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Seok MC, Koo HW, Jeong JH, Ko MJ, Lee BJ. Bone Substitute Options for Spine Fusion in Patients With Spine Trauma-Part II: The Role of rhBMP. Korean J Neurotrauma 2024; 20:35-44. [PMID: 38576507 PMCID: PMC10990692 DOI: 10.13004/kjnt.2024.20.e13] [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: 11/19/2023] [Revised: 12/26/2023] [Accepted: 01/14/2024] [Indexed: 04/06/2024] Open
Abstract
In Part II, we focus on an important aspect of spine fusion in patients with spine trauma: the pivotal role of recombinant human bone morphogenetic protein-2 (rhBMP-2). Despite the influx of diverse techniques facilitated by technological advancements in spinal surgery, spinal fusion surgery remains widely used globally. The persistent challenge of spinal pseudarthrosis has driven extensive efforts to achieve clinically favorable fusion outcomes, with particular emphasis on the evolution of bone graft substitutes. Part II of this review aims to build upon the foundation laid out in Part I by providing a comprehensive summary of commonly utilized bone graft substitutes for spinal fusion in patients with spinal trauma. Additionally, it will delve into the latest advancements and insights regarding the application of rhBMP-2, offering an updated perspective on its role in enhancing the success of spinal fusion procedures.
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Affiliation(s)
- Min cheol Seok
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hae-Won Koo
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Byung-Jou Lee
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Singh V, Oppermann M, Evaniew N, Soroceanu A, Nicholls F, Jacobs WB, Thomas K, Swamy G. Lateral Lumbar Interbody Fusion With rhBMP-2 can Achieve High Fusion Rates in Adult Spine Deformity Surgeries. Global Spine J 2024; 14:244-256. [PMID: 35586905 PMCID: PMC10676168 DOI: 10.1177/21925682221103512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN An ambispective, observational study of the prospective, institutional adult spine deformity (ASD) database. OBJECTIVES The study investigates the clinical and radiographic fusion rates with lateral interbody approach and rhBMP-2 in multiple-level lumbar fusion in the ASD population. Previous studies have reported over 10% pseudoarthrosis rate with multiple segment fusions. Lateral lumbar interbody fusion (LLIF) allows multiple-level, less-invasive access to the anterior lumbar spine. We hypothesized that fusion rates with lateral approach with rhBMP-2 use are superior to the published data on lumbar fusion in ASD patients. METHODS The institutional ASD database was searched to identify eligible patients with two or more levels of LLIF (T12-L5), >4 levels of posterior instrumentations and >2 years of follow-up between the years 2010 and 2018. Antero-posterior and lateral 36-inch standing radiographs for each patient and computed tomography scans in select patients were studied to ascertain fusion status and patients were divided into two groups based on fusion status. RESULTS The study included 179 patients with a mean age of 65.3 years and 74% female patients. The median number of interbody fusions was performed at 3 (IQR 3-4) levels. The mean follow-up duration was 4.4 years (SD = 1.9). 169 patients (94.5%) had successful arthrodesis, while 10 patients (5.5%) had radiological pseudoarthrosis at one level. Of the 10 patients, 8 (4.4%) were either clinically asymptomatic or had manageable back pain. Two patients (1.1%) required revision surgery for symptomatic pseudoarthrosis. CONCLUSION This is the largest known series of ASD patients investigating the fusion rates with multiple-level LLIFs. LLIF along with rhBMP-2 can achieve high fusion success across interbody fusion levels in multi-segmental ASD surgeries.
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Affiliation(s)
- Vishwajeet Singh
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Marcelo Oppermann
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan Evaniew
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alex Soroceanu
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Fred Nicholls
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - W. Bradley Jacobs
- Division of Neurosurgery Spine Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Thomas
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ganesh Swamy
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Varshneya K, Bhattacharjya A, Jokhai RT, Fatemi P, Medress ZA, Stienen MN, Ho AL, Ratliff JK, Veeravagu A. The impact of osteoporosis on adult deformity surgery outcomes in Medicare patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:88-94. [PMID: 34655336 DOI: 10.1007/s00586-021-06985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify the impact of osteoporosis (OS) on postoperative outcomes in Medicare patients undergoing ASD surgery. BACKGROUND Patients with OP and advanced age experience higher than average rates of ASD. However, poor bone density could undermine the durability of a deformity correction. METHODS We queried the MarketScan Medicare Supplemental database to identify patients Medicare patients who underwent ASD surgery from 2007 to 2016. RESULTS A total of 2564 patients met the inclusion criteria of this study, of whom n = 971 (61.0%) were diagnosed with osteoporosis. Patients with OP had a similar 90-day postoperative complication rates (OP: 54.6% vs. non-OP: 49.2%, p = 0.0076, not significant after multivariate regression correction). This was primarily driven by posthemorrhagic anemia (37.6% in OP, vs. 33.1% in non-OP). Rates of revision surgery were similar at 90 days (non-OP 15.0%, OP 16.8%), but by 2 years, OP patients had a significantly higher reoperation rate (30.4% vs. 22.9%, p < 0.0001). In multivariate regression analysis, OP increased odds for revision surgery at 1 year (OR 1.4) and 2 years (OR 1.5) following surgery (all p < 0.05). OP was also an independent predictor of readmission at all time points (90 days, OR 1.3, p < 0.005). CONCLUSION Medicare patients with OP had elevated rates of complications, reoperations, and outpatient costs after undergoing primary ASD surgery.
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Affiliation(s)
- Kunal Varshneya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA. .,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
| | - Anika Bhattacharjya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Rayyan T Jokhai
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Parastou Fatemi
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Zachary A Medress
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martin N Stienen
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Allen L Ho
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - John K Ratliff
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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Eleswarapu A, Rowan FA, Le H, Wick JB, Roberto RF, Javidan Y, Klineberg EO. Efficacy, Cost, and Complications of Demineralized Bone Matrix in Instrumented Lumbar Fusion: Comparison With rhBMP-2. Global Spine J 2021; 11:1223-1229. [PMID: 32748702 PMCID: PMC8453673 DOI: 10.1177/2192568220942501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate demineralized bone matrix as an adjunct for instrumented lumbar spine fusion compared with recombinant human bone morphogenetic protein-2 (rhBMP-2). METHODS Clinical and radiographic review was performed of 43 patients with degenerative spine disease treated with posterolateral spinal fusion with or without posterior or transforaminal lumbar interbody fusion. Final analysis included sixteen patients treated with demineralized bone matrix (DBM; Accell Evo3, SeaSpine) compared with a retrospective matched group of 21 patients treated with rhBMP-2 (rhBMP-2, Infuse, Medtronic). All patients were followed for 24 months. Fusion was evaluated by computed tomography and/or x-ray. Clinical outcomes included visual analogue scale (VAS), Oswestry Disability Index (ODI), and Short Form 12 (SF-12). RESULTS Overall fusion rate, including posterolateral and/or interbody fusion, was 100% for both groups, though the fusion rates in the posterolateral space alone were 93.5% and 100% for the DBM and rhBMP-2 groups, respectively. Clinical outcomes were similar between groups, with the DBM group showing greater improvement in ODI. The rhBMP-2 group showed higher rates of radiographic complications with 7 of 21 patients (33.3%) demonstrating either adjacent level fusion or ectopic bone formation, compared with zero in the DBM group. Average biologic cost per level was $1522 for DBM and $3505 for rhBMP-2. CONCLUSIONS DBM and rhBMP-2 demonstrated similar radiographic and clinical outcomes in instrumented lumbar fusions. rhBMP-2 was associated with higher rates of radiographic complications and significantly higher costs.
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Affiliation(s)
| | | | - Hai Le
- University of California Davis, Sacramento, CA, USA
| | | | | | | | - Eric O. Klineberg
- University of California Davis, Sacramento, CA, USA,Eric O. Klineberg, Department of Orthopaedic Surgery, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
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Abeynayake N, Arthur A, Gronthos S. Crosstalk between skeletal and neural tissues is critical for skeletal health. Bone 2021; 142:115645. [PMID: 32949783 DOI: 10.1016/j.bone.2020.115645] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022]
Abstract
Emerging evidence in the literature describes a physical and functional association between the neural and skeletal systems that forms a neuro-osteogenic network. This communication between bone cells and neural tissues within the skeleton is important in facilitating bone skeletal growth, homeostasis and repair. The growth and repair of the skeleton is dependent on correct neural innervation for correct skeletal developmental growth and fracture repair, while pathological conditions such as osteoporosis are accelerated by disruptions to sympathetic innervation. To date, different molecular mechanisms have been reported to mediate communication between bone and neural populations. This review highlights the important role of various cell surface receptors, cytokines and associated ligands as potential regulators of skeletal development, homeostasis, and repair, by mediating interactions between the skeletal and nervous systems. Specifically, this review describes how Bone Morphogenetic Proteins (BMPs), Eph/ephrin, Chemokine CXCL12, Calcitonin Gene-related Peptide (CGRP), Netrins, Neurotrophins (NTs), Slit/Robo and the Semaphorins (Semas) contribute to the cross talk between bone cells and peripheral nerves, and the importance of these interactions in maintaining skeletal health.
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Affiliation(s)
- Nethmi Abeynayake
- Mesenchymal Stem Cell Laboratory, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Agnieszka Arthur
- Mesenchymal Stem Cell Laboratory, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Stan Gronthos
- Mesenchymal Stem Cell Laboratory, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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Arthur A, Gronthos S. Clinical Application of Bone Marrow Mesenchymal Stem/Stromal Cells to Repair Skeletal Tissue. Int J Mol Sci 2020; 21:E9759. [PMID: 33371306 PMCID: PMC7767389 DOI: 10.3390/ijms21249759] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
There has been an escalation in reports over the last decade examining the efficacy of bone marrow derived mesenchymal stem/stromal cells (BMSC) in bone tissue engineering and regenerative medicine-based applications. The multipotent differentiation potential, myelosupportive capacity, anti-inflammatory and immune-modulatory properties of BMSC underpins their versatile nature as therapeutic agents. This review addresses the current limitations and challenges of exogenous autologous and allogeneic BMSC based regenerative skeletal therapies in combination with bioactive molecules, cellular derivatives, genetic manipulation, biocompatible hydrogels, solid and composite scaffolds. The review highlights the current approaches and recent developments in utilizing endogenous BMSC activation or exogenous BMSC for the repair of long bone and vertebrae fractures due to osteoporosis or trauma. Current advances employing BMSC based therapies for bone regeneration of craniofacial defects is also discussed. Moreover, this review discusses the latest developments utilizing BMSC therapies in the preclinical and clinical settings, including the treatment of bone related diseases such as Osteogenesis Imperfecta.
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Affiliation(s)
- Agnieszka Arthur
- Mesenchymal Stem Cell Laboratory, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
| | - Stan Gronthos
- Mesenchymal Stem Cell Laboratory, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
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7
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Dubey S, Mishra R, Roy P, Singh RP. 3-D macro/microporous-nanofibrous bacterial cellulose scaffolds seeded with BMP-2 preconditioned mesenchymal stem cells exhibit remarkable potential for bone tissue engineering. Int J Biol Macromol 2020; 167:934-946. [PMID: 33189758 DOI: 10.1016/j.ijbiomac.2020.11.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/30/2020] [Accepted: 11/07/2020] [Indexed: 12/13/2022]
Abstract
Bone repair using BMP-2 is a promising therapeutic approach in clinical practices, however, high dosages required to be effective pose issues of cost and safety. The present study explores the potential of low dose BMP-2 treatment via tissue engineering approach, which amalgamates 3-D macro/microporous-nanofibrous bacterial cellulose (mNBC) scaffolds and low dose BMP-2 primed murine mesenchymal stem cells (C3H10T1/2 cells). Initial studies on cell-scaffold interaction using unprimed C3H10T1/2 cells confirmed that scaffolds provided a propitious environment for cell adhesion, growth, and infiltration, owing to its ECM-mimicking nano-micro-macro architecture. Osteogenic studies were conducted by preconditioning the cells with 50 ng/mL BMP-2 for 15 min, followed by culturing on mNBC scaffolds for up to three weeks. The results showed an early onset and significantly enhanced bone matrix secretion and maturation in the scaffolds seeded with BMP-2 primed cells compared to the unprimed ones. Moreover, mNBC scaffolds alone were able to facilitate the mineralization of cells to some extent. These findings suggest that, with the aid of 'osteoinduction' from low dose BMP-2 priming of stem cells and 'osteoconduction' from nano-macro/micro topography of mNBC scaffolds, a cost-effective bone tissue engineering strategy can be designed for quick and excellent in vivo osseointegration.
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Affiliation(s)
- Swati Dubey
- Microbial Biotechnology Laboratory, Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee 247667, India.
| | - Rutusmita Mishra
- Molecular Endocrinology Laboratory, Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee 247667, India
| | - Partha Roy
- Molecular Endocrinology Laboratory, Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee 247667, India
| | - R P Singh
- Microbial Biotechnology Laboratory, Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee 247667, India.
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8
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Varshneya K, Jokhai RT, Fatemi P, Stienen MN, Medress ZA, Ho AL, Ratliff JK, Veeravagu A. Predictors of 2-year reoperation in Medicare patients undergoing primary thoracolumbar deformity surgery. J Neurosurg Spine 2020; 33:572-576. [PMID: 32707541 DOI: 10.3171/2020.5.spine191425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This was a retrospective cohort study in which the authors used a nationally representative administrative database. Their goal was to identify the risk factors for reoperation in Medicare patients undergoing primary thoracolumbar adult spinal deformity (ASD) surgery. Previous literature reports estimate that 20% of patients undergoing thoracolumbar ASD correction undergo revision surgery within 2 years. Most published data discuss risk factors for revision surgery in the general population, but these have not been explored specifically in the Medicare population. METHODS Using the MarketScan Medicare Supplemental database, the authors identified patients who were diagnosed with a spinal deformity and underwent ASD surgery between 2007 and 2015. The interactions of patient demographics, surgical factors, and medical factors with revision surgery were investigated during the 2 years following primary ASD surgery. The authors excluded patients without Medicare insurance and those with any prior history of trauma or tumor. RESULTS Included in the data set were 2564 patients enrolled in Medicare who underwent ASD surgery between 2007 and 2015. The mean age at diagnosis with spinal deformity was 71.5 years. A majority of patients (68.5%) were female. Within 2 years of follow-up, 661 (25.8%) patients underwent reoperation. Preoperative osteoporosis (OR 1.58, p < 0.0001), congestive heart failure (OR 1.35, p = 0.0161), and paraplegia (OR 2.41, p < 0.0001) independently increased odds of revision surgery. The use of intraoperative bone morphogenetic protein was protective against reoperation (OR 0.71, p = 0.0371). Among 90-day postoperative complications, a wound complication was the strongest predictor of undergoing repeat surgery (OR 2.85, p = 0.0061). The development of a pulmonary embolism also increased the odds of repeat surgery (OR 1.84, p = 0.0435). CONCLUSIONS Approximately one-quarter of Medicare patients with ASD who underwent surgery required an additional spinal surgery within 2 years. Baseline comorbidities such as osteoporosis, congestive heart failure, and paraplegia, as well as short-term complications such as pulmonary embolism and wound complications significantly increased the odds of repeat surgery.
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Affiliation(s)
- Kunal Varshneya
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Rayyan T Jokhai
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Parastou Fatemi
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Martin N Stienen
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
- 2Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Zachary A Medress
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Allen L Ho
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - John K Ratliff
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Anand Veeravagu
- 1Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
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Štoković N, Ivanjko N, Pećin M, Erjavec I, Karlović S, Smajlović A, Capak H, Milošević M, Bubić Špoljar J, Vnuk D, Matičić D, Oppermann H, Sampath TK, Vukičević S. Evaluation of synthetic ceramics as compression resistant matrix to promote osteogenesis of autologous blood coagulum containing recombinant human bone morphogenetic protein 6 in rabbit posterolateral lumbar fusion model. Bone 2020; 140:115544. [PMID: 32730919 DOI: 10.1016/j.bone.2020.115544] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
Posterolateral lumbar fusion (PLF) is a commonly performed surgical procedure for the treatment of pathological conditions of the lumbosacral spine. In the present study, we evaluated an autologous bone graft substitute (ABGS) containing rhBMP6 in autologous blood coagulum (ABC) and synthetic ceramics used as compression resistant matrix (CRM) in the rabbit PLF model. In the pilot PLF rabbit experiment, we tested four different CRMs (BCP 500-1700 μm, BCP 1700-2500 μm and two different TCP in the form of slabs) which were selected based on achieving uniform ABC distribution. Next, ABGS implants composed of 2.5 mL ABC with 0.5 g ceramic particles (TCP or BCP (TCP/HA 80/20) of particle size 500-1700 μm) and 125 μg rhBMP6 (added to blood or lyophilized on ceramics) were placed bilaterally between transverse processes of the lumbar vertebrae (L5-L6) following exposition and decortication in 12 New Zealand White Rabbits observed for 7 weeks following surgery. Spinal fusion outcome was analysed by μCT, palpatory segmental mobility testing and selected specimens were either tested biomechanically (three-point bending test) and/or processed histologically. The total fusion success rate was 90.9% by both μCT analyses and by palpatory segmental mobility testing. The volume of newly formed bone between experimental groups with TCP or BCP ceramics and the different method of rhBMP6 application was comparable. The newly formed bone and ceramic particles integrated with the transverse processes on histological sections resulting in superior biomechanical properties. The results were retrospectively found superior to allograft devitalized mineralized bone as a CRM as reported previously in rabbit PLF. Overall, this novel ABGS containing rhBMP6, ABC and the specific 500-1700 μm synthetic ceramic particles supported new bone formation for the first time and successfully promoted posterolateral lumbar fusion in rabbits.
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Affiliation(s)
- Nikola Štoković
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Zagreb, Croatia
| | - Natalia Ivanjko
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Zagreb, Croatia
| | - Marko Pećin
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Igor Erjavec
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Zagreb, Croatia
| | - Sven Karlović
- Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Ana Smajlović
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Hrvoje Capak
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Milan Milošević
- Department for Environmental Health, Occupational and Sports Medicine, Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jadranka Bubić Špoljar
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Zagreb, Croatia
| | - Dražen Vnuk
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Dražen Matičić
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Slobodan Vukičević
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Zagreb, Croatia.
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Lee JH, Jin YZ. Recombinant human bone morphogenetic protein-2 loaded porous β-tricalcium phosphate microsphere-hyaluronic acid composites promoted osseointegration around titanium implants. INT J POLYM MATER PO 2019. [DOI: 10.1080/00914037.2018.1446138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jae Hyup Lee
- Department of Orthopedic Surgery, College of Medicine, SMG-SNU Boramae Medical Center, Seoul National University, Seoul, Korea
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yuan Zhe Jin
- Department of Orthopedic Surgery, College of Medicine, SMG-SNU Boramae Medical Center, Seoul National University, Seoul, Korea
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11
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Han SH, Zheng GB, Lee JH. The toxicological effect of 4-week repeated intravenous injection of activin a/BMP-2 chimera and 2-week recovery study in Beagle dog. Drug Chem Toxicol 2019; 44:250-258. [PMID: 30880490 DOI: 10.1080/01480545.2019.1572181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purposes of this study was to determine the toxicological effect of repeated intravenous administration of Activin A/BMP-2 chimera (AB204) in beagle dogs for a long period of four weeks and evaluate two-week recovery. AB204 was administered at doses of 0.08, 0.16, or 0.32 mg/kg/day to three male and three female beagle dogs for 4 weeks as the experimental group. For the control group, sterile saline was administered to three male and three female beagle dogs. For the two-week recovery test, two male and two female beagle dogs were randomly selected from the control group and the 0.32 mg/kg/day administered experimental group. General symptoms, body weight, food consumption, ophthalmological examination, electrocardiogram, urinalysis, hematology and blood biochemistry, organ weights, autopsy, and histopathological examination were observed or conducted. No animals died. There was no significant difference in any parameter evaluated between the experimental group and the control group. Histopathological examination revealed compound inflammation at the administration site in both the experimental group and the control group. The inflammation disappeared during the two-week recovery. These results indicated that repetitive intravenous injection of AB204 in beagle dog for a long period of four weeks did not show any toxicity. Therefore, no observed adverse effects level (NOAEL) of AB204 was 0.32 mg/kg/day in big animal model.
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Affiliation(s)
- Shi Huan Han
- Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Korea.,Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Orthopedic Surgery, YanBian University Hospital, Yanji, Jilin Province, China
| | - Guang Bin Zheng
- Department of Orthopedic Surgery, TaiZhou Hospital, Linhai, Zhejiang Province, China
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Korea.,Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea.,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Medical Research Center, Seoul, Korea
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12
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Controlled-release nanotherapeutics: State of translation. J Control Release 2018; 284:39-48. [DOI: 10.1016/j.jconrel.2018.06.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/04/2018] [Accepted: 06/10/2018] [Indexed: 12/14/2022]
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Esmail N, Buser Z, Cohen JR, Brodke DS, Meisel HJ, Park JB, Youssef JA, Wang JC, Yoon ST. Postoperative Complications Associated With rhBMP2 Use in Posterior/Posterolateral Lumbar Fusion. Global Spine J 2018; 8:142-148. [PMID: 29662744 PMCID: PMC5898669 DOI: 10.1177/2192568217698141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE Posterior/posterolateral lumbar fusion (PLF) is an effective treatment for a variety of spinal disorders; however, variations in surgical technique have different complication profiles. The aim of our study was to quantify the frequency of various complications in patients undergoing PLF with and without human recombinant bone morphogenetic protein 2 (rhBMP2). METHODS We queried the orthopedic subset of the Medicare database (PearlDiver) between 2005 and 2011 for patients undergoing PLF procedures with and without rhBMP2. Complication and reoperation rates were analyzed within 1 year of the index procedure. Complications assessed include: acute renal failure, deep vein thrombosis, dural tear, hematoma, heterotopic ossification, incision and drainage, cardiac complications, nervous system complications, osteolysis, pneumonia, pseudarthrosis, pulmonary embolism, radiculopathy, respiratory complications, sepsis, urinary retention, urinary tract infection, mechanical, and wound complications. Chi-square analysis was used to calculate the complication differences between the groups. RESULTS Our data revealed higher overall complication rates in patients undergoing PLF with rhBMP2 versus no_rhBMP2 (76.9% vs 68.8%, P < .05). Stratified by gender, rhBMP2 males had higher rates of mechanical complications, pseudarthrosis, and reoperations compared with no_rhBMP2 males (P < .05), whereas rhBMP2 females had higher rates of pseudarthrosis, urinary tract infection, and urinary retention compared with no_rhBMP2 females (P < .05). CONCLUSION Our data revealed higher overall complication rates in PLF patients given rhBMP2 compared with no_rhBMP2. Furthermore, our data suggests that rhBMP2-associated complications may be gender specific.
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Affiliation(s)
- Nabil Esmail
- University of Southern California, Los Angeles, CA, USA
| | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Jong-Beom Park
- Uijongbu St. Mary’s Hospital, The Catholic University of Korea School of Medicine, Uijongbu, Korea
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Huang RL, Sun Y, Ho CK, Liu K, Tang QQ, Xie Y, Li Q. IL-6 potentiates BMP-2-induced osteogenesis and adipogenesis via two different BMPR1A-mediated pathways. Cell Death Dis 2018; 9:144. [PMID: 29396550 PMCID: PMC5833364 DOI: 10.1038/s41419-017-0126-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 02/08/2023]
Abstract
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is widely used in the clinic for bone defect reconstruction because of its powerful osteoinductive capacity. However, commercially available rhBMP-2 requires a high concentration in the clinical setting for consistent bone formation. A high dose of rhBMP-2 induces a promising bone formation yield but also leads to inflammation-related events, deteriorated bone quality, and fatty tissue formation. We hypothesize that the seemingly contradictory phenomenon of coformation of new bone and excessive adipose tissue in rhBMP-2-induced bone voids may be associated with interleukin-6 (IL-6), which is significantly elevated after application of rhBMP-2/absorbable collagen sponge (rhBMP-2/ACS). Here, we show that IL-6 injection enhances new bone regeneration and induces excessive adipose tissue formation in an rhBMP-2/ACS-induced ectopic bone formation model in rats. In vitro data further show that IL-6 and its soluble receptor sIL-6R synergistically augment rhBMP-2-induced osteogenic and adipogenic differentiation of human BMSCs (hBMSCs) by promoting cell surface translocation of BMPR1A and then amplifying BMPR1A-mediated BMP/Smad and p38 MAPK pathways, respectively. Our study suggests elevated IL-6 may be responsible for coformation of new bone and excessive adipose tissue in rhBMP-2-induced bone voids.
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Affiliation(s)
- Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yangbai Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chia-Kang Ho
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qi-Qun Tang
- Key Laboratory of Metabolism and Molecular Medicine, the Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai, 200032, China
| | - Yun Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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15
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Zheng GB, Lee JH, Jin YZ. In vitro and in vivo evaluation of osteoinductivity and bone fusion ability of an activin a/BMP2 chimera (AB204): a comparison study between AB204 and rhBMP-2. Growth Factors 2017; 35:249-258. [PMID: 29651874 DOI: 10.1080/08977194.2018.1459597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study compared osteoinductivity and osteogenic capacity between AB204 and rhBMP-2 using hMSCs in vitro and a beagle's posterolateral spinal fusion model. Cultured hMSCs were treated with AB204 or rhBMP-2 with low to high doses. Three male beagles were performed posterolateral spinal fusion with biphasic calcium phosphate (2 ml) + AB204 or rhBMP-2 (20, 50 or 200 µg). They were euthanized after 8 weeks. The fusion rate and bone formation of spine samples were examined. AB204 had higher alkaline phosphatase activity, mineralization and osteogenic-related gene expression than rhBMP-2. Fusion rates in all rhBMP-2 groups were 0. They were 100% for 50 μg and 200 μg AB204 groups. Therefore, AB204 showed higher osteogenicity than rhBMP-2. It could be a better bone graft substitute.
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Affiliation(s)
- Guang Bin Zheng
- a Department of Orthopaedics , Taizhou Hospial of Zhejiang Province, Wenzhou Medical University, Linhai , Zhejiang , China
- b Department of Orthopedic Surgery , Seoul National University, College of Medicine , Seoul , Korea
| | - Jae Hyup Lee
- b Department of Orthopedic Surgery , Seoul National University, College of Medicine , Seoul , Korea
- c Department of Orthopaedic Surgery , SMG-SNU Boramae Medical Center , Seoul , Korea
- d Institute of Medical and Biological Engineering , Seoul National University Medical Research Center , Seoul , Korea
| | - Yuan-Zhe Jin
- b Department of Orthopedic Surgery , Seoul National University, College of Medicine , Seoul , Korea
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16
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Mitchell K, Shah JP, Dalgard CL, Tsytsikova LV, Tipton AC, Dmitriev AE, Symes AJ. Bone morphogenetic protein-2-mediated pain and inflammation in a rat model of posterolateral arthrodesis. BMC Neurosci 2016; 17:80. [PMID: 27905881 PMCID: PMC5134101 DOI: 10.1186/s12868-016-0314-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 11/24/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bone morphogenetic protein-2 (BMP-2) is a pleiotropic, secreted molecule with diverse effects. The potent ability of BMP-2 to stimulate bone growth prompted its widespread clinical use for arthrodesis (spine fusion). However, elevated post-operative pain in patients treated with BMP-2 has been increasingly reported. Determining whether BMP-2 induces pain directly or whether it induces neuroinflammation, which could lower the threshold for pain, is important for developing therapeutic interventions. We therefore modeled the clinical use of BMP-2 for posterior lumbar fusion by implanting absorbable collagen sponges soaked with either recombinant human BMP-2 (rhBMP-2) or vehicle above the L4-L5 transverse processes of rat spine. RESULTS Using microarray analysis we found that implantation of rhBMP-2-soaked absorbable collagen sponges resulted in altered expression of numerous pro-inflammatory genes in the adjacent dorsal root ganglia (DRG) showing that implantation of rhBMP-2/absorbable collagen sponges triggers potent neuroinflammatory responses in the DRG-2. Interestingly, direct BMP-2 treatment of DRG explants resulted in changes in gene expression that were not specifically pro-inflammatory. Rats implanted with rhBMP-2 in absorbable collagen sponges also exhibited a transient change in thermal and mechanical sensitivity indicating that rhBMP-2 applied to the lumbar spine could increase pain sensitivity. Immunohistochemical analysis indicated macrophage infiltration in the DRG and spinal nerve in rats implanted with rhBMP-2/absorbable collagen sponges or absorbable collagen sponges alone, but not in rats that underwent surgery without implantation of the absorbable collagen sponges suggesting that the sponges contributed to the biological response. Indeed, analysis of DRGs taken from rats implanted with absorbable collagen sponges without rhBMP-2 showed a significant change in gene expression distinct from DRGs from rats undergoing surgery only. CONCLUSIONS Our data indicate that implantation of rhBMP-2/absorbable collagen sponges on the lumbar spine triggers potent neuroinflammatory responses in the DRG. Importantly, however, these BMP-2 effects may be partially mediated through a response to the absorbable collagen sponges.
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Affiliation(s)
- Kendall Mitchell
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Jill P Shah
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Clifton L Dalgard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA
| | - Lyubov V Tsytsikova
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Ashley C Tipton
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Anton E Dmitriev
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA.,Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, 20814, USA.,Division of Applied Mechanics, CDRH/OSEL, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Aviva J Symes
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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