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Perez-Araluce M, Jüngst T, Sanmartin C, Prosper F, Plano D, Mazo MM. Biomaterials-Based Antioxidant Strategies for the Treatment of Oxidative Stress Diseases. Biomimetics (Basel) 2024; 9:23. [PMID: 38248597 PMCID: PMC10813727 DOI: 10.3390/biomimetics9010023] [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: 11/17/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Oxidative stress is characterized by an increase in reactive oxygen species or a decrease in antioxidants in the body. This imbalance leads to detrimental effects, including inflammation and multiple chronic diseases, ranging from impaired wound healing to highly impacting pathologies in the neural and cardiovascular systems, or the bone, amongst others. However, supplying compounds with antioxidant activity is hampered by their low bioavailability. The development of biomaterials with antioxidant capacity is poised to overcome this roadblock. Moreover, in the treatment of chronic inflammation, material-based strategies would allow the controlled and targeted release of antioxidants into the affected tissue. In this review, we revise the main causes and effects of oxidative stress, and survey antioxidant biomaterials used for the treatment of chronic wounds, neurodegenerative diseases, cardiovascular diseases (focusing on cardiac infarction, myocardial ischemia-reperfusion injury and atherosclerosis) and osteoporosis. We anticipate that these developments will lead to the emergence of new technologies for tissue engineering, control of oxidative stress and prevention of diseases associated with oxidative stress.
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Affiliation(s)
- Maria Perez-Araluce
- Biomedical Engineering Program, Enabling Technologies Division, CIMA Universidad de Navarra, 31008 Pamplona, Spain;
| | - Tomasz Jüngst
- Department for Functional Materials in Medicine and Dentistry, Institute of Functional Materials and Biofabrication, University of Würzburg, D-97070 Würzburg, Germany
- Bavarian Polymer Institute, University of Bayreuth, 95447 Bayreuth, Germany
| | - Carmen Sanmartin
- Department of Pharmaceutical Science, Universidad de Navarra, 31008 Pamplona, Spain;
| | - Felipe Prosper
- Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
- Centro de Investigacion Biomedica en Red de Cancer (CIBERONC) CB16/12/00489, 28029 Madrid, Spain
- Hemato-Oncology Program, Cancer Division, CIMA Universidad de Navarra, 31008 Pamplona, Spain
| | - Daniel Plano
- Department of Pharmaceutical Science, Universidad de Navarra, 31008 Pamplona, Spain;
| | - Manuel M. Mazo
- Biomedical Engineering Program, Enabling Technologies Division, CIMA Universidad de Navarra, 31008 Pamplona, Spain;
- Hematology and Cell Therapy Area, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain;
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Ding W, Zhou Q, Lu Y, Wei Q, Tang H, Zhang D, Liu Z, Wang G, Wu D. ROS-scavenging hydrogel as protective carrier to regulate stem cells activity and promote osteointegration of 3D printed porous titanium prosthesis in osteoporosis. Front Bioeng Biotechnol 2023; 11:1103611. [PMID: 36733970 PMCID: PMC9887181 DOI: 10.3389/fbioe.2023.1103611] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Stem cell-based therapy has drawn attention as an alternative option for promoting prosthetic osteointegration in osteoporosis by virtue of its unique characteristics. However, estrogen deficiency is the main mechanism of postmenopausal osteoporosis. Estrogen, as an effective antioxidant, deficienncy also results in the accumulation of reactive oxygen species (ROS) in the body, affecting the osteogenic differentiation of stem cells and the bone formation i osteoporosis. In this study, we prepared a ROS-scavenging hydrogel by crosslinking of epigallocatechin-3-gallate (EGCG), 3-acrylamido phenylboronic acid (APBA) and acrylamide. The engineered hydrogel can scavenge ROS efficiently, enabling it to be a cell carrier of bone marrow-derived mesenchymal stem cells (BMSCs) to protect delivered cells from ROS-mediated death and osteogenesis inhibition, favorably enhancing the tissue repair potential of stem cells. Further in vivo investigations seriously demonstrated that this ROS-scavenging hydrogel encapsulated with BMSCs can prominently promote osteointegration of 3D printed microporous titanium alloy prosthesis in osteoporosis, including scavenging accumulated ROS, inducing macrophages to polarize toward M2 phenotype, suppressing inflammatory cytokines expression, and improving osteogenesis related markers (e.g., ALP, Runx-2, COL-1, BSP, OCN, and OPN). This work provides a novel strategy for conquering the challenge of transplanted stem cells cannot fully function in the impaired microenvironment, and enhancing prosthetic osteointegration in osteoporosis.
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Affiliation(s)
- Wenbin Ding
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qirong Zhou
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yifeng Lu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qiang Wei
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hao Tang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Donghua Zhang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhixiao Liu
- Department of Histology and Embryology, College of Basic Medicine, Shanghai, China
| | - Guangchao Wang
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Dajiang Wu
- Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai, China
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Zheng S, Zhong H, Cheng H, Li X, Zeng G, Chen T, Zou Y, Liu W, Sun C. Engineering Multifunctional Hydrogel With Osteogenic Capacity for Critical-Size Segmental Bone Defect Repair. Front Bioeng Biotechnol 2022; 10:899457. [PMID: 35615472 PMCID: PMC9124794 DOI: 10.3389/fbioe.2022.899457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/01/2022] [Indexed: 12/15/2022] Open
Abstract
Treating critical-size segmental bone defects is an arduous challenge in clinical work. Preparation of bone graft substitutes with notable osteoinductive properties is a feasible strategy for critical-size bone defects. Herein, a biocompatible hydrogel was designed by dynamic supramolecular assembly of polyvinyl alcohol (PVA), sodium tetraborate (Na2B4O7), and tetraethyl orthosilicate (TEOS). The characteristics of the supramolecular hydrogel were evaluated by rheological analysis, swelling ratio, degradation experiments, and scanning electron microscopy (SEM). In in vitro experiments, this TEOS-hydrogel had self-healing property, low swelling rate, degradability, good biocompatibility, and induced osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) by upregulating the expression of Runx-2, Col-1, OCN, and osteopontin (OPN). In segmental bone defect rabbit models, the TEOS-containing hydrogel accelerated bone regeneration, thus restoring the continuity of bone and recanalization of the medullary cavity. The abovementioned results demonstrated that this TEOS-hydrogel has the potential to realize bone healing in critical-size segmental bone defects.
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Affiliation(s)
- Shaowei Zheng
- Department of Orthopaedic, Huizhou First Hospital, Guangdong Medical University, Huizhou, China
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haobo Zhong
- Department of Orthopaedic, Huizhou First Hospital, Guangdong Medical University, Huizhou, China
| | - Hao Cheng
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xu Li
- Department of Orthopaedic, Huizhou First Hospital, Guangdong Medical University, Huizhou, China
| | - Guowei Zeng
- Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Tianyu Chen
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yucong Zou
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Weile Liu
- Department of Orthopaedic, Huizhou First Hospital, Guangdong Medical University, Huizhou, China
| | - Chunhan Sun
- Department of Orthopaedic, Huizhou First Hospital, Guangdong Medical University, Huizhou, China
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Chen Q, Xia C, Shi B, Chen C, Yang C, Mao G, Shi F. Extracorporeal Shock Wave Combined with Teriparatide-Loaded Hydrogel Injection Promotes Segmental Bone Defects Healing in Osteoporosis. Tissue Eng Regen Med 2021; 18:1021-1033. [PMID: 34427911 DOI: 10.1007/s13770-021-00381-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/09/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Osteoporosis is a systemic bone disease characterized by decreased bone density and deterioration of bone microstructure, leading to an increased probability of fragility fractures. Once segmental bone defect occurs, it is easy to cause delayed union and nonunion. METHODS The aim of this study is to investigate the efficacy of extracorporeal shock wave (ESW) and teriparatide-loaded hydrogel (T-Gel) combined strategy on the cell activity and differentiation of osteoporosis derived bone marrow mesenchymal stem cells (OP-BMSCs) in vitro and bone regeneration in osteoporotic segmental bone defects in vivo. RESULTS In vitro, the strategy of combining ESW and T-Gel significantly enhanced OP-BMSCs proliferation, survival, migration, and osteogenic differentiation by up-regulating the alkaline phosphatase activity, mineralization, and expression of runt-related transcription factor-2, type I collagen, osteocalcin, and osteopontin. In the segmental bone defect models of osteoporotic rabbits, Micro-CT evaluation and histological observation demonstrated this ESW-combined with T-Gel injection significantly induced bone healing by enhancing the osteogenic activity of the local microenvironment in osteoporotic defects. CONCLUSION In conclusion, ESW-combined with T-Gel injection could regulate the poor osteogenic microenvironment in osteoporotic defects and show potential for enhancing fragility fractures healing.
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Affiliation(s)
- Qi Chen
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China
| | - Chen Xia
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China
| | - Binbin Shi
- Department of Orthopedic Surgery, Tongxiang First People's Hospital, Tongxiang, 314500, People's Republic of China
| | - Chuyong Chen
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China
| | - Chen Yang
- Department of Orthopedic Surgery, No 1 People's Hospital of AkeSu, AkeSu, 843000, Xinjiang, People's Republic of China
| | - Guangfeng Mao
- Department of Orthopedic Surgery, The Third People Hospital of Zhuji, Shaoxing, 310014, People's Republic of China
| | - Fangfang Shi
- Department of Hematology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, People's Republic of China.
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Ye M, Liu W, Yan L, Cheng S, Li X, Qiao S. 3D‑printed Ti6Al4V scaffolds combined with pulse electromagnetic fields enhance osseointegration in osteoporosis. Mol Med Rep 2021; 23:410. [PMID: 33786622 PMCID: PMC8025457 DOI: 10.3892/mmr.2021.12049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
The loosening and displacement of prostheses after dental implantation and arthroplasty is a substantial medical burden due to the complex correction surgery. Three-dimensional (3D)-printed porous titanium (pTi) alloy scaffolds are characterized by low stiffness, are beneficial to bone ingrowth, and may be used in orthopedic applications. However, for the bio-inert nature between host bone and implants, titanium alloy remains poorly compatible with osseointegration, especially in disease conditions, such as osteoporosis. In the present study, 3D-printed pTi scaffolds with ideal pore size and porosity matching the bone tissue, were combined with pulse electromagnetic fields (PEMF), an exogenous osteogenic induction stimulation, to evaluate osseointegration in osteoporosis. In vitro, external PEMF significantly improved osteoporosis-derived bone marrow mesenchymal stem cell proliferation and osteogenic differentiation on the surface of pTi scaffolds by enhancing the expression of alkaline phosphatase, runt-related transcription factor-2, osteocalcin, and bone morphogenetic protein-2. In vivo, Microcomputed tomography analysis and histological evaluation indicated the external PEMF markedly enhanced bone regeneration and osseointegration. This novel therapeutic strategy has potential to promote osseointegration of dental implants or artificial prostheses for patients with osteoporosis.
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Affiliation(s)
- Mingfu Ye
- Department of Oral Implantology, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Stomatological Hospital of Xiamen Medical College, Xiamen, Fujian 361008, P.R. China
| | - Wenjun Liu
- Department of Oral Implantology, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Stomatological Hospital of Xiamen Medical College, Xiamen, Fujian 361008, P.R. China
| | - Lihui Yan
- Department of Oral Implantology, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Stomatological Hospital of Xiamen Medical College, Xiamen, Fujian 361008, P.R. China
| | - Shaolong Cheng
- Department of Oral Implantology, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Stomatological Hospital of Xiamen Medical College, Xiamen, Fujian 361008, P.R. China
| | - Xiaoxiong Li
- Department of Pain, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201112, P.R. China
| | - Shichong Qiao
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
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Cui Y, Zhu T, Li D, Li Z, Leng Y, Ji X, Liu H, Wu D, Ding J. Bisphosphonate-Functionalized Scaffolds for Enhanced Bone Regeneration. Adv Healthc Mater 2019; 8:e1901073. [PMID: 31693315 DOI: 10.1002/adhm.201901073] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/28/2019] [Indexed: 12/11/2022]
Abstract
The local sustained release of bioactive substances are attracting increasing attention in bone tissue engineering, which is beneficial to bone tissue formation and helps to improve the bone ingrowth ability of a scaffold. Bisphosphonates (BPs), as a representative kind of osteoclast inhibitors, are proven to possess excellent osteogenic induction capability. Accordingly, various physical and chemical strategies are developed to functionalize bone tissue scaffolds with BPs to achieve controlled release profiles. Compared with traditional treatment modalities, local release of BPs from these composite scaffolds will contribute to continuous bone integration without the risk of many complications. This review explores the molecular mechanisms of BPs on bone metabolism and analyzes the appropriate concentrations of BPs that promote bone regeneration. The advanced BP loading strategies, implant modification technologies, and BP-loaded composite scaffolds based on different matrices are summarized. Finally, the latest advances and the future development of BP-modified scaffolds for enhanced bone regeneration are discussed. This article provides leading-edge design strategies of the BP-functionalized bone engineering scaffolds for improved bone repairability.
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Affiliation(s)
- Yutao Cui
- Department of OrthopedicsThe Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Tongtong Zhu
- Department of OrthopedicsChina‐Japan Union Hospital of Jilin University Changchun 130033 P. R. China
| | - Di Li
- Key Laboratory of Polymer EcomaterialsChangchun Institute of Applied ChemistryChinese Academy of Sciences Changchun 130022 P. R. China
| | - Zuhao Li
- Department of OrthopedicsThe Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Yi Leng
- Department of OrthopedicsThe Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Xuan Ji
- Department of StomatologyThe Second Hospital of Jilin University Changchun 130041 P. R. China
| | - He Liu
- Department of OrthopedicsThe Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Dankai Wu
- Department of OrthopedicsThe Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Jianxun Ding
- Key Laboratory of Polymer EcomaterialsChangchun Institute of Applied ChemistryChinese Academy of Sciences Changchun 130022 P. R. China
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Tanjaya J, Lord EL, Wang C, Zhang Y, Kim JK, Nguyen A, Baik L, Pan HC, Chen E, Kwak JH, Zhang X, Wu B, Soo C, Ting K. The Effects of Systemic Therapy of PEGylated NEL-Like Protein 1 (NELL-1) on Fracture Healing in Mice. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 188:715-727. [PMID: 29294300 DOI: 10.1016/j.ajpath.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/04/2017] [Accepted: 11/21/2017] [Indexed: 01/05/2023]
Abstract
Fractures are common, with an incidence of 13.7 per 1000 adults annually. Systemic agents have been widely used for enhancing bone regeneration; however, the efficacy of these therapeutics for the management and prevention of fracture remains unclear. NEL-like protein 1 (NELL-1) is a potent pro-osteogenic cytokine that has been modified with polyethylene glycol (PEG)ylation [PEGylated NELL-1 (NELL-PEG)] to enhance its pharmacokinetics for systemic therapy. Our aim was to investigate the effects of systemic administration of NELL-PEG on fracture healing in mice and on overall bone properties in uninjured bones. Ten-week-old CD-1 mice were subjected to an open osteotomy of bilateral radii and treated with weekly injections of NELL-PEG or PEG phosphate-buffered saline as control. Systemic injection of NELL-PEG resulted in improved bone mineral density of the fracture site and accelerated callus union. After 4 weeks of treatment, mice treated with NELL-PEG exhibited substantially enhanced callus volume, callus mineralization, and biomechanical properties. NELL-PEG injection significantly augmented bone regeneration, as confirmed by high expression of bone turnover rate, bone formation rate, and mineral apposition rate. Consistently, the immunohistochemistry results also confirmed a high bone remodeling activity in the NELL-PEG-treated group. Our findings suggest that weekly injection of NELL-PEG may have the clinical potential to accelerate fracture union and enhance overall bone properties, which may help prevent subsequent fractures.
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Affiliation(s)
- Justine Tanjaya
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Elizabeth L Lord
- Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, University of California, Los Angeles, Los Angeles, California
| | - Chenchao Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Plastic Surgery, First Hospital of China Medical University, Shenyang, China
| | - Yulong Zhang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California
| | - Jong K Kim
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Alan Nguyen
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Llyod Baik
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Hsin C Pan
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Eric Chen
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Jin H Kwak
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Xinli Zhang
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Benjamin Wu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California
| | - Chia Soo
- Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, University of California, Los Angeles, Los Angeles, California; Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Kang Ting
- Division of Growth and Development and the Section of Orthodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, California.
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Capone A, Congia S, Civinini R, Marongiu G. Periprosthetic fractures: epidemiology and current treatment. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:189-196. [PMID: 29263732 PMCID: PMC5726208 DOI: 10.11138/ccmbm/2017.14.1.189] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Periprosthetic fractures are becoming increasingly frequent due to aging population and growing number of total joint replacements involving joints different from hip and knee, such as shoulder and elbow. The treatment of these fractures still represents one of the major challenges for the orthopedic surgeon. Despite all efforts to understand and treat these patients, high rate of failure and mortality are still reported. In this review, the epidemiology of periprosthetic fractures, risk factors and results of surgical treatment are disclosed. Moreover, we propose a treatment algorithm based on the findings of the New Unified Classification System.
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Affiliation(s)
- Antonio Capone
- Orthopedic Clinic, Department of Special Surgical Science, University of Cagliari, Ospedale Marino, Cagliari, Italy
| | - Stefano Congia
- Orthopedic Clinic, Department of Special Surgical Science, University of Cagliari, Ospedale Marino, Cagliari, Italy
| | - Roberto Civinini
- Orthopedic Clinic, Department of Special Surgical Science, University of Florence, CTO, Florence, Italy
| | - Giuseppe Marongiu
- Orthopedic Clinic, Department of Special Surgical Science, University of Cagliari, Ospedale Marino, Cagliari, Italy
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Marongiu G, Capone A. Atypical periprosthetic acetabular fracture in long-term alendronate therapy. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2016; 13:209-213. [PMID: 28228784 PMCID: PMC5318174 DOI: 10.11138/ccmbm/2016.13.3.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bisphosphonates have been commonly used in the treatment of osteoporosis, demonstrating its efficacy in fracture risk reduction. However, even if are generally safe and well tolerated, concerns have emerged about atypical fractures related to its prolonged use. Although atypical femoral fracture are more common, case reports demonstrated that even other skeletal areas can be involved by unusual pattern of fracture. We report a atypical acetabular periprosthetic fracture in a 83-year-old female patient after prolonged alendronate treatment for osteoporosis and isolated acetabular revision surgery. The patient underwent to clinical, bioumoral and radiological evaluation and all the history cases were fully reported. We believe this periprosthetic fracture, according to the available data, may have similar underlying pathology to atypical femoral fractures. Awareness of symptoms, in addition to a regular radiographic survey may facilitate early diagnosis and possible prevention of spontaneous periprosthetic fractures, in patients receiving bisphosphonate therapy beyond 5 years. The treatment of this atypical periprosthetic fracture should include both surgical than pharmacological therapy to obtained bone healing.
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Bhandari M, Jin L, See K, Burge R, Gilchrist N, Witvrouw R, Krohn KD, Warner MR, Ahmad QI, Mitlak B. Does Teriparatide Improve Femoral Neck Fracture Healing: Results From A Randomized Placebo-controlled Trial. Clin Orthop Relat Res 2016; 474:1234-44. [PMID: 26932738 PMCID: PMC4814417 DOI: 10.1007/s11999-015-4669-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/02/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a medical need for therapies that improve hip fracture healing. Teriparatide (Forteo(®)/ Forsteo(®), recombinant human parathyroid hormone) is a bone anabolic drug that is approved for treatment of osteoporosis and glucocorticoid-induced osteoporosis in men and postmenopausal women at high fracture risk. Preclinical and preliminary clinical data also suggest that teriparatide may enhance bone healing. QUESTIONS/PURPOSES We wished to test the hypotheses that treatment with teriparatide versus placebo would improve femoral neck fracture healing after internal fixation as measured by (1) frequency of revision surgery, (2) radiographic fracture healing, and (3) other outcomes including pain control, gait speed, and safety. METHODS We initiated two separate, but identically designed, clinical trials to meet FDA requirements to provide substantial evidence to support approval of a new indication. The two prospective, randomized double-blind, placebo-controlled Phase III studies were designed to evaluate the effect of subcutaneous teriparatide (20 μg/day) for 6 months versus placebo on fracture healing at 24 months. The trials were conducted concurrently with a planned enrollment of 1220 patients per trial. However, enrollment was stopped owing to very slow patient accrual, and an a priori decision was made to pool the results of those studies for statistical analyses before study completion; pooling was specified in both protocols. Randomization was stratified by fixation (sliding hip screw or multiple cancellous screws) and fracture type (displaced or nondisplaced). An independent Central Adjudication Committee reviewed revision surgical procedures and radiographs. A total of 159 patients were randomized in the two trials (81 placebo, 78 teriparatide). The combined program had very low power to detect the originally expected treatment effect but had approximately 80% power to detect a larger difference of 12% between treatment groups for risk of revision surgery. RESULTS The proportion of patients undergoing revision surgery at 12 months was 14% (11 of 81) in the placebo group versus 17% (13 of 78) in the teriparatide group. Central Adjudication Committee review excluded two of these patients treated with placebo from the primary analysis. After exclusions, the proportion of patients who did not undergo revision surgery at 12 months (primary endpoint) was not different between the study and placebo groups, at 88% in the placebo group (90% CI, 0.79-0.93) versus 84% in the teriparatide group (90% CI, 0.75-0.90; p = 0.743). There also were no differences between groups in the proportion of patients achieving radiographic fracture healing at 12 months (75% [61 of 81] placebo versus 73% [57 of 78] teriparatide; odds ratio, 0.89; 90% CI, 0.46-1.72; p = 0.692) or in measures of pain control (such as pain during ambulation, 92% [55 of 62] placebo versus 91% [52 of 57] teriparatide; odds ratio, 0.91; 90% CI, 0.25-3.37; p = 0.681). The frequency of patients reporting adverse events was 49% [40 of 81] in the placebo group versus 45% [35 of 78] in the teriparatide group (p = 0.634) during the 6-month treatment period. CONCLUSIONS The small sample size limited this study's power to detect potential differences, and the results are exploratory. With the patients available, teriparatide did not decrease the risk of revision surgery, improve radiographic signs of fracture healing, or decrease pain compared with the placebo. The adverse event data observed were consistent with the teriparatide safety profile. Functional and health outcome data from the studies may help improve our understanding of patients recovering from femoral neck fractures. Further large controlled studies are required to determine the effect of teriparatide on fracture healing. LEVEL OF EVIDENCE Level II, prospective study.
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Affiliation(s)
- Mohit Bhandari
- Department of Surgery, McMaster University, 293 Wellington Street N, Suite 110, Hamilton, ON L8L8E7 Canada
| | - Ling Jin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
| | - Kyoungah See
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
| | - Russel Burge
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
| | - Nigel Gilchrist
- Canterbury District Health Board and Canterbury Geriatric Medical Research Trust Research, The Princess Margaret Hospital, Christchurch, New Zealand
| | - Richard Witvrouw
- Department of Traumatology and Orthopaedics, Sint Jan Hospital, Genk, Belgium
| | - Kelly D. Krohn
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
| | - Margaret R. Warner
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
| | - Qasim I. Ahmad
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
| | - Bruce Mitlak
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN USA
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E. Klontzas M, I. Kenanidis E, J. MacFarlane R, Michail T, E. Potoupnis M, Heliotis M, Mantalaris A, Tsiridis E. Investigational drugs for fracture healing: preclinical & clinical data. Expert Opin Investig Drugs 2016; 25:585-96. [DOI: 10.1517/13543784.2016.1161757] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Wan L, Zhang F, He Q, Tsang WP, Lu L, Li Q, Wu Z, Qiu G, Zhou G, Wan C. EPO promotes bone repair through enhanced cartilaginous callus formation and angiogenesis. PLoS One 2014; 9:e102010. [PMID: 25003898 PMCID: PMC4087003 DOI: 10.1371/journal.pone.0102010] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/13/2014] [Indexed: 12/13/2022] Open
Abstract
Erythropoietin (EPO)/erythropoietin receptor (EPOR) signaling is involved in the development and regeneration of several non-hematopoietic tissues including the skeleton. EPO is identified as a downstream target of the hypoxia inducible factor-α (HIF-α) pathway. It is shown that EPO exerts a positive role in bone repair, however, the underlying cellular and molecular mechanisms remain unclear. In the present study we show that EPO and EPOR are expressed in the proliferating, pre-hypertrophic and hypertrophic zone of the developing mouse growth plates as well as in the cartilaginous callus of the healing bone. The proliferation rate of chondrocytes is increased under EPO treatment, while this effect is decreased following siRNA mediated knockdown of EPOR in chondrocytes. EPO treatment increases biosynthesis of proteoglycan, accompanied by up-regulation of chondrogenic marker genes including SOX9, SOX5, SOX6, collagen type 2, and aggrecan. The effects are inhibited by knockdown of EPOR. Blockage of the endogenous EPO in chondrocytes also impaired the chondrogenic differentiation. In addition, EPO promotes metatarsal endothelial sprouting in vitro. This coincides with the in vivo data that local delivery of EPO increases vascularity at the mid-stage of bone healing (day 14). In a mouse femoral fracture model, EPO promotes cartilaginous callus formation at days 7 and 14, and enhances bone healing at day 28 indexed by improved X-ray score and micro-CT analysis of microstructure of new bone regenerates, which results in improved biomechanical properties. Our results indicate that EPO enhances chondrogenic and angiogenic responses during bone repair. EPO's function on chondrocyte proliferation and differentiation is at least partially mediated by its receptor EPOR. EPO may serve as a therapeutic agent to facilitate skeletal regeneration.
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Affiliation(s)
- Lin Wan
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fengjie Zhang
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Biomedical Sciences Core Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Qiling He
- Departments of Microbiology and Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Wing Pui Tsang
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Biomedical Sciences Core Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Li Lu
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Guangdong Key Laboratory of Pharmaceutical Bioactive Substances, New Drug Function Research Center, School of Life Science and Biopharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qingnan Li
- Guangdong Key Laboratory of Pharmaceutical Bioactive Substances, New Drug Function Research Center, School of Life Science and Biopharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhihong Wu
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guixing Qiu
- Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guangqian Zhou
- The Center for Anti-Ageing and Regenerative Medicine, Medical School, Shenzhen University, Shenzhen, China
| | - Chao Wan
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Biomedical Sciences Core Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- * E-mail:
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