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Schindler M, Walter N, Reinhard J, Pagano S, Szymski D, Alt V, Rupp M, Lang S. Midterm survival and risk factor analysis in patients with pyogenic vertebral osteomyelitis: a retrospective study of 155 cases. Front Surg 2024; 11:1357318. [PMID: 38835852 PMCID: PMC11148346 DOI: 10.3389/fsurg.2024.1357318] [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: 12/17/2023] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
Background Pyogenic vertebral osteomyelitis (VO) represents a clinical challenge and is linked to substantial morbidity and mortality. This study aimed to examine mortality as well as potential risk factors contributing to in-hospital mortality among patients with VO. Methods This retrospective analysis involved patients receiving treatment for VO at University Regensburg in Germany from January 1, 2000, to December 3, 2020. It included in-hospital mortality rate, comorbidities and pathogens. Patients were identified using ICD-10 diagnosis codes: M46.2, M46.3, M46.4, and M46.5. Kaplan-Meier probability plots and odds ratios (OR) for mortality were calculated. Results Out of the total cohort of 155 patients with VO, 53 patients (34.1%) died during a mean follow-up time of 87.8 ± 70.8 months. The overall mortality was 17.2% at one year, 19.9% at two years and 28.3% at five years. Patients with congestive heart failure (p = 0.005), renal disease (p < 0.001), symptoms of paraplegia (p = 0.029), and sepsis (p = 0.006) demonstrated significantly higher overall mortality rates. In 56.1% of cases, pathogens were identified, with Staphylococcus aureus (S. aureus) and other unidentified pathogens being the most common. Renal disease (OR 1.85) and congestive heart failure (OR 1.52) were identified as significant risk factors. Conclusion Early assessment of the specific risk factors for each patient may prove beneficial in the management and treatment of VO to reduce the risk of mortality. These findings demonstrate the importance of close monitoring of VO patients with underlying chronic organ disease and early identification and treatment of sepsis. Prioritizing identification of the exact pathogens and antibiotic sensitivity testing can improve outcomes for patients in this high-risk group.
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Affiliation(s)
- Melanie Schindler
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jan Reinhard
- Department of Orthopaedic Surgery, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Stefano Pagano
- Department of Orthopaedic Surgery, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Wagner JM, Wille A, Fueth M, Weske S, Lotzien S, Reinkemeier F, Wallner C, Sogorski A, Dittfeld S, Becerikli M, Schildhauer TA, Lehnhardt M, Levkau B, Behr B. Pharmacological elevation of sphingosine-1-phosphate by S1P lyase inhibition accelerates bone regeneration after post-traumatic osteomyelitis. J Cell Mol Med 2023; 27:3786-3795. [PMID: 37710406 PMCID: PMC10718149 DOI: 10.1111/jcmm.17952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
Posttraumatic osteomyelitis and the ensuing bone defects are a debilitating complication after open fractures with little therapeutic options. We have recently identified potent osteoanabolic effects of sphingosine-1-phosphate (S1P) signalling and have now tested whether it may beneficially affect bone regeneration after infection. We employed pharmacological S1P lyase inhibition by 4-deoxypyrodoxin (DOP) to raise S1P levels in vivo in an unicortical long bone defect model of posttraumatic osteomyelitis in mice. In a translational approach, human bone specimens of clinical osteomyelitis patients were treated in organ culture in vitro with DOP. Bone regeneration was assessed by μCT, histomorphometry, immunohistology and gene expression analysis. The role of S1P receptors was addressed using S1PR3 deficient mice. Here, we present data that DOP treatment markedly enhanced osteogenesis in posttraumatic osteomyelitis. This was accompanied by greatly improved osteoblastogenesis and enhanced angiogenesis in the callus accompanied by osteoclast-mediated bone remodelling. We also identified the target of increased S1P to be the S1PR3 as S1PR3-/- mice showed no improvement of bone regeneration by DOP. In the human bone explants, bone mass significantly increased along with enhanced osteoblastogenesis and angiogenesis. Our data suggest that enhancement of S1P/S1PR3 signalling may be a promising therapeutic target for bone regeneration in posttraumatic osteomyelitis.
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Affiliation(s)
- Johannes M. Wagner
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
- Department of Trauma Surgery and General SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Annalena Wille
- Institute of Molecular Medicine IIIUniversity Hospital Düsseldorf and Heinrich Heine Universität DüsseldorfDüsseldorfGermany
| | - Maria Fueth
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Sarah Weske
- Institute of Molecular Medicine IIIUniversity Hospital Düsseldorf and Heinrich Heine Universität DüsseldorfDüsseldorfGermany
| | - Sebastian Lotzien
- Department of Trauma Surgery and General SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Felix Reinkemeier
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Christoph Wallner
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Alexander Sogorski
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Stephanie Dittfeld
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Mustafa Becerikli
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Thomas A. Schildhauer
- Department of Trauma Surgery and General SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Marcus Lehnhardt
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
| | - Bodo Levkau
- Institute of Molecular Medicine IIIUniversity Hospital Düsseldorf and Heinrich Heine Universität DüsseldorfDüsseldorfGermany
| | - Björn Behr
- Department of Plastic SurgeryBG University Hospital Bergmannsheil BochumBochumGermany
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Huang S, Wen J, Zhang Y, Bai X, Cui ZK. Choosing the right animal model for osteomyelitis research: Considerations and challenges. J Orthop Translat 2023; 43:47-65. [PMID: 38094261 PMCID: PMC10716383 DOI: 10.1016/j.jot.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 03/22/2024] Open
Abstract
Osteomyelitis is a debilitating bone disorder characterized by an inflammatory process involving the bone marrow, bone cortex, periosteum, and surrounding soft tissue, which can ultimately result in bone destruction. The etiology of osteomyelitis can be infectious, caused by various microorganisms, or noninfectious, such as chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO). Researchers have turned to animal models to study the pathophysiology of osteomyelitis. However, selecting an appropriate animal model that accurately recapitulates the human pathology of osteomyelitis while controlling for multiple variables that influence different clinical presentations remains a significant challenge. In this review, we present an overview of various animal models used in osteomyelitis research, including rodent, rabbit, avian/chicken, porcine, minipig, canine, sheep, and goat models. We discuss the characteristics of each animal model and the corresponding clinical scenarios that can provide a basic rationale for experimental selection. This review highlights the importance of selecting an appropriate animal model for osteomyelitis research to improve the accuracy of the results and facilitate the development of novel treatment and management strategies.
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Affiliation(s)
| | | | - Yiqing Zhang
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xiaochun Bai
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhong-Kai Cui
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
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Thavarajasingam SG, Vemulapalli KV, Vishnu K S, Ponniah HS, Vogel ASM, Vardanyan R, Neuhoff J, Kramer A, Shiban E, Ringel F, Demetriades AK, Davies BM. Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: a systematic review and meta-analysis. Sci Rep 2023; 13:15647. [PMID: 37730826 PMCID: PMC10511402 DOI: 10.1038/s41598-023-41381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
Spondylodiscitis is the commonest spine infection, and pyogenic spondylodiscitis is the most common subtype. Whilst antibiotic therapy is the mainstay of treatment, some advocate that early surgery can improve mortality, relapse rates, and length of stay. Given that the condition carries a high mortality rate of up to 20%, the most effective treatment must be identified. We aimed to compare the mortality, relapse rate, and length of hospital stay of conservative versus early surgical treatment of pyogenic spondylodiscitis. All major databases were searched for original studies, which were evaluated using a qualitative synthesis, meta-analyses, influence, and regression analyses. The meta-analysis, with an overall pooled sample size of 10,954 patients from 21 studies, found that the pooled mortality among the early surgery patient subgroup was 8% versus 13% for patients treated conservatively. The mean proportion of relapse/failure among the early surgery subgroup was 15% versus 21% for the conservative treatment subgroup. Further, it concluded that early surgical treatment, when compared to conservative management, is associated with a 40% and 39% risk reduction in relapse/failure rate and mortality rate, respectively, and a 7.75 days per patient reduction in length of hospital stay (p < 0.01). The meta-analysis demonstrated that early surgical intervention consistently significantly outperforms conservative management in relapse/failure and mortality rates, and length of stay, in patients with pyogenic spondylodiscitis.
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Affiliation(s)
- Santhosh G Thavarajasingam
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK.
- Imperial Brain and Spine Initiative, Imperial College London, London, UK.
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany.
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
| | - Kalyan V Vemulapalli
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Sajeenth Vishnu K
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Hariharan Subbiah Ponniah
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Alexander Sanchez-Maroto Vogel
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
- Faculty of Medicine, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Robert Vardanyan
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Jonathan Neuhoff
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas Kramer
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Florian Ringel
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas K Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Division of Clinical Neurosciences, NHS Lothian, Edinburgh University Hospitals, Edinburgh, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Benjamin M Davies
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
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Wagner JM, Steubing Y, Dadras M, Wallner C, Lotzien S, Huber J, Sogorski A, Sacher M, Reinkemeier F, Dittfeld S, Becerikli M, Lehnhardt M, Behr B. Wnt3a and ASCs are capable of restoring mineralization in staph aureus-infected primary murine osteoblasts. J Bone Miner Metab 2022; 40:20-28. [PMID: 34562154 DOI: 10.1007/s00774-021-01269-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 08/23/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Bone infections are one of the main reasons for impaired bone regeneration and non-union formation. In previous experimental animal studies we could already demonstrate that bone defects due to prior infections showed a markedly reduced healing capacity, which could effectively be enhanced via application of Wnt3a and Adipose-derived stromal cells (ASCs). For a more in-depth analysis, we investigated proliferation and mineralization of cultured osteoblasts infected with staph aureus and sought to investigate effects of Wnt3a and ASCs on infected osteoblasts. MATERIALS AND METHODS Primary murine osteoblasts were isolated from calvariae and infected with staph aureus. Infected osteoblasts received treatment via application of recombinant Wnt3a, ASC conditioned medium and were furthermore cocultured with ASCs. Osteoblasts were evaluated by Alamar blue assay for metabolic activity, TUNEL-assay for apoptosis, ALP and Alizarin Red staining for mineralization. In addition, immunoflourescent staining (IF) and qRT-PCR analyses were performed. RESULTS Infected osteoblasts showed a markedly reduced ability for mineralization and increased apoptosis, which could be restored to physiological levels by Wnt3a and ASC treatment. Interestingly, metabolic activity of osteoblasts seemed to be unaffected by staph aureus infection. Additional analyses of Wnt-pathway activity revealed effective enhancement of canonical Wnt-pathway activity in Wnt3a-treated osteoblasts. CONCLUSIONS In summary, we gained further osteoblast-related insights into pathomechanisms of reduced bone healing capacity upon infections.
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Affiliation(s)
| | - Yonca Steubing
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Mehran Dadras
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Christoph Wallner
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Sebastian Lotzien
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Julika Huber
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Alexander Sogorski
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Maxi Sacher
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Felix Reinkemeier
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Stephanie Dittfeld
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Mustafa Becerikli
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Marcus Lehnhardt
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Björn Behr
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
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Gupta R, Sharma AR, Singhal A, Shail S, Masih GD. Concepts in wound irrigation of open fractures: 'Where we came from, and where are we now? J Clin Orthop Trauma 2021; 23:101638. [PMID: 34745874 PMCID: PMC8551466 DOI: 10.1016/j.jcot.2021.101638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022] Open
Abstract
Wound irrigation is described as the flow of a solution through an exposed fracture surface to reduce the microbial colonization, to remove apparent foreign particles and wound exudates. . While recent literature and various in-vitro and in-vivo trials have cleared some clouds of doubt from the mind, it still remains a topic of debate. Normal saline remains the standard irrigation solution as it is non tissue toxic and has the same tonicity as body fluids. The quantity and duration of washing though is not standardized and is the surgeon's choice. This adds to the dilemma in the minds of the surgeon, with the timing of the debridement and the duration of wound irrigation depending on the surgeon's discretion. Future studies should aim to regulate the duration of the wound irrigation besides guiding about the ideal fluid volume to be used for the irrigation. Further, secondary end-points like the duration of hospital stay, rate of infections and use of hospital resources, should be computed to know about the adequacy of the wound debridement and irrigation. Antimicrobial solutions can kill microorganisms in the wound but are toxic to the host tissues as well, which limits their use. In addition, pulsatile (high pressure) lavage has not been seen to increase overall effectiveness. Recent research trials have found cumulative use of innovative solutions like phenols and EDTA along with enzymes to be encouraging though large randomized controlled trials are lacking.
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Affiliation(s)
- Ravi Gupta
- Sports Injury Center, Government Medical College Hospital, Chandigarh, India
| | | | - Akash Singhal
- Government Medical College and Hospital, Chandigarh, India,Corresponding author.
| | - Sumukh Shail
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
| | - Gladson David Masih
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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Gardezi M, Roque D, Barber D, Spake CS, Glasser J, Berns E, Antoci V, Born C, Garcia DR. Wound Irrigation in Orthopedic Open Fractures: A Review. Surg Infect (Larchmt) 2021; 22:245-252. [PMID: 32589513 PMCID: PMC9639236 DOI: 10.1089/sur.2020.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Management of open fractures remains a major clinical challenge because of the higher energy involved in the injury, the greater local trauma, tissue necrosis, and extensive contamination. Even though early surgical debridement was thought to be critical, limited available operative techniques have minimized surgery in favor of early antibiotic administration. No clear agreement on the surgical approach, debridement, or irrigation technique exists. Surgeons continue to argue about the use of various fluids, the appropriate pressure of irrigation, antiseptics, and other factors. The current work reviews the available data and summarizes the capabilities of modern orthopedic irrigation solutions. Methods: To delineate available research on the topic, the PubMed database was queried for the most common techniques, fluid variables, and chemical adjuvants utilized in current open fracture and wound irrigation methodologies. Modes of delivery, volume, pressure, temperature, timing, solution type, and additives are evaluated in the context of known outcomes to determine which solutions may be preferable. Results: Various methods have been described with their own advantages as well as limitations. Particular solutions may apply to specific clinical scenarios, presence of implants, and degree of tissue contamination. Desired irrigation solutions are isotonic, non-toxic, non-hemolytic, transparent, sterilizable, efficient in removing debris and pathogens, as well as affordable; however, no current irrigant achieves all these desired characteristics. Conclusions: Despite being crucial for the healing of open fractures, there is no clear gold standard for irrigation. Although there are some novel irrigation solutions, there has been a paucity of research on finding new, safer, and more effective irrigation solutions that will promote wound healing and reduce infection.
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Affiliation(s)
- Mursal Gardezi
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Daniel Roque
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Douglas Barber
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Carole S.L. Spake
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Jillian Glasser
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Ellis Berns
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Valentin Antoci
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Christopher Born
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Dioscaris R. Garcia
- The Diane N. Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedics, The Warren Alpert School of Medicine, Brown University, Providence, USA
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Roux KM, Cobb LH, Seitz MA, Priddy LB. Innovations in osteomyelitis research: A review of animal models. Animal Model Exp Med 2021; 4:59-70. [PMID: 33738438 PMCID: PMC7954837 DOI: 10.1002/ame2.12149] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
Infection of bone tissue, or osteomyelitis, has become a growing concern in modern healthcare due in no small part to a rise in antibiotic resistance among bacteria, notably Staphylococcus aureus. The current standard of care involves aggressive, prolonged antibiotic therapy combined with surgical debridement of infected tissues. While this treatment may be sufficient for resolving a portion of cases, recurrences of the infection and associated risks including toxicity with long-term antibiotic usage have been reported. Therefore, there exists a need to produce safer, more efficacious options of treatment for osteomyelitis. In order to test treatment regimens, animal models that closely mimic the clinical condition and allow for accurate evaluation of therapeutics are necessary. Establishing a model that replicates features of osteomyelitis in humans continues to be a challenge to scientists, as there are many variables involved, including choosing an appropriate species and method to establish infection. This review addresses the refinement of animal models of osteomyelitis to reflect the clinical disease and test prospective therapeutics. The aim of this review is to explore studies regarding the use of animals for osteomyelitis therapeutics research and encourage further development of such animal models for the translation of results from the animal experiment to human medicine.
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Affiliation(s)
- Kylie M. Roux
- College of Veterinary MedicineMississippi State UniversityMississippi StateMSUSA
| | - Leah H. Cobb
- Department of Agricultural and Biological EngineeringMississippi State UniversityMississippi StateMSUSA
| | - Marc A. Seitz
- College of Veterinary MedicineMississippi State UniversityMississippi StateMSUSA
| | - Lauren B. Priddy
- Department of Agricultural and Biological EngineeringMississippi State UniversityMississippi StateMSUSA
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Cobb LH, McCabe EM, Priddy LB. Therapeutics and delivery vehicles for local treatment of osteomyelitis. J Orthop Res 2020; 38:2091-2103. [PMID: 32285973 PMCID: PMC8117475 DOI: 10.1002/jor.24689] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/07/2020] [Accepted: 04/11/2020] [Indexed: 02/04/2023]
Abstract
Osteomyelitis, or the infection of the bone, presents a major complication in orthopedics and may lead to prolonged hospital visits, implant failure, and in more extreme cases, amputation of affected limbs. Typical treatment for this disease involves surgical debridement followed by long-term, systemic antibiotic administration, which contributes to the development of antibiotic-resistant bacteria and has limited ability to eradicate challenging biofilm-forming pathogens including Staphylococcus aureus-the most common cause of osteomyelitis. Local delivery of high doses of antibiotics via traditional bone cement can reduce systemic side effects of an antibiotic. Nonetheless, growing concerns over burst release (then subtherapeutic dose) of antibiotics, along with microbial colonization of the nondegradable cement biomaterial, further exacerbate antibiotic resistance and highlight the need to engineer alternative antimicrobial therapeutics and local delivery vehicles with increased efficacy against, in particular, biofilm-forming, antibiotic-resistant bacteria. Furthermore, limited guidance exists regarding both standardized formulation protocols and validated assays to predict efficacy of a therapeutic against multiple strains of bacteria. Ideally, antimicrobial strategies would be highly specific while exhibiting a broad spectrum of bactericidal activity. With a focus on S. aureus infection, this review addresses the efficacy of novel therapeutics and local delivery vehicles, as alternatives to the traditional antibiotic regimens. The aim of this review is to discuss these components with regards to long bone osteomyelitis and to encourage positive directions for future research efforts.
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Affiliation(s)
- Leah H. Cobb
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Emily M. McCabe
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, MS, USA,Department of Mechanical Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Lauren B. Priddy
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, MS, USA,corresponding author: Contact: , (662) 325-5988, Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS, USA 39762
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10
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Local Wnt3a treatment restores bone regeneration in large osseous defects after surgical debridement of osteomyelitis. J Mol Med (Berl) 2020; 98:897-906. [PMID: 32424558 PMCID: PMC8526481 DOI: 10.1007/s00109-020-01924-9] [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] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Impaired bone homeostasis caused by osteomyelitis provokes serious variations in the bone remodeling process, thereby involving multiple inflammatory cytokines to activate bone healing. We have previously established a mouse model for post-traumatic osteomyelitis and studied bone regeneration after sufficient debridement. Moreover, we could further characterize the postinfectious inflammatory state of bony defects after debridement with elevated osteoclasts and decreased bone formation despite the absence of bacteria. In this study, we investigated the positive effects of Wnt-pathway modulation on bone regeneration in our previous established mouse model. This was achieved by local application of Wnt3a, a recombinant activator of the canonical Wnt-pathway. Application of Wnt3a could enhance new bone formation, which was verified by histological and μ-CT analysis. Moreover, histology and western blots revealed enhanced osteoblastogenesis and downregulated osteoclasts in a RANKL-dependent manner. Further analysis of Wnt-pathway showed downregulation after bone infections were reconstituted by application of Wnt3a. Interestingly, Wnt-inhibitory proteins Dickkopf 1 (DKK1), sclerostin, and secreted frizzled protein 1 (sFRP1) were upregulated simultaneously to Wnt-pathway activation, indicating a negative feedback for active form of Beta-catenin. In this study, we could demonstrate enhanced bone formation in defects caused by post-traumatic osteomyelitis after Wnt3a application. KEY MESSAGES: Osteomyelitis decreases bone regeneration Wnt3a restores bone healing after infection Canonical Wnt-pathway activation with negative feedback.
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Felin GC, Taparello C, Fornari V, Filho PM, Grandii J, Dogenski LC, De Carli JP. Facial trauma followed by osteomyelitis - Case report. Int J Surg Case Rep 2020; 68:246-250. [PMID: 32199249 PMCID: PMC7082611 DOI: 10.1016/j.ijscr.2020.03.009] [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: 12/17/2019] [Revised: 01/22/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Osteomyelitis is an inflammatory-infectious state that may involve trabecular bone, cortical bone, bone marrow and periosteum. The source of the infection may be hematogenic, acquired from an adjoining infectious focus or by direct inoculation into the bone. Its treatment involves antibiotic administration and surgery, but its management remains challenging. Presentation of case A 76-year-old male patient with a history of car accident 3 months earlier sought hospital care with nasal fracture and loss of substance in the right frontotemporal region, where a pectoral muscle free graft was performed to reconstruct the facial defect. The grafted region had hyperemic edges, necrotic appearance, purulent discharge and bone exposure in the nasal dorsum. The initial diagnostic hypothesis was an infectious process due to graft rejection, with likely evolution to osteomyelitis. The surgical procedure was performed by a multidisciplinary team and the patient received the antibiotic regimen according to the antibiogram, with hospital discharge after 39 days of hospitalization. Discussion Treatment of osteomyelitis requires the combination of antimicrobial therapy and surgery. Despite surgical and chemotherapeutic advances, it is a difficult condition to treat and there is no universally accepted protocol for treatment. Conclusion Surgical treatment was essential for stabilization of the condition. Due to the complexity of this type of infection in the craniofacial region, planning and execution must be carried out through a multidisciplinary team.
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Affiliation(s)
- Gabriela Caovilla Felin
- Department of Oral Surgery, Faculty of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.
| | - Cassian Taparello
- Resident in Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.
| | - Vinicios Fornari
- Resident in Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.
| | | | | | | | - João Paulo De Carli
- Departments of Oral Medicine and Prosthodontics, Faculty of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.
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Wagner JM, Reinkemeier F, Wallner C, Dadras M, Huber J, Schmidt SV, Drysch M, Dittfeld S, Jaurich H, Becerikli M, Becker K, Rauch N, Duhan V, Lehnhardt M, Behr B. Adipose-Derived Stromal Cells Are Capable of Restoring Bone Regeneration After Post-Traumatic Osteomyelitis and Modulate B-Cell Response. Stem Cells Transl Med 2019; 8:1084-1091. [PMID: 31179644 PMCID: PMC6766598 DOI: 10.1002/sctm.18-0266] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/10/2019] [Indexed: 12/17/2022] Open
Abstract
Bone infections are a frequent cause for large bony defects with a reduced healing capacity. In previous findings, we could already show diminished healing capacity after bone infections, despite the absence of the causing agent, Staphylococcus aureus. Moreover, these bony defects showed reduced osteoblastogenesis and increased osteoclastogenesis, meaning elevated bone resorption ongoing with an elevated B‐cell activity. To overcome the negative effects of this postinfectious inflammatory state, we tried to use the regenerative capacity of mesenchymal stem cells derived from adipose tissue (adipose‐derived stem cells [ASCs]) to improve bone regeneration and moreover were curious about immunomodulation of applicated stem cells in this setting. Therefore, we used our established murine animal model and applicated ASCs locally after sufficient debridement of infected bones. Bone regeneration and resorption as well as immunological markers were investigated via histology, immunohistochemistry, Western blot, and fluorescence‐activated cell scanning (FACS) analysis and μ‐computed tomography (CT) analysis. Interestingly, ASCs were able to restore bone healing via elevation of osteoblastogenesis and downregulation of osteoclasts. Surprisingly, stem cells showed an impact on the innate immune system, downregulating B‐cell population. In summary, these data provide a fascinating new and innovative approach, supporting bone healing after bacterial infections and moreover gain insights into the complex ceremony of stem cell interaction in terms of bone infection and regeneration. stem cells translational medicine2019;8:1084–1091
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Affiliation(s)
| | - Felix Reinkemeier
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Julika Huber
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Sonja Verena Schmidt
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Marius Drysch
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Stephanie Dittfeld
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Henriette Jaurich
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Mustafa Becerikli
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Kathrin Becker
- Poliklinik für Kieferorthopädie, University Hospital Düsseldorf, Poliklinik für Kieferorthopädie, Düsseldorf, Germany
| | - Nicole Rauch
- Poliklinik für Kieferorthopädie, University Hospital Düsseldorf, Poliklinik für Kieferorthopädie, Düsseldorf, Germany
| | - Vikas Duhan
- Institute of Immunology, University Hospital Essen, Essen, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, University Hospital BG Bergmannsheil Bochum, Bochum, Germany
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Wagner JM, Jaurich H, Wallner C, Abraham S, Becerikli M, Dadras M, Harati K, Duhan V, Khairnar V, Lehnhardt M, Behr B. Diminished bone regeneration after debridement of posttraumatic osteomyelitis is accompanied by altered cytokine levels, elevated B cell activity, and increased osteoclast activity. J Orthop Res 2017; 35:2425-2434. [PMID: 28263017 DOI: 10.1002/jor.23555] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/27/2017] [Indexed: 02/04/2023]
Abstract
Osteomyelitis is a frequent consequence of open fractures thus representing a common bone infection with subsequent alteration of bone regeneration. Impaired bone homeostasis provokes serious variations in the bone remodeling process, thereby involving multiple inflammatory cytokines to activate bone healing. Our previously established mouse model of posttraumatic osteomyelitis provides the chance to study regulation of selected cytokines after surgical debridement of osteomyelitis thus illustrating the course of initial infectious recovery. An inflammatory cytokine array revealed specifically upregulated cytokines in debrided animals after bone infection, that were verified by Western blot analysis, identifying increased levels of CCL2, CCL3, and CXCL2. Increased osteoclastogenesis after debridement of osteomyelitis was demonstrated by Calcitonin-receptor and RANKL detection via immunohistochemical and -fluorescence stainings. The substantial protein analysis was complemented by uncovering diminished osteogenesis and proliferation in debrided group, tracking Osteocalcin, RUNX2, and PCNA expression. Interestingly TNF-α expression seemed to have no effect on altered bone regeneration after bone infection. Additional flow cytometry analysis proved elevated B cell activity, subsequently increased osteoclast activity and accelerated bone resorption. Based on the variety of severely altered cytokines, we propose a RANKL-dependent osteoclastogenesis after debridement of osteomyelitis coinciding with elevated B cells and simultaneously decreased osteogenesis. A comprehensive understanding of these mechanisms provides new therapeutic options of osteomyelitis cure and is of great importance in prospective medical treatment. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2425-2434, 2017.
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Affiliation(s)
- Johannes M Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Henriette Jaurich
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Stephanie Abraham
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Mustafa Becerikli
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Kamran Harati
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Vikas Duhan
- Institute of Immunology, University Hospital Essen, Essen, Germany
| | - Vishal Khairnar
- Institute of Immunology, University Hospital Essen, Essen, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-camp Platz 1, 44789, Bochum, Germany
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Alves De Souza C, Queiroz Alves De Souza A, Queiroz Alves De Souza MDS, Dias Leite JA, Silva De Morais M, Barem Rabenhorst SH. A link between osteomyelitis and IL1RN and IL1B polymorphisms-a study in patients from Northeast Brazil. Acta Orthop 2017; 88:556-561. [PMID: 28682145 PMCID: PMC5560221 DOI: 10.1080/17453674.2017.1348439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Treatment failure of osteomyelitis can result from genetic susceptibility, highlighting polymorphisms of the interleukin-1 (IL-1) family members, central mediators of innate immunity and inflammation. Polymorphisms are DNA sequence variations that are common in the population (1% or more) and represent multiple forms of a single gene. We investigated the association of IL1RNVNTR (rs2234663) and IL1B-511C > T (rs16944) polymorphisms with osteomyelitis development in patients operated on because of bone trauma. Patients and methods - 153 patients who fulfilled the inclusion criteria were enrolled from a referral public hospital for trauma. All the patients were followed up daily until hospital discharge and, after this, on an outpatient basis. Patients were treated with prophylactic antimicrobials and surgery according to traumatology service protocol. The IL1RNVNTR and the IL1B-511C > T polymorphisms were determined by PCR and PCR-RFLP, respectively. Results - The IL1RN*2/*2 genotype was associated (OR: 7; p < 0.001) with a higher risk of osteomyelitis and was also significantly associated with Staphylococcus aureus infection. The haplotypes (combination of different markers) *2-C and *2-T were also associated with osteomyelitis development. Interpretation - IL1B-511C > T and IL1RNVNTR polymorphisms were associated with osteomyelitis development, which may have implications for patients with bone traumas. These data may be relevant for new therapeutic strategies for this disease.
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Staphylococcus aureus protein A enhances osteoclastogenesis via TNFR1 and EGFR signaling. Biochim Biophys Acta Mol Basis Dis 2016; 1862:1975-83. [PMID: 27475257 DOI: 10.1016/j.bbadis.2016.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/04/2016] [Accepted: 07/26/2016] [Indexed: 01/18/2023]
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Lovati AB, Bottagisio M, de Vecchi E, Gallazzi E, Drago L. Animal Models of Implant-Related Low-Grade Infections. A Twenty-Year Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 971:29-50. [PMID: 27718217 DOI: 10.1007/5584_2016_157] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The demand for joint replacement and surgical treatment is continuously increasing, thus representing a clinical burden and a cost for the healthcare system. Among several pathogens involved in implant-related infections, staphylococci account for the two-thirds of clinically isolated bacteria. Despite most of them are highly virulent microorganisms (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa), low virulent bacteria (Staphylococcus epidermidis, Propionibacterium acnes) are responsible for delayed, low-grade infections without specific clinical signs and hardly distinguishable from aseptic prosthetic failure. Therefore, there is a real need to study the pathogenesis of orthopedic infections through in vivo animal models. The present review of the literature provides a 20-year overview of animal models of acute, subclinical or chronic orthopedic infections according to the pathogen virulence and inocula. Through this analysis, a great variety of conditions in terms of bacterial strains and inocula emerged, thus encouraging the development of more reproducible in vivo studies to provide relevant information for a translational approach to humans.
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Affiliation(s)
- Arianna Barbara Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.
| | - Marta Bottagisio
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.,Department of Veterinary Medicine, University of Milan, via Celoria 10, 20133, Milan, Italy
| | - Elena de Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy
| | - Enrico Gallazzi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopedic Institute, via R. Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Science for Health, University of Milan, via L. Mangiagalli 31, 20133, Milan, Italy
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