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Cao G, Li L, Xiang S, Lin H, Pei F, Tuan RSC, Alexander PG. The development of a mouse model to investigate the formation of heterotopic ossification. J Orthop Surg (Hong Kong) 2023; 31:10225536231163466. [PMID: 36943428 DOI: 10.1177/10225536231163466] [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: 03/23/2023] Open
Abstract
BACKGROUND Muscle injury and concomitant bone injury are important drivers to induce heterotopic ossification (HO). However, the related roles of muscle and concomitant bone injury in HO formation are still unclear. This study aims to develop a mouse model through the combination of hindlimb amputation (Am) and cardiotoxin (CTX) injection to investigate the mechanism of HO formation. METHOD The mice were randomly divided into Am group (Am of right hindlimb, n = 12), CTX group (CTX injection in the calf muscle of left hindlimb, n = 12) and Am + CTX group (the combination of Am of right hindlimb and CTX injection of left hindlimb, n = 18). MicroCT was used to evaluate the incidence of HO. Histology was used to investigate the progression of HO. RESULTS The MicroCT showed that only Am or CTX injection failed to induce HO while the combination of Am and CTX injection successfully induced HO. The incidence of HO was significant in Am + CTX group on day 7 (0% vs 0% vs 83.3%, p = 0.001) and day 14 (0% vs 0% vs 83.3%, p = 0.048). HO was located on the left hindlimb where CTX was injected. Moreover, the bone volume and bone density on day 14 were higher than those on day 7 in Am + CTX group. Histology revealed the evidence of calcification and expression of osteogenic markers in calcification sites in Am + CTX group. CONCLUSION In summary, the combination of Am and CTX injection could successfully induce dystrophic calcification/HO, which occurs in the location of muscle injury.
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Affiliation(s)
- Guorui Cao
- Department of Knee Surgery, 523047Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - La Li
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shiqi Xiang
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Fuxing Pei
- Department of Orthopaedic Surgery, 34753West China Hospital, Sichuan University, Chengdu, China
| | - Rocky Sung Chi Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Kazezian Z, Yu X, Ramette M, Macdonald W, Bull AMJ. Development of a rodent high-energy blast injury model for investigating conditions associated with traumatic amputations. Bone Joint Res 2021; 10:166-172. [PMID: 33663228 PMCID: PMC7998070 DOI: 10.1302/2046-3758.103.bjr-2020-0367.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS In recent conflicts, most injuries to the limbs are due to blasts resulting in a large number of lower limb amputations. These lead to heterotopic ossification (HO), phantom limb pain (PLP), and functional deficit. The mechanism of blast loading produces a combined fracture and amputation. Therefore, to study these conditions, in vivo models that replicate this combined effect are required. The aim of this study is to develop a preclinical model of blast-induced lower limb amputation. METHODS Cadaveric Sprague-Dawley rats' left hindlimbs were exposed to blast waves of 7 to 13 bar burst pressures and 7.76 ms to 12.68 ms positive duration using a shock tube. Radiographs and dissection were used to identify the injuries. RESULTS Higher burst pressures of 13 and 12 bar caused multiple fractures at the hip, and the right and left limbs. Lowering the pressure to 10 bar eliminated hip fractures; however, the remaining fractures were not isolated to the left limb. Further reducing the pressure to 9 bar resulted in the desired isolated fracture of the left tibia with a dramatic reduction in the fractures to other sites. CONCLUSION In this paper, a rodent blast injury model has been developed in the hindlimb of cadaveric rats that combines the blast and fracture in one insult, necessitating amputation. Experimental setup with 9 bar burst pressure and 9.13 ms positive duration created a fracture at the tibia with total reduction in non-targeted fractures, rendering 9 bar burst pressure suitable for translation to a survivable model to investigate blast injury-associated diseases. Cite this article: Bone Joint Res 2021;10(3):166-172.
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Affiliation(s)
- Zepur Kazezian
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Xiancheng Yu
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Martin Ramette
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Warren Macdonald
- Department of Bioengineering, Imperial College London, London, UK
| | - Anthony M. J. Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
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Kazezian Z, Bull AMJ. A review of the biomarkers and in vivo models for the diagnosis and treatment of heterotopic ossification following blast and trauma-induced injuries. Bone 2021; 143:115765. [PMID: 33285256 DOI: 10.1016/j.bone.2020.115765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022]
Abstract
Heterotopic ossification (HO) is the process of de novo bone formation in non-osseous tissues. HO can occur following trauma and burns and over 60% of military personnel with blast-associated amputations develop HO. This rate is far higher than in other trauma-induced HO development. This suggests that the blast effect itself is a major contributing factor, but the pathway triggering HO following blast injury specifically is not yet fully identified. Also, because of the difficulty of studying the disease using clinical data, the only sources remain the relevant in vivo models. The aim of this paper is first to review the key biomarkers and signalling pathways identified in trauma and blast induced HO in order to summarize the molecular mechanisms underlying HO development, and second to review the blast injury in vivo models developed. The literature derived from trauma-induced HO suggests that inflammatory cytokines play a key role directing different progenitor cells to transform into an osteogenic class contributing to the development of the disease. This highlights the importance of identifying the downstream biomarkers under specific signalling pathways which might trigger similar stimuli in blast to those of trauma induced formation of ectopic bone in the tissues surrounding the site of the injury. The lack of information in the literature regarding the exact biomarkers leading to blast associated HO is hampering the design of specific therapeutics. The majority of existing blast injury in vivo models do not fully replicate the combat scenario in terms of blast, fracture and amputation; these three usually happen in one insult. Hence, this paper highlights the need to replicate the full effect of the blast in preclinical models to better understand the mechanism of blast induced HO development and to enable the design of a specific therapeutic to supress the formation of ectopic bone.
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Affiliation(s)
- Zepur Kazezian
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
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Pan H, Fleming N, Hong CC, Mishina Y, Perrien DS. Methods for the reliable induction of heterotopic ossification in the conditional Alk2Q207D mouse. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:149-159. [PMID: 32131380 PMCID: PMC7104591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Conditional Alk2Q207D-floxed (caALK2fl) mice have previously been used as a model of heterotopic ossification (HO). However, HO formation in this model can be highly variable, and it is unclear which methods reliably induce HO. Hence, these studies report validated methods for reproducibly inducing HO in caALK2fl mice. METHODS Varying doses of Adex-cre and cardiotoxin (CTX) were injected into the calf muscles of 9, 14, or 28-day-old caALK2fl/- or caALK2fl/fl mice. HO was measured by planar radiography or microCT at 14-28 days post-injury. RESULTS In 9-day-old caALK2fl/- or caALK2fl/fl mice, single injections of 109 PFU Adex-cre and 0.3 μg of CTX were sufficient to induce extensive HO within 14 days post-injury. In 28-day-old mice, the doses were increased to 5 x 109 PFU Adex-cre and 3.0 μg of CTX to achieve similar consistency, but at a slower rate versus younger mice. Using a crush injury, instead of CTX, also provided consistent induction of HO. Finally, the Type 1 BMPR inhibitor, DMH1, significantly reduced HO formation in 28-day-old caALK2fl/fl mice. CONCLUSIONS These data illustrate multiple methods for reliable induction of localized HO in the caALK2flmouse that can serve as a starting point for new laboratories utilizing this model.
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Affiliation(s)
- Haichun Pan
- University of Michigan School of Dentistry, Ann Arbor, MI
| | - Nicole Fleming
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Charles C Hong
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN,Department of Pharmacology, and Vanderbilt University Medical Center, Nashville, TN,Division of Cardiology in the Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville TN
| | - Yuji Mishina
- University of Michigan School of Dentistry, Ann Arbor, MI
| | - Daniel S. Perrien
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville TN,Division of Clinical Pharmacology in the Department of Medicine and Vanderbilt University Medical Center, Nashville, TN,Center for Small Animal Imaging, Vanderbilt University Institute of Imaging Sciences, Vanderbilt University Medical Center, Nashville, TN,Corresponding author: Daniel S. Perrien, Ph.D., 101 Woodruff Circle, 1027 WMRB, Atlanta, GA 30322 E-mail: •
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de Vasconcellos JF, Zicari S, Fernicola SD, Griffin DW, Ji Y, Shin EH, Jones P, Christopherson GT, Bharmal H, Cirino C, Nguyen T, Robertson A, Pellegrini VD, Nesti LJ. In vivo model of human post-traumatic heterotopic ossification demonstrates early fibroproliferative signature. J Transl Med 2019; 17:248. [PMID: 31375141 PMCID: PMC6679453 DOI: 10.1186/s12967-019-1996-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background The relationship between the tissue injury healing response and development of heterotopic ossification (HO) is poorly understood. Here we compare a rat blast model and human traumatized muscle from a blast injury to study the early signatures of osteogenesis and fibrosis during the formation of HO. Methods Rat and human tissues were characterized using histology, scanning electron microscopy, immunohistochemistry, as well as gene and protein expression analysis. Additionally, animals and humans were assessed radiographically for HO formation following injury. Results Markers of bone formation were dramatically increased in tissue samples from both humans and rats, and both displayed increased fibroproliferative regions within the injured tissues and elevated expression of markers of tissue fibrosis such as TGF-β1, Fibronectin, SMAD3 and PAI-1. Markers of inflammation and fibrosis (ACTA, TNFα, BMP1 and BMP3) were elevated at the RNA level in both rat and human samples. By day 42, bone formation in the rat blast model appeared similar in radiographs compared to human patients who progressed to develop post-traumatic HO. Conclusions Our data demonstrates that a similar early fibrotic response is evident in both the rat blast model and the human tissues following a traumatic injury and demonstrates the relevance of this animal model for future translational studies.
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Affiliation(s)
- Jaira F de Vasconcellos
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Sonia Zicari
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Stephen D Fernicola
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Daniel W Griffin
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Youngmi Ji
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Emily H Shin
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Patrick Jones
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Gregory T Christopherson
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Husain Bharmal
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Carl Cirino
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA
| | - Thao Nguyen
- Department of Orthopaedic Surgery, University of Maryland Medical Center, 22 S. Green St., Baltimore, MD, 21201, USA
| | - Astor Robertson
- Department of Orthopaedic Surgery, University of Maryland Medical Center, 22 S. Green St., Baltimore, MD, 21201, USA
| | - Vincent D Pellegrini
- Department of Orthopaedic Surgery, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA
| | - Leon J Nesti
- Department of Surgery, Walter Reed National Military Medical Center & Uniformed Services University of Health Sciences, 4801 Rockville Pike, Bethesda, MD, 20889, USA. .,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room A3008C, Bethesda, MD, 20892-8022, USA.
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Chiaramonti AM, Robertson AD, Nguyen TP, Jaffe DE, Hanna EL, Holmes R, Barfield WR, Fourney WL, Stains JP, Pellegrini VD. Pulsatile Lavage of Musculoskeletal Wounds Causes Muscle Necrosis and Dystrophic Calcification in a Rat Model. J Bone Joint Surg Am 2017; 99:1851-1858. [PMID: 29088040 DOI: 10.2106/jbjs.17.00330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adequate irrigation of open musculoskeletal injuries is considered the standard of care to decrease bacterial load and other contaminants. While the benefit of debris removal compared with the risk of further seeding by high-pressure lavage has been studied, the effects of irrigation on muscle have been infrequently reported. Our aim in the present study was to assess relative damage to muscle by pulsatile lavage compared with bulb-syringe irrigation. METHODS In an animal model of heterotopic ossification, 24 Sprague-Dawley rats underwent hindlimb blast amputation via detonation of a submerged explosive, with subsequent through-the-knee surgical amputation proximal to the zone of injury. All wounds were irrigated and underwent primary closure. In 12 of the animals, pulsatile lavage (20 psi [138 kPa]) was used as the irrigation method, and in the other 12 animals, bulb-syringe irrigation was performed. A third group of 6 rats did not undergo the blast procedure but instead underwent surgical incision into the left thigh muscle followed by pulsatile lavage. Serial radiographs of the animals were made to monitor the formation of soft-tissue radiopaque lesions until euthanasia at 6 months. Image-guided muscle biopsies were performed at 8 weeks and 6 months (at euthanasia) on representative animals from each group. Histological analysis was performed with hematoxylin and eosin, alizarin red, and von Kossa staining on interval biopsy and postmortem specimens. RESULTS All animals managed with pulsatile lavage, with or without blast injury, developed soft-tissue radiopaque lesions, whereas no animal that had bulb-syringe irrigation developed these lesions (p = 0.001). Five of the 12 animals that underwent blast amputation with pulsatile lavage experienced wound complications, whereas no animal in the other 2 groups experienced wound complications (p = 0.014). Radiopaque lesions appeared approximately 10 days postoperatively, increased in density until approximately 16 weeks, then demonstrated signs of variable regression. Histological analysis of interval biopsy and postmortem specimens demonstrated tissue damage with inflammatory cells, cell death, and dystrophic calcification. CONCLUSIONS Pulsatile lavage of musculoskeletal wounds can cause irreversible insult to tissue, resulting in myonecrosis and dystrophic calcification. CLINICAL RELEVANCE The benefits and offsetting harm of pulsatile lavage (20 psi) should be considered before its routine use in the management of musculoskeletal wounds.
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Affiliation(s)
- Alexander M Chiaramonti
- 1Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina 2Departments of Orthopaedics (A.D.R., T.P.N., D.E.J., and J.P.S.) and Engineering (W.L.F.), University of Maryland School of Medicine, Baltimore, Maryland
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The traumatic bone: trauma-induced heterotopic ossification. Transl Res 2017; 186:95-111. [PMID: 28668522 PMCID: PMC6715128 DOI: 10.1016/j.trsl.2017.06.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 01/08/2023]
Abstract
Heterotopic ossification (HO) is a common occurrence after multiple forms of extensive trauma. These include arthroplasties, traumatic brain and spinal cord injuries, extensive burns in the civilian setting, and combat-related extremity injuries in the battlefield. Irrespective of the form of trauma, heterotopic bone is typically endochondral in structure and is laid down via a cartilaginous matrix. Once formed, the heterotopic bone typically needs to be excised surgically, which may result in wound healing complications, in addition to a risk of recurrence. Refinements of existing diagnostic modalities, like micro- and nano-CT are being adapted toward early intervention. Trauma-induced HO is a consequence of aberrant wound healing, systemic and local immune system activation, infections, extensive vascularization, and innervation. This intricate molecular crosstalk culminates in activation of stem cells that initiate heterotopic endochondral ossification. Development of animal models recapitulating the unique traumatic injuries has greatly facilitated the mechanistic understanding of trauma-induced HO. These same models also serve as powerful tools to test the efficacy of small molecules which specifically target the molecular pathways underlying ectopic ossification. This review summarizes the recent advances in the molecular understanding, diagnostic and treatment modalities in the field of trauma-induced HO.
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