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Tian X, Vater C, Raina DB, Findeisen L, Matuszewski LM, Tägil M, Lidgren L, Winkler A, Gottwald R, Modler N, Schaser KD, Disch AC, Zwingenberger S. Co-delivery of rhBMP-2 and zoledronic acid using calcium sulfate/hydroxyapatite carrier as a bioactive bone substitute to enhance and accelerate spinal fusion. Bioact Mater 2024; 36:256-271. [PMID: 38487704 PMCID: PMC10937206 DOI: 10.1016/j.bioactmat.2024.02.034] [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: 10/21/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been FDA-approved for lumbar fusion, but supraphysiologic initial burst release due to suboptimal carrier and late excess bone resorption caused by osteoclast activation have limited its clinical usage. One strategy to mitigate the pro-osteoclast side effect of rhBMP-2 is to give systemic bisphosphonates, but it presents challenges with systemic side effects and low local bioavailability. The aim of this in vivo study was to analyze if posterolateral spinal fusion (PLF) could be improved by utilizing a calcium sulfate/hydroxyapatite (CaS/HA) carrier co-delivering rhBMP-2 and zoledronic acid (ZA). Six groups were allocated (CaS/HA, CaS/HA + BMP-2, CaS/HA + systemic ZA, CaS/HA + local ZA, CaS/HA + BMP-2 + systemic ZA, and CaS/HA + BMP-2 + local ZA). 10-week-old male Wistar rats, were randomly assigned to undergo L4-L5 PLF with implantation of group-dependent scaffolds. At 3 and 6 weeks, the animals were euthanized for radiography, μCT, histological staining, or biomechanical testing to evaluate spinal fusion. The results demonstrated that the CaS/HA biomaterial alone or in combination with local or systemic ZA didn't support PLF. However, the delivery of rhBMP-2 significantly promoted PLF. Combining systemic ZA with BMP-2 didn't enhance spinal fusion. Notably, the co-delivery of rhBMP-2 and ZA using the CaS/HA carrier significantly enhanced and accelerated PLF, without inhibiting systemic bone turnover, and potentially reduced the dose of rhBMP-2. Together, the treatment regimen of CaS/HA biomaterial co-delivering rhBMP-2 and ZA could potentially be a safe and cost-effective off-the-shelf bioactive bone substitute to enhance spinal fusion.
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Affiliation(s)
- Xinggui Tian
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
| | - Corina Vater
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
| | - Deepak Bushan Raina
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, 22185, Sweden
| | - Lisa Findeisen
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
| | - Lucas-Maximilian Matuszewski
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
| | - Magnus Tägil
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, 22185, Sweden
| | - Lars Lidgren
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, 22185, Sweden
| | - Anja Winkler
- Institute of Lightweight Engineering and Polymer Technology at TUD Dresden University of Technology, 01062, Dresden, Germany
| | - Robert Gottwald
- Institute of Lightweight Engineering and Polymer Technology at TUD Dresden University of Technology, 01062, Dresden, Germany
| | - Niels Modler
- Institute of Lightweight Engineering and Polymer Technology at TUD Dresden University of Technology, 01062, Dresden, Germany
| | - Klaus-Dieter Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
| | - Alexander C. Disch
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
| | - Stefan Zwingenberger
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus at TUD Dresden University of Technology, 01307, Dresden, Germany
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Markeviciute V, Puthia M, Arvidsson L, Liu Y, Törnquist E, Tengattini A, Huang J, Bai Y, Vater C, Petrolis R, Zwingenberger S, Krisciukaitis A, Smailys A, Lukosevicius S, Stravinskas M, Isaksson H, Tarasevicius S, Lidgren L, Tägil M, Raina DB. Systemically administered zoledronic acid activates locally implanted synthetic hydroxyapatite particles enhancing peri-implant bone formation: A regenerative medicine approach to improve fracture fixation. Acta Biomater 2024; 179:354-370. [PMID: 38490481 DOI: 10.1016/j.actbio.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/11/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
Fracture fixation in an ageing population is challenging and fixation failure increases mortality and societal costs. We report a novel fracture fixation treatment by applying a hydroxyapatite (HA) based biomaterial at the bone-implant interface and biologically activating the biomaterial by systemic administration of a bisphosphonate (zoledronic acid, ZA). We first used an animal model of implant integration and applied a calcium sulphate (CaS)/HA biomaterial around a metallic screw in the tibia of osteoporotic rats. Using systemic ZA administration at 2-weeks post-surgery, we demonstrated that the implant surrounded by HA particles showed significantly higher peri‑implant bone formation compared to the unaugmented implants at 6-weeks. We then evaluated the optimal timing (day 1, 3, 7 and 14) of ZA administration to achieve a robust effect on peri‑implant bone formation. Using fluorescent ZA, we demonstrated that the uptake of ZA in the CaS/HA material was the highest at 3- and 7-days post-implantation and the uptake kinetics had a profound effect on the eventual peri‑implant bone formation. We furthered our concept in a feasibility study on trochanteric fracture patients randomized to either CaS/HA augmentation or no augmentation followed by systemic ZA treatment. Radiographically, the CaS/HA group showed signs of increased peri‑implant bone formation compared with the controls. Finally, apart from HA, we demonstrated that the concept of biologically activating a ceramic material by ZA could also be applied to β-tricalcium phosphate. This novel approach for fracture treatment that enhances immediate and long-term fracture fixation in osteoporotic bone could potentially reduce reoperations, morbidity and mortality. STATEMENT OF SIGNIFICANCE: • Fracture fixation in an ageing population is challenging. Biomaterial-based augmentation of fracture fixation devices has been attempted but lack of satisfactory biological response limits their widespread use. • We report the biological activation of locally implanted microparticulate hydroxyapatite (HA) particles placed around an implant by systemic administration of the bisphosphonate zoledronic acid (ZA). The biological activation of HA by ZA enhances peri‑implant bone formation. •Timing of ZA administration after HA implantation is critical for optimal ZA uptake and consequently determines the extent of peri‑implant bone formation. • We translate the developed concept from small animal models of implant integration to a proof-of-concept clinical study on osteoporotic trochanteric fracture patients. • ZA based biological activation can also be applied to other calcium phosphate biomaterials.
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Affiliation(s)
- Vetra Markeviciute
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania; The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Manoj Puthia
- The Faculty of Medicine, Division of Dermatology and Venerology, Lund University, 221 84 Lund, Sweden
| | - Linnea Arvidsson
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Yang Liu
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, China
| | - Elin Törnquist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Jintian Huang
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Yiguang Bai
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Cell, Tissue & Organ engineering laboratory, Department of Clinical Sciences Lund, Stem Cell Centre, Lund University, Lund, Sweden; Department of Orthopaedics, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College Nanchong, Sichuan, China
| | - Corina Vater
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedics, Trauma and Plastic Surgery, 01307 Dresden, Germany
| | - Robertas Petrolis
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Stefan Zwingenberger
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedics, Trauma and Plastic Surgery, 01307 Dresden, Germany
| | - Algimantas Krisciukaitis
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alfredas Smailys
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Saulius Lukosevicius
- Department of Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Stravinskas
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sarunas Tarasevicius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lars Lidgren
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Magnus Tägil
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
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Huo D, Liu T, Huang K, Que C, Jiang S, Yang Y, Tan S, Huang L. AgBiS 2@CQDs/Ti nanocomposite coatings for combating implant-associated infections by photodynamic /photothermal therapy. BIOMATERIALS ADVANCES 2024; 158:213763. [PMID: 38227988 DOI: 10.1016/j.bioadv.2024.213763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/18/2023] [Accepted: 01/06/2024] [Indexed: 01/18/2024]
Abstract
Biofilm-mediated implant-associated infections are one of the most serious complications of implantation surgery, posing a grave threat to patient well-being. Effectively addressing bacterial infections is crucial for the success of implantation procedures. In this study, we prepared a bismuth sulfide silver@carbon quantum dot composite coating (AgBiS2@CQDs/Ti) on a medical titanium surface by surface engineering design to treat implant-associated infections. The photocatalytic/photothermal activity test results confirmed the excellent photogenerated ROS and photothermal properties of AgBiS2@CQDs/Ti under near-infrared laser irradiation. In vitro antibacterial and in vivo anti-infection experiments showed that the coating combined with photodynamic and photothermal therapies to eradicate bacteria and disrupt mature biofilms under 1064 nm laser irradiation. Consequently, AgBiS2@CQDs/Ti shows promise as an implant coating for treating implant-associated infections post-surgery, thereby enhancing the success rate of implantation procedures. This study also provides a new idea for combating implant-associated infections.
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Affiliation(s)
- Dongliang Huo
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China
| | - Ting Liu
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China
| | - Kangkang Huang
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China
| | - Changhui Que
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China
| | - Shuoyan Jiang
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China
| | - Yuxia Yang
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China
| | - Shaozao Tan
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China.
| | - Langhuan Huang
- Guangdong Engineering & Technology Research Centre of Graphene-like Materials and Products, Department of Chemistry, College of Chemistry and Materials Science, Jinan University, Guangzhou 510632, PR China.
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Liu Q, Yang J, Wang R, Yuan L, Yu K. Dental implant failure rates with low insertion torque with a nonsubmerged surgical approach: A retrospective clinical study. Clin Implant Dent Relat Res 2023; 25:118-123. [PMID: 36398387 DOI: 10.1111/cid.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND It is currently unclear if a low insertion torque (IT) should prompt a clinician to submerge the dental implant at time of placement. PURPOSE This study aimed to analyze implant failure rates and marginal bone loss (MBL) as a function of IT and surgical approach. MATERIALS AND METHODS A total of 197 patients who had received 295 Mozo Grau (MG) implants were included in this study. The healing of submerged or nonsubmerged implants was evaluated in regular IT (≥20-25 Ncm) or low IT (<20-25 Ncm) cases. Implant failure and MBL were evaluated before prosthesis placement and at 6 and 12 months after functional loading with generalized estimating equations. RESULTS The overall 12-month implant failure rate was 4.8% (95% confidence interval [CI]: 2.7%-8.2%). When successful at 12 months, dental implants placed with low IT and nonsubmerging had the same MBL as implants dental implants placed with other approaches (mean difference = -0.02 mm; 95% CI -0.05 to 0.02). Low IT combined with nonsubmerging of the dental implant was associated with a 30-fold increased odds for dental implant failure (95% CI: 3.8-236.6). CONCLUSION low IT and nonsubmerged healing was associated with a high failure rate.
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Affiliation(s)
- Qiqi Liu
- College of Stomatology, Hospital of Stomatology, Southwest Medical University, Luzhou, China
| | - Jian Yang
- College of Stomatology, Hospital of Stomatology, Southwest Medical University, Luzhou, China
| | - Ruibin Wang
- College of Stomatology, Hospital of Stomatology, Southwest Medical University, Luzhou, China
| | - Lingling Yuan
- College of Stomatology, Hospital of Stomatology, Southwest Medical University, Luzhou, China
| | - Ke Yu
- College of Stomatology, Hospital of Stomatology, Southwest Medical University, Luzhou, China
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Xin H, Shi Q, Ning X, Chen Y, Jia X, Zhang Z, Zhu S, Li Y, Liu F, Kong L. Biomimetic Mineralized Fiber Bundle-Inspired Scaffolding Surface on Polyetheretherketone Implants Promotes Osseointegration. Macromol Biosci 2023; 23:e2200436. [PMID: 36617598 DOI: 10.1002/mabi.202200436] [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: 10/16/2022] [Revised: 12/11/2022] [Indexed: 01/10/2023]
Abstract
The stress shielding effect caused by traditional metal implants is circumvented by using polyetheretherketone (PEEK), due to its excellent mechanical properties; however, the biologically inert nature of PEEK limits its application. Endowing PEEK with biological activity to promote osseointegration would increase its applicability for bone replacement implants. A biomimetic study is performed, inspired by mineralized collagen fiber bundles that contact bone marrow mesenchymal stem cells (BMMSCs) on the native trabecular bone surface. The PEEK surface (P) is first sulfonated with sulfuric acid to form a porous network structure (sP). The surface is then encapsulated with amorphous hydroxyapatite (HA) by magnetron sputtering to form a biomimetic scaffold that resembles mineralized collagen fiber bundles (sPHA). Amorphous HA simulates the composition of osteogenic regions in vivo and exhibits strong biological activity. In vitro results show that more favorable cell adhesion and osteogenic differentiation can be attained with the novelsurface of sPHA than with SP. The results of in vivo experiments show that sPHA exhibits osteoinductive and osteoconductive activity and facilitates bone formation and osseointegration. Therefore, the surface modification strategy can significantly improve the biological activity of PEEK, facilitate effective osseointegration, and inspire further bionic modification of other inert polymers similar to PEEK.
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Affiliation(s)
- He Xin
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China
| | - Qianwen Shi
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiaona Ning
- Department of Ophthalmology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Yicheng Chen
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China
| | - Xuelian Jia
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China.,College of Life Sciences, Northwest University, Xi'an, 710032, China
| | - Zhouyang Zhang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China
| | - Simin Zhu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China.,College of Life Sciences, Northwest University, Xi'an, 710032, China
| | - Yunpeng Li
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China
| | - Fuwei Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China
| | - Liang Kong
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, 710032, China
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Liu Y, Sebastian S, Huang J, Corbascio T, Engellau J, Lidgren L, Tägil M, Raina DB. Longitudinal in vivo biodistribution of nano and micro sized hydroxyapatite particles implanted in a bone defect. Front Bioeng Biotechnol 2022; 10:1076320. [PMID: 36601389 PMCID: PMC9806272 DOI: 10.3389/fbioe.2022.1076320] [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: 10/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Hydroxyapatite (HA) has been widely used as a bone substitute and more recently as a carrier for local delivery of bone targeted drugs. Majority of the approved HA based biomaterials and drug carriers comprise of micrometer sized particulate HA (mHA) or granules and can therefore only be used for extracellular drug release. This shortcoming could be overcome with the use of cell penetrating HA nanoparticles (nHA) but a major concern with the clinical use of nHA is the lack of data on its in vivo biodistribution after implantation. In this study, we aimed to study the in vivo biodistribution of locally implanted nHA in a clinically relevant tibial void in rats and compare it with mHA or a combination of mHA and nHA. To enable in vivo tracking, HA particles were first labelled with 14C-zoledronic acid (14C-ZA), known to have a high binding affinity to HA. The labelled particles were then implanted in the animals and the radioactivity in the proximal tibia and vital organs was detected at various time points (Day 1, 7 and 28) post-implantation using scintillation counting. The local distribution of the particles in the bone was studied with micro-CT. We found that majority (>99.9%) of the implanted HA particles, irrespective of the size, stayed locally at the implantation site even after 28 days and the findings were confirmed using micro-CT. Less than 0.1% radioactivity was observed in the kidney and the spleen at later time points of day 7 and 28. No pathological changes in any of the vital organs could be observed histologically. This is the first longitudinal in vivo HA biodistribution study showing that the local implantation of nHA particles in bone is safe and that nHA could potentially be used for localized drug delivery.
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Affiliation(s)
- Yang Liu
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden,*Correspondence: Yang Liu, ; Deepak Bushan Raina,
| | - Sujeesh Sebastian
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Jintian Huang
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Tova Corbascio
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Jacob Engellau
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden,*Correspondence: Yang Liu, ; Deepak Bushan Raina,
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Tian X, Raina DB, Vater C, Kilian D, Ahlfeld T, Platzek I, Nimtschke U, Tägil M, Lidgren L, Thomas A, Platz U, Schaser KD, Disch AC, Zwingenberger S. Evaluation of an Injectable Biphasic Calcium Sulfate/Hydroxyapatite Cement for the Augmentation of Fenestrated Pedicle Screws in Osteoporotic Vertebrae: A Biomechanical Cadaver Study. J Funct Biomater 2022; 13:jfb13040269. [PMID: 36547529 PMCID: PMC9786089 DOI: 10.3390/jfb13040269] [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: 10/23/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
Cement augmentation of pedicle screws is one of the most promising approaches to enhance the anchoring of screws in the osteoporotic spine. To date, there is no ideal cement for pedicle screw augmentation. The purpose of this study was to investigate whether an injectable, bioactive, and degradable calcium sulfate/hydroxyapatite (CaS/HA) cement could increase the maximum pull-out force of pedicle screws in osteoporotic vertebrae. Herein, 17 osteoporotic thoracic and lumbar vertebrae were obtained from a single fresh-frozen human cadaver and instrumented with fenestrated pedicle screws. The right screw in each vertebra was augmented with CaS/HA cement and the un-augmented left side served as a paired control. The cement distribution, interdigitation ability, and cement leakage were evaluated using radiographs. Furthermore, pull-out testing was used to evaluate the immediate mechanical effect of CaS/HA augmentation on the pedicle screws. The CaS/HA cement presented good distribution and interdigitation ability without leakage into the spinal canal. Augmentation significantly enhanced the maximum pull-out force of the pedicle screw in which the augmented side was 39.0% higher than the pedicle-screw-alone side. Therefore, the novel biodegradable biphasic CaS/HA cement could be a promising material for pedicle screw augmentation in the osteoporotic spine.
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Affiliation(s)
- Xinggui Tian
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Deepak B. Raina
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, 22184 Lund, Sweden
| | - Corina Vater
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - David Kilian
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Tilman Ahlfeld
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Ivan Platzek
- Department of Radiology, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Ute Nimtschke
- Institute of Anatomy, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, 22184 Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, 22184 Lund, Sweden
| | - Alexander Thomas
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Uwe Platz
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Klaus-Dieter Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Alexander C. Disch
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
| | - Stefan Zwingenberger
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, Faculty of Medicine, University Hospital Carl Gustav Carus at Technische Universität Dresden, 01307 Dresden, Germany
- Correspondence:
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Törnquist E, Le Cann S, Tengattini A, Helfen L, Kok J, Hall SA, Isaksson H. The Hydration State of Bone Tissue Affects Contrast in Neutron Tomographic Images. Front Bioeng Biotechnol 2022; 10:911866. [PMID: 35782510 PMCID: PMC9247154 DOI: 10.3389/fbioe.2022.911866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/24/2022] [Indexed: 12/25/2022] Open
Abstract
Neutron tomography has emerged as a promising imaging technique for specific applications in bone research. Neutrons have a strong interaction with hydrogen, which is abundant in biological tissues, and they can penetrate through dense materials such as metallic implants. However, in addition to long imaging times, two factors have led to challenges in running in situ mechanical characterization experiments on bone tissue using neutron tomography: 1) the high water content in specimens reduces the visibility of internal trabecular structures; 2) the mechanical properties of bone are dependent on the hydration state of the tissue, with drying being reported to cause increased stiffness and brittleness. This study investigates the possibility of improving image quality in terms of neutron transmission and contrast between material phases by drying and rehydrating in heavy water. Rat tibiae and trabecular bovine bone plugs were imaged with neutron tomography at different hydration states and mechanical testing of the bone plugs was carried out to assess effects of drying and rehydration on the mechanical properties of bone. From analysis of image histograms, it was found that drying reduced the contrast between bone and soft tissue, but the contrast was restored with rehydration. Contrast-to-noise ratios and line profiles revealed that the contrast between bone tissue and background was reduced with increasing rehydration duration but remained sufficient for identifying internal structures as long as no free liquid was present inside the specimen. The mechanical analysis indicated that the proposed fluid exchange protocol had no adverse effects on the mechanical properties.
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Affiliation(s)
- Elin Törnquist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sophie Le Cann
- CNRS, Université Paris Est Créteil, Université Gustave Eiffel, UMR 8208, MSME, F-94010, Créteil, France
| | - Alessandro Tengattini
- Institut Laue-Langevin, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP 3SR, Grenoble, France
| | | | - Joeri Kok
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- *Correspondence: Hanna Isaksson,
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9
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Xu H, Liu Y, Sezgin EA, Tarasevičius Š, Christensen R, Raina DB, Tägil M, Lidgren L. Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: a systematic review and meta-analysis of randomized trials. J Orthop Surg Res 2022; 17:292. [PMID: 35658909 PMCID: PMC9164432 DOI: 10.1186/s13018-022-03189-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. We aimed to assess the comparative effectiveness of these interventions for trochanteric fractures by evaluating the surgical performance and postoperative outcomes.
Methods PubMed, Web of Science and Cochrane Central Register were searched for RCTs comparing DHS and PFN for trochanteric fractures. All selected studies and the risk of bias were assessed. Clinical data including operative time, intraoperative blood loss, intraoperative fluoroscopy time, successful closed reduction and complications like nonunion, implant failure and reoperation were recorded. Random-effects models were used in Review Manager software, and GRADE was applied for the interpretation of the evidence. Results From 286 identified trials, twelve RCTs including 1889 patients were eligible for inclusion; six RCTs directly comparing DHS with PFN, while other six compared DHS with proximal femoral nail antirotation (PFNA). Compared to DHS, PFN had shorter operative time and led to less intraoperative blood loss. However, DHS need less intraoperative fluoroscopy time than PFN. No difference was seen for the achievement of closed reduction. For risk of postoperative complications, no difference was seen between PFN and DHS for non-union, risk of implant failure and revision surgery. Conclusions PFN(A) resulted in a shorter operative time and less intraoperative blood loss compared to DHS. However, no difference was seen for postoperative complications. Trial registration PROSPERO: CRD42021239974. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03189-z.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, China.
| | - Yang Liu
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
| | - Erdem Aras Sezgin
- Department of Orthopaedics&Traumatology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Šarūnas Tarasevičius
- Department of Orthopedics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Deepak Bushan Raina
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences Lund, The Faculty of Medicine, Orthopedics, Lund University, Lund, Sweden
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10
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Raina DB, Markevičiūtė V, Stravinskas M, Kok J, Jacobson I, Liu Y, Sezgin EA, Isaksson H, Zwingenberger S, Tägil M, Tarasevičius Š, Lidgren L. A New Augmentation Method for Improved Screw Fixation in Fragile Bone. Front Bioeng Biotechnol 2022; 10:816250. [PMID: 35309986 PMCID: PMC8926351 DOI: 10.3389/fbioe.2022.816250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
Pertrochanteric fractures (TF) due to osteoporosis constitute nearly half of all proximal femur fractures. TFs are treated with a surgical approach and fracture fixation is achieved using metallic fixation devices. Poor quality cancellous bone in osteoporotic patients makes anchorage of a fixation device challenging, which can lead to failure of the fracture fixation. Methods to reinforce the bone-implant interface using bone cement (PMMA) and other calcium phosphate cements in TFs have been described earlier but a clear evidence on the advantage of using such biomaterials for augmentation is weak. Furthermore, there is no standardized technique for delivering these biomaterials at the bone-implant interface. In this study, we firstly describe a method to deliver a calcium sulphate/hydroxyapatite (CaS/HA) based biomaterial for the augmentation of a lag-screw commonly used for TF fixation. We then used an osteoporotic Sawbones model to study the consequence of CaS/HA augmentation on the immediate mechanical anchorage of the lag-screw to osteoporotic bone. Finally, as a proof-of-concept, the method of delivering the CaS/HA biomaterial at the bone-implant interface as well as spreading of the CaS/HA material at this interface was tested in patients undergoing treatment for TF as well as in donated femoral heads. The mechanical testing results indicated that the CaS/HA based biomaterial increased the peak extraction force of the lag-screw by 4 times compared with un-augmented lag-screws and the results were at par with PMMA. The X-ray images from the patient series showed that it was possible to inject the CaS/HA material at the bone-implant interface without applying additional pressure and the CaS/HA material spreading was observed at the interface of the lag-screw threads and the bone. Finally, the spreading of the CaS/HA material was also verified on donated femoral heads and micro-CT imaging indicated that the entire length of the lag-screw threads was covered with the CaS/HA biomaterial. In conclusion, we present a novel method for augmenting a lag-screw in TFs, which could potentially reduce the risk of fracture fixation failure and reoperation in fragile osteoporotic patients.
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Affiliation(s)
- Deepak Bushan Raina
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
- *Correspondence: Deepak Bushan Raina,
| | - Vetra Markevičiūtė
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Stravinskas
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Joeri Kok
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Ida Jacobson
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Yang Liu
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Erdem Aras Sezgin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Stefan Zwingenberger
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedic, Trauma and Plastic Surgery, Dresden, Germany
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Šarūnas Tarasevičius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lars Lidgren
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
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11
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Kok J, Törnquist E, Raina DB, Le Cann S, Novak V, Širka A, Lidgren L, Grassi L, Isaksson H. Fracture behavior of a composite of bone and calcium sulfate/hydroxyapatite. J Mech Behav Biomed Mater 2022; 130:105201. [DOI: 10.1016/j.jmbbm.2022.105201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022]
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12
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Liu Y, Nadeem A, Sebastian S, Olsson MA, Wai SN, Styring E, Engellau J, Isaksson H, Tägil M, Lidgren L, Raina DB. Bone mineral: A trojan horse for bone cancers efficient mitochondria targeted delivery and tumor eradication with nano hydroxyapatite containing doxorubicin. Mater Today Bio 2022; 14:100227. [PMID: 35265825 PMCID: PMC8898975 DOI: 10.1016/j.mtbio.2022.100227] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/04/2022] Open
Abstract
Efficient systemic pharmacological treatment of solid tumors is hampered by inadequate tumor concentration of cytostatics necessitating development of smart local drug delivery systems. To overcome this, we demonstrate that doxorubicin (DOX), a cornerstone drug used for osteosarcoma treatment, shows reversible accretion to hydroxyapatite (HA) of both nano (nHA) and micro (mHA) size. nHA particles functionalized with DOX get engulfed in the lysosome of osteosarcoma cells where the acidic microenvironment causes a disruption of the binding between DOX and HA. The released DOX then accumulates in the mitochondria causing cell starvation, reduced migration and apoptosis. The HA+DOX delivery system was also tested in-vivo on osteosarcoma bearing mice. Locally delivered DOX via the HA particles had a stronger tumor eradication effect compared to the controls as seen by PET-CT and immunohistochemical staining of proliferation and apoptosis markers. These results indicate that in addition to systemic chemotherapy, an adjuvant nHA could be used as a carrier for intracellular delivery of DOX for prevention of tumor recurrence after surgical resection in an osteosarcoma. Furthermore, we demonstrate that nHA particles are pivotal in this approach but a combination of nHA with mHA could increase the safety associated with particulate nanomaterials while maintaining similar therapeutic potential.
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13
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A Critical Review of the Design, Manufacture, and Evaluation of Bone Joint Replacements for Bone Repair. MATERIALS 2021; 15:ma15010153. [PMID: 35009299 PMCID: PMC8746215 DOI: 10.3390/ma15010153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/04/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022]
Abstract
With the change of people’s living habits, bone trauma has become a common clinical disease. A large number of bone joint replacements is performed every year around the world. Bone joint replacement is a major approach for restoring the functionalities of human joints caused by bone traumas or some chronic bone diseases. However, the current bone joint replacement products still cannot meet the increasing demands and there is still room to increase the performance of the current products. The structural design of the implant is crucial because the performance of the implant relies heavily on its geometry and microarchitecture. Bionic design learning from the natural structure is widely used. With the progress of technology, machine learning can be used to optimize the structure of bone implants, which may become the focus of research in the future. In addition, the optimization of the microstructure of bone implants also has an important impact on its performance. The widely used design algorithm for the optimization of bone joint replacements is reviewed in the present study. Regarding the manufacturing of the implant, the emerging additive manufacturing technique provides more room for the design of complex microstructures. The additive manufacturing technique has enabled the production of bone joint replacements with more complex internal structures, which makes the design process more convenient. Numerical modeling plays an important role in the evaluation of the performance of an implant. For example, theoretical and numerical analysis can be carried out by establishing a musculoskeletal model to prepare for the practical use of bone implants. Besides, the in vitro and in vivo testing can provide mechanical properties of bone implants that are more in line with the implant recipient’s situation. In the present study, the progress of the design, manufacture, and evaluation of the orthopedic implant, especially the joint replacement, is critically reviewed.
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14
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Cyphert EL, Zhang N, Learn GD, Hernandez CJ, von Recum HA. Recent Advances in the Evaluation of Antimicrobial Materials for Resolution of Orthopedic Implant-Associated Infections In Vivo. ACS Infect Dis 2021; 7:3125-3160. [PMID: 34761915 DOI: 10.1021/acsinfecdis.1c00465] [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: 12/25/2022]
Abstract
While orthopedic implant-associated infections are rare, revision surgeries resulting from infections incur considerable healthcare costs and represent a substantial research area clinically, in academia, and in industry. In recent years, there have been numerous advances in the development of antimicrobial strategies for the prevention and treatment of orthopedic implant-associated infections which offer promise to improve the limitations of existing delivery systems through local and controlled release of antimicrobial agents. Prior to translation to in vivo orthopedic implant-associated infection models, the properties (e.g., degradation, antimicrobial activity, biocompatibility) of the antimicrobial materials can be evaluated in subcutaneous implant in vivo models. The antimicrobial materials are then incorporated into in vivo implant models to evaluate the efficacy of using the material to prevent or treat implant-associated infections. Recent technological advances such as 3D-printing, bacterial genomic sequencing, and real-time in vivo imaging of infection and inflammation have contributed to the development of preclinical implant-associated infection models that more effectively recapitulate the clinical presentation of infections and improve the evaluation of antimicrobial materials. This Review highlights the advantages and limitations of antimicrobial materials used in conjunction with orthopedic implants for the prevention and treatment of orthopedic implant-associated infections and discusses how these materials are evaluated in preclinical in vivo models. This analysis serves as a resource for biomaterial researchers in the selection of an appropriate orthopedic implant-associated infection preclinical model to evaluate novel antimicrobial materials.
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Affiliation(s)
- Erika L. Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Ningjing Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Greg D. Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Christopher J. Hernandez
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York 14853, United States
- Hospital for Special Surgery, New York, New York 10021, United States
| | - Horst A. von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
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15
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Sezgin EA, Tor AT, Markevičiūtė V, Širka A, Tarasevičius Š, Raina DB, Liu Y, Isaksson H, Tägil M, Lidgren L. A combined fracture and mortality risk index useful for treatment stratification in hip fragility fractures. Jt Dis Relat Surg 2021; 32:583-589. [PMID: 34842088 PMCID: PMC8650669 DOI: 10.52312/jdrs.2021.382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 02/06/2023] Open
Abstract
Objectives
In this study, we aimed to assess the stratification ability of the Fracture and Mortality Risk Evaluation (FAME) index for reoperation, new fragility fracture, and mortality during one-year follow-up. Patients and methods
Between November 2018 and July 2019, a total of 94 consecutive hip fragility fracture patients from two centers (20 males, 74 females; mean age: 79.3±8.9 years; range, 57 to 100 years) were retrospectively analyzed. The patients were classified into high, intermediate, and low fracture and mortality risk groups according to the Fracture Risk Assessment Tool (FRAX) score and Sernbo score, respectively, as well as nine combined categories according to the FAME index. Hospital records were reviewed to identify re-fractures (reoperations, implant failure, new fragility fractures on any site) and mortality at one year following the FAME index classification. Results
Overall re-fracture and mortality rates were 20.2% and 33%, respectively. High fracture risk category (FRAX-H) was significantly associated with higher re-fracture (odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1-8.2, p=0.037) and mortality rates compared to others (OR: 3.7, 95% CI: 1.5-9.3, p=0.003). The patients classified within the FRAX-H category (n=35) had different mortality rates according to their Sernbo classification; i.e., patients classified as low mortality risk (Sernbo-L) (n=17) had lower mortality rates compared to others in this group (n=18) (35.3% and 66.7%, respectively), indicating a low statistical significance (OR: 0.3, 95% CI: 0.1-1.1, p=0.063). Similarly, within patients classified in Sernbo-L category (n=64), those classified as high fracture risk (FRAX-H) (n=17) had significantly higher re-fracture rates compared to others in this group (n=47) (35.3% and 8.5%, respectively), (OR: 5.9; 95% CI: 1.4-24.5), (p=0.017). Multivariate logistic regression analyses adjusting for covariates (age, sex, length of hospital stay and BMI) yielded similar results. Conclusion
The FAME index appears to be a useful stratification tool for allocating patients in a randomized-controlled trial for augmentation of hip fragility fractures.
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Affiliation(s)
- Erdem Aras Sezgin
- Aksaray Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 68200 Aksaray, Türkiye.
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16
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Liu Y, Raina DB, Sebastian S, Nagesh H, Isaksson H, Engellau J, Lidgren L, Tägil M. Sustained and controlled delivery of doxorubicin from an in-situ setting biphasic hydroxyapatite carrier for local treatment of a highly proliferative human osteosarcoma. Acta Biomater 2021; 131:555-571. [PMID: 34271171 DOI: 10.1016/j.actbio.2021.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022]
Abstract
Doxorubicin (DOX) is a cornerstone drug in the treatment of osteosarcoma. However, achieving sufficient concentration in the tumor tissue after systemic administration with few side effects has been a challenge. Even with the most advanced nanotechnology approaches, less than 5% of the total administered drug gets delivered to the target site. Alternatives to increase the local concentration of DOX within the tumor using improved drug delivery methods are needed. In this study, we evaluate a clinically approved calcium sulfate/hydroxyapatite (CaS/HA) carrier, both in-vitro and in-vivo, for local, sustained and controlled delivery of DOX to improve osteosarcoma treatment. In-vitro drug release studies indicated that nearly 28% and 36% of the loaded drug was released over a period of 4-weeks at physiological pH (7.4) and acidic pH (5), respectively. About 63% of the drug had been released after 4-weeks in-vivo. The efficacy of the released drug from the CaS/HA material was verified on two human osteosarcoma cell lines MG-63 and 143B. It was demonstrated that the released drug fractions functioned the same way as the free drug without impacting its efficacy. Finally, the carrier system with DOX was assessed using two clinically relevant human osteosarcoma xenograft models. Compared to no treatment or the clinical standard of care with systemic DOX administration, the delivery of DOX using a CaS/HA biomaterial could significantly hinder tumor progression by inhibiting angiogenesis and cell proliferation. Our results indicate that a clinically approved CaS/HA biomaterial containing cytostatics could potentially be used for the local treatment of osteosarcoma. STATEMENT OF SIGNIFICANCE: The triad of doxorubicin (DOX), methotrexate and cisplatin has routinely been used for the treatment of osteosarcoma. These drugs dramatically improved the prognosis, but 45-55% of the patients respond poorly to the treatment with low 5-year survival. In the present study, we repurpose the cornerstone drug DOX by embedding it in a calcium sulfate/hydroxyapatite (CaS/HA) biomaterial, ensuring a spatio-temporal drug release and a hypothetically higher and longer lasting intra-tumoral concentration of DOX. This delivery system could dramatically hinder the progression of a highly aggressive osteosarcoma compared to systemic administration, by inhibiting angiogenesis and cell proliferation. Our data show an efficient method for supplementary osteosarcoma treatment with possible rapid translational potential due to clinically approved constituents.
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17
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Törnquist E, Le Cann S, Tudisco E, Tengattini A, Andò E, Lenoir N, Hektor J, Raina DB, Tägil M, Hall SA, Isaksson H. Dual modality neutron and x-ray tomography for enhanced image analysis of the bone-metal interface. Phys Med Biol 2021; 66. [PMID: 34010812 DOI: 10.1088/1361-6560/ac02d4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/19/2021] [Indexed: 11/11/2022]
Abstract
The bone tissue formed at the contact interface with metallic implants, particularly its 3D microstructure, plays a pivotal role for the structural integrity of implant fixation. X-ray tomography is the classical imaging technique used for accessing microstructural information from bone tissue. However, neutron tomography has shown promise for visualising the immediate bone-metal implant interface, something which is highly challenging with x-rays due to large differences in attenuation between metal and biological tissue causing image artefacts. To highlight and explore the complementary nature of neutron and x-ray tomography, proximal rat tibiae with titanium-based implants were imaged with both modalities. The two techniques were compared in terms of visualisation of different material phases and by comparing the properties of the individual images, such as the contrast-to-noise ratio. After superimposing the images using a dedicated image registration algorithm, the complementarity was further investigated via analysis of the dual modality histogram, joining the neutron and x-ray data. From these joint histograms, peaks with well-defined grey value intervals corresponding to the different material phases observed in the specimens were identified and compared. The results highlight differences in how neutrons and x-rays interact with biological tissues and metallic implants, as well as the benefits of combining both modalities. Future refinement of the joint histogram analysis could improve the segmentation of structures and tissues, and yield novel information about specimen-specific properties such as moisture content.
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Affiliation(s)
- Elin Törnquist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sophie Le Cann
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, Creteil, France
| | - Erika Tudisco
- Division of Geotechnical Engineering, Lund University, Lund, Sweden
| | - Alessandro Tengattini
- Institut Laue-Langevin (ILL), Grenoble, France.,Univ. Grenoble Alpes, CNRS, Grenoble INP, 3SR, Grenoble, France
| | - Edward Andò
- Univ. Grenoble Alpes, CNRS, Grenoble INP, 3SR, Grenoble, France
| | - Nicolas Lenoir
- Institut Laue-Langevin (ILL), Grenoble, France.,Univ. Grenoble Alpes, CNRS, Grenoble INP, 3SR, Grenoble, France
| | - Johan Hektor
- LUNARC-Centre for Scientific and Technical Computing at Lund University, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- Orthopaedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Magnus Tägil
- Orthopaedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Stephen A Hall
- Division of Solid Mechanics, Lund University, Lund, Sweden.,Lund Institute of Advanced Neutron and X-ray Science (LINXS), Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Orthopaedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
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18
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Lee J, Lee JB, Yun J, Rhyu IC, Lee YM, Lee SM, Lee MK, Kim B, Kim P, Koo KT. The impact of surface treatment in 3-dimensional printed implants for early osseointegration: a comparison study of three different surfaces. Sci Rep 2021; 11:10453. [PMID: 34001989 PMCID: PMC8129142 DOI: 10.1038/s41598-021-89961-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
3D printing technology has been gradually applied to various areas. In the present study, 3D-printed implants were fabricated with direct metal laser sintering technique for a dental single root with titanium. The 3D implants were allocated into following groups: not treated (3D-None), sandblasted with a large grit and acid-etched (3D-SLA), and target-ion-induced plasma-sputtered surface (3D-TIPS). Two holes were drilled in each tibia of rabbit, and the three groups of implants were randomly placed with a mallet. Rabbits were sacrificed at two, four, and twelve weeks after the surgery. Histologic and histomorphometric analyses were performed for the evaluation of mineralized bone-to-implant contact (mBIC), osteoid-to-implant contact (OIC), total bone-to-implant contact (tBIC), mineralized bone area fraction occupancy (mBAFO), osteoid area fraction occupancy (OAFO), and total bone area fraction occupancy (tBAFO) in the inner and outer areas of lattice structure. At two weeks, 3D-TIPS showed significantly higher inner and outer tBIC and inner tBAFO compared with other groups. At four weeks, 3D-TIPS showed significantly higher outer OIC than 3D-SLA, but there were no significant differences in other variables. At twelve weeks, there were no significant differences. The surface treatment with TIPS in 3D-printed implants could enhance the osseointegration process in the rabbit tibia model, meaning that earlier osseointegration could be achieved.
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Affiliation(s)
- Jungwon Lee
- One-Stop Specialty Center, Seoul National University Dental Hospital, Seoul, Republic of Korea.,Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jun-Beom Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Junseob Yun
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - In-Chul Rhyu
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yong-Moo Lee
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Sung-Mi Lee
- Department of Materials Science and Engineering, Seoul National University, Seoul, Republic of Korea.,Biomedical Implant Convergence Research Center, Advanced Institutes of Convergence Technology, Suwon, Korea
| | - Min-Kyu Lee
- Department of Materials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Byoungkook Kim
- 3D Printer R&D Team, Dentium Co., Ltd., Suwon, Republic of Korea
| | - Pangyu Kim
- 3D Printer R&D Team, Dentium Co., Ltd., Suwon, Republic of Korea
| | - Ki-Tae Koo
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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19
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Kok J, Širka A, Liu Y, Tarasevičius Š, Belickas J, Tägil M, Lidgren L, Isaksson H, Raina DB. Augmenting a dynamic hip screw with a calcium sulfate/hydroxyapatite biomaterial. Med Eng Phys 2021; 92:102-109. [PMID: 34167704 DOI: 10.1016/j.medengphy.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/30/2021] [Accepted: 05/09/2021] [Indexed: 11/28/2022]
Abstract
Internal fixation failure in hip fractures can lead to reoperation. Calcium sulfate/hydroxyapatite (CaS/HA) is a biomaterial that can be used for augmenting fracture fixation. We aimed to determine whether an injection of 2 ml CaS/HA increases the fixation of a dynamic hip screw inserted in synthetic and human trabecular bone. The study consists of two parts: 1) synthetic bone blocks (n = 74), with three subgroups: empty (cannulated screw, no injection), cannulated, and fenestrated; and 2) osteoporotic human femoral heads (n = 29), with the same subgroups. The heads were imaged using µCT. Bone volume fraction, insertion angle, and head diameter were measured. Pullout tests were performed and peak force, stiffness, and work were measured. The fenestrated group showed increases in pullout strength compared to no injection in the synthetic blocks. The cannulated group showed a higher pullout strength in low-density blocks. In the femoral heads, the variation was larger and there were no significant differences between groups. The bone volume fraction correlated with the peak force and work, and the insertion angle correlated with the stiffness. CaS/HA can improve the fixation of a dynamic hip screw. For clinical use, spreading of the material around the threads of the screw must be ensured.
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Affiliation(s)
- Joeri Kok
- Department of Biomedical Engineering, Lund University, Box 118, 22100 Lund, Sweden.
| | - Aurimas Širka
- Department of Orthopedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu ave.2, Kaunas, Lithuania.
| | - Yang Liu
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Šarūnas Tarasevičius
- Department of Orthopedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu ave.2, Kaunas, Lithuania.
| | - Juozas Belickas
- Department of Orthopedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu ave.2, Kaunas, Lithuania.
| | - Magnus Tägil
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Lars Lidgren
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, 22100 Lund, Sweden; Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
| | - Deepak Bushan Raina
- Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, BMC C12, 22184 Lund, Sweden.
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20
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Xie D, Xu C, Ye C, Mei S, Wang L, Zhu Q, Chen Q, Zhao Q, Xu Z, Wei J, Yang L. Fabrication of Submicro-Nano Structures on Polyetheretherketone Surface by Femtosecond Laser for Exciting Cellular Responses of MC3T3-E1 Cells/Gingival Epithelial Cells. Int J Nanomedicine 2021; 16:3201-3216. [PMID: 34007174 PMCID: PMC8121686 DOI: 10.2147/ijn.s303411] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/12/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose Polyetheretherketone (PEEK) exhibits high mechanical strengths and outstanding biocompatibility but biological inertness that does not excite the cell responses and stimulate bone formation. The objective of this study was to construct submicro-nano structures on PEEK by femtosecond laser (FSL) for exciting the responses of MC3T3-E1 cells and gingival epithelial (GE) cells, which induce regeneration of bone/gingival tissues for long-term stability of dental implants. Materials and Methods In this study, submicro-nano structures were created on PEEK surface by FSL with power of 80 mW (80FPK) and 160 mW (160FPK). Results Compared with PEEK, both 80FPK and 160FPK with submicro-nano structures exhibited elevated surface performances (hydrophilicity, surface energy, roughness and protein absorption). Furthermore, in comparison with 80FPK, 160FPK further enhanced the surface performances. In addition, compared with PEEK, both 80FPK and 160FPK significantly excited not only the responses (adhesion, proliferation, alkaline phosphatase [ALP] activity and osteogenic gene expression) of MC3T3-E1 cells but also responses (adhesion as well as proliferation) of GE cells of human in vitro. Moreover, in comparison with 80FPK, 160FPK further enhanced the responses of MC3T3-E1 cells/GE cells. Conclusion FSL created submicro-nano structures on PEEK with elevated surface performances, which played crucial roles in exciting the responses of MC3T3-E1 cells/GE cells. Consequently, 160FPK with elevated surface performances and outstanding cytocompatibility would have enormous potential as an implant for dental replacement.
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Affiliation(s)
- Dong Xie
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China.,Department of Orthopaedics, PLA Navy No.905 Hospital, Shanghai, 200052, People's Republic of China
| | - Chenhui Xu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Cheng Ye
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Shiqi Mei
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Longqing Wang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Qi Zhu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Qing Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Qi Zhao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
| | - Zhiyan Xu
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Jie Wei
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, People's Republic of China
| | - Lili Yang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People's Republic of China
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21
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Raina DB, Matuszewski LM, Vater C, Bolte J, Isaksson H, Lidgren L, Tägil M, Zwingenberger S. A facile one-stage treatment of critical bone defects using a calcium sulfate/hydroxyapatite biomaterial providing spatiotemporal delivery of bone morphogenic protein-2 and zoledronic acid. SCIENCE ADVANCES 2020; 6:6/48/eabc1779. [PMID: 33246951 PMCID: PMC7695465 DOI: 10.1126/sciadv.abc1779] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/09/2020] [Indexed: 05/11/2023]
Abstract
Bone morphogenic proteins (BMPs) are the only true osteoinductive molecules. Despite being tremendously potent, their clinical use has been limited for reasons including supraphysiological doses, suboptimal delivery systems, and the pro-osteoclast effect of BMPs. Efforts to achieve spatially controlled bone formation using BMPs are being made. We demonstrate that a carrier consisting of a powder of calcium sulfate/hydroxyapatite (CaS/HA) mixed with bone active molecules provides an efficient drug delivery platform for critical femoral defect healing in rats. The bone-active molecules were composed of osteoinductive rhBMP-2 and the bisphosphonate, and zoledronic acid (ZA) was chosen to overcome BMP-2-induced bone resorption. It was demonstrated that delivery of rhBMP-2 was necessary for critical defect healing and restoration of mechanical properties, but codelivery of BMP-2 and ZA led to denser and stronger fracture calluses. Together, the CaS/HA biomaterial with rhBMP-2 and/or ZA can potentially be used as an off-the-shelf alternative to autograft bone.
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Affiliation(s)
- Deepak Bushan Raina
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund 22185, Sweden.
| | - Lucas-Maximilian Matuszewski
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedic, Trauma and Plastic Surgery, Dresden 01307, Germany
| | - Corina Vater
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedic, Trauma and Plastic Surgery, Dresden 01307, Germany
| | - Julia Bolte
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedic, Trauma and Plastic Surgery, Dresden 01307, Germany
| | - Hanna Isaksson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund 22185, Sweden
- Lund University, Department of Biomedical Engineering, Lund 22100, Sweden
| | - Lars Lidgren
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund 22185, Sweden
| | - Magnus Tägil
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund 22185, Sweden
| | - Stefan Zwingenberger
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedic, Trauma and Plastic Surgery, Dresden 01307, Germany
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22
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Geng Z, Ji L, Li Z, Wang J, He H, Cui Z, Yang X, Liu C. Nano-needle strontium-substituted apatite coating enhances osteoporotic osseointegration through promoting osteogenesis and inhibiting osteoclastogenesis. Bioact Mater 2020; 6:905-915. [PMID: 33102935 PMCID: PMC7553892 DOI: 10.1016/j.bioactmat.2020.09.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/11/2020] [Accepted: 09/27/2020] [Indexed: 12/30/2022] Open
Abstract
Implant loosening remains a major clinical challenge for osteoporotic patients. This is because osteoclastic bone resorption rate is higher than osteoblastic bone formation rate in the case of osteoporosis, which results in poor bone repair. Strontium (Sr) has been widely accepted as an anti-osteoporosis element. In this study, we fabricated a series of apatite and Sr-substituted apatite coatings via electrochemical deposition under different acidic conditions. The results showed that Ca and Sr exhibited different mineralization behaviors. The main mineralization products for Ca were CaHPO4·2H2O and Ca3(PO4)2 with the structure changed from porous to spherical as the pH values increased. The main mineralization products for Sr were SrHPO4 and Sr5(PO4)3OH with the structure changed from flake to needle as the pH values increased. The in vitro experiment demonstrated that coatings fabricated at high pH condition with the presence of Sr were favorable to MSCs adhesion, spreading, proliferation, and osteogenic differentiation. In addition, Sr-substituted apatite coatings could evidently inhibit osteoclast differentiation and fusion. Moreover, the in vivo study indicated that nano-needle like Sr-substituted apatite coating could suppress osteoclastic activity, improve new bone formation, and enhance bone-implant integration. This study provided a new theoretical guidance for implant coating design and the fabricated Sr-substituted coating might have potential applications for osteoporotic patients. Ca2+ and Sr2+ showed different mineralization behaviors in acidic environments. Apatites fabricated at high pH conditions were beneficial to MSCs growth. Sr-substituted apatite exhibited superior anti-osteoclast activity ability. Sr-substituted apatite facilitated osteogenesis, bone growth, and osseointegration.
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Affiliation(s)
- Zhen Geng
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China.,Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Luli Ji
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China.,Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Zhaoyang Li
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Jing Wang
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China.,The State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Hongyan He
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China.,Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China
| | - Zhenduo Cui
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin, 300350, China
| | - Xianjin Yang
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin, 300350, China
| | - Changsheng Liu
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China.,Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, China.,The State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, China
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23
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Raina DB, Širka A, Qayoom I, Teotia AK, Liu Y, Tarasevicius S, Tanner KE, Isaksson H, Kumar A, Tägil M, Lidgren L. Long-Term Response to a Bioactive Biphasic Biomaterial in the Femoral Neck of Osteoporotic Rats. Tissue Eng Part A 2020; 26:1042-1051. [PMID: 32242474 PMCID: PMC7580608 DOI: 10.1089/ten.tea.2020.0018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
Osteoporosis often leads to fragility fractures of the hip, resulting in impaired quality of life and increased mortality. Augmenting the proximal femur could be an attractive option for prevention of fracture or fixation device failure. We describe a tissue engineering based strategy to enhance long-term bone formation in the femoral neck of osteoporotic rats by locally delivering bioactive molecules; recombinant human bone morphogenic protein-2 (rhBMP-2), and zoledronic acid (ZA) by using a calcium sulfate/hydroxyapatite (CaS/HA) biomaterial. A defect was created by reaming the femoral neck canal of osteoporotic (OVX) rats and they were treated as follows: G1. Empty, G2. CaS/HA, G3. CaS/HA+Systemic ZA, G4. CaS/HA+Local ZA, and G5. CaS/HA+Local ZA+rhBMP-2. Bone formation was evaluated 6 months after treatment. Further, radioactively labeled 14C-ZA was used to study the bioavailability of ZA at the defect location, which was determined by using scintillation counting. Micro-CT indicated significantly higher bone volume in groups G4 and G5 compared with the other treatment groups. This was confirmed qualitatively by histological assessment. Addition of rhBMP-2 gave no additional benefit in this model. Local delivery of ZA performed better than systemic administration of ZA. Mechanical testing showed no differences between the groups, likely reflecting that the addition of bioactive molecules had limited effect on cortical bone or the choice of mechanical testing setup was not optimal. Scintillation counting revealed higher amounts of 14C-ZA present in the treated leg of G4 compared with its contralateral control and compared with G3, indicating that local ZA delivery can be used to achieve high local concentrations without causing a systemic effect. This long-term study shows that local delivery of ZA using a CaS/HA carrier can regenerate cancellous bone in the femoral neck canal and has clear implications for enhancing implant integration and fixation in fragile bone.
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Affiliation(s)
- Deepak Bushan Raina
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Aurimas Širka
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irfan Qayoom
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India
| | - Arun Kumar Teotia
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India
| | - Yang Liu
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sarunas Tarasevicius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kathleen Elizabeth Tanner
- Queen Mary University of London, School of Engineering and Materials Science and Institute of Bioengineering, London, United Kingdom
| | - Hanna Isaksson
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Ashok Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
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24
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Le Cann S, Tudisco E, Tägil M, Hall SA, Isaksson H. Bone Damage Evolution Around Integrated Metal Screws Using X-Ray Tomography - in situ Pullout and Digital Volume Correlation. Front Bioeng Biotechnol 2020; 8:934. [PMID: 32850760 PMCID: PMC7419699 DOI: 10.3389/fbioe.2020.00934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022] Open
Abstract
Better understanding of the local deformation of the bone network around metallic implants subjected to loading is of importance to assess the mechanical resistance of the bone-implant interface and limit implant failure. In this study, four titanium screws were osseointegrated into rat tibiae for 4 weeks and screw pullout was conducted in situ under x-ray microtomography, recording macroscopic mechanical behavior and full tomographies at multiple load steps before failure. Images were analyzed using Digital Volume Correlation (DVC) to access internal displacement and deformation fields during loading. A repeatable failure pattern was observed, where a ∼300–500 μm-thick envelope of bone detached from the trabecular structure. Fracture initiated close to the screw tip and propagated along the implant surface, at a distance of around 500 μm. Thus, the fracture pattern appeared to be influenced by the microstructure of the bone formed closely around the threads, which confirmed that the model is relevant for evaluating the effect of pharmacological treatments affecting local bone formation. Moreover, cracks at the tibial plateau were identified by DVC analysis of the tomographic images acquired during loading. Moderate strains were first distributed in the trabecular bone, which localized into higher strains regions with subsequent loading, revealing crack-formation not evident in the tomographic images. The in situ loading methodology followed by DVC is shown to be a powerful tool to study internal deformation and fracture behavior of the newly formed bone close to an implant when subjected to loading. A better understanding of the interface failure may help improve the outcome of surgical implants.
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Affiliation(s)
- Sophie Le Cann
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Erika Tudisco
- Division of Geotechnical Engineering, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
| | - Stephen A Hall
- Division of Solid Mechanics, Lund University, Lund, Sweden.,Lund Institute for Advanced Neutron and X-ray Science, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden.,Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
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25
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Sommer U, Laurich S, de Azevedo L, Viehoff K, Wenisch S, Thormann U, Alt V, Heiss C, Schnettler R. In Vitro and In Vivo Biocompatibility Studies of a Cast and Coated Titanium Alloy. Molecules 2020; 25:E3399. [PMID: 32727093 PMCID: PMC7436028 DOI: 10.3390/molecules25153399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022] Open
Abstract
The biocompatibility of a cast porous and with a calcium titanate reaction layer functionalized titanium alloy (Ti-6Al-7Nb) was tested by means of cell culture, and a small (rat) and large animal (sheep) model. The uncoated titanium material served as a control. In-vitro tests included the validation of osteoblast-like cells attached to the surface of the material with scanning electron microscopy and immunofluorescence of cytoskeletal actin as well as their osteogenic development, the ability to mineralize, and their vitality. Following the in-vitro tests a small animal (rat) and big animal (sheep) model were accomplished by inserting a cylindrical titanium implant into a drill hole defect in the femoral condyle. After 7, 14, and 30 days (rat) and 6 months (sheep) the condyles were studied regarding histological and histomorphometrical characteristics. Uncoated and coated material showed a good biocompatibility both in cell culture and animal models. While the defect area in the rat is well consolidated after 30 days, the sheep show only little bone inside the implant after 6 months, possibly due to stress shielding. None of the executed methods indicated a statistically significant difference between coated and uncoated material.
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Affiliation(s)
- Ursula Sommer
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128 (ForMED), 35392 Giessen, Germany; (S.L.); (L.d.A.); (K.V.); (U.T.); (C.H.)
| | - Stephan Laurich
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128 (ForMED), 35392 Giessen, Germany; (S.L.); (L.d.A.); (K.V.); (U.T.); (C.H.)
| | - Lucie de Azevedo
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128 (ForMED), 35392 Giessen, Germany; (S.L.); (L.d.A.); (K.V.); (U.T.); (C.H.)
| | - Katharina Viehoff
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128 (ForMED), 35392 Giessen, Germany; (S.L.); (L.d.A.); (K.V.); (U.T.); (C.H.)
| | - Sabine Wenisch
- Clinic of Small Animals, c/o Institute of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University Giessen, Frankfurter Strasse 98, 35392 Giessen, Germany;
| | - Ulrich Thormann
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128 (ForMED), 35392 Giessen, Germany; (S.L.); (L.d.A.); (K.V.); (U.T.); (C.H.)
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen-Marburg GmbH, Campus Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Christian Heiss
- Experimental Trauma Surgery, Justus-Liebig-University Giessen, Aulweg 128 (ForMED), 35392 Giessen, Germany; (S.L.); (L.d.A.); (K.V.); (U.T.); (C.H.)
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen-Marburg GmbH, Campus Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany
| | - Reinhard Schnettler
- Department of Oral and Maxillofacial Surgery, Division for Regenerative Orofacial Medicine, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany;
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26
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Combined fracture and mortality risk evaluation for stratifying treatment in hip fracture patients: A feasibility study. Jt Dis Relat Surg 2020; 31:163-168. [PMID: 32315279 PMCID: PMC7489183 DOI: 10.5606/ehc.2020.73458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/18/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to test the feasibility of the Fracture and Mortality Risk Evaluation (FAME) Index. PATIENTS AND METHODS Two academic centers in Lithuania and Turkey participated in this retrospective study conducted between November 2018 and July 2019. A total of 100 consecutive patients (22 males, 78 females; mean age 78.9 years; range, 45 to 100 years) with low energy proximal femur fractures admitted for surgery were included in the study. Fracture Risk Assessment tool (FRAX) and the Sernbo scores were calculated and patients were classified into one of the nine subcategories of the FAME Index. RESULTS Demographics and FAME Index classifications were similar between centers. Patients with high risk of fracture and low risk of mortality accounted for 18% of all patients, which is the FAME Index subcategory to theoretically benefit from cancellous bone augmentation during internal fixation of a fragility hip fracture the most. CONCLUSION The FAME Index was successfully applied in clinical emergency setting utilizing a simple form, and demonstrated promising potential in stratification of hip fractures most suitable for screw and device augmentation. Larger studies with at least one-year of follow-up are warranted to verify the validity of FAME Index.
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27
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Raina DB, Glencross A, Chaher N, Liu Y, Lidgren L, Isaksson H, Tägil M. Synthesis and Characterization of a Biocomposite Bone Bandage for Controlled Delivery of Bone-Active Drugs in Fracture Nonunions. ACS Biomater Sci Eng 2020; 6:2867-2878. [PMID: 33463281 DOI: 10.1021/acsbiomaterials.9b01574] [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] [Indexed: 11/30/2022]
Abstract
Fracture nonunions are common in orthopedics and their treatment often involves multiple surgical interventions. The aim of this study was to fabricate and characterize a gelatin-nano-hydroxyapatite membrane (GM)-based bone bandage for controlled delivery of bio-active molecules; recombinant human bone morphogenic protein-2 (rhBMP-2) and zoledronic acid (ZA) to promote osteoinduction and prevent callus resorption, respectively. In vitro cell-material interaction experiments using MC3T3 cells seeded on the GM indicated good biocompatibility. rhBMP-2-functionalized GM promoted osteogenic differentiation of MC3T3 cells and the rhBMP-2 bio-activity thus remained, as indicated by increased levels of alkaline phosphatase compared to only GM. The GM released a small amount (1.1%) of rhBMP-2 in vitro over a period of 5 weeks, demonstrating a strong interaction of rhBMP-2 with the GM. In the first animal study, the GM specimens loaded with rhBMP-2 or with the combination of rhBMP-2 + ZA were placed in the abdominal muscle pouch of rats. In the GM + rhBMP-2 + ZA group, significantly higher bone volume (21.5 ± 5.9 vs 2.7 ± 1.0 mm3) and area (3.3 ± 2.3 vs 1.0 ± 0.4 mm2) of bone were observed compared to GM + rhBMP-2 after 4 weeks, as indicated by micro-computed tomography and histomorphometry, respectively. Finally, a nonunion model in rats was used to evaluate the efficacy of the GM bandage and bio-active molecules in healing of fracture nonunions. The GM functionalized with rhBMP-2 + ZA led to higher bone formation around the fracture (63.9 ± 19.0 vs 31.8 ± 3.7 mm3) and stronger fracture callus (110.8 ± 46.8 vs 45.6 ± 17.8 N) compared to the empty controls. However, the overall union rate was only marginally improved. The GM alone or combined with ZA did not aid in bone healing in this model. Thus, this study shows that controlled delivery of rhBMP-2 + ZA via the developed GM is a promising approach that could aid in earlier full load bearing in patients with nonunion.
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Affiliation(s)
- Deepak Bushan Raina
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund 221 85, Sweden
| | - Alexandra Glencross
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund 221 85, Sweden.,Biomedical Engineering, Glasgow University, Glasgow G12 8QQ, U.K
| | - Nadia Chaher
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund 221 85, Sweden.,Biomedical Engineering, Glasgow University, Glasgow G12 8QQ, U.K
| | - Yang Liu
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund 221 85, Sweden
| | - Lars Lidgren
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund 221 85, Sweden
| | - Hanna Isaksson
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund 221 85, Sweden.,Department of Biomedical Engineering, Lund University, Lund 221 00, Sweden
| | - Magnus Tägil
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund 221 85, Sweden
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Raina DB, Liu Y, Isaksson H, Tägil M, Lidgren L. Synthetic hydroxyapatite: a recruiting platform for biologically active molecules. Acta Orthop 2019; 91:126-132. [PMID: 31680611 PMCID: PMC7144254 DOI: 10.1080/17453674.2019.1686865] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Targeted delivery of drugs is important to achieve efficient local concentrations and reduce systemic side effects. We hypothesized that locally implanted synthetic hydroxyapatite (HA) particles can act as a recruiting moiety for systemically administered drugs, leading to targeted drug accretion.Methods - Synthetic HA particles were implanted ectopically in a muscle pouch in rats, and the binding of systemically circulating drugs such as zoledronic acid (ZA), tetracycline and 18F-fluoride (18F) was studied. The local biological effect was verified in an implant integration model in rats, wherein a hollow implant was filled with synthetic HA particles and the animals were given systemic ZA, 2-weeks post-implantation. The effect of HA particle size on drug binding and the possibility of reloading HA particles were also evaluated in the muscle pouch.Results - The systemically administered biomolecules (ZA, tetracycline and 18F) all sought the HA moiety placed in the muscle pouch. Statistically significant higher peri-implant bone volume and peak force were observed in the implant containing HA particles compared with the empty implant. After a single injection of ZA at 2 weeks, micro HA particles showed a tendency to accumulate more 14C-zoledronic acid (14C-ZA) than nano-HA particles in the muscle pouch. HA particles could be reloaded when ZA was given again at 4 weeks, showing increased 14C-ZA accretion by 73% in microparticles and 77% in nanoparticles.Interpretation - We describe a novel method of systemic drug loading resulting in targeted accretion in locally implanted particulate HA, thereby biologically activating the material.
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Affiliation(s)
- Deepak Bushan Raina
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund; ,Correspondence:
| | - Yang Liu
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund;
| | - Hanna Isaksson
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund; ,Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Magnus Tägil
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund;
| | - Lars Lidgren
- Faculty of Medicine, Department of Clinical Sciences, Orthopedics, Lund University, Lund;
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