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Trippel SB. Harnessing Growth Factor Interactions to Optimize Articular Cartilage Repair. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1402:135-143. [PMID: 37052852 DOI: 10.1007/978-3-031-25588-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The failure of cartilage healing is a major impediment to recovery from joint disease or trauma. Growth factors play a central role in cell function and have been proposed as potential therapeutic agents to promote cartilage repair. Decades of investigation have identified many growth factors that promote the formation of cartilage in vitro and in vivo. However, very few of these have progressed to human trials. A growth factor that robustly augments articular cartilage healing remains elusive. This is not surprising. Articular cartilage repair involves multiple cellular processes and it is unlikely that any single agent will be able to optimally regulate all of them. It is more likely that multiple regulatory molecules may be required to optimize the maintenance and restoration of articular cartilage. If this is the case, then interactions among growth factors may be expected to play a key role in determining their therapeutic value. This review explores the hypothesis that growth factor interactions could help optimize articular cartilage healing.
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Affiliation(s)
- Stephen B Trippel
- Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
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Toosi S, Behravan J. Osteogenesis and bone remodeling: A focus on growth factors and bioactive peptides. Biofactors 2020; 46:326-340. [PMID: 31854489 DOI: 10.1002/biof.1598] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/30/2019] [Indexed: 12/14/2022]
Abstract
Bone is one of the most frequently transplanted tissues. The bone structure and its physiological function and stem cells biology were known to be closely related to each other for many years. Bone is considered a home to the well-known systems of postnatal mesenchymal stem cells (MSCs). These bone resident MSCs provide a range of growth factors (GF) and cytokines to support cell growth following injury. These GFs include a group of proteins and peptides produced by different cells which are regulators of important cell functions such as division, migration, and differentiation. GF signaling controls the formation and development of the MSCs condensation and plays a critical role in regulating osteogenesis, chondrogenesis, and bone/mineral homeostasis. Thus, a combination of both MSCs and GFs receives high expectations in regenerative medicine, particularly in bone repair applications. It is known that the delivery of exogenous GFs to the non-union bone fracture site remarkably improves healing results. Here we present updated information on bone tissue engineering with a specific focus on GF characteristics and their application in cellular functions and tissue healing. Moreover, the interrelation of GFs with the damaged bone microenvironment and their mechanistic functions are discussed.
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Affiliation(s)
- Shirin Toosi
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical, Mashhad, Iran
- Food and Drug Administration, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Behravan
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical, Mashhad, Iran
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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Dual functional approaches for osteogenesis coupled angiogenesis in bone tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109761. [PMID: 31349418 DOI: 10.1016/j.msec.2019.109761] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/11/2019] [Accepted: 05/15/2019] [Indexed: 12/31/2022]
Abstract
Bone fracture healing is a multistep and overlapping process of inflammation, angiogenesis and osteogenesis. It is initiated by inflammation, causing the release of various cytokines and growth factors. It leads to the recruitment of stem cells and formation of vasculature resulting in the functional bone formation. This combined phenomenon is used by bone tissue engineers from past few years to address the problem of vasculature and osteogenic differentiation during bone regeneration. In this review, we have discussed all major studies reporting the dual functioning approach to promote osteogenesis coupled angiogenesis using various scaffolds. These scaffolds are broadly classified into four types based on the nature of their structural and functional components. The functionality of the scaffold is either due to the structural components or the loaded cargo which conducts or induces the coupled functionality. Dual delivery system for osteoinductive and angioinductive factors ensures the co-delivery of two different types of molecules to induce osteogenesis and angiogenesis. Single delivery scaffold for angioinductive and osteoinductive molecule releases single type of molecules which could induce both angiogenesis and osteogenesis. Osteoconductive scaffold consisted of bone constituents releases angioinductive factors. Osteoconductive and angioconductive scaffold composed of components which provide the native substrate features for osteogenesis and angiogenesis. This review article also discusses the studies highlighting the synergism of physico-chemical stimuli as dual functioning feature to enhance angiogenesis and osteogenesis simultaneously. In addition, this article covers one of the least discussed area of the bone regeneration i.e. 'cartilage formation as a median between angiogenesis and osteogenesis'.
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Kasemkijwattana C, Menetrey J, Somogyl G, Moreland MS, Fu FH, Buranapanitkit B, Watkins SC, Huard J. Development of Approaches to Improve the Healing following Muscle Contusion. Cell Transplant 2017; 7:585-98. [PMID: 9853587 DOI: 10.1177/096368979800700609] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Muscle injuries are a challenging problem in traumatology, and the most frequent occurrence in sports medicine. Muscle contusions are among the most common muscle injuries. Although this injury is capable of healing, an incomplete functional recovery often occurs, depending on the severity of the blunt trauma. We have developed an animal model of muscle contusion in mice (high energy blunt trauma) and characterized the muscle's ability to heal following this injury using histology and immunohistochemistry to determine the level of muscle regeneration and the development of scar tissue. We have observed a massive muscle regeneration occurring in the first 2 wk postinjury that is subsequently followed by the development of muscle fibrosis. Based on these observations, we propose that the enhancement of muscle growth and regeneration, as well as the prevention of fibrotic development, could be used as approach(es) to improve the healing of muscle injuries. In fact, we have identified three growth factors (bFGF, IGF-1, and NGF) capable of enhancing myoblast proliferation and differentiation in vitro and improving the healing of the injured muscle in vivo. Furthermore, the ability of adenovirus to mediate direct and ex vivo gene transfer of β-galactosidase into the injured site opens possibilities of delivering an efficient and persistent expression of these growth factors in the injured muscle. These studies should help in the development of strategies to promote efficient muscle healing with complete functional recovery following muscle contusion. © 1998 Elsevier Science Inc.
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Affiliation(s)
- C Kasemkijwattana
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburgh, and Children's Hospital of Pittsburgh, PA 15261, USA
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Memeo A, Verdoni F, De Bartolomeo O, Albisetti W, Pedretti L. A new way to treat forearm post-traumatic non-union in young patients with intramedullary nailing and platelet-rich plasma. Injury 2014; 45:418-23. [PMID: 24119491 DOI: 10.1016/j.injury.2013.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Non-union rate in forearm fractures is generally less than 2% when a proper technique is used; this rate increases when ulnar lesions are involved. PATIENTS AND METHODS We present a case series of seven young patients whose average age was 14 years (range 11-19 years) at the time of surgery and who presented with a forearm post-traumatic non-union that was previously treated in different ways (three isolated ulnar non-union, two isolated radial non-union and two combined). Average follow-up was 34 months (range 9-72 months). Surgical treatment began with the removal of the previous synthesis and with curettage of the non-union area. The Acumed ulnar rod, Acumed radial rod and Thalon elastic nail (all of them are unreamed and locked nails) together with autologous platelet-rich plasma (PRP) obtained with the Biomet System (concentration of 158.2×10(4) platelets/μL) were chosen to treat the patients. X-rays and clinical controls were conducted every 30 days until recovery. RESULTS All patients recovered: average recovery was 23 weeks from operation (range 16-36 weeks) and nails were removed 3 months after complete healing. Six patients had excellent results and one patient had a good result (Patient 2, forearm pronosupination 60-0-40 degrees). DISCUSSION The purpose of the case series was to establish a better way of treatment and to find a technique that could avoid the use of bone grafts, because obtaining autologous bone requires a further surgical procedure that can be really invasive depending on the amount of bone needed. CONCLUSION All patients in the study showed complete recovery, with excellent clinical outcomes. Although there were only seven patients in this case series, and there is a need to analyse more patients, this study showed that the use of a specific locking nail system can provide proper stability to ulnar or radial atrophic non-union despite rotational forces, and when combined with autologous growth factors (PRP) is sufficient to promote bone healing in young patients without the necessity to take autologous bone grafts.
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Affiliation(s)
- A Memeo
- Unità Operativa Complessa di Ortopedia e Traumatologia Pediatrica, Istituto Ortopedico G. Pini, Milan, Italy
| | - F Verdoni
- Unità Operativa Complessa di Ortopedia e Traumatologia Pediatrica, Istituto Ortopedico G. Pini, Milan, Italy
| | | | - W Albisetti
- Università degli Studi of Milan, Department of Orthopaedics and Rehabilitation, Istituto Ortopedico G. Pini, Milan, Italy
| | - L Pedretti
- Università degli Studi of Milan, Department of Orthopaedics and Rehabilitation, Istituto Ortopedico G. Pini, Milan, Italy.
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Shi S, Mercer S, Eckert GJ, Trippel SB. Growth factor regulation of growth factor production by multiple gene transfer to chondrocytes. Growth Factors 2013; 31:32-8. [PMID: 23302100 PMCID: PMC3976180 DOI: 10.3109/08977194.2012.750652] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Of the many classes of molecules regulated by growth factors, growth factors themselves are not well investigated. We tested the hypothesis that combinations of endogenous growth factors interactively regulate the production of other growth factors. Growth factors have therapeutic potential for articular cartilage repair, and gene transfer is a promising approach to growth factor delivery. We tested the hypothesis using adult bovine articular chondrocytes treated with combinations of cDNAs encoding insulin-like growth factor I, bone morphogenetic protein-2 and protein-7, transforming growth factor β1, and fibroblast growth factor 2. We found that these growth factor transgenes regulated each other's growth factor production. This regulation ranged from stimulation to inhibition. Regulation by multiple transgenes was not predictable from the regulatory actions of the individual transgenes. Such interactions may be important for the selection of growth factor genes for cell-based therapies, including articular cartilage repair.
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Affiliation(s)
- Shuiliang Shi
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202-5111, USA
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Draenert ME, Kunzelmann KH, Forriol F, Hickel R, Draenert K. Primary cancellous bone formation with BMP and micro-chambered beads: experimental study on sheep. Bone 2013; 52:465-73. [PMID: 23339247 DOI: 10.1016/j.bone.2012.08.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM The physiological reconstruction of cancellous bone defects in surgery of the locomotor system is an unsatisfactorily solved problem. AIMS The aims of this study are to examine whether micro-chambered ß-tricalcium-phosphate (ß-TCP) beads provide a certain capillary force suctioning in blood and bone marrow thus forming a stable "negative"-replica of the bone marrow spaces. If so, a new approach for osteoconduction would yield primarily a scaffold of lamellar cancellous bone under load without a long-lasting remodeling process. Recombinant human bone morphogenetic protein (rhBMP) might even enhance all processes of defect healing, remodeling and ß-TCP resorption; gentamicin-loaded ε-caprolactone might protect the implant. MATERIAL AND METHODS Ten sheep were operated on; the patella-groove model and the tibial head were used. A defect of 9.4 × 20 mm was created using wet-grinding-diamond instruments. Micro-chambered ß-TCP-beads of 4-6 mm with 0.35 mg rhBMP-7 + 0.1 g collagen per animal, or 1.5 g demineralized bone matrix (DBM) paste on the contra-lateral side were implanted. Both osteoinduction groups were compared with the defect in the tibial heads where plain micro-chambered ceramic beads were inserted. Added to the beads was 12.5 mg gentamicin sulphate in 12.5 mg ε-caprolactone-carrier. Outward diffusion was prevented using a 1-mm-thick press-fit inserted ceramic lid. The bone healing, remodeling and resorption of the ceramic in a right-left comparison of the patella groove and the tibial head was examined at 6 weeks, 2 and 3 months; one animal in reserve was followed for 14 months. The animals were perfusion-fixed, the vasculature micro-casted with an acrylate and nondemineralized processed, and with μ-CT and microscopically documented. RESULTS A primary load-bearing spongiosa had developed around the beads, which shortened the remodeling process. The strong micro-chambered, resorbable ß-TCP-beads demonstrate high capillary strength, resorb blood and bone marrow, and represent a stable formative material which, as a carrier for the controlled local release of BMP, that accelerates bone healing, shortens resorption and remodeling compared with plain and DBM loaded implants. CONCLUSION Micro-chambered beads represent the bone-forming element, BMP yields a fast defect healing and enhanced remodeling of bone and resorption of ß-TCP compared to delayed and incomplete reconstruction and resorption of ß-TCP on the DBM-side, the plain implants reached nearly the same reconstruction, but far later compared with the BMP loaded implants.
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Affiliation(s)
- M E Draenert
- Clinic for Restorative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Goethestrasse 70, 80336 Munich, Germany.
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Shi S, Mercer S, Eckert GJ, Trippel SB. Regulation of articular chondrocyte aggrecan and collagen gene expression by multiple growth factor gene transfer. J Orthop Res 2012; 30:1026-31. [PMID: 22180348 PMCID: PMC4133938 DOI: 10.1002/jor.22036] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 11/08/2011] [Indexed: 02/04/2023]
Abstract
Gene transfer is a promising approach to the delivery of chondrotrophic growth factors to promote cartilage repair. It is unlikely that a single growth factor transgene will optimally regulate these cells. The aim of this study was to identify those growth factor transgene combinations that optimally regulate aggrecan, collagen type II and collagen type I gene expression by articular chondrocytes. We delivered combinations of the transgenes encoding fibroblast growth factor-2, insulin-like growth factor I, transforming growth factor beta1, bone morphogenetic protein-2, and/or bone morphogenetic protein-7 and assessed chondrocyte responses by measuring changes in the expression of aggrecan, type II collagen and type I collagen genes. These growth factor transgenes differentially regulated the magnitude and time course of all three-matrix protein genes. In concert, the transgenes regulated matrix gene expression in an interactive fashion that ranged from synergistic to inhibitory. Maximum stimulation of aggrecan (16-fold) and type II collagen (35-fold) expression was with the combination of IGF-I, BMP-2, and BMP-7 transgenes. The results indicate that the optimal choice of growth factor genes for cell-based cartilage repair cannot be predicted from observations of individual transgenes. Rather, such gene therapy will require an empirically based selection of growth factor gene combinations.
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Affiliation(s)
- Shuiliang Shi
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Scott Mercer
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - George J. Eckert
- Department of Medicine Division of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen B. Trippel
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
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Bordei P. Locally applied platelet-derived growth factor accelerates fracture healing. ACTA ACUST UNITED AC 2011; 93:1653-9. [DOI: 10.1302/0301-620x.93b12.27244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Platelet-derived growth factor (PDGF) is known to stimulate osteoblast or osteoprogenitor cell activity. We investigated the effect of locally applied PDGF from poly-d,l-lactide (PDLLA)-coated implants on fracture healing in a rat model. A closed fracture of the right tibia of four-month-old Sprague-Dawley rats (n = 40) was stabilised with implants coated with a biodegradable PDLLA versus implants coated with PDLLA and PDGF. Radiographs were taken throughout the study, and a marker of DNA activity, bromodeoxyuridine (BrdU), was injected before the rats were killed at three, seven and ten days. The radiographs showed consolidation of the callus in the PDGF-treated group compared with the control group at all three time points. In the PDGF-treated group, immunohistochemical staining of BrdU showed that the distribution of proliferating cells in all cellular events was higher after ten days compared with that at three and seven days. These results indicate that local application of PDGF from biodegradable PDLLA-coated implants significantly accelerates fracture healing in experimental animals. Further development may help fracture healing in the clinical situation.
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Affiliation(s)
- P. Bordei
- Ovidius University of Constanta, Department
of Anatomy, Faculty of Medicine, 1 University
str., B, 900527 Constanta, Romania
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10
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Xu Y, Bai Y, Li Q, Shen X, Jiang L. Experimental study of prognosis of chronic compartment syndrome. Connect Tissue Res 2010; 51:419-25. [PMID: 20367119 DOI: 10.3109/03008200903585278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is little in the literature concerning the pathobiology and repair processes of impaired skeletal muscle after decompressive operation for chronic compartment syndrome (CCS), which would be valuable for prognosis. Repeated tourniquet compression through cuff inflation on rabbits' claves was performed daily for 2 hr, then stopped for 30 min, and applied for another 2 hr. The contralateral hindlimb, which was not compressed, served as a control. Rabbits were allocated to four groups: groups I and II were pressured with 80 and 120 mmHg for 3 days, and groups III and IV were pressured with 80 and 120 mmHg for 14 days. Skeletal muscle specimens from each group were obtained for histological and ultrastructural observation at day 1, 7, 14, and 28 post-compression. In groups I and II, a few necrotic fibers were observed and basal lamina was intact at 1 day after compression. Seven days after compression, there was an observable increase in the proliferation of satellite cells and development of myotube structures. Fourteen days after compression, regeneration of muscles was complete, and there was no significant difference compared with the control group. In groups III and IV, 1 day post-compression examination revealed a large area of necrotic fibers, fibrotic interstitium, and disintegratin basal lamina. Seven days later, proliferation of satellite cells was observed around the surviving basal lamina, and 28 days after compression we could see a large area of fibrosis. The degree of recovery of impaired muscle in rabbit's CCS-induced tissues is related to pressure and duration of compression. Complete recovery of the impaired muscle is determined by survival of basal lamina.
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Affiliation(s)
- YiMing Xu
- Shanghai Sixth People's hospital, Shanghai JiaoTong University, Shanghai, China
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Abstract
Osteoblasts are integral to the development, growth, function, repair and maintenance of bone. The osteoblast forms organic, non-mineralized bone matrix and is involved in complex interactions with a variety of factors, mediators and cell types. Degeneration, pathology, and trauma cause disruption and destruction of the normal skeletal environment and may lead to bone loss. There is a rise in active populations involved in trauma, elderly patients with fragility fractures and an overall increase in primary, revision and reconstructive bone and joint surgery. Despite the rapid evolution of implant technologies and bone grafting techniques, there is still a great demand for novel bone replacement strategies. Bone tissue engineering is the state of the art science with the potential to regenerate bone with natural form and function. This review presents the biology of osteoblasts and their current applications in bone tissue engineering biotechnologies and role in stem cell, bioactive factor, recombinant signalling molecule and gene therapy research.
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Affiliation(s)
- P Jayakumar
- Department of Biomaterials, Kings College London, UK
| | - L Di Silvio
- Department of Biomaterials, Kings College London, UK
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12
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Abstract
STUDY DESIGN Literature-based topic review. OBJECTIVE To review the complications and the concerns that may be associated with all of the commonly used osteobiologic options for spine fusion. SUMMARY OF BACKGROUND DATA Obtaining a solid arthrodesis is an important objective in many lumbar surgical procedures, and a wide array of bone graft materials may be used in an attempt to achieve this goal. Iliac crest bone graft, as well as all of the available osteobiologic alternatives, carries potential risks and concerns for both patient and surgeon. METHODS Review of literature and expert opinion. CONCLUSION Some of the potential complications associated with osteobiologic materials used in spinal fusion are well understood and clearly documented whereas others require further study and clarification. In any given clinical situation, the patient and surgeon need to balance the benefits and performance characteristics of the graft material with the risk profile to optimize clinical management.
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Bernstein A, Mayr HO, Hube R. Can bone healing in distraction osteogenesis be accelerated by local application of IGF-1 and TGF-beta1? J Biomed Mater Res B Appl Biomater 2010; 92:215-25. [PMID: 19810114 DOI: 10.1002/jbm.b.31508] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Because complications of distraction osteogenesis are largely related to the long duration of therapy, increasing efforts were reached to shorten treatment by using osteoconductive replacement materials incorporating bioactive molecules such as IGF-1 and TGF-beta1. The controlled release of IGF-1 and TGF-beta1 from coated biodegradable poly(D,L-lactide) implants could stimulate fracture healing locally. We investigated the effect of locally applied IGF-1 and TGF-beta1 from IGF-1/TGF-beta1-enriched polylactide membranes on fracture healing in a sheep model of delayed callus formation. Twenty-eight sheep were used for this study. Callus distraction of 1 mm/day by means of a unilateral fixator was continued for 30 days. At the beginning of the subsequent consolidation phase, either growth factors were applied locally or the defect was packed with cancellous bone, or both. The groups treated with growth factors were compared to a control group. The consolidation phase lasted for 60 days and both tibiae were dissected for histological and histomorphometric analyses. This investigation found a reduced absolute callus area in the lengthening zone in all treatment groups. The two treatment groups that received a membrane coated with growth factors showed distinctly higher relative bone areas than the groups treated with an uncoated membrane or packing of the osteotomy defect with cancellous bone. The differences in bone areas were not statistically significant. Application of the growth factors accelerated bone healing and achieved results comparable with those of established treatment methods (packing with autologous cancellous bone). The best results were achieved with a combination of both methods.
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Affiliation(s)
- Anke Bernstein
- Department of Orthopedics, Martin Luther University of Halle-Wittenberg, Halle 06097, Germany.
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Giannoudis PV, Kanakaris NK, Einhorn TA. Interaction of bone morphogenetic proteins with cells of the osteoclast lineage: review of the existing evidence. Osteoporos Int 2007; 18:1565-81. [PMID: 17694399 DOI: 10.1007/s00198-007-0441-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Accepted: 07/17/2007] [Indexed: 11/25/2022]
Abstract
The present review evaluates the existing scientific proofs of this supplementary role of the BMPs and summarises its clinical implications. Bone regeneration is a process consisting of bone formation and bone resorption, two different but closely coupling pathways, which in most circumstances proceed simultaneously. Plenty of evidence has also characterised the bone morphogenetic proteins (BMPs) as inducing factors of bone formation. However, there is also evidence that these multifunctioning proteins affect bone resorption and the osteoclast homeostasis utilising various pathways. The present review evaluates the existing scientific evidence of this supplementary role of the BMPs, and summarises its clinical implications.
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Affiliation(s)
- P V Giannoudis
- Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.
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15
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Abstract
Still a major problem in orthopedic and trauma surgery is the delayed healing or the non-union of long bone fractures. Demographic data reveal that due to the steadily rising age of the population, complications with the musculoskeletal system will increase during the next years. Bone morphogenetic proteins (BMPs) have successfully been applied in clinic for the treatment of delayed healing and non-unions. The broad difference concerning the indication, timing of treatment, dosage and application technique of BMPs calls for the need to perform further prospective studies in order to standardize the treatment and furthermore optimize the procedures or even develop new therapeutic strategies. For example, the application technique may be improved and in some cases injectable BMP preparations could be of use. Also the coating of implants with growth factors might be valuable in order to stimulate bone healing and to prevent delayed healing or non-union. This article tries to discuss some of the open questions, however can and will not reflect the absolute standard of care. To make the BMP treatment a standard of care, more clinical data and long time experiences are necessary. The intramedullary application of BMP in combination with autologous or allogenic bone grafts or bone substitutes after debridement and stabilization with implants seems to be an adequate procedure for treatment of atrophic non-unions. However, the total number of patients is too small to draw final conclusions. Further clinical studies need to be performed in the future.
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Trippel S, Cucchiarini M, Madry H, Shi S, Wang C. Gene therapy for articular cartilage repair. Proc Inst Mech Eng H 2007; 221:451-9. [PMID: 17822147 DOI: 10.1243/09544119jeim237] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Articular cartilage serves as the gliding surface of joints. It is susceptible to damage from trauma and from degenerative diseases. Restoration of damaged articular cartilage may be achievable through the use of cell-regulatory molecules that augment the reparative activities of the cells, inhibit the cells' degradative activities, or both. A variety of such molecules have been identified. These include insulin-like growth factor I, fibroblast growth factor 2, bone morphogenetic proteins 2, 4, and 7, and interleukin-1 receptor antagonist. It is now possible to transfer the genes encoding such molecules into articular cartilage and synovial lining cells. Although preliminary, data from in-vitro and in-vivo studies suggest that gene therapy can deliver such potentially therapeutic agents to protect existing cartilage and to build new cartilage.
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Affiliation(s)
- S Trippel
- Department of Orthopaedic Surgery, Indiana University School of Medicine, 541 Clinical Drive, Suite 600, Indianapolis, IP 46202-5111, USA.
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Park JB, Lee JY, Park HN, Seol YJ, Park YJ, Rhee SH, Lee SC, Kim KH, Kim TI, Lee YM, Ku Y, Rhyu IC, Han SB, Chung CP. Osteopromotion with synthetic oligopeptide-coated bovine bone mineral in vivo. J Periodontol 2007; 78:157-63. [PMID: 17199553 DOI: 10.1902/jop.2007.060200] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recombinant human bone morphogenetic protein (rhBMP)-2 has been shown to stimulate significant regeneration of alveolar bone and cementum in periodontal defects clinically. The aim of this study was to evaluate the osteopromotive effect of oligopeptide domain-coated bovine bone mineral granules in a rabbit calvarial defect model. METHODS The peptide-coated bovine bone was fabricated by incubating the graft material in a solution of oligopeptide domain. The cell attachment and proliferation were measured in vitro. Peptide-coated (test group) or uncoated (control group) bone minerals were implanted into 10-mm calvarial defects in rabbits, and the animals were sacrificed at 1, 2, or 4 weeks post-surgery. RESULTS The cells grown with peptide-coated bone showed significantly higher proliferation activity at all times compared to cells grown with peptide-uncoated bone mineral. At 2 weeks post-surgery, the control wounds showed a limited amount of osteoid formation in a centripetal pattern around the grafted bone, but the oligopeptide domain-coated grafted bone had formed new bone around the grafted area. At 4 weeks post-surgery, the control sites showed increased new bone formation, but they still showed a significant difference from the peptide-coated bone-implanted sites. CONCLUSIONS At 2 and 4 weeks, accelerated new bone formation was observed within the experimental sites compared to control groups. The use of deproteinized bovine bone combined with a synthetic oligopeptide seems to be a more beneficial material for bone regeneration in the early healing period.
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Affiliation(s)
- Jun-Beom Park
- Department of Periodontology, School of Dentistry, Seoul National University, Seoul, Korea
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Shen FH, Zeng Q, Lv Q, Choi L, Balian G, Li X, Laurencin CT. Osteogenic differentiation of adipose-derived stromal cells treated with GDF-5 cultured on a novel three-dimensional sintered microsphere matrix. Spine J 2006; 6:615-23. [PMID: 17088192 DOI: 10.1016/j.spinee.2006.03.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 03/10/2006] [Accepted: 03/12/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It is well known that under the proper conditions multipotential bone marrow stromal cells are capable of osteogenic differentiation. Recently studies have demonstrated that an analogous subpopulation of cells exist within adipose tissue. Although early studies characterizing these adipose-derived stromal (ADS) cells in culture exist, investigations exploring the characteristics and viability of these cells cultured on a three-dimensional sintered microsphere matrix are absent. PURPOSE To characterize and investigate the viability of ADS cells cultured on bioengineered three-dimensional sintered microsphere matrices (SMM). STUDY DESIGN Basic science, laboratory study. PATIENT SAMPLE Sixty SMM total. Six underwent examination by scanning electron microscopy, 18 for cellular viability, 18 for biochemical assay, and 18 for evaluation by gene expression. OUTCOME MEASURES The SMM were examined under scanning electron microscopy to evaluate for adherence, migration, and proliferation at 7, 14, and 28 days. Cellular viability was assessed using colorimetric assay for mitochondrial dehydrogenases activity in viable cells (MTS [3-(4,5-dimethylthiazol-2-yl)5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] assay) at each corresponding time point. Osteoblastic differentiation was determined using biochemical assays for alkaline phosphatase activity and gene expression for alkaline phosphatase (ALP), osteocalcin (OC), and core binding factor alpha-1 (Cbfa1). METHODS Multipotential ADS cells from adult Sprague Dawley rats were isolated and maintained in media. Sintered microsphere matrices of poly(lactide-co-glycolide) [85:15] were prepared using solvent evaporation technique followed by mechanical sieving and fabricated by heating in metal molds. ADS cells were then seeded on the SMM and cultured in media with growth and differentiation factor-5 (GDF-5). Treated samples and controls were evaluated at 7, 14, and 28 days. Statistical significance was set at p<.05. RESULTS Multipotential ADS cells were capable of being isolated from adipose tissue. Scanning electron microscopy evaluation revealed cells adherent to the scaffold surface in a monolayer by 7 days. Cytoplasmic extensions were seen linking the cells on adjacent microspheres. Migration and proliferation resulting in extension of the cellular elements into the scaffold was apparent by 14 days. MTS confirmed cell viability within the scaffold throughout the 28-day study. Osteoblastic differentiation was confirmed using biochemical assays for alkaline phosphatase activity and gene expression for ALP, OC, and Cbfa1. CONCLUSIONS This is the first study to investigate the fate of ADS seeded on a three-dimensional sintered microsphere matrix. The results of this study confirm that ADS cells, when treated with GDF-5, are not only capable of adhering to the bioengineered scaffold, but also remain viable and demonstrated the ability to migrate, proliferate, and subsequently undergo osteogenic differentiation under the conditions described. These early findings support the concept that ADS cells cultured on a SMM may serve as a viable alternative to more traditional methods of bone graft materials.
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Affiliation(s)
- Francis H Shen
- Department of Orthopaedic Surgery, School of Medicine, P.O. Box 800159, University of Virginia, Charlottesville, VA 22908-0159, USA.
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Peidro L, Segur JM, Poggio D, de Retana PF. Use of freeze-dried bone allograft with platelet-derived growth factor for revision of a glenoid component. ACTA ACUST UNITED AC 2006; 88:1228-31. [PMID: 16943478 DOI: 10.1302/0301-620x.88b9.17471] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Glenoid replacement is technically challenging. Removal of a cemented glenoid component often results in a large osseous defect which makes the immediate introduction of a revision prosthesis almost impossible. We describe a two-stage revision procedure using a reversed shoulder prosthesis. Freeze-dried allograft with platelet-derived growth factor was used to fill the glenoid defect. Radiological incorporation of the allograft was seen and its consistency allowed the placement of a screwed glenoid component. There were no signs of new mature bone formation on histological examination. The addition of platelet-derived growth factor to the allograft seems to contribute to an increase in incorporation and hardness, but does not promote the growth of new bone.
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Affiliation(s)
- L Peidro
- Department of Orthopaedic Surgery, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain.
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Siebert CH, Schneider U, Sopka S, Wahner T, Miltner O, Niedhart C. Ingrowth of osteochondral grafts under the influence of growth factors: 6-month results of an animal study. Arch Orthop Trauma Surg 2006; 126:247-52. [PMID: 16362426 DOI: 10.1007/s00402-005-0061-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Indexed: 12/21/2022]
Abstract
INTRODUCTION In the age of growth factors and gene therapy, the induction of cartilage healing remains an unsolved problem. Even in autologous grafting, one of the preferred methods of treatment for focal osteochondral lesions, chondral integration remains difficult. This study aims to define a possible positive influence of growth factor augmentation on the ingrowth of these transplants. MATERIALS AND METHODS In an ovine model, questions regarding the healing of osteochondral transplants under the influence of two different growth factors were to be addressed. Two osteochondral autologous transplantations (OAT), one in the weight-bearing surface of each femoral condyle, were performed on the ovine knee using the standard operative protocol. One of the grafts was bathed in augmented PBS containing 50 microg bFGF or bone morphogenetic protein (BMP)-2 directly prior to implantation, while the other condyle served as the control. Two groups, consisting of eight sheep each, were evaluated for each growth factor after 6 months. RESULTS During the evaluation of all the specimens, neither osteophytes nor synovial changes were observed. The mechanical consistency of the cartilaginous tissue began to reach a level equivalent to the surrounding tissue at 6 months, independent of the use of growth factor. Macroscopically, the superficial border of the transplanted osteochondral plug could easily be outlined in all groups, while the cartilage interface of the bFGF specimens was determined to be less demarcated than the BMP augmented plugs or the controls. Radiographically, a solid osteointegration of the graft could be documented at 6 months in the native and augmented groups. In contrast, integration of the chondral surface of the OAT was not seen macro- or microscopically in any specimen, even though cartilage surfaces remained viable. A firm physical interdigitation of the reconstructed joint surface could not be demonstrated in either of the two augmented groups or the control population. The augmentation with bFGF and BMP-2 stimulated the osseous ingrowth and seems to expedite the remodelling process, but was not able to improve chondral healing. CONCLUSION The lack of integration of the cartilaginous portion of the transplanted plugs into the reconstructed joint surface, even following the augmentation with bFGF and BMP-2, does not bode well for the long-term survival of the joint itself.
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Affiliation(s)
- Christian H Siebert
- Orthopaedic Department, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
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Hwang JH, Ra YJ, Lee KM, Lee JY, Ghil SH. Therapeutic Effect of Passive Mobilization Exercise on Improvement of Muscle Regeneration and Prevention of Fibrosis After Laceration Injury of Rat. Arch Phys Med Rehabil 2006; 87:20-6. [PMID: 16401433 DOI: 10.1016/j.apmr.2005.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the muscle healing effect of passive mobilization exercises after a laceration injury. DESIGN Randomized controlled trial. SETTING Basic science laboratory. ANIMALS Male Sprague-Dawley rats (N=36), age ranging from 8 to 10 weeks and weight ranging from 300 to 400 g. INTERVENTION The bilateral gastrocnemius muscles were lacerated. The left leg muscles were used as the study groups and the right side was used as the control (lacerated muscles without any treatment, n=8). In the exercise group (n=24), passive mobilization exercise (15 min/d) was performed for 5 days starting from different time points (2, 7, and 14d postlaceration). The decorin group (n=8) was injected with decorin (50 microg at 14d postlaceration), which is a well-known antifibrotic agent. Four animals were used as the normal controls, in which only the muscle strength was evaluated. All the animals were killed 4 weeks after the laceration. MAIN OUTCOME MEASURES The histologic characterization of muscle regeneration (hematoxylin and eosin staining, number and diameter of the centronucleated, regenerating myofibers), muscle fibrosis (vimentin-positive area, Masson modified trichrome staining positive area), and muscle strength (analysis of fast twitch strength). RESULTS The level of fibrosis was more than 50% lower in the exercise and decorin groups than in the control (P<.05). The decorin group showed the highest number of regenerated, new myofibers and the highest muscle strength. All of the exercise groups, regardless of the starting time of exercise, also showed significant improvement in regeneration and strength. However, the exercise group starting 14 days after the laceration showed the best results. CONCLUSIONS Stretching exercises after a muscle laceration injury has a strong antifibrotic effect, as much as a well-known antifibrotic agent, decorin. According to the results, the best time to begin stretching exercises is 14 days after laceration for antifibrosis and muscle regeneration.
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Affiliation(s)
- Ji Hye Hwang
- Department of Physical Medicine and Rehabilitation, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Smith E, Yang J, McGann L, Sebald W, Uludag H. RGD-grafted thermoreversible polymers to facilitate attachment of BMP-2 responsive C2C12 cells. Biomaterials 2005; 26:7329-38. [PMID: 16019067 DOI: 10.1016/j.biomaterials.2005.05.060] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to design thermoreversible biomaterials for enhanced adhesion of bone morphogenetic protein-2 (BMP-2)-responsive cells. Peptides containing the arginine-glycine-aspartic acid (RGD) sequence were conjugated to N-isopropylacrylamide (NiPAM) polymers via amine-reactive N-acryloxysuccinimide (NASI) groups. In monolayer cultures, the adhesion of BMP-2-responsive C2C12 cells to RGD-grafted NiPAM/NASI surfaces was significantly higher than adhesion on ungrafted NiPAM/NASI surfaces. Although the morphology of cells adhered to RGD-grafted NiPAM/NASI surfaces was comparable to cells adhered on tissue culture polystyrene (TCPS), long-term cell growth was limited on the NiPAM/NASI surfaces, even for RGD-grafted surfaces. Treatment of C2C12 cells with recombinant BMP-2 induced dose-dependent osteoblastic differentiation as assessed by alkaline phosphatase (ALP) activity. In the absence of BMP-2, cells cultured on NiPAM/NASI polymers (either grafted with RGD peptide or not) expressed significantly higher levels of ALP activity than the cells cultured on TCPS, indicating that the polymer surfaces induced some osteoblastic activity in C2C12 cells without the need for BMP-2. We conclude that NiPAM-based thermoreversible biomaterials, despite their limited ability to support cell growth, allowed an enhanced expression of the chosen osteogenic marker (ALP) by C2C12 cells in vitro.
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Affiliation(s)
- Erin Smith
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G6
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Gille J, Meisner U, Ehlers EM, Müller A, Russlies M, Behrens P. Migration pattern, morphology and viability of cells suspended in or sealed with fibrin glue: a histomorphologic study. Tissue Cell 2005; 37:339-48. [PMID: 16009388 DOI: 10.1016/j.tice.2005.05.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 05/06/2005] [Accepted: 05/09/2005] [Indexed: 02/03/2023]
Abstract
INTRODUCTION We studied the migration pattern, morphology and viability of cells suspended in five different fibrin glues. Besides this, the behaviour of chondrocytes seeded on porous matrices comprising different collagen types sealed with fibrin glue was investigated. MATERIAL AND METHODS In an experiment A, cell suspension (0.5x10(6) cells) was incubated with different fibrin glues. Experiment B was set up to evaluate chondrocytes migration either through a collagen I/III (Chondro-Gide, Geistlich Biomaterials, Switzerland) or collagen II matrix sealed with different fibrin glues in a perfusion chamber system. Analysis were performed by lightmicroscopy (Mayer's hematoxylin-eosin; Masson-Goldner; TUNEL test) and by transmission and scanning electron microscopy. All fibrin glues were measured for TGF-beta 1 and 2 with a specific ELISA. RESULTS After incubation of cell suspension in autologous fibrin glue, the morphology of cells is chondrocyte-like. Spindly, process-bearing cells were seen in commercial fibrin glue. Cells suspended in commercial fibrin glue revealed a significant higher percentage of TUNEL positive cells compared to fibrin tissue adhesives mixed with autologous serum (p=0.006). The TGF-beta 1 and 2 concentration was significantly higher in partial autologous fibrin sealant (PAF) compared to their commercial counterparts (p=0.001). Cells seeded on the collagen I/III matrix retained their chondrocytic morphology, while in the type II collagen matrix the chondrocytes displayed a fibroblastic phenotype. The ratio of TUNEL positive cells for the collagen I/III matrix was significantly surpassed by the values, when a collagen II matrix was used (p=0.008). No ingrowth of cells was seen in any of the experimental conditions. CONCLUSION Partial autologous fibrin glue and collagen I/III matrices are favourable in respect to migration pattern, morphology and viability, but definitive conclusions can only be drawn after in vivo studies. This will be addressed in future animal studies.
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Affiliation(s)
- J Gille
- Department of Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160 D-23538, Germany
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Coetzee JC, Pomeroy GC, Watts JD, Barrow C. The use of autologous concentrated growth factors to promote syndesmosis fusion in the Agility total ankle replacement. A preliminary study. Foot Ankle Int 2005; 26:840-6. [PMID: 16221457 DOI: 10.1177/107110070502601009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Agility (DePuy, Warsaw, Indiana) total ankle replacement has been in use since 1984. One of the most common complications continues to be delayed union or nonunions of the distal tibiofibular syndesmosis. In the reported studies on the Agility ankle the delayed union and nonunion rate can be as high as 38%. METHODS Since 1999, 114 Agility total ankle replacements were done at two centers in the United States without the use of autologous concentrated growth factors. Since July of 2001, 66 Agility ankles were implanted with Symphony (DePuy, Warsaw, Indiana) augmented bone grafting. The standard operative technique was followed in all the patients. Prospective data was collected on all patients. The standard ankle radiographs were taken preoperatively and postoperative at 8 weeks, 12 weeks, 16 weeks, 6 months, and yearly. CT scans were obtained at 6 months if fusion at the syndesmosis was questionable. The Graphpad Instat software (Graphpad Software Inc., San Diego, CA) was used for statistical analysis. The two-tailed unpaired t-test was used, and the value <0.05 was considered significant. RESULTS There was no statistical difference in the demographic data for the two groups. In 114 ankle replacements without autologous concentrated growth factors 70 fused at 8 weeks (61%), 14 fused at 12 weeks (12%), 13 fused at 6 months (12%). There were 17 nonunions (15%); delayed unions (3 to 6 months) and nonunions, therefore, equaled 27%. The syndesmosis fused in 50 of the 66 ankle replacements (76%) that had autologous concentrated growth fractures at 8 weeks (76%); 12 fused at 3 months (18%), 2 fused at 6 months (3%), 2 had nonunions (3%). Delayed unions (3 to 6 months) and nonunions equaled 6%. There was a statistically significant improvement in the 8- and 12-week fusion rates, and a statistically significant reduction in delayed unions and nonunions. CONCLUSION Autologous concentrated growth factors appear to make a significant positive difference in the syndesmosis union rate in total ankle replacements.
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Affiliation(s)
- J Chris Coetzee
- Department of Orthopaedic Surgery, University of Minnesota R200, 2450 Riverside Avenue South, Minneapolis, MN 55454, USA.
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Grant WP, Jerlin EA, Pietrzak WS, Tam HS. The utilization of autologous growth factors for the facilitation of fusion in complex neuropathic fractures in the diabetic population. Clin Podiatr Med Surg 2005; 22:561-84, vi. [PMID: 16213380 DOI: 10.1016/j.cpm.2005.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A review of current knowledge of autologous growth factors as used in foot and ankle surgery is presented. This knowledge is clinically correlated with 50 Charcot's foot reconstruction patients who had diabetes and who were randomized to a platelet-rich plasma (PRP) concentration system (Symphony, DePuy, Warsaw, Indiana) or a hollow-fiber hemoconcentration system (Interpore Cross AGF, Interpore Cross, Irvine, California) trial. Although the literature supports the notion that Symphony produces a higher yield of intact platelets more consistently, clinically, a statistically significantly higher number of patients treated with Interpore Cross AGF went on to solid fusion. The findings may indicate that one type of PRP may be indicated for a particular clinical circumstance based on the patient's medical history and resultant local wound environment.
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Affiliation(s)
- William P Grant
- Tidewater Foot and Ankle Center, 762 Independence Blvd., Suite 771, Virginia Beach, VA 23455, USA.
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Carreon LY, Glassman SD, Anekstein Y, Puno RM. Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions. Spine (Phila Pa 1976) 2005; 30:E243-6; discussion E247. [PMID: 15864142 DOI: 10.1097/01.brs.0000160846.85397.44] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the effect on fusion of adding platelet gel to autologous iliac crest graft. SUMMARY OF BACKGROUND DATA Platelet gel is an osteoinductive material prepared by ultra-concentration of platelets and contains multiple growth factors. Proprietary commercial methods are available for harvesting autologous platelet gel concentrates for use as graft supplement in spine fusions. METHODS We reviewed 76 consecutive patients who underwent instrumented posterolateral lumbar fusion with autologous iliac crest bone graft mixed with autologous growth factor (AGF). A control group was randomly selected from patients who underwent instrumented posterolateral lumbar fusion with autologous bone graft alone. The groups were matched for age, sex, smoking history, and number of levels fused. Demographic, surgical, and clinical data were collected from medical records. Diagnosis of nonunion was based on exploration during revision surgery or evidence of nonunion on computerized tomography. The Fisher exact test was used to compare fusion rates. RESULTS In both groups, mean age was 50 years, and 24% were smokers. The nonunion rate was 25% in the AGF group and 17% in the control group. This difference was not statistically significant (P = 0.18). CONCLUSIONS Platelet gel preparation requires blood draws from the patient. This procedure adds to the risk and cost of surgery. The technique for AGF harvest evaluated in this study provides the highest concentration of platelets among the commercially available methods. Despite this, we showed that platelet gel failed to enhance fusion rate when added to autograft in patients undergoing instrumented posterolateral spinal fusion. The authors do not recommend the use of platelet gel to supplement autologous bone graft during instrumented posterolateral spinal fusion.
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Wildemann B, Kadow-Romacker A, Lübberstedt M, Raschke M, Haas NP, Schmidmaier G. Differences in the fusion and resorption activity of human osteoclasts after stimulation with different growth factors released from a polylactide carrier. Calcif Tissue Int 2005; 76:50-5. [PMID: 15477999 DOI: 10.1007/s00223-004-0040-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2004] [Accepted: 07/07/2004] [Indexed: 11/26/2022]
Abstract
Previous in vivo studies were able to demonstrate the efficacy of locally released growth factors IGF-I, TGF-beta1, and BMP-2 from a poly(D,L-lactide) (PDLLA) implant coating on fracture healing. In vitro studies using human osteoblast-like cells showed an enhanced collagen-1 production due to growth factor application without an effect of the PDLLA on the investigated parameter. Both bone-forming osteoblasts and bone-resorbing osteoclasts are important during bone formation and fracture healing. The aim of this study was to investigate the influence of different growth factors and the polylactide coating into which they were incorporated on isolated osteoclasts. In vitro studies using human osteoclast-like cells derived from peripheral blood mononuclear cells (PBMNCs) were performed. Titanium K-wires coated with the lactide loaded with IGF-I and TGF-beta1 (alone and in combination) or BMP-2 were added to the culture in a non-contact manner and the fusion, resorption activity (pit formation assay), and TRAP 5b synthesis of the cells were analyzed. Differences in the effect of the growth factors were seen depending on the differentiation state of the cells. The fusion of the monocytes to multinuclear osteoclasts was significantly enhanced by the application of TGF-beta1 both alone and in combination with IGF-I. No effect was seen after application of IGF-I alone or BMP-2. The resorption activity of the osteoclasts analyzed on dentine chips was significantly enhanced after application of TGF-beta1 or BMP-2. These results indicate a differentiation-dependent effect of growth factors on osteoclasts. TGF-beta1 affects both the osteoclastogenesis and the activity of osteoclasts, whereas BMP-2 had an effect only on the activity of mature osteoclasts but not on the fusion of the PBMNCs.
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Affiliation(s)
- B Wildemann
- Center for Musculoskeletal Surgery, Charité, Campus Virchow, University Medicine, Augustenburger Platz1, D-13353, Berlin, Germany.
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Alt V, Pfefferle HJ, Kreuter J, Stahl JP, Pavlidis T, Meyer C, Mockwitz J, Wenisch S, Schnettler R. Effect of glycerol-l-lactide coating polymer on bone ingrowth of bFGF-coated hydroxyapatite implants. J Control Release 2004; 99:103-11. [PMID: 15342184 DOI: 10.1016/j.jconrel.2004.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 06/22/2004] [Indexed: 11/24/2022]
Abstract
Basic fibroblast growth factor (bFGF)-coated hydroxyapatite (HA) cylinders showed good bony incorporation in a previously conducted animal study. However, some cylinders exhibited focal inhomogeneous bone ingrowth. The purpose of the current study was to test whether glycerol-L-lactide polymer coating could improve release properties and bone incorporation of bFGF-coated HA implants. bFGF-coated HA cylinders with or without coating polymer were investigated for in vitro release of bFGF by an immuno-ligand-assay and also for bone ingrowth in miniature pigs after 42 and 84 days. Release from bFGF polymer composites was lower for the first 3 days compared to the other group but was more homogenous and detectable amounts were still found after 20 days. There was significant delay in bone ingrowth of the polymer implants in which even after 84 days bone ingrowth was not completed, whereas in the other group incorporation after 42 days occurred. Detailed histology revealed filling of the HA pores with the polymer, making ingrowth of the surrounding host bone impossible. Only after 84 days starting resorption of the polymer accompanied by bone ingrowth was found. The current study showed that glycerol-L-lactide is not suitable for coating of HA implants due to polymer induced "locking" of HA pores.
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Affiliation(s)
- Volker Alt
- Department of Trauma Surgery, Justus-Liebig-University Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany.
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Seeherman HJ, Bouxsein M, Kim H, Li R, Li XJ, Aiolova M, Wozney JM. Recombinant human bone morphogenetic protein-2 delivered in an injectable calcium phosphate paste accelerates osteotomy-site healing in a nonhuman primate model. J Bone Joint Surg Am 2004; 86:1961-72. [PMID: 15342759 DOI: 10.2106/00004623-200409000-00015] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In recent clinical trials demonstrating the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) for the acceleration of bone-healing, investigators used carriers requiring open surgery for administration. In this study, we used a nonhuman primate fibular osteotomy model to evaluate injectable rhBMP-2/carrier formulations that can be administered in closed fractures. METHODS The fibular osteotomy model was first characterized by evaluating surgically harvested fibular segments containing untreated osteotomy sites (controls) from seventy adult male Cynomolgus monkeys at eight weeks (twenty-four monkeys), ten weeks (thirty-four), twelve weeks (six), and fourteen weeks (six). Fibular segments, from twenty-four animals, in which an osteotomy had not been performed served as normal controls (intact). The contralateral limb of twenty-four of the animals was then used to evaluate the effect of rhBMP-2 administered, three hours after the osteotomy, in eight carrier formulations (buffer, calcium phosphate paste, and hyaluronan gel, hyaluronan paste, and gelatin foam formulated with and without tricalcium phosphate granules). Each carrier was used in three monkeys. At ten weeks, the fibulae with the treated osteotomy sites were harvested and were compared with the contralateral, untreated osteotomized fibulae (paired control). The most promising carrier, calcium phosphate paste (alpha bone substitute material, or alpha-BSM), was then evaluated in eleven additional animals. The outcomes included the findings on radiographs made weekly until the time of fibular harvest, the callus area, the biomechanical properties, and the histologic findings. RESULTS Radiographic and histologic studies confirmed complete bridging of the control osteotomy sites in most animals by fourteen weeks. The mean torsional stiffness and maximum torque of the control osteotomy sites were 42.7% and 53.7%, 55.2% and 60.4%, 66.7% and 66.4% of the mean torsional stiffness and maximum torque of the intact fibulae at eight, ten, and twelve weeks, respectively, but they were not substantially different from the mean torsional stiffness and maximum torque of the intact fibulae at fourteen weeks (82.3% and 79.8%). In the carrier screening study, outcome measures of healing were more consistently enhanced in the rhBMP-2/alpha-BSM-treated osteotomy sites. In the confirmatory study, the mean callus area, torsional stiffness, and maximum torque were 86%, 72%, and 68% greater in the rhBMP-2/alpha-BSM-treated osteotomy sites than in the paired-control osteotomy sites at ten weeks (p < 0.001). The torsional stiffness and maximum torque in the rhBMP-2/alpha-BSM-treated osteotomy sites were equal to those in the intact fibulae, whereas those parameters in the paired-control osteotomy sites were only 55% and 58%, respectively, of the torsional stiffness and maximum torque of the intact fibulae. Histologic analysis confirmed complete osseous bridging of the rhBMP-2/alpha-BSM-treated osteotomy sites but incomplete bridging of the paired-control osteotomy sites at ten weeks. CONCLUSIONS A single percutaneous injection of rhBMP-2/alpha-BSM accelerates the healing of fibular osteotomy sites in nonhuman primates by approximately 40% compared with the healing of untreated osteotomy sites.
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Affiliation(s)
- Howard J Seeherman
- Women's Health and Bone, Wyeth Discovery Research, 200 Cambridge Park Drive, Cambridge, MA 02140, USA.
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Seeherman H, Li R, Wozney J. A review of preclinical program development for evaluating injectable carriers for osteogenic factors. J Bone Joint Surg Am 2003; 85-A Suppl 3:96-108. [PMID: 12925616 DOI: 10.2106/00004623-200300003-00016] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Kloen P, Di Paola M, Borens O, Richmond J, Perino G, Helfet DL, Goumans MJ. BMP signaling components are expressed in human fracture callus. Bone 2003; 33:362-71. [PMID: 13678778 DOI: 10.1016/s8756-3282(03)00191-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Of the various growth factors involved in the healing response after a fracture, bone morphogenetic proteins (BMPs) are emerging as key modulators. BMPs exert their effects by binding to a complex of type I and type II receptors leading to the phosphorylation of specific downstream effector proteins called Smads. The current study examined the presence of BMP signaling components in human callus obtained from five nascent malunions undergoing fracture fixation. These callus samples represented various stages of bone healing and a mixture of endochondral and intramembraneous bone healing. We performed immunohistochemistry on the callus, using antibodies for BMP (BMP-2,-3,-4,-7), their receptors (BMPR-IA, -IB, -II), and phosphorylated BMP receptor-regulated Smads (pBMP-R-Smads). Active osteoblasts showed fairly consistent positive staining for all BMPs that were examined, with the immunoreactivity most intense for BMP-7 and BMP-3. Immunostaining for BMPs in osteoblasts appeared to colocalize with the expression of BMPR-IA, -IB, and -II. Positive immunostaining for pBMP-R-Smads suggests that the BMP receptors expressed in these cells are activated. Staining for BMPs in cartilage cells was variable. The immunostaining appeared stronger in more mature cells, whereas staining for BMP receptors in cartilage cells was less ubiquitous. However, the expression of pBMP-R-Smads in cartilage cells suggests active signal transduction. Fibroblast-like cells also had a variable staining pattern. Overall, our findings indicate the presence of BMPs, their various receptors, and activated forms of receptor-regulated Smads in human fracture callus. To the best of our knowledge, this is the first study that documents the expression of these proteins in human fracture tissue. Complete elucidation of the roles of BMP in bone formation will hopefully lead to improved fracture healing care.
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Affiliation(s)
- P Kloen
- Hospital for Special Surgery, New York, NY 10021, USA.
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Franke Stenport V, Johansson CB, Sawase T, Yamasaki Y, Oida S. FGF-4 and titanium implants: a pilot study in rabbit bone. Clin Oral Implants Res 2003; 14:363-8. [PMID: 12755787 DOI: 10.1034/j.1600-0501.2003.00846.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To evaluate the effect of a local single injection of amino-terminally truncated recombinant human fibroblast growth factor-4 (rhFGF-4s) on titanium implant incorporation in a rabbit bone. MATERIAL AND METHODS Thirty-six threaded titanium implants were inserted into the femur and tibia of six rabbits. Three weeks prior to implant insertion 10 microg of FGF-4 in an altelocollagen carrier or the carrier alone was injected into the intended implant sites. Biomechanical evaluation by (i) resonance frequency analysis and (ii) peak removal torque measurements was performed after 6 weeks. The implants with surrounding tissue were processed to undecalcified ground sections followed by light-microscopic quantifications of the bone in threaded area and the apical parts of the implants. RESULTS A general trend, however not statistically significant, with higher mean values obtained in the above-mentioned tests was found. The FGF-4-treated implants revealed a significantly increased bone area in the apical part of the implants compared to the corresponding control implants. CONCLUSION A local single injection of rhFGF-4 may stimulate bone formation around titanium implants in bone. However, further research is required to confirm these results, understand the mechanisms of FGF, and establish optimal dose and delivery methods.
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Affiliation(s)
- Victoria Franke Stenport
- Department of Biomaterials/Handicap Research, Institute of Surgical Sciences, Göteborg University, Göteborg, Sweden.
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Wildemann B, Schmidmaier G, Ordel S, Stange R, Haas NP, Raschke M. Cell proliferation and differentiation during fracture healing are influenced by locally applied IGF-I and TGF-beta1: comparison of two proliferation markers, PCNA and BrdU. J Biomed Mater Res B Appl Biomater 2003; 65:150-6. [PMID: 12632384 DOI: 10.1002/jbm.b.10512] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Growth factors IGF-I and TGF-beta1 are known to stimulate fracture healing. The purpose of this study was to investigate the role of locally applied IGF-I and TGF-beta1 during the early phase of fracture healing (Days 5, 10, and 15 after fracture) on cellular processes like proliferation and differentiation in a rat model. Two different immunohistochemical markers were used to analyze cell proliferation: (1) injection of the thymidine analogue BrdU and subsequent immunohistochemical staining for BrdU-positive nuclei, and (2) the antibody against the "proliferating cell nuclear antigen" (PCNA). In comparison, both methods revealed similar results concerning the types of proliferating cells at the different time points and the two groups. Labeling indices of both methods showed very good correlation (e.g., r(s): 0.887 and p < 0.001 at day 10 in the control group without growth factors). Comparison of the callus morphology and the proliferation rate showed differences during fracture healing due to the local application of IGF-I and TGF-beta1 from coated implants. At Day 5 the callus of the group treated with growth factors displayed an earlier appearance of cartilage compared to the control group. This was accompanied by an onset of cell proliferation in chondrocytes. Likewise, at the later time points an enhanced maturation of the callus tissue and the proliferation pattern were detectable in the growth-factor group. These results indicate that local application of IGF-I and TGF-beta1 accelerates early cellular processes during fracture healing.
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Affiliation(s)
- B Wildemann
- Department of Trauma and Reconstructive Surgery, Charité, Campus Virchow, Humboldt-University of Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
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Schmidmaier G, Wildemann B, Lübberstedt M, Haas NP, Raschke M. IGF-I and TGF-beta 1 incorporated in a poly(D,L-lactide) implant coating stimulates osteoblast differentiation and collagen-1 production but reduces osteoblast proliferation in cell culture. J Biomed Mater Res B Appl Biomater 2003; 65:157-62. [PMID: 12632385 DOI: 10.1002/jbm.b.10513] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous in vivo studies revealed a stimulating effect of locally applied IGF-I and TGF-beta1 released from poly(D,L-lactide)-coated titanium implants on rat and porcine fracture healing. The purpose of the present study was to evaluate the effect of IGF-I (5% w/w) and TGF-beta1 (1% w/w) and the carrier PDLLA on osteoblasts in cell culture to improve the understanding of these growth factors. The well-characterized human osteoblast cell line hFOB 1.19 was used in the study. The implants and cells were cocultured in a noncontact manner. The cells were incubated for 10 days in total, and the implants (n = 6 each group and time point) were added for 1 h, 12 h, 24 h, 2 d, 4 d, or 10 d. To analyze a possible effect of the growth factors or the coating, cell proliferation, metabolism, and differentiation were investigated. As an indicator for differentiation the production of collagen I was chosen. All experimental groups showed comparable cell vitality. No change in the pH of the medium was detectable between the analyzed groups. When the effect of the titanium implant and the PDLLA coating were compared with the control culture, no differences in proliferation, metabolic activity, and collagen I production were detectable. The osteoblasts treated with IGF-I and TGF-beta1 released from PDLLA revealed a significantly enhanced collagen I production with a decrease in proliferation and metabolic activity compared to the other groups. No significant differences in collagen I production were seen due to the incubation time points. None of the experimental groups evoked an immunological response on mouse macrophages. In conclusion, the PDLLA-carrier showed no negative effect on osteoblasts, whereas the incorporated growth factors stimulated osteoblast differentiation.
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Affiliation(s)
- G Schmidmaier
- Department of Trauma and Reconstructive Surgery, Charité, Campus Virchow, Humboldt-University of Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
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Huard J, Li Y, Peng H, Fu FH. Gene therapy and tissue engineering for sports medicine. J Gene Med 2003; 5:93-108. [PMID: 12539148 DOI: 10.1002/jgm.344] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Sports injuries usually involve tissues that display a limited capacity for healing. The treatment of sports injuries has improved over the past 10 to 20 years through sophisticated rehabilitation programs, novel operative techniques, and advances in the field of biomechanical research. Despite this considerable progress, no optimal solution has been found for treatment of various sports-related injuries, including muscle injuries, ligament and tendon ruptures, central meniscal tears, cartilage lesions, and delayed bone fracture healing. New biological approaches focus on the treatment of these injuries with growth factors to stimulate and hasten the healing process. Gene therapy using the transfer of defined genes encoding therapeutic proteins represents a promising way to efficiently deliver suitable growth factors into the injured tissue. Tissue engineering, which may eventually be combined with gene therapy, may potentially result in the creation of tissues or scaffolds for regeneration of tissue defects following trauma. In this article we will discuss why gene therapy and tissue engineering are becoming increasingly important in modern orthopaedic sports medicine practice. We then will review recent research achievements in the area of gene therapy and tissue engineering for sports-related injuries, and highlight the potential clinical applications of this technology in the treatment of patients with musculoskeletal problems following sports-related injuries.
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Affiliation(s)
- Johnny Huard
- University of Pittsburgh, Department of Orthopaedic Surgery, Growth and Development Laboratory, 4151 Rangos Research Center, Pittsburgh, PA 15213, USA. jhuard+@pitt.edu
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Siebert CH, Miltner O, Weber M, Sopka S, Koch S, Niedhart C. Healing of osteochondral grafts in an ovine model under the influence of bFGF. Arthroscopy 2003; 19:182-7. [PMID: 12579151 DOI: 10.1053/jars.2003.50000] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The well-recognized limitations in cartilage healing have lead to the development of a number of resurfacing techniques for defects of joint surfaces. Autologous grafting has developed into 1 of the preferred methods of treatment for focal osteochondral lesions, although basic research on this topic remains sparse. TYPE OF STUDY In an animal study, questions regarding the healing of osteochondral transplants under the influence of basic fibroblast growth factor (bFGF) were addressed. METHODS Two osteochondral autologous transplantations (OAT), 1 in the weight-bearing surface of each femoral condyle, were performed on the ovine knee using a standard operative protocol. One of the grafts was bathed in phosphate buffered sulfate (PBS) containing 50 microgram of recombinant human bFGF (rh-bFGF) directly before implantation. Two groups consisting of 10 sheep each were evaluated after 3 and 6 months, respectively. RESULTS During the evaluation of the specimens, neither osteophytes nor synovial changes were observed. Macroscopically, the superficial border of the transplanted osteochondral plug could easily be outlined at both time periods, even though the cartilage interface of the rh-bFGF specimens was less demarcated. Radiographically, a solid osteointegration of the graft could already be documented at 3 months in the control group. In contrast, integration of the chondral surface of the OAT was not seen macroscopically or microscopically at any point. A firm physical interdigitation of the reconstructed joint surface could not be demonstrated in either of the 2 groups. The augmentation with rh-bFGF stimulated the osseous ingrowth, but was not able to improve chondral healing. CONCLUSIONS The lack of integration of the cartilaginous portion of the transplanted plugs into the reconstructed joint surface, even following augmentation with bFGF, leads to questions regarding the long-term survival of the joint itself.
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Affiliation(s)
- Christian H Siebert
- Orthopaedic Department, University Hospital of the RWTH, Interdisciplinary Center for Clinical Research, Aachen, Germany.
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Shen FH, Visger JM, Balian G, Hurwitz SR, Diduch DR. Systemically administered mesenchymal stromal cells transduced with insulin-like growth factor-I localize to a fracture site and potentiate healing. J Orthop Trauma 2002; 16:651-9. [PMID: 12368646 DOI: 10.1097/00005131-200210000-00007] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine to the ability of systemically administered pluripotential mesenchymal stromal cells to localize to a fracture site and whether transduction with a therapeutic gene, insulin-like growth factor-I (D1-IGF-I), could potentiate healing. DESIGN Murine model, basic science study. SETTING Laboratory. SPECIMENS Closed, transverse, mid-shaft femur fractures were produced in 108 Balb/c mice after intramedullary stabilization. INTERVENTIONS A cloned, pluripotential, mesenchymal cell line, termed D1, was stably transfected with either the gene beta-galactosidase (D1-BAG) as a histologic marker or with the gene IGF-I (D1-IGF-I) growth factor. Mice received systemic injections of either D1-BAG cells for in vivo localization or D1-IGF-I for therapeutic intervention. A third group received lactated Ringer's solution and served as control. MAIN OUTCOME MEASUREMENTS Sections obtained from the fracture site and contralateral femurs were examined histologically and by deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) to detect the presence of transplanted cells at 2, 4, and 6 weeks after fracture. Matrix mineralization and callus maturation were evaluated by histology. RESULTS At all time points, using histologic staining with X-gal and deoxyribonucleic acid-polymerase chain reaction for marker genes, there was a statistically greater number of transplanted cells ( p< 0.001) and significantly higher DNA-PCR for marker genes ( p< 0.001) in the fractured femurs than in the nonfractured femurs. Mice receiving D1-IGF-I cells demonstrated a greater percent of mineralized callus than controls at two weeks (p < 0.05). At 4 and 6 weeks, treated mice demonstrated on average greater mineralized matrix and accelerated progression to an osseous callus as compared with the control group. CONCLUSIONS Cell-based gene therapy has the potential to deliver higher therapeutic levels of growth factors specifically at the site of cell localization while minimizing wider systemic side effects. This study demonstrates that systemically injected IGF-I transduced, mesenchymal cells are able to return to and repopulate the bone marrow. More importantly, these cells localize preferentially to a fracture site and accelerated fracture healing.
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Affiliation(s)
- Francis H Shen
- Department of Orthopaedics, University of Virginia Health Systems, Charlottesville, Virginia 22908, USA
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Day CS, Buranapanitkit B, Riano FA, Tomaino MM, Somogyi G, Sotereanos DG, Kuroda R, Huard J. Insulin growth factor-1 decreases muscle atrophy following denervation. Microsurgery 2002; 22:144-51. [PMID: 12111979 DOI: 10.1002/micr.21742] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite modern microsurgical techniques for nerve repair, functional outcome following proximal injury is often unsatisfactory because irreversible muscle atrophy may develop before reinnervation occurs. Because insulin growth factor-1 (IGF-1) has been shown to improve muscle regeneration after injury, and may have a role in muscle preservation following denervation, the purpose of this investigation was to evaluate the histological, immunohistochemical, and electrophysiological differences between normal, denervated, and IGF-1-injected denervated muscle over an 8-week period. Denervated mice gastrocnemius muscles demonstrated a decrease in muscle weight, a decrease in myofiber diameter, an absence of muscle regeneration, an early increase in the number of neuromuscular junctions (NMJs), and a decrease in fast-twitch and maximum tetanic strength as compared to normal muscle up to 8 weeks following denervation. IGF-1-injected denervated muscle, on the other hand, sustained muscle diameter and muscle weight, maintained a smaller number of NMJs, and relatively sustained fast-twitch and maximum tetanic strength as compared to normal muscle over 8 weeks. These data suggest that IGF-1 may help prevent muscle atrophy and secondary functional compromise after denervation.
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Affiliation(s)
- Charles S Day
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Kandziora F, Schmidmaier G, Schollmeier G, Bail H, Pflugmacher R, Görke T, Wagner M, Raschke M, Mittlmeier T, Haas NP. IGF-I and TGF-beta1 application by a poly-(D,L-lactide)-coated cage promotes intervertebral bone matrix formation in the sheep cervical spine. Spine (Phila Pa 1976) 2002; 27:1710-23. [PMID: 12195060 DOI: 10.1097/00007632-200208150-00006] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A sheep cervical spine interbody fusion model was used to determine the effect of combined insulin-like growth factor-I (IGF-I) and transforming growth factor-beta-1 (TGF-beta1) applied by a poly-(D,L-lactide) (PDLLA)-coated cage. OBJECTIVES The purpose of this study was to determine the effect of a new PDLLA carrier system, and to evaluate the effect of combined IGF-I and TGF-beta1 application in a sheep cervical spine model. SUMMARY AND BACKGROUND DATA Growth factors such as bone morphogenic protein-2 have been shown to promote spine fusion and to overcome the disadvantages of an autologous bone graft. The optimum growth factor for promoting spinal fusion and the optimum method for delivering such growth factors are still a matter of discussion. METHOD In this study, 32 sheep underwent C3-C4 discectomy and fusion: Group 1 (autologous tricortical iliac crest bone graft; n = 8), Group 2 (titanium cage; n = 8), Group 3 (titanium cage coated with a PDLLA carrier; n = 8), and Group 4 (titanium cage coated with a PDLLA carrier including IGF-I [5% w/w] and TGF-beta1 [1% w/w; n = 8). Blood samples, body weight, and body temperature were analyzed. Radiographic scans were performed before and after surgery, then at 1, 2, 4, 8, and 12 weeks, respectively. At the same time points, the disc space height, intervertebral angle, and lordosis angle were measured. After 12 weeks, the animals were killed, and fusion sites were evaluated using functional radiographic views of the animals in flexion and extension. Quantitative computed tomographic scans were performed to assess bone mineral density, bone mineral content, and bony callus volume. Biomechanical testing of the motion segment C3-C4 was performed in flexion, extension, axial rotation, and lateral bending. The stiffness, range of motion, neutral zone, and elastic zone were determined. Histomorphologic and histomorphometric analysis was performed, and polychrome sequential labeling was used to determine the time frame of new bone formation. RESULTS There were no differences between the groups in terms of blood counts, body weight, and temperature. Over a 12-week period, cage Groups 2 to 4 showed significantly higher values for the intervertebral angle than for the bone graft. Functional radiographic assessment showed significantly lower residual flexion-extension movement in Group 4 than in any other group. The PDLLA-coated cages with IGF-I and TGF-beta1 showed significantly higher values for bone mineral density, bone mineral content, and bony callus volume. The average stiffness in rotation and bending was significantly higher, and the range of motion, neutral zone, and elastic zone in rotation were significantly lower in Group 4 than in any other group. Although only one animal in Group 4 demonstrated solid bony fusion after 12 weeks, histomorphometric evaluation showed a more progressed bone matrix formation in the group that had PDLLA-coated cages with IGF-I and TGF-beta1 than in any other group. Polychrome sequential labeling showed accelerated intervertebral bone matrix formation in Group 4. CONCLUSIONS The findings showed that PDLLA coating of cervical spine interbody fusion cages as a delivery system for growth factors was effective. Although IGF-I and TGF-beta1 application by a PDLLA-coated interbody cage was not able to achieve solid bony fusion during the 12-week follow-up period, these growth factors significantly increased the results of interbody bone matrix formation. Additional longer-term studies are required to determine whether combined IGF-I and TGF-beta1 application leads to a successful spinal fusion.
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Affiliation(s)
- Frank Kandziora
- Unfall und Wiederherstellungschirurgie, Universitätsklinikum Charité der Humboldt, Universität Berlin Campus Virchow, Klinikum, Berlin, Germany
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Lieberman JR, Daluiski A, Einhorn TA. The role of growth factors in the repair of bone. Biology and clinical applications. J Bone Joint Surg Am 2002; 84:1032-44. [PMID: 12063342 DOI: 10.2106/00004623-200206000-00022] [Citation(s) in RCA: 719] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jay R Lieberman
- Department of Orthopaedic Surgery, University of California at Los Angeles Medical Center, 90077, USA
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Anderson DD, Campbell PG, Guanche CA. The use of biological agents toaccelerate recovery from rotator cuff repair: Path to clinical application. OPER TECHN SPORT MED 2002. [DOI: 10.1053/otsm.2002.31604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schmidmaier G, Wildemann B, Stemberger A, Haas NP, Raschke M. Biodegradable poly(D,L-lactide) coating of implants for continuous release of growth factors. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2002; 58:449-55. [PMID: 11410904 DOI: 10.1002/jbm.1040] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Local application of growth factors like insulin like growth factor-I (IGF-I) and transforming growth factor-beta 1 (TGF-beta1) from a biodegradable thin layer of poly(D,L-lactide) (PDLLA) coated implants could stimulate fracture healing. A new "cold coating technique" for metallic implants was established to produce a biodegradable coating with a high mechanical stability that provides a continuous release of incorporated growth factors. The properties of this bioactive coating were investigated in vitro and in vivo. Scanning electron microscope analysis revealed a coating thickness of in average 14.8 microm on titanium and 10.7 microm on steel wires. Intramedullary implantation and extraction experiments depicted a loss of PDLLA coating from titanium and steel implants of less than 5%. After explantation of the implants, the coating displayed a complete and regular layer without any defects of PDLLA uncovering the metallic surface. Smear tests demonstrate that the coating can be performed under sterile conditions. The PDLLA depicted a reduction of about 8% within 6 weeks in vitro and in vivo. The growth factors were incorporated in a stable form and demonstrated a loss of stability of less than 3% within 42 days and less than 5% within one year. In an elution experiment, 54% IGF-I and 48% TGF-beta1 were released within the first 48 h. After 42 days, 76% of IGF-I and 71% of TGF-beta1 were detected in the elution fluid by ELISA. Comparable results were obtained in the in vivo experiments after 42 days.
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Affiliation(s)
- G Schmidmaier
- Dept. of Trauma and Reconstructive Surgery, Charité, Humboldt-University of Berlin, Berlin, Germany.
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van Strijen PJ, Breuning KH, Becking AG, Tuinzing DB. Condylar resorption following distraction osteogenesis: a case report. J Oral Maxillofac Surg 2001; 59:1104-7; discussion 1107-8. [PMID: 11526589 DOI: 10.1053/joms.2001.25860] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P J van Strijen
- Department of Oral and Maxillofacial Surgery, Gelderse Vallei Hospital, Ede, The Netherlands.
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Fukushima K, Badlani N, Usas A, Riano F, Fu F, Huard J. The use of an antifibrosis agent to improve muscle recovery after laceration. Am J Sports Med 2001; 29:394-402. [PMID: 11476375 DOI: 10.1177/03635465010290040201] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Muscle injuries are challenging problems in traumatology and the most frequent injuries in sports medicine. Muscle injuries are capable of healing, although slowly and occasionally with incomplete functional recovery. We observed that lacerated muscle undergoes a rapid process of regeneration, which is hindered by the development of fibrosis. Biologic approaches to enhance muscle regeneration and prevent fibrosis are being investigated to improve muscle healing after injuries. We observed that growth factors can improve muscle regeneration but cannot prevent muscle fibrosis. We investigated the use of an antifibrosis substance, decorin, as an approach to prevent fibrosis and thereby improve muscle healing after injury in murine muscle. We observed that direct injection of human recombinant decorin can efficiently prevent fibrosis and enhance muscle regeneration in the lacerated muscle. More importantly, decorin can improve the recovery of strength in the injured muscle to a level similar to that observed in normal noninjured muscle. These results suggest that injection of decorin improves both the muscle structure and the function of the lacerated muscle to near complete recovery. This study will contribute significantly to the development of strategies to promote efficient muscle healing and complete functional recovery after muscle injuries.
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Affiliation(s)
- K Fukushima
- Department of Orthopaedic Surgery, Children's Hospital of Pittsburgh and University of Pittsburgh, Pennsylvania 15213, USA
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Abstract
Part II of this two-part review focuses on the function of specific growth factors in wound healing and considers the results of clinical trials of their use in chronic wounds.
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Affiliation(s)
- L Krishnamoorthy
- Wound Healing Research Unit, University of Wales College of Medicine, Cardiff, UK
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Schmidmaier G, Wildemann B, Bail H, Lucke M, Fuchs T, Stemberger A, Flyvbjerg A, Haas NP, Raschke M. Local application of growth factors (insulin-like growth factor-1 and transforming growth factor-beta1) from a biodegradable poly(D,L-lactide) coating of osteosynthetic implants accelerates fracture healing in rats. Bone 2001; 28:341-50. [PMID: 11336914 DOI: 10.1016/s8756-3282(00)00456-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In vitro and in vivo studies have demonstrated an osteoinductive effect of growth factors such as insulin-like growth factor-1 (IGF-1) and transforming growth factor-beta1 (TGF-beta1). However, for therapeutic use in fracture treatment, questions remain with regard to the local application of these proteins. A controlled, local release of growth factors from a biodegradable polylactide coating of osteosynthetic implants may have a stimulating effect on fracture healing. Such implants could stabilize the fracture and their bioactive surface could function simultaneously as a local drug-delivery system. Previous studies have demonstrated the high mechanical stability of an approximately 10-14-microm-thick poly(D,L-lactide) (PDLLA) coating on metallic implants, which can even withstand the process of intramedullary insertion. Following an initial peak, 80% of incorporated growth factors IGF-1 and TGF-beta1 were continuously released within 42 days. The effect of locally applied IGF-1 and TGF-beta1 from a biodegradable PDLLA coating of intramedullary implants on fracture healing was investigated in a rat model. Midshaft fractures of the right tibia of 5-month-old female Sprague-Dawley rats (n = 127) were stabilized with coated vs. uncoated titanium Kirschner wires. X-ray examinations and blood analyses were performed, and body weight and body temperature measurements were taken throughout the experimental period. After 28 and 42 days, respectively, tibiae were dissected for mechanical torsional testing and histomorphometrical analyses. X-rays demonstrated an almost completely consolidated fracture, biomechanical testing showed a significantly higher maximum load and torsional stiffness, and histological and histomorphometric analyses demonstrated progressed remodeling after 28 and 42 days in the group treated with growth factors as compared with controls. Interestingly, the PDLLA coating itself revealed a positive effect on fracture healing even without incorporated growth factors. No systemic changes of serum parameters, including IGF-1 and IGF binding proteins, and no differences in body weight and body temperature were observed within and between groups. These findings suggest that the local application of growth factors from a biodegradable PDLLA coating of osteosynthetic implants accelerates fracture healing significantly without systemic side effects.
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Affiliation(s)
- G Schmidmaier
- Department of Trauma and Reconstructive Surgery, Charité, Humboldt University of Berlin, Berlin, Germany.
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Simank HG, Manggold J, Sebald W, Ries R, Richter W, Ewerbeck V, Sergi C. Bone morphogenetic protein-2 and growth and differentiation factor-5 enhance the healing of necrotic bone in a sheep model. Growth Factors 2001; 19:247-57. [PMID: 11811780 DOI: 10.3109/08977190109001090] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Osteotropic growth factors enhance bone repair, but their efficacy in an area of necrotic bone is not known. The purpose of this study was to investigate the effects and potential side effects of an intraosseous application of absorbable bone morphogenetic protein-2 (BMP-2) and growth and differentiation factor-5 (GDF-5) composites in a sheep model for partial necrosis of the femoral head. MATERIALS AND METHODS The direct injection of ethanol under fluoroscopy into the superior centre of the right femoral head produced histologically documentable necrosis of the central region of the head in a previous study of ten sheep. Another 27 sheep constituted the sample to study the effects of BMP-2 and GDF-5. Necrosis was produced in the same fashion in these animals. Four weeks later nine sheep received 300 microg recombinant BMP-2 and nine sheep 300 microg recombinant GDF-5 on an absorbable carrier by surgical implantation. Nine sheep received the carrier alone (control group). The animals were sacrificed at 3, 6, and 12 weeks after implantation and both femora were harvested. RESULTS Bone density analysis and microscopic examination indicated that bone formation was noticeably induced as early as 3 weeks postoperatively in the growth factor treated animals. Bone regeneration was enhanced by growth factor composites. This was documented by histological scoring and histomorphometric analysis. No severe local side effects secondary to the growth factors, such as heterotopic ossification or inflammation, were observed in either group. DISCUSSION The application of an absorbable growth factor composite in combination with established surgical techniques is a promising approach, that may enhance the healing of devitalised bone defects. Based on these results, further studies regarding biodegradation, dosage of the protein and surgical technique are required.
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Affiliation(s)
- H G Simank
- Department of Orthopaedics, University of Heidelberg, Germany.
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Abstract
Following injury, bone has the ability to regenerate itself to a form and function nearly indistinguishable from the pre-injury state. However, if the injury is beyond a critical limit, recovery will not occur without therapeutic interventions. Autografts and implants with banked bone continue as the treatments of choice, although each exhibits limitations and liabilities. Alternatives have included the utilization of bone-graft substitutes that may incorporate bone derivatives and soluble signaling molecules such as mitogens and morphogens. In addition, an evolving treatment modality, gene therapy, offers an exciting avenue for bone regeneration. This review presents some of the current concepts for developing a rational gene therapy approach in bone regeneration.
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Affiliation(s)
- S R Winn
- Department of Surgery, School of Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.
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