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Broussolle T, Roux JP, Chapurlat R, Barrey C. Murine models of posterolateral spinal fusion: A systematic review. Neurochirurgie 2023; 69:101428. [PMID: 36871885 DOI: 10.1016/j.neuchi.2023.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Rodent models are commonly used experimentally to assess treatment effectiveness in spinal fusion. Certain factors are associated with better fusion rates. The objectives of the present study were to report the protocols most frequently used, to evaluate factors known to positively influence fusion rate, and to identify new factors. METHOD A systematic literature search of PubMed and Web of Science found 139 experimental studies of posterolateral lumbar spinal fusion in rodent models. Data for level and location of fusion, animal strain, sex, weight and age, graft, decortication, fusion assessment and fusion and mortality rates were collected and analyzed. RESULTS The standard murine model for spinal fusion was male Sprague Dawley rats of 295g weight and 13 weeks' age, using decortication, with L4-L5 as fusion level. The last two criteria were associated with significantly better fusion rates. On manual palpation, the overall mean fusion rate in rats was 58% and the autograft mean fusion rate was 61%. Most studies evaluated fusion as a binary on manual palpation, and only a few used CT and histology. Average mortality was 3.03% in rats and 1.56% in mice. CONCLUSIONS These results suggest using a rat model, younger than 10 weeks and weighing more than 300 grams on the day of surgery, to optimize fusion rates, with decortication before grafting and fusing the L4-L5 level.
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Affiliation(s)
- T Broussolle
- Department of Spine Surgery, P. Wertheimer University Hospital, GHE, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France.
| | - Jean-Paul Roux
- Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France
| | - R Chapurlat
- Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France
| | - C Barrey
- Department of Spine Surgery, P. Wertheimer University Hospital, GHE, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Arts et métiers ParisTech, ENSAM, 151, boulevard de l'Hôpital, 75013 Paris, France
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Krticka M, Planka L, Vojtova L, Nekuda V, Stastny P, Sedlacek R, Brinek A, Kavkova M, Gopfert E, Hedvicakova V, Rampichova M, Kren L, Liskova K, Ira D, Dorazilová J, Suchy T, Zikmund T, Kaiser J, Stary D, Faldyna M, Trunec M. Lumbar Interbody Fusion Conducted on a Porcine Model with a Bioresorbable Ceramic/Biopolymer Hybrid Implant Enriched with Hyperstable Fibroblast Growth Factor 2. Biomedicines 2021; 9:733. [PMID: 34202232 PMCID: PMC8301420 DOI: 10.3390/biomedicines9070733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Many growth factors have been studied as additives accelerating lumbar fusion rates in different animal models. However, their low hydrolytic and thermal stability both in vitro and in vivo limits their workability and use. In the proposed work, a stabilized vasculogenic and prohealing fibroblast growth factor-2 (FGF2-STAB®) exhibiting a functional half-life in vitro at 37 °C more than 20 days was applied for lumbar fusion in combination with a bioresorbable scaffold on porcine models. An experimental animal study was designed to investigate the intervertebral fusion efficiency and safety of a bioresorbable ceramic/biopolymer hybrid implant enriched with FGF2-STAB® in comparison with a tricortical bone autograft used as a gold standard. Twenty-four experimental pigs underwent L2/3 discectomy with implantation of either the tricortical iliac crest bone autograft or the bioresorbable hybrid implant (BHI) followed by lateral intervertebral fixation. The quality of spinal fusion was assessed by micro-computed tomography (micro-CT), biomechanical testing, and histological examination at both 8 and 16 weeks after the surgery. While 8 weeks after implantation, micro-CT analysis demonstrated similar fusion quality in both groups, in contrast, spines with BHI involving inorganic hydroxyapatite and tricalcium phosphate along with organic collagen, oxidized cellulose, and FGF2- STAB® showed a significant increase in a fusion quality in comparison to the autograft group 16 weeks post-surgery (p = 0.023). Biomechanical testing revealed significantly higher stiffness of spines treated with the bioresorbable hybrid implant group compared to the autograft group (p < 0.05). Whilst histomorphological evaluation showed significant progression of new bone formation in the BHI group besides non-union and fibrocartilage tissue formed in the autograft group. Significant osteoinductive effects of BHI based on bioceramics, collagen, oxidized cellulose, and FGF2-STAB® could improve outcomes in spinal fusion surgery and bone tissue regeneration.
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Affiliation(s)
- Milan Krticka
- Trauma Surgery Department, Faculty of Medicine, Masaryk University and The University Hospital Brno, 625 00 Brno, Czech Republic; (M.K.); (V.N.); (D.I.)
| | - Ladislav Planka
- Department of Paediatric Surgery, Orthopedics and Traumatology, Faculty of Medicine, Masaryk University and The University Hospital Brno, 662 63 Brno, Czech Republic; (L.P.); (D.S.)
| | - Lucy Vojtova
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
| | - Vladimir Nekuda
- Trauma Surgery Department, Faculty of Medicine, Masaryk University and The University Hospital Brno, 625 00 Brno, Czech Republic; (M.K.); (V.N.); (D.I.)
| | - Premysl Stastny
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
| | - Radek Sedlacek
- Department of Mechanics, Biomechanics and Mechatronics, Faculty of Mechanical Engineering, Czech Technical University in Prague, 160 00 Prague, Czech Republic;
| | - Adam Brinek
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
| | - Michaela Kavkova
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
| | - Eduard Gopfert
- Veterinary Research Institute, 621 00 Brno, Czech Republic; (E.G.); (M.F.)
| | - Vera Hedvicakova
- University Center for Energy Efficient Buildings, Czech Technical University in Prague, 273 43 Bustehrad, Czech Republic; (V.H.); (M.R.)
- Department of Tissue Engineering, Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic
| | - Michala Rampichova
- University Center for Energy Efficient Buildings, Czech Technical University in Prague, 273 43 Bustehrad, Czech Republic; (V.H.); (M.R.)
- Department of Tissue Engineering, Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic
| | - Leos Kren
- Department of Pathology, Faculty of Medicine of Masaryk University and The University Hospital Brno, 625 00 Brno, Czech Republic; (L.K.); (K.L.)
| | - Kvetoslava Liskova
- Department of Pathology, Faculty of Medicine of Masaryk University and The University Hospital Brno, 625 00 Brno, Czech Republic; (L.K.); (K.L.)
| | - Daniel Ira
- Trauma Surgery Department, Faculty of Medicine, Masaryk University and The University Hospital Brno, 625 00 Brno, Czech Republic; (M.K.); (V.N.); (D.I.)
| | - Jana Dorazilová
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
| | - Tomas Suchy
- Department of Composites and Carbon Materials, Institute of Rock Structure and Mechanics, The Czech Academy of Sciences, 182 09 Prague, Czech Republic;
| | - Tomas Zikmund
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
| | - Jozef Kaiser
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
| | - David Stary
- Department of Paediatric Surgery, Orthopedics and Traumatology, Faculty of Medicine, Masaryk University and The University Hospital Brno, 662 63 Brno, Czech Republic; (L.P.); (D.S.)
| | - Martin Faldyna
- Veterinary Research Institute, 621 00 Brno, Czech Republic; (E.G.); (M.F.)
| | - Martin Trunec
- CEITEC-Central European Institute of Technology, Brno University of Technology, 612 00 Brno, Czech Republic; (P.S.); (A.B.); (M.K.); (J.D.); (T.Z.); (J.K.); (M.T.)
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Holmes C, Elder BD, Ishida W, Perdomo-Pantoja A, Locke J, Cottrill E, Lo SFL, Witham TF. Comparing the efficacy of syngeneic iliac and femoral allografts with iliac crest autograft in a rat model of lumbar spinal fusion. J Orthop Surg Res 2020; 15:410. [PMID: 32933551 PMCID: PMC7490887 DOI: 10.1186/s13018-020-01936-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite widespread use of femoral-sourced allografts in clinical spinal fusion procedures and the increasing interest in using femoral reamer-irrigator-aspirator (RIA) autograft in clinical bone grafting, few studies have examined the efficacy of femoral grafts compared to iliac crest grafts in spinal fusion. The objective of this study was to directly compare the use of autologous iliac crest with syngeneic femoral and iliac allograft bone in the rat model of lumbar spinal fusion. METHODS Single-level bilateral posterolateral intertransverse process lumbar spinal fusion surgery was performed on Lewis rats divided into three experimental groups: iliac crest autograft, syngeneic iliac crest allograft, and syngeneic femoral allograft bone. Eight weeks postoperatively, fusion was evaluated via microCT analysis, manual palpation, and histology. In vitro analysis of the colony-forming and osteogenic capacity of bone marrow cells derived from rat femurs and hips was also performed to determine whether there was a correlation with the fusion efficacy of these graft sources. RESULTS Although no differences were observed between groups in CT fusion mass volumes, iliac allografts displayed an increased number of radiographically fused fusion masses and a higher rate of bilateral fusion via manual palpation. Histologically, hip-derived grafts showed better integration with host bone than femur derived ones, likely associated with the higher concentration of osteogenic progenitor cells observed in hip-derived bone marrow. CONCLUSIONS This study demonstrates the feasibility of using syngeneic allograft bone in place of autograft bone within inbred rat fusion models and highlights the need for further study of femoral-derived grafts in fusion.
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Affiliation(s)
- Christina Holmes
- Department of Chemical and Biomedical Engineering, Florida A&M University-Florida State University College of Engineering, Tallahassee, FL, USA.
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
| | | | - Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - John Locke
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Ethan Cottrill
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Ren X, Zhao M, Lash B, Martino MM, Julier Z. Growth Factor Engineering Strategies for Regenerative Medicine Applications. Front Bioeng Biotechnol 2020; 7:469. [PMID: 32039177 PMCID: PMC6985039 DOI: 10.3389/fbioe.2019.00469] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/23/2019] [Indexed: 01/07/2023] Open
Abstract
Growth factors are critical molecules for tissue repair and regeneration. Therefore, recombinant growth factors have raised a lot of hope for regenerative medicine applications. While using growth factors to promote tissue healing has widely shown promising results in pre-clinical settings, their success in the clinic is not a forgone conclusion. Indeed, translation of growth factors is often limited by their short half-life, rapid diffusion from the delivery site, and low cost-effectiveness. Trying to circumvent those limitations by the use of supraphysiological doses has led to serious side-effects in many cases and therefore innovative technologies are required to improve growth factor-based regenerative strategies. In this review, we present protein engineering approaches seeking to improve growth factor delivery and efficacy while reducing doses and side effects. We focus on engineering strategies seeking to improve affinity of growth factors for biomaterials or the endogenous extracellular matrix. Then, we discuss some examples of increasing growth factor stability and bioactivity, and propose new lines of research that the field of growth factor engineering for regenerative medicine may adopt in the future.
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Affiliation(s)
- Xiaochen Ren
- European Molecular Biology Laboratory Australia, Australian Regenerative Medicine Institute, Monash University, Melbourne, VIC, Australia
| | - Moyuan Zhao
- European Molecular Biology Laboratory Australia, Australian Regenerative Medicine Institute, Monash University, Melbourne, VIC, Australia
| | - Blake Lash
- European Molecular Biology Laboratory Australia, Australian Regenerative Medicine Institute, Monash University, Melbourne, VIC, Australia
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Mikaël M. Martino
- European Molecular Biology Laboratory Australia, Australian Regenerative Medicine Institute, Monash University, Melbourne, VIC, Australia
| | - Ziad Julier
- European Molecular Biology Laboratory Australia, Australian Regenerative Medicine Institute, Monash University, Melbourne, VIC, Australia
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Cottrill E, Ahmed AK, Lessing N, Pennington Z, Ishida W, Perdomo-Pantoja A, Lo SF, Howell E, Holmes C, Goodwin CR, Theodore N, Sciubba DM, Witham TF. Investigational growth factors utilized in animal models of spinal fusion: Systematic review. World J Orthop 2019; 10:176-191. [PMID: 31041160 PMCID: PMC6475812 DOI: 10.5312/wjo.v10.i4.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/03/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over 400000 Americans annually undergo spinal fusion surgeries, yet up to 40% of these procedures result in pseudoarthrosis even with iliac crest autograft, the current “gold standard” treatment. Tissue engineering has the potential to solve this problem via the creation of bone grafts involving bone-promoting growth factors (e.g., bone morphogenetic protein 2). A broad assessment of experimental growth factors is important to inform future work and clinical potential in this area. To date, however, no study has systematically reviewed the investigational growth factors utilized in preclinical animal models of spinal fusion.
AIM To review all published studies assessing investigational growth factors for spinal fusion in animal models and identify promising agents for translation.
METHODS We conducted a systematic review of the literature using PubMed, Embase, Cochrane Library, and Web of Science databases with searches run on May 29th, 2018. The search query was designed to include all non-human, preclinical animal models of spinal fusion reported in the literature without a timespan limit. Extracted data for each model included surgical approach, level of fusion, animal species and breed, animal age and sex, and any other relevant characteristics. The dosages/sizes of all implant materials, spinal fusion rates, and follow-up time points were recorded. The data were analyzed and the results reported in tables and text. PRISMA guidelines were followed for this systematic review.
RESULTS Twenty-six articles were included in this study, comprising 14 experimental growth factors: AB204 (n = 1); angiopoietin 1 (n = 1); calcitonin (n = 3); erythropoietin (n = 1); basic fibroblast growth factor (n = 1); growth differentiation factor 5 (n = 4), combined insulin-like growth factor 1 + transforming growth factor beta (n = 4); insulin (n = 1); NELL-1 (n = 5); noggin (n = 1); P-15 (n = 1); peptide B2A (n = 2); and secreted phosphoprotein 24 (n = 1). The fusion rates of the current gold standard treatment (autologous iliac crest bone graft, ICBG) and the leading clinically used growth factor (BMP-2) ranged widely in the included studies, from 0-100% for ICBG and from 13%-100% for BMP-2. Among the identified growth factors, calcitonin, GDF-5, NELL-1, and P-15 resulted in fusion rates of 100% in some cases. In addition, six growth factors - AB204, angiopoietin 1, GDF-5, insulin, NELL-1, and peptide B2A - resulted in significantly enhanced fusion rates compared to ICBG, BMP-2, or other internal control in some studies. Large heterogeneity in animal species, fusion method, and experimental groups and time points was observed across the included studies, limiting the direct comparison of the growth factors identified herein.
CONCLUSION Several promising investigational growth factors for spinal fusion have been identified herein; directly comparing the fusion efficacy and safety of these agents may inform clinical translation.
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Affiliation(s)
- Ethan Cottrill
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - A Karim Ahmed
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Noah Lessing
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Zachary Pennington
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | | | - Sheng-fu Lo
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Elizabeth Howell
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Christina Holmes
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Nicholas Theodore
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD 21287, United States
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Li ZJ, Lu CT, Lai RF. Ectopic osteogenesis effect of antigen-extracted xenogeneic cancellous bone graft with chitosan/rhBMP-2/bFGF sequential sustained-release nanocapsules. J Biomater Appl 2018; 33:23-43. [PMID: 29498305 DOI: 10.1177/0885328218761193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To explore the ectopic osteogenesis effect of sequential sustained release application of recombinant human bone morphogenic protein-2 (rhBMP-2) and basic fibroblast growth factor (bFGF). Antigen-extracted xenogeneic cancellous bone coupled with growth factor-loaded chitosan nanocapsules were implanted in rats in intramuscular site in accordance with the following experimental pattern: group A: simultaneous burst release of rhBMP-2 and bFGF; group B: simultaneous sustained release of rhBMP-2 and bFGF; group C: preferential burst release of rhBMP-2, then sustained release of bFGF; group D: preferential burst release of bFGF, then sustained release of rhBMP-2; group E: sustained release of rhBMP-2 alone; group F: sustained release of bFGF alone, blank control group G: antigen-extracted xenogeneic cancellous bone graft only; negative control group H: not filled with anything. Specimens were obtained after executing the animals at 2 and 4 weeks for general observation and weighing, calcium content detection, micro-CT scanning and bone parameter measurement analysis, H&E staining, ALP staining and CD34 staining. The materials weight of A-2, B-2, C-2, A-4, B-4, C-4, D-4 and E-4 were significantly higher than that of preoperative materials ( P < 0.05). The concentration of calcium of group B-4 was the highest (414.7 ± 12.03 mg/dl). Micro-CT scanning and bone parameter measurement analysis showed that the values of bone mineral density and trabecular thickness of group A, B, D, E at 4 weeks were both higher than the ones at 2 weeks ( P < 0.05), and both the bone mineral density (367.52 ± 11.64 mg/cc) and the trabecular thickness (126.17 ± 11.36 μm) of group B-4 were the highest. H&E staining showed that a large region of calcified cartilage and haemopoietic tissues were newly formed, especially in group B-4. ALP staining and CD34 staining showed the most positive expression region in group B-4. Therefore, we conclude that simultaneous sustained release of rhBMP-2 and bFGF is the ideal way to release drug, and has better inducement of antigen-extracted xenogeneic cancellous bone graft.
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Affiliation(s)
- Ze-Jian Li
- 1 Medical Centre of Stomatology, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Chun-Ting Lu
- 2 Science and Education Office, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Ren-Fa Lai
- 1 Medical Centre of Stomatology, First Affiliated Hospital, Jinan University, Guangzhou, China
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