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Sauer K, Zizak I, Forien JB, Rack A, Scoppola E, Zaslansky P. Primary radiation damage in bone evolves via collagen destruction by photoelectrons and secondary emission self-absorption. Nat Commun 2022; 13:7829. [PMID: 36539409 PMCID: PMC9768145 DOI: 10.1038/s41467-022-34247-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/18/2022] [Indexed: 12/24/2022] Open
Abstract
X-rays are invaluable for imaging and sterilization of bones, yet the resulting ionization and primary radiation damage mechanisms are poorly understood. Here we monitor in-situ collagen backbone degradation in dry bones using second-harmonic-generation and X-ray diffraction. Collagen breaks down by cascades of photon-electron excitations, enhanced by the presence of mineral nanoparticles. We observe protein disintegration with increasing exposure, detected as residual strain relaxation in pre-stressed apatite nanocrystals. Damage rapidly grows from the onset of irradiation, suggesting that there is no minimal 'safe' dose that bone collagen can sustain. Ionization of calcium and phosphorous in the nanocrystals yields fluorescence and high energy electrons giving rise to structural damage that spreads beyond regions directly illuminated by the incident radiation. Our findings highlight photoelectrons as major agents of damage to bone collagen with implications to all situations where bones are irradiated by hard X-rays and in particular for small-beam mineralized collagen fiber investigations.
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Affiliation(s)
- Katrein Sauer
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, Department for Operative, Preventive and Pediatric Dentistry, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| | - Ivo Zizak
- grid.424048.e0000 0001 1090 3682Helmholtz-Zentrum Berlin, Department for Structure and Dynamics of Energy Materials (SE-ASD), Albert-Einstein-Straße 15, 12489 Berlin, Germany
| | - Jean-Baptiste Forien
- grid.250008.f0000 0001 2160 9702Lawrence Livermore National Laboratory, Materials Science Division, 7000 East Ave, Livermore, CA 94550 USA
| | - Alexander Rack
- grid.5398.70000 0004 0641 6373ESRF - The European Synchrotron, Structure of Materials Group - ID19, CS 40220, F-38043, Grenoble, Cedex 9 France
| | - Ernesto Scoppola
- grid.461615.10000 0000 8925 2562Max Planck Institute of Colloids and Interfaces, Department of Biomaterials, Am Mühlenberg 1, 14476 Potsdam, Brandenburg Germany
| | - Paul Zaslansky
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, Department for Operative, Preventive and Pediatric Dentistry, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
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Montagner G, De Vettor R, Favaretto F, Vici D, Del Vecchio C, Franchin E, Trojan D, Feltrin G. Impact of Sars-CoV-2 pandemic on the Veneto Region multitissue bank activity. Cell Tissue Bank 2022; 23:825-832. [PMID: 35235097 PMCID: PMC8889055 DOI: 10.1007/s10561-022-09997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/13/2022] [Indexed: 01/08/2023]
Abstract
Covid pandemic affected donation activities worldwide, especially for living donation due to the lack of elective surgery. Moreover, the number of heart-beating and non-heart beating donors has recorded a decrease. Fondazione Banca dei Tessuti di Treviso (FBTV) is a non-profit healthcare organisation, located in Veneto Region, tasked with procurement, processing, preserving, validating and distributing human tissue for clinical use. During Covid-19 outbreak, operations in FBTV have never stopped and a great effort was required to maintain a standard trend of activity. The aim of this study was to describe the impact of Sars-CoV-2 on the activity of a multitissue bank in Italy. Moreover, we investigated the presence of the virus in tissues retrieved from two Sars-CoV-2 positive cadaver donors. Our survey demonstrated that the transplantation network of Veneto Region has positively reacted to the pandemic scenario, thanks to the effort of all personnel involved. Statistical analyses underlined that most of the activities of the tissue bank were unaffected during the Sars-CoV-2 pandemic.
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Affiliation(s)
| | - Rudy De Vettor
- Fondazione Banca dei Tessuti di Treviso Onlus, Treviso, Italy
| | | | - Daniela Vici
- Fondazione Banca dei Tessuti di Treviso Onlus, Treviso, Italy
| | | | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Diletta Trojan
- Fondazione Banca dei Tessuti di Treviso Onlus, Treviso, Italy
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Effect of Gamma Irradiation on the Osteoinductivity of Demineralized Dentin Matrix for Allografts: A Preliminary Study. J Funct Biomater 2022; 13:jfb13010014. [PMID: 35225977 PMCID: PMC8883982 DOI: 10.3390/jfb13010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 12/03/2022] Open
Abstract
Demineralized dentin matrix (DDM) treated with gamma irradiation (GR) has shown promising results as an allograft without any adverse effects in in vivo and clinical studies. The purpose of this study was to evaluate the effects of 15 and 25 kGy GR on the osteoinductive properties of DDM at extra-skeletal sites. As a control group, non-irradiated DDM powder was implanted into the right subcutaneous tissues of the dorsal thigh muscles of 20 nude mice. DDM powder irradiated with 15 and 25 kGy was implanted into the left side. After two and four weeks, the bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry. After confirming osteoblast- and osteoclast-specific activities by alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP) staining, a histological analysis was performed to measure the new bone formation and the number of osteoblasts and osteoclast-like cells on the surface of the DDMs. Histomorphometry was used to calculate the new bone formation area on the surface of the DDM particles (DDMs). The BMD in all the groups increased from two and four weeks without statistically significant differences. The osteoblasts were dominantly activated on DDM without GR, and DDM treated with 25 kGy compared to DDM treated with 15 kGy. Among the groups, new bone formation was identified in all the groups at each time point. In conclusion, GR at doses of 15 and 25 kGy does not affect the osteoinductive properties of DDM powder.
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Baseri N, Meysamie A, Campanile F, Hamidieh AA, Jafarian A. Bacterial contamination of bone allografts in the tissue banks: a systematic review and meta-analysis. J Hosp Infect 2021; 123:156-173. [PMID: 34752801 DOI: 10.1016/j.jhin.2021.10.020] [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: 06/15/2021] [Revised: 10/02/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone allografts are harvested and transplanted under sterile conditions. However, the risk of bacterial contamination of grafts during these processes is a health concern. Bioburden testing and bacterial contamination detection are conducted to ensure allograft sterility. AIM The present study aimed to determine the incidence of bacterial contamination in bone allografts based on different classifications. METHODS PROSPERO registration number was received for the study. Systematic searches were conducted in PubMed and EMBASE databases with relevant keywords from January 2000 to March 2021. After choosing related studies according to the PRISMA flow diagram, Stata software was used for data analysis. We considered I2 ˃ 50% as heterogeneity between studies. FINDINGS The overall incidence of bacterial contamination was 12.6% (95% CI 0.100, 0.152) among 19,805 bone allografts of 17 studies. The bacterial contamination rate among bone allografts was 10.8% before 2010 and 14.7% in 2010-March 2021. The contamination frequency in Asia, Europe, and Australia was 11.5%, 14.3%, and 5.2%, respectively. Bone contamination rates were higher in cadaver donors (19.9%), retrieval time sampling (13.5%), and swab samples (13.2%) compared to those in living donors (7.5%), implantation time sampling (6.9%), and bone fragments cultures (6.3%). Bacterial contamination was recovered 24.4%, 19.7%, 13.2%, and 21% from tibia, fibula, femoral, and other bones, respectively. Staphylococcus spp. was the predominant isolated bacteria from bones (63.2% of all isolated genera), followed by Propionibacterium spp. (10.6%). CONCLUSION The high contamination of bone allografts is a health concern, indicating the need for more health monitoring and improvement of standards.
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Affiliation(s)
- Neda Baseri
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging infectious diseases, Pasteur Institute of Iran, Tehran, Iran; National Reference laboratory for Plague, Tularemia and Q fever, Research Centre for Emerging and Reemerging infectious diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran
| | - Alipasha Meysamie
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Floriana Campanile
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Medical Molecular Microbiology and Antibiotic Resistance laboratory (MMARLab), University of Catania, Catania, Italy
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arefeh Jafarian
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Supercritical CO 2 technology for one-pot foaming and sterilization of polymeric scaffolds for bone regeneration. Int J Pharm 2021; 605:120801. [PMID: 34139307 DOI: 10.1016/j.ijpharm.2021.120801] [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: 04/21/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/21/2022]
Abstract
Sterilization is a quite challenging step in the development of novel polymeric scaffolds for regenerative medicine since conventional sterilization techniques may significantly alter their morphological and physicochemical properties. Supercritical (sc) sterilization, i.e. the use of scCO2 as a sterilizing agent, emerges as a promising sterilization method due to the mild operational conditions and excellent penetration capability. In this work, a scCO2 protocol was implemented for the one-pot preparation and sterilization of poly(ε-caprolactone) (PCL)/poly(lactic-co-glycolic acid) (PLGA) scaffolds. The sterilization conditions were established after screening against both Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli, Pseudomonas aeruginosa) vegetative bacteria and spores of Bacillus stearothermophilus, Bacillus pumilus and Bacillus atrophaeus. The transition from the sterilization conditions (140 bar, 39 °C) to the compressed foaming (60 bar, 26 °C) was performed through controlled depressurization (3.2 bar/min) and CO2 liquid flow. Controlled depressurization/pressurization cycles were subsequently applied. Using this scCO2 technology toolbox, sterile scaffolds of well-controlled pore architecture were obtained. This sterilization procedure successfully achieved not only SAL-6 against well-known resistant bacteria endospores but also improved the scaffold morphologies compared to standard gamma radiation sterilization procedures.
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Bargh S, Silindir-Gunay M, Ozer AY, Ekizoglu M, Kart D, Kutlu B, Nohutcu R. The effect of gamma and microwave radiation sterilization on periodontological grafts for microbiological evaluation. APMIS 2021; 129:587-597. [PMID: 34117658 DOI: 10.1111/apm.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/05/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
Abstract
Periodontological grafts are materials used in dentistry to regenerate lost gingival soft tissues or bone parts. In the case of direct contact with blood, the possibility of disease transmission from the source to the patient is high. This source can be an animal or a human. Therefore, the sterilization of grafts before implanting to the patient is of significant importance. The purpose of this study was to evaluate gamma radiation and microwave sterilization processes from microbiological and sterility perspectives and to compare the effectiveness of these two sterilization methods. Grafts were irradiated with 2, 4, 5, 10, 25 and 50 kGy doses of gamma radiation. Another group of same materials was irradiated by microwave for 1, 2, 3 and 4 min at 24,500 MHz and 900 W. Gamma radiation and microwave sterilization methods were evaluated as successful at minimum doses as 5 kGy and 3 min, respectively. Both gamma and microwave sterilization successfu lly sterilized periodontological grafts coded as PBG1, HBG1, HL1, PDG1, MBG3, MDG2 and PDG3. Moreover, microwave sterilization can be used as an alternative novel method to gamma radiation sterilization.
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Affiliation(s)
- Saharnaz Bargh
- Department of Radiopharmacy, Faculty of Pharmacy, Hacettepe, Ankara, Turkey
| | | | - A Yekta Ozer
- Department of Radiopharmacy, Faculty of Pharmacy, Hacettepe, Ankara, Turkey
| | - Melike Ekizoglu
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe, Ankara, Turkey
| | - Didem Kart
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe, Ankara, Turkey
| | - Burak Kutlu
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Rahime Nohutcu
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Pendleton MM, Emerzian SR, Liu J, Tang SY, O'Connell GD, Alwood JS, Keaveny TM. Effects of ex vivo ionizing radiation on collagen structure and whole-bone mechanical properties of mouse vertebrae. Bone 2019; 128:115043. [PMID: 31445224 PMCID: PMC6813909 DOI: 10.1016/j.bone.2019.115043] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022]
Abstract
Bone can become brittle when exposed to ionizing radiation across a wide range of clinically relevant doses that span from radiotherapy (accumulative 50 Gy) to sterilization (~35,000 Gy). While irradiation-induced embrittlement has been attributed to changes in the collagen molecular structure, the relative role of collagen fragmentation versus non-enzymatic collagen crosslinking remains unclear. To better understand the effects of radiation on the bone material without cellular activity, we conducted an ex vivo x-ray radiation experiment on excised mouse lumbar vertebrae. Spinal tissue from twenty-week old, female, C57BL/6J mice were randomly assigned to a single x-ray radiation dose of either 0 (control), 50, 1000, 17,000, or 35,000 Gy. Measurements were made for collagen fragmentation, non-enzymatic collagen crosslinking, and both monotonic and cyclic-loading compressive mechanical properties. We found that the group differences for mechanical properties were more consistent with those for collagen fragmentation than for non-enzymatic collagen crosslinking. Monotonic strength at 17,000 and 35,000 Gy was lower than that of the control by 50% and 73% respectively, (p < 0.001) but at 50 and 1000 Gy was not different than the control. Consistent with those trends, collagen fragmentation only occurred at 17,000 and 35,000 Gy. By contrast, non-enzymatic collagen crosslinking was greater than control for all radiation doses (p < 0.001). All results were consistent both for monotonic and cyclic loading conditions. We conclude that the reductions in bone compressive monotonic strength and fatigue life due to ex vivo ionizing radiation are more likely caused by fragmentation of the collagen backbone than any increases in non-enzymatic collagen crosslinks.
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Affiliation(s)
- Megan M Pendleton
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Shannon R Emerzian
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Jennifer Liu
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Simon Y Tang
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA; Department of Material Science & Mechanical Engineering, Washington University, St. Louis, MO, USA
| | - Grace D O'Connell
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA; Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Joshua S Alwood
- Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Tony M Keaveny
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA; Department of Bioengineering, University of California, Berkeley, CA, USA.
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Erivan R, Aubret S, Villatte G, Cueff R, Mulliez A, Descamps S, Boisgard S. Irradiation at 11 kGy conserves the biomechanical properties of fascia lata better than irradiation at 25 kGy. Clin Biomech (Bristol, Avon) 2018; 60:100-107. [PMID: 30340149 DOI: 10.1016/j.clinbiomech.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/24/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
The objective of this study was to determine the biomechanical properties of the fascia lata and the effects of three preservation methods: freezing, cryopreservation with dimethylsulfoxide solution and lyophilization; and to compare the effects of low-dose (11 kGy) and normal-dose (25 kGy) gamma-ray sterilization versus no irradiation. 248 samples from 14 fasciae latae were collected. Freezing samples were frozen at -80 °C. Cryopreservation with dimethylsulfoxide solution samples were frozen with 10 cl dimethylsulfoxide solution at -80 °C. Lyophilization samples were frozen at -22 °C and lyophilized. Each preservation group were then randomly divided into 3 irradiation groups. The cryopreservation with dimethylsulfoxide solution samples had significantly worse results in all 3 irradiation conditions. Young's modulus was lower for the freezing samples (p < 0.001) and lyophilization samples groups (p < 0.001). Tear deformation was lower for the freezing samples (p = 0.001) and lyophilization samples groups (p = 0.003), as was stress at break (p < 0.001 and p < 0.001). Taking all preservation methods together, samples irradiated at 25 kGy had worse results than the 0 kGy and 11 kGy groups in terms of Young's modulus (p = 0.007 and p = 0.13) and of stress at break (p = 0.006 and p = 0.06). The biomechanical properties of fascia lata allografts were significantly worse under dimethylsulfoxide cryopreservation. The deleterious effects of irradiation were dose-dependent.
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Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France.
| | - Sylvain Aubret
- Université Clermont Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Régis Cueff
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la Recherche Clinique et aux Innovations (DRCI), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France
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Rahman N, Khan R, Badshah S. Effect of x-rays and gamma radiations on the bone mechanical properties: literature review. Cell Tissue Bank 2018; 19:457-472. [PMID: 30426337 DOI: 10.1007/s10561-018-9736-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022]
Abstract
The bone auto grafting, isografting, allografting and xenografting are used for defective bone replacement or treatment in almost all living species. The X-ray and Gamma (electromagnetic radiation) sterilization performed on the donor bone graft to prevent toxicity or migration of virus/bacterial infections from donors to reciver. Conversely, X-ray and Gamma radiation deteriorates the bone mechanical properties and bone become more susceptible to fracture. Fracture toughness as well as other mechanical properties of bone change with these radiations. In this literature review the effect of the X-rays and Gamma radiation on bone mechanical properties are discussed. All relevant literature was reviewed. After reviewing the literature only the research relating to the effect of X-rays and Gamma radiations on bone mechanical properties are included. Literature studies showed significant effect of the X-rays and Gamma radiations on the mechanical properties of the bones. In some studies the differences exists on the doses of radiations which were discussed in this study. The high energetic electromagnetic radiation (X-rays and Gamma radiations) changed/modify the collagen network of the bone, which reduced the mechanical properties of bone; however these changes depend on the radiation dose.
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Affiliation(s)
- Noor Rahman
- Department of Mechanical Engineering, Faculty of Engineering and Technology, International Islamic University, Islamabad, H-10, Pakistan.
| | - Rafiullah Khan
- Department of Mechanical Engineering, Faculty of Engineering and Technology, International Islamic University, Islamabad, H-10, Pakistan
| | - Saeed Badshah
- Department of Mechanical Engineering, Faculty of Engineering and Technology, International Islamic University, Islamabad, H-10, Pakistan
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10
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Yusof N. Advances of radiation sterilisation in tissue banking. Cell Tissue Bank 2017; 19:175-186. [PMID: 29022196 DOI: 10.1007/s10561-017-9651-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/08/2017] [Indexed: 01/20/2023]
Abstract
Under the auspices of the IAEA tissue banking programme on "Radiation Sterilisation of Tissue Graft" conducted from 1985 to 2004, many scientists and surgeons were involved in various regional research and development (R&D) projects mainly in dealing with radiation dose selection, radiation effects on human tissues and quality system in radiation sterilisation. New findings on radiation effects, tissue processing and preservation were shared during the regional and interregional meetings and workshops. Many tissue banks started to use radiation (25 kGy) to sterilize tissue grafts for tissue safety and efficacy and still continue to use it. The IAEA Code of Practice for Radiation Sterilization of Tissues Allografts developed in 2007 offered simpler methods to conduct radiation dose setting and dose validation experiments for tissue grafts. Advances in dose selection and dose mapping are continued under the quality management system when banks need to be certified to continue their operation. The combination of good tissue processing and preservation as well as good radiation practice will ensure the tissue products are properly sterilised thus safe and of high quality. Experience in meeting challenges in using radiation sterilisation and achievements reported by the tissue bankers are shared here.
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Affiliation(s)
- Norimah Yusof
- UMMC Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Mohr J, Germain M, Winters M, Fraser S, Duong A, Garibaldi A, Simunovic N, Alsop D, Dao D, Bessemer R, Ayeni OR. Disinfection of human musculoskeletal allografts in tissue banking: a systematic review. Cell Tissue Bank 2016; 17:573-584. [PMID: 27665294 PMCID: PMC5116033 DOI: 10.1007/s10561-016-9584-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/09/2016] [Indexed: 01/12/2023]
Abstract
Musculoskeletal allografts are typically disinfected using antibiotics, irradiation or chemical methods but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of microorganism kill; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. A systematic review of three databases found 68 laboratory and clinical studies that analyzed the microbial bioburden or contamination rates of musculoskeletal allografts. The use of peracetic acid–ethanol or ionizing radiation was found to be most effective for disinfection of tissues. The use of irradiation is the most frequently published method for the terminal sterilization of musculoskeletal allografts; it is widely used and its efficacy is well documented in the literature. However, effective disinfection results were still observed using the BioCleanse™ Tissue Sterilization process, pulsatile lavage with antibiotics, ethylene oxide, and chlorhexidine. The variety of effective methods to reduce contamination rate or bioburden, in conjunction with limited high quality evidence provides little support for the recommendation of a single bioburden reduction method.
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Affiliation(s)
- J Mohr
- Canadian Blood Services, 270 John Savage Ave., Dartmouth, NS, B3B 0H7, Canada
| | - M Germain
- Héma-Québec, 1070 Sciences-de-la-Vie Avenue, Quebec, QC, G1V 5C3, Canada
| | - M Winters
- Nelson Laboratories, 6280 South Redwood Road, Salt Lake City, UT, 84123-6600, USA
| | - S Fraser
- Canadian Blood Services, 270 John Savage Ave., Dartmouth, NS, B3B 0H7, Canada
| | - A Duong
- Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - A Garibaldi
- Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - N Simunovic
- Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - D Alsop
- Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - D Dao
- Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - R Bessemer
- Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - O R Ayeni
- Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada. .,McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Singh AK, Gajiwala AL, Rai RK, Khan MP, Singh C, Barbhuyan T, Vijayalakshmi S, Chattopadhyay N, Sinha N, Kumar A, Bellare JR. Cross-correlative 3D micro-structural investigation of human bone processed into bone allografts. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 62:574-84. [DOI: 10.1016/j.msec.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
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13
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Akhtar N, Rahman MS, Jamil HM, Arifuzzaman M, Miah MM, Asaduzzaman SM. Tissue banking in Bangladesh: 12 years of experience (2003–2014). Cell Tissue Bank 2016; 17:189-97. [DOI: 10.1007/s10561-016-9549-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 02/22/2016] [Indexed: 01/28/2023]
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A retrospective study on annual evaluation of radiation processing for frozen bone allografts complying to quality system requirements. Cell Tissue Bank 2015; 16:545-52. [PMID: 25687771 DOI: 10.1007/s10561-015-9501-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
Abstract
Bone allografts have been used widely to fill up essential void in orthopaedic surgeries. The benefit of using allografts to replace and reconstruct musculoskeletal injuries, fractures or disease has obtained overwhelming acceptance from orthopaedic surgeons worldwide. However, bacterial infection and disease transmission through bone allograft transplantation have always been a significant issue. Sterilization by radiation is an effective method to eliminate unwanted microorganisms thus assist in preventing life threatening allograft associated infections. Femoral heads procured from living donors and long bones (femur and tibia) procured from cadaveric donors were sterilized at 25 kGy in compliance with international standard ISO 11137. According to quality requirements, all records of bone banking were evaluated annually. This retrospective study was carried out on annual evaluation of radiation records from 1998 until 2012. The minimum doses absorbed by the bones were ranging from 25.3 to 38.2 kGy while the absorbed maximum doses were from 25.4 to 42.3 kGy. All the bones supplied by our UMMC Bone Bank were sterile at the required minimum dose of 25 kGy. Our analysis on dose variation showed that the dose uniformity ratios in 37 irradiated boxes of 31 radiation batches were in the range of 1.003-1.251, which indicated the doses were well distributed.
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Varettas K. RT-PCR testing of allograft musculoskeletal tissue: is it time for culture-based methods to move over? Pathology 2014; 46:640-3. [PMID: 25393256 DOI: 10.1097/pat.0000000000000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Allograft musculoskeletal tissue samples are assessed for microbial bioburden to reduce the risk of post-transplant infection. Traditionally, solid agar and broth culture media have been used however, nucleic acid testing, such as real-time (RT) polymerase chain reaction (PCR), has been described as more sensitive. This study evaluated the recovery of low numbers of challenge organisms from inoculated swab and musculoskeletal biopsy samples using solid agar culture, cooked meat medium, blood culture bottles and a RT-PCR assay. It was found that broth culture methods were the most sensitive with RT-PCR unable to detect low numbers of bacteria from these samples. Investigation of other non-culture methods may be worthwhile.
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Affiliation(s)
- Kerry Varettas
- South Eastern Area Laboratory Services (SEALS), St George Hospital, Sydney, NSW, Australia
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Türker NS, Özer AY, Kutlu B, Nohutcu R, Sungur A, Bilgili H, Ekizoglu M, Özalp M. The effect of gamma radiation sterilization on dental biomaterials. Tissue Eng Regen Med 2014. [DOI: 10.1007/s13770-014-0016-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nguyen H, Cassady AI, Bennett MB, Gineyts E, Wu A, Morgan DAF, Forwood MR. Reducing the radiation sterilization dose improves mechanical and biological quality while retaining sterility assurance levels of bone allografts. Bone 2013; 57:194-200. [PMID: 23912050 DOI: 10.1016/j.bone.2013.07.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bone allografts carry a risk of infection, so terminal sterilization by gamma irradiation at 25kGy is recommended; but is deleterious to bone quality. Contemporary bone banking significantly reduces initial allograft bioburden, questioning the need to sterilize at 25kGy. METHODS We inoculated allograft bone with Staphylococcus epidermidis and Bacillus pumilus, then exposed them to gamma irradiation at 0, 5, 10, 15, 20 and 25kGy. Mechanical and biological properties of allografts were also assessed. Our aim was to determine an optimal dose that achieves sterility assurance while minimizing deleterious effects on allograft tissue. RESULTS 20-25kGy eliminated both organisms at concentrations from 10(1) to 10(3)CFU, while 10-15kGy sterilized bone samples to a bioburden concentration of 10(2)CFU. Irradiation did not generate pro-inflammatory bone surfaces, as evidenced by macrophage activation, nor did it affect attachment or proliferation of osteoblasts. At doses ≥10kGy, the toughness of cortical bone was reduced (P<0.05), and attachment and fusion of osteoclasts onto irradiated bone declined at 20 and 25kGy (P<0.05). There was no change in collagen cross-links, but a significant dose-response increase in denatured collagen (P<0.05). CONCLUSIONS Our mechanical and cell biological data converge on 15kGy as a threshold for radiation sterilization of bone allografts. Between 5 and 15kGy, bone banks can undertake validation that provides allografts with an acceptable sterility assurance level, improving their strength and biocompatibility significantly. CLINICAL RELEVANCE The application of radiation sterilization doses between 5 and 15kGy will improve bone allograft mechanical performance and promote integration, while retaining sterility assurance levels. Improved quality of allograft bone will promote superior clinical outcomes.
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Affiliation(s)
- Huynh Nguyen
- Griffith Health Institute and School of Medical Science, Griffith University, Gold Coast, QLD 4222, Australia; Queensland Bone Bank, Organ and Tissue Donation Service, Queensland Health, Brisbane, QLD, Australia
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18
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Costi JJ, Edmonds-Wilson RH, Howie DW, Stamenkov R, Field JR, Stanley RM, Hearn TC, Callary SA, McGee MA. Stem micromotion after femoral impaction grafting using irradiated allograft bone: a time zero in vitro study. Clin Biomech (Bristol, Avon) 2013; 28:770-6. [PMID: 23896432 DOI: 10.1016/j.clinbiomech.2013.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 06/30/2013] [Accepted: 07/04/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND A gamma irradiation dose of 15kGy has been shown to adequately sterilise allograft bone, commonly used in femoral impaction bone grafting to treat bone loss at revision hip replacement, without significantly affecting its mechanical properties. The objective of this study was to evaluate whether use of 15kGy irradiated bone affects the initial mechanical stability of the femoral stem prosthesis, as determined by micromotion in a comprehensive testing apparatus, in a clinically relevant time zero in vitro model of revision hip replacement. METHODS Morselised ovine bone was nonirradiated (control), or irradiated at 15kGy or 60kGy. For each dose, six ovine femurs were implanted with a cemented polished taper stem following femoral impaction bone grafting. Using testing apparatus that reproduces stem loading, stems were cyclically loaded and triaxial micromotion of the stem relative to the bone was measured at the proximal and distal stem regions using non-contact laser transducers and linear variable differential transformers. FINDINGS There were no significant differences in proximal or distal stem micromotion between groups for all directions (p≤0.80), apart for significantly greater distal stem medial-lateral micromotion in the 60kGy group compared to the 15kGy group (P=0.03), and near-significance in the anterior-posterior direction (P=0.08, power=0.85). INTERPRETATION Using a clinically relevant model and loading apparatus, irradiation of bone at 15kGy does not affect initial femoral stem stability following femoral impaction bone grafting.
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Affiliation(s)
- John J Costi
- Biomechanics & Implants Research Group, The Medical Device Research Institute, Flinders University, South Australia, Australia.
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Wong MYW, Yu Y, Yang JL, Woolford T, Morgan DAF, Walsh WR. 11 kGy gamma irradiated demineralized bone matrix enhances osteoclast activity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:655-61. [DOI: 10.1007/s00590-013-1238-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/15/2013] [Indexed: 12/29/2022]
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Dosimetric studies for gamma radiation validation of medical devices. Appl Radiat Isot 2013; 71:21-8. [DOI: 10.1016/j.apradiso.2012.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 09/11/2012] [Accepted: 09/20/2012] [Indexed: 11/19/2022]
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Matković I, Maltar-Strmečki N, Babić-Ivančić V, Dutour Sikirić M, Noethig-Laslo V. Characterisation of β-tricalcium phosphate-based bone substitute materials by electron paramagnetic resonance spectroscopy. Radiat Phys Chem Oxf Engl 1993 2012. [DOI: 10.1016/j.radphyschem.2012.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Inactivation of enveloped and non-enveloped viruses on seeded human tissues by gamma irradiation. Cell Tissue Bank 2011; 13:401-7. [PMID: 21809182 PMCID: PMC3432196 DOI: 10.1007/s10561-011-9266-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/25/2011] [Indexed: 12/11/2022]
Abstract
Human tissue allografts are widely used in a variety of clinical applications with over 1.5 million implants annually in the US alone. Since the 1990s, most clinically available allografts have been disinfected to minimize risk of disease transmission. Additional safety assurance can be provided by terminal sterilization using low dose gamma irradiation. The impact of such irradiation processing at low temperatures on viruses was the subject of this study. In particular, both human tendon and cortical bone samples were seeded with a designed array of viruses and the ability of gamma irradiation to inactivate those viruses was tested. The irradiation exposures for the samples packed in dry ice were 11.6–12.9 kGy for tendon and 11.6–12.3 kGy for bone, respectively. The viruses, virus types, and log reductions on seeded tendon and bone tissue, respectively, were as follows: Human Immunodeficiency Virus (RNA, enveloped), >2.90 and >3.20; Porcine Parvovirus (DNA, non-enveloped), 1.90 and 1.58; Pseudorabies Virus (DNA, enveloped), 3.80 and 3.79; Bovine Viral Diarrhea Virus (RNA, enveloped), 2.57 and 4.56; and Hepatitis A Virus (RNA, non-enveloped), 2.54 and 2.49, respectively. While proper donor screening, aseptic technique, and current disinfection practices all help reduce the risk of viral transmission from human allograft tissues, data presented here indicate that terminal sterilization using a low temperature, low dose gamma irradiation process inactivates both enveloped and non-enveloped viruses containing either DNA or RNA, thus providing additional assurance of safety from viral transmission.
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Sponge swabs increase sensitivity of sterility testing of processed bone and tendon allografts. J Ind Microbiol Biotechnol 2011; 38:1127-32. [DOI: 10.1007/s10295-011-0982-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/04/2011] [Indexed: 11/29/2022]
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