1
|
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)."
Collapse
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
| |
Collapse
|
2
|
Mohaghegh S, Alirezaei F, Ahmadi N, Kouhestani F, Motamedian SR. Application of chemical factors for acceleration of consolidation phase of the distraction osteogenesis: a scoping review. Oral Maxillofac Surg 2023; 27:559-579. [PMID: 35852720 DOI: 10.1007/s10006-022-01097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to analyze the effect of injecting chemical factors compared to conventional distraction osteogenesis (DO) treatment on the bone formation of the distracted area of the maxillofacial region in human and animal studies. METHOD Electronic search was done in PubMed, Scopus, Embase, and Cochrane database for studies published until September 2021. The studies' risk of bias (ROB) was assessed using the Cochrane Collaborations and NIH quality assessment tools. Meta-analyses were performed to assess the difference in the amount of bone formation and maximal load tolerance. RESULTS Among a total of 58 included studies, eight studies analyzed the bone formation rate of the distracted area in human models and others in animal models. Results of the human studies showed acceptable outcomes in the case of using bone morphogenic protein-2 (BMP-2), autologous bone-platelet gel, and calcium sulfate. However, using platelet reach plasma does not increase the rate of bone formation significantly. Quantitative analyses showed that both BMP-2 (SMD = 26.57; 95% CI = 18.86 to 34.28) and neuron growth factor (NGF) (SMD = 16.19; 95% CI = 9.64 to 22.75) increase the amount of bone formation. Besides, NGF increased the amount of load tolerance significantly (SMD = 30.03; 95% CI = 19.91 to 40.16). Additionally, BMP-2 has no significant impact on the post-treatment maxillary length (SMD = 9.19; 95% CI = - 2.35 to 20.73). CONCLUSION Limited number of human studies with low quality used chemical factors to enhance osteogenesis and showed acceptable results. However, more studies with higher quality are required.
Collapse
Affiliation(s)
- Sadra Mohaghegh
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
| | - Fatemeh Alirezaei
- Department of Orthodontics, School of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | - Nima Ahmadi
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
| | - Farnaz Kouhestani
- Department of Periodontics, School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Saeed Reza Motamedian
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran.
| |
Collapse
|
3
|
Fu R, Feng Y, Liu Y, Gao X, Bertrand DT, Du T, Liu Y, Willie BM, Yang H. Effect of the accordion technique on bone regeneration during distraction osteogenesis: A computational study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 227:107232. [PMID: 36371976 DOI: 10.1016/j.cmpb.2022.107232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Distraction osteogenesis (DO), a bone lengthening technique, is widely employed to treat congenital and acquired limb length discrepancies and large segmental bone defects. However, a major issue of DO is the prolonged consolidation phase (10-36 months) during which patients must wear a cumbersome external fixator. Attempts have been made to accelerate the healing process of DO by an alternating distraction and compression mode (so-called "accordion" technique or AT). However, it remains unclear how varied AT parameters affect DO outcomes and what the most effective AT mode is. METHODS Based on an experimentally-verified mechanobiological model, we performed a parametric analysis via in silico simulation of the bone regeneration process of DO under different AT modes, including combinations of varied application times (AT began at week 1-8 of the consolidation phase), durations (AT was used continuously for 1 week, 2 weeks or 4 weeks) and rates (distraction or compression at 0.25, 0.5, 0.75, and 1 mm/12 h). The control group had no AT applied during the consolidation phase. RESULTS Compared with the control group (no AT), AT applied at an early consolidation stage (e.g. week 1 of the consolidation phase) significantly enhanced bone formation and reduced the overall healing time. However, the effect of AT on bone healing was dependent on its duration and rate. Specifically, a moderate rate of AT (e.g. 0.5 mm/12 h) lasting for two weeks promoted blood perfusion recovery and bone regeneration, ultimately shortening the healing time. Conversely, over-high rates (e.g. 1 mm/12 h) and longer durations (e.g. 4 weeks) of AT adversely affected bone regeneration and blood perfusion recovery, thereby delaying bone bridging. CONCLUSIONS These results suggest that the therapeutic effects of AT on DO are highly dependent of the AT parameters of choice. Under appropriate durations and rates, the AT applied at an early consolidation phase is beneficial for blood recovery and bone regeneration. These results may provide a basis for selecting effective AT modes to accelerate consolidation and reduce the overall treatment period of DO.
Collapse
Affiliation(s)
- Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Yang Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Xing Gao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - David T Bertrand
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Tianming Du
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Bettina M Willie
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
| |
Collapse
|
4
|
Fu R, Bertrand D, Wang J, Kavaseri K, Feng Y, Du T, Liu Y, Willie BM, Yang H. In vivo and in silico monitoring bone regeneration during distraction osteogenesis of the mouse femur. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 216:106679. [PMID: 35139460 DOI: 10.1016/j.cmpb.2022.106679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Distraction osteogenesis (DO) is a mechanobiological process of producing new bone by gradual and controlled distraction of the surgically separated bone segments. Mice have been increasingly used to study the role of relevant biological factors in regulating bone regeneration during DO. However, there remains a lack of in silico DO models and related mechano-regulatory tissue differentiation algorithms for mouse bone. This study sought to establish an in silico model based on in vivo experimental data to simulate the bone regeneration process during DO of the mouse femur. METHODS In vivo micro-CT, including time-lapse morphometry was performed to monitor the bone regeneration in the distraction gap. A 2D axisymmetric finite element model, with a geometry originating from the experimental data, was created. Bone regeneration was simulated with a fuzzy logic-based two-stage (distraction and consolidation) mechano-regulatory tissue differentiation algorithm, which was adjusted from that used for fracture healing based on our in vivo experimental data. The predictive potential of the model was further tested with varied distraction frequencies and distraction rates. RESULTS The computational simulations showed similar bone regeneration patterns to those observed in the micro-CT data from the experiment throughout the DO process. This consisted of rapid bone formation during the first 10 days of the consolidation phase, followed by callus reshaping via bone remodeling. In addition, the computational model predicted a faster and more robust bone healing response as the model's distraction frequency was increased, whereas higher or lower distraction rates were not conducive to healing. CONCLUSIONS This in silico model could be used to investigate basic mechanobiological mechanisms involved in bone regeneration or to optimize DO strategies for potential clinical applications.
Collapse
Affiliation(s)
- Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - David Bertrand
- Department of Pediatric Surgery, McGill University, Montreal, Canada; Research Center, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Jianing Wang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Kyle Kavaseri
- Department of Pediatric Surgery, McGill University, Montreal, Canada; Research Center, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Tianming Du
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Bettina M Willie
- Department of Pediatric Surgery, McGill University, Montreal, Canada; Research Center, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
| |
Collapse
|
5
|
Liang W, Zhao E, Li G, Bi H, Zhao Z. Suture Cells in a Mechanical Stretching Niche: Critical Contributors to Trans-sutural Distraction Osteogenesis. Calcif Tissue Int 2022; 110:285-293. [PMID: 34802070 DOI: 10.1007/s00223-021-00927-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023]
Abstract
Trans-sutural distraction osteogenesis has been proposed as an alternative technique of craniofacial remodelling surgery for craniosynostosis correction. Many studies have defined the contribution of a series of biological events to distraction osteogenesis, such as changes in gene expression, changes in suture cell behaviour and changes in suture collagen fibre characteristics. However, few studies have elucidated the systematic molecular and cellular mechanisms of trans-sutural distraction osteogenesis, and no study has highlighted the contribution of cell-cell or cell-matrix interactions with respect to the whole expansion process to date. Therefore, it is difficult to translate largely primary mechanistic insights into clinical applications and optimize the clinical outcome of trans-sutural distraction osteogenesis. In this review, we carefully summarize in detail the literature related to the effects of mechanical stretching on osteoblasts, endothelial cells, fibroblasts, immune cells (macrophages and T cells), mesenchymal stem cells and collagen fibres in sutures during the distraction osteogenesis process. We also briefly review the contribution of cell-cell or cell-matrix interactions to bone regeneration at the osteogenic suture front from a comprehensive viewpoint.
Collapse
Affiliation(s)
- Wei Liang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Enzhe Zhao
- Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Guan Li
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Hongsen Bi
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China.
| | - Zhenmin Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, 100191, China.
| |
Collapse
|
6
|
Yang S, Wang N, Ma Y, Guo S, Guo S, Sun H. Immunomodulatory effects and mechanisms of distraction osteogenesis. Int J Oral Sci 2022; 14:4. [PMID: 35067679 PMCID: PMC8784536 DOI: 10.1038/s41368-021-00156-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022] Open
Abstract
Distraction osteogenesis (DO) is widely used for bone tissue engineering technology. Immune regulations play important roles in the process of DO like other bone regeneration mechanisms. Compared with others, the immune regulation processes of DO have their distinct features. In this review, we summarized the immune-related events including changes in and effects of immune cells, immune-related cytokines, and signaling pathways at different periods in the process of DO. We aim to elucidated our understanding and unknowns about the immunomodulatory role of DO. The goal of this is to use the known knowledge to further modify existing methods of DO, and to develop novel DO strategies in our unknown areas through more detailed studies of the work we have done.
Collapse
|
7
|
Yang Y, Zhou J, Liang C, Xiao Q, Chen Y, Yu B. Effects of highly selective sensory/motor nerve injury on bone metabolism and bone remodeling in rats. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2022; 22:524-535. [PMID: 36458390 PMCID: PMC9716294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This work aimed to investigate the mechanism of selective sensory/motor nerve injury in affecting bone metabolism and remodeling. METHODS The selective sensory/motor nerve injury rat model was constructed through posterior rhizotomy (PRG), anterior rhizotomy (ARG), or anterior combined with posterior rhizotomy (APRG) at the L4-6 sensory/motor nerves on the right side of rats. Sham-operated (SOG) rats served as control. At 8 weeks after surgery, the sciatic nerves, spinal cord segments L5 and tibial tissues were collected for analysis. RESULTS the integrity of trabecular bone was damaged, the number of trabecular bone was decreased and the number of osteoclasts were increased in ARG group. ARG activated NF-κβ and PPAR-γ pathways, and inhibited Wnt/β-catenin pathway. ARG group exhibited high turnover bone metabolism. In PRG group, the trabecular bone morphology became thinner, and the number of osteoclasts was increased. NF-κβ pathway was activated and OPG/RANKL ratio was decreased in PRG group. The activated osteoclasts, reduced osteoblasts activity and lower turnover bone metabolism were observed in PRG group. Additionally, the bone metabolism in APRG group was similar to ARG group. CONCLUSION The posterior rhizotomy and anterior rhizotomy induced the different degree of osteoporosis in rats, which may attribute to regulate Wnt/β-catenin, NF-κβ and PPAR-γ signalling pathways.
Collapse
Affiliation(s)
- Yadong Yang
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China,Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Juan Zhou
- School of Basic Medicine, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Chen Liang
- Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Qi Xiao
- Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yan Chen
- Ultrasound Medical Center, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China,Corresponding authors: Yan Chen, Ultrasound Medical Center, Zhujiang Hospital of Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, China 510285 E-mail:
| | - Bo Yu
- Department of Orthopedics, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China,Corresponding authors: Bo Yu, Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu District, Guangzhou, Guangdong, China 510285
| |
Collapse
|
8
|
Fu R, Feng Y, Liu Y, Yang H. Mechanical regulation of bone regeneration during distraction osteogenesis. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
9
|
Management of infected nonunions of the femur and tibia with compression-distraction osteogenesis coupled with modern methods at a tertiary military establishment: a prospective case series. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Li X, Liu D, Li J, Yang S, Xu J, Yokota H, Zhang P. Wnt3a involved in the mechanical loading on improvement of bone remodeling and angiogenesis in a postmenopausal osteoporosis mouse model. FASEB J 2019; 33:8913-8924. [PMID: 31017804 DOI: 10.1096/fj.201802711r] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteoporosis is a major health problem, making bones fragile and susceptible to fracture. Previous works showed that mechanical loading stimulated bone formation and accelerated fracture healing. Focusing on the role of Wnt3a (wingless/integrated 3a), this study was aimed to assess effects of mechanical loading to the spine, using ovariectomized (OVX) mice as a model of osteoporosis. Two-week daily application of this novel loading (4 N, 10 Hz, 5 min/d) altered bone remodeling with an increase in Wnt3a. Spinal loading promoted osteoblast differentiation, endothelial progenitor cell migration, and tube formation and inhibited osteoclast formation, migration, and adhesion. A transient silencing of Wnt3a altered the observed loading effects. Spinal loading significantly increased bone mineral density, bone mineral content, and bone area per tissue area. The loaded OVX group showed a significant increase in the number of osteoblasts and reduction in osteoclast surface/bone surface. Though expression of osteoblastic genes was increased, the levels of osteoclastic genes were decreased by loading. Spinal loading elevated a microvascular volume as well as VEGF expression. Collectively, this study supports the notion that Wnt3a-mediated signaling involves in the effect of spinal loading on stimulating bone formation, inhibiting bone resorption, and promoting angiogenesis in OVX mice. It also suggests that Wnt3a might be a potential therapeutic target for osteoporosis treatment.-Li, X., Liu, D., Li, J., Yang, S., Xu, J., Yokota, H., Zhang, P. Wnt3a involved in the mechanical loading on improvement of bone remodeling and angiogenesis in a postmenopausal osteoporosis mouse model.
Collapse
Affiliation(s)
- Xinle Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.,Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, China; and
| | - Daquan Liu
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.,Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, China; and
| | - Jie Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Shuang Yang
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Jinfeng Xu
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Hiroki Yokota
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Ping Zhang
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.,Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, China; and.,Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indiana, USA
| |
Collapse
|
11
|
Dissaux C, Wagner D, George D, Spingarn C, Rémond Y. Mechanical impairment on alveolar bone graft: A literature review. J Craniomaxillofac Surg 2019; 47:149-157. [DOI: 10.1016/j.jcms.2018.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/08/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022] Open
|
12
|
McEwan JK, Tribe HC, Jacobs N, Hancock N, Qureshi AA, Dunlop DG, Oreffo RO. Regenerative medicine in lower limb reconstruction. Regen Med 2018; 13:477-490. [PMID: 29985779 DOI: 10.2217/rme-2018-0011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Bone is a highly specialized connective tissue and has a rare quality as one of the few tissues that can repair without a scar to regain pre-injury structure and function. Despite the excellent healing capacity of bone, tumor, infection, trauma and surgery can lead to significant bone loss requiring skeletal augmentation. Bone loss in the lower limb poses a complex clinical problem, requiring reconstructive techniques to restore form and function. In the past, amputation may have been the only option; however, there is now an array of reconstructive possibilities and cellular therapies available to salvage a limb. In this review, we will evaluate current applications of bone tissue engineering techniques in limb reconstruction and identify potential strategies for future work.
Collapse
Affiliation(s)
- Josephine K McEwan
- Bone & Joint Research Group, Centre for Human Development, Stem Cell & Regeneration, Institute of Developmental Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Howard C Tribe
- Bone & Joint Research Group, Centre for Human Development, Stem Cell & Regeneration, Institute of Developmental Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Neal Jacobs
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Nicholas Hancock
- Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
| | - Amir A Qureshi
- Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
| | - Douglas G Dunlop
- Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
| | - Richard Oc Oreffo
- Bone & Joint Research Group, Centre for Human Development, Stem Cell & Regeneration, Institute of Developmental Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| |
Collapse
|
13
|
Alzahrani MM, Makhdom AM, Rauch F, Lauzier D, Kotsiopriftis M, Ghadakzadeh S, Hamdy RC. Assessment of the effect of systemic delivery of sclerostin antibodies on Wnt signaling in distraction osteogenesis. J Bone Miner Metab 2018. [PMID: 28647818 DOI: 10.1007/s00774-017-0847-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sclerostin is a known inhibitor of the Wnt signaling pathway which is involved in osteogenesis and, when inactivated, stimulates bone formation. To our knowledge, this effect has not been studied in the context of distraction osteogenesis (DO). Tibial DO was conducted on a total of 24 wild-type mice, which were then divided into 2 groups-a saline injection group (control) and an anti-sclerostin (Scl-Ab) injection group (treatment). The mice in the treatment group received 100 mg/kg intravenous injections of the antibody weekly until killing. The 12 mice in each group were subdivided into four time points according to post-osteotomy time of killing-11 days (mid-distraction), 17 days (late distraction), 34 days (mid-consolidation) and 51 days (late consolidation), with 3 mice per subgroup. After killing, the tibia specimens were collected for immunohistochemical analysis. Our results show that the group injected with anti-sclerostin had an earlier peak (day 11) in the distraction phase of the osteogenic molecules involved in the Wnt signaling pathway in comparison to the placebo group. In addition, downregulation of the inhibitors of this pathway was noted in the treatment group when compared with the placebo group. Furthermore, LRP-5 showed a significant increase in expression in the treatment group. Sclerostin inhibition has a significant effect on the DO process through its effect on the Wnt pathway. This effect was evident through the decreased effect of sclerostin on LRP-5 and earlier upregulation of the osteogenic molecules involved in this pathway.
Collapse
Affiliation(s)
- Mohammad M Alzahrani
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada.
- Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia.
| | - Asim M Makhdom
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada
- Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Frank Rauch
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada
| | - Dominique Lauzier
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada
| | - Maria Kotsiopriftis
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada
| | - Saber Ghadakzadeh
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada
| | - Reggie C Hamdy
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada
| |
Collapse
|
14
|
Mechanical solutions to salvage failed distraction osteogenesis in large bone defect management. INTERNATIONAL ORTHOPAEDICS 2018; 43:1051-1059. [PMID: 29934717 DOI: 10.1007/s00264-018-4032-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/12/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Ilizarov bone transport for large bone defect is challenging and may end in distraction osteogenesis failure. MATERIAL AND METHODS Ten forearm and seven tibial defect cases with failed regeneration due to ischaemia during bone transport were studied retrospectively. Mean forearm and tibial defects were 5.5 ± 0.8 and 7.6 ± 1 cm respectively, or 22.3 ± 3.6 and 20 ± 2.3% as compared with healthy segments. Most patients had numerous previous operations (2.6 ± 0.5 and 3.4 ± 0.8 per patient, respectively), extensive scars locally and post-traumatic neuropathy. There were seven infected defects. Mechanical solutions used were (1) additional osteotomy and transport of the fragment to compact the ischaemic regenerate (10 forearms, 4 tibias) and (2) compaction of the connective tissue layer in the tibial regenerate with either two 5-mm steps (two cases) or gradually (one case). RESULTS Bone integrity was restored in all the cases. Complete compensation of the defects was achieved in 12 patients with the first technique. Two patients with 8-cm ulna defects remained with residual discrepancy. In the forearm, mean compaction was 1.7 ± 0.4 cm. It took 25.7 ± 5.4 days followed by an average fixation period of 107.1 ± 11.8 days. In the tibia, mean longitudinal compaction by distraction measured 1.7 ± 0.8 cm. The second technique ended up with an acceptable shortening of 1 cm in two cases. Four centimeters were compressed in the third case gradually. CONCLUSION The technical solutions used for mechanical effects on the ischaemic distraction regenerate resulted in its rescue and bone union in all the cases.
Collapse
|
15
|
Yin C, Zhang Y, Hu L, Tian Y, Chen Z, Li D, Zhao F, Su P, Ma X, Zhang G, Miao Z, Wang L, Qian A, Xian CJ. Mechanical unloading reduces microtubule actin crosslinking factor 1 expression to inhibit β-catenin signaling and osteoblast proliferation. J Cell Physiol 2018; 233:5405-5419. [PMID: 29219183 DOI: 10.1002/jcp.26374] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/29/2017] [Indexed: 02/03/2023]
Abstract
Mechanical unloading was considered a major threat to bone homeostasis, and has been shown to decrease osteoblast proliferation although the underlying mechanism is unclear. Microtubule actin crosslinking factor 1 (MACF1) is a cytoskeletal protein that regulates cellular processes and Wnt/β-catenin pathway, an essential signaling pathway for osteoblasts. However, the relationship between MACF1 expression and mechanical unloading, and the function and the associated mechanisms of MACF1 in regulating osteoblast proliferation are unclear. This study investigated effects of mechanical unloading on MACF1 expression levels in cultured MC3T3-E1 osteoblastic cells and in femurs of mice with hind limb unloading; and it also examined the role and potential action mechanisms of MACF1 in osteoblast proliferation in MACF1-knockdown, overexpressed or control MC3T3-E1 cells treated with or without the mechanical unloading condition. Results showed that the mechanical unloading condition inhibited osteoblast proliferation and MACF1 expression in MC3T3-E1 osteoblastic cells and mouse femurs. MACF1 knockdown decreased osteoblast proliferation, while MACF1 overexpression increased it. The inhibitory effect of mechanical unloading on osteoblast proliferation also changed with MACF1 expression levels. Furthermore, MACF1 was found to enhance β-catenin expression and activity, and mechanical unloading decreased β-catenin expression through MACF1. Moreover, β-catenin was found an important regulator of osteoblast proliferation, as its preservation by treatment with its agonist lithium attenuated the inhibitory effects of MACF1-knockdown or mechanical unloading on osteoblast proliferation. Taken together, mechanical unloading decreases MACF1 expression, and MACF1 up-regulates osteoblast proliferation through enhancing β-catenin signaling. This study has thus provided a mechanism for mechanical unloading-induced inhibited osteoblast proliferation.
Collapse
Affiliation(s)
- Chong Yin
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Yan Zhang
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Lifang Hu
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Ye Tian
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Zhihao Chen
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Dijie Li
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Fan Zhao
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Peihong Su
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Xiaoli Ma
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China
| | - Ge Zhang
- Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Zhiping Miao
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Liping Wang
- Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Airong Qian
- Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, Shaanxi, China.,Shenzhen Research Institute of Northwestern Polytechnical University, Shenzhen, China.,NPU-HKBU Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Northwestern Polytechnical University, Xi'an, China
| | - Cory J Xian
- Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| |
Collapse
|
16
|
Alzahrani MM, Anam E, AlQahtani SM, Makhdom AM, Hamdy RC. Strategies of enhancing bone regenerate formation in distraction osteogenesis. Connect Tissue Res 2018; 59:1-11. [PMID: 28165797 DOI: 10.1080/03008207.2017.1288725] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distraction osteogenesis (DO) is a commonly used technique in multiple orthopedic sub-specialties, including trauma, oncology and pediatrics. This technique aims to produce new bone formation in the distraction gap in a controlled manner. The issue with this technique has been the high risk of complications, one of which is poor regenerate formation during the distraction process. Although several factors (including patient and operative factors) and techniques (including surgical, mechanical and pharmacological) have been described to ensure successful regenerate formation during the process of DO, these factors are sometimes difficult to control clinically. Our aim from this review is to highlight the different factors that affect DO, modalities to assess the regenerate and review treatment options for poor regenerate in the distraction gap. In addition, we propose a management protocol derived from the available literature that can be used to facilitate the management of inadequate regenerate formation.
Collapse
Affiliation(s)
- Mohammad Mesfer Alzahrani
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,b Department of Orthopaedic Surgery , University of Dammam , Dammam , Saudi Arabia
| | - Emad Anam
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,c Department of Orthopaedic Surgery , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Saad M AlQahtani
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,b Department of Orthopaedic Surgery , University of Dammam , Dammam , Saudi Arabia
| | - Asim M Makhdom
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada.,c Department of Orthopaedic Surgery , King Abdulaziz University , Jeddah , Saudi Arabia
| | - Reggie C Hamdy
- a Division of Orthopaedic Surgery , Shriners Hospital for Children, Montreal Children's Hospital, McGill University , Montreal , Canada
| |
Collapse
|
17
|
Lundblad H, Karlsson-Thur C, Maguire GQ, Jonsson C, Noz ME, Zeleznik MP, Weidenhielm L. Can Spatiotemporal Fluoride ( 18F -) Uptake be Used to Assess Bone Formation in the Tibia? A Longitudinal Study Using PET/CT. Clin Orthop Relat Res 2017; 475:1486-1498. [PMID: 28150226 PMCID: PMC5384929 DOI: 10.1007/s11999-017-5250-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/13/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND When a bone is broken for any reason, it is important for the orthopaedic surgeon to know how bone healing is progressing. There has been resurgence in the use of the fluoride (18F-) ion to evaluate various bone conditions. This has been made possible by availability of positron emission tomography (PET)/CT hybrid scanners together with cyclotrons. Absorbed on the bone surface from blood flow, 18F- attaches to the osteoblasts in cancellous bone and acts as a pharmacokinetic agent, which reflects the local physiologic activity of bone. This is important because it shows bone formation indicating that the bone is healing or no bone formation indicating no healing. As 18F- is extracted from blood in proportion to blood flow and bone formation, it thus enables determination of bone healing progress. QUESTIONS/PURPOSES The primary objective of this study was to determine whether videos showing the spatiotemporal uptake of 18F- via PET bone scans could show problematic bone healing in patients with complex tibia conditions. A secondary objective was to determine if semiquantification of radionuclide uptake was consistent with bone healing. METHODS This study investigated measurements of tibia bone formation in patients with complex fractures, osteomyelitis, and osteotomies treated with a Taylor Spatial FrameTM (TSF) by comparing clinical healing progress with spatiotemporal fluoride (18F-) uptake and the semiquantitative standardized uptake value (SUV). This procedure included static and dynamic image acquisition. For intrapatient volumes acquired at different times, the CT and PET data were spatially registered to bring the ends of the bones that were supposed to heal into alignment. To qualitatively observe how and where bone formation was occurring, time-sequenced volumes were reconstructed and viewed as a video. To semiquantify the uptake, the mean and maximum SUVs (SUVmean, SUVmax) were calculated for the ends of the bones that were supposed to heal and for normal bone, using a spherical volume of interest drawn on the registered volumes. To make the semiquantitative data comparable for all patients with multiple examinations, the SUVmean and SUVmax difference per day (SUVmeanDPD and SUVmaxDPD) between the first PET/CT scan and each subsequent one was calculated. Indicators of poor healing progress were (1) uneven distribution of the radionuclide uptake between ends of the bones that were supposed to heal as seen in the video or, (2) low absolute magnitude of the SUV difference data. Twenty-four patients treated between October 2013 and April 2015 with a TSF gave informed consent to be examined with 18F- PET/CT bone scans. Twenty-two patients successfully completed treatment, one of whom had only one PET/CT scan. RESULTS Observation of 18F- uptake was able to identify three patients whose healing progress was poor, indicated by uneven distribution of radionuclide uptake across the ends of the bones that were supposed to heal. An absolute magnitude of the SUVmaxDPD of 0.18 or greater indicated good bone formation progress. This was verified in 10 patients by the days between the operation to attach and to remove the TSF being less than 250 days, whereas other SUVmaxDPD values were ambiguous, with 11 patients achieving successful completion. CONCLUSIONS Observation of the spatiotemporal uptake of 18F- appears to be a promising method to enable the clinician to assess the progress of bone formation in different parts of the bone. Bone uptake which is uneven across the ends of bone that were supposed to heal or very low bone uptake might indicate impaired bone healing where early intervention may then be needed. However, semiquantification of 18F- uptake (SUVmaxDPD), SUVmeanDPD) was ambiguous in showing consistency with the bone-healing progress. LEVEL OF EVIDENCE Level III, diagnostic study.
Collapse
Affiliation(s)
- Henrik Lundblad
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Gerald Q Maguire
- School of Information and Communication Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Cathrine Jonsson
- Department of Medical Physics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Marilyn E Noz
- Department of Radiology, New York University, New York, NY, USA
| | - Michael P Zeleznik
- School of Computing, College of Engineering, University of Utah, Salt Lake City, UT, USA
| | - Lars Weidenhielm
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, K l, Orthopedics, A2:07, 171 76, Stockholm, Sweden.
| |
Collapse
|
18
|
Abstract
Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced membrane technique is an alternative to bone transport to fill gaps. It needs large amounts of bone graft from iliac crest or femoral canal. This is an expensive method physiologically and economically. Infection can resorb the graft and cause failure of treatment. It can be done in select cases after thorough eradication of infection. Patience and perseverance are needed for successful resolution of infection and achieving union.
Collapse
Affiliation(s)
- Milind Madhav Chaudhary
- Director, Orthopaedic Surgery, Centre for Ilizarov Techniques, Chaudhary Hospital, Akola, Maharashtra, India,Address for correspondence: Dr. Milind Madhav Chaudhary, Chaudhary Hospital, Akola - 444 001, Maharashtra, India. E-mail:
| |
Collapse
|
19
|
Abstract
Distraction osteogenesis biologically resembles fracture healing with distinctive characteristics notably in the distraction phase of osteogenesis. In the latency phase of bone lengthening, like in the inflammatory phase of fracture repair, interleukines are released and act with growth factors released from platelets in the local haematoma, leading to attraction, proliferation and differentiation of mesenchymal stem cells into osteoblasts and other differentiated mesenchymal cells. These in turn produce matrix, collagen fibers and growth factors. A callus containing cells, collagen fibers, osteoid and cartilage matrix is formed. Provided stable fixation, distraction will trigger intramembranous bone formation. As distraction proceeds, the distraction gap develops five distinctive zones with unmineralized bone in the middle, remodelling bone peripherally, and mineralizing bone in between. During consolidation, the high concentration of anabolic growth factors in the regenerate diminishes with time as remodelling takes over to form mature cortical and cancellous bone. Systemic disease, congenital bone deficiencies, medications and substance abuse can influence the quality and quantity of regenerate bone, usually in a negative way. The regenerate bone can be manipulated when needed by using injection of mesenchymal stem cells and platelets, growth factors (BMP-2 and -7), and systemic medications (bisphosphonates and parathyroid hormone). Growth factors and systemic anabolic and antiresorptive drugs are prescribed on special indications, while distraction osteogenesis is not an authorized indication. To some extent, however, these compounds can be used off-label. Use in children presents special problems since growth factors and specific anabolic medications may involve a risk of inducing cancer.
Collapse
Affiliation(s)
- Ivan Hvid
- Section of Pediatric and Reconstructive Orthopaedic Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Joachim Horn
- Section of Pediatric and Reconstructive Orthopaedic Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Stefan Huhnstock
- Section of Pediatric and Reconstructive Orthopaedic Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Harald Steen
- Section of Pediatric and Reconstructive Orthopaedic Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| |
Collapse
|
20
|
Golding A, Guay JA, Herrera-Rincon C, Levin M, Kaplan DL. A Tunable Silk Hydrogel Device for Studying Limb Regeneration in Adult Xenopus Laevis. PLoS One 2016; 11:e0155618. [PMID: 27257960 PMCID: PMC4892606 DOI: 10.1371/journal.pone.0155618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/02/2016] [Indexed: 01/08/2023] Open
Abstract
In certain amphibian models limb regeneration can be promoted or inhibited by the local wound bed environment. This research introduces a device that can be utilized as an experimental tool to characterize the conditions that promotes limb regeneration in the adult frog (Xenopus laevis) model. In particular, this device was designed to manipulate the local wound environment via a hydrogel insert. Initial characterization of the hydrogel insert revealed that this interaction had a significant influence on mechanical forces to the animal, due to the contraction of the hydrogel. The material and mechanical properties of the hydrogel insert were a factor in the device design in relation to the comfort of the animal and the ability to effectively manipulate the amputation site. The tunable features of the hydrogel were important in determining the pro-regenerative effects in limb regeneration, which was measured by cartilage spike formation and quantified by micro-computed tomography. The hydrogel insert was a factor in the observed morphological outcomes following amputation. Future work will focus on characterizing and optimizing the device's observed capability to manipulate biological pathways that are essential for limb regeneration. However, the present work provides a framework for the role of a hydrogel in the device and a path forward for more systematic studies.
Collapse
Affiliation(s)
- Anne Golding
- Department of Chemical and Biological Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Justin A. Guay
- Department of Biology, Center for Regenerative and Developmental Biology, Tufts University, Medford, Massachusetts, United States of America
| | - Celia Herrera-Rincon
- Department of Biology, Center for Regenerative and Developmental Biology, Tufts University, Medford, Massachusetts, United States of America
| | - Michael Levin
- Department of Biology, Center for Regenerative and Developmental Biology, Tufts University, Medford, Massachusetts, United States of America
| | - David L. Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts, United States of America
| |
Collapse
|
21
|
Abstract
The regulation of organ size is essential to human health and has fascinated biologists for centuries. Key to the growth process is the ability of most organs to integrate organ-extrinsic cues (eg, nutritional status, inflammatory processes) with organ-intrinsic information (eg, genetic programs, local signals) into a growth response that adapts to changing environmental conditions and ensures that the size of an organ is coordinated with the rest of the body. Paired organs such as the vertebrate limbs and the long bones within them are excellent models for studying this type of regulation because it is possible to manipulate one member of the pair and leave the other as an internal control. During development, growth plates at the end of each long bone produce a transient cartilage model that is progressively replaced by bone. Here, we review how proliferation and differentiation of cells within each growth plate are tightly controlled mainly by growth plate-intrinsic mechanisms that are additionally modulated by extrinsic signals. We also discuss the involvement of several signaling hubs in the integration and modulation of growth-related signals and how they could confer remarkable plasticity to the growth plate. Indeed, long bones have a significant ability for "catch-up growth" to attain normal size after a transient growth delay. We propose that the characterization of catch-up growth, in light of recent advances in physiology and cell biology, will provide long sought clues into the molecular mechanisms that underlie organ growth regulation. Importantly, catch-up growth early in life is commonly associated with metabolic disorders in adulthood, and this association is not completely understood. Further elucidation of the molecules and cellular interactions that influence organ size coordination should allow development of novel therapies for human growth disorders that are noninvasive and have minimal side effects.
Collapse
Affiliation(s)
- Alberto Roselló-Díez
- Developmental Biology Program, Sloan Kettering Institute, New York, New York 10065
| | - Alexandra L Joyner
- Developmental Biology Program, Sloan Kettering Institute, New York, New York 10065
| |
Collapse
|