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Assad M, Downey AM, Cluzel C, Trudel Y, Doyle N, Authier S. Characterization of an Acute Rodent Osteomyelitis Infectious Model Using a Tibial Intramedullary Implant Inoculation. Front Bioeng Biotechnol 2020; 8:567647. [PMID: 33163477 PMCID: PMC7584072 DOI: 10.3389/fbioe.2020.567647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022] Open
Abstract
Chronic osteomyelitis in presence of orthopedic implants is a condition observed in the field of biomaterials as it impairs early bone-implant contact, fixation and integration. In this study, a surgical intramedullary tibial insertion was performed using a titanium wire previously inoculated with Staphylococcus aureus in order to develop an osteomyelitis model in a clinically relevant long bone and in absence of any prophylactic treatment. As such, twenty-two male Sprague-Dawley rats received a sterile or inoculated intramedullary biomaterial with either 2 × 106 or 1 × 107S. aureus colony forming units. Bacterial burden, inflammation, morphological changes, as well as newly formed bone tissues were evaluated for histopathology following a period of either eight or fifteen days of implantation. The implant inoculated in presence of the highest bacterial load was effective to produce significant periprosthetic infection observations in addition to hard and soft tissue inflammation consistent with the development of osteomyelitis. In contrast, neither the sterile nor the low-dose implant inoculation showed inflammation and clinical infection signs, but rather produced an expected bone remodeling and appropriate healing associated with biomaterial implantation. Complete health assessment is presented with histopathological periprosthetic results.
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Affiliation(s)
- Michel Assad
- Charles River Laboratories, Boisbriand, QC, Canada
| | | | | | | | - Nancy Doyle
- Charles River Laboratories, Boisbriand, QC, Canada
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Erivan R, Lopez-Chicon P, Fariñas O, Perez Prieto D, Grau S, Boisgard S, Monllau JC, Vilarrodona A. Which type of bone releases the most vancomycin? Comparison of spongious bone, cortical powder and cortico-spongious bone. Cell Tissue Bank 2019; 21:131-137. [PMID: 31865504 DOI: 10.1007/s10561-019-09806-2] [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: 09/18/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022]
Abstract
Bone infections can be challenging to treat and can lead to several surgeries and relapses. When a graft is needed, cavitary bone loss can be grafted with cancellous or cortical bone. Both can be used for grafting. However, the antibiotic releasing capacity of these grafts has not been compared. Which type of bone is best at releasing the most antibiotic has not been well established. The aim of this study was to determine which type of bone is best for antibiotic release when the bone is suffused with antibiotics by the surgeon. The hypothesis is that there would be a difference between the type of bone tested due to different release capacities of cortical and cancellous bone. This was an experimental study. Cortical spongy bone in chips, Spongy bone in chips and demineralized cortical bone powder were compared. For each type of bone, 5 samples were tested. Processed and decontaminated grafts were freeze-dried to be kept at room temperature. The primary endpoint was the amount of vancomycin released by the graft as it affects the concentration of antibiotic around the graft in clinical practice. The procedure for the study consisted of full graft immersion in a vancomycin solution. Then, the liquid was removed with aspiration. In order to measure the quantity of antibiotic released, the bone was put into distilled water in agitation in a heated rocker at 37 °C. After 30 min of soaking, 1 mL of the liquid was removed. The same extraction process was also carried out after 60 min soaking, 2 h, 3 h, 24 h, and 48 h. No differences were found between each type of bone relative to the concentration of vancomycin released at each time of the assessment. There was a significant difference in the weight of the bone with a higher weight for the cortical powder (1.793 g) versus cortical spongy bone and spongy bone (1.154 g and 1.013 g) with a p value < 0.0001. A significant difference was seen in the weight of the bone with vancomycin after the aspiration of the liquid with 3.026 g for cortical powder, 2.140 g and 2.049 g for the cortical spongy bone and the spongy bone with a p value < 0.0001. In daily clinical practice, one can use cancellous bone, cortico-cancellous bone or cortical powder in order to add vancomycin to a bone graft. Our results show the release kinetics of the soaked allografts. With a maximum of 14 mg/mL in the first minutes and a rapid decrease it shows a pattern comparable to antibiotic loaded bone cement. The method used appears favourable for prophylactic use, protecting the graft against contamination at implantation, but is not sufficient for treating chronic bone infection. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Roger Erivan
- CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
- Orthopedic and Trauma Surgery Department, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, BP 69, 63003, Clermont-Ferrand, France.
| | | | - Oscar Fariñas
- Barcelona Tissue Bank, Banc de Sang I Teixits, Barcelona, Spain
| | | | - Santiago Grau
- ICATME- Hospital, Universitari Dexeus, Parc de Salut Mar, Barcelona, Spain
- Department of Pharmacy, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Stéphane Boisgard
- CNRS, SIGMA Clermont, ICCF, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
- Orthopedic and Trauma Surgery Department, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, BP 69, 63003, Clermont-Ferrand, France
| | - Juan C Monllau
- ICATME- Hospital, Universitari Dexeus, Parc de Salut Mar, Barcelona, Spain
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Beuttel E, Bormann N, Pobloth AM, Duda GN, Wildemann B. Impact of Gentamicin-Loaded Bone Graft on Defect Healing in a Sheep Model. MATERIALS 2019; 12:ma12071116. [PMID: 30987272 PMCID: PMC6480073 DOI: 10.3390/ma12071116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/23/2023]
Abstract
Infections of bone are severe complications, and an optimization of grafting material with antimicrobial drugs might be useful for prevention and treatment. This study aimed to investigate the influence of gentamicin-loaded bone graft on the healing of bone defects in a sheep model. Metaphyseal and diaphyseal drill hole defects (diameter: 6 mm, depth: 15 mm) were filled with graft or gentamicin-loaded graft (50 mg/g graft) or were left untreated. Analysis of regeneration after three and nine weeks, micro-computed tomography (μCT), and histology revealed a significant increase in bone formation in the drill hole defects, which began at the edges of the holes and grew over time into the defect center. The amount of graft decreased over time due to active resorption by osteoclasts, while osteoblasts formed new bone. No difference between the groups was seen after three weeks. After nine weeks, significantly less mineralized tissue was formed in the gentamicin-loaded graft group. Signs of inflammatory reactions were seen in all three groups. Even though the applied gentamicin concentration was based on the concentration of gentamicin mixed with cement, the healing process was impaired. When using local gentamicin, a dose-dependent, compromising effect on bone healing should be considered.
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Affiliation(s)
- Elisabeth Beuttel
- Julius Wolff Institute and Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.
| | - Nicole Bormann
- Julius Wolff Institute and Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.
| | - Anne-Marie Pobloth
- Julius Wolff Institute and Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.
| | - Georg N Duda
- Julius Wolff Institute and Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.
| | - Britt Wildemann
- Julius Wolff Institute and Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.
- Experimental Trauma Surgery, University Hospital Jena, 07740 Jena, Germany.
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Shiels SM, Tennent DJ, Lofgren AL, Wenke JC. Topical rifampin powder for orthopaedic trauma part II: Topical rifampin allows for spontaneous bone healing in sterile and contaminated wounds. J Orthop Res 2018; 36:3142-3150. [PMID: 30270538 DOI: 10.1002/jor.24155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
Infectious complications can reduce fracture healing rate. Broad spectrum antibiotics are commonly administered to prevent and treat musculoskeletal infections. Local antibiotics are applied to the wound site to increase therapeutic concentrations without increasing systemic toxicity, however, may hinder local tissue recovery. Rifampin has been shown to eradicate mature Staphylococcal biofilms and its use proven for treating musculoskeletal infections. In this study, a spontaneously healing defect model in a rat was used to investigate the impact rifampin powder has on endogenous bone healing in both a sterile and contaminated wound. No significant differences were identified in bone volume fraction via microcomputed tomography, radiological scoring, or histology between an empty defect and animals that received vancomycin or rifampin powder in a sterile wound. When applied to a contaminated musculoskeletal wound, the rifampin powder had significantly greater bone formation compared to the control, as measured by microcomputed tomography, plain radiology, and histology. In addition, the animals treated with rifampin powder had reduced bacteria, reduced white blood cell count and reduced number of clinical indications of infection. Interestingly, while the vancomycin group still displayed signs of infection via quantitative microbiology, plain radiology, and histology, there was significant bone formation within the defect and reduction of systemic signs of infection. We demonstrated that the use of rifampin powder allows bone to heal in both a sterile and contaminated model of musculoskeletal infection. To our knowledge, this is the first time the direct impact of local antibiotics on bone healing has been investigated. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 36:3142-3150, 2018.
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Affiliation(s)
- Stefanie M Shiels
- U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, Texas, 78234
| | - David J Tennent
- US Army Institute of Surgical Research, Fort Sam Houston, Department of Orthopaedics, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Alicia L Lofgren
- U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, Texas, 78234
| | - Joseph C Wenke
- U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, Texas, 78234
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Wu T, Zhang J, Wang B, Sun Y, Liu Y, Li G. Staphylococcal enterotoxin C2 promotes osteogenesis of mesenchymal stem cells and accelerates fracture healing. Bone Joint Res 2018; 7:179-186. [PMID: 29682284 PMCID: PMC5895947 DOI: 10.1302/2046-3758.72.bjr-2017-0229.r1] [Citation(s) in RCA: 8] [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: 01/13/2023] Open
Abstract
Objectives As one of the heat-stable enterotoxins, Staphylococcal enterotoxin C2 (SEC2) is synthesized by Staphylococcus aureus, which has been proved to inhibit the growth of tumour cells, and is used as an antitumour agent in cancer immunotherapy. Although SEC2 has been reported to promote osteogenic differentiation of human mesenchymal stem cells (MSCs), the in vivo function of SCE2 in animal model remains elusive. The aim of this study was to further elucidate the in vivo effect of SCE2 on fracture healing. Materials and Methods Rat MSCs were used to test the effects of SEC2 on their proliferation and osteogenic differentiation potentials. A rat femoral fracture model was used to examine the effect of local administration of SEC2 on fracture healing using radiographic analyses, micro-CT analyses, biomechanical testing, and histological analyses. Results While SEC2 was found to have no effect on rat MSCs proliferation, it promoted the osteoblast differentiation of rat MSCs. In the rat femoral fracture model, the local administration of SEC2 accelerated fracture healing by increasing fracture callus volumes, bone volume over total volume (BV/TV), and biomechanical recovery. The SEC2 treatment group has superior histological appearance compared with the control group. Conclusion These data suggest that local administration of SEC2 may be a novel therapeutic approach to enhancing bone repair such as fracture healing. Cite this article: T. Wu, J. Zhang, B. Wang, Y. Sun, Y. Liu, G. Li. Staphylococcal enterotoxin C2 promotes osteogenesis of mesenchymal stem cells and accelerates fracture healing. Bone Joint Res 2018;7:179–186. DOI: 10.1302/2046-3758.72.BJR-2017-0229.R1.
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Affiliation(s)
- T Wu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, TianLin, Xuhui Qu, Shanghai 200235, China and Department of Orthopaedics and Traumatology, Lui Che Woo Institute of Innovative Medicine
| | - J Zhang
- Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - B Wang
- Department of Orthopaedics and Traumatology, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Y Sun
- Department of Orthopaedics and Traumatology, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Y Liu
- Department of Orthopaedics and Traumatology, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - G Li
- Department of Orthopaedics and Traumatology, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China and Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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