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Hall TAG, Theodoridis K, Kohli N, Cegla F, van Arkel RJ. Active osseointegration in an ex vivo porcine bone model. Front Bioeng Biotechnol 2024; 12:1360669. [PMID: 38585711 PMCID: PMC10995341 DOI: 10.3389/fbioe.2024.1360669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Achieving osseointegration is a fundamental requirement for many orthopaedic, oral, and craniofacial implants. Osseointegration typically takes three to 6 months, during which time implants are at risk of loosening. The aim of this study was to investigate whether osseointegration could be actively enhanced by delivering controllable electromechanical stimuli to the periprosthetic bone. First, the osteoconductivity of the implant surface was confirmed using an in vitro culture with murine preosteoblasts. The effects of active treatment on osseointegration were then investigated in a 21-day ex vivo model with freshly harvested cancellous bone cylinders (n = 24; Ø10 mm × 5 mm) from distal porcine femora, with comparisons to specimens treated by a distant ultrasound source and static controls. Cell viability, proliferation and distribution was evident throughout culture. Superior ongrowth of tissue onto the titanium discs during culture was observed in the actively stimulated specimens, with evidence of ten-times increased mineralisation after 7 and 14 days of culture (p < 0.05) and 2.5 times increased expression of osteopontin (p < 0.005), an adhesive protein, at 21 days. Moreover, histological analyses revealed increased bone remodelling at the implant-bone interface in the actively stimulated specimens compared to the passive controls. Active osseointegration is an exciting new approach for accelerating bone growth into and around implants.
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Affiliation(s)
- Thomas A G Hall
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Konstantinos Theodoridis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Nupur Kohli
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Frederic Cegla
- Non-Destructive Evaluation Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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Martín D, Ruano D, Yúfera A, Daza P. Electrical pulse stimulation parameters modulate N2a neuronal differentiation. Cell Death Discov 2024; 10:49. [PMID: 38272891 PMCID: PMC10810886 DOI: 10.1038/s41420-024-01820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Electrical pulse stimulation has been used to enhance the differentiation or proliferation of neuronal progenitor cells in tissue engineering and cancer treatment. Therefore, a comprehensive investigation of the effects caused by its parameters is crucial for improvements in those fields. We propose a study of pulse parameters, to allow the control of N2a cell line fate and behavior. We have focused on designing an experimental setup that allows for the knowledge and control over the environment and the stimulation signals applied. To map the effects of the stimulation on N2a cells, their morphology and the cellular and molecular reactions induced by the pulse stimulation have been analyzed. Immunofluorescence, rt-PCR and western blot analysis have been carried out for this purpose, as well as cell counting. Our results show that low-amplitude electrical pulse stimulation promotes proliferation of N2a cells, whilst amplitudes in the range 250 mV/mm-500 mV/mm induce differentiation. Amplitudes higher than 750 mV/mm produce cell damage at low frequencies. For high frequencies, large amplitudes are needed to cause cell death. An inverse relation has been found between cell density and pulse-induced neuronal differentiation. The best condition for neuronal differentiation was found to be 500 mV/mm at 100 Hz. These findings have been confirmed by up-regulation of the Neurod1 gene. Our preliminary study of the molecular effects of electrical pulse stimulation on N2a offers premonitory clues of the PI3K/Akt/GSK-3β pathway implications on the neuronal differentiation process through ES. In general, we have successfully mapped the sensitivity of N2a cells to electrical pulse stimulation parameters.
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Affiliation(s)
- Daniel Martín
- Departamento de Biología Celular, Facultad de Biología, Universidad de Sevilla, Sevilla, Spain.
- Instituto de Microelectrónica de Sevilla (IMSE), Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain.
| | - Diego Ruano
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain
| | - Alberto Yúfera
- Instituto de Microelectrónica de Sevilla (IMSE), Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain
- Departamento de Tecnología Electrónica, ETSII, Universidad de Sevilla, Sevilla, Spain
| | - Paula Daza
- Departamento de Biología Celular, Facultad de Biología, Universidad de Sevilla, Sevilla, Spain
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Wang A, Ma X, Bian J, Jiao Z, Zhu Q, Wang P, Zhao Y. Signalling pathways underlying pulsed electromagnetic fields in bone repair. Front Bioeng Biotechnol 2024; 12:1333566. [PMID: 38328443 PMCID: PMC10847561 DOI: 10.3389/fbioe.2024.1333566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Pulsed electromagnetic field (PEMF) stimulation is a prospective non-invasive and safe physical therapy strategy for accelerating bone repair. PEMFs can activate signalling pathways, modulate ion channels, and regulate the expression of bone-related genes to enhance osteoblast activity and promote the regeneration of neural and vascular tissues, thereby accelerating bone formation during bone repair. Although their mechanisms of action remain unclear, recent studies provide ample evidence of the effects of PEMF on bone repair. In this review, we present the progress of research exploring the effects of PEMF on bone repair and systematically elucidate the mechanisms involved in PEMF-induced bone repair. Additionally, the potential clinical significance of PEMF therapy in fracture healing is underscored. Thus, this review seeks to provide a sufficient theoretical basis for the application of PEMFs in bone repair.
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Affiliation(s)
- Aoao Wang
- Medical School of Chinese PLA, Beijing, China
| | - Xinbo Ma
- Department of Chemistry, Capital Normal University, Beijing, China
| | - Jiaqi Bian
- Senior Department of Orthopaedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | | | - Qiuyi Zhu
- Medical School of Chinese PLA, Beijing, China
| | - Peng Wang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yantao Zhao
- Senior Department of Orthopaedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
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Min Q, Gao Y, Wang Y. Bioelectricity in dental medicine: a narrative review. Biomed Eng Online 2024; 23:3. [PMID: 38172866 PMCID: PMC10765628 DOI: 10.1186/s12938-023-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Bioelectric signals, whether exogenous or endogenous, play crucial roles in the life processes of organisms. Recently, the significance of bioelectricity in the field of dentistry is steadily gaining greater attention. OBJECTIVE This narrative review aims to comprehensively outline the theory, physiological effects, and practical applications of bioelectricity in dental medicine and to offer insights into its potential future direction. It attempts to provide dental clinicians and researchers with an electrophysiological perspective to enhance their clinical practice or fundamental research endeavors. METHODS An online computer search for relevant literature was performed in PubMed, Web of Science and Cochrane Library, with the keywords "bioelectricity, endogenous electric signal, electric stimulation, dental medicine." RESULTS Eventually, 288 documents were included for review. The variance in ion concentration between the interior and exterior of the cell membrane, referred to as transmembrane potential, forms the fundamental basis of bioelectricity. Transmembrane potential has been established as an essential regulator of intercellular communication, mechanotransduction, migration, proliferation, and immune responses. Thus, exogenous electric stimulation can significantly alter cellular action by affecting transmembrane potential. In the field of dental medicine, electric stimulation has proven useful for assessing pulp condition, locating root apices, improving the properties of dental biomaterials, expediting orthodontic tooth movement, facilitating implant osteointegration, addressing maxillofacial malignancies, and managing neuromuscular dysfunction. Furthermore, the reprogramming of bioelectric signals holds promise as a means to guide organism development and intervene in disease processes. Besides, the development of high-throughput electrophysiological tools will be imperative for identifying ion channel targets and precisely modulating bioelectricity in the future. CONCLUSIONS Bioelectricity has found application in various concepts of dental medicine but large-scale, standardized, randomized controlled clinical trials are still necessary in the future. In addition, the precise, repeatable and predictable measurement and modulation methods of bioelectric signal patterns are essential research direction.
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Affiliation(s)
- Qingqing Min
- Department of Endodontics, Wuxi Stomatology Hospital, Wuxi, 214000, China
| | - Yajun Gao
- Department of Endodontics, Wuxi Stomatology Hospital, Wuxi, 214000, China
| | - Yao Wang
- Department of Implantology, Wuxi Stomatology Hospital, Wuxi, 214000, China.
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Bielfeldt M, Budde-Sagert K, Weis N, Buenning M, Staehlke S, Zimmermann J, Arbeiter N, Mobini S, González MU, Rebl H, Uhrmacher A, van Rienen U, Nebe B. Discrimination between the effects of pulsed electrical stimulation and electrochemically conditioned medium on human osteoblasts. J Biol Eng 2023; 17:71. [PMID: 37996914 PMCID: PMC10668359 DOI: 10.1186/s13036-023-00393-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Electrical stimulation is used for enhanced bone fracture healing. Electrochemical processes occur during the electrical stimulation at the electrodes and influence cellular reactions. Our approach aimed to distinguish between electrochemical and electric field effects on osteoblast-like MG-63 cells. We applied 20 Hz biphasic pulses via platinum electrodes for 2 h. The electrical stimulation of the cell culture medium and subsequent application to cells was compared to directly stimulated cells. The electric field distribution was predicted using a digital twin. RESULTS Cyclic voltammetry and electrochemical impedance spectroscopy revealed partial electrolysis at the electrodes, which was confirmed by increased concentrations of hydrogen peroxide in the medium. While both direct stimulation and AC-conditioned medium decreased cell adhesion and spreading, only the direct stimulation enhanced the intracellular calcium ions and reactive oxygen species. CONCLUSION The electrochemical by-product hydrogen peroxide is not the main contributor to the cellular effects of electrical stimulation. However, undesired effects like decreased adhesion are mediated through electrochemical products in stimulated medium. Detailed characterisation and monitoring of the stimulation set up and electrochemical reactions are necessary to find safe electrical stimulation protocols.
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Affiliation(s)
- Meike Bielfeldt
- Institute for Cell Biology, Rostock University Medical Center, 18057, Rostock, Germany.
| | - Kai Budde-Sagert
- Institute of Communications Engineering, University of Rostock, 18051, Rostock, Germany
- Institute for Visual and Analytic Computing, University of Rostock, 18051, Rostock, Germany
| | - Nikolai Weis
- Institute for Cell Biology, Rostock University Medical Center, 18057, Rostock, Germany
| | - Maren Buenning
- Institute for Cell Biology, Rostock University Medical Center, 18057, Rostock, Germany
| | - Susanne Staehlke
- Institute for Cell Biology, Rostock University Medical Center, 18057, Rostock, Germany
| | - Julius Zimmermann
- Institute of General Electrical Engineering, University of Rostock, 18051, Rostock, Germany
| | - Nils Arbeiter
- Institute of General Electrical Engineering, University of Rostock, 18051, Rostock, Germany
| | - Sahba Mobini
- Instituto de Micro y Nanotecnología, IMN-CNM, CSIC (CEI UAM+CSIC), Isaac Newton 8, E-28760 Tres Cantos, Madrid, Spain
| | - María Ujué González
- Instituto de Micro y Nanotecnología, IMN-CNM, CSIC (CEI UAM+CSIC), Isaac Newton 8, E-28760 Tres Cantos, Madrid, Spain
| | - Henrike Rebl
- Institute for Cell Biology, Rostock University Medical Center, 18057, Rostock, Germany
| | - Adelinde Uhrmacher
- Institute for Visual and Analytic Computing, University of Rostock, 18051, Rostock, Germany
- Interdisciplinary Faculty, University of Rostock, 18051, Rostock, Germany
| | - Ursula van Rienen
- Institute of General Electrical Engineering, University of Rostock, 18051, Rostock, Germany
- Interdisciplinary Faculty, University of Rostock, 18051, Rostock, Germany
| | - Barbara Nebe
- Institute for Cell Biology, Rostock University Medical Center, 18057, Rostock, Germany
- Interdisciplinary Faculty, University of Rostock, 18051, Rostock, Germany
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6
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Wang Q, Zhang J, Yao G, Lou W, Zhang T, Zhang Z, Xie M, Gan X, Pan T, Gao M, Zhao Z, Zhang H, Wang J, Lin Y. Effective Orthodontic Tooth Movement via an Occlusion-Activated Electromechanical Synergistic Dental Aligner. ACS NANO 2023; 17:16757-16769. [PMID: 37590490 DOI: 10.1021/acsnano.3c03385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Malocclusion is a prevalent dental health problem plaguing over 56% worldwide. Mechanical orthodontic aligners render directional teeth movement extensively used for malocclusion treatment in the clinic, while mechanical regulation inefficiency prolongs the treatment course and induces adverse complications. As a noninvasive physiotherapy, an appropriate electric field plays a vital role in tissue metabolism engineering. Here, we propose an occlusion-activated electromechanical synergistic dental aligner that converts occlusal energy into a piezo-excited alternating electric field for accelerating orthodontic tooth movement. Within an 18-day intervention, significantly facilitated orthodontic results were obtained from young and aged Sprague-Dawley rats, increasing by 34% and 164% in orthodontic efficiency, respectively. The different efficiencies were attributed to age-distributed periodontal tissue status. Mechanistically, the electromechanical synergistic intervention modulated the microenvironment, enhanced osteoblast and osteoclast activity, promoted alveolar bone metabolism, and ultimately accelerated tooth movement. This work holds excellent potential for personalized and effective treatment for malocclusions, which would vastly reduce the suffering of the long orthodontic course.
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Affiliation(s)
- Qian Wang
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Jie Zhang
- Department of Orthodontics, National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Guang Yao
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
- State Key Laboratory of Electronic Thin Films and Integrated Devices, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
- Medico-Engineering Cooperation on Applied Medicine Research Center, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
- Shenzhen Institute for Advanced Study, University of Electronic Science and Technology of China, Shenzhen 518110, Guangdong, China
| | - Wenhao Lou
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Tianyao Zhang
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Zihan Zhang
- Department of Orthodontics, National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Maowen Xie
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Xingyi Gan
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Taisong Pan
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Min Gao
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
| | - Zhihe Zhao
- Department of Orthodontics, National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hulin Zhang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China
| | - Jun Wang
- Department of Orthodontics, National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yuan Lin
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
- State Key Laboratory of Electronic Thin Films and Integrated Devices, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
- Medico-Engineering Cooperation on Applied Medicine Research Center, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, China
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7
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Fernandes BF, Silva N, Marques JF, Da Cruz MB, Tiainen L, Gasik M, Carvalho Ó, Silva FS, Caramês J, Mata A. Bio-Piezoelectric Ceramic Composites for Electroactive Implants-Biological Performance. Biomimetics (Basel) 2023; 8:338. [PMID: 37622943 PMCID: PMC10452837 DOI: 10.3390/biomimetics8040338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Barium titanate (BaTiO3) piezoelectric ceramic may be a potential alternative for promoting osseointegration due to its piezoelectric properties similar to bone electric potentials generated in loading function. In this sense, the aim of this in vitro study was to evaluate the cellular response of human osteoblasts and gingival fibroblasts as well as the impact on S. oralis when in contact with BaTiO3 functionalized zirconia implant surfaces with piezoelectric properties. Zirconia discs with BaTiO3 were produced and contact poling (piezo activation) was performed. Osteoblasts (hFOB 1.19), fibroblasts (HGF hTERT) and S. oralis were culture on discs. Cell viability and morphology, cell differentiation markers, bacterial adhesion and growth were evaluated. The present study suggests that zirconia composite surfaces with the addition of piezoelectric BaTiO3 are not cytotoxic to peri-implant cells. Also, they seem to promote a faster initial osteoblast differentiation. Moreover, these surfaces may inhibit the growth of S. oralis by acting as a bacteriostatic agent over time. Although the piezoelectric properties do not affect the cellular inflammatory profile, they appear to enable the initial adhesion of bacteria, however this is not significant over the entire testing period. Furthermore, the addition of non-poled BaTiO3 to zirconia may have a potential reduction effect on IL-6 mediated-inflammatory activity in fibroblasts.
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Affiliation(s)
- Beatriz Ferreira Fernandes
- Oral Biology and Biochemistry Research Group—Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
| | - Neusa Silva
- Oral Biology and Biochemistry Research Group—Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
| | - Joana Faria Marques
- Oral Biology and Biochemistry Research Group—Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
| | - Mariana Brito Da Cruz
- Oral Biology and Biochemistry Research Group—Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
| | - Laura Tiainen
- Department of Mechanical Engineering, Center for Microelectromechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal
| | - Michael Gasik
- Department of Chemical and Metallurgical Engineering, Aalto University, 02780 Espoo, Finland
| | - Óscar Carvalho
- Department of Mechanical Engineering, Center for Microelectromechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal
| | - Filipe Samuel Silva
- Department of Mechanical Engineering, Center for Microelectromechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal
| | - João Caramês
- Implant & Tissue Regeneration Group—Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), LIBPhys-FTC UID/FIS/04559/2013, Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
| | - António Mata
- Oral Biology and Biochemistry Research Group—Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), LIBPhys-FCT UID/FIS/04559/2013, Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
- CEMDBE—Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
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Verma N, Le T, Mudge J, Nicksic PJ, Xistris L, Kasole M, Shoffstall AJ, Poore SO, Ludwig KA, Dingle AM. Efficacy of bone stimulators in large-animal models and humans may be limited by weak electric fields reaching fracture. Sci Rep 2022; 12:21798. [PMID: 36526728 PMCID: PMC9758190 DOI: 10.1038/s41598-022-26215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Noninvasive electronic bone growth stimulators (EBGSs) have been in clinical use for decades. However, systematic reviews show inconsistent and limited clinical efficacy. Further, noninvasive EBGS studies in small animals, where the stimulation electrode is closer to the fracture site, have shown promising efficacy, which has not translated to large animals or humans. We propose that this is due to the weaker electric fields reaching the fracture site when scaling from small animals to large animals and humans. To address this gap, we measured the electric field strength reaching the bone during noninvasive EBGS therapy in human and sheep cadaver legs and in finite element method (FEM) models of human and sheep legs. During application of 1100 V/m with an external EBGS, only 21 V/m reached the fracture site in humans. Substantially weaker electric fields reached the fracture site during the later stages of healing and at increased bone depths. To augment the electric field strength reaching the fracture site during noninvasive EBGS therapy, we introduced the Injectrode, an injectable electrode that spans the distance between the bone and subcutaneous tissue. Our study lays the groundwork to improve the efficacy of noninvasive EBGSs by increasing the electric field strength reaching the fracture site.
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Affiliation(s)
- Nishant Verma
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA
| | - Todd Le
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Jonah Mudge
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA
| | - Peter J. Nicksic
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Lillian Xistris
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Maisha Kasole
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA
| | - Andrew J. Shoffstall
- grid.67105.350000 0001 2164 3847Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA ,grid.410349.b0000 0004 5912 6484Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH USA
| | - Samuel O. Poore
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
| | - Kip A. Ludwig
- grid.14003.360000 0001 2167 3675Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Wisconsin Institute for Translational Neuroengineering (WITNe), University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI USA
| | - Aaron M. Dingle
- grid.14003.360000 0001 2167 3675Division of Plastic Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI USA
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Guo S, Dai X, Chen X, Zhao G, Xue Y, Zhang C, Liu J, Ouyang X, Li Z, Shi Y, Yao Q, Han L, Li B, Zhao B. Effect of transcutaneous electrical acupoint stimulation on bone loss for patients with foot and ankle fracture: a pragmatic randomized controlled trial. Am J Transl Res 2022; 14:8191-8203. [PMID: 36505292 PMCID: PMC9730072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/01/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim for this trial was to preliminarily evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) for bone loss in patients with immobilization after surgical fixation of ankle and foot fractures. METHODS A total of 80 patients with immobilization after surgical fixation of ankle and foot fractures were randomly divided into an intervention group (n=40) or control group (n=40). The intervention group was given TEAS treatment combined with routine orthopedic treatment, and the control group was given only routine orthopedic treatment. The CT attenuation values, bone turnover markers (ALP, PINP, BGP, CTX, Ca/Cr), bone mineral density (BMD), blood phosphorus, and blood calcium were observed and compared between the two groups at 8 weeks. This was a prospective study. The protocol was registered in the Chinese clinical trial registry (No. ChiCTR2000039944). RESULTS The CT attenuation values of the intervention group decreased more than those of the control group (P<0.05), however the between group differences in ALP, BGP, Ca/Cr, CTX and BMD (all P>0.05) were not statistically significant. Three mild adverse events were recorded. CONCLUSION TEAS treatment may confer additional benefits for bone loss in patients with immobilization after surgical fixation of ankle and foot fractures. Since this was a pilot study, the efficacy of TEAS requires further evaluation through full-scale randomized controlled trials.
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Affiliation(s)
- Shiqi Guo
- Department of School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese MedicineBeijing 100700, China
| | - Xiaoqian Dai
- China Astronaut Research and Training CenterBeijing 100094, China
| | - Xueming Chen
- Beijing Luhe Hospital, Capital Medical UniversityBeijing 100069, China
| | - Guozhen Zhao
- Evidence-based Medicine Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical UniversityBeijing 100069, China
| | - Ying Xue
- Department of School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese MedicineBeijing 100700, China
| | - Chunhui Zhang
- Beijing Luhe Hospital, Capital Medical UniversityBeijing 100069, China
| | - Jinyi Liu
- Department of School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese MedicineBeijing 100700, China
| | - Xiali Ouyang
- Department of School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese MedicineBeijing 100700, China
| | - Zhili Li
- China Astronaut Research and Training CenterBeijing 100094, China
| | - Yuqing Shi
- Department of School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese MedicineBeijing 100700, China
| | - Qin Yao
- Department of School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese MedicineBeijing 100700, China
| | - Li Han
- Department of School of Traditional Chinese Medicine, Beijing University of Chinese MedicineBeijing 100700, China
| | - Bo Li
- Evidence-based Medicine Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical UniversityBeijing 100069, China
| | - Baixiao Zhao
- Department of Dongzhimen Hospital, Beijing University of Chinese MedicineBeijing 100700, China
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Pettersen E, Anderson J, Ortiz-Catalan M. Electrical stimulation to promote osseointegration of bone anchoring implants: a topical review. J Neuroeng Rehabil 2022; 19:31. [PMID: 35313892 PMCID: PMC8939223 DOI: 10.1186/s12984-022-01005-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 03/01/2022] [Indexed: 01/22/2023] Open
Abstract
Electrical stimulation has shown to be a promising approach for promoting osseointegration in bone anchoring implants, where osseointegration defines the biological bonding between the implant surface and bone tissue. Bone-anchored implants are used in the rehabilitation of hearing and limb loss, and extensively in edentulous patients. Inadequate osseointegration is one of the major factors of implant failure that could be prevented by accelerating or enhancing the osseointegration process by artificial means. In this article, we reviewed the efforts to enhance the biofunctionality at the bone-implant interface with electrical stimulation using the implant as an electrode. We reviewed articles describing different electrode configurations, power sources, and waveform-dependent stimulation parameters tested in various in vitro and in vivo models. In total 55 English-language and peer-reviewed publications were identified until April 2020 using PubMed, Google Scholar, and the Chalmers University of Technology Library discovery system using the keywords: osseointegration, electrical stimulation, direct current and titanium implant. Thirteen of those publications were within the scope of this review. We reviewed and compared studies from the last 45 years and found nonuniform protocols with disparities in cell type and animal model, implant location, experimental timeline, implant material, evaluation assays, and type of electrical stimulation. The reporting of stimulation parameters was also found to be inconsistent and incomplete throughout the literature. Studies using in vitro models showed that osteoblasts were sensitive to the magnitude of the electric field and duration of exposure, and such variables similarly affected bone quantity around implants in in vivo investigations. Most studies showed benefits of electrical stimulation in the underlying processes leading to osseointegration, and therefore we found the idea of promoting osseointegration by using electric fields to be supported by the available evidence. However, such an effect has not been demonstrated conclusively nor optimally in humans. We found that optimal stimulation parameters have not been thoroughly investigated and this remains an important step towards the clinical translation of this concept. In addition, there is a need for reporting standards to enable meta-analysis for evidence-based treatments.
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Affiliation(s)
- Emily Pettersen
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Center for Advanced Reconstruction of Extremities (C.A.R.E.), Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jenna Anderson
- Center for Bionics and Pain Research, Mölndal, Sweden.,Center for Advanced Reconstruction of Extremities (C.A.R.E.), Sahlgrenska University Hospital, Mölndal, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden. .,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden. .,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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