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Karavasili C, Young T, Francis J, Blanco J, Mancini N, Chang C, Bernstock JD, Connolly ID, Shankar GM, Traverso G. Local drug delivery challenges and innovations in spinal neurosurgery. J Control Release 2024; 376:1225-1250. [PMID: 39505215 DOI: 10.1016/j.jconrel.2024.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 10/11/2024] [Accepted: 10/28/2024] [Indexed: 11/08/2024]
Abstract
The development of novel therapeutics in the field of spinal neurosurgery faces a litany of translational challenges. Achieving precise drug targeting within the confined spaces associated with the spinal cord, canal and vertebra requires the development of next generation delivery systems and devices. These must be capable of overcoming inherent barriers related to drug diffusion, whilst concurrently ensuring optimal drug distribution and retention. In this review, we provide an overview of the most recent advances in the therapeutic management of diseases and disorders affecting the spine, including systems and devices capable of releasing small molecules and biopharmaceuticals that help eliminate pain and restore the mechanical function and stability of the spine. We highlight material-based approaches and minimally invasive techniques that can be employed to provide control over drug release kinetics and improve retention. We also seek to explore how the newest advancements in nanotechnology, biomaterials, additive manufacturing technologies and imaging modalities can be employed in this translational pursuit. Finally, we discuss the landscape of clinical trials and recently approved products aimed at overcoming the complexities associated with drug delivery to the spine.
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Affiliation(s)
- Christina Karavasili
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas Young
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Joshua Francis
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Julianna Blanco
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nicholas Mancini
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Charmaine Chang
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Joshua D Bernstock
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ian D Connolly
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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Wang Z, Liang W, Wang G, Wu H, Dang W, Zhen Y, An Y. Construction Form and Application of Three-Dimensional Bioprinting Ink Containing Hydroxyapatite. TISSUE ENGINEERING. PART B, REVIEWS 2024; 30:507-521. [PMID: 38569169 DOI: 10.1089/ten.teb.2023.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
With the increasing prevalence of bone tissue diseases, three-dimensional (3D) bioprinting applied to bone tissue engineering for treatment has received a lot of interests in recent years. The research and popularization of 3D bioprinting in bone tissue engineering require bioinks with good performance, which is closely related to ideal material and appropriate construction form. Hydroxyapatite (HAp) is the inorganic component of natural bone and has been widely used in bone tissue engineering and other fields due to its good biological and physicochemical properties. Previous studies have prepared different bioinks containing HAp and evaluated their properties in various aspects. Most bioinks showed significant improvement in terms of rheology and biocompatibility; however, not all of them had sufficiently favorable mechanical properties and antimicrobial activity. The deficiencies in properties of bioink and 3D bioprinting technology limited the applications of bioinks containing HAp in clinical trials. This review article summarizes the construction forms of bioinks containing HAp and its modifications in previous studies, as well as the 3D bioprinting techniques adopted to print bioink containing HAp. In addition, this article summarizes the advantages and underlying mechanisms of bioink containing HAp, as well as its limitations, and suggests possible improvement to facilitate the development of bone tissue engineering bioinks containing HAp in the future.
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Affiliation(s)
- Zimo Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Wei Liang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Huiting Wu
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Wanwen Dang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
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Iqbal J, Zafar Z, Skandalakis G, Kuruba V, Madan S, Kazim SF, A Bowers C. Recent advances of 3D-printing in spine surgery. Surg Neurol Int 2024; 15:297. [PMID: 39246777 PMCID: PMC11380890 DOI: 10.25259/sni_460_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/27/2024] [Indexed: 09/10/2024] Open
Abstract
Background The emerging use of three-dimensional printing (3DP) offers improved surgical planning and personalized care. The use of 3DP technology in spinal surgery has several common applications, including models for preoperative planning, biomodels, surgical guides, implants, and teaching tools. Methods A literature review was conducted to examine the current use of 3DP technology in spinal surgery and identify the challenges and limitations associated with its adoption. Results The review reveals that while 3DP technology offers the benefits of enhanced stability, improved surgical outcomes, and the feasibility of patient-specific solutions in spinal surgeries, several challenges remain significant impediments to widespread adoption. The obvious expected limitation is the high cost associated with implementing and maintaining a 3DP facility and creating customized patient-specific implants. Technological limitations, including the variability between medical imaging and en vivo surgical anatomy, along with the reproduction of intricate high-fidelity anatomical detail, pose additional challenges. Finally, the lack of comprehensive clinical monitoring, inadequate sample sizes, and high-quality scientific evidence all limit our understanding of the full scope of 3DP's utility in spinal surgery and preclude widespread adoption and implementation. Conclusion Despite the obvious challenges and limitations, ongoing research and development efforts are expected to address these issues, improving the accessibility and efficacy of 3DP technology in spinal surgeries. With further advancements, 3DP technology has the potential to revolutionize spinal surgery by providing personalized implants and precise surgical planning, ultimately improving patient outcomes and surgical efficiency.
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Affiliation(s)
- Javed Iqbal
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
| | - Zaitoon Zafar
- Department of Biotechnology, University of San Francisco, San Francisco, California, United States
| | - Georgios Skandalakis
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
| | | | - Shreya Madan
- Department of Neurosurgery, Desert Mountain High School, Scottsdale, Arizona, United States
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, United States
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, United States
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Yun C, Kim SH, Kim KM, Yang MH, Byun MR, Kim JH, Kwon D, Pham HTM, Kim HS, Kim JH, Jung YS. Advantages of Using 3D Spheroid Culture Systems in Toxicological and Pharmacological Assessment for Osteogenesis Research. Int J Mol Sci 2024; 25:2512. [PMID: 38473760 DOI: 10.3390/ijms25052512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Bone differentiation is crucial for skeletal development and maintenance. Its dysfunction can cause various pathological conditions such as rickets, osteoporosis, osteogenesis imperfecta, or Paget's disease. Although traditional two-dimensional cell culture systems have contributed significantly to our understanding of bone biology, they fail to replicate the intricate biotic environment of bone tissue. Three-dimensional (3D) spheroid cell cultures have gained widespread popularity for addressing bone defects. This review highlights the advantages of employing 3D culture systems to investigate bone differentiation. It highlights their capacity to mimic the complex in vivo environment and crucial cellular interactions pivotal to bone homeostasis. The exploration of 3D culture models in bone research offers enhanced physiological relevance, improved predictive capabilities, and reduced reliance on animal models, which have contributed to the advancement of safer and more effective strategies for drug development. Studies have highlighted the transformative potential of 3D culture systems for expanding our understanding of bone biology and developing targeted therapeutic interventions for bone-related disorders. This review explores how 3D culture systems have demonstrated promise in unraveling the intricate mechanisms governing bone homeostasis and responses to pharmacological agents.
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Affiliation(s)
- Chawon Yun
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Republic of Korea
| | - Sou Hyun Kim
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Republic of Korea
| | - Kyung Mok Kim
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Republic of Korea
| | - Min Hye Yang
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Republic of Korea
| | - Mi Ran Byun
- College of Pharmacy, Daegu Catholic University, Gyeongsan 38430, Republic of Korea
| | - Joung-Hee Kim
- Department of Medical Beauty Care, Dongguk University Wise, Gyeongju 38066, Republic of Korea
| | - Doyoung Kwon
- Jeju Research Institute of Pharmaceutical Sciences, College of Pharmacy, Jeju National University, Jeju 63243, Republic of Korea
| | - Huyen T M Pham
- Department of Molecular Science and Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Hyo-Sop Kim
- Department of Molecular Science and Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Jae-Ho Kim
- Department of Molecular Science and Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Young-Suk Jung
- Department of Pharmacy, Research Institute for Drug Development, College of Pharmacy, Pusan National University, Busan 46241, Republic of Korea
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da Silva de Barros AO, Ricci-Junior E, Alencar LMR, Fechine PBA, Andrade Neto DM, Bouskela E, Santos-Oliveira R. High doses of hydroxyapatite nanoparticle (nHAP) impairs microcirculation in vivo. Colloids Surf B Biointerfaces 2024; 233:113601. [PMID: 37939551 DOI: 10.1016/j.colsurfb.2023.113601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
Nanoparticles has surrounded the population by their use in electronics, medicine and cosmetics. The exposure to nanoparticles coming from different sources is uncountable as the amount of nanoparticles in which a person is exposed daily. In this direction and considering that microcirculation is the main and most affected system by nanoparticles in the first moment, responsible to transport and deal with nanoparticles internally, we evaluated a massive exposure (1 g/Kg) of a well-known nanoparticle (hydroxyapatite) and the impact on the microvessels. The results showed a massive destruction of venules, arterioles, and capillaries when nHAPs were administered topically. However, systemic administration of high doses of nHAP did not affect microcirculation but altered biochemical parameters of blood samples from treated animals. The data demonstrated that even well documented nanoparticles at high doses might affect the whole-body homeostasis. Finally, the results raise the necessity for further investigation of the effect of nanoparticles in microcirculation and the impact in the whole-body homeostasis.
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Affiliation(s)
- Aline Oliveira da Silva de Barros
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Rio de Janeiro 21941906, Brazil
| | - Eduardo Ricci-Junior
- Laboratório de Desenvolvimento Galênico, Departamento de Fármacos e Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (FF/UFRJ), Brazil
| | - Luciana Magalhães Rebelo Alencar
- Federal University of Maranhão, Department of Physics, Laboratory of Biophysics and Nanosystems, Campus Bacanga, Maranhão 65080-805, Brazil
| | - Pierre Basilio Almeida Fechine
- Grupo de Química de Materiais Avançados (GQMat), Departamento de Química Analítica e Físico-Química, Universidade Federal do Ceará-UFC, Campus do Pici, CP 12100, Fortaleza, Ceará, CEP 60451-970, Brazil
| | - Davino Machado Andrade Neto
- Grupo de Química de Materiais Avançados (GQMat), Departamento de Química Analítica e Físico-Química, Universidade Federal do Ceará-UFC, Campus do Pici, CP 12100, Fortaleza, Ceará, CEP 60451-970, Brazil; Federal Institute of Education, Science, and Technology of Ceará, Campus Camocim, 62400-000 Camocim, CE, Brazil
| | - Eliete Bouskela
- Universidade do Estado do Rio de Janeiro (UERJ), Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BioVasc), Rio de Janeiro, 20550-013, Brazil
| | - Ralph Santos-Oliveira
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Rio de Janeiro 21941906, Brazil; State University of Rio de Janeiro, Laboratory of Nanoradiopharmaceuticals and Radiopharmacy, Rio de Janeiro, RJ 23070200, Brazil.
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Gasperini FM, Fernandes GVO, Mitri FF, Calasans-Maia MD, Mavropoulos E, Malta Rossi A, Granjeiro JM. Histomorphometric evaluation, SEM, and synchrotron analysis of the biological response of biodegradable and ceramic hydroxyapatite-based grafts: from the synthesis to the bed application. Biomed Mater 2023; 18:065023. [PMID: 37844570 DOI: 10.1088/1748-605x/ad0397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/16/2023] [Indexed: 10/18/2023]
Abstract
This study aimed to analyze the physicochemical and histological properties of nanostructured hydroxyapatite and alginate composites produced at different temperatures with and without sintering and implanted in rabbit tibiae. Hydroxyapatite-alginate (HA) microspheres (425-600 µm) produced at 90 and 5 °C without (HA90 and HA5) or with sintering at 1000 °C (HA90S and HA5S) were characterized and applied to evaluate thein vitrodegradation; also were implanted in bone defects on rabbit's tibiae (n= 12). The animals were randomly divided into five groups (blood clot, HA90S, HA5S, HA90, and HA5) and euthanized after 7 and 28 d. X-ray diffraction and Fourier-transform infrared analysis of the non-sintered biomaterials showed a lower crystallinity than sintered materials, being more degradablein vitroandin vivo. However, the sinterization of HA5 led to the apatite phase's decomposition into tricalcium phosphate. Histomorphometric analysis showed the highest (p< 0.01) bone density in the blood clot group, similar bone levels among HA90S, HA90, and HA5, and significantly less bone in the HA5S. HA90 and HA5 groups presented higher degradation and homogeneous distribution of the new bone formation onto the surface of biomaterial fragments, compared to HA90S, presenting bone only around intact microspheres (p< 0.01). The elemental distribution (scanning electron microscope and energy dispersive spectroscopy andμXRF-SR analysis) of Ca, P, and Zn in the newly formed bone is similar to the cortical bone, indicating bone maturity at 28 d. The synthesized biomaterials are biocompatible and osteoconductive. The heat treatment directly influenced the material's behavior, where non-sintered HA90 and HA5 showed higher degradation, allowing a better distribution of the new bone onto the surface of the biomaterial fragments compared to HA90S presenting the same level of new bone, but only on the surface of the intact microspheres, potentially reducing the bone-biomaterial interface.
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Affiliation(s)
- Flávio Marcos Gasperini
- Prosthetic Dentistry Department, Dentistry School, Iguaçu University Nova Iguaçu, RJ, Brazil
| | | | - Fabio Franceschini Mitri
- Department of Morphology, Biomedical Sciences Institute, Federal Uberlandia University, Uberlandia, MG, Brazil
| | - Mônica Diuana Calasans-Maia
- Clinical Research Laboratory in Dentistry, Dentistry School, Fluminense Federal University, Niteroi, RJ, Brazil
| | - Elena Mavropoulos
- Biomaterials Laboratory-LABIOMAT, Brazilian Center of Physics Research, Rio de Janeiro, RJ, Brazil
| | - Alexandre Malta Rossi
- Biomaterials Laboratory-LABIOMAT, Brazilian Center of Physics Research, Rio de Janeiro, RJ, Brazil
| | - José Mauro Granjeiro
- Clinical Research Laboratory in Dentistry, Dentistry School, Fluminense Federal University, Niteroi, RJ, Brazil
- Laboratory of Biology, Coordination of Biology, National Institute of Metrology, Quality, and Technology, Duque de Caxias, RJ, Brazil
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Hogan KJ, Öztatlı H, Perez MR, Si S, Umurhan R, Jui E, Wang Z, Jiang EY, Han SR, Diba M, Jane Grande-Allen K, Garipcan B, Mikos AG. Development of photoreactive demineralized bone matrix 3D printing colloidal inks for bone tissue engineering. Regen Biomater 2023; 10:rbad090. [PMID: 37954896 PMCID: PMC10634525 DOI: 10.1093/rb/rbad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023] Open
Abstract
Demineralized bone matrix (DBM) has been widely used clinically for dental, craniofacial and skeletal bone repair, as an osteoinductive and osteoconductive material. 3D printing (3DP) enables the creation of bone tissue engineering scaffolds with complex geometries and porosity. Photoreactive methacryloylated gelatin nanoparticles (GNP-MAs) 3DP inks have been developed, which display gel-like behavior for high print fidelity and are capable of post-printing photocrosslinking for control of scaffold swelling and degradation. Here, novel DBM nanoparticles (DBM-NPs, ∼400 nm) were fabricated and characterized prior to incorporation in 3DP inks. The objectives of this study were to determine how these DBM-NPs would influence the printability of composite colloidal 3DP inks, assess the impact of ultraviolet (UV) crosslinking on 3DP scaffold swelling and degradation and evaluate the osteogenic potential of DBM-NP-containing composite colloidal scaffolds. The addition of methacryloylated DBM-NPs (DBM-NP-MAs) to composite colloidal inks (100:0, 95:5 and 75:25 GNP-MA:DBM-NP-MA) did not significantly impact the rheological properties associated with printability, such as viscosity and shear recovery or photocrosslinking. UV crosslinking with a UV dosage of 3 J/cm2 directly impacted the rate of 3DP scaffold swelling for all GNP-MA:DBM-NP-MA ratios with an ∼40% greater increase in scaffold area and pore area in uncrosslinked versus photocrosslinked scaffolds over 21 days in phosphate-buffered saline (PBS). Likewise, degradation (hydrolytic and enzymatic) over 21 days for all DBM-NP-MA content groups was significantly decreased, ∼45% less in PBS and collagenase-containing PBS, in UV-crosslinked versus uncrosslinked groups. The incorporation of DBM-NP-MAs into scaffolds decreased mass loss compared to GNP-MA-only scaffolds during collagenase degradation. An in vitro osteogenic study with bone marrow-derived mesenchymal stem cells demonstrated osteoconductive properties of 3DP scaffolds for the DBM-NP-MA contents examined. The creation of photoreactive DBM-NP-MAs and their application in 3DP provide a platform for the development of ECM-derived colloidal materials and tailored control of biochemical cue presentation with broad tissue engineering applications.
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Affiliation(s)
- Katie J Hogan
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
- Baylor College of Medicine Medical Scientist Training Program, Houston, TX 77030, USA
| | - Hayriye Öztatlı
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, 34684, Turkey
| | - Marissa R Perez
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Sophia Si
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Reyhan Umurhan
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Elysa Jui
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Ziwen Wang
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Emily Y Jiang
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Sa R Han
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Mani Diba
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - K Jane Grande-Allen
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
| | - Bora Garipcan
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, 34684, Turkey
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, MS-142, 6500 Main Street, Houston, TX 77030, USA
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8
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Foley D, Hardacker P, McCarthy M. Emerging Technologies within Spine Surgery. Life (Basel) 2023; 13:2028. [PMID: 37895410 PMCID: PMC10608700 DOI: 10.3390/life13102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
New innovations within spine surgery continue to propel the field forward. These technologies improve surgeons' understanding of their patients and allow them to optimize treatment planning both in the operating room and clinic. Additionally, changes in the implants and surgeon practice habits continue to evolve secondary to emerging biomaterials and device design. With ongoing advancements, patients can expect enhanced preoperative decision-making, improved patient outcomes, and better intraoperative execution. Additionally, these changes may decrease many of the most common complications following spine surgery in order to reduce morbidity, mortality, and the need for reoperation. This article reviews some of these technological advancements and how they are projected to impact the field. As the field continues to advance, it is vital that practitioners remain knowledgeable of these changes in order to provide the most effective treatment possible.
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Affiliation(s)
- David Foley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Pierce Hardacker
- Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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9
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Zhou J, See CW, Sreenivasamurthy S, Zhu D. Customized Additive Manufacturing in Bone Scaffolds-The Gateway to Precise Bone Defect Treatment. RESEARCH (WASHINGTON, D.C.) 2023; 6:0239. [PMID: 37818034 PMCID: PMC10561823 DOI: 10.34133/research.0239] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023]
Abstract
In the advancing landscape of technology and novel material development, additive manufacturing (AM) is steadily making strides within the biomedical sector. Moving away from traditional, one-size-fits-all implant solutions, the advent of AM technology allows for patient-specific scaffolds that could improve integration and enhance wound healing. These scaffolds, meticulously designed with a myriad of geometries, mechanical properties, and biological responses, are made possible through the vast selection of materials and fabrication methods at our disposal. Recognizing the importance of precision in the treatment of bone defects, which display variability from macroscopic to microscopic scales in each case, a tailored treatment strategy is required. A patient-specific AM bone scaffold perfectly addresses this necessity. This review elucidates the pivotal role that customized AM bone scaffolds play in bone defect treatment, while offering comprehensive guidelines for their customization. This includes aspects such as bone defect imaging, material selection, topography design, and fabrication methodology. Additionally, we propose a cooperative model involving the patient, clinician, and engineer, thereby underscoring the interdisciplinary approach necessary for the effective design and clinical application of these customized AM bone scaffolds. This collaboration promises to usher in a new era of bioactive medical materials, responsive to individualized needs and capable of pushing boundaries in personalized medicine beyond those set by traditional medical materials.
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Affiliation(s)
- Juncen Zhou
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
| | - Carmine Wang See
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
| | - Sai Sreenivasamurthy
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
| | - Donghui Zhu
- Department of Biomedical Engineering,
Stony Brook University, Stony Brook, NY, USA
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10
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Vasconcelos DP, Costa M, Reis JL, Pinto VS, Sousa AB, Águas AP, Barbosa MA, Barbosa JN. Chitosan 3D scaffolds with resolvin D1 for vertebral arthrodesis: a pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1985-1991. [PMID: 37106251 DOI: 10.1007/s00586-023-07725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Over the last years, the number of vertebral arthrodesis has been steadily increasing. The use of iliac crest bone autograft remains the "gold standard" for bone graft substitute in these procedures. However, this solution has some side effects, such as the problem of donor site morbidity indicating that there is a real need for adequate alternatives. This pilot study aimed to evaluate the usefulness of chitosan (Ch) porous 3D scaffolds incorporated with resolvin D1 (RvD1) as an alternative implant to iliac bone autograft. METHODS We have performed bilateral posterolateral lumbar vertebral arthrodesis in a rat animal model. Three experimental groups were used: (i) non-operated animals; (ii) animals implanted with Ch scaffolds incorporated with RvD1 and (iii) animals implanted with iliac bone autograft. RESULTS The collagenous fibrous capsule formed around the Ch scaffolds with RvD1 is less dense when compared with the iliac bone autograft, suggesting an important anti-inflammatory effect of RvD1. Additionally, new bone formation was observed in the Ch scaffolds with RvD1. CONCLUSION These results demonstrate the potential of these scaffolds for bone tissue repair applications.
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Affiliation(s)
- Daniela P Vasconcelos
- i3S - Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal
- INEB - Instituto de Engenharia Biomédica, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal
| | - Madalena Costa
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
- UMIB - Unit for Multidisciplinary Biomedical Research of ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Joaquim L Reis
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
- UMIB - Unit for Multidisciplinary Biomedical Research of ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- CHUPorto - Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - Vasco S Pinto
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
- CHUPorto - Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - Ana B Sousa
- i3S - Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal
- INEB - Instituto de Engenharia Biomédica, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Artur P Águas
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
- UMIB - Unit for Multidisciplinary Biomedical Research of ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Mário A Barbosa
- i3S - Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal
- INEB - Instituto de Engenharia Biomédica, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Judite N Barbosa
- i3S - Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal.
- INEB - Instituto de Engenharia Biomédica, Rua Alfredo Allen, 208, 4200-125, Porto, Portugal.
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal.
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Abstract
Purpose of Review Despite the continued growth of spine fusion procedures, the ideal material for bone regeneration remains unclear. Current bone graft substitutes and extenders in use such as exogenous BMP-2 or demineralized bone matrix and hydroxyapatite either have serious complications associated with use or lead to clinically significant rates of non-union. The introduction of nanotechnology and 3D printing to regenerative medicine facilitates the development of safer and more efficacious bone regenerative scaffolds that present solutions to these problems. Many researchers in orthopedics recognize the importance of lowering the dose of recombinant growth factors like BMP-2 to avoid the complications associated with its normal required supraphysiologic dosing to achieve high rates of fusion in spine surgery. Recent Findings Recent iterations of bioactive scaffolds have moved towards peptide amphiphiles that bind endogenous osteoinductive growth factor sources at the site of implantation. These molecules have been shown to provide a highly fluid, natural mimetic of natural extracellular matrix to achieve 100% fusion rates at 10–100 times lower doses of BMP-2 relative to controls in pre-clinical animal posterolateral fusion models. Alternative approaches to bone regeneration include the combination of existing natural growth factor sources like human bone combined with bioactive, biocompatible components like hydroxyapatite using 3D-printing technologies. Their elastomeric, 3D-printed scaffolds demonstrate an optimal safety profile and high rates of fusion (~92%) in the rat posterolateral fusion model. Summary Bioactive peptide amphiphiles and developments in 3D printing offer the promising future of a recombinant growth factor- free bone graft substitute with similar efficacy but improved safety profiles compared to existing bone graft substitutes.
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