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Li K, Liu L, Liu H, Xing J, Hu P, Song J. LATS1/YAP1 Axis Controls Bone Regeneration on Distraction Osteogenesis by Activating Wnt/β-Catenin. Tissue Eng Part A 2024; 30:154-167. [PMID: 37930731 DOI: 10.1089/ten.tea.2023.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
The Hippo signaling pathway inhibits cell growth, and its components and functions are highly conserved in mammals. LATS1 is a core component of the Hippo signaling pathway associated with lymphatic invasion, astrogliosis, apoptosis, and autophagy. Nevertheless, the role of Hippo/LATS1 in osteogenesis remains unclear. In this study, we used ribonucleic acid (RNA) lentiviruses to inhibit the expression of Lats1 in bone marrow-derived stem cells (BMSCs) and distraction osteogenic regions in rats. Increased osteogenic, proliferative, and migratory abilities of BMSCs were observed in Lats1-inhibited BMSCs, while these phenotypes were partially reversed by YAP1 inhibition. In vivo, we found that the LATS1/YAP1 axis promoted osteogenesis during distraction osteogenesis (DO). β-catenin was positively correlated with YAP1 expression in vivo and in vitro. When YAP1 was strongly positive in the nucleus, β-catenin expression was upregulated; when YAP1 expression was inhibited by verteporfin, β-catenin was not expressed in the nucleus. These findings suggest that the LATS1/YAP1 signaling axis promotes DO by activating the Wnt/β-catenin signaling pathway. This study provides insights into the molecular mechanism of osteogenesis and a potential therapeutic strategy for bone regeneration in DO by associating with LATS1/YAP1-β-catenin.
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Affiliation(s)
- Kehan Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- National Center for Stomatology, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Linan Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiawei Xing
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Pei Hu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jian Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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An Inexpensive 3D Printed Mouse Model of Successful, Complication-free Long Bone Distraction Osteogenesis. Plast Reconstr Surg Glob Open 2023; 11:e4674. [PMID: 36798717 PMCID: PMC9925097 DOI: 10.1097/gox.0000000000004674] [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: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 02/17/2023]
Abstract
Distraction osteogenesis (DO) is used for skeletal defects; however, up to 50% of cases exhibit complications. Previous mouse models of long bone DO have been anecdotally hampered by postoperative complications, expense, and availability. To improve clinical techniques, cost-effective, reliable animal models are needed. Our focus was to develop a new mouse tibial distractor, hypothesized to result in successful, complication-free DO. Methods A lightweight tibial distractor was developed using CAD and 3D printing. The device was fixed to the tibia of C57Bl/6J mice prior to osteotomy. Postoperatively, mice underwent 5 days latency, 10 days distraction (0.15 mm every 12 hours), and 28 days consolidation. Bone regeneration was examined on postoperative day 43 using micro-computed tomography (μCT) and Movat's modified pentachrome staining on histology (mineralized volume fraction and pixels, respectively). Costs were recorded. We compared cohorts of 11 mice undergoing sham, DO, or acute lengthening (distractor acutely lengthened 3.0 mm). Results The histological bone regenerate was significantly increased in DO (1,879,257 ± 155,415 pixels) compared to acute lengthening (32847 ± 1589 pixels) (P < 0.0001). The mineralized volume fraction (bone/total tissue volume) of the regenerate was significantly increased in DO (0.9 ± 0.1) compared to acute lengthening (0.7 ± 0.1) (P < 0.001). There was no significant difference in bone regenerate between DO and sham. The distractor was relatively low cost ($11), with no complications. Conclusions Histology and µCT analysis confirmed that the proposed tibial DO model resulted in successful bone formation. Our model is cost-effective and reproducible, enabling implementation in genetically dissectible transgenic mice.
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Zhang T, Jiang W, Liao F, Zhu P, Guo L, Zhao Z, Liu Y, Huang X, Zhou N. Identification of the key exosomal lncRNAs/mRNAs in the serum during distraction osteogenesis. J Orthop Surg Res 2022; 17:291. [PMID: 35643547 PMCID: PMC9148531 DOI: 10.1186/s13018-022-03163-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Distraction osteogenesis (DO), a kind of bone regenerative process, is not only extremely effective, but the osteogenesis rate is far beyond ordinary bone fracture (BF) healing. Exosomes (Exo) are thought to play a part in bone regeneration and healing as key players in cell-to-cell contact. The object of this work was to determine whether exosomes derived from DO and BF serum could stimulate the Osteogenic Differentiation in these two processes, and if so, which genes could be involved. Methods The osteogenesis in DO-gap or BF-gap was evaluated using radiographic analysis and histological analysis. On the 14th postoperative day, DO-Exos and BF-Exos were isolated and cocultured with the jaw of bone marrow mesenchymal stem cells (JBMMSCs). Proliferation, migration and osteogenic differentiation of JBMMSCs were ascertained, after which exosomes RNA-seq was performed to identify the relevant gene. Results Radiographic and histological analyses manifested that osteogenesis was remarkably accelerated in DO-gap in comparison with BF-gap. Both of the two types of Exos were taken up by JBMMSCs, and their migration and osteogenic differentiation were also seen to improve. However, the proliferation showed no significant difference. Finally, exosome RNA-seq revealed that the lncRNA MSTRG.532277.1 and the mRNA F-box and leucine-rich repeat protein 14(FBXL14) may play a key role in DO. Conclusions Our findings suggest that exosomes from serum exert a critical effect on the rapid osteogenesis in DO. This promoting effect might have relevance with the co-expression of MSTRG.532277.1 and FBXL14. On the whole, these findings provide new insights into bone regeneration, thereby outlining possible therapeutic targets for clinical intervention.
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Figueroa AA, Figueroa AD, Burton RG, Tragos C. Cleft Lip and Palate: LeFort I Distraction with Halo and Hybrid Internal Maxillary Distractors. Clin Plast Surg 2021; 48:391-405. [PMID: 34051893 DOI: 10.1016/j.cps.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Distraction osteogenesis is a viable treatment option for patients with a cleft associated with severe maxillary retrusion. A rigid external distraction device and a hybrid internal maxillary distractor have been used to advance the maxilla allowing for predictable and stable results. These techniques can be applied by itself or as an adjunct to traditional orthognathic procedures. The technical aspects are presented. These procedures tend to be simpler and demonstrate great stability compared to traditional surgical methods. The reasons for stability are discussed.
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Affiliation(s)
- Alvaro A Figueroa
- Division of Plastic Surgery, Department of Surgery, Rush Craniofacial Center, Rush University Medical Center, 1725 West Harrison Street, Suite 425 POB 1, Chicago, IL 60612, USA.
| | - Aaron D Figueroa
- Oral and Maxillofacial Surgery, Hospital Dentistry Institute, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Richard G Burton
- Oral and Maxillofacial Surgery, Hospital Dentistry Institute, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Christina Tragos
- Division of Plastic Surgery, Department of Surgery, Rush Craniofacial Center, Rush University Medical Center, 1725 West Harrison Street, Suite 425 POB 1, Chicago, IL 60612, USA
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Evaluation of Effects of Systemic Zoledronic Acid Application on Bone Maturation in the Consolidation Period in Distraction Osteogenesis. J Craniofac Surg 2021; 32:2901-2905. [PMID: 33935139 DOI: 10.1097/scs.0000000000007698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Distraction osteogenesis (DO) is a physiological process that generates new bone tissue formation, using progressively separated bone fragments. Recently, several techniques have been investigated to develop the maturation of the new bone tissue. Bisphosphonates was an effective material for the acceleration of bone formation in DO procedures. The purpose of this study was to evaluate the effects of the systemic zoledronic acid application at the beginning of the consolidation period on new bone genesis in a DO model of rat femurs. The rats were divided randomly into 3 groups, as follows: Control group (CNT group) (n = 10), zoledronic acid dosage-1 (n = 10), and dosage-2 (n = 10) groups (ZA-D-1 and ZA-D-2). No treatment was administered in controls, but DO was applied to the rat femurs. A single dose of 0.1 mg/kg and 0.2 mg/kg of zoledronic acid was administered systematically at the beginning of the consolidation period after the distraction in treatment groups, respectively. Histomorphometric analyses were performed on the original distracted bone area and the surrounding bone tissue. Osteoblasts, new bone formation, and fibrosis were scored. New bone formation in the ZA-D-1 and ZA-D-2 groups, when compared with the control group, was detected highly (P < 0.05). The numbers of osteoblasts in the ZA-D-1 and ZA-D-2 groups were higher when compared with the controls (P < 0.05). Fibrosis in the controls, when compared with the ZA-D-1 and ZA-D-2 groups, was found to be higher (P < 0.05). Zoledronic acid application is an effective method for bone maturation in consolidation period in DO.
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Altay B, Dede EÇ, Özgul Ö, Atıl F, Koçyiğit İD, Orhan K, Tekin U, Korkusuz P, Önder ME. Effect of Systemic Oxytocin Administration on New Bone Formation and Distraction Rate in Rabbit Mandible. J Oral Maxillofac Surg 2020; 78:1171-1182. [PMID: 32275899 DOI: 10.1016/j.joms.2020.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The main disadvantage of distraction osteogenesis is the prolonged treatment protocol. Recently, oxytocin (OT) has been found to have anabolic effects on bone metabolism. In this experimental study, the effects of OT on the mandibular distraction gap in rabbits at 2 different distraction rates were evaluated. MATERIALS AND METHODS This experimental study was conducted on 28 male New Zealand white rabbits. The animals were divided into 3 experimental groups and 1 control group. Group A (control group, n = 7) consisted of animals with distraction at a rate of 1 mm/day, and group B (n = 7) consisted of animals with a distraction rate of 2 mm/day; groups A and B received postoperative saline solution injection. Group C (n = 7) consisted of animals with distraction at a rate of 1 mm/day, and group D (n = 7) consisted of animals with a distraction rate of 2 mm/day; postoperative OT injection was performed in groups C and D. RESULTS Both histomorphologic and micro-computed tomography evaluations showed increased bone healing in the OT-treated groups. CONCLUSIONS On the basis of the evaluation of both the histomorphometric and micro-computed tomographic data, systemic OT administration was found to increase new bone formation and bone healing with distraction osteogenesis.
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Affiliation(s)
- Berkan Altay
- Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - Eda Çiftci Dede
- Resident, Department of Bioengineering, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey
| | - Özkan Özgul
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - Fethi Atıl
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - İsmail Doruk Koçyiğit
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey.
| | - Kaan Orhan
- Professor, Department of DentoMaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Umut Tekin
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - Petek Korkusuz
- Department Head and Professor, Department of Histology and Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - M Ercüment Önder
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
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Song MH, Kim TJ, Kang SH, Song HR. Low-intensity pulsed ultrasound enhances callus consolidation in distraction osteogenesis of the tibia by the technique of lengthening over the nail procedure. BMC Musculoskelet Disord 2019; 20:108. [PMID: 30871538 PMCID: PMC6419405 DOI: 10.1186/s12891-019-2490-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 03/04/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Low-intensity pulsed ultrasound (LIPUS) has been widely accepted in promoting the fracture healing process. However, there have been limited clinical trials focused on the efficacy of LIPUS during distraction osteogenesis (DO) by the technique of lengthening over the nail procedure. The purpose of the current study was to evaluate the efficacy of LIPUS during DO. METHODS We retrospectively evaluated 30 patients (60 segments) who underwent simultaneous bilateral tibial lengthening over the nail. The patients were grouped into the LIPUS group and the control group based on LIPUS stimulation. The two patient groups were compared for demographic data (sex, age at operation, preoperative height, BMI, and smoking history), qualitative assessments of the callus (callus shape and type), external fixation index, and four cortical healing indexes. RESULTS Fifteen patients (30 segments) were classified as the LIPUS group, and another 15 patients (30 segments) were classified as the control group. No significant differences were found in the assessed demographic data between the groups. LIPUS stimulated a more cylindrical, more homogenous, and denser type of callus formation at the end of the distraction phase. The two groups exhibited equivalent outcomes in terms of external fixation index (p = 0.579). However, significant differences were found in healing indexes of the anterior and medial cortices (p < 0.001 and p = 0.002, respectively). The healing indexes of those cortices in the LIPUS group (mean of 36.6 days/cm and 32.5 days/cm, respectively) reflected their significantly faster healing compared to the control group (mean HI of 57.5 days/cm and 44.2 days/cm, respectively). There were no LIPUS-related complications. CONCLUSIONS LIPUS is a noninvasive and effective adjuvant therapy to enhance callus maturation during DO. It enhances callus consolidation and may have a positive effect on the appropriate callus shape and type.
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Affiliation(s)
- Mi Hyun Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Tae-Jin Kim
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Sung Hyun Kang
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Hae-Ryong Song
- Department of Orthopaedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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Hosseini S, Naderi-Manesh H, Vali H, Baghaban Eslaminejad M, Azam Sayahpour F, Sheibani S, Faghihi S. Contribution of osteocalcin-mimetic peptide enhances osteogenic activity and extracellular matrix mineralization of human osteoblast-like cells. Colloids Surf B Biointerfaces 2019; 173:662-671. [DOI: 10.1016/j.colsurfb.2018.10.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/22/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022]
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Application of Autologous Human Bone Marrow-Derived Mesenchymal Stem Cells in Distraction Osteogenesis for the Treatment of Bilateral Mandibular Hypoplasia. J Craniofac Surg 2018; 29:1629-1632. [DOI: 10.1097/scs.0000000000004614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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10
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Song J, Ye B, Liu H, Bi R, Zhang N, Hu J, Luo E. Fak-Mapk, Hippo and Wnt signalling pathway expression and regulation in distraction osteogenesis. Cell Prolif 2018; 51:e12453. [PMID: 29504176 PMCID: PMC6528869 DOI: 10.1111/cpr.12453] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/27/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To investigate the mechanism of mechanical stimulation in bone formation and regeneration during distraction osteogenesis. MATERIALS AND METHODS In this study, microarray technology was used to investigate the time course of bone-related molecular changes in distraction osteogenesis in rats. Real-time PCR and Western-blot analyses were used to confirm the expression of genes identified in microarrays. Meanwhile, we used a lentivirus vector to inhibit Fak expression, in order to identify the osteogenic effect of Fak and Fak-Mapk pathway during distraction osteogenesis. RESULTS Several components of the Wnt and Hippo pathways were found to be up- or down-regulated during distraction osteogenesis by microarray. Meanwhile, it was found that Fak, Src, Raf-1, Erk1, Jnk and p38-Mapk were up-regulated during gradual distraction, compared with consolidation. To further determine whether Fak-Mapk pathway played an important role in distraction osteogenesis, Fak was disrupted with a lentivirus vector. The expressions levels of p-Fak, p-Erk1/2, p-JNK and p-p38Mapk were decreased. Meanwhile, a poor early and late osteogenesis effect was found in the shRNA-Fak group. CONCLUSION It was inferred that the mechanical stimulus induces increased expression of Fak and activates Fak-Mapk pathway, by activation of Erk, Jnk and p38-Mapk pathway, and that Fak at least, in part, plays an important role in maintaining osteogenic effect by activating Fak-Mapk pathway during distraction osteogenesis.
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Affiliation(s)
- Jian Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral DiseasesDepartment of oral and Maxillofacial SurgeryWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Bin Ye
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral DiseasesDepartment of oral and Maxillofacial SurgeryWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral DiseasesDepartment of oral and Maxillofacial SurgeryWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Ruiye Bi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral DiseasesDepartment of oral and Maxillofacial SurgeryWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Nian Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral DiseasesDepartment of oral and Maxillofacial SurgeryWest China Hospital of StomatologySichuan UniversityChengduChina
| | - Jing Hu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral DiseasesDepartment of oral and Maxillofacial SurgeryWest China Hospital of StomatologySichuan UniversityChengduChina
| | - En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral DiseasesDepartment of oral and Maxillofacial SurgeryWest China Hospital of StomatologySichuan UniversityChengduChina
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Floerkemeier T, Thorey F, Wellmann M, Hurschler C, Budde S, Windhagen H. rhBMP-2 in an injectable Gelfoam carrier enhances consolidation of the distracted callus in a sheep model. Technol Health Care 2017; 25:1163-1172. [DOI: 10.3233/thc-170944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Thilo Floerkemeier
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
| | | | - Mathias Wellmann
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
| | | | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
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Jauregui JJ, Ventimiglia AV, Grieco PW, Frumberg DB, Herzenberg JE. Regenerate bone stimulation following limb lengthening: a meta-analysis. BMC Musculoskelet Disord 2016; 17:407. [PMID: 27686373 PMCID: PMC5043605 DOI: 10.1186/s12891-016-1259-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/14/2016] [Indexed: 12/23/2022] Open
Abstract
Background Limb lengthening with external fixation is performed to treat patients with leg length discrepancy or short stature. Although the procedure has a high rate of success, one potential drawback from limb lengthening is the amount of time spent in the fixation device while regenerate bone consolidates. Although some studies have assessed different treatment modalities, there has not been a study that has systematically evaluated whether low intensity pulsed ultrasound (LIPUS) or pulsed electromagnetic fields (PEMF) have significant effects on regenerate bone growth. The purpose of this study was to evaluate these two non-pharmacological treatment options to stimulate regenerate bone, and to assess whether they affect the treatment time in limb lengthening. Methods Utilizing the electronic databases Medline, Embase and Ovid, we performed a literature search for studies describing the application of LIPUS or PEMF following limb lengthening. With the aid of a statistical software package, Forest-Plots were generated to compare the differences in bone healing index with and without the use of regenerate bone stimulation. Results A total of 7 studies assessed these two bone stimulation modalities in a cohort of 153 patients. Overall, the mean healing index was 11.7 days/cm faster when using bone stimulation that in the comparison cohorts (33.7 vs 45.4 day, standardized mean difference of 1.16; p = 0.003). Conclusion Amongst the drawbacks from limb lengthening is the relatively high rate of non- and delayed-union. Several methods, both pharmacological and non-pharmacological, have been investigated for their potential to stimulate the growth of regenerate bone. After systematically evaluating the limited and heterogeneous current literature, we found that LIPUS and PEMF both decreased the time for bone healing (healing index in days/cm) of the newly formed regenerate bone in an adequately selected cohort of patients that underwent limb lengthening. However, a high number of complications should be noted, which could be attributed to the lengthening procedure or to the additional bone stimulation. PROSPERO registration number CRD42016039024 Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1259-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julio J Jauregui
- Department of Orthopaedics, University of Maryland Medical Center, 110 S. Paca Street, 6th Floor, Suite 300, Baltimore, Maryland, 21201, USA
| | - Anthony V Ventimiglia
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 450 Clarkson Avenue, Brooklyn, New York, 11203, USA
| | - Preston W Grieco
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 450 Clarkson Avenue, Brooklyn, New York, 11203, USA
| | - David B Frumberg
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 450 Clarkson Avenue, Brooklyn, New York, 11203, USA
| | - John E Herzenberg
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, Maryland, 21215, USA.
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Bodelón OG, Clemente C, Alobera MA, Aguado-Henche S, Escudero ML, Alonso MCG. Osseointegration of TI6Al4V dental implants modified by thermal oxidation in osteoporotic rabbits. Int J Implant Dent 2016; 2:18. [PMID: 27747710 PMCID: PMC5005616 DOI: 10.1186/s40729-016-0051-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/07/2016] [Indexed: 02/05/2023] Open
Abstract
Background In this work, the effect of the heat treatment on Ti6Al4V implants and topical administration of growth hormone to address a better osseointegration in osteoporotic patients has been analysed. Methods The osseointegration process of Ti6Al4V implants modified by oxidation treatment at 700 °C for 1 h and the influence of local administration of growth hormone (GH) in osteoporotic female rabbits after 15 and 30 days of implantation have been studied. Bone response was analysed through densitometric and histomorphometric studies. Characterization of the surface was provided by scanning electron microscopy. Results The oxidation treatment promotes the formation of an oxide scale grown on the Ti6Al4V implants that alters the nanoroughness of the surface. Bone mineral density (BMD) increases from 0.347 ± 0.014 (commercial) to 0.383 ± 0.012 g cm−2 (modified), and bone-to-implant contact (BIC) goes from 48.01 ± 14.78 (commercial) to 55.37 ± 15.31 (modified) after 30 days of implantation. Conclusions The oxidation treatment on the Ti6Al4V dental implants enhances the early bone formation at the longest periods of implantation. No significant differences in the BMD and BIC results in healthy and osteoporotic rabbits were revealed with respect to the local administration of GH in the implantation site.
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Affiliation(s)
- Oscar G Bodelón
- Department of Characterization, Quality and Safety, Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Madrid, Spain
| | - Celia Clemente
- Department of Human Anatomy and Embryology, School of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - Miguel Angel Alobera
- Stomatology Department IV, Complutense University of Madrid (UCM), Madrid, Spain
| | - Soledad Aguado-Henche
- Department of Human Anatomy and Embryology, School of Medicine, University of Alcalá, Alcalá de Henares, Spain
| | - María Lorenza Escudero
- Department of Surface Engineering, Corrosion and Durability, National Center for Metallurgical Research (CENIM), CSIC, Avda. Gregorio del Amo 8, 28040, Madrid, Spain
| | - María Cristina García Alonso
- Department of Surface Engineering, Corrosion and Durability, National Center for Metallurgical Research (CENIM), CSIC, Avda. Gregorio del Amo 8, 28040, Madrid, Spain.
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Biological basis of distraction osteogenesis – A review. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2015.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee DH, Ryu KJ, Kim JW, Kang KC, Choi YR. Bone marrow aspirate concentrate and platelet-rich plasma enhanced bone healing in distraction osteogenesis of the tibia. Clin Orthop Relat Res 2014; 472:3789-97. [PMID: 24599650 PMCID: PMC4397746 DOI: 10.1007/s11999-014-3548-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND During lower limb lengthening, poor bone regeneration is a devastating complication. Several local or systemic applications have been used to promote osteogenesis, and biologic stimulations are gaining attention, but their utility has not been proven in this setting. QUESTIONS/PURPOSES In patients undergoing bilateral tibial lengthening, we compared those receiving an osteotomy site injection of autologous bone marrow aspirate concentrate (BMAC) plus platelet-rich plasma (PRP) with those not receiving such an injection in terms of external fixator index (time in external fixation divided by amount of lengthening), full weightbearing index (time until a patient was permitted to do full weightbearing divided by amount of lengthening), four cortical healing indexes (time until each cortical union divided by amount of lengthening), and callus shape and type. METHODS Twenty-two patients (44 tibias) undergoing bilateral tibial lengthening enrolled in this randomized trial. Two patients were excluded, one due to insufficient radiographic evaluation and one who was lost to followup, leaving 20 patients (40 segments) for inclusion. Ten patients (20 segments) received BMAC combined with PRP injection (treatment group) and 10 patients (20 segments) received no injection (control group). All patients underwent stature lengthening for familial short stature with the lengthening over nail technique. Autologous BMAC combined with PRP was injected at the tibial osteotomy site at the end of the index surgery. Mean distraction rates were similar between groups (0.75 mm/day in the treatment group versus 0.72 mm/day in the control group; p = 0.24). Full weightbearing was permitted when we observed radiographic evidence of healing at two cortices; this assessment was made by the surgeon who was blinded to the treatment each patient received. Minimum followup was 24 months (mean, 28 months; range, 24-34 months). RESULTS There was no difference in mean external fixator index between groups. However, mean cortical healing indexes (anterior/posterior/medial/lateral) were 1.14/0.81/0.96/0.88 months/cm in the treatment group and 1.47/1.26/1.42/1.22 months/cm in the control group (all p < 0.001), showing faster healing in the treatment group at each cortex. Full weightbearing was permitted earlier in the treatment group than in the control group (index: 0.99 months/cm and 1.38 months/cm, respectively, p < 0.001). Callus shape and type were not different between groups. CONCLUSIONS Autologous BMAC combined with PRP injection at the osteotomy site helped improve bone healing in distraction osteogenesis of the tibia, although the effect size was small. LEVEL OF EVIDENCE Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dong Hoon Lee
- Department of Orthopaedic Surgery, Severance Hospital, College of Medicine, Yonsei University, 134 Sinchondong, CPO Box 8044, Seoul, Republic of Korea
| | - Keun Jung Ryu
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
| | - Jin Woo Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
| | - Kyung Chung Kang
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
| | - Young Rak Choi
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, 351 Yatap-dong, Bundang-gu, Sung-nam, Kyungki-do Republic of Korea
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Ali AM, El-Alfy B, Amin M, Nematalla M, El-Shafaey ESA. Can platelet-rich plasma shorten the consolidation phase of distraction osteogenesis? An experimental study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:543-8. [DOI: 10.1007/s00590-014-1542-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Experimental comparison of the effects of locally administered zoledronic acid and alendronate on the rate of mandibular distraction osteogenesis in dogs. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:35-42. [DOI: 10.1016/j.oooo.2012.09.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 07/08/2012] [Accepted: 09/16/2012] [Indexed: 11/18/2022]
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Sant'Anna EF, Cury-Saramago ADA, Lau GWT, Polley JW, Figueroa ÁA. Treatment of midfacial hypoplasia in syndromic and cleft lip and palate patients by means of a rigid external distractor (RED). Dental Press J Orthod 2013; 18:134-43. [DOI: 10.1590/s2176-94512013000400005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Distraction Osteogenesis (DO) became an alternative for the treatment of severe craniofacial skeletal dysplasias. The rigid external distraction device (RED) is successfully used to advance the maxilla and all the maxillary-orbital-frontal complex (monobloc) in children, adolescents and adults. This approach provides predictable and stable results, and it can be applied alone or with craniofacial orthognathic surgical procedures. OBJECTIVE: In the present article, the technical aspects relevant to an adequate application of the RED will be described, including the planning, surgical and orthodontic procedures.
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Yang JH, Kim HJ, Kim SE, Yun YP, Bae JH, Kim SJ, Choi KH, Song HR. The effect of bone morphogenic protein-2-coated tri-calcium phosphate/hydroxyapatite on new bone formation in a rat model of femoral distraction osteogenesis. Cytotherapy 2011; 14:315-26. [PMID: 22122301 DOI: 10.3109/14653249.2011.630728] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AIMS Distraction osteogenesis (DO) is an increasingly popular technique used to stimulate new bone formation to treat orthopedic disorders resulting from bone defects and deficits. Because of various possible complications that can occur during the long consolidation period, the development of procedures to accelerate regenerated ossification is clearly desirable. The purpose of this study was to evaluate the effect of single insertions of bone morphogenic protein-2 (BMP-2), delivered by tri-calcium phosphate (TCP)/hydroxyapatite (HA), administered at osteotomy sites, on the rate of new bone formation during DO in a rat model. METHODS Thirty-six male Sprague-Dawley rats, aged 12 weeks and weighing a mean (± standard deviation) of 401 ± 14 g, were used in this study. The animals were randomized into three groups of 12 rats each. Group I served as a control, group II was treated with only TCP/HA, and group III was treated with recombinant human (rh) BMP-2-coated TCP/HA. Materials were inserted into the medullary canal at the femoral osteotomy site at the end of the lengthening period. After a 7-day latent phase, distraction was commenced on day 0 at a rate of 0.50 mm every 6 h for 5 days (2 mm daily), resulting in a total of 10 mm of lengthening by day 5. At two different time-points [at 4 weeks (day 33) and 8 weeks (day 61) after cessation of distraction], the progress of bone formation was determined with microcomputed tomography (micro-CT), histology and real-time polymerase chain reaction (PCR). The mean and standard deviation of the values obtained from the experiment were computed and statistical analyses performed using anova. Statistical significance was established at P < 0.05. Results. Radiographically, all group III rat femurs exhibited bridging callus formation 8 weeks after cessation of distraction, whereas group II rat femurs demonstrated non-bridging callus formation. None of the group I rat femurs showed callus in the central zone of the distraction gap. For micro-CT, bone formation and remodeling of the distraction regeneration with beta-TCP/HA coated with rhBMP-2 had greater values than the control sides at all time-points. Two-dimensional quantitative analysis of the distraction regeneration showed that the bone volume of group III had higher values than groups I and II at 4 weeks (P < 0.05). This difference was also evident at 8 weeks. With hematoxylin and eosin (H&E) staining, the control group (group I) did not show any bone tissue at the distraction site. In group II at 4 weeks, abundant fibrous tissue surrounding the particles was visible with some areas of woven bone. At 8 weeks, the woven bone covered the particles but not the whole circumference. In group III at 4 weeks, much of the woven bone surrounded the particle with some fibrocartilagenous materials. At 8 weeks, woven bone covering the whole circumference of the particles was visible. CONCLUSIONS Application of rhBMP-2, at the end of the rather rapid distraction period, as a single bolus significantly increased the osteogenic process, while beta-TCP/HA behaved effectively as a sustained delivery system for this osteoinductive protein.
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Affiliation(s)
- Jae-Hyuk Yang
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, Korea
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Latalski M, Elbatrawy YA, Thabet AM, Gregosiewicz A, Raganowicz T, Fatyga M. Enhancing bone healing during distraction osteogenesis with platelet-rich plasma. Injury 2011; 42:821-4. [PMID: 21513935 DOI: 10.1016/j.injury.2011.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 02/18/2011] [Accepted: 03/07/2011] [Indexed: 02/02/2023]
Abstract
UNLABELLED Gradual limb lengthening with external fixators using distraction osteogenesis principles is the gold standard for treatment of limb-length discrepancy. However, long treatment time is a major disadvantage of the current lengthening procedures. Efforts to decrease the treatment include biological and biomechanical factors. Injection of platelet-rich plasma (PRP) is a biological method to enhance bone healing during distraction osteogenesis. We hypothesised that PRP can enhance bone healing during limb lengthening. We report our experience with the use of PRP during distraction osteogenesis. This retrospective study included 19 patients divided into the standard group of 10 patients who did not receive PRP and the PRP group of nine patients who received PRP at the end of the distraction phase. The study variables included external fixator time, external fixation index, and complications during treatment. The PRP group had statistically significantly shorter treatment time (p=0.0412). Injection of PRP into regenerate bone might be an effective method to shorten treatment time during limb lengthening and lead to better functional outcomes and improved patient satisfaction. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Michał Latalski
- Children Orthopedic Department Medical University, Lublin, Poland
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Zhao ZY, Shao L, Zhao HM, Zhong ZH, Liu JY, Hao CG. Osteogenic Growth Peptide Accelerates Bone Healing during Distraction Osteogenesis in Rabbit Tibia. J Int Med Res 2011; 39:456-63. [PMID: 21672349 DOI: 10.1177/147323001103900213] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Distraction osteogenesis is a valuable treatment method that allows limb lengthening or reconstruction of large bone defects. However, its major disadvantage is the long period required for the consolidation of a distraction callus. Osteogenic growth peptide (OGP) stimulates endochondral bone formation in fracture callus, but its capacity to promote regenerate ossification during distraction osteogenesis has not been evaluated. This study investigated whether intravenously administered OGP accelerated bone healing during distraction osteogenesis in 36 male New Zealand White rabbits, randomized into two groups. The treatment group received OGP (200 ng/kg body weight) in phosphate-buffered saline (PBS), intravenously, each day; the control group received PBS alone. A 15-mm lengthening of the right lower leg was performed using the method of Ilizarov. Evidence from biomechanical, histological and radiographic evaluations demonstrated that systemic OGP treatment promoted optimal new bone formation during distraction osteogenesis in this rabbit model.
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Affiliation(s)
- Z-Y Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - L Shao
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - H-M Zhao
- Department of Gynaecology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Z-H Zhong
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - J-Y Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - C-G Hao
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Extracorporeal shock wave accelerates consolidation in distraction osteogenesis of the rat mandible. ACTA ACUST UNITED AC 2011; 69:1252-8. [PMID: 20404761 DOI: 10.1097/ta.0b013e3181cbc7ac] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND One of major limitations of applying distraction osteogenesis for craniofacial skeleton hypoplasia is the long duration for bony consolidation. This study investigated whether extracorporeal shock wave therapy (ESWT) could accelerate bony consolidation in distraction osteogenesis of the rat mandible. METHODS AND MATERIALS An L-shape osteotomy was performed unilaterally in the hemimandible of Sprague-Dawley rats. An internal distracter was employed to create a 7-mm distraction gap in the mandible. One hundred twenty rats were divided into three groups. The distraction zone of the mandible was received no treatment as controls (group I). Group II received ESWT (500 impulses at 14 kV) at 2 weeks postoperatively. Group III treated with 500 ESW impulses at 21 kV at 2 weeks postoperatively. RESULTS Dual-energy X-ray absorptiometry and material testing showed that optimal dosage of ESWT in group II significantly increased mineral density and enhanced biomechanical strength of the bone tissue. In histomorphological analysis, the mandibular tissue in group II showed intense osteoblastic cell recruitment, new bone formation, and vascularization. The osteoblasts in the distracted zone in group II indicated significantly strong immunoreactivities for proliferating cell nuclear antigen, vascular endothelial growth factor, and bone morphogenetic protein-2, when compared with other groups. CONCLUSION Optimal dosage of ESWT was beneficial for accelerating facial skeleton consolidation and bone regeneration in the distracted rat mandible tissue. The mechanism was presumably associated with the up-regulation of neovascularization, cell proliferation, and osteogenic growth factor expression in bone microenvironment.
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Kim UK, Park SJ, Seong WJ, Heo J, Hwang DS, Kim YD, Shin SH, Kim GC. Expression of TGF-beta1, osteonectin, and BMP-4 in mandibular distraction osteogenesis with compression stimulation: reverse transcriptase-polymerase chain reaction study and biomechanical test. J Oral Maxillofac Surg 2010; 68:2076-84. [PMID: 20542368 DOI: 10.1016/j.joms.2009.09.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 08/15/2009] [Accepted: 09/23/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE This study compared the levels of transforming growth factor-beta1 (TGF-beta1), osteonectin, and bone morphogenetic protein-4 (BMP-4) expression in regenerated bone in a rabbit mandible that had undergone conventional distraction osteogenesis (DO) with those in regenerated bone from a modified DO technique with compression stimulation. MATERIALS AND METHODS A total of 42 rabbits were used in this reverse transcriptase-polymerase chain reaction study. In the control group, distraction was performed at 1 mm/day for 8 days. In the experimental group, overdistraction was performed for 10 days, followed by a 3-day latency period and 2 days of compression to achieve the same amount of DO. Three rabbits per subgroup were killed at 0, 5, 13, 20, 27, 34, and 41 days after the initial osteotomy. The levels of TGF-beta1, osteonectin, and BMP-4 in the bone regenerates were measured by reverse transcriptase-polymerase chain reaction. A biomechanical microhardness test was also performed in 8 rabbits as a separate experiment. RESULTS Reverse transcriptase-polymerase chain reaction revealed a greater level of TGF-beta1 in the experimental group immediately after applying the compression force that continued for 2 weeks. The level then decreased to that of the control group at 3 weeks. The greater level of osteonectin in the experimental group after compression than that in the control group continued for 3 weeks. In the experimental group, the level of BMP-4 increased immediately after compression. However, the level in the control group decreased. The microhardness ratio of distracted bone to normal bone on the cortex was statistically different at 0.47 in the control group and 0.80 in the experimental group (P = .049) at 55 days after osteotomy. CONCLUSION The effectiveness of the new DO technique with compression stimulation was confirmed by the gene expression study and the biomechanical test findings.
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Affiliation(s)
- Uk-Kyu Kim
- Department of Oral and Maxillofacial Surgery, Pusan National University School of Dentistry, Pusan, Republic of Korea.
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Mihmanli A, Dolanmaz D, Avunduk MC, Erdemli E. Effects of recombinant human erythropoietin on mandibular distraction osteogenesis. J Oral Maxillofac Surg 2009; 67:2337-43. [PMID: 19837300 DOI: 10.1016/j.joms.2008.06.082] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 06/23/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effects of subcutaneous administration of recombinant human erythropoietin (rHuEPO) on regeneration formation and quality during mandibular distraction osteogenesis. MATERIALS AND METHODS Sixteen adult male New Zealand rabbits were used in this study. Ethical approval was obtained from the Animal Research Institute of Selcuk University, Konya, Turkey. Subjects were randomly divided into 2 groups. Distraction osteogenesis (DO) was performed with a custom-made distractor on the left mandibles of rabbits. In the experimental group, 4 doses of 150 IU/kg rHuEPO were administered at 48-hour intervals. The first dose was given immediately after surgery. Control subjects received 0.5 mL/kg isotonic solution in the same manner. After 2 days of latency, mandibles were distracted 1 mm/day at 12-hour intervals for 5 days. A 5-mm lengthening was achieved. All animals were sacrificed after 30 days of consolidation. Afterward, samples were prepared for histomorphometric evaluation of newly formed bone area. RESULTS The number of osteoblasts and blood vessels was significantly higher, whereas the number of osteoclasts was significantly lower, in the experimental group than in the control group (P < .05). In the experimental group, the area of new bone formation was greater than in the control group (P < .05). Moreover, fibroblast and collagen numbers per unit area were higher in the experimental group. However, this finding was not statistically significant (P > .05). CONCLUSION The subcutaneous administration of rHuEPO improves the rate and quality of bone-healing during distraction osteogenesis. However, the short-term favorable effects of rHuEPO in this study should be extended with long-term investigations before clinical application.
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Affiliation(s)
- Ahmet Mihmanli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Selcuk University, Konya, Turkey.
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Figueroa AA, Polley JW. Clinical controversies in oral and maxillofacial surgery: Part two. External versus internal distraction osteogenesis for the management of severe maxillary hypoplasia: external distraction. J Oral Maxillofac Surg 2008; 66:2598-604. [PMID: 19022141 DOI: 10.1016/j.joms.2008.05.371] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 05/14/2008] [Indexed: 11/18/2022]
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Effects of Alendronate on Rate of Distraction in Rabbit Mandibles. J Oral Maxillofac Surg 2008; 66:2042-9. [DOI: 10.1016/j.joms.2008.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 03/03/2008] [Accepted: 06/16/2008] [Indexed: 11/18/2022]
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Gotterbarm T, Breusch SJ, Schneider U, Jung M. The minipig model for experimental chondral and osteochondral defect repair in tissue engineering: retrospective analysis of 180 defects. Lab Anim 2008; 42:71-82. [PMID: 18348768 DOI: 10.1258/la.2007.06029e] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Articular cartilage repair is still a challenge in orthopaedic surgery. Although many treatment options have been developed in the last decade, true regeneration of hyaline articular cartilage is yet to be accomplished. In vitro experiments are useful for evaluating cell-matrix interactions under controlled parameters. When introducing new treatment options into clinical routine, adequate animal models are capable of closing the gap between in vitro experiments and the clinical use in human beings. We developed an animal model in the Göttingen minipig (GMP) to evaluate the healing of osteochondral or full-thickness cartilage defects. The defects were located in the middle third of the medial portion of the patellofemoral joint at both distal femurs. Chondral defects were 6.3 mm, osteochondral defects either 5.4 or 6.3 mm in diameter and 8 or 10 mm deep. In both defects the endogenous repair response showed incomplete repair tissue formation up to 12 months postoperatively. Based on its limited capability for endogenous repair of chondral and osteochondral defects, the GMP is a useful model for critical assessment of new treatment strategies in articular cartilage tissue engineering.
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Affiliation(s)
- T Gotterbarm
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Weiss S, Henle P, Bidlingmaier M, Moghaddam A, Kasten P, Zimmermann G. Systemic response of the GH/IGF-I axis in timely versus delayed fracture healing. Growth Horm IGF Res 2008; 18:205-212. [PMID: 17936052 DOI: 10.1016/j.ghir.2007.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 08/27/2007] [Accepted: 09/04/2007] [Indexed: 11/24/2022]
Abstract
The GH-IGF axis has profound effects on the local and systemic regulation of bone metabolism and may be important for quality of fracture healing. To test the hypothesis that deficiency of the GH/IGF axis may play a role in the pathogenesis of fracture non-union we investigated whether alterations of serum concentrations of the GH-IGF axis could be related to failed fracture healing compared to timely fracture healing in trauma patients. Serum probes were prospectively collected from 186 patients with surgical treatment of long bone fractures up to 6 months after surgery. Samples from 14 patients with atrophic type of non-union have been compared to 14 matched patients with normal bone healing. Postoperative time courses of serum concentrations have been analyzed using commercially available chemiluminescence sandwich assays (GH), fully automated assay systems (IGF-I, IGFBP-3) or sandwich immunometric assays (ALS). Comparison between both collectives revealed significantly lower serum concentrations of GH dependent ALS during early (1st week after surgery) and of both IGFBP-3 and ALS during late stages of fracture healing (6 and 8 weeks after surgery) in non-union patients, coinciding clinically with failed fracture healing. Tendentially lower serum levels of IGF-I in the non-union group over the entire investigation period were statistically not significant. We have been able to show time courses of serum concentrations of the GH/IGF-I axis during normal and failed fracture healing in humans. An impairment of the GH/IGF-I axis might be involved in the biochemical mechanisms determining delayed or failed fracture healing.
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Affiliation(s)
- Stefan Weiss
- Stiftung Orthopädische Universitätsklinik, University of Heidelberg, Germany
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Kitoh H, Kitakoji T, Tsuchiya H, Katoh M, Ishiguro N. Distraction osteogenesis of the lower extremity in patients with achondroplasia/hypochondroplasia treated with transplantation of culture-expanded bone marrow cells and platelet-rich plasma. J Pediatr Orthop 2007; 27:629-34. [PMID: 17717461 DOI: 10.1097/bpo.0b013e318093f523] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Longer treatment period in distraction osteogenesis (DO) of the lower extremity leads to more frequent complications. We have developed a new technique of transplantation of culture-expanded bone marrow cells (BMCs) and platelet-rich plasma (PRP) during DO to accelerate new bone formation. To assess the efficacy of this cell therapy, retrospective comparative study was conducted between the bones treated with BMC and PRP and the bones treated without BMC and PRP during DO in patients with achondroplasia (ACH) and hypochondroplasia (HCH). METHODS Fifty-six bones in 20 patients (ACH, 16; HCH, 4) that were lengthened in our hospital were divided into 2 groups. Twenty-four bones (femora, 12; tibiae, 12) in 11 patients (boys, 7; girls, 4) were treated with BMC and PRP transplantation (BMC-PRP group), whereas 32 bones (femora, 14; tibiae, 18) in 9 patients (boys, 3; girls, 6) did not undergo additional cell therapy (control group). The parameters, including the age at operation, the increase in length, and the healing index, were compared between the 2 groups. The clinical outcome was also compared between the femoral and tibial lengthenings. RESULTS Bone marrow cells (average number, +/- SD, 3.2 +/- 1.37 x 10 cells) and PRP (average platelet concentration +/- SD, 2.36 +/- 0.57 x 10 cells/muL) were transplanted. Although there were no significant differences in the age at operation and the length gained between the 2 groups, the average healing index of the BMC-PRP group (27.1 +/- 6.89 d/cm) was significantly lower than that of the control group (36.2 +/- 10.4 d/cm) (P = 0.0005). The femoral lengthening showed significantly faster healing than did the tibial lengthening in the BMC-PRP group (P = 0.0092). CONCLUSIONS Transplantation of BMC and PRP shortened the treatment period by accelerating new bone regeneration during DO of the lower extremity in patients with ACH and HCH, especially in the femoral lengthening.
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Affiliation(s)
- Hiroshi Kitoh
- Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan.
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Abstract
Distraction Osteogenesis (DO) has become a treatment alternative to treat severe craniofacial skeletal dysplasias. A rigid external distraction (RED) device has been successfully used to advance the maxilla as well as the maxillary, orbital and forehead complex (monobloc) in children as young as two years, adolescents and adults. This approach has provided predictable and stable results. It can be applied by itself or as an adjunct to traditional orthognathic and craniofacial surgical procedures. The technical aspects, including planning, surgical and orthodontic procedures, required to properly apply the technique are presented. For this severe group of patients the technique has been found to be simpler and safer than traditional surgical methods. Maxillary and midfacial advancement through distraction has been found to be extremely stable in the patients in whom the technique was used. The reasons for stability are discussed as well as the observed morphologic changes in the facial soft tissues, velopharyngeal mechanism and airway. However, challenges remain to be solved to improve all distraction techniques and the need for collaboration between researchers and clinicians is emphasized to maximize the benefits of this already promising and rewarding approach.
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Affiliation(s)
- A A Figueroa
- Rush Craniofacial Center, Rush University Medical Center, Chicago, IL 60612, USA.
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Fuchs T, Schmidmaier G, Raschke MJ, Stange R. Bioactive-Coated Implants in Trauma Surgery. Eur J Trauma Emerg Surg 2007; 34:60-8. [DOI: 10.1007/s00068-006-6110-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 06/27/2006] [Indexed: 10/23/2022]
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Kitoh H, Kitakoji T, Tsuchiya H, Katoh M, Ishiguro N. Transplantation of culture expanded bone marrow cells and platelet rich plasma in distraction osteogenesis of the long bones. Bone 2007; 40:522-8. [PMID: 17070744 DOI: 10.1016/j.bone.2006.09.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 08/12/2006] [Accepted: 09/21/2006] [Indexed: 11/27/2022]
Abstract
Longer treatment period in distraction osteogenesis (DO) leads to more frequent complications. We developed a new technique of transplantation of culture expanded bone marrow cells (BMC) and platelet rich plasma (PRP) in DO of the long bones. Retrospective comparative study was conducted between the bones treated with and without BMC and PRP in DO to assess the efficacy of this new technique of transplantation. Ninety-two bones (46 patients) that were lengthened in our hospital and followed up until removal of the pins were divided into two groups according to the cell (BMC+PRP) treatment. The BMC-PRP(+) group consisted of 32 bones (14 femora, 18 tibiae) in 17 patients (10 boys and 7 girls), while the BMC-PRP(-) group consisted of 60 bones (25 femora, 35 tibiae) in 29 patients (13 boys and 16 girls). The clinical outcome including the age at operation, amount of length gained, the healing index, the delay in consolidation, and complications were compared between the two groups. The healing between the femoral and the tibial lengthening was also assessed. The average age at operation was 15.8 years in the BMC-PRP(+) group and 15.5 years in the BMC-PRP(-) group. Although there were no significant differences in the age at operation and the length gained between the two groups, the average healing indices of the BMC-PRP(+) group in short stature and in limb length discrepancy were significantly lower than those of the BMC-PRP(-) group (P=0.0019 and P=0.0031, respectively). A delay in consolidation was seen in 45% of the BMC-PRP(-) group but never observed in the BMC-PRP(+) group (P<0.0001). The rate of complications was 23% of the BMC-PRP(-) group and only 6% of the BMC-PRP(+) group (P=0.0406). The femoral lengthening showed significantly faster healing than the tibial lengthening by the BMC and PRP transplantation (P=0.0004) In conclusion, transplantation of BMC and PRP shortened the treatment period and reduced associated complications by accelerating new bone formation in DO.
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Affiliation(s)
- Hiroshi Kitoh
- Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Aichi 466-8550, Japan.
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Wang L, Zhou S, Liu B, Lei D, Zhao Y, Lu C, Tan A. Locally applied nerve growth factor enhances bone consolidation in a rabbit model of mandibular distraction osteogenesis. J Orthop Res 2006; 24:2238-45. [PMID: 17001706 DOI: 10.1002/jor.20269] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Distraction osteogenesis is widely used in treating deformities, defects, and fractures of both long bones and craniofacial bones. Demands for acceleration of bone consolidation are increased in distraction osteogenesis. Nerve growth factor (NGF) can enhance innervation and bone regeneration in a fracture model and stimulate differentiation of osteoblastic cells. In this study, we tested the ability of locally applied NGF to enhance bone regeneration in a rabbit model of mandibular distraction osteogenesis. Twenty rabbits underwent bilateral distraction osteogenesis with a rate of 0.5 mm per 12 h. Two times 0.04 mg human NGFbeta (hNGFbeta) in buffer was injected into the callus after distraction. The contralateral side received placebo injections. Rabbits were euthanized at consolidation times of 14 and 28 days. Specimens were subjected to radiography, callus dimensions measurement, mechanical testing, and bone histological and histomorphometric analysis. The maximum load, bone volume/total volume, mineral apposition rate of the 1st to 11th day, and mineralized bone percentage were significantly higher in the hNGFbeta side at 14 and 28 days (p<0.05). The data indicate that locally applied hNGFbeta can accelerate callus maturation and may be an option to shorten the consolidation period in distraction osteogenesis.
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Affiliation(s)
- Lei Wang
- Department of Oral and Maxillofacial Surgery, Fourth Military Medical University, Chang Le Road 145, Xi'an, and No.537 Hospital of PLA, Baoji, P.R. China
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Kim UK, Chung IK, Lee KH, Swift JQ, Seong WJ, Ko CC. Bone regeneration in mandibular distraction osteogenesis combined with compression stimulation. J Oral Maxillofac Surg 2006; 64:1498-505. [PMID: 16982308 DOI: 10.1016/j.joms.2006.03.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE This study compared modified distraction osteogenesis (DO) protocol with conventional DO protocol on healing bone formation. Computer simulation was performed to understand the mechanical environment of modified DO protocol, which applies compression during the consolidation period. MATERIALS AND METHODS Fifty rats were used in this study. Twenty-five rats in the conventional DO (control) group were sacrificed at postoperative days 11, 21, 28, 35, and 49 after osteotomy. In the modified DO (experimental) group, compression was applied on day 7 after distraction (day 18 postoperatively) for 4 days during the early consolidation period and 25 rats were sacrificed on postoperative day 19, 28, 39, 46, and 53. The histologic and radiographic findings were used to compare the 2 groups. Further, computer simulation was used to predict the mechanical environment of healing bone under conventional and modified DO protocol. RESULTS Radiographic findings showed that the experimental group resulted in denser and wider healing bone. Histologically, the experimental group yielded more mature lamellar bone than the control group. Computer simulation showed that absolute values of tissue strains were nearly double in the control group because of the softer healing tissues. Both the experimental and control groups showed high strains at the ridge crest. Concentrated tensile strain along the distraction direction at the ridge crest might hinder bone formation at the interface, while compressive strain could facilitate the process. CONCLUSION This study proposed a modified DO protocol of adding compression during the early consolidation period of conventional DO protocol. This new technique appears to provide faster and denser bone regeneration.
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Affiliation(s)
- Uk-Kyu Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Busan, South Korea.
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Pampu AA, Dolanmaz D, Tüz HH, Karabacakoglu A. Experimental evaluation of the effects of zoledronic acid on regenerate bone formation and osteoporosis in mandibular distraction osteogenesis. J Oral Maxillofac Surg 2006; 64:1232-6. [PMID: 16860215 DOI: 10.1016/j.joms.2006.04.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of systemically administered zoledronic acid (ZA) on the bone mineral density (BMD) and bone mineral content (BMC) at mandibular distraction sites in rabbits. MATERIALS AND METHODS Eighteen New Zealand white rabbits were randomly divided into 2 groups. Bone lengthening was performed in the left portion of the mandible through distraction osteogenesis at a rate of 0.5 mm every 12 hours for 5 days. While the experimental group rabbits were administered intravenous 0.1 mg/kg ZA, control group rabbits were given only saline infusion during operation. All animals were sacrificed at the end of the consolidation period of 28 days. The mandibles of all animals were removed and both the anterior and posterior pin regions of the regenerate and regenerate region were evaluated by dual energy x-ray absorptiometry (DEXA). BMD and BMC data were statistically analyzed. RESULTS Except for 1 rabbit from the experimental group that had an infection at the external pin region, all animals showed complete clinical healing. When the values in the group receiving ZA were compared with those of the control group, it was observed that the BMD values of the anterior pin region of regenerate, regenerate region, and posterior pin region increased by 23%, 20%, and 31%, respectively; and BMC values increased by 22%, 24%, and 32%, respectively. When data of these regions were compared, both BMD and BMC were found statistically different in all regions (P < .05). CONCLUSION Results of this study showed that ZA had positive effects on new bone formation at and around the distraction gaps of the lengthened rabbit mandibles by distraction osteogenesis.
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Affiliation(s)
- A Alper Pampu
- Department of Oral and Maxillofacial Surgery, Selcuk University, Faculty of Dentistry, Konya, Turkey.
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Theyse LFH, Oosterlaken-Dijksterhuis MA, van Doorn J, Dhert WJA, Hazewinkel HAW. Growth hormone stimulates bone healing in a critical-sized bone defect model. Clin Orthop Relat Res 2006; 446:259-67. [PMID: 16505713 DOI: 10.1097/01.blo.0000203490.21206.7f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Growth hormone plays an important role in bone metabolism. Treating bone deficits is a major topic in orthopaedic surgery. Our hypothesis was that local continuous growth hormone administration stimulates bone healing in a canine critical-sized bone defect model. Bone formation in the defects was quantified using densitometric image analysis and histomorphometry. After growth hormone treatment, expression levels of insulin-like growth factors-I and II, and growth hormone receptor were determined in the bone regenerate of the original defects. Circulating plasma concentrations of insulin-like growth factors-I and II, and insulin- like growth factor binding proteins-4, and 6 were measured during treatment. Growth hormone administration resulted in healing of bone defects but without an additional effect of local infusion. Expression of insulin-like growth factor-I in the bone regenerate was lower in the growth hormone-treated dogs, whereas insulin-like growth factor-II and growth hormone receptor expression were not increased. Growth hormone increased circulating insulin-like growth factor-I and growth factor-II plasma concentrations. Continuous infusion of growth hormone stimulated bone healing in a canine critical-sized bone defect model. Local delivery of growth hormone did not additionally enhance bone healing. Increased circulating plasma concentrations of insulin-like growth factors-I and II most likely induced bone formation.
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Affiliation(s)
- L F H Theyse
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
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Ozeç Y, Oztürk M, Kýlýç E, Yeler H, Göze F, Gümüş C. Effect of Recombinant Human Bone Morphogenetic Protein-2 on Mandibular Distraction Osteogenesis. J Craniofac Surg 2006; 17:80-3. [PMID: 16432412 DOI: 10.1097/01.scs.0000188747.60087.40] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this investigation was to study the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) on bone formation of mandibular distraction osteogenesis. Six skeletally mature sheep underwent 10 mm of bilateral mandibular distraction osteogenesis via a custom-made distractor. Three micrograms of rhBMP-2 with a collagen carrier was implanted in the osteotomy site of one side of the mandible during the osteotomy phase. The contralateral side was used as the control group, and no material was implanted into the distracted area. At 10 days after the end of distraction, all animals were killed, and the distracted calluses were harvested for radiologic and histologic analysis. New bone was generated in the distracted zone in all groups. Histologic and radiologic examination showed that the new bone formation was greater in the rhBMP-2 group than in the control group. Quantitative computed tomography evaluation, however, did not demonstrate a significantly different mean bone density of the regenerates between the 2 groups. The results indicate that application of a rhBMP-2/collagen implant during the osteotomy phase of distraction osteogenesis increased bone formation but did not have a significant effect on bone density of the regenerates.
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Affiliation(s)
- Ylker Ozeç
- Department of Oral and Maxillofacial Surgery, Dental School, Cumhuriyet University, Sivas, Turkey.
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Discussion. J Craniofac Surg 2006. [DOI: 10.1097/01.scs.0000188746.52464.b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Theyse LFH, Oosterlaken-Dijksterhuis MA, van Doorn J, Terlou M, Mol JA, Voorhout G, Hazewinkel HAW. Expression of osteotropic growth factors and growth hormone receptor in a canine distraction osteogenesis model. J Bone Miner Metab 2006; 24:266-73. [PMID: 16816920 DOI: 10.1007/s00774-006-0683-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 01/23/2006] [Indexed: 10/24/2022]
Abstract
Osteotropic growth factors play an important role in bone metabolism. Nevertheless, knowledge about their expression in relation to distraction osteogenesis remains limited. The aim of the present study was to determine the expression of growth hormone (GH), growth hormone receptor (GHR), insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II), and bone morphogenetic protein 2 (BMP-2) in distraction-induced bone regeneration. Expression of these factors was assessed during the consolidation phase, comparing distraction osteogenesis with osteotomy-induced bone formation. Real-time PCR was performed as a semiquantitative measurement of mRNA, and the relative expression levels of these factors were determined. In addition, plasma GH profiles and plasma concentrations of IGF-I, IGF-II, and insulin-like growth factor-binding protein 4 and -6 (IGFBP-4 and -6) were measured to assess their potential systemic role during bone formation. Expression of GHR, IGF-I, and BMP-2 had significantly increased in comparison with the expression of these factors in mature bone. Expression of GHR was significantly higher in distraction-induced bone regenerate than in osteotomy-induced bone. No significant differences were found for the expression of IGF-I and BMP-2 between distraction and osteotomy. Plasma concentrations of GH, IGF-I, IGF-II, IGFBP-4, and IGFBP-6 did not demonstrate any significant differences between treatment groups and controls. Upregulation of GHR expression in distraction osteogenesis may enhance sensitivity to endogenous systemic GH and thus promote consolidation of the regenerated bone. Changes in the systemic osteotropic growth factors GH, IGF-I, IGF-II, IGFBP-4, and IGFBP-6 do not seem to be of importance during distraction osteogenesis.
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Affiliation(s)
- Lars F H Theyse
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80.154, NL-3508, TD, Utrecht, The Netherlands.
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Degat MC, Ferreira E, Logeart-Avramoglou D. Utilisation de facteurs de croissance pour la réparation osseuse. ACTA ACUST UNITED AC 2005; 53:131-41. [PMID: 15781371 DOI: 10.1016/j.patbio.2004.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Accepted: 03/04/2004] [Indexed: 11/17/2022]
Abstract
Osteoformation is induced by numerous growth factors that play an important role in bone repair such as fracture healing. They may serve as therapeutic agent in the treatment of squeletal injuries in the orthopeadic and maxillo-facial fields. Among these proteins, Bone Morphogenetic Proteins (BMP) are the only known osteoinductive growth factors. Unfortunately, they are highly susceptible to proteolysis in vivo and require a suitable delivery system to potentiate their biological activity in a local, controlled and durable manner. In this aim, three options are under investigations: (i) osteoinductive materials made of appropriate carrier to release the protein in situ, (ii) in vivo gene therapy in which the gene is directly transfected in cells of the patient or (iii) ex vivo gene therapy in which cells are harvested from the patient, transfected with DNA in culture and then implanted in the defect. These different kinds of BMP delivery will be discussed.
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Affiliation(s)
- M-C Degat
- Laboratoire de recherches orthopédiques, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 10, avenue de Verdun, 75010 Paris, France
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Duda GN, Maldonado ZM, Klein P, Heller MOW, Burns J, Bail H. On the influence of mechanical conditions in osteochondral defect healing. J Biomech 2005; 38:843-51. [PMID: 15713306 DOI: 10.1016/j.jbiomech.2004.04.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2004] [Indexed: 11/27/2022]
Abstract
Despite the introduction of new surgical techniques, the treatment of cartilage defects remains challenging. Delay or complete failure of cartilage healing is associated with problems in biological regeneration. The influence of mechanical conditions on this process, however, remains unevaluated. Osteochondral defects were generated on the left femoral condyle in 18 Yucatan minipigs. After 4, 6 and 12 weeks the defect filling, trabecular orientation and bone density were compared to the intact contralateral side. The mechanical straining during this period was then analyzed using an adaptive finite element technique. Histologically, the osteochondral defects showed bone resorption at the base and bone formation from the circumference. At 12 weeks, the macroscopically healed specimens showed fibrous cartilage formation, a minimally organized trabecular structure and increased trabecular volume fraction compared to the controls (p < 0.002). The amount of cancellous, cartilagineous, and fibrous tissue and the defect size as measured in histomorphometric analysis for the three time points (4, 6 and 12 weeks) was comparable in magnitude to that predicted by finite element analysis. The simulated osteochondral healing process was not fully capable of re-establishing a hyaline-like cartilage layer. The correlation between simulation and histology allows identification of mechanical factors that appear to have a larger impact on the healing of osteochondral defects than previously considered.
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Affiliation(s)
- Georg N Duda
- Center for Musculoskeletal Surgery, Charité, Campus Virchow-Clinic, Humboldt University of Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
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Kitoh H, Kitakoji T, Tsuchiya H, Mitsuyama H, Nakamura H, Katoh M, Ishiguro N. Transplantation of marrow-derived mesenchymal stem cells and platelet-rich plasma during distraction osteogenesis--a preliminary result of three cases. Bone 2004; 35:892-8. [PMID: 15454096 DOI: 10.1016/j.bone.2004.06.013] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2004] [Revised: 05/28/2004] [Accepted: 06/18/2004] [Indexed: 01/23/2023]
Abstract
Clinical results of distraction osteogenesis with transplantation of marrow-derived mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) were reviewed in three femora and two tibiae of the two patients with achondroplasia and one patient with congenital pseudarthrosis of the tibia. MSCs derived from the iliac crest were cultured with osteogenic supplements and differentiated into osteoblast-like cells. PRP, which is known to contain several growth factors and coagulate immediately by a minute introduction of thrombin and calcium, was prepared just before transplantation. Culture-expanded osteoblast-like cells and autologous PRP were injected into the distracted callus with the thrombin-calcium mixture so that the PRP gel might develop within the injected site. Transplantation of MSCs and PRP was done at the lengthening and consolidation period in each patient. The target lengths were obtained in every leg without major complications and the average healing index was 23.0 days/cm (18.8-26.9 days/cm). Although these results are still preliminary, transplantation of osteoblast-like cells and PRP, which seemed to be a safe and minimally invasive cell therapy, could shorten the treatment period by acceleration of bone regeneration during distraction osteogenesis.
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Affiliation(s)
- Hiroshi Kitoh
- Department of Orthopaedic Surgery, Nagoya University School of Medicine, Showa-ku, Nagoya, Aichi 466-8550, Japan.
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Clarke SA, Brooks RA, Lee PTH, Rushton N. The effect of osteogenic growth factors on bone growth into a ceramic filled defect around an implant. J Orthop Res 2004; 22:1016-24. [PMID: 15304274 DOI: 10.1016/j.orthres.2004.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2003] [Accepted: 01/21/2004] [Indexed: 02/04/2023]
Abstract
Currently available synthetic bone substitutes perform poorly compared to autograft. It is hoped that by adding osteogenic growth factors to the materials, new bone formation could be increased and the clinical outcome improved. In this study, IGF-1, bFGF and TGFbeta1, alone and in combination, were absorbed onto a carrier of beta-tricalcium phosphate (betaTCP) and implanted into a defect around a hydroxyapatite-coated, stainless steel implant in the proximal tibia of rat in a model of revision arthroplasty. Animals were sacrificed at 6 and 26 weeks for routine histology and histomorphometry and mechanical push out tests. The results show that only bFGF had a significant effect on ceramic resorption. The groups that received bFGF and bFGF in combination with TGFbeta1 had smaller and fewer betaTCP particles remaining in the defect at 6 and 26 weeks. No growth factor combination significantly enhanced new bone formation or the mechanical strength of the implant. These results indicate that, of the growth factors tested, only bFGF had any beneficial effect on the host response to the implant, perhaps by delaying osteoblast differentiation and thereby prolonging osteoclast access to the ceramic.
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Affiliation(s)
- S A Clarke
- Orthopaedic Research Unit, University of Cambridge, Box 180, Addenbrooke's Hospital, Hill's Road, Cambridge CB2 2QQ, UK
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Cho BC, Kim JY, Lee JH, Chung HY, Park JW, Roh KH, Kim GU, Kwon IC, Jang KH, Lee DS, Park NW, Kim IS. The bone regenerative effect of chitosan microsphere-encapsulated growth hormone on bony consolidation in mandibular distraction osteogenesis in a dog model. J Craniofac Surg 2004; 15:299-311; discussion 312-3. [PMID: 15167253 DOI: 10.1097/00001665-200403000-00028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this project was to study the effect of chitosan microsphere-encapsulated human growth hormone, which causes sustained release of chitosan and human growth hormone after implantation on early bony consolidation in distraction osteogenesis of a canine model. Forty-eight dogs were used for this study. An external distraction device was applied to the mandibular body after a vertical osteotomy, and the mandibular distraction was started 5 days after the operation at a rate of 1 mm/d up to a 10-mm distraction. The experimental group was divided into a control group (I), hyaluronic acid group (II), chitosan microsphere group (III), and chitosan microsphere-encapsulated human growth hormone group (IV). Normal saline was injected in group I. In group II, a 1-ml volume of hyaluronic acid solution was injected into the distracted area. In the group III, powder of chitosan microspheres and hGH were mixed with a 1-ml volume of hyaluronic acid to make an injectable form, and it was implanted into the distracted area. In group IV, powder of chitosan microsphere-encapsulated hGH was mixed with a 1-ml volume of hyaluronic acid. A total of 1-ml volume of the solution mix was implanted into the distracted area. Five dogs in each group (total of 20 dogs) were killed 3 weeks after completion of distraction. Twenty-eight dogs were killed at 6 weeks. Bone mineral density was 13.1% of the contralateral normal mandible at 3 weeks and 29.6% at 6 weeks in group I, 16.4% at 3 weeks and 40.4% at 6 weeks in group II, 16.6% at 3 weeks and 45.95% at 6 weeks in group III, and 29.6% at 3 weeks and 66.7% at 6 weeks in group IV. The mean three-point failure load was 16.1% in the control group, 34.7% in group II, 41.5% in group III, and 52.1% in group IV compared with the intact contralateral mandible, with statistical significance. In the histological findings, new bone was generated in all groups. In group IV, the formation of active woven bone was observed throughout the distracted area at 6 weeks. The amount of new bone formation in the distracted zone was in the order of group IV, group III, group II, and the control group. In conclusion, these findings suggest that chitosan microsphere-encapsulated hGH seems to be quite effective in early bone consolidation in distraction osteogenesis.
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Affiliation(s)
- Byung Chae Cho
- Department of Plastic and Reconstructive Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.
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Loboa EG, Fang TD, Warren SM, Lindsey DP, Fong KD, Longaker MT, Carter DR. Mechanobiology of mandibular distraction osteogenesis: experimental analyses with a rat model. Bone 2004; 34:336-43. [PMID: 14962812 DOI: 10.1016/j.bone.2003.10.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2003] [Revised: 09/08/2003] [Accepted: 10/31/2003] [Indexed: 11/21/2022]
Abstract
We analyzed mechanobiological influences on successful distraction osteogenesis (DO). Mandibular distraction surgeries were performed on 15 adult male Sprague-Dawley rats. Animals underwent gradual distraction (GD), progressive lengthening by small increments (5-day latency followed by 0.25 mm distractions twice daily for 8 days followed by 28-day maturation period). Distracted hemimandibles were harvested on postoperative days (POD) 5, 7, 10, 13, and 41. Load-displacement curves were then recorded for ex vivo distractions of 0.25 mm and stresses determined. Histologically, new bone formation appeared in GD specimens on distraction day 2 (POD 7), filling 50-60% of the gap by distraction day 8 (POD 13), with nearly complete bony bridging at end maturation (POD 41). Average tensile strains imposed by each incremental distraction ranged from approximately 10% to 12.5% during distraction days 2-8 and were associated with bone apposition rates of about 260 microm/day. Because this GD protocol was previously determined to be optimal for DO, we conclude that strains within this range provide an excellent environment for de novo bone apposition. Distraction caused tissue damage in distraction day 2, 5, and 8 specimens as evidenced by distinct drops in the load/displacement curves. Taken together, our interpretation of these data is that daily distractions cause daily tissue damage which triggers new mesenchymal tissue formation.
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Affiliation(s)
- Elizabeth G Loboa
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305-5148, USA.
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Mizumoto Y, Moseley T, Drews M, Cooper VN, Reddi AH. Acceleration of regenerate ossification during distraction osteogenesis with recombinant human bone morphogenetic protein-7. J Bone Joint Surg Am 2003; 85-A Suppl 3:124-30. [PMID: 12925619 DOI: 10.2106/00004623-200300003-00019] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bone-lengthening can be accomplished by means of distraction osteogenesis. In the present study, we examined the effect of a single dose of recombinant human bone morphogenetic protein-7 (rhBMP-7) on the rate of new-bone formation during distraction osteogenesis in the rat. METHODS Fourteen Long-Evans rats were randomized into two groups of seven rats each. An external fixator was applied to the left femur, and a transverse osteotomy was performed. One group was treated with rhBMP-7 in an aqueous solvent, and the other group received the solvent alone and served as the control. rhBMP-7 was administered on the day of surgery by means of a single injection into the osteotomy gap. Distraction was started seven days after surgery at a rate of 0.25 mm every twelve hours. Distraction was continued for twenty days, resulting in a total of 10 mm of lengthening. The regenerate was monitored with use of radiographs and bone-mineral-density measurements at the conclusion of distraction and at two and four weeks after the cessation of distraction. The lengthened femora were harvested, and biomechanical studies were carried out to determine the stiffness and maximum torque to failure. RESULTS Radiographs showed accelerated regenerate ossification in the BMP-7 group, with a larger amount of new bone compared with the control group. The bone-mineral-density values were dramatically enhanced on Day 20 in the BMP-7 group (103.6 +/- 12.6 mg/cm (2) ) compared with the control group (26.2 +/- 15.1 mg/cm (2) ). These differences continued to be greater at two and four weeks after the cessation of distraction. Normalized values of stiffness (percent stiffness) reached 76.5% +/- 5.4% in the BMP-7 group, compared with 6.6% +/- 0.5% in the control group. The percent maximum torque at failure was 81.1% +/- 1.2% in the BMP-7 group, compared with 20.8% +/- 0.3% in the control group. CONCLUSION A single injection of rhBMP-7 at the time of osteotomy surgery stimulated the rate of regenerate ossification and increased bone-mineral density during distraction osteogenesis. The biomechanical properties of the newly formed bone were also increased by BMP-7 injection.
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Kokoroghiannis C, Papaïoannou N, Lyritis G, Katsiri M, Kalogera P. Calcitonin administration in a rabbit distraction osteogenesis model. Clin Orthop Relat Res 2003:286-92. [PMID: 14612658 DOI: 10.1097/01.blo.0000092966.12414.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effect of salmon calcitonin on the maturation of the regenerate bone was assessed in an experimental model in rabbits. Twenty-six New Zealand White male rabbits, approximately 5 months old and weighing 3 to 3.5 kg, were subjected to a mid-diaphyseal tibial osteotomy. After 5 days, the right tibia was lengthened gradually at a rate of 0.375 mm every 12 hours, for 10 days. Ten international units of salmon calcitonin were administered daily subcutaneously to the study group (14 animals), whereas the animals of the control group (12 animals) were injected with a placebo, for the duration of the experiment. The bone mineral density of the regenerate bone was assessed on Days 20, 35, 45, and 55 of the experiment, in both groups, using dual energy xray absorptiometry. No statistical significant difference was found in the dual energy xray absorptiometry measurements between the study and control groups regarding the change of the bone mineral density of the new bone relative to a preoperative baseline measurement. Characteristic time-related changes were observed in the bone mineral density of the regenerate bone during its maturation, which proved to be identical in both groups. It seems that the administration of calcitonin does not enhance regenerate bone mineralization rate and tendency during bone lengthening.
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Kolbeck S, Bail H, Schmidmaier G, Alquiza M, Raun K, Kappelgard A, Flyvbjerg A, Haas N, Raschke M. Homologous growth hormone accelerates bone healing--a biomechanical and histological study. Bone 2003; 33:628-37. [PMID: 14555268 DOI: 10.1016/s8756-3282(03)00232-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to prove whether homologous growth hormone has a beneficial effect in the early phase of bone healing. Therefore the left tibias of 24 Yucatan micropigs were osteotomized and stabilized by plate fixation. The treatment group (12 animals) received 100 microg of recombinant porcine growth hormone (rpGH)/kg body w/day sc, whereas the control pigs (12 animals) received 1 ml sodium chloride as placebo. After a healing period of 4 weeks the animals were sacrificed and destructive torsional testing was performed. For histological evaluation 6 microm serial slices of the tibiae were stained with von Kossa. The total area of callus formation (CA) and the mineralized bone area (BA) were quantified by image analysis. The fraction of mineralized bone tissue within the callus area, the bone density (BD), was calculated as follows: BD = (BA/CA) x 100. Torsional failure load was 91% higher and torsional stiffness 61% higher in the treatment group than in the control group (P < 0.05). The histomorphometric measurements revealed an advance for the CA (GH: 127.6 +/- 38.9 mm(2); placebo: 75.9 +/- 50.7 mm(2); P < 0.005) as well as for the BA (GH: 89.3 +/- 25.8 mm(2); placebo: 55.9 +/- 38.5 mm(2); P < 0.001) for the GH-treated animals in comparison to the control animals. The BD was similar in both groups (GH: 70.6 +/- 8.4%; placebo: 74.0 +/- 6.24%; P = 0.28). These data indicate that administration of homologous GH stimulates callus formation and ossification in the early phase of bone healing, which consequently results in an increased mechanical strength and stiffness.
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Affiliation(s)
- S Kolbeck
- Trauma and Reconstructive Surgery, Medical Faculty Charité, Virchow Clinic, Humboldt University, Berlin, Germany.
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Hamdy RC, Amako M, Beckman L, Kawaguchi M, Rauch F, Lauzier D, Steffen T. Effects of osteogenic protein-1 on distraction osteogenesis in rabbits. Bone 2003; 33:248-55. [PMID: 14499359 DOI: 10.1016/s8756-3282(03)00154-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study we tested the effect of locally applied osteogenic protein 1 (OP-1) on distraction osteogenesis in rabbits. Seven days after tibial osteotomy, distraction was started at a rate of 0.25 mm per 12 h for 3 weeks. At the end of the distraction period, OP-1 was injected at the site of osteotomy. Four different dosages were tested (0, 80, 800, or 2000 microg; eight rabbits per dose group). Rabbits were sacrificed 3 weeks later, and histologic, densitometric, and biomechanical parameters were assessed. No significant differences were found between groups for any parameter. To explain why this approach was only modestly successful, the expression of BMP receptor protein in the newly formed tissue was analyzed by immunohistochemistry. Strong expression of BMP receptor IA, IB, and II was found during the early distraction phase, but not during later stages of the process. Thus, it appears that the lack of receptor protein in the target tissue impairs the effect of OP-1 given at the end of the distraction period. Possibly, OP-1 could be more useful when applied early in the distraction phase.
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Affiliation(s)
- Reggie C Hamdy
- Shriners Hospital for Children, Canadian Unit, Division of Orthopaedics, McGill University, 1529 Cedar Avenue, Montreal, Quebec, Canada H3G 1A6.
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