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Sachse A, Hasenbein I, Hortschansky P, Schmuck KD, Maenz S, Illerhaus B, Kuehmstedt P, Ramm R, Huber R, Kunisch E, Horbert V, Gunnella F, Roth A, Schubert H, Kinne RW. BMP-2 (and partially GDF-5) coating significantly accelerates and augments bone formation close to hydroxyapatite/tricalcium-phosphate/brushite implant cylinders for tibial bone defects in senile, osteopenic sheep. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:31. [PMID: 37378714 PMCID: PMC10307740 DOI: 10.1007/s10856-023-06734-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Bilateral defects (diameter 8 mm) in the medial tibial head of senile, osteopenic female sheep (n = 48; 9.63 ± 0.10 years; mean ± SEM) were treated with hydroxyapatite (HA)/beta-tricalcium phosphate (β-TCP)/dicalcium phosphate dihydrate (DCPD; brushite) cylinders coated with BMP-2 (25 or 250 micrograms) or growth differentiation factor (GDF)-5 (125 or 1250 micrograms; left side); cylinders without BMP served as controls (right side). Three, 6, and 9 months post-operation (n = 6 each group), bone structure and formation were analyzed in vivo by X-ray and ex vivo by osteodensitometry, histomorphometry, and micro-computed tomography (micro-CT) at 3 and 9 months. Semi-quantitative X-ray evaluation showed significantly increasing bone densities around all implant cylinders over time. High-dose BMP-2-coated cylinders (3 and 9 months) and low-dose GDF-5-coated cylinders (3 and 6 months) demonstrated significantly higher densities than controls (dose-dependent for BMP-2 at 3 months). This was confirmed by osteodensitometry at 9 months for high-dose BMP-2-coated cylinders (and selected GDF-5 groups), and was again dose-dependent for BMP-2. Osteoinduction by BMP-2 was most pronounced in the adjacent bone marrow (dynamic histomorphometry/micro-CT). BMP-2 (and partially GDF-5) significantly increased the bone formation in the vicinity of HA/TCP/DCPD cylinders used to fill tibial bone defects in senile osteopenic sheep and may be suitable for surgical therapy of critical size, non-load-bearing bone defects in cases of failed tibial head fracture or defect healing.
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Affiliation(s)
- André Sachse
- Experimental Rheumatology Unit, Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
- Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
| | - Ines Hasenbein
- Experimental Rheumatology Unit, Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
- Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
| | - Peter Hortschansky
- Leibniz-Institute for Natural Products Research and Infection Biology-Hans-Knoell-Institute, Jena, Germany
| | - Klaus D Schmuck
- Johnson & Johnson Medical GmbH, DePuy Synthes, Norderstedt, Germany
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Jena, Germany
| | - Bernhard Illerhaus
- Federal Institute for Materials Research and Testing (BAM), Berlin, Germany
| | - Peter Kuehmstedt
- Fraunhofer Institute for Applied Optics and Precision Engineering IOF, Jena, Germany
| | - Roland Ramm
- Fraunhofer Institute for Applied Optics and Precision Engineering IOF, Jena, Germany
| | - René Huber
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Elke Kunisch
- Experimental Rheumatology Unit, Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
| | - Francesca Gunnella
- Experimental Rheumatology Unit, Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
| | - Andreas Roth
- Bereich Endoprothetik/Orthopädie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Uniklinik Leipzig AöR, Leipzig, Germany
| | - Harald Schubert
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Jena, Germany
| | - Raimund W Kinne
- Experimental Rheumatology Unit, Orthopedic Professorship, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany.
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Keyak JH, Eijansantos ML, Rosecrance KG, Wong D, Feizi S, Meldosian AL, Peddinti P, Les CM, Skinner HB, Sehgal V. A preliminary safety assessment of vertebral augmentation with 32P brachytherapy bone cement. Phys Med Biol 2022; 67. [PMID: 35294928 PMCID: PMC9045587 DOI: 10.1088/1361-6560/ac5e5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/16/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Comprehensive treatment for vertebral metastatic lesions commonly involves vertebral augmentation (vertebroplasty or kyphoplasty) to relieve pain and stabilize the spine followed by multiple sessions of radiotherapy. We propose to combine vertebral augmentation and radiotherapy into a single treatment by adding 32P, a β-emitting radionuclide, to bone cement, thereby enabling spinal brachytherapy to be performed without irradiating the spinal cord. The goal of this study was to address key dosimetry and safety questions prior to performing extensive animal studies. The 32P was in the form of hydroxyapatite powder activated by neutron bombardment in a nuclear reactor. We performed ex vivo dosimetry experiments to establish criteria for safe placement of the cement within the sheep vertebral body. In an in vivo study, we treated three control ewes and three experimental ewes with brachytherapy cement containing 2.23–3.03 mCi 32P ml−1 to identify the preferred surgical approach, to determine if 32P leaches from the cement and into the blood, urine, or feces, and to identify unexpected adverse effects. Our ex vivo experiments showed that cement with 4 mCi 32P ml−1 could be safely implanted in the vertebral body if the cement surface is at least 4 mm from the spinal cord in sheep and 5 mm from the spinal cord in humans. In vivo, a lateral retroperitoneal surgical approach, ventral to the transverse processes, was identified as easy to perform while allowing a safe distance to the spinal cord. The blood, urine, and feces of the sheep did not contain detectable levels of 32P, and the sheep did not experience any neurologic or other adverse effects from the brachytherapy cement. These results demonstrate, on a preliminary level, the relative safety of this brachytherapy cement and support additional development and testing.
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Ruediger T, Horbert V, Reuther A, Kumar Kalla P, Burgkart RH, Walther M, Kinne RW, Mika J. Thickness of the Stifle Joint Articular Cartilage in Different Large Animal Models of Cartilage Repair and Regeneration. Cartilage 2021; 13:438S-452S. [PMID: 33269611 PMCID: PMC8721693 DOI: 10.1177/1947603520976763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Regulatory guidelines for preclinical cartilage repair studies suggest large animal models (e.g., sheep, goat, [mini]-pig, or horse) to obtain results representative for humans. However, information about the 3-dimensional thickness of articular cartilage at different implantation sites in these models is limited. DESIGN To identify the most suitable site for experimental surgery, cartilage thickness at the medial femoral condyle (MFC), lateral femoral condyle (LFC), and trochlea in ovine, caprine, and porcine cadaver stifle joints was systematically measured using hematoxylin-eosin staining of 6 µm paraffin sections and software-based image analysis. RESULTS Regarding all ventral-dorsal regions of the MFC, goat showed the thickest articular cartilage (maximal mean thickness: 1299 µm), followed by sheep (1096 µm) and mini-pig (604 µm), with the highest values in the most ventral and dorsal regions. Also for the LFC, the most ventral regions showed the thickest cartilage in goat (maximal mean thickness: 1118 µm), followed by sheep (678 µm) and mini-pig (607 µm). Except for the mini-pig, however, the cartilage thickness on the LFC was consistently lower than that on the MFC. The 3 species also differed along the transversal measuring points on the MFC and LFC. In contrast, there were no consistent differences for the regional cartilage thickness of the trochlea among goat and sheep (≥780 µm) and mini-pig (≤500 µm). CONCLUSIONS Based on their cartilage thickness, experimental defects on goat and sheep MFC may be viable options for preclinical cartilage repair studies, in addition to well-established horse models.
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Affiliation(s)
- Tina Ruediger
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Anne Reuther
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Pavan Kumar Kalla
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Rainer H. Burgkart
- Biomechanics Laboratory, Chair of
Orthopedics and Sport Orthopedics, Technische Universität München, Munich,
Germany
| | - Mario Walther
- Department of Medical Statistics,
Computer Sciences and Documentation, Jena University Hospital, Jena, Germany,Ernst-Abbe-Hochschule Jena, University
of Applied Sciences, Jena, Germany
| | - Raimund W. Kinne
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany,Raimund W. Kinne, Experimental Rheumatology
Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken
Eisenberg GmbH, Klosterlausnitzer Straße 81, Eisenberg, 07607, Germany.
| | - Joerg Mika
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
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Kinne RW, Gunnella F, Kunisch E, Heinemann S, Nies B, Maenz S, Horbert V, Illerhaus B, Huber R, Firkowska-Boden I, Bossert J, Jandt KD, Sachse A, Bungartz M, Brinkmann O. Performance of Calcium Phosphate Cements in the Augmentation of Sheep Vertebrae-An Ex Vivo Study. MATERIALS 2021; 14:ma14143873. [PMID: 34300793 PMCID: PMC8307240 DOI: 10.3390/ma14143873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
Oil-based calcium phosphate cement (Paste-CPC) shows not only prolonged shelf life and injection times, but also improved cohesion and reproducibility during application, while retaining the advantages of fast setting, mechanical strength, and biocompatibility. In addition, poly(L-lactide-co-glycolide) (PLGA) fiber reinforcement may decrease the risk for local extrusion. Bone defects (diameter 5 mm; depth 15 mm) generated ex vivo in lumbar (L) spines of female Merino sheep (2–4 years) were augmented using: (i) water-based CPC with 10% PLGA fiber reinforcement (L3); (ii) Paste-CPC (L4); or (iii) clinically established polymethylmethacrylate (PMMA) bone cement (L5). Untouched (L1) and empty vertebrae (L2) served as controls. Cement performance was analyzed using micro-computed tomography, histology, and biomechanical testing. Extrusion was comparable for Paste-CPC(-PLGA) and PMMA, but significantly lower for CPC + PLGA. Compressive strength and Young’s modulus were similar for Paste-CPC and PMMA, but significantly higher compared to those for empty defects and/or CPC + PLGA. Expectedly, all experimental groups showed significantly or numerically lower compressive strength and Young’s modulus than those of untouched controls. Ready-to-use Paste-CPC demonstrates a performance similar to that of PMMA, but improved biomechanics compared to those of water-based CPC + PLGA, expanding the therapeutic arsenal for bone defects. O, significantly lower extrusion of CPC + PLGA fibers into adjacent lumbar spongiosa may help to reduce the risk of local extrusion in spinal surgery.
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Affiliation(s)
- Raimund W. Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Correspondence: ; Tel.: +49-36691-81228
| | - Francesca Gunnella
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Sascha Heinemann
- INNOTERE GmbH, Meissner Str. 191, 01445 Radebeul, Germany; (S.H.); (B.N.)
| | - Berthold Nies
- INNOTERE GmbH, Meissner Str. 191, 01445 Radebeul, Germany; (S.H.); (B.N.)
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
- Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Bernhard Illerhaus
- BAM Bundesanstalt für Materialforschung und –Prüfung (BAM), 12205 Berlin, Germany;
| | - René Huber
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany;
| | - Izabela Firkowska-Boden
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
| | - Jörg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
| | - Klaus D. Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
- Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany
- Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, 07743 Jena, Germany
| | - André Sachse
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
| | - Matthias Bungartz
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
| | - Olaf Brinkmann
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
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Systematic Postoperative Assessment of a Minimally-Invasive Sheep Model for the Treatment of Osteochondral Defects. Life (Basel) 2020; 10:life10120332. [PMID: 33297497 PMCID: PMC7762399 DOI: 10.3390/life10120332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022] Open
Abstract
To assess the clinical course of a sheep stifle joint model for osteochondral (OC) defects, medial femoral condyles (MFC) were exposed without patella luxation using medial parapatellar skin (3–4 cm) and deep incisions (2–3 cm). Two defects (7 mm diameter; 10 mm depth; OC punch) were left empty or refilled with osteochondral autologous transplantation cylinders (OATS) and explanted after six weeks. Incision-to-suture time, anesthesia time, and postoperative wound or impairment scores were compared to those in sham-operated animals. Implant performance was assessed by X-ray, micro-computed tomography, histology, and immunohistology (collagens 1, 2; aggrecan). There were no surgery-related infections or patellar luxations. Operation, anesthesia, and time to complete stand were short (0.5, 1.4, and 1.5 h, respectively). The wound trauma score was low (0.4 of maximally 4; day 7). Empty-defect and OATS animals reached an impairment score of 0 significantly later than sham animals (7.4 and 4.0 days, respectively, versus 1.5 days). Empty defects showed incomplete healing and dedifferentiation/heterotopic differentiation; OATS-filled defects displayed advanced bone healing with remaining cartilage gaps and orthotopic expression of bone and cartilage markers. Minimally-invasive, medial parapatellar surgery of OC defects on the sheep MFC allows rapid and low-trauma recovery and appears well-suited for implant testing.
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Maenz S, Brinkmann O, Hasenbein I, Braun C, Kunisch E, Horbert V, Gunnella F, Sachse A, Bischoff S, Schubert H, Jandt KD, Bossert J, Driesch D, Kinne RW, Bungartz M. The old sheep: a convenient and suitable model for senile osteopenia. J Bone Miner Metab 2020; 38:620-630. [PMID: 32296985 DOI: 10.1007/s00774-020-01098-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 03/08/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Existing osteoporosis models in sheep exhibit some disadvantages, e.g., challenging surgical procedures, serious ethical concerns, failure of reliable induction of substantial bone loss, or lack of comparability to the human condition. This study aimed to compare bone morphological and mechanical properties of old and young sheep, and to evaluate the suitability of the old sheep as a model for senile osteopenia. MATERIALS AND METHODS The lumbar vertebral body L3 of female merino sheep with two age ranges, i.e., old animals (6-10 years; n = 41) and young animals (2-4 years; n = 40), was analyzed concerning its morphological and mechanical properties by bone densitometry, quantitative histomorphometry, and biomechanical testing of the corticalis and/or central spongious region. RESULTS In comparison with young sheep, old animals showed only marginally diminished bone mineral density of the vertebral bodies, but significantly decreased structural (bone volume, - 15.1%; ventral cortical thickness, - 11.8%; lateral cortical thickness, - 12.2%) and bone formation parameters (osteoid volume, osteoid surface, osteoid thickness, osteoblast surface, all - 100.0%), as well as significantly increased bone erosion (eroded surface, osteoclast surface). This resulted in numerically decreased biomechanical properties (compressive strength; - 6.4%). CONCLUSION Old sheep may represent a suitable model of senile osteopenia with markedly diminished bone structure and formation, and substantially augmented bone erosion. The underlying physiological aging concept reduces challenging surgical procedures and ethical concerns and, due to complex alteration of different facets of bone turnover, may be well representative of the human condition.
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Affiliation(s)
- Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich-Schiller-University Jena, Jena, Germany
| | - Olaf Brinkmann
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Ines Hasenbein
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Christina Braun
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Francesca Gunnella
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - André Sachse
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Sabine Bischoff
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Jena, Germany
| | - Harald Schubert
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Jena, Germany
| | - Klaus D Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich-Schiller-University Jena, Jena, Germany
| | - Jörg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich-Schiller-University Jena, Jena, Germany
| | | | - Raimund W Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Matthias Bungartz
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Eisenberg, Germany
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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de Lacerda Schickert S, Pinto JC, Jansen J, Leeuwenburgh SCG, van den Beucken JJJP. Tough and injectable fiber reinforced calcium phosphate cement as an alternative to polymethylmethacrylate cement for vertebral augmentation: a biomechanical study. Biomater Sci 2020; 8:4239-4250. [PMID: 32579633 DOI: 10.1039/d0bm00413h] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vertebral compression fractures (VCFs) are a very common problem among the elderly, which ultimately result in severe pain and a drastically reduced quality of life. An effective treatment for VCFs is the minimally invasive augmentation of the damaged vertebrae through vertebroplasty and/or kyphoplasty. These surgical procedures treat the affected vertebrae by injection of poly(methyl methacrylate) cement (PMMA) into the vertebral body. However, clinical use of PMMA cement is associated with major drawbacks. Bioceramic cements such as injectable calcium phosphate cements (CPC) exhibit a superior osteocompatibility over PMMA cements, but are too brittle for load-bearing applications. Here, we evaluated the handling and mechanical properties of a recently developed CPC formulation containing both poly(vinyl alcohol) (PVA) fibers and carboxymethyl cellulose (CMC) as an alternative to PMMA cement for vertebro- and kyphoplasty. Our results demonstrate that the addition of CMC rendered fiber-reinforced CPC injectable without negatively affecting its mechanical properties. Further, an ex vivo mechanical analysis clearly showed that extravasation of PVA fiber-reinforced CPC with CMC into trabecular bone was limited as compared to PMMA. Finally, we observed that the ex vivo biomechanical performance of vertebrae treated with CMC and PVA fibers was similar to PMMA-treated vertebrae. The obtained data suggests that PVA fiber-reinforced CPCs with CMC possesses adequate handling, mechanical and structural characteristics for vertebro- and kyphoplasty procedures. These data pave the way for future preclinical studies on the feasibility of treating vertebral compression fractures using PVA fiber-reinforced CPC with CMC.
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Affiliation(s)
- Sónia de Lacerda Schickert
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - João Castro Pinto
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - John Jansen
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - Sander C G Leeuwenburgh
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
| | - Jeroen J J P van den Beucken
- Radboud University Medical Center, Radboud Institute for Molecular Life Sciences; Department of Dentistry - Regenerative Biomaterials, Philips van Leydenlaan 25, Nijmegen, The Netherlands.
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8
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Horbert V, Lange M, Reuter T, Hoffmann M, Bischoff S, Borowski J, Schubert H, Driesch D, Mika J, Hurschler C, Kinne RW. Comparison of Near-Infrared Spectroscopy with Needle Indentation and Histology for the Determination of Cartilage Thickness in the Large Animal Model Sheep. Cartilage 2019; 10:173-185. [PMID: 28980486 PMCID: PMC6425542 DOI: 10.1177/1947603517731851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The suitability of near-infrared spectroscopy (NIRS) for non-destructive measurement of cartilage thickness was compared with the gold standard needle indentation. A combination of NIRS and biomechanical indentation (NIRS-B) was used to address the influence of varying loads routinely applied for hand-guided NIRS during real-life surgery on the accuracy of NIRS-based thickness prediction. NIRS-B was performed under three different loading conditions in 40 osteochondral cylinders from the load-bearing area of the medial and lateral femur condyle of 20 cadaver joints (left stifle joints; female Merino sheep; 6.1 ± 0.6 years, mean ± standard error of the mean). The cartilage thickness measured by needle indentation within the region analyzed by NIRS-B was then compared with cartilage thickness prediction based on NIRS spectral data using partial least squares regression. NIRS-B repeat measurements yielded highly reproducible values concerning force and absorbance. Separate or combined models for the three loading conditions (the latter simulating load-independent measurements) resulted in models with optimized quality parameters (e.g., coefficients of determination R2 between 92.3 and 94.7) and a prediction accuracy of < 0.1 mm. NIRS appears well suited to determine cartilage thickness (possibly in a hand-guided, load-independent fashion), as shown by high reproducibility in repeat measurements and excellent reliability compared with tissue-destructive needle indentation. This may provide the basis for non-destructive, intra-operative assessment of cartilage status quo and fine-tuning of repair procedures.
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Affiliation(s)
- Victoria Horbert
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkrankenhaus “Rudolf Elle”,
Eisenberg, Germany
| | - Matthias Lange
- fzmb GmbH, Research Centre for Medical
Technology and Biotechnology, Bad Langensalza, Germany
| | - Thomas Reuter
- fzmb GmbH, Research Centre for Medical
Technology and Biotechnology, Bad Langensalza, Germany
| | - Martin Hoffmann
- Department of Electrical Engineering and
Information Technology, University of Applied Sciences, Jena, Germany
| | - Sabine Bischoff
- Institute of Laboratory Animal Sciences
and Welfare, Jena University Hospital, Jena, Germany
| | - Juliane Borowski
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkrankenhaus “Rudolf Elle”,
Eisenberg, Germany
| | - Harald Schubert
- Institute of Laboratory Animal Sciences
and Welfare, Jena University Hospital, Jena, Germany
| | | | - Joerg Mika
- Department of Trauma Surgery, University
Hospital Giessen and Marburg, Giessen, Germany,Laboratory of Experimental Trauma
Surgery, Justus-Liebig University, Giessen, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and
Biomaterials, Orthopaedic Surgery Department, Hannover Medical School, Hannover,
Germany
| | - Raimund W. Kinne
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkrankenhaus “Rudolf Elle”,
Eisenberg, Germany,Raimund W. Kinne, MD, Experimental
Rheumatology Unit, Department of Orthopedics, Jena University Hospital,
Waldkrankenhaus “Rudolf Elle”, Klosterlausnitzer Straße 81, 07607 Eisenberg,
Germany.
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Dias IR, Camassa JA, Bordelo JA, Babo PS, Viegas CA, Dourado N, Reis RL, Gomes ME. Preclinical and Translational Studies in Small Ruminants (Sheep and Goat) as Models for Osteoporosis Research. Curr Osteoporos Rep 2018; 16:182-197. [PMID: 29460175 DOI: 10.1007/s11914-018-0431-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW This review summarizes research on the use of sheep and goats as large animal models of human osteoporosis for preclinical and translational studies. RECENT FINDINGS The most frequent osteoporotic sheep model used is the ovariectomized sheep with 12 months post-operatively or more and the combined treatment of ovariectomized sheep associated to calcium/vitamin D-deficient diet and glucocorticoid applications for 6 months, but other methods are also described, like pinealectomy or hypothalamic-pituitary disconnection in ovariectomized sheep. The goat model for osteoporosis research has been used in a very limited number of studies in osteoporosis research relative to sheep. These osteoporotic small ruminant models are applied for biomaterial research, bone augmentation, efficacy of implant fixation, fragility fracture-healing process improvement, or bone-defect repair studies in the osteopenic or osteoporotic bone. Sheep are a recognized large animal model for preclinical and translational studies in osteoporosis research and the goat to a lesser extent. Recently, the pathophysiological mechanism underlying induction of osteoporosis in glucocorticoid-treated ovariectomized aged sheep was clarified, being similar to what occurs in postmenopausal women with glucocorticoid-induced osteoporosis. It was also concluded that the receptor activator of NF-κB ligand was stimulated in the late progressive phase of the osteoporosis induced by steroids in sheep. The knowledge of the pathophysiological mechanisms at the cellular and molecular levels of the induction of osteoporosis in small ruminants, if identical to humans, will allow in the future, the use of these animal models with greater confidence in the preclinical and translational studies for osteoporosis research.
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Affiliation(s)
- Isabel R Dias
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal.
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal.
| | - José A Camassa
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
| | - João A Bordelo
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
| | - Pedro S Babo
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Carlos A Viegas
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Quinta de Prados, 5000-801, Vila Real, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Nuno Dourado
- CMEMS-UMinho, Department of Mechanical Engineering, University of Minho, Campus de Azurém, 4804-533, Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
| | - Manuela E Gomes
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Braga, Portugal
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The GDF5 mutant BB-1 enhances the bone formation induced by an injectable, poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming cement in a sheep defect model of lumbar osteopenia. Spine J 2018; 18:357-369. [PMID: 29031993 DOI: 10.1016/j.spinee.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Targeted delivery of osteoinductive bone morphogenetic proteins (eg, GDF5) in bioresorbable calcium phosphate cement (CPC), potentially suitable for vertebroplasty and kyphoplasty of osteoporotic vertebral fractures, may be required to counteract augmented local bone catabolism and to support complete bone regeneration. The biologically optimized GDF5 mutant BB-1 may represent an attractive drug candidate for this purpose. PURPOSE The aim of the current study was to test an injectable, poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming CPC containing low-dose BB-1 in a sheep lumbar osteopenia model. STUDY DESIGN/ SETTING This is a prospective experimental animal study. METHODS Bone defects (diameter 5 mm) were generated in aged, osteopenic female sheep and were filled with fiber-reinforced CPC alone (L4; CPC+fibers) or with CPC containing different dosages of BB-1 (L5; CPC+fibers+BB-1; 5, 100, and 500 µg BB-1; n=6 each). The results were compared with those of untouched controls (L1). Three and 9 months after the operation, structural and functional effects of the CPC (±BB-1) were analyzed ex vivo by measuring (1) bone mineral density (BMD); (2) bone structure, that is, bone volume/total volume (BV/TV) (assessed by micro-CT and histomorphometry), trabecular thickness (Tb.Th), and trabecular number (Tb.N); (3) bone formation, that is, osteoid volume/bone volume (OV/BV), osteoid surface/bone surface (OS/BS), osteoid thickness, mineralizing surface/bone surface (MS/BS), mineral apposition rate, and bone formation rate/bone surface; (4) bone resorption, that is, eroded surface/bone surface; and (5) compressive strength. RESULTS Compared with untouched controls (L1), CPC+fibers (L4) and/or CPC+fibers+BB-1 (L5) significantly improved all parameters of bone formation, bone resorption, and bone structure. These effects were observed at 3 and 9 months, but were less pronounced for some parameters at 9 months. Compared with CPC without BB-1, additional significant effects of BB-1 were demonstrated for BMD, bone structure (BV/TV, Tb.Th, and Tb.N), and bone formation (OS/BS and MS/BS). The BB-1 effects on bone formation at 3 and 9 months were dose dependent, with 100 µg as the potentially optimal dosage. CONCLUSIONS BB-1 significantly enhanced the bone formation induced by a PLGA fiber-reinforced CPC in sheep lumbar osteopenia. A single local dose as low as 100 µg BB-1 was sufficient to augment middle- to long-term bone formation. A CPC containing the novel GDF5 mutant BB-1 may thus represent an alternative to the bioinert, supraphysiologically stiff polymethylmethacrylate cement presently used to treat osteoporotic vertebral fractures by vertebroplasty and kyphoplasty.
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GDF5 significantly augments the bone formation induced by an injectable, PLGA fiber-reinforced, brushite-forming cement in a sheep defect model of lumbar osteopenia. Spine J 2017. [PMID: 28642196 DOI: 10.1016/j.spinee.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Biodegradable calcium phosphate cement (CPC) represents a promising option for the surgical treatment of osteoporotic vertebral fractures. Because of augmented local bone catabolism, however, additional targeted delivery of bone morphogenetic proteins with the CPC may be needed to promote rapid and complete bone regeneration. PURPOSE In the present study, an injectable, poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming cement (CPC) containing the bone morphogenetic protein GDF5 was tested in a sheep lumbar osteopenia model. STUDY DESIGN/SETTING This is a prospective experimental animal study. METHODS Defined bone defects (diameter 5 mm) were placed in aged, osteopenic female sheep. Defects were treated with fiber-reinforced CPC alone (L4; CPC+fibers) or with CPC containing different dosages of GDF5 (L5; CPC+fibers+GDF5; 1, 5, 100, and 500 µg GDF5; n=5 or 6 each). The results were compared with those of untouched controls (L1). Three and 9 months postoperation, structural and functional effects of the CPC (±GDF5) were assessed ex vivo by measuring (1) bone mineral density (BMD); (2) bone structure, that is, bone volume/total volume (assessed by micro-computed tomography and histomorphometry), trabecular thickness, and trabecular number; (3) bone formation, that is, osteoid volume/bone volume, osteoid surface/bone surface, osteoid thickness, mineralized surface/bone surface, mineral apposition rate, and bone formation rate/bone surface; (4) bone resorption, that is, eroded surface/bone surface; and (5) compressive strength. RESULTS Compared with untouched controls (L1), both CPC+fibers (L4) and CPC+fibers+GDF5 (L5) numerically or significantly improved all parameters of bone formation, bone resorption, and bone structure. These significant effects were observed both at 3 and 9 months, but for some parameters they were less pronounced at 9 months. Compared with CPC without GDF5, additional significant effects of CPC with GDF5 were demonstrated for BMD and parameters of bone formation and structure (bone volume/total volume, trabecular thickness, and trabecular number, as well as mineralized surface/bone surface). The GDF5 effects were dose-dependent (predominantly in the 5-100 µg range) at 3 and 9 months. CONCLUSIONS GDF5 significantly enhanced the bone formation induced by a PLGA fiber-reinforced CPC in sheep lumbar osteopenia. The results indicated that a local dose as low as ≤100 µg GDF5 may be sufficient to augment middle to long-term bone formation. The novel CPC+GDF5 combination may thus qualify as an alternative to the bioinert, supraphysiologically stiff poly(methyl methacrylate) cement currently applied for vertebroplasty/kyphoplasty of osteoporotic vertebral fractures.
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12
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Gunnella F, Kunisch E, Bungartz M, Maenz S, Horbert V, Xin L, Mika J, Borowski J, Bischoff S, Schubert H, Hortschansky P, Sachse A, Illerhaus B, Günster J, Bossert J, Jandt KD, Plöger F, Kinne RW, Brinkmann O. Low-dose BMP-2 is sufficient to enhance the bone formation induced by an injectable, PLGA fiber-reinforced, brushite-forming cement in a sheep defect model of lumbar osteopenia. Spine J 2017; 17:1699-1711. [PMID: 28619686 DOI: 10.1016/j.spinee.2017.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/23/2017] [Accepted: 06/08/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Bioresorbable calcium phosphate cement (CPC) may be suitable for vertebroplasty/kyphoplasty of osteoporotic vertebral fractures. However, additional targeted delivery of osteoinductive bone morphogenetic proteins (BMPs) in the CPC may be required to counteract the augmented local bone catabolism and support complete bone regeneration. PURPOSE This study aimed at testing an injectable, poly (l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming cement (CPC) containing low-dose bone morphogenetic protein BMP-2 in a sheep lumbar osteopenia model. STUDY DESIGN/ SETTING This is a prospective experimental animal study. METHODS Bone defects (diameter 5 mm) were generated in aged, osteopenic female sheep and filled with fiber-reinforced CPC alone (L4; CPC+fibers) or with CPC containing different dosages of BMP-2 (L5; CPC+fibers+BMP-2; 1, 5, 100, and 500 µg BMP-2; n=5 or 6 each). The results were compared with those of untouched controls (L1). Three and 9 months after the operation, structural and functional effects of the CPC (±BMP-2) were analyzed ex vivo by measuring (1) bone mineral density (BMD); (2) bone structure, that is, bone volume/total volume (assessed by micro-computed tomography [micro-CT] and histomorphometry), trabecular thickness, and trabecular number; (3) bone formation, that is, osteoid volume/bone volume, osteoid surface/bone surface, osteoid thickness, mineralizing surface/bone surface, mineral apposition rate, and bone formation rate/bone surface; (4) bone resorption, that is, eroded surface/bone surface; and (5) compressive strength. RESULTS Compared with untouched controls (L1), CPC+fibers (L4) and/or CPC+fibers+BMP-2 (L5) significantly improved all parameters of bone formation, bone resorption, and bone structure. These effects were observed at 3 and 9 months, but were less pronounced for some parameters at 9 months. Compared with CPC without BMP-2, additional significant effects of BMP-2 were demonstrated for bone structure (bone volume/total volume, trabecular thickness, trabecular number) and formation (osteoid surface/bone surface and mineralizing surface/bone surface), as well as for the compressive strength. The BMP-2 effects on bone formation at 3 and 9 months were dose-dependent, with 5-100 µg as the optimal dosage. CONCLUSIONS BMP-2 significantly enhanced the bone formation induced by a PLGA fiber-reinforced CPC in sheep lumbar osteopenia. A single local dose as low as ≤100 µg BMP-2 was sufficient to augment middle to long-term bone formation. The novel CPC+BMP-2 may thus represent an alternative to the bioinert, supraphysiologically stiff polymethylmethacrylate cement presently used to treat osteoporotic vertebral fractures by vertebroplasty/kyphoplasty.
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Affiliation(s)
- Francesca Gunnella
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Matthias Bungartz
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany; Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany; Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Long Xin
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Joerg Mika
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Juliane Borowski
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Sabine Bischoff
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Dornburger Straße 23, 07743 Jena, Germany
| | - Harald Schubert
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Dornburger Straße 23, 07743 Jena, Germany
| | - Peter Hortschansky
- Leibniz-Institute for Natural Products Research and Infection Biology - Hans-Knoell-Institute, Beutenbergstr. 11a, 07745 Jena, Germany
| | - Andre Sachse
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Bernhard Illerhaus
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Dornburger Straße 23, 07743 Jena, Germany
| | - Jens Günster
- BAM Bundesanstalt für Materialforschung und -prüfung (BAM), Unter den Eichen 44-46, 12203 Berlin; Germany
| | - Jörg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Klaus D Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany; Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany; Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, 07743 Jena, Germany
| | - Frank Plöger
- BIOPHARM GmbH, Handelsstrasse 15, 69214 Eppelheim, Germany
| | - Raimund W Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany.
| | - Olaf Brinkmann
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany; Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
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Kunisch E, Maenz S, Knoblich M, Ploeger F, Jandt KD, Bossert J, Kinne RW, Alsalameh S. Short-time pre-washing of brushite-forming calcium phosphate cement improves its in vitro cytocompatibility. Tissue Cell 2017; 49:697-710. [PMID: 29102397 DOI: 10.1016/j.tice.2017.10.002] [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: 05/06/2017] [Revised: 09/04/2017] [Accepted: 10/12/2017] [Indexed: 12/26/2022]
Abstract
A pre-washing protocol was developed for resorbable, brushite-forming calcium phosphate cements (CPCs) to avoid harmful in vitro effects on cells. CPC discs (JectOS+, Kasios; self-developed CPC) were pre-washed with repeated changes of phosphate-buffered saline (PBS; 24h total). Unwashed or PBS-pre-washed discs were incubated in culture medium (5% fetal calf serum; up to 10days) and then tested for their influence on pH/calcium/phosphate levels in H2O extracts. Effects on pH/calcium/phosphate levels in culture supernatants, and morphology, adherence, number, and viability of ATDC5 cells and adipose-tissue derived stem cells were analyzed in co-culture. Pre-washing did not alter CPC surface morphology or Ca/P ratio (scanning electron microscopy; energy-dispersive X-ray spectroscopy). However, acidic pH of unwashed JectOS+ and self-developed CPC (5.82; 5.11), and high concentrations of Ca (2.17; 2.40mM) and PO4 (38.15; 49.28mM) in H2O extracts were significantly counteracted by PBS-pre-washing (pH: 7.92; 7.92; Ca: 0.64; 1.11mM; PO4: 5.39-5.97mM). Also, PBS-pre-washing led to physiological pH (approx. 7.5) and PO4 levels (max. 5mM), and sub-medium Ca levels (0.5-1mM) in supernatants and normalized cell morphology, adherence, number, and viability. This CPC pre-washing protocol improves in vitro co-culture conditions without influencing its structure or chemical composition.
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Affiliation(s)
- Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Eisenberg, Germany
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Germany
| | - Marie Knoblich
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Eisenberg, Germany
| | | | - Klaus D Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Germany
| | - Joerg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Germany
| | - Raimund W Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Eisenberg, Germany.
| | - Saifeddin Alsalameh
- Department of Medicine 3 (Rheumatology and Immunology), University Hospital Erlangen (Academic and Teaching Association), Germany
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Shen GY, Ren H, Tang JJ, Qiu T, Zhang ZD, Zhao WH, Yu X, Huang JJ, Liang D, Yao ZS, Yang ZD, Jiang XB. Effect of osteoporosis induced by ovariectomy on vertebral bone defect/fracture in rat. Oncotarget 2017; 8:73559-73567. [PMID: 29088726 PMCID: PMC5650281 DOI: 10.18632/oncotarget.20611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022] Open
Abstract
Osteoporotic vertebral fracture (OVF) is a worldwide health concern and lacks sufficient basic studies. Suitable animal models should be the foundation for basic study and treatment of OVF. There have been few studies on the development of animal models of osteoporotic vertebral bone defects. OVF models using various animal species should be developed to evaluate the therapeutic strategy in preclinical testing. We developed an OVF model in rats. Rat osteoporosis was induced by ovariectomy (OVX), and 3 months after OVX, a 3 mm diameter hemispheric vertebral bone defect was developed in lumbar vertebra 6 (L6). Sagittal plain X-rays of the rats, their bone quantity, bone microarchitecture, and histomorphology were analyzed: 3 months after OVX, rats showed significantly lower bone quantity, relative bone volume, and total volume bone mineral density. After the vertebral bone defect had developed for 16 weeks, no significant indication of self-healing could be observed from the sagittal plain X-rays, three-dimensional images, and histomorphology. These results indicate that the rat model of osteoporotic vertebral bone defect, induced by OVX and a 3 mm diameter hemispheric vertebral bone defect, can sufficiently mimic OVF patients in clinic and provide a sound basis for subsequent studies.
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Affiliation(s)
- Geng-Yang Shen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Ren
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing-Jing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Qiu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Da Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Hua Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang Yu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin-Jing Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen-Song Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Dong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Bing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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Enhanced bone formation in sheep vertebral bodies after minimally invasive treatment with a novel, PLGA fiber-reinforced brushite cement. Spine J 2017; 17:709-719. [PMID: 27871820 DOI: 10.1016/j.spinee.2016.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/21/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Injectable, brushite-forming calcium phosphate cements (CPC) show potential for bone replacement, but they exhibit low mechanical strength. This study tested a CPC reinforced with poly(l-lactide-co-glycolide) acid (PLGA) fibers in a minimally invasive, sheep lumbar vertebroplasty model. PURPOSE The study aimed to test the in vivo biocompatibility and osteogenic potential of a PLGA fiber-reinforced, brushite-forming CPC in a sheep large animal model. STUDY DESIGN/SETTING This is a prospective experimental animal study. METHODS Bone defects (diameter: 5 mm) were placed in aged, osteopenic female sheep, and left empty (L2) or injected with pure CPC (L3) or PLGA fiber-reinforced CPC (L4; fiber diameter: 25 µm; length: 1 mm; 10% [wt/wt]). Three and 9 months postoperation (n=20 each), the structural and functional CPC effects on bone regeneration were documented ex vivo by osteodensitometry, histomorphometry, micro-computed tomography (micro-CT), and biomechanical testing. RESULTS Addition of PLGA fibers enhanced CPC osteoconductivity and augmented bone formation. This was demonstrated by (1) significantly enhanced structural (bone volume/total volume, shown by micro-CT and histomorphometry; 3 or 9 months) and bone formation parameters (osteoid volume and osteoid surface; 9 months); (2) numerically enhanced bone mineral density (3 and 9 months) and biomechanical compression strength (9 months); and (3) numerically decreased bone erosion (eroded surface; 3 and 9 months). CONCLUSIONS The PLGA fiber-reinforced CPC is highly biocompatible and its PLGA fiber component enhanced bone formation. Also, PLGA fibers improve the mechanical properties of brittle CPC, with potential applicability in load-bearing areas.
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16
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Decreased extrusion of calcium phosphate cement versus high viscosity PMMA cement into spongious bone marrow-an ex vivo and in vivo study in sheep vertebrae. Spine J 2016; 16:1468-1477. [PMID: 27496285 DOI: 10.1016/j.spinee.2016.07.529] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/28/2016] [Accepted: 07/18/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebroplasty or kyphoplasty of osteoporotic vertebral fractures bears the risk of pulmonary cement embolism (3.5%-23%) caused by leakage of commonly applied acrylic polymethylmethacrylate (PMMA) cement to spongious bone marrow or outside of the vertebrae. Ultraviscous cement and specific augmentation systems have been developed to reduce such adverse effects. Rapidly setting, resorbable, physiological calcium phosphate cement (CPC) may also represent a suitable alternative. PURPOSE This study aimed to compare the intravertebral extrusion of CPC and PMMA cement in an ex vivo and in vivo study in sheep. STUDY DESIGN/SETTING A prospective experimental animal study was carried out. METHODS Defects (diameter 5 mm; 15 mm depth) were created by a ventrolateral percutaneous approach in lumbar vertebrae of female Merino sheep (2-4 years) either ex vivo (n=17) or in vivo (n=6), and injected with: (1) CPC (L3); (2) CPC reinforced with 10% poly(l-lactide-co-glycolide) (PLGA) fibers (L4); or (3) PMMA cement (L5; Kyphon HV-R). Controls were untouched (L1) or empty defects (L2). The effects of the cement injections were assessed in vivo by blood gas analysis and ex vivo by computed tomography (CT), micro-CT (voxel size: 67 µm), histology, and biomechanical testing. RESULTS Following ex vivo injection, micro-CT documented significantly increased extrusion of PMMA cement in comparison to CPC (+/- fibers) starting at a distance of 1 mm from the edge of the defect (confirmed by histology); this was also demonstrated by micro-CT following in vivo cement injection. In addition, blood gas analysis showed consistently significantly lower values for the fraction of oxygenized hemoglobin/total hemoglobin (FO2Hb) in the arterial blood until 25 minutes following injection of the PMMA cement (p ≤ .05 vs. CPC; 7, 15 minutes). Biomechanical testing following ex vivo injection showed significantly lower compressive strength and Young modulus than untouched controls for the empty defect (40% and 34% reduction, respectively) and all three cement-injected defects (21%-27% and 29%-32% reduction, respectively), without significant differences among the cements. CONCLUSIONS Because of comparable compressive strength, but significantly lower cement extrusion into spongious bone marrow than PMMA cement, physiological CPC (+/- PLGA fibers) may represent an attractive alternative to PMMA for vertebroplasty or kyphoplasty of osteoporotic vertebral fractures to reduce the frequency or severity of adverse effects.
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