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Henderson ER, Hebert KA, Werth PM, Streeter SS, Rosenthal EL, Paulsen KD, Pogue BW, Samkoe KS. Fluorescence guidance improves the accuracy of radiological imaging-guided surgical navigation. J Surg Oncol 2023; 127:490-500. [PMID: 36285723 PMCID: PMC10176708 DOI: 10.1002/jso.27128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Imaging-based navigation technologies require static referencing between the target anatomy and the optical sensors. Imaging-based navigation is therefore well suited to operations involving bony anatomy; however, these technologies have not translated to soft-tissue surgery. We sought to determine if fluorescence imaging complement conventional, radiological imaging-based navigation to guide the dissection of soft-tissue phantom tumors. METHODS Using a human tissue-simulating model, we created tumor phantoms with physiologically accurate optical density and contrast concentrations. Phantoms were dissected using all possible combinations of computed tomography (CT), magnetic resonance, and fluorescence imaging; controls were included. The data were margin accuracy, margin status, tumor spatial alignment, and dissection duration. RESULTS Margin accuracy was higher for combined navigation modalities compared to individual navigation modalities, and accuracy was highest with combined CT and fluorescence navigation (p = 0.045). Margin status improved with combined CT and fluorescence imaging. CONCLUSIONS At present, imaging-based navigation has limited application in guiding soft-tissue tumor operations due to its inability to compensate for positional changes during surgery. This study indicates that fluorescence guidance enhances the accuracy of imaging-based navigation and may be best viewed as a synergistic technology, rather than a competing one.
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Affiliation(s)
- Eric R. Henderson
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kendra A. Hebert
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Paul M. Werth
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Samuel S. Streeter
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Eben L. Rosenthal
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith D. Paulsen
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Brian W. Pogue
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kimberley S. Samkoe
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
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Ottesen TD, Shultz BN, Munger AM, Amick M, Toombs CS, Friedaender GE, Grauer JN. Chondrosarcoma patient characteristics, management, and outcomes based on over 5,000 cases from the National Cancer Database (NCDB). PLoS One 2022; 17:e0268215. [PMID: 35901087 PMCID: PMC9333210 DOI: 10.1371/journal.pone.0268215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chondrosarcoma, although relatively uncommon, represents a significant percentage of primary osseous tumors. Nonetheless, there are few large-cohort, longitudinal studies of long-term survival and treatment outcomes of chondrosarcoma patients and none using the National Cancer Database (NCDB). METHODS Chondrosarcoma patients were identified from the 2004-2015 NCDB datasets and divided on three primary tumor sites: appendicular, axial, and other. Demographic, treatment, and long-term survival data were determined for each group. Multivariate Cox analysis and Kaplan-Meier survival curves were generated to assess long-term survival over time for each. RESULTS In total, 5,329 chondrosarcoma patients were identified, of which 2,686 were appendicular and 1,616 were axial. Survival was higher among the appendicular cohort than axial at 1-year, 5-year, and 10-year (89.52%, 75.76%, and 65.24%, respectively). Multivariate Cox analysis identified patients in the appendicular cohort to have significantly greater likelihood of death with increasing age category, distant metastases at presentation, and male sex (p<0.001 for each). Best outcomes for seen for those undergoing surgical treatment (p<0.001). Patients in the axial cohort were with increased likelihood of death with increasing age category and distant metastases (p<0.001), while surgical treatment with or without radiation were associated with a significant decrease (p<0.001). Kaplan-Meier survival analysis showed worst survival for the axial cohort (p<0.001) and patients with distant metastases at presentation (p<0.001). Survival was not significantly different between older (2004-2007) and more recent years (2012-2016) (p = 0.742). CONCLUSIONS For both appendicular and axial chondrosarcomas, surgical treatment remains the mainstay of treatment due to its continued superiority for the long-term survival of patients, although advancements in survival over the last decade have been insignificant. Presence of distant metastases and axial involvement are significant, poor prognostic factors perhaps because of difficulty in surgical excision or extent of disease.
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Affiliation(s)
- Taylor D. Ottesen
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
- Harvard Combined Orthopaedics Residency Program, Boston, MA, United States of America
| | - Blake N. Shultz
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Alana M. Munger
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael Amick
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Courtney S. Toombs
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Gary E. Friedaender
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
- * E-mail:
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Pelvic Chondrosarcoma Treated by En Bloc Resection with Patient-Specific Osteotomy Guides and Reimplantation of the Extracorporeally Irradiated Bone as an Osseocartilaginous Structural Orthotopic Autograft: A Report of Two Cases with Description of the Surgical Technique. Case Rep Orthop 2021; 2021:5512143. [PMID: 33868736 PMCID: PMC8035037 DOI: 10.1155/2021/5512143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 11/18/2022] Open
Abstract
Primary tumors of the pelvis are considered difficult to treat due to the complex anatomy and the proximity of important neurovascular structures. The surgical armamentarium for the treatment of these tumors has evolved with the help of cutting-edge technology from debilitating hemipelvectomies to solutions such as precise resections guided by patient-specific instruments or computer navigation and reconstruction by modular prostheses, 3D-printed custom-made implants, or orthotopic autograft reimplantation after extracorporeal irradiation. Different combinations of these techniques have been described in the literature with various rates of success. We present two cases of pelvic chondrosarcomas successfully treated by a combination of periacetabular resection with patient-specific osteotomy guides and orthotopic reimplantation of the extracorporeally irradiated autograft resulting in retention of the native hip.
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Prognostic Nomograms to Predict Overall Survival and Cancer-specific Survival in Sacrum/Pelvic Chondrosarcoma (SC) Patients: A Population-based Propensity Score-matched Study. Clin Spine Surg 2021; 34:E177-E185. [PMID: 33017339 DOI: 10.1097/bsd.0000000000001089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/19/2020] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A longitudinal cohort study. OBJECTIVE The objective of this study was to evaluate the prognostic factors and determine the difference between different surgery scopes. Nomograms were constructed and validated to predict overall survival (OS) and cancer-specific survival (CSS) of sacrum/pelvic chondrosarcoma (SC) patients. SUMMARY OF BACKGROUND DATA Chondrosarcoma is a bone malignancy which is reported to be resistant to both chemotherapy and radiotherapy. Therefore, surgery is the most preferred treatment method. However, this remains a great challenge due to the complex anatomy of the area. MATERIALS AND METHODS Data from the Surveillance, Epidemiology, and End Results (SEER) database of patients with conventional SC between 1998 and 2016 was retrieved for analysis. Cox analysis was used to estimate the mortality hazards ratios among patients. Propensity score matching was used to compare different surgery scope. Nomograms were constructed to predict the OS and CSS of patients with SC. RESULTS A total of 377 patients were included in this study. The cutoff value for tumor size was considered to be 118 mm. The concordance indices (C-index) value for nomogram predictions of CSS were 0.871. Following propensity score matching, 158 patients were selected for the second time and its result showed no significant difference between the scope of surgery. CONCLUSIONS Tumor size was considered to be closely related to the outcome of SC. There is no significant difference in the scope of surgery and limb salvage can be considered. The nomograms can precisely predict OS and CSS in patients with SC. These could help clinicians to perform survival assessments and identify patients at high risk. LEVEL OF EVIDENCE Level IV.
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Hayashi S, Matsubara T, Fukuda K, Funahashi K, Hashimoto M, Maeda T, Kamenaga T, Takashima Y, Matsumoto T, Niikura T, Kuroda R. Predictive factors for effective selection of Interleukin-6 inhibitor and tumor necrosis factor inhibitor in the treatment of rheumatoid arthritis. Sci Rep 2020; 10:16645. [PMID: 33024253 PMCID: PMC7538428 DOI: 10.1038/s41598-020-73968-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
Treatment of rheumatoid arthritis (RA) is aimed at long-term remission and inhibition of joint destruction by different biologic drugs. However, the choice of a particular biologic agent based on individual cases of RA remains unestablished. Interleukin-6 (IL-6) inhibitor and tumor necrosis factor (TNF) inhibitor are common biologics used for the treatment of RA. This study aimed to investigate predictive factors for effective selection of tocilizumab (IL-6 inhibitor) and etanercept (TNF inhibitor) in patients with RA. This is a retrospective cohort study. The 196 patients analyzed in this study were divided into four groups: tocilizumab treatment as the first biologic group (TCZ first, 42 patients), tocilizumab as second/ third biologic group (TCZ second, 34 patients), etanercept as the first biologic group (ETN first, 103 patients) and etanercept as second/third group (ETN second, 17 patients). Visual analog scale (VAS), clinical disease activity index (CDAI), and modified health assessment questionnaire (mHAQ) scores at the initiation of biologic treatment and after 6 months of tocilizumab and etanercept therapy were measured and compared to clinical parameters and radiographical parameters among the four groups. CRP, MMP-3, VAS, CDAI, and HAQ were improved after 6 months of treatment in all groups. Improvement of clinical outcomes was correlated with CRP value, duration of RA, and Sharp scores at the initiation of treatment. Multivariate analysis demonstrated improvement in CDAI was significantly associated with the yearly progression of erosion according to the Sharp score in TCZ first group (OR, 1.5; 95% CI, 1.03–2.07) and was negatively associated with the duration of RA (OR, 0.49; 95% CI, 0.29–0.86) at the initiation of treatment with ETN first group. We identified the predictive factors for effective selection of tocilizumab and etanercept treatment and established the effectiveness of tocilizumab for the patients with rapid progressive joint erosion and etanercept for the early administration from diagnosis of RA.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Tsukasa Matsubara
- Department of Orthopaedic Surgery, Matsubara Mayflower Hospital, Kato, Japan
| | - Koji Fukuda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | | | | | - Toshihisa Maeda
- Department of Orthopaedic Surgery, Matsubara Mayflower Hospital, Kato, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshinori Takashima
- 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
| | - Takahiro Niikura
- 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
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Hayashi K, Yamamoto N, Takeuchi A, Miwa S, Igarashi K, Higuchi T, Abe K, Taniguchi Y, Aiba H, Araki Y, Yonezawa H, Morinaga S, Tsuchiya H. Clinical course of grafted cartilage in osteoarticular frozen autografts for reconstruction after resection of malignant bone and soft-tissue tumor involving an epiphysis. J Bone Oncol 2020; 24:100310. [PMID: 32802735 PMCID: PMC7419662 DOI: 10.1016/j.jbo.2020.100310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 11/24/2022] Open
Abstract
Frozen autograft of tumour-bearing bone using liquid nitrogen as a recycling autograft has various advantages. This paper is the first report focusing on the fate of grafted cartilage in recycled autograft after bone tumour excision. We found hemicondylar frozen autograft is promising reconstruction method.
There are several options for biological reconstruction after bone tumor resection. If the tumor invades an epiphysis, the reconstruction is far more complicated because there is no option to restore large joint cartilage using currently available medical techniques. Frozen autograft with liquid nitrogen has been used as recycled autologous bone graft and the purpose of the present study was to assess the outcome of grafted cartilage in osteoarticular frozen autografts used in the treatment of patients with bone and soft-tissue sarcoma. We have treated 27 patients with cases of bone tumor resection involving an epiphysis where frozen autografts were used for reconstruction. If the tumor was located in a limited part of the epiphysis, partial resection of the epiphysis was performed to preserve the healthy part of the cartilage in 4 cases. The survival of grafted frozen cartilage was assessed by X-ray imaging. The end point was defined as grade IV of the Kellgren and Lawrence osteoarthritis grading system and was recorded using the Kaplan–Meier method. In case of removal of grafted bone after the surgery, pathological findings were assessed by hematoxylin and eosin staining of sections of resected cartilage in available cases to observe the fate of grafted cartilage over time. The postoperative mean follow-up period was 94.0 months. Grade IV osteoarthritis occurred in 12 patients. All patients in the partial epiphyseal freezing group survived compared with only 1 patient in the total epiphyseal freezing group who had survived to the final follow up (p < 0.01). Resected specimens with grafted cartilage were examined histologically. A sample excised after 14 months had dead cartilage with empty lacunae and the surface of the cartilage had reactive fibrous tissue. Grafted cartilage of frozen osteoarticular autografts was worn out over time. However, intraepiphyseal resection preserving partial healthy cartilage resulted in excellent survival. This technique requires careful planning of the surgery but might be an alternative to megaprosthesis.
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Affiliation(s)
- Katsuhiro Hayashi
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Norio Yamamoto
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Shinji Miwa
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Kentaro Igarashi
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takashi Higuchi
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Kensaku Abe
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yuta Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Yoshihiro Araki
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Sei Morinaga
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedics, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
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Xu G, Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Higuchi T, Taniguchi Y, Araki Y, Yonezawa H, Morinaga S, Tsuchiya H. Pedicle frozen autograft-prosthesis composite reconstructions for malignant bone tumors of the proximal femur. BMC Musculoskelet Disord 2020; 21:81. [PMID: 32028976 PMCID: PMC7006402 DOI: 10.1186/s12891-020-3112-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Limb salvage surgery is becoming increasingly popular after tumor resection in the lower extremity. Biological reconstruction and use of megaprosthesis are main methods for malignant bone tumors of the proximal femur, which remain controversial due to short- and long-term complication in the proximal femur. Tumor-bearing bone treated by liquid nitrogen is one of biological reconstruction. This study aimed to evaluate the mid- and long-term functional outcomes and complications in patients treated with frozen autograft–prosthesis composite (FAPC) reconstructions in the proximal femur. Methods This retrospective study included 19 patients (10 women, 9 men) with malignant tumors of the proximal femur who underwent tumor-wide resection and FAPC reconstruction (mean age, 46 years; range, 9–77 years). The mean follow-up period of 69 months (range, 9–179 months). Functional outcomes, oncological outcome and complications were evaluated by Musculoskeletal Tumor Society score, clinical and radiological examinations. Results The overall survival rate was 68.4%, and the mean Musculoskeletal Tumor Society functional score was 26.4 points (88%). FAPC survival rates were 100 and 50% at 5 and 10 years, respectively. Five of the 19 patients (26%) had complications: 2 required prosthesis removal and 2 developed a deep infection around acetabular. Wear of the acetabulum occurred in 2 cases, while disease recurrence was occurred in 1 case. There were no cases of greater trochanter avulsion, obvious absorption around frozen bone, prosthesis loosening or leg length discrepancy. Conclusions Due to without femoral osteotomy, this technique features satisfactory functional outcome and provide biomechanical stability that is comparable to those of other methods of biological reconstruction or megaprosthesis.
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Affiliation(s)
- Gang Xu
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Humbert P, Brennan MÁ, Davison N, Rosset P, Trichet V, Blanchard F, Layrolle P. Immune Modulation by Transplanted Calcium Phosphate Biomaterials and Human Mesenchymal Stromal Cells in Bone Regeneration. Front Immunol 2019; 10:663. [PMID: 31001270 PMCID: PMC6455214 DOI: 10.3389/fimmu.2019.00663] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
A wide variety of biomaterials have been developed as both stabilizing structures for the injured bone and inducers of bone neoformation. They differ in chemical composition, shape, porosity, and mechanical properties. The most extensively employed and studied subset of bioceramics are calcium phosphate materials (CaPs). These materials, when transplanted alongside mesenchymal stem cells (MSCs), lead to ectopic (intramuscular and subcutaneous) and orthotopic bone formation in preclinical studies, and effective fracture healing in clinical trials. Human MSC transplantation in pre-clinical and clinical trials reveals very low engraftment in spite of successful clinical outcomes and their therapeutic actions are thought to be primarily through paracrine mechanisms. The beneficial role of transplanted MSC could rely on their strong immunomodulatory effect since, even without long-term engraftment, they have the ability to alter both the innate and adaptive immune response which is critical to facilitate new bone formation. This study presents the current knowledge of the immune response to the implantation of CaP biomaterials alone or in combination with MSC. In particular the central role of monocyte-derived cells, both macrophages and osteoclasts, in MSC-CaP mediated bone formation is emphasized. Biomaterial properties, such as macroporosity and surface microstructure, dictate the host response, and the ultimate bone healing cascade. Understanding intercellular communications throughout the inflammation, its resolution and the bone regeneration phase, is crucial to improve the current therapeutic strategies or develop new approaches.
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Affiliation(s)
- Paul Humbert
- Laboratory Phy-Os, Inserm UMR1238, University of Nantes, Nantes, France
| | - Meadhbh Á. Brennan
- Laboratory Phy-Os, Inserm UMR1238, University of Nantes, Nantes, France
- Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States
| | - Noel Davison
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
- Instructure Labs, B.V., The Hague, Netherlands
| | - Philippe Rosset
- Laboratory Phy-Os, Inserm UMR1238, University of Nantes, Nantes, France
- Centre Hospitalier Universitaire de Tours, Tours, France
| | - Valérie Trichet
- Laboratory Phy-Os, Inserm UMR1238, University of Nantes, Nantes, France
| | | | - Pierre Layrolle
- Laboratory Phy-Os, Inserm UMR1238, University of Nantes, Nantes, France
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