The effect of insulin-like growth factor 1 on craniofacial bone healing

Platelets: A Potential Factor that Offers Strategies for Promoting Bone Regeneration

Bone defects represent a prevalent category of clinical injuries, causing significant pain and escalating health care burdens. Effectively addressing bone defects is thus of paramount importance. Platelets, formed from megakaryocyte lysis, have emerged as pivotal players in bone tissue repair, inflammatory responses, and angiogenesis. Their intracellular storage of various growth factors, cytokines, and membrane protein receptors contributes to these crucial functions. This article provides a comprehensive overview of platelets' roles in hematoma structure, inflammatory responses, and angiogenesis throughout the process of fracture healing. Beyond their application in conjunction with artificial bone substitute materials for treating bone defects, we propose the potential future use of anticoagulants such as heparin in combination with these materials to regulate platelet number and function, thereby promoting bone healing. Ultimately, we contemplate whether manipulating platelet function to modulate bone healing could offer innovative ideas and directions for the clinical treatment of bone defects. Impact statement Given that 5-10% of fracture patients with delayed bone healing or even bone nonunion, this review explores the potential role of platelets in bone healing (directly/indirectly) and proposes ideas and directions for the future as to whether it is possible to promote bone healing and improve fracture healing rates by modulating platelets.

Intraoperative Creation of Tissue-Engineered Grafts with Minimally Manipulated Cells: New Concept of Bone Tissue Engineering In Situ

Transfer of regenerative approaches into clinical practice is limited by strict legal regulation of in vitro expanded cells and risks associated with substantial manipulations. Isolation of cells for the enrichment of bone grafts directly in the Operating Room appears to be a promising solution for the translation of biomedical technologies into clinical practice. These intraoperative approaches could be generally characterized as a joint concept of tissue engineering in situ. Our review covers techniques of intraoperative cell isolation and seeding for the creation of tissue-engineered grafts in situ, that is, directly in the Operating Room. Up-to-date, the clinical use of tissue-engineered grafts created in vitro remains a highly inaccessible option. Fortunately, intraoperative tissue engineering in situ is already available for patients who need advanced treatment modalities.

Platelet-Rich Preparations to Improve Healing. Part I: Workable Options for Every Size Practice

Numerous studies have demonstrated that platelet-rich preparations applied to surgical sites, injuries, or wounds are a safe and effective way to promote soft tissue healing and bone growth. Various protocols have been developed for preparing platelet-rich preparations, with subtle but important differences between them. Unfortunately, only a minority of clinicians use platelet-rich preparations, such as platelet-rich plasma and platelet-rich fibrin, in their practice, possibly due to confusion about the different methods and their advantages and disadvantages. Therefore, the different types of preparations are described to help guide the selection of the best method for any size practice. Classic methods generally require large volumes of blood and can be expensive, complicated, and time-intensive. Simpler protocols have been developed recently, which require relatively inexpensive equipment and small blood volumes and, thus, may be more applicable for small clinical practices. Platelet-rich preparations accelerate healing at earlier time points to reduce discomfort and the potential for adverse outcomes, including infection, poor wound closure, and delays in forming strong bone for subsequent procedures (such as implants). However, platelet-rich preparations may also improve long-term outcomes in patients expected to have impaired healing, such as with lifestyle choices (eg, smoking), medications (eg, steroids), diseases (eg, diabetes, osteoporosis, atherosclerosis), and aging, by supplementing the deficient wound environment to restore proper healing. Therefore, both large and small clinical practices would benefit from utilizing platelet-rich preparations to enhance healing in their patients.

Insulin-Like Growth Factor I Inhibits Alveolar Bone Loss Following Tooth Extraction in Rats

BACKGROUND

Alveolar bone is often lost after tooth extraction. Few studies have assessed the longitudinal changes in bone volume that occur within these extraction sites.

PURPOSE

To investigate the longitudinal morphological changes in extraction sockets following sustained continuous subcutaneous infusion of human recombinant insulin-like growth factor I (IGF-I).

MATERIALS AND METHODS

Fourteen rats were subjected to right mandibular first molar extraction. Experimental rats (n = 7) received a continuous subcutaneous infusion of human recombinant IGF-I (320 mg/day) for 3 weeks by osmotic minipump. Control animals were treated with saline via the same method (n = 7). All rats were then housed for an additional 3 weeks. Micro-CT scanning was performed immediately after tooth extraction and at 1, 2, 3, and 6 weeks after extraction.

RESULTS

New bone formation was markedly higher in the IGF-I-treated group as compared with the control group. The loss in alveolar ridge height in the IGF-I group was significantly lower than that in the control group at each time point after extraction on the buccal side and at 2, 3, and 6 weeks on the lingual side.

CONCLUSIONS

IGF-I treatment increases the volume of newly formed bone and reduces the loss in alveolar ridge height following tooth extraction.

Cranial bone defect healing is accelerated by mesenchymal stem cells induced by coadministration of bone morphogenetic protein-2 and basic fibroblast growth factor

Hypoalbuminemia is often claimed to impair wound healing, and therefore albumin has traditionally been administered to derive beneficial effects on general physiologic conditions including the nutritional state. However, the influence of albumin administration on systemic protein metabolism and wound healing is still unclear. Therefore, the objective of this study was to investigate the influence of albumin administration on protein metabolism and wound healing in burned rats. After receiving basic total parenteral nutrition (TPN) for 4 days, Sprague-Dawley rats underwent a 6-cm skin incision in the back and a burn involving 20 percent of the whole body surface. The rats were divided into three groups. Group I continued to receive basic TPN. Group II was given basic TPN, but 20 percent of the total nitrogen was replaced by albumin. Group III was administered basic TPN plus albumin equivalent to 20 percent of the total nitrogen of basic TPN. Group IV had the skin incision but no burn, receiving only basic TPN. All the groups were euthanized 4 days after the burn or skin incision. The wound healing potential in terms of tensile strength was enhanced by replacement and addition of albumin (groups II and III, respectively) after a 20 percent burn. Hydroxyproline levels in the wound tended to increase in group II, and significantly increased in group III. Whereas albumin replacement (group II) did not remarkably change the protein metabolism, albumin addition (group III) significantly increased both protein synthesis (S) and breakdown (B) with the S/B ratio and nitrogen balance remaining the same as with albumin-free nutrition (group I). The urinary 3-methyl-histidine/creatinine ratio significantly increased after burn in group III. We conclude that intravenous albumin administration enhanced incisional wound healing in burned rats. Increased protein synthesis with concurrent myolysis and protein breakdown by albumin addition (group III) was observed during wound healing.

New frontiers in bone tissue engineering

No single scientific field can generate the ideal method of engineering bone. However, through collaboration and expansion of programs in bone tissue engineering, the right combination of materials, cells, growth factors, and methodology will come together for each clinical situation such that harvesting bone grafts will become obsolete. This article reviews the need for engineered bone and provides a historical perspective of bone engineering research, current research efforts, and the future direction of this work.

Bone bonding in bioactive glass ceramics combined with a new synthesized agent TAK-778

We studied the stimulatory effects of TAK-778, a new synthetic 3-benzothiepin derivative that promotes osteoblast differentiation, in the bonding of bone to bioactive glass ceramic implants in rabbit tibiae. Smooth-surfaced, rectangular plates (15 x 10 x 2 mm) made of apatite-wollastonite-containing glass ceramic were implanted bilaterally into the proximal metaphyses of rabbit tibiae. Sustained-release microcapsules containing TAK-778 were packed into the medullary cavity in one limb and untreated microcapsules were packed into the contralateral limb to serve as a paired control. At 4, 8, and 16 weeks after implantation, bonding at the bone/implant interfaces was evaluated using a detaching test and histological examination of undecalcified specimens. The tensile failure load increased during weeks 4 to 16 in both groups; the tensile failure load in the TAK-778-treated group was significantly greater than that in the control group at each interval after implantation. Histologically, the TAK-778-treated specimens showed greater active new bone formation mainly in the medullary cavity and more extensive bonding between the implant and bone than the untreated specimens. The results of this study suggest that adding the bone formation-promoting TAK-778 to bioactive glass ceramic implants may significantly accelerate bone apposition to the implants and improve the bonding process at the interface. This would help to establish earlier and stronger bonding of orthopedic ceramic implants to the surrounding bone tissue.

Bone bonding in sintered hydroxyapatite combined with a new synthesized agent, TAK-778

We studied the stimulatory effects of TAK-778, a new synthetic 3-benzothiepin derivative that promotes osteoblast differentiation, in bone bonding to sintered hydroxyapatite implants in rabbit tibiae. Smooth-surfaced rectangular plates (15 x 10 x 2 mm) made of sintered hydroxyapatite were implanted into the proximal metaphyses of bilateral rabbit tibiae, with TAK-778-containing sustained-release microcapsules packed into the medullary cavity in one limb and untreated microcapsules packed in the contralateral limb to serve as a paired control. At 4, 8, and 16 weeks after implantation, bone bonding at the bone-implant interfaces was evaluated by a detaching test and undecalcified histological examination. The tensile failure load increased from 4 to 16 weeks for both groups; however, the tensile failure load of the TAK-778-treated group was significantly greater than that of the control group at each interval after implantation. Histologically, the TAK-778-treated specimens showed greater active new bone formation mainly in the medullary cavity and more extensive bonding between the implant and bone than the untreated specimens. The results of this study suggest that adding osteoinductive TAK-778 to hydroxyapatite implants may significantly accelerate bone apposition to the implants and improve the bonding process at the interface. This would help to establish an earlier and stronger bonding of orthopedic ceramic implants between the surrounding bone tissue.

Effects of Systemically Applied IGF-1 on Motor Nerve Recovery After Peripheral Nerve Transection and Repair in the Rat - A Functional Study

The trophic effects of systemically applied Rh insulin-like growth factor-1 (rhIGF-1) on peripheral motor nerve regeneration following transection and epineural repair in rats median nerve have been examined. RhIGF-1 (0.5 mg/kg/rat) was administered subcutaneously to the neck region of the repaired side for 14 days post-operation. Motor recovery was tested with the grasping test that is an objective quantitative behavioural assessment of regeneration of the rats median nerve. Muscle twitch tension and muscle weight were measured in the flexor digitorum sublimus muscle. No significant differences between experimental and control animals regarding onset of muscle function, recovery of muscle power, and muscle weight were found. These results demonstrate that subcutaneously applied rhIGF-1 cannot improve functional motor recovery after nerve transection and repair in the rat as has been demonstrated after nerve crushing injury. This is regarded as a consequence of specificity failure during reinnervation, which occurs after nerve transection and repair, whereas after crushing injury specific reinnervation is a common feature.

Experimental study of bone formation from autogenous periosteal graft following insulin-like growth factor I administration

The present study evaluates the effect of insulin-like growth factor I (IGF-I) administration on bone formation following grafted periosteum. Twenty-four Japanese white rabbits were randomly assigned into one IGF-I administered group (1 mg for 14 days) and a second control group. Grafted periosteum taken from the tibia was placed under the submandibular muscles. At 14, 21, and 28 days following the operation, the grafted periosteum was extirpated and examined. Throughout all stages of the experiment, active bone formation was confirmed histologically and radiographically in both control and experimental groups. In addition, a micro-CT scan was used to observe three-dimensional micro structures in newly formed bone and to measure the trabecular bone thickness as a marker of bone development. As a result, a significant increase in bone formation in the IGF-I group was observed when compared with the findings in the control group. Trabecular bone thickness in the IGF-I group was significantly greater when compared with the control group at 14 days and 21 days following grafting (P < 0.01). At 28 days following grafting, there were no significant differences, suggesting that administration of IGF-I may play an important role in inducing bone formation from grafted periosteum in the early stages.

Expression of growth factors in the mandibular distraction zone: a sheep study

Interest in craniofacial osteodistraction has increased in recent years parallel with the growing attention given to the role of growth factors in tissue healing and regeneration. This study was embarked upon to investigate the expression of bFGF, TGF-beta and IGF-1 in the distraction zone of the mandible. Fourteen growing sheep were allocated to three experimental groups. Six animals were allocated to Groups A and B (n = 12) and underwent bilateral mandibular corticotomies with fixation of an external lengthening device. The distraction protocol consisted of a rate of 1.0 mm/day (twice daily) for 20 days followed by a consolidation phase of 20 days after which the sheep were sacrificed. Group C comprised of age matched sham operated animals (n = 2). Bone histochemistry for growth factors were performed in the harvested mandibles. A strong staining of bFGF was seen in the osteoblasts, osteocytes and osteoid matrix following 20 days of distraction and 20 days of consolidation compared to the control group. TGF-beta and IGF-1 demonstrated mild but clear staining in osteocyte and osteoblast cells and TGF-beta stained positively in the osteoid seam in the experimental groups. These finding suggest that bFGF, IGF-1 and TGF-beta may play different roles in the remodelling phase of distraction osteogenesis.

Some basic factors essential to autogeneic nonvascularized onlay bone grafting to the craniofacial skeleton

The aim of this review is to provide a background on the experiences gained experimentally with autogeneic nonvascularized onlay bone transplantation, survey the most essential information in the medical literature, and to present modern trends and future expectations in bone graft science.

Experimental reconstruction of the mandible using polylactic acid tubes and basic fibroblast growth factor in alloplastic scaffolds

PURPOSE

This study evaluated the use of a mitogenic growth factor in combination with barrier membranes and porous alloplastic scaffolds for the repair of segmental defects of the mandible.

MATERIALS AND METHODS

Fifteen Göttingen minipigs were used for the study. In five animals, mandibular defects of 2 cm were created on both sides of the mandible and bridged by a system of polylactic acid (PLA) tubes and pyrolized bovine bone. On one side of the mandible, the alloplastic scaffolds were loaded with 115 microg recombinant human basic fibroblast growth factor (rhbFGF). In five other animals, defects 4 cm in length were created bilaterally, similarly bridged, and loaded with 230 microg of rhFGF. In five control animals, bilateral 2-cm defects were created that were left empty on one side and bridged with an empty PLA tube on the other. Mitogenic efficacy of the growth factor was assessed on fibroblast cultures by di-methyl-thiazol-2-tetrazolium-bromide assay before implantation.

RESULTS

After 5 months, there was negligible bone regeneration in the control defects, regardless of whether they had been left completely empty or bridged by empty PLA tubes. The 2-cm defects showed bridging in 8 of 10 tubes, with complete consolidation by bone ingrowth in four defects. The 4-cm defects showed bony union in six cases, with complete bone fill in two tubes, and four defects incompletely filled. The bFGF had no appreciable effect with regard to velocity, quantity, and three-dimensional structure of bone formation, neither in the short nor in the long defects despite clear in vitro efficacy.

CONCLUSION

Repair of segmental defects using bioresorbable membranes appears to be possible. However, a single-dose application of bFGF is apparently ineffective, possibly because of rapid dilution.

Healing in other tissues

Wound healing in many tissue types is essentially the same as that which occurs in skin. The repair processes that occur in bone, tendon, the alimentary tract, skin grafts, and bone grafts are substantially different from cutaneous wound repair. Because surgeons frequently encounter these tissues, it is essential to understand how they heal.