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Yang Q, Xu M, Fang H, Gao Y, Zhu D, Wang J, Chen Y. Targeting micromotion for mimicking natural bone healing by using NIPAM/Nb 2C hydrogel. Bioact Mater 2024; 39:41-58. [PMID: 38800718 PMCID: PMC11127186 DOI: 10.1016/j.bioactmat.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Natural fracture healing is most efficient when the fine-tuned mechanical force and proper micromotion are applied. To mimick this micromotion at the fracture gap, a near-infrared-II (NIR-II)-activated hydrogel was fabricated by integrating two-dimensional (2D) monolayer Nb2C nanosheets into a thermally responsive poly(N-isopropylacrylamide) (NIPAM) hydrogel system. NIR-II-triggered deformation of the NIPAM/Nb2C hydrogel was designed to generate precise micromotion for co-culturing cells. It was validated that micromotion at 1/300 Hz, triggering a 2.37-fold change in the cell length/diameter ratio, is the most favorable condition for the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Moreover, mRNA sequencing and verification revealed that micromotion-induced augmentation was mediated by Piezo1 activation. Suppression of Piezo1 interrupts the mechano-sensitivity and abrogates osteogenic differentiation. Calvarial and femoral shaft defect models were established to explore the biocompatibility and osteoinductivity of the Micromotion Biomaterial. A series of research methods, including radiography, micro-CT scanning, and immunohistochemical staining have been performed to evaluate biosafety and osteogenic efficacy. The in vivo results revealed that tunable micromotion strengthens the natural fracture healing process through the sequential activation of endochondral ossification, promotion of neovascularization, initiation of mineral deposition, and combinatory acceleration of full-thickness osseous regeneration. This study demonstrated that Micromotion Biomaterials with controllable mechanophysical characteristics could promote the osteogenic differentiation of BMSCs and facilitate full osseous regeneration. The design of NIPAM/Nb2C hydrogel with highly efficient photothermal conversion, specific features of precisely controlled micromotion, and bionic-mimicking bone-repair capabilities could spark a new era in the field of regenerative medicine.
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Affiliation(s)
- Qianhao Yang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Mengqiao Xu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Haoyu Fang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Youshui Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Daoyu Zhu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jing Wang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Yixuan Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
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Görlitz S, Brauer E, Günther R, Duda GN, Knaus P, Petersen A. Temporal regulation of BMP2 growth factor signaling in response to mechanical loading is linked to cytoskeletal and focal adhesion remodeling. Commun Biol 2024; 7:1064. [PMID: 39215206 PMCID: PMC11364689 DOI: 10.1038/s42003-024-06753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Biophysical cues have the ability to enhance cellular signaling response to Bone Morphogenetic Proteins, an essential growth factor during bone development and regeneration. Yet, therapeutic application of Bone Morphogenetic Protein 2 (BMP2) is restricted due to uncontrolled side effects. An understanding of the temporal characteristics of mechanically regulated signaling events and underlying mechanism is lacking. Using a 3D bioreactor system in combination with a soft macroporous biomaterial substrate, we mimic the in vivo environment that BMP2 is acting in. We show that the intensity and duration of BMP2 signaling increases with increasing loading frequency in synchrony with the number and size of focal adhesions. Long-term mechanical stimulation increases the expression of BMP receptor type 1B, specific integrin subtypes and integrin clustering. Together, this triggered a short-lived mechanical echo that enhanced BMP2 signaling even when BMP2 is administered directly after mechanical stimulation, but not when it is applied after a resting period of ≥30 min. Interfering with cytoskeletal remodeling hinders focal adhesion remodeling verifying its critical role in shifting cells into a state of high BMP2 responsiveness. The design of biomaterials that exploit this potential locally at the site of injury will help to overcome current limitations of clinical growth factor treatment.
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Affiliation(s)
- Sophie Görlitz
- Julius Wolff Institute, Berlin Institute of Health at Charité, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité, Berlin, Germany
| | - Erik Brauer
- Julius Wolff Institute, Berlin Institute of Health at Charité, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité, Berlin, Germany
| | - Rebecca Günther
- Julius Wolff Institute, Berlin Institute of Health at Charité, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Knaus
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité, Berlin, Germany
- Freie Universität Berlin, Institute for Chemistry and Biochemistry, Berlin, Germany
| | - Ansgar Petersen
- Julius Wolff Institute, Berlin Institute of Health at Charité, Berlin, Germany.
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité, Berlin, Germany.
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Bowers KM, Anderson DE. Delayed Union and Nonunion: Current Concepts, Prevention, and Correction: A Review. Bioengineering (Basel) 2024; 11:525. [PMID: 38927761 PMCID: PMC11201148 DOI: 10.3390/bioengineering11060525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Surgical management of fractures has advanced with the incorporation of advanced technology, surgical techniques, and regenerative therapies, but delayed bone healing remains a clinical challenge and the prevalence of long bone nonunion ranges from 10 to 15% of surgically managed fractures. Delayed bone healing arises from a combination of mechanical, biological, and systemic factors acting on the site of tissue remodeling, and careful consideration of each case's injury-related, patient-dependent, surgical, and mechanical risk factors is key to successful bone union. In this review, we describe the biology and biomechanics of delayed bone healing, outline the known risk factors for nonunion development, and introduce modern preventative and corrective therapies targeting fracture nonunion.
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Affiliation(s)
| | - David E. Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996-4550, USA;
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4
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Hast M, Glatt V, Archdeacon M, Ledet E, Lewis G, Ahn J, Haller J. Biomechanics of fracture healing: how best to optimize your construct in the OR. OTA Int 2024; 7:e304. [PMID: 38487404 PMCID: PMC10936157 DOI: 10.1097/oi9.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Orthopaedic surgeons routinely assess the biomechanical environment of a fracture to create a fixation construct that provides the appropriate amount of stability in efforts to optimize fracture healing. Emerging concepts and technologies including reverse dynamization, "smart plates" that measure construct strain, and FractSim software that models fracture strain represent recent developments in optimizing construct biomechanics to accelerate bone healing and minimize construct failure.
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Affiliation(s)
- Michael Hast
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Michael Archdeacon
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, OH
| | - Eric Ledet
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, OH
| | - Gregory Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - Jaimo Ahn
- Department Orthopedics Surgery, University of Michigan, Ann Arbor, MI
| | - Justin Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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Bafor A, Iobst C, Samchukov M, Cherkashin A, Singh S, Aguilar L, Glatt V. Reverse Dynamization Accelerates Regenerate Bone Formation and Remodeling in a Goat Distraction Osteogenesis Model. J Bone Joint Surg Am 2023; 105:1937-1946. [PMID: 37639500 DOI: 10.2106/jbjs.22.01342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
UPDATE This article was updated on December 20, 2023, because of previous errors, which were discovered after the preliminary version of the article was posted online. Figure 4 has been replaced with a figure that presents different p values. Also, on page 1943, the text that had read: "Quantitative microCT confirmed that the total volume of the regenerate in the RD group was much smaller compared with the SF (p = 0.06) and DF (p = 0.007) groups, although it was significantly smaller only compared with the DF group (Fig. 4-A). The total volume of the intact bone (contralateral tibia) was significantly smaller in the RD group compared with the other groups, but the RD group had values closest to those for the intact tibia. Similarly, the RD group had less bone volume compared with the SF and DF groups, and this value was significantly different from the DF group (p = 0.034; Fig. 4-B). Of the 3 groups, the RD group had vBMD that was the closest to that of intact bone. It also had significantly higher vBMD compared with the SF and DF groups (p < 0.0001 for both; Fig. 4-C).The results of torsional testing (Fig. 4-D) confirmed that the regenerate bone formed under conditions of RD was significantly stronger than that formed under SF or DF (p < 0.001 versus SF group, and p = 0.0493 versus DF group)."now reads: "Quantitative microCT confirmed that the total volume of the regenerate in the RD group was significantly smaller compared with the SF and DF groups (p < 0.01 for both groups; Fig. 4-A). The total volume of the intact bone (contralateral tibia) was significantly smaller compared with the SF and DF groups (p < 0.0001 for both). The RD group had values closest to those for the intact tibia, and this difference was not significant (Fig. 4-A). Similarly, the RD group had less bone volume compared with the SF and DF groups, and this value was significantly different from the DF group (p < 0.01; Fig. 4-B). Of the 3 groups, the RD group had vBMD that was the closest to that of intact bone, but the intact bone was significantly different compared with all of the other groups (p < 0.0001 for all groups). The RD group had significantly higher vBMD compared with the SF and DF groups (p = 0.042 and p = 0.046, respectively; Fig. 4-C).The results of torsional testing (Fig. 4-D) confirmed that the regenerate bone formed under conditions of RD was significantly stronger than that formed under SF or DF (p < 0.0001 versus SF group, and p = 0.0493 versus DF group). The intact group was significantly different compared with the SF group (p < 0.0001)."
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Affiliation(s)
- Anirejuoritse Bafor
- Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Christopher Iobst
- Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mikhail Samchukov
- The Center for Excellence in Limb Lengthening & Reconstruction, Texas Scottish Rite Hospital for Children, Dallas, Texas
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander Cherkashin
- The Center for Excellence in Limb Lengthening & Reconstruction, Texas Scottish Rite Hospital for Children, Dallas, Texas
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satbir Singh
- Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Leonardo Aguilar
- Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Vaida Glatt
- Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Williams KE, Andraca Harrer J, LaBelle SA, Leguineche K, Kaiser J, Karipott S, Lin A, Vongphachanh A, Fulton T, Rosenthal JW, Muhib F, Ong KG, Weiss JA, Willett NJ, Guldberg RE. Early Resistance Rehabilitation Improves Functional Regeneration Following Segmental Bone Defect Injury. RESEARCH SQUARE 2023:rs.3.rs-3236150. [PMID: 37886569 PMCID: PMC10602073 DOI: 10.21203/rs.3.rs-3236150/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Mechanical loading is integral to bone development and repair. The application of mechanical loads through rehabilitation are regularly prescribed as a clinical aide following severe bone injuries. However, current rehabilitation regimens typically involve long periods of non-loading and rely on subjective patient feedback, leading to muscle atrophy and soft tissue fibrosis. While many pre-clinical studies have focused on unloading, ambulatory loading, or direct mechanical compression, rehabilitation intensity and its impact on the local strain environment and subsequent bone healing have largely not been investigated. This study combines implantable strain sensors and subject-specific finite element models in a pre-clinical rodent model with a defect size on the cusp of critically-sized. Animals were enrolled in either high or low intensity rehabilitation one week post injury to investigate how rehabilitation intensity affects the local mechanical environment and subsequent functional bone regeneration. The high intensity rehabilitation animals were given free access to running wheels with resistance, which increased local strains within the regenerative niche by an average of 44% compared to the low intensity (no-resistance) group. Finite element modeling demonstrated that resistance rehabilitation significantly increased compressive strain by a factor of 2.0 at week 1 and 4.45 after 4 weeks of rehabilitation. The resistance rehabilitation group had significantly increased regenerated bone volume and higher bone bridging rates than its sedentary counterpart (bone volume: 22.00 mm3 ± 4.26 resistance rehabilitation vs 8.00 mm3 ± 2.27 sedentary; bridging rates: 90% resistance rehabilitation vs 50% sedentary). In addition, animals that underwent resistance running had femurs with improved mechanical properties compared to those left in sedentary conditions, with failure torque and torsional stiffness values matching their contralateral, intact femurs (stiffness: 0.036 Nm/deg ± 0.006 resistance rehabilitation vs 0.008 Nm/deg ± 0.006 sedentary). Running on a wheel with no resistance rehabilitation also increased bridging rates (100% no resistance rehabilitation vs 50% sedentary). Analysis of bone volume and von Frey suggest no-resistance rehabilitation may improve bone regeneration and hindlimb functionality. These results demonstrate the potential for early resistance rehabilitation as a rehabilitation regimen to improve bone regeneration and functional recovery.
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Affiliation(s)
- Kylie E. Williams
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Julia Andraca Harrer
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
- Atlanta Veteran’s Affairs Medical Center, Decatur, GA
| | - Steven A. LaBelle
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 841123
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112
| | - Kelly Leguineche
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Jarred Kaiser
- Atlanta Veteran’s Affairs Medical Center, Decatur, GA
- Emory University, Decatur, GA
| | - Salil Karipott
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Angela Lin
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Alyssa Vongphachanh
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Travis Fulton
- Atlanta Veteran’s Affairs Medical Center, Decatur, GA
| | - J. Walker Rosenthal
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Farhan Muhib
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 841123
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112
| | - Keat Ghee Ong
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Jeffrey A. Weiss
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 841123
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 841123
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112
| | - Nick J. Willett
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
| | - Robert E. Guldberg
- Phil and Penny Knight Campus for Accelerating Scientific Impact Department of Bioengineering, University of Oregon, Eugene, OR 97403
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Li R, Cheng W, Liu H, Luo R, Zou H, Zhang L, Ren T, Xu C. Effect of Mechanical Loading on Bone Regeneration in HA/β-TCP/SF Scaffolds Prepared by Low-Temperature 3D Printing In Vivo. ACS Biomater Sci Eng 2023; 9:4980-4993. [PMID: 37428513 DOI: 10.1021/acsbiomaterials.3c00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
It has been well demonstrated that a dynamic culture environment improves tissue-engineered bone formation in vitro, but little is known about how cyclical mechanical loading induced bone formation in scaffolds in situ. To mimic the organic and inorganic components and multilevel structure of a bony microenvironment, hydroxyapatite/β tricalcium phosphate/silk fibroin(HA/β-TCP/SF) composite scaffolds with macro- and micropores were fabricated in this study. The mechanical properties and structure of the scaffolds were adjusted based on the ratio of organic and inorganic components and three-dimensional (3D) printing parameters. Dynamic sinusoidal loading with different frequencies was applied to the composite scaffold. Mouse bone precursor cells MC3T3-E1 were seeded on the scaffolds, and the cell compatibility of the scaffolds was investigated by MTT, SEM, and HE. The effect of the loading on bone formation in the scaffold in situ was investigated in a rabbit tibia defect model. The scaffold showed viscoelasticity and hysteresis under dynamic sinusoidal loading with different frequencies. With an increase in HA/β-TCP, the stress and modulus of the scaffolds increased. MTT, SEM, and HE results showed that MC3T3-E1 cells could adhere and proliferate on the composite scaffolds. After loading in vivo, the quantity of newly formed bone and the bone volume fraction increased. Micro-CT, undecalcified Van Gieson (VG) staining, and fluorescent double-labeling results suggested that appropriate cyclical mechanical loading at frequencies of 1 and 10 Hz had positive effects on bone formation in situ and it may play a role in clinical bone defect repair.
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Affiliation(s)
- Ruixin Li
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, The Affiliated Stomatological Hospital of Nankai University, Tianjin 300041, China
| | - Wei Cheng
- People's Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450003, China
| | - Hao Liu
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, The Affiliated Stomatological Hospital of Nankai University, Tianjin 300041, China
| | - Rui Luo
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, The Affiliated Stomatological Hospital of Nankai University, Tianjin 300041, China
| | - Huiru Zou
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, The Affiliated Stomatological Hospital of Nankai University, Tianjin 300041, China
| | - Linkun Zhang
- Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, The Affiliated Stomatological Hospital of Nankai University, Tianjin 300041, China
| | - Tingting Ren
- China National Accreditation Service for Conformity Assessment, Beijing 100062, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing 100048, China
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Glatt V, O'Toole R, Mehta S, Kandemir U, Ricci W, Nauth A, Schemitsch E, Hast MW. Great debates in trauma biomechanics. OTA Int 2023; 6:e249. [PMID: 37168029 PMCID: PMC10166369 DOI: 10.1097/oi9.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/22/2022] [Indexed: 05/13/2023]
Abstract
At the 2021 annual meeting of the Orthopaedic Trauma Association, the Basic Science Focus Forum hosted its first ever debate-style symposium focused on biomechanics and fracture repair. The 3 subjects of debate were "Mechanics versus Biology-Which is 'More Important' to Consider?" "Locked Plate versus Forward Dynamization versus Reverse Dynamization-Which Way Should I Go?" and "Sawbones versus Cadaver Models-What Should I Believe Most?" These debates were held because fracture healing is a highly organized synergistic response between biological factors and the local mechanical environment. Multiple studies have demonstrated that both factors play roles in governing bone healing responses, and the causal relationships between the 2 remain unclear. The lack of clarity in this space has led to a spectrum of research with the common goal of helping surgeons make good decisions. Before reading further, the reader should understand that the questions posed in the debate titles are unanswerable and might represent a false choice. Instead, the reader should appreciate that the debates were held to gain a more thorough understanding of these topics based on the current state of the art of experimental and clinical studies, by using an engaging and thought-provoking format.
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Affiliation(s)
- Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Robert O'Toole
- Department of Orthopaedic Surgery, University of Maryland Medical System, Baltimore, MD
| | - Samir Mehta
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Utku Kandemir
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - William Ricci
- Department of Orthopaedic Surgery, Hospital for Special Surgery and New York Presbyterian Hospital, New York, NY
| | - Aaron Nauth
- Department of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada; and
| | - Emil Schemitsch
- Department of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Michael W. Hast
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Surgical Classification for Preclinical Rat Femoral Bone Defect Model: Standardization Based on Systematic Review, Anatomical Analysis and Virtual Surgery. Bioengineering (Basel) 2022; 9:bioengineering9090476. [PMID: 36135022 PMCID: PMC9495991 DOI: 10.3390/bioengineering9090476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 12/03/2022] Open
Abstract
Though surgical techniques profoundly influence in vivo experiments, significant heterogeneity exists in current surgeries for inducing rat femoral bone defects. Such variations reduce the reproducibility and comparability of preclinical studies, and are detrimental to clinical translation. The purposes of this study were: (1) to conduct a systematic review of rat femoral defect models, summarizing and analyzing the surgical techniques; (2) to analyze surgical design and potential pitfalls via 3D anatomy and virtual surgeries for fostering future precision research; and (3) to establish a surgical classification system, for improving the reproducibility and comparability among studies, avoiding unnecessary repetitive experiments. The online database PubMed was searched to identify studies from January 2000 to June 2022 using keywords, including rat, femur, bone defect. Eligible publications were included for a review of surgical methods. Anatomical analysis and virtual surgeries were conducted based on micro-CT reconstruction of the rat femur for further investigation and establishment of a classification system. A total of 545 publications were included, revealing marked heterogeneity in surgical methods. Four major surgical designs were reported for inducing defects from the proximal to distal femur: bone tunnel, cortical window, segmental defect, and wedge-shaped defect. Anatomical analysis revealed potential pitfalls hindering efficient clinical translation. A classification system was established according to the anatomical region, surgical design, and fixation devices. This systematic review in combination with 3D analysis and virtual surgery provides a general overview of current surgical approaches to inducing femoral defects in rats, and establishes a surgical classification facilitating preclinical research of quality and translational value.
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Lackington WA, Gehweiler D, Zhao E, Zderic I, Nehrbass D, Zeiter S, González-Vázquez A, O'Brien FJ, Stoddart MJ, Thompson K. Interleukin-1 receptor antagonist enhances the therapeutic efficacy of a low dose of rhBMP-2 in a weight-bearing rat femoral defect model. Acta Biomater 2022; 149:189-197. [PMID: 35840106 DOI: 10.1016/j.actbio.2022.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/01/2022]
Abstract
In the clinical treatment of fractures, rhBMP-2 administration is associated with a well-established profile of side-effects, including osteolysis and ectopic bone formation, which are driven by pro-inflammatory processes triggered by the use of high doses. Immunomodulatory strategies could minimize the incidence of side-effects by enabling the use of lower, and safer, rhBMP-2 doses. This study investigated whether interleukin-1 receptor antagonist (IL-1Ra) can enhance the therapeutic efficacy of a low dose of rhBMP-2 in a weight-bearing femoral fracture healing model. Exogenous IL-1Ra, in combination with rhBMP-2, was delivered using a collagen-hydroxyapatite scaffold (CHA) to attenuate IL-1β produced in response to fracture. Femoral defects were treated with CHA scaffolds alone, or loaded with IL-1Ra (2.5 µg), rhBMP-2 (1 µg), IL-1Ra (2.5 µg) in combination with rhBMP-2 (1 µg). Bone healing was assessed over 14 weeks in comparison to control groups, empty defect, and a higher dose of rhBMP-2 (5 µg), which were recently demonstrated to lead to non-union, and successful bridging of the defect, respectively. The combination of IL-1Ra and rhBMP-2 led to significantly faster early bone formation, at both week 4 and 6, compared to a low dose of rhBMP-2 alone. By 14 weeks, the combination of IL-1Ra and a rhBMP-2 promoted full bridging of femurs, which were 3-fold more mechanically reliable compared to the femurs treated with a low dose of rhBMP-2 alone. Taken together, this study demonstrates that IL-1Ra can significantly enhance femoral bone healing when used in combination with a low dose of rhBMP-2. STATEMENT OF SIGNIFICANCE: Enabling the use of lower and safer doses of rhBMP-2, a potent inducer of bone formation, is of clinical relevance in orthopaedic medicine. In this study, the immunomodulatory interleukin-1 receptor antagonist (IL-1Ra) was investigated for its capacity to enhance the therapeutic efficacy of rhBMP-2 when used at lower doses in a weight-bearing femoral fracture healing model. The combination of IL-1Ra and rhBMP-2 led to significantly faster early bone formation, and resulted in more mechanically reliable healed femurs, compared to a low dose of rhBMP-2 alone. This demonstrates for the first time in a rat long bone healing model that IL-1Ra can significantly enhance bone healing when used in combination with a low dose of rhBMP-2.
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Affiliation(s)
- William A Lackington
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland; Present address: Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biointerfaces, St. Gallen, Switzerland
| | - Dominic Gehweiler
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Ensi Zhao
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Dirk Nehrbass
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Stephan Zeiter
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Arlyng González-Vázquez
- Tissue Engineering Research Group, Dept. of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland; AMBER Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Dept. of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin, Ireland; AMBER Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Martin J Stoddart
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Keith Thompson
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland.
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11
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Lowen GB, Garrett KA, Moore-Lotridge SN, Uppuganti S, Guelcher SA, Schoenecker JG, Nyman JS. Effect of Intramedullary Nailing Patterns on Interfragmentary Strain in a Mouse Femur Fracture: A Parametric Finite Element Analysis. J Biomech Eng 2022; 144:051007. [PMID: 34802060 PMCID: PMC8822464 DOI: 10.1115/1.4053085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/17/2021] [Indexed: 11/08/2022]
Abstract
Delayed long bone fracture healing and nonunion continue to be a significant socioeconomic burden. While mechanical stimulation is known to be an important determinant of the bone repair process, understanding how the magnitude, mode, and commencement of interfragmentary strain (IFS) affect fracture healing can guide new therapeutic strategies to prevent delayed healing or nonunion. Mouse models provide a means to investigate the molecular and cellular aspects of fracture repair, yet there is only one commercially available, clinically-relevant, locking intramedullary nail (IMN) currently available for studying long bone fractures in rodents. Having access to alternative IMNs would allow a variety of mechanical environments at the fracture site to be evaluated, and the purpose of this proof-of-concept finite element analysis study is to identify which IMN design parameters have the largest impact on IFS in a murine transverse femoral osteotomy model. Using the dimensions of the clinically relevant IMN as a guide, the nail material, distance between interlocking screws, and clearance between the nail and endosteal surface were varied between simulations. Of these parameters, changing the nail material from stainless steel (SS) to polyetheretherketone (PEEK) had the largest impact on IFS. Reducing the distance between the proximal and distal interlocking screws substantially affected IFS only when nail modulus was low. Therefore, IMNs with low modulus (e.g., PEEK) can be used alongside commercially available SS nails to investigate the effect of initial IFS or stability on fracture healing with respect to different biological conditions of repair in rodents.
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Affiliation(s)
- Gregory B. Lowen
- Vanderbilt University, Department of Chemical and Biomolecular Engineering, 2201 West End Ave, Nashville, TN 37235
| | - Katherine A. Garrett
- Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232
| | - Stephanie N. Moore-Lotridge
- Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232;Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212
| | - Sasidhar Uppuganti
- Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232;Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212
| | - Scott A. Guelcher
- Vanderbilt University, Department of Chemical and Biomolecular Engineering, 2201 West End Ave, Nashville, TN 37235; Vanderbilt University, Department of Biomedical Engineering, 5824 Stevenson Center, Nashville, TN 37232; Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212; Vanderbilt University Medical Center, Division of Clinical Pharmacology, 1211 Medical Center Dr, Nashville, TN 37217
| | - Jonathan G. Schoenecker
- Vanderbilt University, Department of Pharmacology, 465 21 Ave South, 7124 Medical Research Building III, Nashville, TN 37232; Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212; Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, 1161 21 Ave S C-3322 Medical Center North, Nashville, TN 37232; Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232
| | - Jeffry S. Nyman
- Vanderbilt University, Department of Biomedical Engineering, 5824 Stevenson Center, Nashville, TN 37232; Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232; Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212; Tennessee Valley Healthcare System, Department of Veterans Affairs, 1310 24 Ave. S, Nashville, TN 37212
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12
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DeBaun MR, Salazar BP, Bai Y, Gardner MJ, Yang YP, Pan CC, Stahl AM, Moeinzadeh S, Kim S, Lui E, Kim C, Lin S, Goodnough LH, Wadhwa H. A bioactive synthetic membrane improves bone healing in a preclinical nonunion model. Injury 2022; 53:1368-1374. [PMID: 35078617 PMCID: PMC8940692 DOI: 10.1016/j.injury.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES High energy long bone fractures with critical bone loss are at risk for nonunion without strategic intervention. We hypothesize that a synthetic membrane implanted at a single stage improves bone healing in a preclinical nonunion model. METHODS Using standard laboratory techniques, microspheres encapsulating bone morphogenic protein-2 (BMP2) or platelet derived growth factor (PDGF) were designed and coupled to a type 1 collagen sheet. Critical femoral defects were created in rats and stabilized by locked retrograde intramedullary nailing. The negative control group had an empty defect. The induced membrane group (positive control) had a polymethylmethacrylate spacer inserted into the defect for four weeks and replaced with a bare polycaprolactone/beta-tricalcium phosphate (PCL/β-TCP) scaffold at a second stage. For the experimental groups, a bioactive synthetic membrane embedded with BMP2, PDGF or both enveloped a PCL/β-TCP scaffold was implanted in a single stage. Serial radiographs were taken at 1, 4, 8, and 12 weeks postoperatively from the definitive procedure and evaluated by two blinded observers using a previously described scoring system to judge union as primary outcome. RESULTS All experimental groups demonstrated better union than the negative control (p = 0.01). The groups with BMP2 incorporated into the membrane demonstrated higher average union scores than the other groups (p = 0.01). The induced membrane group performed similarly to the PDGF group. Complete union was only demonstrated in groups with BMP2-eluting membranes. CONCLUSIONS A synthetic membrane comprised of type 1 collagen embedded with controlled release BMP2 improved union of critical bone defects in a preclinical nonunion model.
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Affiliation(s)
| | - Brett P Salazar
- Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Yan Bai
- Department of Orthopaedic Surgery, Stanford University, CA, USA; School of Pharmacy, Chongqing Medical University, Chongqing, China
| | | | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA; Department of Bioengineering, Stanford University, CA, USA.
| | - Chi-Chun Pan
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA
| | | | | | - Sungwoo Kim
- Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA
| | - Carolyn Kim
- Department of Orthopaedic Surgery, Stanford University, CA, USA; Department of Mechanical Engineering, Stanford University, CA, USA
| | - Sien Lin
- Department of Orthopaedic Surgery, Stanford University, CA, USA
| | | | - Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford University, CA, USA
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13
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Margolis DS, Figueroa G, Barron Villalobos E, Smith JL, Doane CJ, Gonzales DA, Szivek JA. A Large Segmental Mid-Diaphyseal Femoral Defect Sheep Model: Surgical Technique. J INVEST SURG 2022; 35:1287-1295. [DOI: 10.1080/08941939.2022.2045393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- David S. Margolis
- Orthopedic Research Laboratory, College of Medicine, University of Arizona, Tucson, Arizona
| | - Gerardo Figueroa
- Orthopedic Research Laboratory, College of Medicine, University of Arizona, Tucson, Arizona
| | | | - Jordan L. Smith
- Orthopedic Research Laboratory, College of Medicine, University of Arizona, Tucson, Arizona
| | | | - David A. Gonzales
- Orthopedic Research Laboratory, College of Medicine, University of Arizona, Tucson, Arizona
| | - John A. Szivek
- Orthopedic Research Laboratory, College of Medicine, University of Arizona, Tucson, Arizona
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14
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Fu R, Feng Y, Liu Y, Willie BM, Yang H. The combined effects of dynamization time and degree on bone healing. J Orthop Res 2022; 40:634-643. [PMID: 33913530 DOI: 10.1002/jor.25060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
Dynamization, increasing the interfragmentary movement (IFM) by reducing the fixation stiffness from a rigid to a more flexible condition, is widely used clinically to promote fracture healing. However, it remains unknown how dynamization degree (relative change in fixation stiffness/IFM from a rigid to a flexible fixation) affects bone healing at various stages. To address this issue, we used a fuzzy logic-based mechano-regulated tissue differentiation algorithm on published experimental data from a sheep osteotomy healing model. We applied a varied degree of dynamization, from 0 (fully rigid fixation) to 0.9 (90% reduction in stiffness relative to the rigid fixation) after 1, 2, 3, and 4 weeks of osteotomy (R1wF, R2wF, R3wF, and R4wF) and computationally evaluated bone regeneration and biomechanical integrity over the healing process of 8 weeks. Compared with the constant rigid fixation, early dynamization (R1wF and R2wF) led to delays in bone bridging and biomechanical recovery of the osteotomized bone. However, the effect of early dynamization on healing was dependent of the degree of dynamization. Specifically, a higher dynamization degree (e.g., 0.9 for R1wF) led to a prolonged delay in bone bridging and largely unrecovered bending stiffness (48% relative to the intact bone), whereas a moderate degree of dynamization (e.g., 0.5 or 0.7) significantly enhanced bone formation and biomechanical properties of the osteotomized bone. These results suggest that dynamization degree and timing interactively affect the healing process. A combination of early dynamization with a moderate degree could enhance the ultimate biomechanical recovery of the fractured bone.
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Affiliation(s)
- Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bettina M Willie
- Department of Pediatric Surgery, Research Centre, Shriners Hospital for Children-Canada, McGill University, Montreal, Quebec, Canada
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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15
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Schmidt EC, Judkins LM, Manogharan G, Mehta S, Hast MW. Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing. OTA Int 2022; 5:e164. [PMID: 35282393 PMCID: PMC8900457 DOI: 10.1097/oi9.0000000000000164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
Objectives Current surgical fracture treatment paradigms, which use rigid metallic constructs to heal bones, provide reasonable clinical outcomes; however, they do not leverage recent advances in our understanding of bone healing and mechanotransduction throughout bone healing. The objective of this review was to investigate the efficacy and potential clinical applicability of surgical techniques and implants that deliberately introduce interfragmentary motion throughout the healing process. Methods The authors searched PubMed and Google Scholar databases for articles reporting on fracture repair using dynamic locking plates, dynamized surgical techniques, and reverse dynamization. Data collection also included assessment of additively manufactured (AM) implants that provide dynamic mechanical behaviors. Results Forty articles were included for final review. It was found that accelerated rates of fracture healing can be achieved with staged 2-part surgeries or dynamic implant designs. Temporal dynamization, where static fixation of bones is followed by the introduction of micromotion and controlled loading, has been shown to improve callus volume and accelerate the healing response. Reverse dynamization, where micromotion is encouraged during early callus formation and arrested later, may represent a significant advance for the treatment of critical defect injuries. Advances in AM techniques will likely provide the ability to create high-resolution implants capable of dynamized and reverse dynamized modalities. Conclusions There is no one-size-fits-all approach to optimization of fracture healing. However, it has been clearly demonstrated that fracture treatment can be enhanced by systematically altering the construct stiffness throughout the different phases of healing, which may be achieved with AM implant designs.
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Affiliation(s)
| | | | - Guha Manogharan
- Pennsylvania State University, University Park, Pennsylvania
| | - Samir Mehta
- University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Wildemann B, Ignatius A, Leung F, Taitsman LA, Smith RM, Pesántez R, Stoddart MJ, Richards RG, Jupiter JB. Non-union bone fractures. Nat Rev Dis Primers 2021; 7:57. [PMID: 34354083 DOI: 10.1038/s41572-021-00289-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
The human skeleton has remarkable regenerative properties, being one of the few structures in the body that can heal by recreating its normal cellular composition, orientation and mechanical strength. When the healing process of a fractured bone fails owing to inadequate immobilization, failed surgical intervention, insufficient biological response or infection, the outcome after a prolonged period of no healing is defined as non-union. Non-union represents a chronic medical condition not only affecting function but also potentially impacting the individual's psychosocial and economic well-being. This Primer provides the reader with an in-depth understanding of our contemporary knowledge regarding the important features to be considered when faced with non-union. The normal mechanisms involved in bone healing and the factors that disrupt the normal signalling mechanisms are addressed. Epidemiological considerations and advances in the diagnosis and surgical therapy of non-union are highlighted and the need for greater efforts in basic, translational and clinical research are identified.
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Affiliation(s)
- Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany. .,Julius Wolff Institute and BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University, Ulm, Baden Württemberg, Germany
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Hong Kong, Hong Kong
| | - Lisa A Taitsman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - R Malcolm Smith
- Orthopedic trauma service, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rodrigo Pesántez
- Departamento de Ortopedia Y Traumatología Fundación Santa Fé de Bogotá - Universidad de los Andes, Bogotá, Colombia
| | | | | | - Jesse B Jupiter
- Department of Orthopaedic surgery, Massachussets General Hospital, Boston, MA, USA.
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17
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Strategies to Improve Bone Healing: Innovative Surgical Implants Meet Nano-/Micro-Topography of Bone Scaffolds. Biomedicines 2021; 9:biomedicines9070746. [PMID: 34203437 PMCID: PMC8301359 DOI: 10.3390/biomedicines9070746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022] Open
Abstract
Successful fracture healing is dependent on an optimal mechanical and biological environment at the fracture site. Disturbances in fracture healing (non-union) or even critical size bone defects, where void volume is larger than the self-healing capacity of bone tissue, are great challenges for orthopedic surgeons. To address these challenges, new surgical implant concepts have been recently developed to optimize mechanical conditions. First, this review article discusses the mechanical environment on bone and fracture healing. In this context, a new implant concept, variable fixation technology, is introduced. This implant has the unique ability to change its mechanical properties from “rigid” to “dynamic” over the time of fracture healing. This leads to increased callus formation, a more homogeneous callus distribution and thus improved fracture healing. Second, recent advances in the nano- and micro-topography of bone scaffolds for guiding osteoinduction will be reviewed, particularly emphasizing the mimicry of natural bone. We summarize that an optimal scaffold should comprise micropores of 50–150 µm diameter allowing vascularization and migration of stem cells as well as nanotopographical osteoinductive cues, preferably pores of 30 nm diameter. Next to osteoinduction, such nano- and micro-topographical cues may also reduce inflammation and possess an antibacterial activity to further promote bone regeneration.
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18
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Barcik J, Epari DR. Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time? Biomedicines 2021; 9:691. [PMID: 34207370 PMCID: PMC8234230 DOI: 10.3390/biomedicines9060691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.
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Affiliation(s)
- Jan Barcik
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
- Bulgarian Academy of Sciences, Institute of Metal Science “Acad. A. Balevski”, Shipchenski prohod 67, 1574 Sofia, Bulgaria
| | - Devakara R. Epari
- Institute of Health and Biomedical Innovation, Queensland University of Technology, George Street 2, Brisbane, QLD 4000, Australia;
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19
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Augat P, Hollensteiner M, von Rüden C. The role of mechanical stimulation in the enhancement of bone healing. Injury 2021; 52 Suppl 2:S78-S83. [PMID: 33041020 DOI: 10.1016/j.injury.2020.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023]
Abstract
The biomechanical environment plays a dominant role in the process of fracture repair. Mechanical signals control biological activities at the fracture site, regulate the formation and proliferation of different cell types, and are responsible for the formation of connective tissues and the consolidation of the fractured bone. The mechanobiology at the fracture site can be easily manipulated by the design and configuration of the fracture fixation construct and by the loading of the extremity (weight-bearing prescription). Depending on the choice of fracture fixation, the healing response can be directed towards direct healing or towards indirect healing through callus formation. This manuscript summarizes the evidence from experimental studies and clinical observations on the effect of mechanical manipulation on the healing response. Parameters like fracture gap size, interfragmentary movement, interfragmentary strain, and axial and shear deformation will be explored with respect to their respective effects on fracture repair. Also, the role of externally applied movement on the potential enhancement on the fracture repair process will be explored. Factors like fracture gap size, type and amplitude of the mechanical deformation as well as the loading history and its timing will be discussed.
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Affiliation(s)
- Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Marianne Hollensteiner
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany; Institute for Biomechanics Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian von Rüden
- Institute for Biomechanics Paracelsus Medical University Salzburg, Salzburg, Austria; Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
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20
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Borgiani E, Duda GN, Willie BM, Checa S. Bone morphogenetic protein 2-induced cellular chemotaxis drives tissue patterning during critical-sized bone defect healing: an in silico study. Biomech Model Mechanobiol 2021; 20:1627-1644. [PMID: 34047890 PMCID: PMC8298257 DOI: 10.1007/s10237-021-01466-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/11/2021] [Indexed: 12/26/2022]
Abstract
Critical-sized bone defects are critical healing conditions that, if left untreated, often lead to non-unions. To reduce the risk, critical-sized bone defects are often treated with recombinant human BMP-2. Although enhanced bone tissue formation is observed when BMP-2 is administered locally to the defect, spatial and temporal distribution of callus tissue often differs from that found during regular bone healing or in defects treated differently. How this altered tissue patterning due to BMP-2 treatment is linked to mechano-biological principles at the cellular scale remains largely unknown. In this study, the mechano-biological regulation of BMP-2-treated critical-sized bone defect healing was investigated using a multiphysics multiscale in silico approach. Finite element and agent-based modeling techniques were combined to simulate healing within a critical-sized bone defect (5 mm) in a rat femur. Computer model predictions were compared to in vivo microCT data outcome of bone tissue patterning at 2, 4, and 6 weeks postoperation. In vivo, BMP-2 treatment led to complete healing through periosteal bone bridging already after 2 weeks postoperation. Computer model simulations showed that the BMP-2 specific tissue patterning can be explained by the migration of mesenchymal stromal cells to regions with a specific concentration of BMP-2 (chemotaxis). This study shows how computational modeling can help us to further understand the mechanisms behind treatment effects on compromised healing conditions as well as to optimize future treatment strategies.
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Affiliation(s)
- Edoardo Borgiani
- Julius Wolff Institute, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Institutsgebäude Süd/ Südstraße 2, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Institutsgebäude Süd/ Südstraße 2, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bettina M Willie
- Research Centre, Department of Pediatric Surgery, Shriners Hospital for Children-Canada, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada
| | - Sara Checa
- Julius Wolff Institute, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Institutsgebäude Süd/ Südstraße 2, Augustenburger Platz 1, 13353, Berlin, Germany.
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21
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Fenelon M, Etchebarne M, Siadous R, Grémare A, Durand M, Sentilhes L, Catros S, Gindraux F, L'Heureux N, Fricain JC. Comparison of amniotic membrane versus the induced membrane for bone regeneration in long bone segmental defects using calcium phosphate cement loaded with BMP-2. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 124:112032. [PMID: 33947534 DOI: 10.1016/j.msec.2021.112032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
Thanks to its biological properties, the human amniotic membrane (HAM) combined with a bone substitute could be a single-step surgical alternative to the two-step Masquelet induced membrane (IM) technique for regeneration of critical bone defects. However, no study has directly compared these two membranes. We first designed a 3D-printed scaffold using calcium phosphate cement (CPC). We assessed its suitability in vitro to support human bone marrow mesenchymal stromal cells (hBMSCs) attachment and osteodifferentiation. We then performed a rat femoral critical size defect to compare the two-step IM technique with a single-step approach using the HAM. Five conditions were compared. Group 1 was left empty. Group 2 received the CPC scaffold loaded with rh-BMP2 (CPC/BMP2). Group 3 and 4 received the CPC/BMP2 scaffold covered with lyophilized or decellularized/lyophilized HAM. Group 5 underwent a two- step induced membrane procedure with insertion of a polymethylmethacrylate (PMMA) spacer followed by, after 4 weeks, its replacement with the CPC/BMP2 scaffold wrapped in the IM. Micro-CT and histomorphometric analysis were performed after six weeks. Results showed that the CPC scaffold supported the proliferation and osteodifferentiation of hBMSCs in vitro. In vivo, the CPC/BMP2 scaffold very efficiently induced bone formation and led to satisfactory healing of the femoral defect, in a single-step, without autograft or the need for any membrane covering. In this study, there was no difference between the two-step induced membrane procedure and a single step approach. However, the results indicated that none of the tested membranes further enhanced bone healing compared to the CPC/BMP2 group.
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Affiliation(s)
- Mathilde Fenelon
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Service de chirurgie orale, F-33076 Bordeaux, France.
| | - Marion Etchebarne
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Department of maxillofacial surgery, F-33076 Bordeaux, France
| | - Robin Siadous
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France
| | - Agathe Grémare
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Odontology and Oral Health Department, F-33076 Bordeaux, France
| | - Marlène Durand
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, CIC 1401, 33000, Bordeaux, France; INSERM, CIC 1401, 33000 Bordeaux, France
| | - Loic Sentilhes
- CHU Bordeaux, Department of Obstetrics and Gynecology, F-33076, Bordeaux, France
| | - Sylvain Catros
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Service de chirurgie orale, F-33076 Bordeaux, France
| | - Florelle Gindraux
- Service de Chirurgie Orthopédique, Traumatologique et Plastique, CHU Besançon, F-25000 Besançon, France; Laboratoire de Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | | | - Jean-Christophe Fricain
- Univ. Bordeaux, INSERM, BIOTIS, U1026, F-33000 Bordeaux, France; CHU Bordeaux, Service de chirurgie orale, F-33076 Bordeaux, France
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22
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Glatt V, Samchukov M, Cherkashin A, Iobst C. Reverse Dynamization Accelerates Bone-Healing in a Large-Animal Osteotomy Model. J Bone Joint Surg Am 2021; 103:257-263. [PMID: 33315696 DOI: 10.2106/jbjs.20.00380] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse dynamization is a mechanical manipulation regimen designed to accelerate bone-healing and remodeling. It is based on the hypothesis that a fracture that is initially stabilized less rigidly allows micromotion to encourage initial cartilaginous callus formation. Once substantial callus has formed, the stabilization should then be converted to a rigid configuration to prevent the disruption of neovascularization. The aim of the present study was to investigate whether bone-healing can be accelerated using a regimen of reverse dynamization in a large-animal osteotomy model. METHODS Transverse 2-mm tibial osteotomies were created in 18 goats, stabilized using circular external fixation, and divided into groups of 6 goats each: static fixation (rigid fixation), dynamic fixation (continuous micromotion using dynamizers), and reverse dynamization (initial micromotion using dynamizers followed by rigid fixation at 3 weeks postoperatively). Healing was assessed with the use of radiographs, micro-computed tomography, and mechanical testing. RESULTS Radiographic evaluation showed earlier and more robust callus formation in the dynamic fixation and reverse dynamization groups compared with the static fixation group. After 8 weeks of treatment, the reverse dynamization group had reduced callus size, less bone volume, higher bone mineral density, and no evidence of radiolucent lines compared with the static fixation and dynamic fixation groups. This appearance is characteristic of advanced remodeling, returning closest to the values of intact bone. Moreover, the tibiae in the reverse dynamization group were significantly stronger in torsion compared with those in the static fixation and dynamic fixation groups. CONCLUSIONS These findings confirmed that tibial osteotomies under reverse dynamization healed faster, healed objectively better, and were considerably stronger, all suggesting an accelerated healing and remodeling process. CLINICAL RELEVANCE This study demonstrates that the concept of reverse dynamization challenges the current understanding regarding the optimal fixation stability necessary to maximize the regenerative capacity of bone-healing. When reverse dynamization is employed in the clinical setting, it may be able to improve the treatment of fractures by reducing the time to union and potentially lowering the risk of delayed union and nonunion.
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Affiliation(s)
- Vaida Glatt
- Department of Orthopedic Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Mikhail Samchukov
- The Center for Excellence in Limb Lengthening & Reconstruction, Texas Scottish Rite Hospital for Children, Dallas, Texas.,Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander Cherkashin
- The Center for Excellence in Limb Lengthening & Reconstruction, Texas Scottish Rite Hospital for Children, Dallas, Texas.,Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher Iobst
- Center for Limb Lengthening and Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
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23
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De la Vega R, Coenen M, Müller S, Nagelli C, Quirk N, Lopez de Padilla C, Evans C. Effects of FK506 on the healing of diaphyseal, critical size defects in the rat femur. Eur Cell Mater 2020; 40:160-171. [PMID: 33021330 PMCID: PMC7816824 DOI: 10.22203/ecm.v040a10] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
There is much interest in understanding the influence of the immune system on bone healing, including a number of reports suggesting a beneficial effect of FK506 (tacrolimus) in this regard. The influence of FK506 in a rat, femoral, critical size defect was examined using locally implanted, recombinant, human (rh) BMP-2 and adenovirally-transduced, autologous, adipose-derived mesenchymal stromal cells (AD-MSCs) expressing BMP-2. FK506 was delivered systemically using an implanted osmotic pump. Empty defects and those implanted with unmodified AD-MSCs did not heal in the presence or absence of FK506. Defects treated with rhBMP-2 healed with a large callus containing thin cortices and wispy trabeculae; this, too, was unaffected by FK506. A third of defects implanted with adenovirally-transduced AD-MSCs healed, but this improved to 100 % in the presence of FK506. New bone formed in response to BMP-2 synthesised endogenously by the genetically modified cells had a slimmer callus than those healed by rhBMP-2, with improved cortication and advanced reconstitution of marrow. These results suggest that FK506 may have had little effect on the intrinsic biology of bone healing, but improved healing in response to adenovirally-transduced cells by inhibiting immune responses to the first-generation adenovirus used here. Because the genetically modified cells produced bone of higher quality at far lower doses of BMP-2, this approach should be explored in subsequent research.
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Affiliation(s)
- R.E. De la Vega
- Musculoskeletal Gene Therapy Research Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA,Department cBITE and Department IBE, MERLN - Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - M.J. Coenen
- Musculoskeletal Gene Therapy Research Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - S.A. Müller
- Musculoskeletal Gene Therapy Research Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA,Orthopaedic Department, University of Basel, Basel, Switzerland
| | - C.V. Nagelli
- Musculoskeletal Gene Therapy Research Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - N.P. Quirk
- Musculoskeletal Gene Therapy Research Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - C. Lopez de Padilla
- Musculoskeletal Gene Therapy Research Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - C.H. Evans
- Musculoskeletal Gene Therapy Research Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA,Address for correspondence: C.H. Evans, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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24
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McDermott AM, Herberg S, Mason DE, Collins JM, Pearson HB, Dawahare JH, Tang R, Patwa AN, Grinstaff MW, Kelly DJ, Alsberg E, Boerckel JD. Recapitulating bone development through engineered mesenchymal condensations and mechanical cues for tissue regeneration. Sci Transl Med 2020; 11:11/495/eaav7756. [PMID: 31167930 DOI: 10.1126/scitranslmed.aav7756] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 01/08/2023]
Abstract
Large bone defects cannot form a callus and exhibit high complication rates even with the best treatment strategies available. Tissue engineering approaches often use scaffolds designed to match the properties of mature bone. However, natural fracture healing is most efficient when it recapitulates development, forming bone via a cartilage intermediate (endochondral ossification). Because mechanical forces are critical for proper endochondral bone development and fracture repair, we hypothesized that recapitulating developmental mechanical forces would be essential for large bone defect regeneration in rats. Here, we engineered mesenchymal condensations that mimic the cellular organization and lineage progression of the early limb bud in response to local transforming growth factor-β1 presentation from incorporated gelatin microspheres. We then controlled mechanical loading in vivo by dynamically tuning fixator compliance. Mechanical loading enhanced mesenchymal condensation-induced endochondral bone formation in vivo, restoring functional bone properties when load initiation was delayed to week 4 after defect formation. Live cell transplantation produced zonal human cartilage and primary spongiosa mimetic of the native growth plate, whereas condensation devitalization before transplantation abrogated bone formation. Mechanical loading induced regeneration comparable to high-dose bone morphogenetic protein-2 delivery, but without heterotopic bone formation and with order-of-magnitude greater mechanosensitivity. In vitro, mechanical loading promoted chondrogenesis and up-regulated pericellular matrix deposition and angiogenic gene expression. In vivo, mechanical loading regulated cartilage formation and neovascular invasion, dependent on load timing. This study establishes mechanical cues as key regulators of endochondral bone defect regeneration and provides a paradigm for recapitulating developmental programs for tissue engineering.
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Affiliation(s)
- Anna M McDermott
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA.,Department of Mechanical Engineering, Trinity Center for Bioengineering, Trinity College Dublin, Dublin D02 PN40, Ireland
| | - Samuel Herberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Devon E Mason
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Joseph M Collins
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hope B Pearson
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - James H Dawahare
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Rui Tang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Amit N Patwa
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Mark W Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Daniel J Kelly
- Department of Mechanical Engineering, Trinity Center for Bioengineering, Trinity College Dublin, Dublin D02 PN40, Ireland
| | - Eben Alsberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA. .,Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH 44106, USA.,National Center for Regenerative Medicine, Division of General Medical Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Joel D Boerckel
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. .,Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA.,Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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25
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Schultz BJ, Koval K, Salehi PP, Gardner MJ, Cerynik DL. Controversies in Fracture Healing: Early Versus Late Dynamization. Orthopedics 2020; 43:e125-e133. [PMID: 32077970 DOI: 10.3928/01477447-20200213-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/11/2019] [Indexed: 02/03/2023]
Abstract
Dynamization of fracture fixation constructs provides early rigidity for primary bone healing and late motion for secondary healing. A review of laboratory, animal, and clinical studies investigating the impact, and optimal timing, of dynamization is limited by lack of standardization across studies. However, in animal models, dynamization improves histologic and biomechanical properties compared with statically rigid or flexible controls. In animals, dynamization at 3 to 4 weeks showed improved histologic results. In clinical studies, it showed faster, stronger, and stiffer bone healing. Clinical success dynamizing external fixators and intramedullary nails suggests a role for late dynamization in other fixation types, such as bridge plating. [Orthopedics. 2020;43(3):e125-e133.].
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26
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Herberg S, McDermott AM, Dang PN, Alt DS, Tang R, Dawahare JH, Varghai D, Shin JY, McMillan A, Dikina AD, He F, Lee YB, Cheng Y, Umemori K, Wong PC, Park H, Boerckel JD, Alsberg E. Combinatorial morphogenetic and mechanical cues to mimic bone development for defect repair. SCIENCE ADVANCES 2019; 5:eaax2476. [PMID: 31489377 PMCID: PMC6713501 DOI: 10.1126/sciadv.aax2476] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/19/2019] [Indexed: 05/28/2023]
Abstract
Endochondral ossification during long bone development and natural fracture healing initiates by mesenchymal cell condensation, directed by local morphogen signals and mechanical cues. Here, we aimed to mimic development for regeneration of large bone defects. We hypothesized that engineered human mesenchymal condensations presenting transforming growth factor-β1 (TGF-β1) and/or bone morphogenetic protein-2 (BMP-2) from encapsulated microparticles promotes endochondral defect regeneration contingent on in vivo mechanical cues. Mesenchymal condensations induced bone formation dependent on morphogen presentation, with BMP-2 + TGF-β1 fully restoring mechanical function. Delayed in vivo ambulatory loading significantly enhanced the bone formation rate in the dual morphogen group. In vitro, BMP-2 or BMP-2 + TGF-β1 initiated robust endochondral lineage commitment. In vivo, however, extensive cartilage formation was evident predominantly in the BMP-2 + TGF-β1 group, enhanced by mechanical loading. Together, this study demonstrates a biomimetic template for recapitulating developmental morphogenic and mechanical cues in vivo for tissue engineering.
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Affiliation(s)
- S. Herberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - A. M. McDermott
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania
- Philadelphia, PA, USA
| | - P. N. Dang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - D. S. Alt
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - R. Tang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | | | - D. Varghai
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - J.-Y. Shin
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - A. McMillan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - A. D. Dikina
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - F. He
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Y. B. Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Y. Cheng
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - K. Umemori
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - P. C. Wong
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - H. Park
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - J. D. Boerckel
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania
- Philadelphia, PA, USA
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - E. Alsberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
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27
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Zhang B, Skelly JD, Maalouf JR, Ayers DC, Song J. Multifunctional scaffolds for facile implantation, spontaneous fixation, and accelerated long bone regeneration in rodents. Sci Transl Med 2019; 11:11/502/eaau7411. [DOI: 10.1126/scitranslmed.aau7411] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/23/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022]
Abstract
Graft-guided regenerative repair of critical long bone defects achieving facile surgical delivery, stable graft fixation, and timely restoration of biomechanical integrity without excessive biotherapeutics remains challenging. Here, we engineered hydration-induced swelling/stiffening and thermal-responsive shape-memory properties into scalable, three-dimensional–printed amphiphilic degradable polymer-osteoconductive mineral composites as macroporous, non–load-bearing, resorbable synthetic grafts. The distinct physical properties of the grafts enabled straightforward surgical insertion into critical-size rat femoral segmental defects. Grafts rapidly recovered their precompressed shape, stiffening and swelling upon warm saline rinse to result in 100% stable graft fixation. The osteoconductive macroporous grafts guided bone formation throughout the defect as early as 4 weeks after implantation; new bone remodeling correlated with rates of scaffold composition-dependent degradation. A single dose of 400-ng recombinant human bone morphogenetic protein-2/7 heterodimer delivered via the graft accelerated bone regeneration bridging throughout the entire defect by 4 weeks after delivery. Full restoration of torsional integrity and complete scaffold resorption were achieved by 12 to 16 weeks after surgery. This biomaterial platform enables personalized bone regeneration with improved surgical handling, in vivo efficacy and safety.
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28
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Fragogeorgi EA, Rouchota M, Georgiou M, Velez M, Bouziotis P, Loudos G. In vivo imaging techniques for bone tissue engineering. J Tissue Eng 2019; 10:2041731419854586. [PMID: 31258885 PMCID: PMC6589947 DOI: 10.1177/2041731419854586] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Bone is a dynamic tissue that constantly undergoes modeling and remodeling. Bone tissue engineering relying on the development of novel implant scaffolds for the treatment of pre-clinical bone defects has been extensively evaluated by histological techniques. The study of bone remodeling, that takes place over several weeks, is limited by the requirement of a large number of animals and time-consuming and labor-intensive procedures. X-ray-based imaging methods that can non-invasively detect the newly formed bone tissue have therefore been extensively applied in pre-clinical research and in clinical practice. The use of other imaging techniques at a pre-clinical level that act as supportive tools is convenient. This review mainly focuses on nuclear imaging methods (single photon emission computed tomography and positron emission tomography), either alone or used in combination with computed tomography. It addresses their application to small animal models with bone defects, both untreated and filled with substitute materials, to boost the knowledge on bone regenerative processes.
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Affiliation(s)
- Eirini A Fragogeorgi
- Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety (INRASTES), NCSR "Demokritos", Athens, Greece
| | - Maritina Rouchota
- Bioemission Technology Solutions (BIOEMTECH), Athens, Greece / Lefkippos Attica Technology Park, NCSR "Demokritos", Athens, Greece
| | - Maria Georgiou
- Department of Biomedical Engineering, University of West Attica, Athens, Greece
| | - Marisela Velez
- Instituto de Catálisis y Petroleoquímica (CSIC), Madrid, Spain
| | - Penelope Bouziotis
- Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety (INRASTES), NCSR "Demokritos", Athens, Greece
| | - George Loudos
- Institute of Nuclear & Radiological Sciences and Technology, Energy & Safety (INRASTES), NCSR "Demokritos", Athens, Greece.,Bioemission Technology Solutions (BIOEMTECH), Athens, Greece / Lefkippos Attica Technology Park, NCSR "Demokritos", Athens, Greece
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29
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Glatt V, Evans CH, Stoddart MJ. Regenerative rehabilitation: The role of mechanotransduction in orthopaedic regenerative medicine. J Orthop Res 2019; 37:1263-1269. [PMID: 30561813 PMCID: PMC6546504 DOI: 10.1002/jor.24205] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/28/2018] [Indexed: 02/04/2023]
Abstract
Regenerative rehabilitation is an emerging area of investigation that seeks to integrate regenerative medicine with rehabilitation medicine. It is based on the realization that combining these two areas of medicine at an early stage of treatment will produce a better clinical outcome than the traditional linear approach of first administering the elements of regeneration followed, after a delay, by rehabilitation. Indeed, in certain settings, a case can be made for initiating rehabilitation protocols before starting regenerative intervention. This review summarizes the contents of a workshop held during the 2018 annual meeting of the Orthopaedic Research Society. It introduced the concept of regenerative rehabilitation and then provided two orthopaedic examples drawn from the domains of cartilage repair and bone healing. Rehabilitation medicine can supply a variety of physical stimuli, including electrical stimulation, thermal stimulation and mechanical stimulation. Of these, mechanical stimulation has the most obvious relevance to orthopaedics. The mechano-responsiveness of cartilage and bone has been known for a long time, but is poorly understood and has led to only limited clinical application. Improved bioreactor designs that allow multi-axial loading enable new insights into the responsiveness of chondrocytes and chondroprogenitor cells to specific types of load, especially shear. Recent studies on the mechanobiology of bone healing show that modulating the mechanical environment of an experimental osseous lesion by a process of "Reverse Dynamization" soon after injury considerably enhances healing. Future studies are needed to probe the molecular mechanisms responsible for these phenomena and to translate these findings into clinical practice. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1263-1269, 2019.
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Affiliation(s)
- Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, Texas
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30
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Ganadhiepan G, Zhang L, Miramini S, Mendis P, Patel M, Ebeling P, Wang Y. The Effects of Dynamic Loading on Bone Fracture Healing Under Ilizarov Circular Fixators. J Biomech Eng 2019; 141:2727816. [DOI: 10.1115/1.4043037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 11/08/2022]
Abstract
Early weight bearing appears to enhance bone fracture healing under Ilizarov circular fixators (ICFs). However, the role of early weight bearing in the healing process remains unclear. This study aims to provide insights into the effects of early weight bearing on healing of bone fractures stabilized with ICFs, with the aid of mathematical modeling. A computational model of fracture site was developed using poro-elastic formulation to simulate the transport of mesenchymal stem cells (MSCs), fibroblasts, chondrocytes, osteoblasts, osteogenic growth factor (OGF), and chondrogenic growth factor (CGF) and MSC differentiation during the early stage of healing, under various combinations of fracture gap sizes (GS), ICF wire pretension forces, and axial loads. 1 h of physiologically relevant cyclic axial loading followed by 23 h of rest in the post-inflammation phase (i.e., callus with granulation tissue) was simulated. The results show that physiologically relevant dynamic loading could significantly enhance cell and growth factor concentrations in the fracture site in a time and spatially dependent manner. 1 h cyclic loading (axial load with amplitude, PA, of 200 N at 1 Hz) increased the content of chondrocytes up to 37% (in all zones of callus), CGF up to 28% (in endosteal and periosteal callus) and OGF up to 50% (in endosteal and cortical callus) by the end of the 24 h period simulated. This suggests that the synergistic effect of dynamic loading-induced advective transport and mechanical stimuli due to early weight bearing is likely to enhance secondary healing. Furthermore, the study suggests that relatively higher PA values or lower ICF wire pretension forces or smaller GS could result in increased chondrocyte and GF content within the callus.
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Affiliation(s)
- Ganesharajah Ganadhiepan
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia e-mail:
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Minoo Patel
- Epworth Hospital Richmond, Victoria 3121, Australia
| | - Peter Ebeling
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Yulong Wang
- Rehabilitation Centre, The First Affiliated Hospital, Shenzhen University, Guangdong 518060, China
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31
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Histomorphometric Analysis of Callus Formation Stimulated by Axial Dynamisation in a Standardised Ovine Osteotomy Model. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4250940. [PMID: 30891456 PMCID: PMC6390264 DOI: 10.1155/2019/4250940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/07/2018] [Accepted: 01/16/2019] [Indexed: 12/30/2022]
Abstract
The cyclic axial dynamisation of a stabilised fracture is intended to promote callus formation and bone healing. Most studies focused on biomechanical properties or the quantity of new bone formation. Far less is known about the quality of newly formed callus tissues, such as tissue distribution and arrangement within the callus. The aim of this current study was to investigate the effect of cyclic, axial dynamisation on the quantity and quality of callus in an established delayed fracture healing model. In 41 sheep transverse osteotomies with a gap size of 3 mm were stabilised with a unilateral external fixator. In 32 of these, fracture ends were axially stimulated with displacement amplitudes of 0.8 mm, 0.4 mm, 0.2 mm, or 0.0 mm, respectively, for six weeks. In the remaining 9 sheep of the control group, an additional external fixator was mounted to achieve almost total rigidity. Animal material originating from a past animal experiment was reanalysed in this study. Histological thin-ground sections were histomorphometrically analysed regarding the histological structure and composition of the defect region. A slight tendency towards an increase in size of total callus area, area of new bone (nB.Ar), and cartilage (Cg.Ar) was detected with increasing displacement amplitudes compared to the control group. At the anterior callus side nB.Ar and Cg.Ar were significantly larger than at the posterior side in all groups independent of treatment. Regarding the quality of callus, areas of very compact bone were predominant in the treatment groups whereas in the control group a slight shift to more porous bone was observed. No difference of callus compactness was observed between the anterior and the posterior side. The established method to assess the local compactness of callus areas is a useful tool to quantitatively determine the spatial distribution of new bone tissue within the callus. The application of this method in combination with biomechanical testing might reveal interesting relations between tissue distribution and bone strength that, with traditional histomorphometry, cannot be identified.
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32
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Tetsworth K, Glatt V. Tipping the Balance: Manipulating the mechanical environment by reverse dynamization can accelerate bone healing. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2019. [DOI: 10.4103/2455-3719.265264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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33
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Tufekci P, Tavakoli A, Dlaska C, Neumann M, Shanker M, Saifzadeh S, Steck R, Schuetz M, Epari D. Early mechanical stimulation only permits timely bone healing in sheep. J Orthop Res 2018; 36:1790-1796. [PMID: 29159911 DOI: 10.1002/jor.23812] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/11/2017] [Indexed: 02/04/2023]
Abstract
Bone fracture healing is sensitive to the fixation stability. However, it is unclear which phases of healing are mechano-sensitive and if mechanical stimulation is required throughout repair. In this study, a novel bone defect model, which isolates an experimental fracture from functional loading, was applied in sheep to investigate if stimulation limited to the early proliferative phase is sufficient for bone healing. An active fixator controlled motion in the fracture. Animals of the control group were unstimulated. In the physiological-like group, 1 mm axial compressive movements were applied between day 5 and 21, thereafter the movements were decreased in weekly increments and stopped after 6 weeks. In the early stimulatory group, the movements were stopped after 3 weeks. The experimental fractures were evaluated with mechanical and micro-computed tomography methods after 9 weeks healing. The callus strength of the stimulated fractures (physiological-like and early stimulatory) was greater than the unstimulated control group. The control group was characterized by minimal external callus formation and a lack of bone bridging at 9 weeks. In contrast, the stimulated groups exhibited advanced healing with solid bone formation across the defect. This was confirmed quantitatively by a lower bone volume in the control group compared to the stimulated groups.The novel experimental model permits the application of a well-defined load history to an experimental bone fracture. The poor healing observed in the control group is consistent with under-stimulation. This study has shown early mechanical stimulation only is sufficient for a timely healing outcome. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1790-1796, 2018.
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Affiliation(s)
- Pelin Tufekci
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia
| | - Aramesh Tavakoli
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia
| | - Constantin Dlaska
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia
| | - Mirjam Neumann
- Trauma Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Mihir Shanker
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia
| | - Siamak Saifzadeh
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia
| | - Roland Steck
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia
| | - Michael Schuetz
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia.,Trauma Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Devakar Epari
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Queensland, Australia
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Winkler T, Sass FA, Duda GN, Schmidt-Bleek K. A review of biomaterials in bone defect healing, remaining shortcomings and future opportunities for bone tissue engineering: The unsolved challenge. Bone Joint Res 2018; 7:232-243. [PMID: 29922441 PMCID: PMC5987690 DOI: 10.1302/2046-3758.73.bjr-2017-0270.r1] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite its intrinsic ability to regenerate form and function after injury, bone tissue can be challenged by a multitude of pathological conditions. While innovative approaches have helped to unravel the cascades of bone healing, this knowledge has so far not improved the clinical outcomes of bone defect treatment. Recent findings have allowed us to gain in-depth knowledge about the physiological conditions and biological principles of bone regeneration. Now it is time to transfer the lessons learned from bone healing to the challenging scenarios in defects and employ innovative technologies to enable biomaterial-based strategies for bone defect healing. This review aims to provide an overview on endogenous cascades of bone material formation and how these are transferred to new perspectives in biomaterial-driven approaches in bone regeneration. Cite this article: T. Winkler, F. A. Sass, G. N. Duda, K. Schmidt-Bleek. A review of biomaterials in bone defect healing, remaining shortcomings and future opportunities for bone tissue engineering: The unsolved challenge. Bone Joint Res 2018;7:232–243. DOI: 10.1302/2046-3758.73.BJR-2017-0270.R1.
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Affiliation(s)
- T Winkler
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F A Sass
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - G N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - K Schmidt-Bleek
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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De La Vega RE, De Padilla CL, Trujillo M, Quirk N, Porter RM, Evans CH, Ferreira E. Contribution of Implanted, Genetically Modified Muscle Progenitor Cells Expressing BMP-2 to New Bone Formation in a Rat Osseous Defect. Mol Ther 2017; 26:208-218. [PMID: 29107477 DOI: 10.1016/j.ymthe.2017.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/01/2017] [Accepted: 10/01/2017] [Indexed: 01/20/2023] Open
Abstract
Because muscle contains osteoprogenitor cells and has a propensity to form bone, we have explored its utility in healing large osseous defects. Healing is achieved by the insertion of muscle fragments transduced with adenovirus encoding BMP-2 (Ad.BMP-2). However, it is not known whether the genetically modified muscle contributes osteoprogenitor cells to healing defects or merely serves as a local source of BMP-2. This question is part of the larger debate on the fate of progenitor cells introduced into sites of tissue damage to promote regeneration. To address this issue, we harvested fragments of muscle from rats constitutively expressing GFP, transduced them with Ad.BMP-2, and implanted them into femoral defects in wild-type rats under various conditions. GFP+ cells persisted within defects for the entire 8 weeks of the experiments. In the absence of bone formation, these cells presented as fibroblasts. When bone was formed, GFP+ cells were present as osteoblasts and osteocytes and also among the lining cells of new blood vessels. The genetically modified muscle thus contributed progenitor cells as well as BMP-2 to the healing defect, a property of great significance in light of the extensive damage to soft tissue and consequent loss of endogenous progenitors in problematic fractures.
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Affiliation(s)
- Rodolfo E De La Vega
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA; Center for Advanced Orthopaedic Studies, BIDMC, Boston, MA 02215, USA
| | | | - Miguel Trujillo
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Nicholas Quirk
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Ryan M Porter
- Center for Advanced Orthopaedic Studies, BIDMC, Boston, MA 02215, USA
| | - Christopher H Evans
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA; Center for Advanced Orthopaedic Studies, BIDMC, Boston, MA 02215, USA; Collaborative Research Center, AO Foundation, Davos, Switzerland.
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Glatt V, Evans CH, Tetsworth K. A Concert between Biology and Biomechanics: The Influence of the Mechanical Environment on Bone Healing. Front Physiol 2017; 7:678. [PMID: 28174539 PMCID: PMC5258734 DOI: 10.3389/fphys.2016.00678] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/20/2016] [Indexed: 01/14/2023] Open
Abstract
In order to achieve consistent and predictable fracture healing, a broad spectrum of growth factors are required to interact with one another in a highly organized response. Critically important, the mechanical environment around the fracture site will significantly influence the way bone heals, or if it heals at all. The role of the various biological factors, the timing, and spatial relationship of their introduction, and how the mechanical environment orchestrates this activity, are all crucial aspects to consider. This review will synthesize decades of work and the acquired knowledge that has been used to develop new treatments and technologies for the regeneration and healing of bone. Moreover, it will discuss the current state of the art in experimental and clinical studies concerning the application of these mechano-biological principles to enhance bone healing, by controlling the mechanical environment under which bone regeneration takes place. This includes everything from the basic principles of fracture healing, to the influence of mechanical forces on bone regeneration, and how this knowledge has influenced current clinical practice. Finally, it will examine the efforts now being made for the integration of this research together with the findings of complementary studies in biology, tissue engineering, and regenerative medicine. By bringing together these diverse disciplines in a cohesive manner, the potential exists to enhance fracture healing and ultimately improve clinical outcomes.
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Affiliation(s)
- Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center San AntonioSan Antonio, TX, USA
- Orthopaedic Research Centre of AustraliaBrisbane, QLD, Australia
| | | | - Kevin Tetsworth
- Orthopaedic Research Centre of AustraliaBrisbane, QLD, Australia
- Department of Orthopaedic Surgery, Royal Brisbane and Women's HospitalHerston, QLD, Australia
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McDermott AM, Mason DE, Lin ASP, Guldberg RE, Boerckel JD. Influence of structural load-bearing scaffolds on mechanical load- and BMP-2-mediated bone regeneration. J Mech Behav Biomed Mater 2016; 62:169-181. [PMID: 27208510 DOI: 10.1016/j.jmbbm.2016.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 01/03/2023]
Abstract
A common design constraint in functional tissue engineering is that scaffolds intended for use in load-bearing sites possess similar mechanical properties to the replaced tissue. Here, we tested the hypothesis that in vivo loading would enhance bone morphogenetic protein-2 (BMP-2)-mediated bone regeneration in the presence of a load-bearing PLDL scaffold, whose pores and central core were filled with BMP-2-releasing alginate hydrogel. First, we evaluated the effects of in vivo mechanical loading on bone regeneration in the structural scaffolds. Second, we compared scaffold-mediated bone regeneration, independent of mechanical loading, with alginate hydrogel constructs, without the structural scaffold, that have been shown previously to facilitate in vivo mechanical stimulation of bone formation. Contrary to our hypothesis, mechanical loading had no effect on bone formation, distribution, or biomechanical properties in structural scaffolds. Independent of loading, the structural scaffolds reduced bone formation compared to non-structural alginate, particularly in regions in which the scaffold was concentrated, resulting in impaired functional regeneration. This is attributable to a combination of stress shielding by the scaffold and inhibition of cellular infiltration and tissue ingrowth. Collectively, these data question the necessity of scaffold similarity to mature tissue at the time of implantation and emphasize development of an environment conducive to cellular activation of matrix production and ultimate functional regeneration.
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Affiliation(s)
- Anna M McDermott
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Devon E Mason
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Angela S P Lin
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Robert E Guldberg
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Joel D Boerckel
- Department of Aerospace and Mechanical Engineering, Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, USA.
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Glatt V, Bartnikowski N, Quirk N, Schuetz M, Evans C. Reverse Dynamization: Influence of Fixator Stiffness on the Mode and Efficiency of Large-Bone-Defect Healing at Different Doses of rhBMP-2. J Bone Joint Surg Am 2016; 98:677-87. [PMID: 27098327 PMCID: PMC4832588 DOI: 10.2106/jbjs.15.01027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse dynamization is a technology for enhancing the healing of osseous defects. With use of an external fixator, the axial stiffness across the defect is initially set low and subsequently increased. The purpose of the study described in this paper was to explore the efficacy of reverse dynamization under different conditions. METHODS Rat femoral defects were stabilized with external fixators that allowed the stiffness to be modulated on living animals. Recombinant human bone morphogenetic protein-2 (rhBMP-2) was implanted into the defects on a collagen sponge. Following a dose-response experiment, 5.5 μg of rhBMP-2 was placed into the defect under conditions of very low (25.4-N/mm), low (114-N/mm), medium (185-N/mm), or high (254-N/mm) stiffness. Reverse dynamization was evaluated with 2 different starting stiffnesses: low (114 N/mm) and very low (25.4 N/mm). In both cases, high stiffness (254 N/mm) was imposed after 2 weeks. Healing was assessed with radiographs, micro-computed tomography (μCT), histological analysis, and mechanical testing. RESULTS In the absence of dynamization, the medium-stiffness fixators provided the best healing. Reverse dynamization starting with very low stiffness was detrimental to healing. However, with low initial stiffness, reverse dynamization considerably improved healing with minimal residual cartilage, enhanced cortication, increased mechanical strength, and smaller callus. Histological analysis suggested that, in all cases, healing provoked by rhBMP-2 occurred by endochondral ossification. CONCLUSIONS These data confirm the potential utility of reverse dynamization as a way of improving bone healing but indicate that the stiffness parameters need to be selected carefully. CLINICAL RELEVANCE Reverse dynamization may reduce the amount of rhBMP-2 needed to induce healing of recalcitrant osseous lesions, reduce the time to union, and decrease the need for prolonged external fixation.
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Affiliation(s)
- Vaida Glatt
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia,E-mail address for V. Glatt:
| | - Nicole Bartnikowski
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicholas Quirk
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia,Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Michael Schuetz
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Christopher Evans
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
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Kozhevnikov E, Hou X, Qiao S, Zhao Y, Li C, Tian W. Electrical impedance spectroscopy - a potential method for the study and monitoring of a bone critical-size defect healing process treated with bone tissue engineering and regenerative medicine approaches. J Mater Chem B 2016; 4:2757-2767. [PMID: 32263340 DOI: 10.1039/c5tb02707a] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The development of strategies of bone tissue engineering and regenerative medicine has been drawing considerable attention to treat bone critical-size defects (CSDs). Notably, new strategies and/or treatment approaches always require appropriate tools to track the healing process so as to evaluate their success. In this paper, we present the development of a novel approach for the non-invasive, yet real-time, monitoring and assessment of bone CSDs treated with biomaterials and biomedical approaches. For this, we employed the technique of electrical impedance spectroscopy (EIS) to quantitatively monitor and assess the changes in electrical impedance, and thus the regeneration process. In our in vitro tests, we examined the biochemical changes of the fracture area and investigated the influence of collagen and hydroxyapatite on the changes in electrical impedance by EIS, thus inferring the changes in bone regeneration and structure. Based on this success, we further demonstrated, in real time, the process of regeneration of the traumatic area in an in vivo rabbit model. Our electrical-impedance data of the experiment groups, i.e., the ones treated with natural coral and bone morphogenetic protein-2 (BMP-2), revealed that each group has its unique impedance graph characteristics, which are directly associated with the degree of regeneration. For comparison, we also employed radiography, gross anatomy, and histological analyses in examination. Our results illustrate that EIS holds considerable potential as a non-invasive tool for monitoring, in real time, the healing of bone CSDs by allowing for quantitatively characterizing the changes of both hydroxyapatite and collagen.
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Affiliation(s)
- Evgeny Kozhevnikov
- Bio-X Center, School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150080, P. R. China
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CORR Insights®: What Are the Biomechanical Effects of Half-pin and Fine-wire Configurations on Fracture Site Movement in Circular Frames? Clin Orthop Relat Res 2016; 474:1050-2. [PMID: 26797907 PMCID: PMC4773336 DOI: 10.1007/s11999-015-4689-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/28/2015] [Indexed: 01/31/2023]
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Liu F, Ferreira E, Porter R, Glatt V, Schinhan M, Shen Z, Randolph M, Kirker-Head C, Wehling C, Vrahas M, Evans C, Wells J, Wells JW. Rapid and reliable healing of critical size bone defects with genetically modified sheep muscle. Eur Cell Mater 2015; 30:118-30; discussion 130-1. [PMID: 26388615 PMCID: PMC4625846 DOI: 10.22203/ecm.v030a09] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Large segmental defects in bone fail to heal and remain a clinical problem. Muscle is highly osteogenic, and preliminary data suggest that autologous muscle tissue expressing bone morphogenetic protein-2 (BMP-2) efficiently heals critical size defects in rats. Translation into possible human clinical trials requires, inter alia, demonstration of efficacy in a large animal, such as the sheep. Scale-up is fraught with numerous biological, anatomical, mechanical and structural variables, which cannot be addressed systematically because of cost and other practical issues. For this reason, we developed a translational model enabling us to isolate the biological question of whether sheep muscle, transduced with adenovirus expressing BMP-2, could heal critical size defects in vivo. Initial experiments in athymic rats noted strong healing in only about one-third of animals because of unexpected immune responses to sheep antigens. For this reason, subsequent experiments were performed with Fischer rats under transient immunosuppression. Such experiments confirmed remarkably rapid and reliable healing of the defects in all rats, with bridging by 2 weeks and remodelling as early as 3-4 weeks, despite BMP-2 production only in nanogram quantities and persisting for only 1-3 weeks. By 8 weeks the healed defects contained well-organised new bone with advanced neo-cortication and abundant marrow. Bone mineral content and mechanical strength were close to normal values. These data demonstrate the utility of this model when adapting this technology for bone healing in sheep, as a prelude to human clinical trials.
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Affiliation(s)
- F. Liu
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Collaborative Research Centre: AO Foundation, Davos, Switzerland
| | - E. Ferreira
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Collaborative Research Centre: AO Foundation, Davos, Switzerland
| | - R.M. Porter
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Collaborative Research Centre: AO Foundation, Davos, Switzerland
| | - V. Glatt
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Collaborative Research Centre: AO Foundation, Davos, Switzerland
| | - M. Schinhan
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Department of Orthopaedic Surgery, University of Vienna Medical School, Vienna, Austria
| | - Z. Shen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Collaborative Research Centre: AO Foundation, Davos, Switzerland
| | - M.A. Randolph
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - C.A. Kirker-Head
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
| | - C. Wehling
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Ludwig Maximilan University Medical School, Munich, Germany
| | - M.S. Vrahas
- Collaborative Research Centre: AO Foundation, Davos, Switzerland
,Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - C.H. Evans
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Collaborative Research Centre: AO Foundation, Davos, Switzerland
,Address for correspondence: Dr Chris Evans, Rehabilitation Medicine Research Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA, Telephone Number: 1-507-255-0099,
| | - J.W. Wells
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
,Collaborative Research Centre: AO Foundation, Davos, Switzerland
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Griffin KS, Davis KM, McKinley TO, Anglen JO, Chu TMG, Boerckel JD, Kacena MA. Evolution of Bone Grafting: Bone Grafts and Tissue Engineering Strategies for Vascularized Bone Regeneration. Clin Rev Bone Miner Metab 2015. [DOI: 10.1007/s12018-015-9194-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Cipitria A, Wagermaier W, Zaslansky P, Schell H, Reichert J, Fratzl P, Hutmacher D, Duda G. BMP delivery complements the guiding effect of scaffold architecture without altering bone microstructure in critical-sized long bone defects: A multiscale analysis. Acta Biomater 2015; 23:282-294. [PMID: 26004222 DOI: 10.1016/j.actbio.2015.05.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/10/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
Scaffold architecture guides bone formation. However, in critical-sized long bone defects additional BMP-mediated osteogenic stimulation is needed to form clinically relevant volumes of new bone. The hierarchical structure of bone determines its mechanical properties. Yet, the micro- and nanostructure of BMP-mediated fast-forming bone has not been compared with slower regenerating bone without BMP. We investigated the combined effects of scaffold architecture (physical cue) and BMP stimulation (biological cue) on bone regeneration. It was hypothesized that a structured scaffold directs tissue organization through structural guidance and load transfer, while BMP stimulation accelerates bone formation without altering the microstructure at different length scales. BMP-loaded medical grade polycaprolactone-tricalcium phosphate scaffolds were implanted in 30mm tibial defects in sheep. BMP-mediated bone formation after 3 and 12 months was compared with slower bone formation with a scaffold alone after 12 months. A multiscale analysis based on microcomputed tomography, histology, polarized light microscopy, backscattered electron microscopy, small angle X-ray scattering and nanoindentation was used to characterize bone volume, collagen fiber orientation, mineral particle thickness and orientation, and local mechanical properties. Despite different observed kinetics in bone formation, similar structural properties on a microscopic and sub-micron level seem to emerge in both BMP-treated and scaffold only groups. The guiding effect of the scaffold architecture is illustrated through structural differences in bone across different regions. In the vicinity of the scaffold increased tissue organization is observed at 3 months. Loading along the long bone axis transferred through the scaffold defines bone micro- and nanostructure after 12 months.
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A Novel Shape Memory Plate Osteosynthesis for Noninvasive Modulation of Fixation Stiffness in a Rabbit Tibia Osteotomy Model. BIOMED RESEARCH INTERNATIONAL 2015; 2015:652940. [PMID: 26167493 PMCID: PMC4475735 DOI: 10.1155/2015/652940] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/30/2015] [Indexed: 01/09/2023]
Abstract
Nickel-titanium shape memory alloy (NiTi-SMA) implants might allow modulating fracture healing, changing their stiffness through alteration of both elastic modulus and cross-sectional shape by employing the shape memory effect (SME). Hypotheses: a novel NiTi-SMA plate stabilizes tibia osteotomies in rabbits. After noninvasive electromagnetic induction heating the alloy exhibits the SME and the plate changes towards higher stiffness (inverse dynamization) resulting in increased fixation stiffness and equal or better bony healing. In 14 rabbits, 1.0 mm tibia osteotomies were fixed with our experimental plate. Animals were randomised for control or induction heating at three weeks postoperatively. Repetitive X-ray imaging and in vivo measurements of bending stiffness were performed. After sacrifice at 8 weeks, macroscopic evaluation, µCT, and post mortem bending tests of the tibiae were carried out. One death and one early implant dislocation occurred. Following electromagnetic induction heating, radiographic and macroscopic changes of the implant proved successful SME activation. All osteotomies healed. In the treatment group, bending stiffness increased over time. Differences between groups were not significant. In conclusion, we demonstrated successful healing of rabbit tibia osteotomies using our novel NiTi-SMA plate. We demonstrated shape-changing SME in-vivo through transcutaneous electromagnetic induction heating. Thus, future orthopaedic implants could be modified without additional surgery.
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Bigham-Sadegh A, Oryan A. Selection of animal models for pre-clinical strategies in evaluating the fracture healing, bone graft substitutes and bone tissue regeneration and engineering. Connect Tissue Res 2015; 56:175-94. [PMID: 25803622 DOI: 10.3109/03008207.2015.1027341] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In vitro assays can be useful in determining biological mechanism and optimizing scaffold parameters, however translation of the in vitro results to clinics is generally hard. Animal experimentation is a better approximation than in vitro tests, and usage of animal models is often essential in extrapolating the experimental results and translating the information in a human clinical setting. In addition, usage of animal models to study fracture healing is useful to answer questions related to the most effective method to treat humans. There are several factors that should be considered when selecting an animal model. These include availability of the animal, cost, ease of handling and care, size of the animal, acceptability to society, resistance to surgery, infection and disease, biological properties analogous to humans, bone structure and composition, as well as bone modeling and remodeling characteristics. Animal experiments on bone healing have been conducted on small and large animals, including mice, rats, rabbits, dogs, pigs, goats and sheep. This review also describes the molecular events during various steps of fracture healing and explains different means of fracture healing evaluation including biomechanical, histopathological and radiological assessments.
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Affiliation(s)
- Amin Bigham-Sadegh
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Radiology, Shahrekord University , Shahrekord , Iran and
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Glatt V, Matthys R. Adjustable stiffness, external fixator for the rat femur osteotomy and segmental bone defect models. J Vis Exp 2014:e51558. [PMID: 25350129 DOI: 10.3791/51558] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The mechanical environment around the healing of broken bone is very important as it determines the way the fracture will heal. Over the past decade there has been great clinical interest in improving bone healing by altering the mechanical environment through the fixation stability around the lesion. One constraint of preclinical animal research in this area is the lack of experimental control over the local mechanical environment within a large segmental defect as well as osteotomies as they heal. In this paper we report on the design and use of an external fixator to study the healing of large segmental bone defects or osteotomies. This device not only allows for controlled axial stiffness on the bone lesion as it heals, but it also enables the change of stiffness during the healing process in vivo. The conducted experiments have shown that the fixators were able to maintain a 5 mm femoral defect gap in rats in vivo during unrestricted cage activity for at least 8 weeks. Likewise, we observed no distortion or infections, including pin infections during the entire healing period. These results demonstrate that our newly developed external fixator was able to achieve reproducible and standardized stabilization, and the alteration of the mechanical environment of in vivo rat large bone defects and various size osteotomies. This confirms that the external fixation device is well suited for preclinical research investigations using a rat model in the field of bone regeneration and repair.
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Affiliation(s)
- Vaida Glatt
- Institute of Health and Biomedical Innovation, Queensland University of Technology;
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48
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Schmidt-Bleek K, Petersen A, Dienelt A, Schwarz C, Duda GN. Initiation and early control of tissue regeneration - bone healing as a model system for tissue regeneration. Expert Opin Biol Ther 2014; 14:247-59. [PMID: 24397854 DOI: 10.1517/14712598.2014.857653] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Tissue regeneration in itself is a fascinating process that promises repeated renewal of tissue and organs. AREAS COVERED This article aims to illustrate the different strategies available to control tissue regeneration at a very early stage, using bone as an exemplary tissue. The aspects of a controlled inflammatory cascade to achieve a balanced immune response, cell therapeutic approaches for improved tissue formation and angiogenesis, guiding the organization of newly formed extracellular matrix by biomaterials, the relevance of mechanical signals for tissue regeneration processes, and the chances and limitations of growth factor treatments are discussed. EXPERT OPINION The currently available knowledge is reviewed and perspectives for potential new targets are given. This is done under the assumption that early identification of risk patients as well as the application of early intervention strategies is possible.
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Affiliation(s)
- Katharina Schmidt-Bleek
- Charité - Universitätsmedizin Berlin, Julius Wolff Institut and Center for Musculoskeletal Surgery , Augustenburger Platz 1, D-13353 Berlin , Germany +49 30 450 536196 ; +49 30 450 559969 ;
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Thompson EM, Matsiko A, Farrell E, Kelly DJ, O'Brien FJ. Recapitulating endochondral ossification: a promising route toin vivobone regeneration. J Tissue Eng Regen Med 2014; 9:889-902. [DOI: 10.1002/term.1918] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/14/2014] [Accepted: 04/24/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Emmet M. Thompson
- Tissue Engineering Research Group, Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute; Trinity College Dublin; Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre; Dublin Ireland
| | - Amos Matsiko
- Tissue Engineering Research Group, Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute; Trinity College Dublin; Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre; Dublin Ireland
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery, Erasmus MC; University Medical Centre Rotterdam; The Netherlands
| | - Daniel J. Kelly
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute; Trinity College Dublin; Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre; Dublin Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering; Trinity College Dublin; Ireland
| | - Fergal J. O'Brien
- Tissue Engineering Research Group, Department of Anatomy; Royal College of Surgeons in Ireland; Dublin Ireland
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute; Trinity College Dublin; Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre; Dublin Ireland
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Bosemark P, Isaksson H, Tägil M. Influence of systemic bisphosphonate treatment on mechanical properties of BMP-induced calluses in a rat fracture model: comparison of three-point bending and twisting test. J Orthop Res 2014; 32:721-6. [PMID: 24522981 DOI: 10.1002/jor.22599] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 01/21/2014] [Indexed: 02/04/2023]
Abstract
The combination of autograft, BMP and bisphosphonate has been shown to produce strong calluses. In this study, without autograft we investigate the effect of bisphosphonate treatment on BMP-induced calluses, both in bending and in rotation. Sprague-Dawley rats (n = 42) underwent femoral osteotomy and BMP-7 treatment. At 2 weeks an injection of saline or bisphosphonate was administered. The animals were sacrificed after 6 weeks. Both femurs were tested in either three-point bending or twisting. All femurs healed. BMP + bisphosphonate-treatment led to larger calluses (p < 0.05) and in three-point bending, higher ultimate force (p < 0.01) and greater stiffness (p < 0.05) than BMP alone. The BMP + bisphosphonate group was nearly 60% stronger than controls, while the BMP group did not reach the strength (p < 0.05) nor stiffness (p < 0.01) of the controls. In the twisting test, similar trends were found but less pronounced. Three-point bending produced transverse callus associated fractures, whereas the twisting test produced spiral fractures, located in the structurally weaker distal femur. BMP + bisphosphonate-treatment produces calluses that are mechanically superior to calluses induced by BMP alone, when tested both in three-point bending and in twisting. For the mechanical evaluation of pharmacologically enhanced calluses with breaking strengths exceeding the native bone, the bending test is recommended.
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Affiliation(s)
- Per Bosemark
- Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
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