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Gai Y, Yin Y, Guan L, Zhang S, Chen J, Yang J, Zhou H, Li J. Rational Design of Bioactive Materials for Bone Hemostasis and Defect Repair. CYBORG AND BIONIC SYSTEMS 2023; 4:0058. [PMID: 37829507 PMCID: PMC10566342 DOI: 10.34133/cbsystems.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Everyday unnatural events such as trauma, accidents, military conflict, disasters, and even medical malpractice create open wounds and massive blood loss, which can be life-threatening. Fractures and large bone defects are among the most common types of injuries. Traditional treatment methods usually involve rapid hemostasis and wound closure, which are convenient and fast but may result in various complications such as nerve injury, deep infection, vascular injury, and deep hematomas. To address these complications, various studies have been conducted on new materials that can be degraded in the body and reduce inflammation and abscesses in the surgical area. This review presents the latest research progress in biomaterials for bone hemostasis and repair. The mechanisms of bone hemostasis and bone healing are first introduced and then principles for rational design of biomaterials are summarized. After providing representative examples of hemostatic biomaterials for bone repair, future challenges and opportunities in the field are proposed.
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Affiliation(s)
- Yuqi Gai
- School of Medical Technology,
Beijing Institute of Technology, Beijing 100081, China
| | - Yue Yin
- School of Medical Technology,
Beijing Institute of Technology, Beijing 100081, China
| | - Ling Guan
- Advanced Research Institute of Multidisciplinary Sciences,
Beijing Institute of Technology, Beijing, 100081, China
- Department of Medicine,
University of British Columbia, Vancouver, BC, Canada
- National Center for Neurological Disorders, Beijing Tiantan Hospital,
Capital Medical University, Beijing 100070, China
| | - Shengchang Zhang
- School of Medical Technology,
Beijing Institute of Technology, Beijing 100081, China
| | - Jiatian Chen
- School of Medical Technology,
Beijing Institute of Technology, Beijing 100081, China
| | - Junyuan Yang
- School of Medical Technology,
Beijing Institute of Technology, Beijing 100081, China
| | - Huaijuan Zhou
- Advanced Research Institute of Multidisciplinary Sciences,
Beijing Institute of Technology, Beijing, 100081, China
| | - Jinhua Li
- School of Medical Technology,
Beijing Institute of Technology, Beijing 100081, China
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He C, Lv Q, Liu Z, Long S, Li H, Xiao Y, Yang X, Liu Y, Liu C, Wang Z. Random and aligned electrostatically spun PLLA nanofibrous membranes enhance bone repair in mouse femur midshaft defects. J Biomater Appl 2023; 37:1582-1592. [PMID: 36662630 DOI: 10.1177/08853282221144220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Long-segment bone defects are a common clinical challenge and abstract biomaterials are a promising therapy. Poly-L-lactic acid (PLLA) nanofibrous membranes prepared by electrostatic spinning have a good bone repair potential. However, there are random and aligned surface morphologies of electrostatic spun PLLA nanofibrous membranes, which can affect the migration, proliferation, and differentiation ability of cells. The role of surface morphology in the repair of long bone defects in vivo is currently unknown. In this study, random and aligned electrostatically spun PLLA nanofibrous membranes were prepared, characterised, and implanted into a femur midshaft defect mouse model. The ability of electrostatically spun PLLA nanofibrous membranes to enhance bone repair was tested using X-ray photography, high-resolution micro-computed tomography (micro-CT), and pathological section specimens. The results showed that both random and aligned electrostatically spun PLLA nanofibrous membranes enhanced bone regeneration at bone defects, but the aligned ones exhibited superior results. These results provide a theoretical basis for engineering the surface morphology of bone repair materials.
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Affiliation(s)
- Chengkai He
- Trauma Center, The First Affiliated Hospital of Kunming Medical University, Kunming, China.,The Basic Medical School of Kunming Medical University, Kunming, China
| | - Qiong Lv
- Outpatient Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhui Liu
- Trauma Center, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shengyu Long
- Trauma Center, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haohan Li
- The First Clinical College of Kunming Medical University, Kunming, China
| | - Ya Xiao
- The Basic Medical School of Kunming Medical University, Kunming, China
| | - Xingyu Yang
- The Basic Medical School of Kunming Medical University, Kunming, China
| | - Yuhang Liu
- The Basic Medical School of Kunming Medical University, Kunming, China
| | - Cai Liu
- The Basic Medical School of Kunming Medical University, Kunming, China
| | - Zhihua Wang
- Trauma Center, The First Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Provincial Clinical Medical for Bone and Joint Diseases, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Ong JL, Shiels SC, Pearson J, Karajgar S, Miar S, Chiou G, Appleford M, Wenke JC, Guda T. Spatial rhBMP2 delivery from hydroxyapatite scaffolds sustains bone regeneration in rabbit radius. Tissue Eng Part C Methods 2022; 28:363-374. [PMID: 35615881 DOI: 10.1089/ten.tec.2022.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Regenerating large bone defects requires a multi-faceted approach combining optimal scaffold designs with appropriate growth factor delivery. Supraphysiological doses of recombinant human bone morphogenetic protein 2(rhBMP2); typically used for the regeneration of large bone defects clinically in conjunction with an acellular collagen sponge (ACS), have resulted in many complications. In the current study, we develop a hydroxyapatite/collagen I (HA/Col) scaffold to improve the mechanical properties of the HA scaffolds while maintaining open connected porosity. Varying rhBMP2 dosages were then delivered from a collagenous periosteal membrane and paired with HA or HA/Col scaffolds to treat critical sized (15mm) diaphyseal radial defect in New Zealand white rabbits. The groups examined were ACS+76µg rhBMP2 (clinically used INFUSE dosage), HA+76µg rhBMP2, HA+15µg rhBMP2, HA/Col+15µg rhBMP2 and HA/Col+15µg rhBMP2+bone marrow derived stromal cells (bMSCs). After 8 weeks of implantation, all regenerated bones were evaluated using micro computed tomography, histology, histomorphometry and torsional testing. It was observed that the bone volume regenerated in the HA/Col + 15 µg rhBMP2 group was significantly higher than that in the groups with 76µg rhBMP2. The same scaffold and growth factor combination resulted in the highest bone mineral density of the regenerated bone, and the most bone apposition on the scaffold surface. Both the HA and HA/Col scaffolds paired with 15 µg rhBMP2 had sustained ingrowth of the mineralization front after 2 weeks compared to the groups with 76µg rhBMP2 which had far greater mineralization in the first 2 weeks after implantation. Complete bridging of the defect site and no significant differences in torsional strength, stiffness or angle at failure was observed across all groups. No benefit of additional bMSC seeding was observed on any of the quantified metrics, while bone-implant apposition was reduced in the cell seeded group. This study demonstrated that the controlled spatial delivery of rhBMP2 at the periosteum at significantly lower doses can be used as a strategy to improve bone regeneration around space maintaining scaffolds.
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Affiliation(s)
- Joo L Ong
- The University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States;
| | - Stefanie C Shiels
- The University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States.,US Army Institute of Surgical Research, 110230, Fort Sam Houston, Texas, United States;
| | - Joseph Pearson
- The University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States.,Georgia Institute of Technology, 1372, Wallace H Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States;
| | - Suyash Karajgar
- The University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States;
| | - Solaleh Miar
- The University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States;
| | - Gennifer Chiou
- The University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States;
| | - Mark Appleford
- The University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States;
| | - Joseph C Wenke
- US Army Institute of Surgical Research, 110230, Fort Sam Houston, Texas, United States.,The University of Texas Medical Branch at Galveston, 12338, Department of Orthopedic Surgery and Rehabilitation, Galveston, Texas, United States;
| | - Teja Guda
- University of Texas at San Antonio, 12346, Biomedical Engineering and Chemical Engineering, San Antonio, Texas, United States;
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Osagie-Clouard L, Meeson R, Sanghani-Kerai A, Bostrom M, Briggs T, Blunn G. The role of intermittent PTH administration in conjunction with allogenic stem cell treatment to stimulate fracture healing. Bone Joint Res 2021; 10:659-667. [PMID: 34634923 PMCID: PMC8559967 DOI: 10.1302/2046-3758.1010.bjr-2019-0371.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims A growing number of fractures progress to delayed or nonunion, causing significant morbidity and socioeconomic impact. Localized delivery of stem cells and subcutaneous parathyroid hormone (PTH) has been shown individually to accelerate bony regeneration. This study aimed to combine the therapies with the aim of upregulating fracture healing. Methods A 1.5 mm femoral osteotomy (delayed union model) was created in 48 female juvenile Wistar rats, aged six to nine months, and stabilized using an external fixator. At day 0, animals were treated with intrafracture injections of 1 × 106 cells/kg bone marrow mesenchymal stem cells (MSCs) suspended in fibrin, daily subcutaneous injections of high (100 μg/kg) or low (25 μg/kg) dose PTH 1-34, or a combination of PTH and MSCs. A group with an empty gap served as a control. Five weeks post-surgery, the femur was excised for radiological, histomorphometric, micro-CT, and mechanical analysis. Results Combination therapy treatment led to increased callus formation compared to controls. In the high-dose combination group there was significantly greater mineralized tissue volume and trabecular parameters compared to controls (p = 0.039). This translated to significantly improved stiffness (and ultimate load to failure (p = 0.049). The high-dose combination therapy group had the most significant improvement in mean modified Radiographic Union Score for Tibia fractures (RUST) compared to controls (13.8 (SD 1.3) vs 5.8 (SD 0.5)). All groups demonstrated significant increases in the radiological scores – RUST and Allen score – histologically compared to controls. Conclusion We demonstrate the beneficial effect of localized MSC injections on fracture healing combined with low- or high-dose teriparatide, with efficacy dependent on PTH dose. Cite this article: Bone Joint Res 2021;10(10):659–667.
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Affiliation(s)
| | | | | | | | | | - Gorden Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Shimatani A, Toyoda H, Orita K, Hirakawa Y, Aoki K, Oh JS, Shirafuji T, Nakamura H. In vivo study on the healing of bone defect treated with non-thermal atmospheric pressure gas discharge plasma. PLoS One 2021; 16:e0255861. [PMID: 34634068 PMCID: PMC8504758 DOI: 10.1371/journal.pone.0255861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/21/2021] [Indexed: 12/21/2022] Open
Abstract
Medical treatment using non-thermal atmospheric pressure plasma (NTAPP) is rapidly gaining recognition. NTAPP is thought to be a new therapeutic method because it could generate highly reactive species in an ambient atmosphere which could be exposed to biological targets (e.g., cells and tissues). If plasma-generated reactive species could stimulate bone regeneration, NTAPP can provide a new treatment opportunity in regenerative medicine. Here, we investigated the impact of NTAPP on bone regeneration using a large bone defect in New Zealand White rabbits and a simple atmospheric pressure plasma (helium microplasma jet). We observed the recovery progress of the large bone defects by X-ray imaging over eight weeks after surgery. The X-ray results showed a clear difference in the occupancy of the new bone of the large bone defect among groups with different plasma treatment times, whereas the new bone occupancy was not substantial in the untreated control group. According to the results of micro-computed tomography analysis at eight weeks, the most successful bone regeneration was achieved using a plasma treatment time of 10 min, wherein the new bone volume was 1.51 times larger than that in the plasma untreated control group. Using H&E and Masson trichrome stains, nucleated cells were uniformly observed, and no inclusion was confirmed, respectively, in the groups of plasma treatment. We concluded the critical large bone defect were filled with new bone. Overall, these results suggest that NTAPP is promising for fracture treatment.
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Affiliation(s)
- Akiyoshi Shimatani
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
- * E-mail: (HT); (J-SO)
| | - Kumi Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | - Kodai Aoki
- Department of Physical Electronics and Informatics, Graduate School of Engineering, Osaka City University, Osaka, Japan
| | - Jun-Seok Oh
- Department of Physical Electronics and Informatics, Graduate School of Engineering, Osaka City University, Osaka, Japan
- BioMedical Engineering Center, Graduate School of Engineering, Osaka City University, Osaka, Japan
- * E-mail: (HT); (J-SO)
| | - Tatsuru Shirafuji
- Department of Physical Electronics and Informatics, Graduate School of Engineering, Osaka City University, Osaka, Japan
- BioMedical Engineering Center, Graduate School of Engineering, Osaka City University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions. J Clin Med 2021; 10:jcm10194597. [PMID: 34640615 PMCID: PMC8509770 DOI: 10.3390/jcm10194597] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Delayed fracture healing continues to cause significant patient morbidity and an economic burden to society. Biological stimulation of non-unions includes application of recombinant bone morphogenetic protein-2 (rhBMP-2). However, rhBMP-2 use continues to be a matter of controversy as literature shows scarce evidence for treatment effectiveness. Questions: The objective of this study was to evaluate the effectiveness of rhBMP-2 treatment on long bone non-unions measuring union rate and time to union. Furthermore, we assess risk factors for treatment failure. Methods and patients: A total of 91 patients with non-unions of long bones were treated with rhBMP-2 (n = 72) or standard care without BMP (n = 19) at our institution. Patient characteristics, comorbidities, nicotine consumption, and complications were recorded. Bone healing was assessed by plane X-rays and clinical examination. Patients were followed up with for 24 months. Results: Overall, there was significantly faster bone healing after rhBMP-2 application compared to the no-BMP group (p < 0.001; HR = 2.78; 95% CI 1.4–5.6). Union rates differed significantly between rhBMP-2 compared to the no-BMP group (89% vs. 47%; p < 0.001). At the humerus, there was neither a significantly higher union rate in the rhBMP-2 (83%) compared to the no-BMP group (50%) (p = 0.26; n = 12) nor a faster bone healing with a median time of 9 months in both groups (HR = 2.01; 95% CI 0.49–8.61; p = 0.315). The 33 femora treated using rhBMP-2 healed significantly faster than 9 femora in the no-BMP group (HR = 2.93; 95% CI 1.00–8.4; p = 0.023) with significant differences in union rate with 85% and 44%, respectively (p = 0.022). Regarding tibia non-unions, 25 out of 27 (93%) healed with a median of 9 months after rhBMP-2 application with no significant difference in the no-BMP group (33%) in time to union (p = 0.097) but a significantly higher union rate (p = 0.039). There was no effect of comorbidities, age, sex, soft tissue damage, or nicotine use on time to union, union rate, or secondary interventions. Conclusion: Consistent with the literature, overall, significantly higher union rates with reduced time to union were achieved after rhBMP-2 application. Femoral and tibial non-unions in particular seem to profit from rhBMP-2 application.
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Zhang Y, Xing F, Luo R, Duan X. Platelet-Rich Plasma for Bone Fracture Treatment: A Systematic Review of Current Evidence in Preclinical and Clinical Studies. Front Med (Lausanne) 2021; 8:676033. [PMID: 34414200 PMCID: PMC8369153 DOI: 10.3389/fmed.2021.676033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Recently, there is an increasing interest in the therapeutic potential of platelet-rich plasma (PRP) for bone fracture treatment. Nevertheless, the effect of PRP for bone fracture treatment remains controversial and is still a matter of discussion. Therefore, we performed a systematic review to evaluate the efficacy and safety of PRP injection for treatment of bone fracture. Methods: The main bibliographic databases, including Medline, PubMed, Embase, Web of Science, and the Cochrane library, were comprehensively searched for studies focusing on the application of platelet-rich plasma (PRP) on bone fracture treatment. All relevant articles were screened for eligibility and subdivided into the preclinical and clinical studies. Data were extracted and presented systematically. Results: Finally, twenty-six in vitro preclinical studies (basic studies), nine in vivo preclinical studies (animal studies), and nine clinical studies, met the selection criteria, and were included in the present systematic review. Preclinical studies showed an overall positive effect of PRP on osteoblast-like cells in vitro and bone healing in animal models. The most used treatment for bone fracture in animal and clinical studies is fixation surgery combined with PRP injection. The clinical studies reported PRP shortened bony healing duration, and had no positive effect on improving the healing rate of closed fractures. However, the results of functional outcomes are controversial. Additionally, compared with control group, PRP would not increase the rate of postoperative wound infection. Conclusion: The present systematic review confirmed the continuing interests of PRP as an additional treatment for bone fracture. Preclinical studies highlighted the potential value of PRP as promising therapy for bone fracture. However, the preclinical evidence did not translate into a similar result in the clinical studies. In addition, types of fractures and procedures of PRP preparation are heterogeneous in enrolled studies, which might result in controversial results. Meanwhile, characteristics of PRP, such as platelet concentration, the numbers of leukocytes, still need to be determined and further research is required.
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Affiliation(s)
- Yangming Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Xing
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Luo
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Duan
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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Xu C, Liu H, He Y, Li Y, He X. Endothelial progenitor cells promote osteogenic differentiation in co-cultured with mesenchymal stem cells via the MAPK-dependent pathway. Stem Cell Res Ther 2020; 11:537. [PMID: 33308309 PMCID: PMC7731475 DOI: 10.1186/s13287-020-02056-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of bone tissue engineering is to regenerate tissue using biomaterials and stem cell-based approaches. Combination of two or more cell types is one of the strategies to promote bone formation. Endothelial progenitor cells (EPCs) may enhance the osteogenic properties of mesenchymal stem cells (MSCs) and promote bone healing; this study aimed to investigate the possible mechanisms of EPCs on promoting osteogenic differentiation of MSCs. METHODS MSCs and EPCs were isolated and co-cultured in Transwell chambers, the effects of EPCs on the regulation of MSC biological properties were investigated. Real-time PCR array, and western blotting were performed to explore possible signaling pathways involved in osteogenesis. The expression of osteogenesis markers and calcium nodule formation was quantified by qRT-PCR, western blotting, and Alizarin Red staining. RESULTS Results showed that MSCs exhibited greater alkaline phosphatase (ALP) activity and increased calcium mineral deposition significantly when co-cultured with EPCs. The mitogen-activated protein kinase (MAPK) signaling pathway was involved in this process. p38 gene expression and p38 protein phosphorylation levels showed significant upregulation in co-cultured MSCs. Silencing expression of p38 in co-cultured MSCs reduced osteogenic gene expression, protein synthesis, ALP activity, and calcium nodule formation. CONCLUSIONS These data suggest paracrine signaling from EPCs influences the biological function and promotes MSCs osteogenic differentiation. Activation of the p38MAPK pathway may be the key to enhancing MSCs osteogenic differentiation via indirect interactions with EPCs.
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Affiliation(s)
- Chu Xu
- Department of Stomatology, The 4th Affiliated Hospital of China Medical University, No.4 Chongshan Dong Road, Shenyang, 110032, Liaoning, China.,Department of General Dentistry, School of Stomatology, China Medical University, Shenyang, 110001, Liaoning, China
| | - Haijie Liu
- Department of Stomatology, The 4th Affiliated Hospital of China Medical University, No.4 Chongshan Dong Road, Shenyang, 110032, Liaoning, China
| | - Yuanjia He
- Department of Stomatology, The 4th Affiliated Hospital of China Medical University, No.4 Chongshan Dong Road, Shenyang, 110032, Liaoning, China
| | - Yuanqing Li
- Department of Stomatology, The 4th Affiliated Hospital of China Medical University, No.4 Chongshan Dong Road, Shenyang, 110032, Liaoning, China
| | - Xiaoning He
- Department of Stomatology, The 4th Affiliated Hospital of China Medical University, No.4 Chongshan Dong Road, Shenyang, 110032, Liaoning, China.
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de Lacerda Schickert S, van den Beucken JJ, Leeuwenburgh SC, Jansen JA. Pre-Clinical Evaluation of Biological Bone Substitute Materials for Application in Highly Loaded Skeletal Sites. Biomolecules 2020; 10:E883. [PMID: 32526829 PMCID: PMC7356650 DOI: 10.3390/biom10060883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The development of bone substitute materials (BSMs) intended for load-bearing bone defects is highly complicated, as biological and mechanical requirements are often contradictory. In recent years, biological BSMs have been developed which allow for a more efficient integration of the material with the surrounding osseous environment and, hence, a higher mechanical stability of the treated defect. However, while these materials are promising, they are still far from ideal. Consequently, extensive preclinical experimentation is still required. The current review provides a comprehensive overview of biomechanical considerations relevant for the design of biological BSMs. Further, the preclinical evaluation of biological BSMs intended for application in highly loaded skeletal sites is discussed. The selected animal models and implantation site should mimic the pathophysiology and biomechanical loading patterns of human bone as closely as possible. In general, sheep are among the most frequently selected animal models for the evaluation of biomaterials intended for highly loaded skeletal sites. Regarding the anatomical sites, segmental bone defects created in the limbs and spinal column are suggested as the most suitable. Furthermore, the outcome measurements used to assess biological BSMs for regeneration of defects in heavily loaded bone should be relevant and straightforward. The quantitative evaluation of bone defect healing through ex vivo biomechanical tests is a valuable addition to conventional in vivo tests, as it determines the functional efficacy of BSM-induced bone healing. Finally, we conclude that further standardization of preclinical studies is essential for reliable evaluation of biological BSMs in highly loaded skeletal sites.
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Affiliation(s)
| | | | | | - John A. Jansen
- Department of Dentistry—Regenerative Biomaterials, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Philips van Leydenlaan 25, 6525EX Nijmegen, The Netherlands; (S.d.L.S.); (J.J.J.P.v.d.B.); (S.C.G.L.)
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10
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Yuliati A, Hartono M, Suardita K. Proliferation and osteogenic differentiation of bone marrow-derived mesenchymal stem cell after exposure to red flesh dragon fruit extract. Dent Res J (Isfahan) 2020. [DOI: 10.4103/1735-3327.280885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Diker N, Sarican H, Cumbul A, Kilic E. Effects of systemic erythropoietin treatment and heterogeneous xenograft in combination on bone regeneration of a critical-size defect in an experimental model. J Craniomaxillofac Surg 2018; 46:1919-1923. [DOI: 10.1016/j.jcms.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/28/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
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Abstract
A substantial proportion of fractures can present with nonunion, and the management of nonunion continues to present a challenge for orthopaedic surgeons. A variety of biological, mechanical, patient, and injury factors can contribute to the occurrence of nonunion, and often the cause of nonunion may be multifactorial. Successful management often requires assessment and treatment of more than one of these factors. This article reviews common factors that may contribute to nonunion including infection, impaired biology, and metabolic disorders. In addition, new and evolving strategies for diagnosing the cause and effectively treating nonunion including the diagnosis of infection, metabolic workup, bone grafting, cell-based therapies, and biological adjuvants are reviewed and discussed.
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13
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Kumabe Y, Lee SY, Waki T, Iwakura T, Takahara S, Arakura M, Kuroiwa Y, Fukui T, Matsumoto T, Matsushita T, Nishida K, Kuroda R, Niikura T. Triweekly administration of parathyroid hormone (1-34) accelerates bone healing in a rat refractory fracture model. BMC Musculoskelet Disord 2017; 18:545. [PMID: 29268728 PMCID: PMC5740882 DOI: 10.1186/s12891-017-1917-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Some reports have shown that intermittent parathyroid hormone (PTH) (1-34) treatment for patients with delayed union or nonunion have led to successful healing. In this study, we investigated whether systemic intermittent administration of PTH (1-34) has a beneficial effect on bone healing in a rat refractory fracture model. METHODS We created a refractory femoral fracture model in 32 rats with periosteal cauterization that leads to atrophic nonunion at 8 weeks after surgery. Half the rats received subcutaneous intermittent human PTH (1-34) injections at a dosage of 100 μg/kg, thrice a week for 8 weeks. The other half received the vehicle only. At 8 weeks after fracture, radiographic, histological and mechanical assessments were performed. RESULTS Radiographic assessments showed that the union rate was significantly higher in the PTH group than in the control group (P < 0.05). The degree of fracture repair as scored using the Allen grading system in histological assessment was significantly greater in the PTH group than in the control group (P < 0.05). The ultimate stress and stiffness measurements were significantly greater in the PTH group than in the control group (p < 0.05). CONCLUSIONS We demonstrated that triweekly administration of PTH (1-34) increased union rate and accelerated bone healing in a rat refractory fracture model, suggesting that systemic administration of PTH (1-34) could become a novel and useful therapy for accelerating fracture healing in patients at high risk of delayed union or nonunion.
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Affiliation(s)
- Yohei Kumabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sang Yang Lee
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Takahiro Waki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takashi Iwakura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shunsuke Takahara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Michio Arakura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yu Kuroiwa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Kim YJ, Park SG, Shin B, Kim J, Kim SW, Choo OS, Yin XY, Min BH, Choung YH. Osteogenesis for postoperative temporal bone defects using human ear adipose-derived stromal cells and tissue engineering: An animal model study. J Biomed Mater Res A 2017; 105:3493-3501. [PMID: 28875515 DOI: 10.1002/jbm.a.36194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023]
Abstract
Mastoidectomy, the removal of infected mastoid bones, is a common surgical procedure for the treatment of chronic otitis media. Persistent and recurrent otorrhea and accumulation of keratin debris following open cavity mastoidectomy are still bothersome issues for both patients and otologists. In this study, we used human ear adipose-derived stromal cells (hEASCs) in combination with polycaprolactone (PCL) scaffolds and osteogenic differentiation medium (ODM) to regenerate temporal bone defects. The hEASCs showed stem cell phenotypes, and these characteristics were maintained up to passage 5. Mastoid bulla and cranial bone defects were induced in Sprague-Dawley rats using AgNO3 and burr hole drilling, respectively, and the rats were then divided into five groups: (1) control, (2) hEASCs, (3) hEASCs + ODM, (4) hEASCs + PCL scaffolds, and (5) hEASCs + PCL scaffolds + ODM. Osteogenesis was evaluated by micro-computed tomography and histology. Compared with the control group, the groups transplanted with hEASCs and PCL scaffolds had significantly higher bone formation along the periphery of the mastoid bulla area. Moreover, ODM synergistically enhanced bone formation in mastoid bulla defects. Our results suggest that combining hEASCs with PCL scaffolds represents a promising method for anatomical and functional reconstruction of postoperative temporal bone defects following mastoidectomy. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 3493-3501, 2017.
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Affiliation(s)
- Yeon Ju Kim
- Department of Otolaryngology, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea
| | - Seung Gu Park
- Department of Otolaryngology, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea
| | - Beomyong Shin
- Department of Otolaryngology, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea.,Department of Biomedical Sciences, BK21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea
| | - Jangho Kim
- Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Seung Won Kim
- Department of Burns and Plastic Surgery, Affiliated Hospital of Yanbian University, 1327 Juzi Street, Yanji, Jilin, 133000, China
| | - Oak-Sung Choo
- Department of Otolaryngology, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea.,Department of Medical Sciences, Ajou University Graduate School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea
| | - Xiang Yun Yin
- Department of Orthopedic Surgery, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea
| | - Byoung Hyun Min
- Department of Orthopedic Surgery, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea.,Department of Biomedical Sciences, BK21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea.,Department of Medical Sciences, Ajou University Graduate School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea
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15
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Wang M, Yang N. A review of bioregulatory and coupled mechanobioregulatory mathematical models for secondary fracture healing. Med Eng Phys 2017; 48:90-102. [DOI: 10.1016/j.medengphy.2017.06.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/18/2017] [Accepted: 06/18/2017] [Indexed: 01/09/2023]
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16
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Ghiasi MS, Chen J, Vaziri A, Rodriguez EK, Nazarian A. Bone fracture healing in mechanobiological modeling: A review of principles and methods. Bone Rep 2017; 6:87-100. [PMID: 28377988 PMCID: PMC5365304 DOI: 10.1016/j.bonr.2017.03.002] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/15/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023] Open
Abstract
Bone fracture is a very common body injury. The healing process is physiologically complex, involving both biological and mechanical aspects. Following a fracture, cell migration, cell/tissue differentiation, tissue synthesis, and cytokine and growth factor release occur, regulated by the mechanical environment. Over the past decade, bone healing simulation and modeling has been employed to understand its details and mechanisms, to investigate specific clinical questions, and to design healing strategies. The goal of this effort is to review the history and the most recent work in bone healing simulations with an emphasis on both biological and mechanical properties. Therefore, we provide a brief review of the biology of bone fracture repair, followed by an outline of the key growth factors and mechanical factors influencing it. We then compare different methodologies of bone healing simulation, including conceptual modeling (qualitative modeling of bone healing to understand the general mechanisms), biological modeling (considering only the biological factors and processes), and mechanobiological modeling (considering both biological aspects and mechanical environment). Finally we evaluate different components and clinical applications of bone healing simulation such as mechanical stimuli, phases of bone healing, and angiogenesis.
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Affiliation(s)
- Mohammad S. Ghiasi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Jason Chen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashkan Vaziri
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Edward K. Rodriguez
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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17
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Nau C, Henrich D, Seebach C, Schröder K, Barker JH, Marzi I, Frank J. Tissue engineered vascularized periosteal flap enriched with MSC/EPCs for the treatment of large bone defects in rats. Int J Mol Med 2017; 39:907-917. [PMID: 28259928 PMCID: PMC5360440 DOI: 10.3892/ijmm.2017.2901] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 02/02/2017] [Indexed: 01/21/2023] Open
Abstract
Vascularized periosteal flaps are used for complex cases if the reconstruction of large bone defects is necessary in modern trauma and orthopedic surgery. In this study, we combined this surgical procedure with β-TCP scaffold and mesenchymal stem cells (MSCs) + endothelial progenitor cells (EPCs) as a tissue engineering approach to obtain optimum conditions for bone healing in rats. A critical size femoral defect was created in 80 rats allocated into 4 groups. Defects were treated according to the following protocol: i) vascularized periosteal flap alone; ii) vascularized periosteal flap + β-TCP scaffold; iii) vascularized periosteal flap + β-TCP scaffold + ligated vascular pedicle; and ii) vascularized periosteal flap + β-TCP scaffold + MSCs/EPCs. After 8 weeks, femur bones were extracted and analyzed for new bone formation, vascularization, proliferation and inflammatory processes and strength. Bone mineral density (BMD) and biomechanical stability at week 8 were highest in group 4 (flap + β-TCP scaffold + MSCs/EPCs) compared to all the other groups. Stability was significantly higher in group 4 (flap + β-TCP scaffold + MSCs/EPCs) in comparison to group 3 (ligated flap + β-TCP scaffold). BMD was found to be significantly lower in group 3 (ligated flap + β-TCP scaffold) compared to group 1 (flap) and group 4 (flap + β-TCP scaffold + MSCs/EPCs). The highest density of blood vessels was observed in group 4 (flap + β-TCP + MSCs/EPCs) and the values were significantly increased in comparison to group 3 (ligated flap), but not to group 1 (flap) and group 2 (flap + β-TCP). The highest amounts of proliferating cells were observed in group 4 (flap + β-TCP scaffold + MSC/EPCs). The percentage of proliferating cells was significantly higher in group 4 (flap + β-TCP scaffold + MSCs/EPCs) in comparison to all the other groups after 8 weeks. Our data thus indicate that critical size defect healing could be improved if MSCs/EPCs are added to β-TCP scaffold in combination with a periosteal flap. Even after 8 weeks, the amount of proliferating cells was increased. The flap blood supply is essential for bone healing and the reduction of inflammatory processes.
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Affiliation(s)
- Christoph Nau
- Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe‑University, Frankfurt/Main, Germany
| | - Dirk Henrich
- Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe‑University, Frankfurt/Main, Germany
| | - Caroline Seebach
- Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe‑University, Frankfurt/Main, Germany
| | - Katrin Schröder
- Institute for Cardiovascular Physiology, Goethe-University, Frankfurt/Main, Germany
| | - John H Barker
- Frankfurt Institute for Regenerative Medicine, Johann Wolfgang Goethe‑University, Frankfurt/Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe‑University, Frankfurt/Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe‑University, Frankfurt/Main, Germany
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18
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Han W, He W, Yang W, Li J, Yang Z, Lu X, Qin A, Qian Y. The osteogenic potential of human bone callus. Sci Rep 2016; 6:36330. [PMID: 27796345 PMCID: PMC5087090 DOI: 10.1038/srep36330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/12/2016] [Indexed: 01/15/2023] Open
Abstract
Bone callus, generated during fracture healing, is commonly discarded during surgical procedures. The aim of this study was to investigate the osteogenic potential of bone callus and its possible use as autograft material for patients needing bone grafts. Histology, immunohistochemistry, micro-computed tomography, and biomechanics were performed to examine osteogenic cells, osteoinductive factors, and the osteoconductive structure of bone callus. Alkaline phosphatase-positive osteoblasts, osteoinductive factors (including BMP2, FGF2, TGFB1, and IGF1), and a porous structure were found in bone callus. Early-stage callus (within 3 months after fracture) presented significantly improved osteogenic properties compared to medium- (3–9 months) and late-stage (longer than 9 months) callus. The results revealed that bone callus induced new bone formation in a nude mouse model. Early-stage callus showed better performance to medium- and late-stage callus in the induction of new bone formation at both 8 and 12 weeks. These findings indicated that bone callus, especially early-stage callus, possesses osteogenic potential and can potentially serve as an alternative source of material for bone grafts.
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Affiliation(s)
- Weiqi Han
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang 312000, PR China
| | - Wei He
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang 312000, PR China
| | - Wanlei Yang
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang 312000, PR China
| | - Jianlei Li
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang 312000, PR China
| | - Zhifan Yang
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang 312000, PR China
| | - Xuanyuan Lu
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang 312000, PR China
| | - An Qin
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, PR China
| | - Yu Qian
- Department of Orthopaedics, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang 312000, PR China
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19
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Nau C, Henrich D, Seebach C, Schröder K, Fitzsimmons SJ, Hankel S, Barker JH, Marzi I, Frank J. Treatment of Large Bone Defects with a Vascularized Periosteal Flap in Combination with Biodegradable Scaffold Seeded with Bone Marrow-Derived Mononuclear Cells: An Experimental Study in Rats. Tissue Eng Part A 2015; 22:133-41. [PMID: 26486307 DOI: 10.1089/ten.tea.2015.0030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The surgical treatment of large bone defects continues to pose a major challenge in modern trauma and orthopedic surgery. In this study we test the effectiveness of a tissue engineering approach, using three-dimensional (3D) β-tricalcium phosphate (β-TCP) scaffolding plus bone marrow-derived mononuclear cells (BM-MNCs), combined with a vascularized periosteal flap, in a rat femur critical size defect model. METHODS Eighty rats were randomly allocated into four equal groups. Under general anesthesia, critical size defects were created on their femurs and were treated with (1) Vascularized periosteal flap alone, (2) Vascularized periosteal flap+β-TCP scaffolding, (3) Vascularized periosteal flap+β-TCP scaffolding+ligated vascular pedicle, and (4) Vascularized periosteal flap+β-TCP scaffolding+BM-MNCs. After 4 and 8 weeks animals were euthanized and the bone defects were harvested for analysis of new bone formation, vascularization, and strength using histology, immunohistology, micro-CT, and biomechanical testing, respectively. RESULTS Group 1: (P. flap) Increase in new bone formation and vascularization. Group 2: (P. flap+scaffold) Increase in new bone formation and vascularization. Group 3: (P. flap+scaffold+ligated vascular pedicle) No new bone formation and no vascularization. Group 4: (P. flap+scaffold+BM-MNCs) A significant (p < 0.05) increase was seen in new bone formation, vascularization, and strength in bones treated with flaps, scaffold, and BM-MNCs, when compared with the other treatment groups. CONCLUSION Combining a vascularized periosteal flap with tissue engineering approach (β-TCP scaffolding and BM-MNC) results in significantly improved bone healing in our rat femur critical size bone defect model.
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Affiliation(s)
- Christoph Nau
- 1 Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
| | - Dirk Henrich
- 1 Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
| | - Caroline Seebach
- 1 Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
| | - Katrin Schröder
- 2 Institut für Kardiovaskuläre Physiologie, Fachbereich Medizin der Goethe-Universität , Frankfurt am Main, Germany
| | - Sammy-Jo Fitzsimmons
- 3 Frankfurt Initiative for Regenerative Medicine, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
| | - Svenja Hankel
- 1 Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
| | - John H Barker
- 3 Frankfurt Initiative for Regenerative Medicine, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
| | - Ingo Marzi
- 1 Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
| | - Johannes Frank
- 1 Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe-University , Frankfurt/Main, Germany
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20
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Verdonk R, Goubau Y, Almqvist FK, Verdonk P. Biological methods to enhance bone healing and fracture repair. Arthroscopy 2015; 31:715-8. [PMID: 25682328 DOI: 10.1016/j.arthro.2014.11.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 02/02/2023]
Abstract
This article looks into normal physiological fracture healing with special emphasis on the diamond concept. A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti-inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented.
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Affiliation(s)
| | - Yannick Goubau
- Department of Orthopaedic Surgery and Traumatology, University Hospital, Gent, Belgium
| | | | - Peter Verdonk
- Orthopaedic and Trauma Department, Monica Ziekenhuizen, Antwerp, Belgium
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21
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Mercado-Pagán ÁE, Stahl AM, Shanjani Y, Yang Y. Vascularization in bone tissue engineering constructs. Ann Biomed Eng 2015; 43:718-29. [PMID: 25616591 PMCID: PMC4979539 DOI: 10.1007/s10439-015-1253-3] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/13/2015] [Indexed: 01/04/2023]
Abstract
Vascularization of large bone grafts is one of the main challenges of bone tissue engineering (BTE), and has held back the clinical translation of engineered bone constructs for two decades so far. The ultimate goal of vascularized BTE constructs is to provide a bone environment rich in functional vascular networks to achieve efficient osseointegration and accelerate restoration of function after implantation. To attain both structural and vascular integration of the grafts, a large number of biomaterials, cells, and biological cues have been evaluated. This review will present biological considerations for bone function restoration, contemporary approaches for clinical salvage of large bone defects and their limitations, state-of-the-art research on the development of vascularized bone constructs, and perspectives on evaluating and implementing novel BTE grafts in clinical practice. Success will depend on achieving full graft integration at multiple hierarchical levels, both between the individual graft components as well as between the implanted constructs and their surrounding host tissues. The paradigm of vascularized tissue constructs could not only revolutionize the progress of BTE, but could also be readily applied to other fields in regenerative medicine for the development of new innovative vascularized tissue designs.
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Affiliation(s)
| | - Alexander M. Stahl
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Yaser Shanjani
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Yunzhi Yang
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
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22
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Schwartz-Arad D, Ofec R, Eliyahu G, Ruban A, Sterer N. Long Term Follow-Up of Dental Implants Placed in Autologous Onlay Bone Graft. Clin Implant Dent Relat Res 2014; 18:449-61. [DOI: 10.1111/cid.12288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Devorah Schwartz-Arad
- Oral and Maxillofacial Surgery; Advanced Implantology, Periodontology & Endodontology; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Ronen Ofec
- Department of Statistics and Operations Research; Tel Aviv University; Tel Aviv Israel
| | - Galit Eliyahu
- Oral and Maxillofacial Surgery; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Angela Ruban
- Clinical Research Units; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
| | - Nir Sterer
- Clinical Research Units; Oral and Maxillofacial Surgery; Schwartz-Arad Day-Care Surgical Center; Ramat Hasharon Israel
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Kfuri M, de Freitas RL, Batista BB, Salim R, Castiglia MT, Tavares RA, Araújo PH. Updates in biological therapies for knee injuries: bone. Curr Rev Musculoskelet Med 2014; 7:220-7. [PMID: 25030275 PMCID: PMC4596166 DOI: 10.1007/s12178-014-9225-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Bone is a unique tissue because of its mechanical properties, ability for self-repair, and enrollment in different metabolic processes such as calcium homeostasis and hematopoietic cell production. Bone barely tolerates deformation and tends to fail when overloaded. Fracture healing is a complex process that in particular cases is impaired. Osteoprogenitor cells proliferation, growth factors, and a sound tridimensional scaffold at fracture site are key elements for new bone formation and deposition. Mechanical stability and ample vascularity are also of great importance on providing a proper environment for bone healing. From mesenchymal stem cells delivery to custom-made synthetic scaffolds, many are the biological attempts to enhance bone healing. Impaired fracture healing represents a real burden to contemporary society. Sound basic science knowledge has contributed to newer approaches aimed to accelerate and improve the quality of bone healing.
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Affiliation(s)
- Mauricio Kfuri
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor - Hospital das Clinicas - Campus USP Av. Bandeirantes 3900 - 11o andar, 14048-900, Ribeirão Preto, SP, Brazil,
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24
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Affiliation(s)
- Michael Bottlang
- Biomechanics Laboratory, Legacy Research Institute, Portland, OR 97232, USA.
| | - Peter Augat
- Institute of Biomechanics, Trauma Center Murnau, Prof.-Kuentscher-Str. 8, 82418 Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria.
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25
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Stimulation of bone healing by sustained bone morphogenetic protein 2 (BMP-2) delivery. Int J Mol Sci 2014; 15:8539-52. [PMID: 24830556 PMCID: PMC4057747 DOI: 10.3390/ijms15058539] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/24/2014] [Accepted: 05/04/2014] [Indexed: 12/12/2022] Open
Abstract
The aim of the study was to investigate the effect of a sustained release of bone morphogenetic protein2 (BMP-2) incorporated in a polymeric implant coating on bone healing. In vitro analysis revealed a sustained, but incomplete BMP-2 release until Day 42. For the in vivo study, the rat tibia osteotomy was stabilized either with control or BMP-2 coated wires, and the healing progress was followed by micro computed tomography (μCT), biomechanical testing and histology at Days 10, 28, 42 and 84. MicroCT showed an accelerated formation of mineralized callus, as well as remodeling and an increase of mineralized/total callus volume (p = 0.021) at Day 42 in the BMP-2 group compared to the control. Histology revealed an increased callus mineralization at Days 42 and 84 (p = 0.006) with reduced cartilage at Day 84 (p = 0.004) in the BMP-2 group. Biomechanical stiffness was significantly higher in the BMP-2 group (p = 0.045) at Day 42. In summary, bone healing was enhanced after sustained BMP-2 application compared to the control. Using the same drug delivery system, but a burst release of BMP-2, a previous published study showed a similar positive effect on bone healing. Distinct differences in the healing outcome might be explained due to the different BMP release kinetics and dosages. However, further studies are necessary to adapt the optimal release profiles to physiological mechanisms.
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26
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Impact of IGF-I release kinetics on bone healing: a preliminary study in sheep. Eur J Pharm Biopharm 2014; 85:99-106. [PMID: 23958321 DOI: 10.1016/j.ejpb.2013.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/11/2013] [Accepted: 03/12/2013] [Indexed: 11/20/2022]
Abstract
Spatiotemporal release of growth factors from a delivery device can profoundly affect the efficacy of bone growth induction. Here, we report on a delivery platform based on the encapsulation of insulin-like growth factor I (IGF-I) in different poly(D,L-lactide) (PLA) and poly(D,L-lactide-co-glycolide) (PLGA) microsphere (MS) formulations to control IGF-I release kinetics. In vitro IGF-I release profiles generally exhibited an initial burst (14-36% of total IGF-I content), which was followed by a more or less pronounced dormant phase with little release (2 to 34 days), and finally, a third phase of re-increased IGF-I release. The osteoinductive potential of these different IGF-I PL(G)A MS formulations was tested in studies using 8-mm metaphyseal drill hole bone defects in sheep. Histomorphometric analysis at 3 and 6 weeks after surgery showed that new bone formation was improved in the defects locally treated with IGF-I PL(G)A MS (n=5) as compared to defects filled with IGF-I-free PL(G)A MS (n=4). The extent of new bone formation was affected by the particular release kinetics, although a definitive relationship was not evident. Local administration of IGF-I resulted in down-regulation of inflammatory marker genes in all IGF-I treated defects. The over-expression of growth factor genes in response to IGF-I delivery was restricted to formulations that produced osteogenic responses. These experiments demonstrate the osteoinductive potential of sustained IGF-I delivery and show the importance of delivery kinetics for successful IGF-I-based therapies.
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Biver E, Thouverey C, Magne D, Caverzasio J. Crosstalk between tyrosine kinase receptors, GSK3 and BMP2 signaling during osteoblastic differentiation of human mesenchymal stem cells. Mol Cell Endocrinol 2014; 382:120-130. [PMID: 24060635 DOI: 10.1016/j.mce.2013.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/16/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
Bone morphogenic proteins (BMPs) promote mesenchymal stem cell (MSC) osteogenic differentiation, whereas platelet derived growth factor (PDGF) and fibroblast growth factor (FGF) activate their proliferation through receptors tyrosine kinase (RTK). The effects of PDGF or FGF receptor signaling pathway on BMP2-induced osteoblastic differentiation was investigated in human MSC (HMSC). Inhibition of PDGF or/and FGF receptors enhanced BMP2-induced alkaline phosphatase (ALP) activity, expression of Osterix, ALP and Bone sialoprotein, and matrix calcification. These effects were associated with increased Smad-1 activity, indicating that mitogenic factors interfere with Smad signaling in HMSC differentiation. RTK activate MAPK and inhibit GSK3 through the PI3K/Akt pathway. Biochemical analysis indicated that MAPK JNK and GSK3 especially are potential signaling molecules regulating BMP-induced osteoblastic HMSC differentiation. These observations highlight that the osteogenic effects of BMP2 are modulated by mitogenic factors acting through RTK.
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Affiliation(s)
- Emmanuel Biver
- Service of Bone Diseases, Department of Internal Medicine Specialties, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland; Pathophysiology of Inflammatory Bone Diseases, PMOI EA4490, Boulogne/Mer, France
| | - Cyril Thouverey
- Service of Bone Diseases, Department of Internal Medicine Specialties, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland
| | - David Magne
- Institut of Molecular and Supramolecular Biochemistry, UMR, CNRS 5246, University of Lyon 1, 69622 Villeurbanne Cedex, France
| | - Joseph Caverzasio
- Service of Bone Diseases, Department of Internal Medicine Specialties, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland.
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DeNicolo PJ, Guyton MK, Cuenin MF, Hokett SD, Sharawy M, Borke J, McPherson JC. Histologic Evaluation of Osseous Regeneration Following Combination Therapy With Platelet-Rich Plasma and Bio-Oss in a Rat Calvarial Critical-Size Defect Model. J ORAL IMPLANTOL 2013; 41:543-9. [PMID: 24003871 DOI: 10.1563/aaid-joi-d-12-00075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Platelet-rich plasma (PRP) is an autogenous source of growth factors shown to facilitate human bone growth. Bio-Oss, an osteoconductive xenograft, is used clinically to regenerate periodontal defects, restore dental alveolar ridges, and facilitate sinus-lift procedures. The purpose of this study was to analyze whether a combination of PRP and Bio-Oss would enhance bone regeneration better than either material alone. PRP and/or Bio-Oss were administered in an 8-mm critical-size defect (CSD) rat calvarial model of bone defect between 2 polytetrafluoroethylene membranes to prevent soft tissue incursion. Eight weeks after the induction of the CSD, histologic sections were stained with hematoxylin and eosin stain and analyzed via light microscopy. Qualitative analyses revealed new bone regeneration in all 4 groups. The Bio-Oss and PRP plus Bio-Oss groups demonstrated greater areas of closure in the defects than the control or PRP-only groups because of the space-maintaining ability of Bio-Oss. The groups grafted with Bio-Oss showed close contact with new bone growth throughout the defects, suggesting a stronger graft. The use of PRP alone or in combination with Bio-Oss, however, did not appear to enhance osseous regeneration at 8 weeks. Areas grafted with Bio-Oss demonstrated greater space-maintaining capacity than controls, and PRP was an effective vehicle for placement of the Bio-Oss. However, at 8 weeks this study was unable to demonstrate a significant advantage of using PRP plus Bio-Oss over using Bio-Oss alone.
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Affiliation(s)
- Philip J DeNicolo
- 1 US Army Dental Activity, Dental and Trauma Research Detachment, Fort Sam Houston, San Antonio, Tex
| | - M Kelly Guyton
- 2 Department of Clinical Investigation, D. D. Eisenhower Army Medical Center, Fort Gordon, Ga
| | | | | | - Mohamed Sharawy
- 5 Department of Oral Biology, Medical College of Georgia, Augusta, Ga
| | - James Borke
- 6 College of Dental Medicine, Western University of Health Sciences, Pomona, Calif
| | - James C McPherson
- 2 Department of Clinical Investigation, D. D. Eisenhower Army Medical Center, Fort Gordon, Ga
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TGF-β1 and BMP-4 carried by liposomes enhance the healing process in alveolar bone. Arch Oral Biol 2013; 58:646-56. [DOI: 10.1016/j.archoralbio.2012.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 10/16/2012] [Accepted: 11/13/2012] [Indexed: 12/25/2022]
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Grundlagen biologischer Augmentationstechniken. ARTHROSKOPIE 2013. [DOI: 10.1007/s00142-012-0734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Using platelet-rich plasma for the treatment of symptomatic cervical ectopy. Int J Gynaecol Obstet 2012; 119:26-9. [PMID: 22835570 DOI: 10.1016/j.ijgo.2012.05.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 05/07/2012] [Accepted: 06/25/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of autologous platelet-rich plasma (PRP) applications in the treatment of benign cervical ectopy. METHODS Symptomatic women with benign cervical ectopy (n=120) were randomized to a PRP or a laser group. In the PRP group, PRP was applied twice on the cervical erosion with a 1-week interval. In the laser group, an Nd-YAG laser was used once for tissue vaporization. RESULTS The complete cure rates were 93.7% for the PRP and 92.4% for the laser group (P>0.05). The mean time to re-epithelialization was significantly shorter in the PRP (6.41 ± 2.05 weeks) than in the laser group (8.28 ± 1.72 weeks) (P<0.01). The rate of adverse treatment effects (i.e. vaginal discharge or vaginal bleeding) was much lower in the PRP than that in the laser group (P<0.01) and the effects were milder. Eleven patients in the PRP group had mild or moderate vaginal bleeding after treatment but none had heavy bleeding. Of 25 patients with vaginal bleeding in the laser group, 2 had heavy bleeding necessitating tamponade. CONCLUSION Autologous PRP applications appear promising for the treatment of cervical ectopy in symptomatic women, as they generate a shorter tissue healing time and milder adverse effects than laser treatment.
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Abstract
INTRODUCTION The biological process of fracture healing is complex with influences that are both patient-dependent and related to the trauma experienced and stability of the fracture. Fracture healing complications negatively affect the patient's quality of life, even more when fractures occur in the elderly osteoporotic patients. AREAS COVERED In the polytherapy for bone regeneration, a high success rate was obtained with the use of growth factors, osteogenic cells, and osteoconductive factors. There have been high expectations that treatment with drugs active on bone remodeling would be efficient for acceleration of fracture healing. A literature search was undertaken using wording like "drug or pharmacology of fracture healing." This report will review the systemic pharmacological agents for which clinical trials documenting their efficacy on bone healing have been carried out or are underway. EXPERT OPINION At present the use of systemic pharmacological agents to enhance fracture healing in the clinical setting is still controversial. However, future clinical trials will offer the possibility to obtain data that will make possible the registration of a drug as a "healer."
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Affiliation(s)
- Maria Luisa Brandi
- University of Florence, Department of Surgery and Translational Medicine, Mineral and Bone Metabolic Diseases Unit, Largo Palagi, 1, 50100 Florence, Italy.
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Dinopoulos H, Dimitriou R, Giannoudis PV. Bone graft substitutes: What are the options? Surgeon 2012; 10:230-9. [PMID: 22682580 DOI: 10.1016/j.surge.2012.04.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/10/2012] [Accepted: 04/10/2012] [Indexed: 12/14/2022]
Abstract
Currently, a number of bone grafting materials are available in the clinical setting to enhance bone regeneration, varying from autologous bone to several bone graft substitutes. Although autologous bone remains the "gold standard" for stimulating bone repair and regeneration, the morbidity from its harvesting and its restricted availability generated the need for the development of other materials or strategies either to substitute autologous bone graft or expand its limited supply. Bone graft substitutes can possess one or more components: an osteoconductive matrix, acting as a scaffold; osteoinductive proteins and other growth factors to induce differentiation and proliferation of bone-forming cells; and osteogenic cells for bone formation. Based on their distinct properties, all these bone grafting alternatives have specific indications, and can be used either alone or in combination. In this review, we summarise the available bone grafting materials, focussing mainly on the various bone substitutes and their characteristics, in an effort to specify the indications for their use.
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Affiliation(s)
- Haralambos Dinopoulos
- Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK
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Dimitriou R, Calori GM, Giannoudis PV. Polytrauma – new horizons for management. TRAUMA-ENGLAND 2012. [DOI: 10.1177/1460408611418766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of polytrauma has evolved considerably in the last century. Advances have been made in all disciplines involved in trauma care from pre-hospital care and resuscitation protocols to diagnostics, surgical techniques, administration of novel pharmacological agents and late reconstruction procedures. Improved understanding of the altered physiology and the induced response at the molecular level offers the potential for novel management strategies and prevention of post-traumatic complications.
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Affiliation(s)
- Rozalia Dimitriou
- Academic Department of Trauma and Orthopaedic Surgery, Leeds General Infirmary, Leeds, UK
| | - Giorgio M Calori
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Milan, Milan, Italy
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK
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Baltzer AWA, Ostapczuk MS, Stosch D, Granrath M. The use of recombinant human bone morphogenetic protein-2 for the treatment of a delayed union following femoral neck open-wedge osteotomy. Orthop Rev (Pavia) 2012; 4:e4. [PMID: 22577505 PMCID: PMC3348692 DOI: 10.4081/or.2012.e4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 03/04/2012] [Indexed: 11/23/2022] Open
Abstract
Although the clinical potential of bone morphogenetic proteins (BMPs) has been known for decades, their use in humans has only been approved for a limited number of orthopaedic conditions. Promising results in animals demonstrate the utility of BMP-2 in regional bone repair without using osteoconductors. To our knowledge, no comparable human case has been described. We report the case of a 50-year-old who suffered a femoral neck fracture. After 9 months of extensive treatment, he was still not pain-free. The following open-wedge osteotomy resulted in a therapy-resistant delayed union. We therefore conducted 4 computer tomography-guided injections of recombinant human (rh) BMP-2 into the bone gap. No osteoconductor was employed. Six weeks later, there was a 55–60% defect filling. Follow-up examination showed a complete union of the bone defect. Our case report shows that in a complicated delayed union rhBMP-2 can be successfully used to induce bone formation without any osteoconductor.
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Hannink G, Arts JJC. Bioresorbability, porosity and mechanical strength of bone substitutes: what is optimal for bone regeneration? Injury 2011; 42 Suppl 2:S22-5. [PMID: 21714966 DOI: 10.1016/j.injury.2011.06.008] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone repair is a multi-dimensional process that requires osteogenic cells, an osteoconductive matrix, osteoinductive signalling, mechanical stability and vascularization. In clinical practice, bone substitute materials are being used for reconstructive purposes, bone stock augmentation, and bone repair. Over the last decade, the use of calcium phosphate (CaP) based bone substitute materials has increased exponentially. These bone substitute materials vary in composition, mechanical strength and biological mechanism of function, each having their own advantages and disadvantages. It is known that intrinsic material properties of CaP bone substitutes have a profound effect on their mechanical and biological behaviour and associated biodegradation. These material properties of bone substitutes, such as porosity, composition and geometry change the trade-off between mechanical and biological performance. The choice of the optimal bone substitutes is therefore not always an easy one, and largely depends on the clinical application and its associated biological and mechanical needs. Not all bone graft substitutes will perform the same way, and their performance in one clinical site may not necessarily predict their performance in another site. CaP bone substitutes unfortunately have yet to achieve optimal mechanical and biological performance and to date each material has its own trade-off between mechanical and biological performance. This review describes the effect of intrinsic material properties on biological performance, mechanical strength and biodegradability of CaP bone substitutes.
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Affiliation(s)
- Gerjon Hannink
- Orthopaedic Research Laboratory, Department of Orthopaedics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Nauth A, Ristevski B, Li R, Schemitsch EH. Growth factors and bone regeneration: how much bone can we expect? Injury 2011; 42:574-9. [PMID: 21489530 DOI: 10.1016/j.injury.2011.03.034] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 03/17/2011] [Indexed: 02/02/2023]
Abstract
A large body of research has investigated the use of growth factors for bone regeneration, as a potential alternative to autogenous bone grafting. The bone morphogenetic proteins (BMPs) represent the most extensively investigated growth factors to date, as potential therapeutic agents for bone regeneration. Despite decades of research, the ideal growth factor or combination of growth factors for bone regeneration remains undefined. This article reviews the current available evidence for the application of growth factors for bone regeneration, with a focus on the clinical evidence for BMP use. Emerging pre-clinical and clinical evidence for growth factors other than the BMPs is also discussed.
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Affiliation(s)
- Aaron Nauth
- Department of Surgery, Division of Orthopaeadics, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Dimitriou R, Jones E, McGonagle D, Giannoudis PV. Bone regeneration: current concepts and future directions. BMC Med 2011; 9:66. [PMID: 21627784 PMCID: PMC3123714 DOI: 10.1186/1741-7015-9-66] [Citation(s) in RCA: 1101] [Impact Index Per Article: 84.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/31/2011] [Indexed: 02/08/2023] Open
Abstract
Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis.
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Affiliation(s)
- Rozalia Dimitriou
- Department of Trauma and Orthopaedics, Academic Unit, Clarendon Wing, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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