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Wang X, Huang Y, Liu D, Zeng T, Wang J, Al Hasan MJ, Liu W, Wang D. The Masquelet induced membrane technique with PRP-FG-nHA/PA66 scaffold can heal a rat large femoral bone defect. BMC Musculoskelet Disord 2024; 25:455. [PMID: 38851675 PMCID: PMC11162015 DOI: 10.1186/s12891-024-07567-y] [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] [Received: 02/12/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Masquelet membrane induction technology is one of the treatment strategies for large bone defect (LBD). However, the angiogenesis ability of induced membrane decreases with time and autologous bone grafting is associated with donor site morbidity. This study investigates if the PRP-FG-nHA/PA66 scaffold can be used as a spacer instead of PMMA to improve the angiogenesis ability of induced membrane and reduce the amount of autologous bone graft. METHODS Platelet rich plasma (PRP) was prepared and PRP-FG-nHA/PA66 scaffold was synthesized and observed. The sustained release of VEGFA and porosity of the scaffold were analyzed. We established a femur LBD model in male SD rats. 55 rats were randomly divided into four groups depending on the spacer filled in the defect area. "Defect only" group (n = 10), "PMMA" group (n = 15), "PRP-nHA/PA66" group (n = 15) and "PRP-FG-nHA/PA66" group (n = 15 ). At 6 weeks, the spacers were removed and the defects were grafted. The induced membrane and bone were collected and stained. The bone formation was detected by micro-CT and the callus union was scored on a three point system. RESULTS The PRP-FG-nHA/PA66 scaffold was porosity and could maintain a high concentration of VEGFA after 30 days of preparation. The induced membrane in PRP-FG-nHA/PA66 group was thinner than PMMA, but the vessel density was higher.The weight of autogenous bone grafted in PRP-FG-nHA/PA66 group was significantly smaller than that of PMMA group. In PRP-FG-nHA/PA66 group, the bone defect was morphologically repaired. CONCLUSION The study showed that PRP-FG-nHA/PA66 scaffold can significantly reduce the amount of autologous bone graft, and can achieve similar bone defect repair effect as PMMA. Our findings provide some reference and theoretical support for the treatment of large segmental bone defects in humans.
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Affiliation(s)
- Xiaoyu Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Yong Huang
- Department of Orthopedic Surgery, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Daqian Liu
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Teng Zeng
- Department of Orthopedic Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Jingzhe Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Md Junaed Al Hasan
- Department of Orthopedic Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Wei Liu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Dawei Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, China.
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Kühl J, Gorb S, Kern M, Klüter T, Kühl S, Seekamp A, Fuchs S. Extrusion-based 3D printing of osteoinductive scaffolds with a spongiosa-inspired structure. Front Bioeng Biotechnol 2023; 11:1268049. [PMID: 37790253 PMCID: PMC10544914 DOI: 10.3389/fbioe.2023.1268049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Critical-sized bone defects resulting from trauma, inflammation, and tumor resections are individual in their size and shape. Implants for the treatment of such defects have to consider biomechanical and biomedical factors, as well as the individual conditions within the implantation site. In this context, 3D printing technologies offer new possibilities to design and produce patient-specific implants reflecting the outer shape and internal structure of the replaced bone tissue. The selection or modification of materials used in 3D printing enables the adaption of the implant, by enhancing the osteoinductive or biomechanical properties. In this study, scaffolds with bone spongiosa-inspired structure for extrusion-based 3D printing were generated. The computer aided design process resulted in an up scaled and simplified version of the bone spongiosa. To enhance the osteoinductive properties of the 3D printed construct, polycaprolactone (PCL) was combined with 20% (wt) calcium phosphate nano powder (CaP). The implants were designed in form of a ring structure and revealed an irregular and interconnected porous structure with a calculated porosity of 35.2% and a compression strength within the range of the natural cancellous bone. The implants were assessed in terms of biocompatibility and osteoinductivity using the osteosarcoma cell line MG63 and patient-derived mesenchymal stem cells in selected experiments. Cell growth and differentiation over 14 days were monitored using confocal laser scanning microscopy, scanning electron microscopy, deoxyribonucleic acid (DNA) quantification, gene expression analysis, and quantitative assessment of calcification. MG63 cells and human mesenchymal stem cells (hMSC) adhered to the printed implants and revealed a typical elongated morphology as indicated by microscopy. Using DNA quantification, no differences for PCL or PCL-CaP in the initial adhesion of MG63 cells were observed, while the PCL-based scaffolds favored cell proliferation in the early phases of culture up to 7 days. In contrast, on PCL-CaP, cell proliferation for MG63 cells was not evident, while data from PCR and the levels of calcification, or alkaline phosphatase activity, indicated osteogenic differentiation within the PCL-CaP constructs over time. For hMSC, the highest levels in the total calcium content were observed for the PCL-CaP constructs, thus underlining the osteoinductive properties.
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Affiliation(s)
- Julie Kühl
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Stanislav Gorb
- Department of Functional Morphology and Biomechanics, Kiel University, Kiel, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Material, University Medical Center, Kiel, Germany
| | - Tim Klüter
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Sebastian Kühl
- Department of Electrical and Information Engineering, Kiel University, Kiel, Germany
| | - Andreas Seekamp
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Sabine Fuchs
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
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Lin S, Maekawa H, Moeinzadeh S, Lui E, Alizadeh HV, Li J, Kim S, Poland M, Gadomski BC, Easley JT, Young J, Gardner M, Mohler D, Maloney WJ, Yang YP. An osteoinductive and biodegradable intramedullary implant accelerates bone healing and mitigates complications of bone transport in male rats. Nat Commun 2023; 14:4455. [PMID: 37488113 PMCID: PMC10366099 DOI: 10.1038/s41467-023-40149-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
Bone transport is a surgery-driven procedure for the treatment of large bone defects. However, challenging complications include prolonged consolidation, docking site nonunion and pin tract infection. Here, we develop an osteoinductive and biodegradable intramedullary implant by a hybrid tissue engineering construct technique to enable sustained delivery of bone morphogenetic protein-2 as an adjunctive therapy. In a male rat bone transport model, the eluting bone morphogenetic protein-2 from the implants accelerates bone formation and remodeling, leading to early bony fusion as shown by imaging, mechanical testing, histological analysis, and microarray assays. Moreover, no pin tract infection but tight osseointegration are observed. In contrast, conventional treatments show higher proportion of docking site nonunion and pin tract infection. The findings of this study demonstrate that the novel intramedullary implant holds great promise for advancing bone transport techniques by promoting bone regeneration and reducing complications in the treatment of bone defects.
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Affiliation(s)
- Sien Lin
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Hirotsugu Maekawa
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
- Department of Mechanical Engineering, School of Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Hossein Vahid Alizadeh
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Jiannan Li
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Sungwoo Kim
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Michael Poland
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Jeffrey Young
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Michael Gardner
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - David Mohler
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - William J Maloney
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Department of Materials Science and Engineering, School of Engineering, Stanford University, Stanford, CA, 94305, USA.
- Department of Bioengineering, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
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Ganguly P, Jones E, Panagiotopoulou V, Jha A, Blanchy M, Antimisiaris S, Anton M, Dhuiège B, Marotta M, Marjanovic N, Panagiotopoulos E, Giannoudis PV. Electrospun and 3D printed polymeric materials for one-stage critical-size long bone defect regeneration inspired by the Masquelet technique: Recent Advances. Injury 2022; 53 Suppl 2:S2-S12. [PMID: 35305805 DOI: 10.1016/j.injury.2022.02.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023]
Abstract
Critical-size long bone defects represent one of the major causes of fracture non-union and remain a significant challenge in orthopaedic surgery. Two-stage procedures such as a Masquelet technique demonstrate high level of success however their main disadvantage is the need for a second surgery, which is required to remove the non-resorbable cement spacer and to place the bone graft into the biological chamber formed by the 'induced membrane'. Recent research efforts have therefore been dedicated towards the design, fabrication and testing of resorbable implants that could mimic the biological functions of the cement spacer and the induced membrane. Amongst the various manufacturing techniques used to fabricate these implants, three-dimensional (3D) printing and electrospinning methods have gained a significant momentum due their high-level controllability, scalable processing and relatively low cost. This review aims to present recent advances in the evaluation of electrospun and 3D printed polymeric materials for critical-size, long bone defect reconstruction, emphasizing both their beneficial properties and current limitations. Furthermore, we present and discuss current state-of-the art techniques required for characterisation of the materials' physical, mechanical and biological characteristics. These represent the essential first steps towards the development of personalised implants for single-surgery, large defect reconstruction in weight-bearing bones.
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Affiliation(s)
- Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Animesh Jha
- School of Chemical and Process Engineering, University of Leeds, Leeds, UK
| | - Marilys Blanchy
- RESCOLL, Allée Geoffroy Saint-Hilaire 8, 33600 Pessac, France
| | - Sophia Antimisiaris
- Panepistimio Patron (UPAT), University Campus Rio Patras, Rio Patras 265 04, Greece
| | - Martina Anton
- Klinikum Rechts Der Isar Der Technischen Universitat Munchen (TUM-MED), Ismaninger Strasse 22, Muenchen 81675, Germany
| | - Benjamin Dhuiège
- Genes'ink (GENE), 39 Avenue Gaston Imbert Zi De Rousset, Rousset 13790, France
| | - Mario Marotta
- Acondicionamiento tarrasense associacion (LEITAT), Carrer de la Innovacio 2, Terrassa 08225, Spain
| | - Nenad Marjanovic
- CSEM Centre Suisse D'electronique et de Microtechnique Sa - Recherche et Developpement (CSEM), Rue Jaquet Droz 1, Neuchatel 2000, Switzerland
| | | | - Peter V Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds General Infirmary, Department of Trauma and Orthopaedic Surgery, University of Leeds, Leeds, UK.
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Stahl A, Park YB, Park SH, Lin S, Pan C, Kim S, Yang Y. Probing the role of methyl methacrylate release from spacer materials in induced membrane bone healing. J Orthop Res 2022; 40:1065-1074. [PMID: 34314063 PMCID: PMC8792109 DOI: 10.1002/jor.25147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
In the induced membrane (IM) technique for bone reconstruction, a poly(methyl methacrylate) (PMMA) spacer is implanted to induce formation of a foreign body membrane around the defect site. Membrane development is essential for later bone grafting success, yet the mechanism by which the IM promotes bone regeneration remains unknown, as are the ways that spacer composition plays a role in the membrane's healing potential. This study investigated the impact of leached methyl methacrylate (MMA)-the major monomeric component of PMMA-on IM development. In vitro cell culture found that MMA elution did not impact endothelial cell or mesenchymal stem cell proliferation. For in vivo analysis, we advanced a streamlined rat femoral model to efficiently study the influence of spacer properties on IM characteristics. Comparison of membrane formation around polycaprolactone (PCL), MMA-eluting PCL (high-dose PCL-MMA and low-dose PCL-MMA), and surgical PMMA revealed robust membranes enveloped all groups after 4 weeks in vivo, with elevated expression of osteogenic bone morphogenetic protein-2 and angiogenic vascular endothelial growth factor compared with the surrounding muscle and bone tissues. Growth factor quantitation in IM tissue found no statistically significant difference between groups. New bone growth, vascularization, and CD163+ macrophage populations surrounding the polymer implants were also quantified; and blood vessel formation around high-dose PCL-MMA was found to be significantly decreased compared with PCL alone. To the best of our knowledge, these findings represent the first time that results have been obtained about the characteristics of membranes formed around PCL in the IM setting.
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Affiliation(s)
- A. Stahl
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
- Department of Chemistry, Stanford University, 121 Mudd Building, CA 94305, USA
| | - YB. Park
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
- Department of Prosthodontics, Yonsei University College of Dentistry, Seoul 120-752, Korea
| | - SH. Park
- Osong Research Institute, TaeWoong Medical Co., Ltd, 55-7, Osongsaengmyeong 2-ro, Korea
| | - S. Lin
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - C.C. Pan
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
- Department of Mechanical Engineering, Stanford University, 440 Escondido Mall, Stanford, CA94305, USA
| | - S. Kim
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - Y.P. Yang
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
- Department of Materials Science and Engineering, Stanford University, 496 Lomita Mall, Stanford, CA94305, USA
- Department of Bioengineering, Stanford University, 443 Via Ortega, Stanford, CA94305, USA
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DeBaun MR, Salazar BP, Bai Y, Gardner MJ, Yang YP, Pan CC, Stahl AM, Moeinzadeh S, Kim S, Lui E, Kim C, Lin S, Goodnough LH, Wadhwa H. A bioactive synthetic membrane improves bone healing in a preclinical nonunion model. Injury 2022; 53:1368-1374. [PMID: 35078617 PMCID: PMC8940692 DOI: 10.1016/j.injury.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES High energy long bone fractures with critical bone loss are at risk for nonunion without strategic intervention. We hypothesize that a synthetic membrane implanted at a single stage improves bone healing in a preclinical nonunion model. METHODS Using standard laboratory techniques, microspheres encapsulating bone morphogenic protein-2 (BMP2) or platelet derived growth factor (PDGF) were designed and coupled to a type 1 collagen sheet. Critical femoral defects were created in rats and stabilized by locked retrograde intramedullary nailing. The negative control group had an empty defect. The induced membrane group (positive control) had a polymethylmethacrylate spacer inserted into the defect for four weeks and replaced with a bare polycaprolactone/beta-tricalcium phosphate (PCL/β-TCP) scaffold at a second stage. For the experimental groups, a bioactive synthetic membrane embedded with BMP2, PDGF or both enveloped a PCL/β-TCP scaffold was implanted in a single stage. Serial radiographs were taken at 1, 4, 8, and 12 weeks postoperatively from the definitive procedure and evaluated by two blinded observers using a previously described scoring system to judge union as primary outcome. RESULTS All experimental groups demonstrated better union than the negative control (p = 0.01). The groups with BMP2 incorporated into the membrane demonstrated higher average union scores than the other groups (p = 0.01). The induced membrane group performed similarly to the PDGF group. Complete union was only demonstrated in groups with BMP2-eluting membranes. CONCLUSIONS A synthetic membrane comprised of type 1 collagen embedded with controlled release BMP2 improved union of critical bone defects in a preclinical nonunion model.
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Affiliation(s)
| | - Brett P Salazar
- Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Yan Bai
- Department of Orthopaedic Surgery, Stanford University, CA, USA; School of Pharmacy, Chongqing Medical University, Chongqing, China
| | | | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA; Department of Bioengineering, Stanford University, CA, USA.
| | - Chi-Chun Pan
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA
| | | | | | - Sungwoo Kim
- Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA
| | - Carolyn Kim
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA
| | - Sien Lin
- Department of Orthopaedic Surgery, Stanford University, CA, USA
| | | | - Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford University, CA, USA
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The induced membrane technique in animal models: a systematic review. OTA Int 2022; 5:e176. [PMID: 35282388 PMCID: PMC8900461 DOI: 10.1097/oi9.0000000000000176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 01/10/2023]
Abstract
Objectives: Data Sources: Study Selection: Data Extraction: Data Synthesis: Conclusions:
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Stahl A, Yang YP. Regenerative Approaches for the Treatment of Large Bone Defects. TISSUE ENGINEERING. PART B, REVIEWS 2021; 27:539-547. [PMID: 33138705 PMCID: PMC8739850 DOI: 10.1089/ten.teb.2020.0281] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022]
Abstract
A variety of engineered materials have gained acceptance in orthopedic practice as substitutes for autologous bone grafts, although the regenerative efficacy of these engineered grafts is still limited compared with that of transplanted native tissues. For bone defects greater than 4-5 cm, however, common bone grafting procedures are insufficient and more complicated surgical interventions are required to repair and regenerate the damaged or missing bone. In this review, we describe current grafting materials and surgical techniques for the reconstruction of large bone defects, followed by tissue engineering (TE) efforts to develop improved therapies. Particular emphasis is placed on graft vascularization, because for both autologous bone and engineered alternatives, achieving adequate vascular development within the regenerating bone tissues remains a significant challenge in the context of large bone defects. To this end, TE and surgical strategies to induce development of a vasculature within bone grafts are discussed. Impact statement This review aims to present an accessible and thorough overview of current orthopedic surgical techniques as well as bone tissue engineering and vascularization strategies that might one day offer improvements to clinical therapies for the repair of large bone defects. We consider the lessons that clinical orthopedic reconstructive practices can contribute to the push toward engineered bone.
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Affiliation(s)
- Alexander Stahl
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Chemistry, Stanford University, Stanford, California, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
- Department of Materials Science and Engineering, and Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
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Sugimoto H, Inagaki Y, Furukawa A, Kira T, Kawasaki S, Uchihara Y, Akahane M, Tanaka Y. Silicate/zinc-substituted strontium apatite coating improves the osteoinductive properties of β-tricalcium phosphate bone graft substitute. BMC Musculoskelet Disord 2021; 22:673. [PMID: 34372804 PMCID: PMC8353809 DOI: 10.1186/s12891-021-04563-4] [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: 06/05/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
Background β-Tricalcium phosphate (β-TCP) is a popular synthetic bone graft substitute with excellent osteoconductive properties and bioabsorbability. However, its osteoinductive properties are inferior to those of autologous or allogeneic bone. Trace elements such as strontium (Sr), silica (Si), and zinc (Zn) have been reported to promote osteogenesis in materials. In this study, we aimed to determine whether a Si/Zn-substituted Sr apatite coating of β-TCP could enhance osteoinductive properties. Methods The apatite-coated β-TCP disks were prepared using nanoparticle suspensions of silicate-substituted Sr apatite (SrSiP) or silicate- and Zn-co-substituted Sr apatite (SrZnSiP). Bone marrow mesenchymal cells (BMSCs) from rat femur were cultured and subsequently seeded at a density of 1.0 × 106/cm2 onto apatite-coated and non-coated β-TCP disks. In vitro, the β-TCP disks were then placed in osteogenic medium, and lactate dehydrogenase (LDH) activity was measured from supernatants after culture for 2 days. Additionally, after culture for 14 days, the mRNA expression of genes encoding osteocalcin (OC), alkaline phosphatase (ALP), bone morphogenetic protein-2 (BMP-2), and vascular endothelial growth factor (VEGF) was evaluated by qRT-PCR. In vivo, the β-TCP disks were transplanted subcutaneously into rats that were sacrificed after 4 weeks. Then, the harvested disks were evaluated biochemically (ALP activity, OC content, mRNA expression of OC, ALP, BMP-2, and VEGF measured by qRT-PCR), radiologically, and histologically. Results Significantly higher mRNA expression of almost all evaluated osteogenic and angiogenic genes was observed in the SrZnSiP and SrSiP groups than in the non-coated group, with no significant cytotoxicity elicited by the apatite coating in vitro. Moreover, in vivo, the SrZnSiP and SrSiP groups showed significantly higher osteogenic and angiogenic gene expression and higher ALP activity and OC content than the non-coated group (P < 0.05). Radiological and histopathological findings revealed abundant bone formation in the apatite-coated group. Conclusions Our findings indicate that apatite coating of β-TCP improves osteoinductive properties without inducing significant cytotoxicity.
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Affiliation(s)
- Hironori Sugimoto
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, 634-8521, Kashihara, Nara, Japan
| | - Yusuke Inagaki
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, 634-8521, Kashihara, Nara, Japan.
| | - Akira Furukawa
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, 634-8521, Kashihara, Nara, Japan
| | - Tsutomu Kira
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, 634-8521, Kashihara, Nara, Japan
| | - Sachiko Kawasaki
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, 634-8521, Kashihara, Nara, Japan
| | - Yoshinobu Uchihara
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, 634-8521, Kashihara, Nara, Japan
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, 351-0197, Wako, Saitama, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, 634-8521, Kashihara, Nara, Japan
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Kawai T, Pan CC, Okuzu Y, Shimizu T, Stahl AM, Matsuda S, Maloney WJ, Yang YP. Combining a Vascular Bundle and 3D Printed Scaffold with BMP-2 Improves Bone Repair and Angiogenesis. Tissue Eng Part A 2021; 27:1517-1525. [PMID: 33906392 DOI: 10.1089/ten.tea.2021.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Vascularization is currently considered the biggest challenge in bone tissue engineering due to necrosis in the center of large scaffolds. We established a new expendable vascular bundle model to vascularize a three-dimensional printed channeled scaffold with and without bone morphogenetic protein-2 (BMP-2) for improved healing of large segmental bone defects. Bone formation and angiogenesis in an 8 mm critical-sized bone defect in the rat femur were significantly promoted by inserting a bundle consisting of the superficial epigastric artery and vein into the central channel of a large porous polycaprolactone scaffold. Vessels were observed sprouting from the vascular bundle inserted in the central tunnel. Although the regenerated bone volume in the group receiving the scaffold and vascular bundle was similar to that of the healthy femur, the rate of union of the group was not satisfactory (25% at 8 weeks). BMP-2 delivery was found to promote not only bone formation but also angiogenesis in the critical-sized bone defects. Both insertion of the vascular bundle alone and BMP-2 loading alone induced comparable levels of angiogenesis and when used in combination, significantly greater vascular volume was observed. These findings suggest a promising new modality of treatment in large bone defects. Level of Evidence: Therapeutic level I.
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Affiliation(s)
- Toshiyuki Kawai
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Chi-Chun Pan
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | | | - Alexander M Stahl
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Chemistry, Stanford University, Stanford, California, USA
| | - Shuich Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Yunzhi P Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Materials Science and Engineering, and Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
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11
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Yang YP, Gadomski BC, Bruyas A, Easley J, Labus KM, Nelson B, Palmer RH, Stewart H, McGilvray K, Puttlitz CM, Regan D, Stahl A, Lui E, Li J, Moeinzadeh S, Kim S, Maloney W, Gardner MJ. Investigation of a Prevascularized Bone Graft for Large Defects in the Ovine Tibia. Tissue Eng Part A 2021; 27:1458-1469. [PMID: 33858216 DOI: 10.1089/ten.tea.2020.0347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In vivo bioreactors are a promising approach for engineering vascularized autologous bone grafts to repair large bone defects. In this pilot parametric study, we first developed a three-dimensional (3D) printed scaffold uniquely designed to accommodate inclusion of a vascular bundle and facilitate growth factor delivery for accelerated vascular invasion and ectopic bone formation. Second, we established a new sheep deep circumflex iliac artery (DCIA) model as an in vivo bioreactor for engineering a vascularized bone graft and evaluated the effect of implantation duration on ectopic bone formation. Third, after 8 weeks of implantation around the DCIA, we transplanted the prevascularized bone graft to a 5 cm segmental bone defect in the sheep tibia, using the custom 3D printed bone morphogenic protein 2 (BMP-2) loaded scaffold without prior in vivo bioreactor maturation as a control. Analysis by micro-computed tomography and histomorphometry found ectopic bone formation in BMP-2 loaded scaffolds implanted for 8 and 12 weeks in the iliac pouch, with greater bone formation occurring after 12 weeks. Grafts transplanted to the tibial defect supported bone growth, mainly on the periphery of the graft, but greater bone growth and less soft tissue invasion was observed in the avascular BMP-2 loaded scaffold implanted directly into the tibia without prior in vivo maturation. Histopathological evaluation noted considerably greater vascularity in the bone grafts that underwent in vivo maturation with an inserted vascular bundle compared with the avascular BMP-2 loaded graft. Our findings indicate that the use of an initial DCIA in vivo bioreactor maturation step is a promising approach to developing vascularized autologous bone grafts, although scaffolds with greater osteoinductivity should be further studied. Impact statement This translational pilot study aims at combining a tissue engineering scaffold strategy, in vivo prevascularization, and a modified transplantation technique to accelerate large segmental bone defect repair. First, we three-dimensional (3D) printed a 5 cm scaffold with a unique design to facilitate vascular bundle inclusion and osteoinductive growth factor delivery. Second, we established a new sheep deep circumflex iliac artery model as an in vivo bioreactor for prevascularizing the novel 3D printed osteoinductive scaffold. Subsequently, we transplanted the prevascularized bone graft to a clinically relevant 5 cm segmental bone defect in the sheep tibia for bone regeneration.
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Affiliation(s)
- Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Material Science and Engineering, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Benjamin C Gadomski
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Arnaud Bruyas
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Jeremiah Easley
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kevin M Labus
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Brad Nelson
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Ross H Palmer
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Holly Stewart
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Dan Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Alexander Stahl
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Chemistry and Stanford University, Stanford, California, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Jiannan Li
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Sungwoo Kim
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - William Maloney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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12
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Alford AI, Nicolaou D, Hake M, McBride-Gagyi S. Masquelet's induced membrane technique: Review of current concepts and future directions. J Orthop Res 2021; 39:707-718. [PMID: 33382115 PMCID: PMC8005442 DOI: 10.1002/jor.24978] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/16/2020] [Accepted: 12/28/2020] [Indexed: 02/04/2023]
Abstract
Masquelet's induced membrane technique (MIMT) is a relatively new, two-stage surgical procedure to reconstruct segmental bone defects. First performed by Dr. Masquelet in the mid-1980s, MIMT has shown great promise to revolutionize critical-sized bone defect repair and has several advantages over its alternative, distraction osteogenesis (DO). Also, its success in extremely challenging cases (defects > 15 cm) suggests that its study could lead to discovery of novel biological mechanisms that might be at play during segmental defect healing and fracture non-union. MIMT's advantages over DO have led to a world-wide increase in MIMT procedures over the past decades. However, MIMT often needs to be repeated and so the average initial success rate in adults lags significantly behind that of DO (86% vs 95%, respectively). The autologous foreign-body membrane created during the first stage by the immune system's response to a polymethyl methacrylate bone cement spacer is critical to supporting the morselized bone graft implanted in the second stage. However, the biological and/or physical mechanisms by which the membrane supports graft to bone union are unclear. This lack of knowledge makes refining MIMT and improving the success rates through technique improvements and patient selection a significant challenge and hinders wider adoption. In this review, current knowledge from basic, translational, and clinical studies is summarized. The dynamics of both stages under normal conditions as well as with drug or material perturbations is discussed along with perspectives on high-priority future research directions.
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Affiliation(s)
- Andrea I. Alford
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Daemeon Nicolaou
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO
| | - Mark Hake
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
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13
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Yang YP, Labus KM, Gadomski BC, Bruyas A, Easley J, Nelson B, Palmer RH, McGilvray K, Regan D, Puttlitz CM, Stahl A, Lui E, Li J, Moeinzadeh S, Kim S, Maloney W, Gardner MJ. Osteoinductive 3D printed scaffold healed 5 cm segmental bone defects in the ovine metatarsus. Sci Rep 2021; 11:6704. [PMID: 33758338 PMCID: PMC7987996 DOI: 10.1038/s41598-021-86210-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
Autologous bone grafts are considered the gold standard grafting material for the treatment of nonunion, but in very large bone defects, traditional autograft alone is insufficient to induce repair. Recombinant human bone morphogenetic protein 2 (rhBMP-2) can stimulate bone regeneration and enhance the healing efficacy of bone grafts. The delivery of rhBMP-2 may even enable engineered synthetic scaffolds to be used in place of autologous bone grafts for the treatment of critical size defects, eliminating risks associated with autologous tissue harvest. We here demonstrate that an osteoinductive scaffold, fabricated by combining a 3D printed rigid polymer/ceramic composite scaffold with an rhBMP-2-eluting collagen sponge can treat extremely large-scale segmental defects in a pilot feasibility study using a new sheep metatarsus fracture model stabilized with an intramedullary nail. Bone regeneration after 24 weeks was evaluated by micro-computed tomography, mechanical testing, and histological characterization. Load-bearing cortical bridging was achieved in all animals, with increased bone volume observed in sheep that received osteoinductive scaffolds compared to sheep that received an rhBMP-2-eluting collagen sponge alone.
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Affiliation(s)
- Yunzhi Peter Yang
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA.
- Department of Material Science and Engineering, Stanford University, Stanford, USA.
- Department of Bioengineering, Stanford University, Stanford, USA.
| | - Kevin M Labus
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Benjamin C Gadomski
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Arnaud Bruyas
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Jeremiah Easley
- Department of Clinical Sciences, Colorado State University, Fort Collins, USA
| | - Brad Nelson
- Department of Clinical Sciences, Colorado State University, Fort Collins, USA
| | - Ross H Palmer
- Department of Clinical Sciences, Colorado State University, Fort Collins, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Daniel Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering and School of Biomedical Engineering, Colorado State University, Fort Collins, USA
| | - Alexander Stahl
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
- Department of Chemistry, Stanford University, Stanford, USA
| | - Elaine Lui
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Jiannan Li
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Sungwoo Kim
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - William Maloney
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
| | - Michael J Gardner
- Department of Orthopedic Surgery, School of Medicine, Stanford University, 240 Pasteur Drive, BMI 258, Stanford, CA, 94304, USA
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14
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de Andrade Pinto SA, de Nadai Dias FJ, Brasil Camargo Cardoso G, Dos Santos Junior AR, de Aro AA, Pino DS, Meneghetti DH, Vitti RP, Dos Santos GMT, de Carvalho Zavaglia CA. Polycaprolactone/Beta-Tricalcium Phosphate Scaffolds Obtained via Rotary Jet-Spinning: in vitro and in vivo Evaluation. Cells Tissues Organs 2021; 211:477-491. [PMID: 33691307 DOI: 10.1159/000511570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022] Open
Abstract
This study aimed to evaluate in vitro and in vivo polymeric membranes obtained by a rotary jet-spinning process for the repair of critical bone defects in the calvaria of Wistar rats, for future use in tissue engineering. Experimental sample collections were performed on the 30, 60 and 90th postoperative days, and the analyses performed were histomorphometric, immunohistochemistry, and western blotting. Reducing inflammatory infiltrate in all groups and experimental periods, angiogenesis on the 30th day did not show any difference between the groups, on the 60th day, 5% polycaprolactone/beta-tricalcium phosphate(PCL/β-TCP) was high compared to control (C), and on the 90th day, the same group reduced when compared to C and 10% PCL/β-TCP. The fibroplasia presented oscillations in every segment; on the 30th and 60th day, there was an increase in 5% PCL/β-TCP, which decreased by the 90th day compared to group C. 10% PCL/β-TCP decreased compared to C on the 60th and 90th day. The percentage of the collagen area remained high in all groups and all experimental periods. Immunohistochemistry quantifications showed variations in bone metabolism suggesting new bone formation. The 5 and 10% PCL/β-TCP scaffold were promising for the bone regeneration process because they participated in the modulation of inflammation, angiogenesis, fibroplasia, and collagenosis.
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Affiliation(s)
- Stella Aparecida de Andrade Pinto
- Department of Materials Engineering, University of Campinas, Campinas, Brazil, .,School of Dentistry, Herminio Ometto University Center, Araras, Brazil,
| | - Francisco José de Nadai Dias
- Department of Materials Engineering, University of Campinas, Campinas, Brazil.,School of Dentistry, Herminio Ometto University Center, Araras, Brazil
| | | | | | - Andréa Aparecida de Aro
- School of Dentistry, Herminio Ometto University Center, Araras, Brazil.,Graduate Program of Biomedical Sciences, Herminio Ometto University Center, Araras, Brazil
| | - Danilo Siqueira Pino
- Department of Materials Engineering, University of Campinas, Campinas, Brazil.,School of Dentistry, Herminio Ometto University Center, Araras, Brazil
| | - Damaris Helena Meneghetti
- School of Dentistry, Herminio Ometto University Center, Araras, Brazil.,Graduate Program of Biomedical Sciences, Herminio Ometto University Center, Araras, Brazil
| | - Rafael Pino Vitti
- School of Dentistry, Herminio Ometto University Center, Araras, Brazil
| | - Gláucia Maria Tech Dos Santos
- School of Dentistry, Herminio Ometto University Center, Araras, Brazil.,Graduate Program of Biomedical Sciences, Herminio Ometto University Center, Araras, Brazil
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15
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Klein C, Monet M, Barbier V, Vanlaeys A, Masquelet AC, Gouron R, Mentaverri R. The Masquelet technique: Current concepts, animal models, and perspectives. J Tissue Eng Regen Med 2020; 14:1349-1359. [PMID: 32621637 DOI: 10.1002/term.3097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
Bone reconstruction within a critical-sized defect remains a real challenge in orthopedic surgery. The Masquelet technique is an innovative, two-step therapeutic approach for bone reconstruction in which the placement of a poly (methylmethacrylate) spacer into the bone defect induces the neo-formation of a tissue called "induced membrane." This surgical technique has many advantages and is often preferred to a vascularized bone flap or Ilizarov's technique. Although the Masquelet technique has achieved high clinical success rates since its development by Alain-Charles Masquelet in the early 2000s, very little is known about how the process works, and few animal models of membrane induction have been developed. Our successful use of this technique in the clinic and our interest in the mechanisms of tissue regeneration (notably bone regeneration) prompted us to develop a surgical model of the Masquelet technique in rats. Here, we provide a comprehensive review of the literature on animal models of membrane induction, encompassing the defect site, the surgical procedure, and the histologic and osteogenic properties of the induced membrane. We also discuss the advantages and disadvantages of those models to facilitate efforts in characterizing the complex biological mechanisms that underlie membrane induction.
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Affiliation(s)
- Céline Klein
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.,MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Michael Monet
- MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Vincent Barbier
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.,MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Alison Vanlaeys
- MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Alain-Charles Masquelet
- Service de Chirurgie Orthopédique, Traumatologie et Chirurgie de la Main, Saint-Antoine Hospital, Paris, France
| | - Richard Gouron
- Department of Pediatric Orthopedic Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France.,MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - Romuald Mentaverri
- MP3CV-EA7517, CURS, miens University Medical Center, Jules Verne University of Picardie, Amiens, France.,Department of Biochemistry and Endocrine Biology, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France
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16
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Introduction of a New Surgical Method to Improve Bone Healing in a Large Bone Defect by Replacement of the Induced Membrane by a Human Decellularized Dermis Repopulated with Bone Marrow Mononuclear Cells in Rat. MATERIALS 2020; 13:ma13112629. [PMID: 32526914 PMCID: PMC7321582 DOI: 10.3390/ma13112629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/28/2022]
Abstract
The Masquelet technique for the treatment of large bone defects is a two-stage procedure based on an induced membrane. We eliminate the first surgical step by using a decellularized dermal skin graft (Epiflex®) populated with bone marrow mononuclear cells (BMC), as a replacement for the induced membrane. The aim of this study was to demonstrate the feasibility of this technology and provide evidence of equivalent bone healing in comparison to the induced membrane-technique. Therefore, 112 male Sprague–Dawley rats were allocated in six groups and received a 10 mm femoral defect. Defects were treated with either the induced membrane or decellularized dermis, with or without the addition of BMC. Defects were then filled with a scaffold (β-TCP), with or without BMC. After a healing time of eight weeks, femurs were taken for histological, radiological and biomechanical analysis. Defects treated with Epiflex® showed increased mineralization and bone formation predominantly in the transplanted dermis surrounding the defect. No significant decrease of biomechanical properties was found. Vascularization of the defect could be enhanced by addition of BMC. Considering the dramatic reduction of a patient’s burden by the reduced surgical stress and shortened time of treatment, this technique could have a great impact on clinical practice.
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17
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Shanjani Y, Siebert SM, Ker DFE, Mercado-Pagán AE, Yang YP. Acoustic Patterning of Growth Factor for Three-Dimensional Tissue Engineering. Tissue Eng Part A 2020; 26:602-612. [PMID: 31950880 PMCID: PMC7310194 DOI: 10.1089/ten.tea.2019.0271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
Temporal and spatial presentations of biological cues are critical for tissue engineering. There is a great need in improving the incorporation of bioagent(s) (specifically growth factor(s) [GF(s)]) onto three-dimensional scaffolds. In this study, we developed a process to combine additive manufacturing (AM) technology with acoustic droplet ejection (ADE) technology to control GF distribution. More specifically, we implemented ADE to control the distribution of recombinant human bone morphogenetic protein-2 (rhBMP-2) onto polycaprolactone (PCL)-based tissue engineering constructs (TECs). Three substrates were used in this study: (1) succinimide-terminated PCL (PCL-N-hydroxysuccinimide [NHS]) as model material, (2) alkali-treated PCL (PCL-NaOH) as first control material, and (3) fibrin-coated PCL (PCL-Fibrin) as second control material. It was shown that our process enables a pattern of BMP-2 spots of ∼250 μm in diameter with ∼700 μm center-to-center spacing. An initial concentration of BMP-2 higher than 300 μg/L was required to retain a detectable amount of GF on the substrate after a wash with phosphate-buffered solution. However, to obtain detectable osteogenic differentiation of C2C12 cells, the initial concentration of BMP-2 higher than 750 μg/L was needed. The cells on PCL-NHS samples showed spatial alkaline phosphatase staining correlating with local patterns of BMP-2, although the intensity was lower than the controls (PCL-NaOH and PCL-Fibrin). Our results have demonstrated that the developed AM-ADE process holds great promise in creating TECs with highly controlled GF patterning. Impact statement The combined process of additive manufacturing with acoustic droplet ejection to control growth factor (GF) distribution across three-dimensional (3D) porous scaffolds that is presented in this study enables creating 3D tissue engineering constructs with highly controlled GF patterning. Such constructs enable temporal and spatial presentations of biological cues for enhancing cell migration and differentiation and eventually the formation of targeted tissues in vitro and in vivo.
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Affiliation(s)
- Yaser Shanjani
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
| | - Sean Michael Siebert
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
| | - Dai Fei Elmer Ker
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
- Institute for Tissue Engineering and Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Angel E. Mercado-Pagán
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
| | - Yunzhi Peter Yang
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
- Department of Materials Science and Engineering, Stanford University, Stanford, California
- Department of Bioengineering, Stanford University, Stanford, California
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18
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The Influence of Electron Beam Sterilization on In Vivo Degradation of β-TCP/PCL of Different Composite Ratios for Bone Tissue Engineering. MICROMACHINES 2020; 11:mi11030273. [PMID: 32155781 PMCID: PMC7142760 DOI: 10.3390/mi11030273] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/12/2022]
Abstract
We evaluated the effect of electron beam (E-beam) sterilization (25 kGy, ISO 11137) on the degradation of β-tricalcium phosphate/polycaprolactone (β-TCP/PCL) composite filaments of various ratios (0:100, 20:80, 40:60, and 60:40 TCP:PCL by mass) in a rat subcutaneous model for 24 weeks. Volumes of the samples before implantation and after explantation were measured using micro-computed tomography (micro-CT). The filament volume changes before sacrifice were also measured using a live micro-CT. In our micro-CT analyses, there was no significant difference in volume change between the E-beam treated groups and non-E-beam treated groups of the same β-TCP to PCL ratios, except for the 0% β-TCP group. However, the average volume reduction differences between the E-beam and non-E-beam groups in the same-ratio samples were 0.76% (0% TCP), 3.30% (20% TCP), 4.65% (40% TCP), and 3.67% (60% TCP). The E-beam samples generally had more volume reduction in all experimental groups. Therefore, E-beam treatment may accelerate degradation. In our live micro-CT analyses, most volume reduction arose in the first four weeks after implantation and slowed between 4 and 20 weeks in all groups. E-beam groups showed greater volume reduction at every time point, which is consistent with the results by micro-CT analysis. Histology results suggest the biocompatibility of TCP/PCL composite filaments.
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19
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Kharkova N, Reshetov I, Zelianin A, Philippov V, Sergeeva N, Sviridova I, Komlev V, Andreeva U, Kuznecova O. Three-dimensional TCP scaffolds enriched with Erythropoietin for stimulation of vascularization and bone formation. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/108620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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