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Nogueira-Júnior V, Sousa FRN, da S M Rebouças C, Braz HLB, Dos S Morais MLG, Goes P, de C Brito GA, Jorge RJB, Barbosa FG, Mafezoli J, Silva-Filho CJA, de O Capistrano AL, Bezerra MM, de C Leitão RF. Exploring the osteogenic potential of semisynthetic triterpenes from Combretum leprosum: An in vitro and in silico study. In Vitro Cell Dev Biol Anim 2024:10.1007/s11626-024-00928-w. [PMID: 38992216 DOI: 10.1007/s11626-024-00928-w] [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: 11/14/2023] [Accepted: 05/13/2024] [Indexed: 07/13/2024]
Abstract
Combretum leprosum Mart. is a plant of the Combretaceae family, widely distributed in the Northeast region of Brazil, popularly used as an anti-inflammatory agent, and rich in triterpenes. This study evaluated in vitro and in silico potential osteogenic of two semisynthetic triterpenes (CL-P2 and CL-P2A) obtained from the pentacyclic triterpene 3β,6β,16β-trihydroxylup-20(29)-ene (CL-1) isolated from C. leprosum. Assays were carried out in cultured murine osteoblasts (OFCOL II), first investigating the possible toxicity of the compounds on these cells through viability assays (MTT). Cell proliferation and activation were investigated by immunohistochemical evaluation of Ki-67, bone alkaline phosphatase (ALP) activity, and mineralization test by Von Kossa. Molecular docking analysis was performed to predict the binding affinity of CL-P2 and CL-P2A to target proteins involved in the regulation of osteogenesis, including: bone morphogenetic protein 2 (BMP-2), proteins related to Wingless-related integration (WNT) pathway (Low-density lipoprotein receptor-related protein 6-LRP6 and sclerostin-SOST), and receptor activator of nuclear factor (NF)-kB-ligand (RANK-L). Next, Western Blot and immunofluorescence investigated BMP-2, WNT, RANK-L, and OPG protein expressions in cultured murine osteoblasts (OFCOL II). None of the CL-P2 and CL-P2A concentrations were toxic to osteoblasts. Increased cell proliferation, ALP activity, and bone mineralization were observed. Molecular docking assays demonstrated interactions with BMP-2, LRP6, SOST, and RANK-L/OPG. There was observed increased expression of BMP-2, WNT, and RANK-L/OPG proteins. These results suggest, for the first time, the osteogenic potential of CL-P2 and CL-P2A.
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Affiliation(s)
- Valdo Nogueira-Júnior
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Fátima Regina N Sousa
- Department of Morphology, Medical School, Federal University of Piaui, Picos, Piauí, Brazil
| | - Conceição da S M Rebouças
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Helyson L B Braz
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Maria Luana G Dos S Morais
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Paula Goes
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Gerly Anne de C Brito
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Roberta Jeane B Jorge
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Physiology and Pharmacology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Francisco Geraldo Barbosa
- Department of Organic and Inorganic Chemistry, Science Centre, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Jair Mafezoli
- Department of Organic and Inorganic Chemistry, Science Centre, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Carlos José A Silva-Filho
- Department of Organic and Inorganic Chemistry, Science Centre, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - André Luiz de O Capistrano
- Department of Organic and Inorganic Chemistry, Science Centre, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Mirna M Bezerra
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Ceará, Sobral, Ceará, Brazil.
| | - Renata F de C Leitão
- Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Trang LT, Le HV, Hiromoto S, Minho O, Kobayashi E, Nguyen NV, Cao NQ. In vitrocellular biocompatibility and in vivodegradation behavior of calcium phosphate-coated ZK60 magnesium alloy. Biomed Mater 2023; 18. [PMID: 36827743 DOI: 10.1088/1748-605x/acbf16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/24/2023] [Indexed: 02/26/2023]
Abstract
Calcium phosphate (Ca-P) surface coating is a simple but effective way to enhance both corrosion resistance and biocompatibility of ZK60 magnesium alloy. However, cell compatibility on different Ca-P layers coated on ZK60 alloy has seldom been investigated. In this study, the effects of type, morphology and corrosion protection of several Ca-P coatings formed at pH 6.5, 7.8 and 10.2 on cell behavior were examined by using an osteoblastic cell line MC3T3-E1. Furthermore,in vivobehavior in rabbits of the alloy coated with the optimum Ca-P layer was also studied. It was found that the surface factors governed the cell morphology and density. The coating morphology plays a dominant role in these surface factors. The sample coated at pH 7.8 showed the best cellular biocompatibility, suggesting that the hydroxyapatite (HAp) layer formed at pH 7.8 was the optimum coating. In rabbits, this optimum coating enhanced remarkably the corrosion resistance of the alloy. During implantation, the outermost crystals of the HAp coating were shortened and thinned due to the dissolution of HAp caused by the body fluid of the rabbits. It is indicated that ZK60 alloy coated at pH 7.8 can be applied as a biodegradable implant.
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Affiliation(s)
- Le Thi Trang
- Department of Materials Science and Engineering, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro, Tokyo 152-8550, Japan
| | - Hai Van Le
- 103 Military Hospital, Vietnam Military Medical University, 160, Phung Hung, Phuc La, Ha Dong, Hanoi, Vietnam
| | - Sachiko Hiromoto
- Research Center for Structural Materials, National Institute for Materials Science, 1-2-1 Sengen, Tsukuba, Ibaraki 305-0047, Japan
| | - O Minho
- Department of Materials Science and Engineering, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro, Tokyo 152-8550, Japan
| | - Equo Kobayashi
- Department of Materials Science and Engineering, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro, Tokyo 152-8550, Japan
| | - Nam Viet Nguyen
- Institute of Traumatology and Orthopedics, 108 Military Central Hospital, 1B Tran Hung Dao, Bach Dang, Hai Ba Trung, Hanoi, Vietnam
| | - Nguyen Quang Cao
- Laboratory for Biomaterials and Bioengineering, Université Laval, 2325, Quebec G1V 0A6, Canada
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3
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Potential bioactive coating system for high-performance absorbable magnesium bone implants. Bioact Mater 2022; 12:42-63. [PMID: 35087962 PMCID: PMC8777287 DOI: 10.1016/j.bioactmat.2021.10.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022] Open
Abstract
Magnesium alloys are considered the most suitable absorbable metals for bone fracture fixation implants. The main challenge in absorbable magnesium alloys is their high corrosion/degradation rate that needs to be controlled. Various coatings have been applied to magnesium alloys to slow down their corrosion rates to match their corrosion rate to the regeneration rate of the bone fracture. In this review, a bioactive coating is proposed to slow down the corrosion rate of magnesium alloys and accelerate the bone fracture healing process. The main aim of the bioactive coatings is to enhance the direct attachment of living tissues and thereby facilitate osteoconduction. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are six bioactive agents that show high potential for developing a bioactive coating system for high-performance absorbable magnesium bone implants. In addition to coating, the substrate itself can be made bioactive by alloying magnesium with calcium, zinc, copper, and manganese that were found to promote bone regeneration. Bioactive-coated magnesium implant could accelerate bone fracture healing time to match with magnesium degradation. Hydroxyapatite, collagen type I, recombinant human bone morphogenetic proteins 2, simvastatin, zoledronate, and strontium are high potential bioactive coating materials. The incorporation of Ca, Zn, Cu, Sr, and Mn in Mg base-metal could further enhance bone formation.
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Cho Y, Moon M, Holló G, Lagzi I, Yang SH. Bioinspired Control of Calcium Phosphate Liesegang Patterns Using Anionic Polyelectrolytes. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2022; 38:2515-2524. [PMID: 35148116 PMCID: PMC8892956 DOI: 10.1021/acs.langmuir.1c02980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/28/2022] [Indexed: 05/31/2023]
Abstract
The Liesegang phenomenon is a spontaneous pattern formation, which is a periodic distribution of the precipitate discovered in diffusion-limited systems. Over the past century, it has been experimentally attempted to control the periodicity of patterns and structures of precipitates by varying the concentration of the hydrogel or electrolytes, adding organic or inorganic impurities, and applying an electric or pH field. In this work, the periodic patterns of calcium phosphate were manipulated with an anionic macromolecular additive inspired by bone mineralization in which various noncollagenous proteins are involved in the formation of a polymer-induced liquid precursor. The periodic patterns were systematically controlled by adjusting the amount of poly(acrylic acid), and they were numerically simulated by adjusting the threshold concentration of nucleation. The change of the pattern is explained by improved stability and directional diffusion of the intermediate.
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Affiliation(s)
- Young
Shin Cho
- Department
of Chemistry Education, Korea National University
of Education (KNUE), Chungbuk 28173, Republic of Korea
| | - Miyoung Moon
- Department
of Chemistry Education, Korea National University
of Education (KNUE), Chungbuk 28173, Republic of Korea
| | - Gábor Holló
- MTA-BME
Condensed Matter Physics Research Group, Budapest University of Technology and Economics, Budapest H-1111, Hungary
| | - István Lagzi
- MTA-BME
Condensed Matter Physics Research Group, Budapest University of Technology and Economics, Budapest H-1111, Hungary
- Department
of Physics, Budapest University of Technology
and Economics, Budapest H-1111, Hungary
| | - Sung Ho Yang
- Department
of Chemistry Education, Korea National University
of Education (KNUE), Chungbuk 28173, Republic of Korea
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Pham DN, Hiromoto S, Yamazaki T, O M, Kobayashi E. Enhanced Corrosion Resistance and In Vitro Biocompatibility of Mg-Zn Alloys by Carbonate Apatite Coating. ACS APPLIED BIO MATERIALS 2021; 4:6881-6892. [PMID: 35006988 DOI: 10.1021/acsabm.1c00594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
B-type carbonate apatite (CAp) coatings were formed on as-cast and T4-treated Mg-xZn (x = 1, 5, and 7 wt %) alloys containing various sized Zn-rich second phase to improve the corrosion resistance and biocompatibility. The CAp coating grew uniformly on the alloys with a thickness of 1.1-1.3 μm and did not show cracks or pores on 30 μm-sized second-phase particles. The CAp coating retarded corrosion of Mg-Zn substrates for the first 3-5 days in Hanks' solution. Polarization resistance of the CAp-coated alloys was 10-90 and 1-70 times higher than the uncoated and hydroxyapatite (HAp)-coated alloys, respectively. The corrosion rate of CAp-coated alloys was greatly affected by the substrate alloys once the coatings were partly broken. The CAp-coated alloys showed 40-60 and 25-45% lower 14-day average corrosion rates than the uncoated and HAp-coated alloys, respectively, in the immersion test. The CAp coating significantly enhanced the viability of osteoblastic MC3T3-E1 cells on the Mg-Zn alloys for 72 h compared to the uncoated and HAp-coated alloys. The cell densities on CAp-coated alloys were similar for 72 h regardless of substrate alloys. Therefore, the CAp coating can be a superior coating candidate for corrosion-control and biocompatibility improvement for biodegradable Mg alloys.
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Affiliation(s)
- Dinh Ngoc Pham
- Department of Materials Science and Engineering, Tokyo Institute of Technology, Tokyo 152-8550, Japan
| | - Sachiko Hiromoto
- Corrosion and Protection Group, Research Center for Structural Materials, National Institute for Materials Science, Tsukuba 305-0047, Japan
| | - Tomohiko Yamazaki
- Nanomedicine Group, Research Center for Functional Materials, National Institute for Materials Science, Tsukuba 305-0047, Japan
| | - Minho O
- Department of Materials Science and Engineering, Tokyo Institute of Technology, Tokyo 152-8550, Japan
| | - Equo Kobayashi
- Department of Materials Science and Engineering, Tokyo Institute of Technology, Tokyo 152-8550, Japan
- VSB-Technical University of Ostrava, Ostrava 708-00, Czech Republic
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6
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In vivo degradation and bone formation behaviors of hydroxyapatite-coated Mg alloys in rat femur. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 122:111942. [PMID: 33641928 DOI: 10.1016/j.msec.2021.111942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/17/2020] [Accepted: 01/31/2021] [Indexed: 01/01/2023]
Abstract
Various coatings have been developed for biodegradable Mg alloys to control the degradation speed and to improve the bone conductivity. In this study, hydroxyapatite (HAp) coatings were formed on pure Mg, Mg-0.8mass% Ca (MgCa), Mg-4mass% Y-3mass% rare earth (RE) (WE43), Mg-3mass% RE-1mass% Y (EW31) and Mg-4mass% RE (RE4) alloy rods with a chemical solution deposition method. The HAp-coated and uncoated Mg/Mg alloy rods were implanted in the femurs of rats for 3-6 months, and the corrosion suppression and bone formation abilities of the HAp coating were examined using a scanning electron microscope. The corrosion rate of WE43 was suppressed by 1/3 with the HAp coating for 6 months, and the corrosion product showed very slow dissolution. The effect of the HAp coating for pure Mg and MgCa disappeared in 1-2 months with the thinning of the rods accompanying with the obvious dissolution of the corrosion products. The effect of the HAp coating for EW31 and RE4 was not stable due to the expansion and collapse of the corrosion products. The bone formation was enhanced on the HAp layers. Eventually, the HAp coating basically suppressed the corrosion initiation and corrosion progress of Mg substrates. The magnitude of the suppression effect depended mainly on the chemical and physical stability of the corrosion products.
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Hiromoto S, Itoh S, Noda N, Yamazaki T, Katayama H, Akashi T. Osteoclast and osteoblast responsive carbonate apatite coatings for biodegradable magnesium alloys. SCIENCE AND TECHNOLOGY OF ADVANCED MATERIALS 2020; 21:346-358. [PMID: 32939160 PMCID: PMC7476515 DOI: 10.1080/14686996.2020.1761237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
Corrosion-control coatings which can enhance bone formation and be completely replaced by bone are attractive for biodegradable Mg alloys. Carbonate apatite (CAp) and hydroxyapatite (HAp) coatings were formed on Mg-4 wt% Y-3 wt% rare earth (WE43) alloy as a corrosion-control and bioabsorbable coating in the coating solution with various concentrations of NaHCO3. The incorporation of carbonate group in apatite structure was examined using X-ray diffraction and Fourier transform infrared spectroscopy. Rat osteoclast precursor and MC3T3-E1 osteoblast cells were cultured on the CAp- and HAp-coated WE43 to examine the osteoclastic resorption and the alkaline phosphatase (ALP) activity, respectively. Mg ions in the used medium were quantified to examine the corrosion-control ability. The NaHCO3 addition in the solution resulted in the formation of B-type CAp in which the phosphate group of apatite structure was substituted with the carbonate group. The osteoclastic resorption was observed only for the CAp coatings as the cracking of the coatings and the corrosion of substrate WE43 strongly localized under osteoclast cell bodies. The CAp and HAp coatings significantly enhanced the ALP activity of osteoblasts. The CAp-coated WE43 specimens showed 1/5 smaller amount of Mg ion release than the uncoated WE43 on the first day of culturing osteoblasts. For the subsequent 22 days, the Mg ion release was reduced to 1/2 by the CAp coatings. In the presence of osteoclasts, the CAp coatings showed slightly lower corrosion protectiveness than the HAp coating. It was demonstrated that the CAp coatings can be a bioabsorbable and corrosion-control coating for biodegradable Mg alloys.
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Affiliation(s)
- Sachiko Hiromoto
- Research Center for Structural Materials, National Institute for Materials Science, Tsukuba, Japan
| | - Sayaka Itoh
- Research Center for Structural Materials, National Institute for Materials Science, Tsukuba, Japan
- Graduate School of Science and Engineering, Hosei University, Tokyo, Japan
| | - Naomi Noda
- Research Center for Structural Materials, National Institute for Materials Science, Tsukuba, Japan
| | - Tomohiko Yamazaki
- Research Center for Functional Materials, National Institute for Materials Science, Tsukuba, Japan
| | - Hideki Katayama
- Research Center for Structural Materials, National Institute for Materials Science, Tsukuba, Japan
| | - Takaya Akashi
- Graduate School of Science and Engineering, Hosei University, Tokyo, Japan
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Han F, Wang J, Ding L, Hu Y, Li W, Yuan Z, Guo Q, Zhu C, Yu L, Wang H, Zhao Z, Jia L, Li J, Yu Y, Zhang W, Chu G, Chen S, Li B. Tissue Engineering and Regenerative Medicine: Achievements, Future, and Sustainability in Asia. Front Bioeng Biotechnol 2020; 8:83. [PMID: 32266221 PMCID: PMC7105900 DOI: 10.3389/fbioe.2020.00083] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Exploring innovative solutions to improve the healthcare of the aging and diseased population continues to be a global challenge. Among a number of strategies toward this goal, tissue engineering and regenerative medicine (TERM) has gradually evolved into a promising approach to meet future needs of patients. TERM has recently received increasing attention in Asia, as evidenced by the markedly increased number of researchers, publications, clinical trials, and translational products. This review aims to give a brief overview of TERM development in Asia over the last decade by highlighting some of the important advances in this field and featuring major achievements of representative research groups. The development of novel biomaterials and enabling technologies, identification of new cell sources, and applications of TERM in various tissues are briefly introduced. Finally, the achievement of TERM in Asia, including important publications, representative discoveries, clinical trials, and examples of commercial products will be introduced. Discussion on current limitations and future directions in this hot topic will also be provided.
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Affiliation(s)
- Fengxuan Han
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Jiayuan Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Luguang Ding
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Yuanbin Hu
- Department of Orthopaedics, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wenquan Li
- Department of Otolaryngology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhangqin Yuan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Qianping Guo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Caihong Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Li Yu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Huan Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Zhongliang Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Luanluan Jia
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Jiaying Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Yingkang Yu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Weidong Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Song Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
| | - Bin Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Orthopaedic Institute, Soochow University, Suzhou, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China
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