMP to treat a variety of spine disorders.
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Affiliation(s)
- Julia Andraca Harrer
- Atlanta VA Medical Center, Decatur, GA 30033, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
| | - Travis M. Fulton
- Atlanta VA Medical Center, Decatur, GA 30033, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Sreedhara Sangadala
- Atlanta VA Medical Center, Decatur, GA 30033, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jarred Kaiser
- Atlanta VA Medical Center, Decatur, GA 30033, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Emily J. Devereaux
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Steven M. Presciutti
- Atlanta VA Medical Center, Decatur, GA 30033, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Scott D. Boden
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nick J. Willett
- Atlanta VA Medical Center, Decatur, GA 30033, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
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Virk S, Vaishnav A, Kumagai H, Yao YC, Dowdell J, Sandhu H, Schwab F, Qureshi S. Pilot Study on Percutaneous Delivery of Recombinant Human Bone Morphongenetic Protein-2 Augments Fusion in a Nicotine-impaired Rabbit Fusion Model. Clin Spine Surg 2023; 36:E512-E518. [PMID: 37651560 DOI: 10.1097/bsd.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/21/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN A nicotine-impaired spinal fusion rabbit model. OBJECTIVE To examine whether controlled delivery of morselized absorbable collagen sponge recombinant human bone morphogenetic protein-2 (rhBMP2) in a delayed manner postsurgery would allow for improved bone healing. SUMMARY OF BACKGROUND DATA The current delivery method of rhBMP-2 during surgery causes a burst of rhBMP-2, which is not sustained. Given that bone morphogenetic protein 2 (BMP-2) expression peaks later in the fusion process, there may be the benefit of delivery of rhBMP-2 later in the healing process. METHODS Sixteen male 1-year-old rabbits underwent a posterolateral spinal fusion with iliac crest bone graft at L5-L6 while being given nicotine to prevent spinal fusion as previously published. Eight were controls, whereas 8 had morselized rhBMP-2 (4.2 mg) injected at the fusion site at 4 weeks postoperatively. Histologic, radiologic, and palpation examinations were performed at 12 weeks to determine fusion status and the volume of bone formed. Hematoxylin and eosin stains were used for histology. A Student t test was used to compare the computed tomography scan measured volume of bone created between the control cohort (CC) and rhBMP-2 delayed delivery cohort (BMP-DDC). RESULTS Of the total, 7/8 rabbits in the BMP-DDC and 5/8 rabbits in the CC formed definitive fusion with a positive palpation examination, bridging bone between transverse processes on computed tomography scan, and an x-ray showing fusion. Histologic analysis revealed newly remodeled bone within the BMP-DDC. There was an increased average volume of bone formed within the BMP-DDC versus the CC (22.6 ± 13.1 vs 11.1 ± 3.6 cm 3 , P = 0.04). CONCLUSION Our study shows that injectable morselized absorbable collagen sponge/rhBMP-2 can create twice as much bone within a nicotine-impaired rabbit spine fusion model when delivered 4 weeks out from the time of surgery.
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Affiliation(s)
- Sohrab Virk
- Department of Orthopedic Surgery, Northwell Health, New Hyde Park, NY
| | - Avani Vaishnav
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA
| | - Hiroshi Kumagai
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Yu-Cheng Yao
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - James Dowdell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Harvinder Sandhu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Frank Schwab
- Department of Orthopedic Surgery, Northwell Health, New Hyde Park, NY
| | - Sheeraz Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Conway JC, Oliver RA, Wang T, Wills DJ, Herbert J, Buckland T, Walsh WR, Gibson IR. The efficacy of a nanosynthetic bone graft substitute as a bone graft extender in rabbit posterolateral fusion. Spine J 2021; 21:1925-1937. [PMID: 34033931 DOI: 10.1016/j.spinee.2021.05.017] [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: 02/25/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Synthetic bone graft substitutes are commonly used in spinal fusion surgery. Preclinical data in a model of spinal fusion to support their efficacy is an important component in clinical adoption to understand how these materials provide a biological and mechanical role in spinal fusion. PURPOSE To evaluate the in vivo response of a nanosynthetic silicated calcium phosphate putty (OstP) combined with autograft compared to autograft alone or a collagen-biphasic calcium phosphate putty (MasP) combined with autograft in a rabbit spinal fusion model. STUDY DESIGN Efficacy of a nanosynthetic silicated calcium phosphate putty as an extender to autograft was studied in an experimental animal model of posterolateral spinal fusion at 6, 9, 12 and 26 weeks, compared to a predicate device. METHODS Skeletally mature female New Zealand White rabbits (70) underwent single level bilateral posterolateral intertransverse process lumbar fusion, using either autograft alone (AG), a nanosynthetic silicated calcium phosphate putty (OstP) combined with autograft (1:1), or a collagen-biphasic calcium phosphate putty (MasP) combined with autograft (1:1). Iliac crest autograft was harvested for each group, and a total of 2 cc of graft material was implanted in the posterolateral gutters per side. Fusion success was assessed at all time points by manual palpation, radiographic assessment, micro-CT and at 12 weeks only using non-destructive range of motion testing. Tissue response, bone formation and graft resorption were assessed by decalcified paraffin histology and by histomorphometry of PMMA embedded sections. RESULTS Assessment of fusion by manual palpation at the 12 week endpoint showed 7 out of 8 (87.5%) bilateral fusions in the OstP extender group, 4 out of 8 (50%) fusions in the MasP extender group, and 6 out of 8 (75%) fusions in the autograft alone group. Similar trends were observed with fusion scores of radiographic and micro-CT data. Histology showed a normal healing response in all groups, and increased bone formation in the OstP extender group at all timepoints compared to the MasP extender group. New bone formed directly on the OstP granule surface within the fusion mass while this was not a feature of the Collagen-Biphasic CaP material. After 26 weeks the OstP extender group exhibited 100% fusions (5 out of 5) by all measures, whereas the MasP extender group resulted in bilateral fusions in 3 out of 5 (60%), assessed by manual palpation, and fusion of only 20 and 0% by radiograph and micro-CT scoring, respectively. Histology at 26 weeks showed consistent bridging of bone between the transverse processes in the Ost P extender group, but this was not observed in the MasP extender group. CONCLUSIONS The nanosynthetic bone graft substituted studied here, used as an extender to autograft, showed a progression to fusion between 6 and 12 weeks that was similar to that observed with autograft alone, and showed excellent fusion outcomes, bone formation and graft resorption at 26 weeks. CLINICAL SIGNIFICANCE This preclinical study showed that the novel nanosynthetic silicated CaP putty, when combined with autograft, achieved equivalent fusion outcomes to autograft. The development of synthetic bone grafts that demonstrate efficacy in such models can eliminate the need for excessive autograft harvest and results from this preclinical study supports their effective use in spinal fusion surgery.
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Affiliation(s)
- Jordan C Conway
- Sirakoss Ltd., Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - Rema A Oliver
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Tian Wang
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Daniel J Wills
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Joe Herbert
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Tom Buckland
- Sirakoss Ltd., Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - William R Walsh
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Iain R Gibson
- Sirakoss Ltd., Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK; Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.
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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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Crowley JD, Oliver RA, Dan MJ, Wills DJ, Rawlinson JW, Crasto RA, O'Connor JM, Mitchell GJ, Tan CJ, Walsh WR. Single level posterolateral lumbar fusion in a New Zealand White rabbit ( Oryctolagus cuniculus) model: Surgical anatomy, operative technique, autograft fusion rates, and perioperative care. JOR Spine 2021; 4:e1135. [PMID: 33778408 PMCID: PMC7984023 DOI: 10.1002/jsp2.1135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/22/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The posterolateral lumbar fusion (PLF) New Zealand White (NZW) (Oryctolagus cuniculus) rabbit model is a long-standing surgical technique for the preclinical evaluation of materials for spinal fusion. A detailed understanding of lumbar spine anatomy and perioperative care requirements of rabbits is imperative for correct execution of the model both scientifically and ethically. This study describes the preoperative procedures and surgical techniques used in single level PLF in a NZW rabbit model as it pertains to the animal husbandry, lumbar spine anatomy, anesthesia, surgical approach, and perioperative care of rabbits in a research setting. MATERIALS AND METHODS We describe the surgical technique and perioperative patient care for single level PLF in a NZW rabbit model. Medical records from a single research facility were retrospectively reviewed for adult NZW rabbits that underwent single level PLF (L4-L5) between January 2016 and December 2019. The number of lumbar vertebrae per rabbit, fusion rates at 12 weeks using iliac crest autograft and complications are reported. Skeletal maturity was confirmed by preoperative fluoroscopic and radiographic documented closure of hindlimb physes. RESULTS The PLF rabbit surgical model and perioperative patient care is described. PLF was performed in 868 adult female entire NZW rabbits. The majority of rabbits had seven lumbar vertebrae (620/868; 71.4%), followed by six (221/868; 25.5%), and eight (27/868; 3.1%). Fusion rates at 12 weeks for PLF using iliac crest autograft as assessed by manual palpation and radiographic assessment was 76.9% and 70.0%, respectively. Postoperative complications included occasional partial autograft site wound dehiscence due to self-trauma. CONCLUSIONS For PLF rabbit models, a detailed understanding of the surgical technique, rabbit lumbar anatomy including number of lumbar vertebrae, and dietary and husbandry requirements of rabbits, is essential for execution of the model and animal welfare.
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Affiliation(s)
- James D. Crowley
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Rema A. Oliver
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Michael J. Dan
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Daniel J. Wills
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - John W. Rawlinson
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Rebekah A. Crasto
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - James M. O'Connor
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Gregory J. Mitchell
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Christopher J. Tan
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
- Sydney Veterinary Emergency and SpecialistsSydneyNew South WalesAustralia
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical SchoolUniversity of New South Wales Sydney, Prince of Wales HospitalSydneyNew South WalesAustralia
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Rodriguez‐Feo J, Fernandes L, Patel A, Doan T, Boden SD, Drissi H, Presciutti SM. The temporal and spatial expression of sclerostin and Wnt signaling factors during the maturation of posterolateral lumbar spine fusions. JOR Spine 2021; 4:e1100. [PMID: 33778403 PMCID: PMC7984013 DOI: 10.1002/jsp2.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 11/23/2022] Open
Abstract
The bone healing environment in the posterolateral spine following arthrodesis surgery is one of the most challenging in all of orthopedics and our understanding of the molecular signaling pathways mediating osteogenesis during spinal fusion is limited. In this study, the spatial and temporal expression pattern of Wnt signaling factors and inhibitors during spinal fusion was assessed for the first time. Bilateral posterolateral spine arthrodesis with autologous iliac crest bone graft was performed on 21 New Zealand White rabbits. At 1-, 2-, 3-, 4-, and 6-weeks, the expression of sclerostin and a variety of canonical and noncanonical Wnts signaling factors was measured by qRT-PCR from tissue separately collected from the transverse processes, the Outer and Inner Zones of the fusion mass, and the adjancent paraspinal muscle. Immunohistochemistry for sclerostin protein was also performed. Sclerostin and many Wnt factors, especially Wnt3a and Wnt5a, were found to have distinct spatial and temporal expression patterns. For example, harvesting ICBG caused a significant increase in sclerostin expression. Furthermore, the paraspinal muscle immediately adjacent to the transplanted ICBG also had significant increases in sclerostin expression at 3 weeks, suggesting new potential mechanisms for pseudarthroses following spinal arthrodesis. The presented work is the first description of the spatial and temporal expression of sclerostin and Wnt signaling factors in the developing spine fusion, filling an important knowledge gap in the basic biology of spinal fusion and potentially aiding in the development of novel biologics to increase spinal fusion rates.
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Affiliation(s)
| | - Lorenzo Fernandes
- Department of Orthopaedic SurgeryEmory UniversityAtlantaGeorgiaUSA
- Atlanta Veteran Affairs Medical CenterDecaturGeorgiaUSA
| | - Anuj Patel
- Department of Orthopaedic SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Thanh Doan
- Department of Orthopaedic SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Scott D. Boden
- Department of Orthopaedic SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Hicham Drissi
- Department of Orthopaedic SurgeryEmory UniversityAtlantaGeorgiaUSA
- Atlanta Veteran Affairs Medical CenterDecaturGeorgiaUSA
| | - Steven M. Presciutti
- Department of Orthopaedic SurgeryEmory UniversityAtlantaGeorgiaUSA
- Atlanta Veteran Affairs Medical CenterDecaturGeorgiaUSA
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Virk SS, Aurand A, Bertone AL, Hussein H, Kaido M, Marras WS, Khan SN. Assessment of a rabbit posterolateral spinal fusion using movement between vertebrae: a modification of the palpation exam for quantifying fusions. JOURNAL OF SPINE SURGERY 2019; 5:215-222. [PMID: 31380475 DOI: 10.21037/jss.2019.04.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Manual palpation of rabbit spine levels has been used to assess fusion status. This method of testing is subject to inter-observer differences in assessment. We attempted to quantify fusion based on the amount of movement between rabbit vertebrae at the level of fusion. Methods Rabbits were divided into three groups. The first underwent a sham surgery; the second underwent a unilateral spinal fusion; and the third underwent a bilateral spinal fusion. All groups were sacrificed at either 5- or 10-week post-procedure. Each spine was tested for fusion using standard manual palpation techniques. The spines were also placed on a specially designed apparatus and moved through 10°, 20°, and 30° of extension/flexion. Results Out of 10 rabbits, 2 underwent sham surgery, 2 underwent a fusion procedure at L4-L5 and 6 underwent a fusion at L5-L6. We only included rabbits that underwent a L5-L6 fusion surgery. Our apparatus did not always rotate the spine the intended amount with up to 30% error. When rabbits graded as fused were compared to sham rabbits, there was a trend towards reduction in percent of overall measured angle within the fused group as compared to the sham group (8.77% vs. 13.84%, P=0.14). Conclusions Our model attempted to quantify the amount of displacement between vertebrae during the manual palpation exam. There is a trend towards reduced measured angle between vertebrae between fused and non-fused spines and no statistically significant difference in overall measured angle between unilaterally and bilaterally fused spines.
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Affiliation(s)
- Sohrab S Virk
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex Aurand
- Biodynamics Laboratory, Spine Research Institute, Department of Integrated Systems Engineering, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Alicia L Bertone
- Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Hayam Hussein
- Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Mari Kaido
- Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - William S Marras
- Biodynamics Laboratory, Spine Research Institute, Department of Integrated Systems Engineering, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Safdar N Khan
- Department of Orthopaedics, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Cottrill E, Ahmed AK, Lessing N, Pennington Z, Ishida W, Perdomo-Pantoja A, Lo SF, Howell E, Holmes C, Goodwin CR, Theodore N, Sciubba DM, Witham TF. Investigational growth factors utilized in animal models of spinal fusion: Systematic review. World J Orthop 2019; 10:176-191. [PMID: 31041160 PMCID: PMC6475812 DOI: 10.5312/wjo.v10.i4.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/03/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over 400000 Americans annually undergo spinal fusion surgeries, yet up to 40% of these procedures result in pseudoarthrosis even with iliac crest autograft, the current “gold standard” treatment. Tissue engineering has the potential to solve this problem via the creation of bone grafts involving bone-promoting growth factors (e.g., bone morphogenetic protein 2). A broad assessment of experimental growth factors is important to inform future work and clinical potential in this area. To date, however, no study has systematically reviewed the investigational growth factors utilized in preclinical animal models of spinal fusion.
AIM To review all published studies assessing investigational growth factors for spinal fusion in animal models and identify promising agents for translation.
METHODS We conducted a systematic review of the literature using PubMed, Embase, Cochrane Library, and Web of Science databases with searches run on May 29th, 2018. The search query was designed to include all non-human, preclinical animal models of spinal fusion reported in the literature without a timespan limit. Extracted data for each model included surgical approach, level of fusion, animal species and breed, animal age and sex, and any other relevant characteristics. The dosages/sizes of all implant materials, spinal fusion rates, and follow-up time points were recorded. The data were analyzed and the results reported in tables and text. PRISMA guidelines were followed for this systematic review.
RESULTS Twenty-six articles were included in this study, comprising 14 experimental growth factors: AB204 (n = 1); angiopoietin 1 (n = 1); calcitonin (n = 3); erythropoietin (n = 1); basic fibroblast growth factor (n = 1); growth differentiation factor 5 (n = 4), combined insulin-like growth factor 1 + transforming growth factor beta (n = 4); insulin (n = 1); NELL-1 (n = 5); noggin (n = 1); P-15 (n = 1); peptide B2A (n = 2); and secreted phosphoprotein 24 (n = 1). The fusion rates of the current gold standard treatment (autologous iliac crest bone graft, ICBG) and the leading clinically used growth factor (BMP-2) ranged widely in the included studies, from 0-100% for ICBG and from 13%-100% for BMP-2. Among the identified growth factors, calcitonin, GDF-5, NELL-1, and P-15 resulted in fusion rates of 100% in some cases. In addition, six growth factors - AB204, angiopoietin 1, GDF-5, insulin, NELL-1, and peptide B2A - resulted in significantly enhanced fusion rates compared to ICBG, BMP-2, or other internal control in some studies. Large heterogeneity in animal species, fusion method, and experimental groups and time points was observed across the included studies, limiting the direct comparison of the growth factors identified herein.
CONCLUSION Several promising investigational growth factors for spinal fusion have been identified herein; directly comparing the fusion efficacy and safety of these agents may inform clinical translation.
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Affiliation(s)
- Ethan Cottrill
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - A Karim Ahmed
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Noah Lessing
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Zachary Pennington
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | | | - Sheng-fu Lo
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Elizabeth Howell
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Christina Holmes
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Nicholas Theodore
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
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Jain N, Himed K, Toth JM, Briley KC, Phillips FM, Khan SN. Opioids delay healing of spinal fusion: a rabbit posterolateral lumbar fusion model. Spine J 2018; 18:1659-1668. [PMID: 29680509 DOI: 10.1016/j.spinee.2018.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/14/2018] [Accepted: 04/09/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Opioid use is prevalent in the management of pre- and postoperative pain in patients undergoing spinal fusion. There is evidence that opioids downregulate osteoblasts in vitro, and a previous study found that morphine delays the maturation and remodeling of callus in a rat femur fracture model. However, the effect of opioids on healing of spinal fusion has not been investigated before. Isolating the effect of opioid exposure in humans would be limited by the numerous confounding factors that affect fusion healing. Therefore, we have used a well-established rabbit model to study the process of spinal fusion healing that closely mimics humans. PURPOSE The objective of this work was to study the effect of systemic opioids on the process of healing of spinal fusion in a rabbit posterolateral spinal fusion model. STUDY DESIGN/SETTING This is a preclinical animal study. MATERIALS AND METHODS Twenty-four adult New Zealand white rabbits were studied in two groups after approval from the Institutional Animal Care and Use Committee (IACUC). The opioid group (n=12) received 4 weeks' preoperative and 6 weeks' postoperative transdermal fentanyl. Serum fentanyl levels were measured just before surgery and 4 weeks postoperatively to ensure adequate levels. The control group (n=12) received only perioperative pain control as necessary. All animals underwent a bilateral L5-L6 posterolateral spinal fusion using iliac crest autograft. Animals were euthanized at the 6-week postoperative time point, and assessment of fusion was done by manual palpation, plain radiographs, microcomputed tomography (microCT), and histology. RESULTS Twelve animals in the control group and 11 animals in the opioid group were available for analysis at the end of 6 weeks. The fusion scores on manual palpation, radiographs, and microCT were not statistically different. Three-dimensional microCT morphometry found that the fusion mass in the opioid group had a lower bone volume (p=.09), a lower trabecular number (p=.02), and a higher trabecular separation (p=.02) compared with the control group. Histologic analysis found areas of incorporation of autograft and unincorporated graft fragments in both groups. In the control group, there was remodeling of de novo woven bone to lamellar organization with incorporation of osteocytes, formation of mature marrow, and relative paucity of hypertrophied osteoblasts lining new bone. Sections from the opioid group showed formation of de novo woven bone, and hypertrophied osteoblasts were seen lining the new bone. There were no sections showing lamellar organization and development of mature marrow elements in the opioid group. Less dense trabeculae on microCT correlated with histologic findings of relatively immature fusion mass in the opioid group. CONCLUSIONS Systemic opioids led to an inferior quality fusion mass with delay in maturation and remodeling at 6 weeks in this rabbit spinal fusion model. These preliminary results lay the foundation for further research to investigate underlying cellular mechanisms, the temporal fusion process, and the dose-duration relationship of opioids responsible for our findings.
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Affiliation(s)
- Nikhil Jain
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 376 W 10th Ave, Columbus, OH 43210, USA
| | - Khaled Himed
- The Ohio State University School of Medicine, 376 W 10th Ave, Columbus, OH 43210, USA
| | - Jeffrey M Toth
- Department of Orthopaedics, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Karen C Briley
- Department of Radiology, Wright Center for Innovation and Biomedical Imaging, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Columbus, OH 43210, USA
| | - Frank M Phillips
- Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
| | - Safdar N Khan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 376 W 10th Ave, Columbus, OH 43210, USA.
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Duarte RM, Varanda P, Reis RL, Duarte ARC, Correia-Pinto J. Biomaterials and Bioactive Agents in Spinal Fusion. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:540-551. [DOI: 10.1089/ten.teb.2017.0072] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Rui M. Duarte
- School of Medicine, University of Minho, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal
| | - Pedro Varanda
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal
| | - Rui L. Reis
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal
| | - Ana Rita C. Duarte
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal
| | - Jorge Correia-Pinto
- School of Medicine, University of Minho, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Pediatric Surgery Department, Hospital de Braga, Braga, Portugal
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The temporal expression of adipokines during spinal fusion. Spine J 2017. [PMID: 28647583 DOI: 10.1016/j.spinee.2017.06.019] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adipokines are secreted by white adipose tissue and have been associated with fracture healing. Our goal was to report the temporal expression of adipokines during spinal fusion in an established rabbit model. PURPOSE Our goal was to report the temporal expression of adipokines during spinal fusion in an established rabbit model. STUDY DESIGN The study design included a laboratory animal model. METHODS New Zealand white rabbits were assigned to either sham surgery (n=2), unilateral posterior spinal fusion (n=14), or bilateral posterior spinal fusion (n=14). Rabbits were euthanized 1-6 and 10 weeks out from surgery. Fusion was evaluated by radiographs, manual palpation, and histology. Reverse transcription-polymerase chain reaction on the bone fusion mass catalogued the gene expression of leptin, adiponectin, resistin, and vascular endothelial growth factor (VEGF) at each time point. Results were normalized to the internal control gene, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) (2^ΔCt), and control bone sites (2^ΔΔCt). Quantitative data were analyzed by two-factor analysis of variance (p<.05). RESULTS Manual palpation scores, radiograph scores, and histologic findings showed progression of boney fusion over time (p<.0003). The frequency of fusion by palpation after 4 weeks was 68.75%. Leptin expression in decortication and bone graft sites peaked at 5 weeks after the fusion procedure (p=.0143), adiponectin expression was greatest 1 week after surgery (p<.001), VEGF expression peaked at 4 weeks just after initial increases in leptin expression (p<.001), and resistin decreased precipitously 1 week after the fusion procedure (p<.001). CONCLUSIONS Leptin expression is likely associated with the maturation phase of bone fusion. Adiponectin and resistin may play a role early on during the fusion process. Our results suggest that leptin expression may be upstream of VEGF expression during spinal fusion, and both appear to play an important role in bone spinal fusion.
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Virk SS, Coble D, Bertone AL, Hussein HH, Khan SN. Experimental Design and Surgical Approach to Create a Spinal Fusion Model in a New Zealand White Rabbit (Oryctolagus cuniculus). J INVEST SURG 2016; 30:226-234. [PMID: 27739917 DOI: 10.1080/08941939.2016.1235748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There are several animal models routinely used for study of the spinal fusion process and animal selection largely depends on the scientific question to be answered. This review outlines the advantages and disadvantages of various animal models used to study spinal fusion and describes the New Zealand White (NSW) rabbit which is the most popular preclinical model to study spinal fusion. We outline critical steps required in planning and performing spinal fusion surgery in this model. This includes determination of the required animal number to obtain statistical significance, an outline of appropriate technique for posterolateral fusion and other components of completing a study. As advances in drug delivery move forward and our understanding of the cascade of gene expression occurring during the fusion process grows, performing and interpreting preclinical animal models will be vital to validating new therapies to enhance spinal fusion.
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Affiliation(s)
- Sohrab S Virk
- a Department of Orthopaedics , Ohio State University Wexner Medical Center , Columbus , Ohio , USA
| | - Dondrae Coble
- b Office of Research, College of Veterinary Medicine, The Ohio State University , Columbus , Ohio , USA
| | - Alicia L Bertone
- a Department of Orthopaedics , Ohio State University Wexner Medical Center , Columbus , Ohio , USA.,c Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University , Columbus , Ohio , USA
| | - Hayam Hamaz Hussein
- c Comparative Orthopedic Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University , Columbus , Ohio , USA
| | - Safdar N Khan
- a Department of Orthopaedics , Ohio State University Wexner Medical Center , Columbus , Ohio , USA
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Ishida W, Elder BD, Holmes C, Lo SFL, Witham TF. Variables Affecting Fusion Rates in the Rat Posterolateral Spinal Fusion Model with Autogenic/Allogenic Bone Grafts: A Meta-analysis. Ann Biomed Eng 2016; 44:3186-3201. [PMID: 27473706 DOI: 10.1007/s10439-016-1701-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/21/2016] [Indexed: 01/14/2023]
Abstract
The rat posterolateral spinal fusion model with autogenic/allogenic bone graft (rat PFABG) has been increasingly utilized as an experimental model to assess the efficacy of novel fusion treatments. The objective of this study was to investigate the reliability of the rat PFABG model and examine the effects of different variables on spinal fusion. A web-based literature search from January, 1970 to September, 2015, yielded 26 studies, which included 40 rat PFABG control groups and 449 rats. Data regarding age, weight, sex, and strain of rats, graft volume, graft type, decorticated levels, surgical approach, institution, the number of control rats, fusion rate, methods of fusion assessment, and timing of fusion assessment were collected and analyzed. The primary outcome variable of interest was fusion rate, as evaluated by manual palpation. Fusion rates varied widely, from 0 to 96%. The calculated overall fusion rate was 46.1% with an I 2 value of 62.4, which indicated moderate heterogeneity. Weight >300 g, age >14 weeks, male rat, Sprague-Dawley strain, and autogenic coccyx grafts increased fusion rates with statistical significance. Additionally, an assessment time-point ≥8 weeks had a trend towards statistical significance (p = 0.070). Multi-regression analysis demonstrated that timing of assessment and age as continuous variables, as well as sex as a categorical variable, can predict the fusion rate with R 2 = 0.82. In an inter-institution reliability analysis, the pooled overall fusion rate was 50.0% [44.8, 55.3%], with statistically significant differences among fusion outcomes at different institutions (p < 0.001 and I 2 of 72.2). Due to the heterogeneity of fusion outcomes, the reliability of the rat PFABG model was relatively limited. However, selection of adequate variables can optimize its use as a control group in studies evaluating the efficacy of novel fusion therapies.
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Affiliation(s)
- Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
| | - Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA.
| | - Christina Holmes
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
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Koerner JD, Vives MJ, O'Connor JP, Chirichella P, Breitbart EA, Chaudhary SB, Uko L, Subramanian S, Fritton JC, Benevenia J, Lin SS. Zinc has insulin-mimetic properties which enhance spinal fusion in a rat model. Spine J 2016; 16:777-83. [PMID: 26850174 DOI: 10.1016/j.spinee.2016.01.190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 12/17/2015] [Accepted: 01/22/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have found that insulin or insulin-like growth factor treatment can stimulate fracture healing in diabetic and normal animal models, and increase fusion rates in a rat spinal fusion model. Insulin-mimetic agents, such as zinc, have demonstrated antidiabetic effects in animal and human studies, and these agents that mimic the effects of insulin could produce the same beneficial effects on bone regeneration and spinal fusion. PURPOSE The purpose of this study was to analyze the effects of locally applied zinc on spinal fusion in a rat model. STUDY DESIGN/SETTING Institutional Animal Care and Use Committee-approved animal study using Sprague-Dawley rats was used as the study design. METHODS Thirty Sprague-Dawley rats (450-500 g) underwent L4-L5 posterolateral lumbar fusion (PLF). After decortication and application of approximately 0.3 g of autograft per side, one of three pellets were added to each site: high-dose zinc calcium sulfate (ZnCaSO4), low-dose ZnCaSO4 (half of the high dose), or a control palmitic acid pellet (no Zn dose). Systemic blood glucose levels were measured 24 hours postoperatively. Rats were sacrificed after 8weeks and the PLFs analyzed qualitatively by manual palpation and radiograph review, and quantitatively by micro-computed tomography (CT) analysis of bone volume and trabecular thickness. Statistical analyses with p-values set at .05 were accomplished with analysis of variance, followed by posthoc tests for quantitative data, or Mann-Whitney rank tests for qualitative assessments. RESULTS Compared with controls, the low-dose zinc group demonstrated a significantly higher manual palpation grade (p=.011), radiographic score (p=.045), and bone formation on micro-CT (172.9 mm(3) vs. 126.7 mm(3) for controls) (p<.01). The high-dose zinc also demonstrated a significantly higher radiographic score (p=.017) and bone formation on micro-CT (172.7 mm(3) vs. 126.7 mm(3)) (p<.01) versus controls, and was trending toward higher manual palpation scores (p=.058). CONCLUSIONS This study demonstrates the potential benefit of a locally applied insulin-mimetic agent, such as zinc, in a rat lumbar fusion model. Previous studies have demonstrated the benefits of local insulin application in the same model, and it appears that zinc has similar effects.
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Affiliation(s)
- John D Koerner
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA.
| | - Michael J Vives
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - J Patrick O'Connor
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - Paul Chirichella
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - Eric A Breitbart
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - Saad B Chaudhary
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - Linda Uko
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - Sangeeta Subramanian
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - J C Fritton
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - Joseph Benevenia
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
| | - Sheldon S Lin
- Department of Orthopaedics, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 7300, Newark, NJ 07101, USA
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Peric M, Dumic-Cule I, Grcevic D, Matijasic M, Verbanac D, Paul R, Grgurevic L, Trkulja V, Bagi CM, Vukicevic S. The rational use of animal models in the evaluation of novel bone regenerative therapies. Bone 2015; 70:73-86. [PMID: 25029375 DOI: 10.1016/j.bone.2014.07.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/30/2014] [Accepted: 07/05/2014] [Indexed: 12/31/2022]
Abstract
Bone has a high potential for endogenous self-repair. However, due to population aging, human diseases with impaired bone regeneration are on the rise. Current strategies to facilitate bone healing include various biomolecules, cellular therapies, biomaterials and different combinations of these. Animal models for testing novel regenerative therapies remain the gold standard in pre-clinical phases of drug discovery and development. Despite improvements in animal experimentation, excessive poorly designed animal studies with inappropriate endpoints and inaccurate conclusions are being conducted. In this review, we discuss animal models, procedures, methods and technologies used in bone repair studies with the aim to assist investigators in planning and performing scientifically sound experiments that respect the wellbeing of animals. In the process of designing an animal study for bone repair investigators should consider: skeletal characteristics of the selected animal species; a suitable animal model that mimics the intended clinical indication; an appropriate assessment plan with validated methods, markers, timing, endpoints and scoring systems; relevant dosing and statistically pre-justified sample sizes and evaluation methods; synchronization of the study with regulatory requirements and additional evaluations specific to cell-based approaches. This article is part of a Special Issue entitled "Stem Cells and Bone".
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Affiliation(s)
- Mihaela Peric
- University of Zagreb School of Medicine, Center for Translational and Clinical Research, Department for Intercellular Communication, Salata 2, Zagreb, Croatia.
| | - Ivo Dumic-Cule
- University of Zagreb School of Medicine, Center for Translational and Clinical Research, Laboratory for Mineralized Tissues, Salata 11, Zagreb, Croatia
| | - Danka Grcevic
- University of Zagreb School of Medicine, Department of Physiology and Immunology, Salata 3, Zagreb, Croatia
| | - Mario Matijasic
- University of Zagreb School of Medicine, Center for Translational and Clinical Research, Department for Intercellular Communication, Salata 2, Zagreb, Croatia
| | - Donatella Verbanac
- University of Zagreb School of Medicine, Center for Translational and Clinical Research, Department for Intercellular Communication, Salata 2, Zagreb, Croatia
| | - Ruth Paul
- Paul Regulatory Services Ltd, Fisher Hill Way, Cardiff CF15 8DR, UK
| | - Lovorka Grgurevic
- University of Zagreb School of Medicine, Center for Translational and Clinical Research, Laboratory for Mineralized Tissues, Salata 11, Zagreb, Croatia
| | - Vladimir Trkulja
- University of Zagreb School of Medicine, Department of Pharmacology, Salata 11, Zagreb, Croatia
| | - Cedo M Bagi
- Pfizer Inc., Global Research and Development, Global Science and Technology, 100 Eastern Point Road, Groton, CT 06340, USA
| | - Slobodan Vukicevic
- University of Zagreb School of Medicine, Center for Translational and Clinical Research, Laboratory for Mineralized Tissues, Salata 11, Zagreb, Croatia.
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Rölfing JHD, Jensen J, Jensen JN, Greve AS, Lysdahl H, Chen M, Rejnmark L, Bünger C. A single topical dose of erythropoietin applied on a collagen carrier enhances calvarial bone healing in pigs. Acta Orthop 2014; 85:201-9. [PMID: 24564750 PMCID: PMC3967265 DOI: 10.3109/17453674.2014.889981] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The osteogenic potency of erythropoietin (EPO) has been documented. However, its efficacy in a large-animal model has not yet been investigated; nor has a clinically safe dosage. The purpose of this study was to overcome such limitations of previous studies and thereby pave the way for possible clinical application. Our hypothesis was that EPO increases calvarial bone healing compared to a saline control in the same subject. METHODS We used a porcine calvarial defect model. In each of 18 pigs, 6 cylindrical defects (diameter: 1 cm; height: 1 cm) were drilled, allowing 3 pairwise comparisons. Treatment consisted of either 900 IU/mL EPO or an equal volume of saline in combination with either autograft, a collagen carrier, or a polycaprolactone (PCL) scaffold. After an observation time of 5 weeks, the primary outcome (bone volume fraction (BV/TV)) was assessed with high-resolution quantitative computed tomography. Secondary outcome measures were histomorphometry and blood samples. RESULTS The median BV/TV ratio of the EPO-treated collagen group was 1.06 (CI: 1.02-1.11) relative to the saline-treated collagen group. Histomorphometry showed a similar median effect size, but it did not reach statistical significance. Autograft treatment had excellent healing potential and was able to completely regenerate the bone defect independently of EPO treatment. Bony ingrowth into the PCL scaffold was sparse, both with and without EPO. Neither a substantial systemic effect nor adverse events were observed. The number of blood vessels was similar in EPO-treated defects and saline-treated defects. INTERPRETATION Topical administration of EPO on a collagen carrier moderately increased bone healing. The dosing regime was safe, and could have possible application in the clinical setting. However, in order to increase the clinical relevance, a more potent but still clinically safe dose should be investigated.
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Affiliation(s)
| | | | | | | | | | | | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Cody Bünger
- Orthopaedic Research Laboratory,Department of Orthopaedics
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Affiliation(s)
- Jan Hendrik Duedal Rölfing
- Orthopaedic Research Laboratory Aarhus University Hospital Noerrebrogade 44, Building 1A, 1.tv DK-8000 Aarhus Denmark +45 7846 4133
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Rölfing JH, Bünger C. Recommendations regarding the rabbit posterolateral spinal fusion model. J Orthop Res 2013; 31:1860. [PMID: 23934632 DOI: 10.1002/jor.22465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/17/2013] [Indexed: 02/04/2023]
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