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Sheng N, Xing F, Wang J, Zhang QY, Nie R, Li-Ling J, Duan X, Xie HQ. Recent progress in bone-repair strategies in diabetic conditions. Mater Today Bio 2023; 23:100835. [PMID: 37928253 PMCID: PMC10623372 DOI: 10.1016/j.mtbio.2023.100835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 10/02/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023] Open
Abstract
Bone regeneration following trauma, tumor resection, infection, or congenital disease is challenging. Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia. It can result in complications affecting multiple systems including the musculoskeletal system. The increased number of diabetes-related fractures poses a great challenge to clinical specialties, particularly orthopedics and dentistry. Various pathological factors underlying DM may directly impair the process of bone regeneration, leading to delayed or even non-union of fractures. This review summarizes the mechanisms by which DM hampers bone regeneration, including immune abnormalities, inflammation, reactive oxygen species (ROS) accumulation, vascular system damage, insulin/insulin-like growth factor (IGF) deficiency, hyperglycemia, and the production of advanced glycation end products (AGEs). Based on published data, it also summarizes bone repair strategies in diabetic conditions, which include immune regulation, inhibition of inflammation, reduction of oxidative stress, promotion of angiogenesis, restoration of stem cell mobilization, and promotion of osteogenic differentiation, in addition to the challenges and future prospects of such approaches.
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Affiliation(s)
- Ning Sheng
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
| | - Fei Xing
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
| | - Jie Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
| | - Qing-Yi Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
| | - Rong Nie
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
| | - Jesse Li-Ling
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
- Frontier Medical Center, Tianfu Jincheng Laboratory, Chengdu, 610212, China
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Duan
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
| | - Hui-Qi Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, China
- Frontier Medical Center, Tianfu Jincheng Laboratory, Chengdu, 610212, China
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Pattayil S, Vadakkekuttical RJ, Radhakrishnan C, Kanakkath H, Hrishi TS. Proportional relationship between periodontal inflamed surface area, clinical attachment loss, and glycated hemoglobin level in patients with type 2 diabetes mellitus on insulin therapy and on oral antidiabetic therapy. J Periodontol 2023; 94:31-40. [PMID: 35716397 DOI: 10.1002/jper.22-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment of diabetes includes oral antidiabetic drugs (OAD), insulin, or their combinations. Insulin can achieve faster glycemic control and have anabolic action on bone. This study was undertaken to assess the prevalence and severity of periodontitis, and to estimate the proportional relationship between periodontal inflamed surface area, clinical attachment loss, and glycated hemoglobin (HbA1c) level in patients with type 2 diabetes (T2DM) on OAD therapy and on insulin therapy. METHODS This cross-sectional study comprised 130 patients with T2DM on OAD therapy (OAD group) and 130 patients with T2DM on insulin therapy (INSULIN group). All patients were assessed for sociodemographic, behavioral characteristics, clinical history, periodontal parameters (bleeding on probing, probing depth, clinical attachment loss [Clinical AL], Oral Hygiene Index-simplified, plaque index, and periodontal inflamed surface area [PISA]), and biochemical variables (HbA1c, fasting plasma glucose, postprandial plasma glucose). RESULTS Prevalence, extent, and severity of periodontitis and PISA were lower in the INSULIN group as compared with the OAD group. A proportional relationship was observed between HbA1c and PISA and between HbA1c and Clinical AL. A unit increase in HbA1c is associated with an increase in PISA of 130.47 mm2 and an increase in Clinical AL of 0.182 mm. CONCLUSION A proportional relationship was observed between PISA, clinical attachment loss, and HbA1c level in patients with type 2 diabetes mellitus on insulin therapy and OAD therapy. Despite comparable oral hygiene status and glycemic control between the two groups, the periodontal parameters were lesser in the INSULIN group as compared with the OAD group.
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Affiliation(s)
- Simna Pattayil
- Department of Periodontics, Government Dental College, Affiliated to Kerala University of Health Sciences, Calicut, Kerala, India
| | - Rosamma Joseph Vadakkekuttical
- Department of Periodontics, Government Dental College, Affiliated to Kerala University of Health Sciences, Calicut, Kerala, India
| | - Chandni Radhakrishnan
- Department of Emergency Medicine, Government Medical College, Affiliated to Kerala University of Health Sciences, Calicut, Kerala, India
| | - Harikumar Kanakkath
- Department of Periodontics, Government Dental College, Affiliated to Kerala University of Health Sciences, Calicut, Kerala, India
| | - Thayyil Sivaraman Hrishi
- Department of Periodontics, Government Dental College, Affiliated to Kerala University of Health Sciences, Calicut, Kerala, India
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Khorsand B, Acri TM, Do A, Femino JE, Petersen E, Fredericks DC, Salem AK. A Multi-Functional Implant Induces Bone Formation in a Diabetic Model. Adv Healthc Mater 2020; 9:e2000770. [PMID: 32815306 DOI: 10.1002/adhm.202000770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/15/2020] [Indexed: 12/21/2022]
Abstract
Patients with diabetes mellitus (DM) have defective healing of bone fractures. It was previously shown that nonviral gene delivery of plasmid DNA (pDNA) that independently encodes bone morphogenetic protein-2 (BMP-2) and fibroblast growth factor-2 (FGF-2), acts synergistically to promote bone regeneration in a DM animal model. Additionally, both insulin (INS) and the hormonally active form of vitamin D3, 1α,25-dihydroxyvitamin D3 (1α,25(OH)2 D3 ) (VD3) have independently been shown to play key roles in regulating bone fracture healing in DM patients. However, these individual therapies fail to adequately stimulate bone regeneration, illustrating a need for novel treatment of bone fractures in diabetic patients. Here, the ability of local delivery of INS and VD3 along with BMP-2 and FGF-2 genes is investigated to promote bone formation ectopically in Type-2 diabetic rats. A composite consisting of VD3 and INS is developed that contains poly(lactic-co-glycolic acid) microparticles (MPs) embedded in a fibrin gel surrounded by a collagen matrix that is permeated with polyethylenimine (PEI)-(pBMP-2+pFGF-2) nanoplexes. Using a submuscular osteoinduction model, it is demonstrated that local delivery of INS, VD3, and PEI-(pBMP-2+pFGF-2) significantly improves bone generation compared to other treatments, thusimplicating this approach as a method to promote bone regeneration in DM patients with bone fractures.
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Affiliation(s)
- Behnoush Khorsand
- Department of Pharmaceutical Sciences and Experimental Therapeutics University of Iowa College of Pharmacy Iowa City IA 52242 USA
| | - Timothy M. Acri
- Department of Pharmaceutical Sciences and Experimental Therapeutics University of Iowa College of Pharmacy Iowa City IA 52242 USA
| | - Anh‐Vu Do
- Department of Pharmaceutical Sciences and Experimental Therapeutics University of Iowa College of Pharmacy Iowa City IA 52242 USA
| | - John E. Femino
- Department of Orthopedics and Rehabilitation University of Iowa Iowa City IA 52242 USA
| | - Emily Petersen
- Department of Orthopedics and Rehabilitation University of Iowa Iowa City IA 52242 USA
| | - Douglas C. Fredericks
- Department of Orthopedics and Rehabilitation University of Iowa Iowa City IA 52242 USA
| | - Aliasger K. Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics University of Iowa College of Pharmacy Iowa City IA 52242 USA
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Zhang N, Jiang H, Bai Y, Lu X, Feng M, Guo Y, Zhang S, Luo Q, Wu H, Wang L. The molecular mechanism study of insulin on proliferation and differentiation of osteoblasts under high glucose conditions. Cell Biochem Funct 2019; 37:385-394. [PMID: 31140646 DOI: 10.1002/cbf.3415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/02/2019] [Accepted: 05/11/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Nong Zhang
- Department of StomatologyShenzhen Longgang District Maternal and Child Health Care Hospital Shenzhen China
| | - Hua Jiang
- Department of StomatologyGeneral Hospital of Chinese People's Liberation Army Beijing China
| | - Yang Bai
- Department of StomatologyGeneral Hospital of Chinese People's Liberation Army Beijing China
| | - Xingmei Lu
- Department of Chemical Engineering and Technology, a CAS key Laboratory of Green Process and Engineering, Institute of Process Engineering, China B college of Chemical and Engineering, University of Chinese Academy of SciencesChinese Academy of Sciences Beijing China
| | - Mi Feng
- Department of Applied Chemistry, a CAS key Laboratory of Green Process and Engineering, Institute of Process Engineering, China B college of Chemical and Engineering, University of Chinese Academy of SciencesChinese Academy of Sciences Beijing China
| | - Yu Guo
- Department of StomatologyGeneral Hospital of Chinese People's Liberation Army Beijing China
| | - Shuo Zhang
- Department of StomatologyGeneral Hospital of Chinese People's Liberation Army Beijing China
| | - Qiang Luo
- Department of StomatologyGeneral Hospital of Chinese People's Liberation Army Beijing China
| | - Hao Wu
- Department of StomatologyGeneral Hospital of Chinese People's Liberation Army Beijing China
| | - Lin Wang
- Department of StomatologyGeneral Hospital of Chinese People's Liberation Army Beijing China
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Wang X, Wu X, Xing H, Zhang G, Shi Q, E L, Liu N, Yang T, Wang D, Qi F, Wang L, Liu H. Porous Nanohydroxyapatite/Collagen Scaffolds Loading Insulin PLGA Particles for Restoration of Critical Size Bone Defect. ACS APPLIED MATERIALS & INTERFACES 2017; 9:11380-11391. [PMID: 28256126 DOI: 10.1021/acsami.6b13566] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Insulin is considered to be a classical central regulator of energy homeostasis. Recently, the effect of insulin on bone has gained a lot of attention, but little attention has been paid to the application in bone tissue engineering. In this study, porous nanohydroxyapatite/collagen (nHAC) scaffolds incorporating poly lactic-co-glycolic acid (PLGA) particles were successfully developed as an insulin delivery platform for bone regeneration. Bioactive insulin was successfully released from the PLGA particles within the scaffold, and the size of the particles as well as the release kinetics of the insulin could be efficiently controlled through Shirasu porous glass premix membrane emulsification technology. It was indicated that the nHAC/PLGA composite scaffolds possessed favorable mechanical and structural properties for cell adhesion and proliferation, as well as the differentiation into osteoblasts. It was also demonstrated that the nHAC/PLGA scaffolds implanted into a rabbit critical-size mandible defect possessed tissue compatibility and higher bone restoration capacity compared with the defects that were filled with or without nHAC scaffolds. Furthermore, the in vivo results showed that the nHAC/PLGA scaffolds which incorporated insulin-loaded microspheres with a size of 1.61 μm significantly accelerated bone healing compared with two other composite scaffolds. Our study indicated that the local insulin released at the optimal time could substantially and reproducibly improve bone repair.
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Affiliation(s)
- Xing Wang
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
- Hospital of Stomatology, Shanxi Medical University , Taiyuan, 030001, China
| | - Xia Wu
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Helin Xing
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Guilan Zhang
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Quan Shi
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Lingling E
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Na Liu
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Tingyuan Yang
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences , Beijing, 100190, China
| | - Dongsheng Wang
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
| | - Feng Qi
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences , Beijing, 100190, China
| | - Lianyan Wang
- National Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences , Beijing, 100190, China
| | - Hongchen Liu
- Institute of Stomatology, Chinese PLA General Hospital , Beijing 100853, China
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Malekzadeh BÖ, Ransjo M, Tengvall P, Mladenovic Z, Westerlund A. Insulin released from titanium discs with insulin coatings-Kinetics and biological activity. J Biomed Mater Res B Appl Biomater 2016; 105:1847-1854. [DOI: 10.1002/jbm.b.33717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 02/01/2023]
Affiliation(s)
- B. Ö. Malekzadeh
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
- Department of Oral and Maxillofacial Surgery; Mölndal Hospital; Sweden
- Department of Biomaterials; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - M. Ransjo
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - P. Tengvall
- Department of Biomaterials; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - Z. Mladenovic
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - A. Westerlund
- Department of Orthodontics; Institute of Odontology, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
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Current Uses of Poly(lactic-co-glycolic acid) in the Dental Field: A Comprehensive Review. J CHEM-NY 2015. [DOI: 10.1155/2015/525832] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Poly(lactic-co-glycolic acid) or PLGA is a biodegradable polymer used in a wide range of medical applications. Specifically PLGA materials are also developed for the dental field in the form of scaffolds, films, membranes, microparticles, or nanoparticles. PLGA membranes have been studied with promising results, either alone or combined with other materials in bone healing procedures. PLGA scaffolds have been used to regenerate damaged tissues together with stem cell-based therapy. There is solid evidence that the development of PLGA microparticles and nanoparticles may be beneficial to a wide range of dental fields such as endodontic therapy, dental caries, dental surgery, dental implants, or periodontology. The aim of the current paper was to review the recent advances in PLGA materials and their potential uses in the dental field.
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