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Truchan K, Osyczka AM. Noggin promotes osteogenesis in human adipose-derived mesenchymal stem cells via FGFR2/Src/Akt and ERK signaling pathway. Sci Rep 2024; 14:6724. [PMID: 38509118 PMCID: PMC10954655 DOI: 10.1038/s41598-024-56858-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
The balance between Noggin and bone morphogenetic proteins (BMPs) is important during early development and skeletal regenerative therapies. Noggin binds BMPs in the extracellular space, thereby preventing BMP signaling. However, Noggin may affect cell response not necessarily through the modulation of BMP signaling, raising the possibility of direct Noggin signaling through yet unspecified receptors. Here we show that in osteogenic cultures of adipose-derived stem cells (ASCs), Noggin activates fibroblast growth factor receptors (FGFRs), Src/Akt and ERK kinases, and it stabilizes TAZ proteins in the presence of dexamethasone. Overall, this leads ASCs to increased expression of osteogenic markers and robust mineral deposition. Our results also indicate that Noggin can induce osteogenic genes expression in normal human bone marrow stem cells and alkaline phosphatase activity in normal human dental pulp stem cells. Besides, Noggin can specifically activate FGFR2 in osteosarcoma cells. We believe our findings open new research avenues to further explore the involvement of Noggin in cell fate modulation by FGFR2/Src/Akt/ERK signaling and potential applications of Noggin in bone regenerative therapies.
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Affiliation(s)
- Karolina Truchan
- Department of Cell Biology and Imaging, Institute of Zoology and Biomedical Research, Jagiellonian University, Gronostajowa St. 9, 30-387, Kraków, Poland.
| | - Anna Maria Osyczka
- Department of Cell Biology and Imaging, Institute of Zoology and Biomedical Research, Jagiellonian University, Gronostajowa St. 9, 30-387, Kraków, Poland.
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2
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Priddy LB, Krishnan L, Hettiaratchi MH, Karthikeyakannan S, Gupte N, Guldberg RE. Amniotic membrane attenuates heterotopic ossification following high-dose bone morphogenetic protein-2 treatment of segmental bone defects. J Orthop Res 2023; 41:130-140. [PMID: 35340049 PMCID: PMC9512937 DOI: 10.1002/jor.25324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
Treatment of large bone defects with supraphysiological doses of bone morphogenetic protein-2 (BMP-2) has been associated with complications including heterotopic ossification (HO), inflammation, and pain, presumably due to poor spatiotemporal control of BMP-2. We have previously recapitulated extensive HO in our rat femoral segmental defect model by treatment with high-dose BMP-2 (30 μg). Using this model and BMP-2 dose, our objective was to evaluate the utility of a clinically available human amniotic membrane (AM) around the defect space for guided bone regeneration and reduction of HO. We hypothesized that AM surrounding collagen sponge would attenuate heterotopic ossification compared with collagen sponge alone. In vitro, AM retained more BMP-2 than a synthetic poly(ε-caprolactone) membrane through 21 days. In vivo, as hypothesized, the collagen + AM resulted in significantly less heterotopic ossification and correspondingly, lower total bone volume (BV), compared with collagen sponge alone. Although bone formation within the defect was delayed with AM around the defect, by 12 weeks, defect BVs were equivalent. Torsional stiffness was significantly reduced with AM but was equivalent to that of intact bone. Collagen + AM resulted in the formation of dense fibrous tissue and mineralized tissue, while the collagen group contained primarily mineralized tissue surrounded by marrow-like structures. Especially in conjunction with high doses of growth factor delivered via collagen sponge, these findings suggest AM may be effective as an overlay adjacent to bone healing sites to spatially direct bone regeneration and minimize heterotopic ossification.
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Affiliation(s)
- Lauren B. Priddy
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
- Current affiliation: Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS 39762, USA
| | - Laxminarayanan Krishnan
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Marian H. Hettiaratchi
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
- Current affiliation: Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, 6231 University of Oregon, Eugene, OR 97403, USA
| | - Sukhita Karthikeyakannan
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Nikhil Gupte
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive NW, Atlanta, GA 30332, USA
| | - Robert E. Guldberg
- Parker H. Petit Institute for Bioengineering & Bioscience, Georgia Institute of Technology, 315 Ferst Drive NW, Atlanta, GA 30332, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 801 Ferst Drive NW, Atlanta, GA 30332, USA
- Current affiliation: Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, 6231 University of Oregon, Eugene, OR 97403, USA
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3
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Wu R, Gao G, Zhang S, Liu R, Dong H, Xu Y. BMP-2 Modified Electrospun Scaffold for Acetabular Labral Reconstruction Promotes Collagen Fiber Regeneration in a Porcine Model. Am J Sports Med 2022; 50:757-768. [PMID: 35112595 DOI: 10.1177/03635465211066948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular labral tear is one of the contributing factors to early hip osteoarthritis. Patients with symptomatic labral tears may require surgical treatment, and labral reconstruction is indicated in cases of irreparable tears. PURPOSE The purpose of the study was to construct the bone morphogenic protein 2 (BMP-2) electrospun scaffold for acetabular labral reconstruction and analyze the composition of the labrum and the influence of collagen fiber distribution in regenerated tissue on the biomechanical properties of labrum. STUDY DESIGN Controlled laboratory study. METHODS Eighteen mature male miniature pigs were selected for labral reconstruction in vivo. The animals were divided into 3 groups, including the autologous tendon group (T group), dopamine/polylactic acid-polyethylene glycol (PELA) electrospun group (DP group), and dopamine/PELA electrospun/BMP-2 group (DPB group), and the native labra were used as the control group. The microstructure of the reconstructed labrum was analyzed by scanning electron microscopy. Histologic and immunohistochemistry sections were used to evaluate the composition and structure of reconstructed labrum. The related gene expression was tested via quantitative reverse transcriptase-polymerase chain reaction test. The compressive and tensile properties of tissues were evaluated using the elasticity test device. RESULTS Hematoxylin and eosin staining showed that the DP group and the T group were mainly composed of fibroblasts. The alignment of fibers was irregular. In the DPB group, the reconstructed tissues were composed of fibroblasts and chondrocytes, with parallel fibers and denser structure. The native labrum was composed of a large number of fibroblasts, which were arranged orderly and parallel, and there was almost no vascular proliferation. Under scanning electron microscopy, the reconstructed tissue of the DBP group was more similar to the native labral structure, forming a denser, clear-layered collagen fibrous structure, while the fiber alignment of the DP and T groups was irregular. The contents of type I, II, and III collagen (COL1, COL2, and COL3, respectively) were upregulated in labrum reconstructed with the DPB scaffold, while the gene expressions did not increase in the DP and T groups. The tensile and compressive properties of the implants in the DPB group were significantly enhanced. CONCLUSION BMP-2 modified electrospun scaffold promotes collagen regeneration and osteogenic differentiation and is associated with better biomechanical performance of the reconstructed labrum. CLINICAL RELEVANCE This study demonstrated that BMP-2 modified electrospun scaffold could induce the regeneration of collagen and osteogenic differentiation and provide better biomechanical performance in labral reconstruction. This scaffold could be used in clinical practice after further improvement.
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Affiliation(s)
- Ruiqi Wu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Guanying Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Siqi Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Rongge Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hanmei Dong
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Abstract
Bone regeneration is a central focus of maxillofacial research, especially when dealing with dental implants or critical sized wound sites. While bone has great regeneration potential, exogenous delivery of growth factors can greatly enhance the speed, duration, and quality of osseointegration, making a difference in a patient’s quality of life. Bone morphogenic protein 2 (BMP-2) is a highly potent growth factor that acts as a recruiting molecule for mesenchymal stromal cells, induces a rapid differentiation of them into osteoblasts, while also maintaining their viability. Currently, the literature data shows that the liposomal direct delivery or transfection of plasmids containing BMP-2 at the bone wound site often results in the overexpression of osteogenic markers and result in enhanced mineralization with formation of new bone matrix. We reviewed the literature on the scientific data regarding BMP-2 delivery with the help of liposomes. This may provide the ground for a future new bone regeneration strategy with real chances of reaching clinical practice.
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Xu L, Ma F, Leung FKL, Qin C, Lu WW, Tang B. Chitosan-strontium chondroitin sulfate scaffolds for reconstruction of bone defects in aged rats. Carbohydr Polym 2021; 273:118532. [PMID: 34560945 DOI: 10.1016/j.carbpol.2021.118532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/30/2021] [Indexed: 12/20/2022]
Abstract
Bone defects caused by trauma have become increasingly common in aged populations. Clinically, because of the relatively decreased bone healing capacity compared with the youth adults, bone defect repair in the elderly remains challenging. The development of effective biomaterials targeted at bone defects in the elderly is a key component of bone-tissue engineering strategies. However, little attention has been paid to bone regeneration in the elderly. Here, we developed a new scaffold chitosan-Strontium chondroitin sulfate (CH-SrCS) and evaluated its effect on improving bone regeneration. We find that the CH-SrCS scaffold displayed positive effects on downregulation of inflammation and osteoclastogenesis related mRNA expressions while demonstrating a significant increase in the expression level of BMP2. Finally, we show that the bone defects healing effects as assessed using an aged rats' bone defects model. Ultimately, this work also provides insights into the design of effective biomaterials targeted at bone defects in the elderly.
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Affiliation(s)
- Lei Xu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, PR China; Department of Orthopeadics and Traumatology, LKS Faculty of Medicine, the University of Hong Kong, HK SAR, PR China; Department of Orthopeadics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou 510317, PR China
| | - Fenbo Ma
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, PR China
| | - Frankie K L Leung
- Department of Orthopeadics and Traumatology, LKS Faculty of Medicine, the University of Hong Kong, HK SAR, PR China
| | - Chenghe Qin
- Department of Orthopeadics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou 510317, PR China.
| | - William W Lu
- Department of Orthopeadics and Traumatology, LKS Faculty of Medicine, the University of Hong Kong, HK SAR, PR China.
| | - Bin Tang
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, PR China; Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, PR China; Shenzhen Key Laboratory of Cell Microenvironment, PR China.
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Kelly CN, Lin AS, Leguineche KE, Shekhar S, Walsh WR, Guldberg RE, Gall K. Functional repair of critically sized femoral defects treated with bioinspired titanium gyroid-sheet scaffolds. J Mech Behav Biomed Mater 2021; 116:104380. [PMID: 33588248 DOI: 10.1016/j.jmbbm.2021.104380] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/05/2021] [Accepted: 01/30/2021] [Indexed: 01/19/2023]
Abstract
Despite the innate ability for bone to remodel and repair, its regeneration has a limit. In these cases of critically sized bone defects (CSBD), the bone deficit must be repaired using reconstructive techniques that support immediate load bearing and encourage bone bridging across the defect. High-strength porous titanium implants offer a solution for treatment of CSBD in which the scaffold can support physiological loads, provide a matrix to guide ingrowth, and carry graft materials and/or biologics. Fabrication of titanium meta-materials via additive manufacturing (AM) has unlocked the potential to modulate mechanical and biological performance to achieve a combination of properties previously unachievable. Meta-material scaffolds with topology based on triply periodic minimal surfaces (TPMS) have gained increasing interest for use in biomedical applications due to their bioinspired nature. Despite enthusiasm for TPMS-based titanium scaffolds due to their high strength to stiffness ratio, high permeability, and curvature similar to trabecular bone, there is little preclinical evidence to support their in vivo response in bone. The present study sought to evaluate the performance of gyroid-sheet titanium scaffolds produced via AM to repair a critically size femoral cortical bone defect in rats. Empty gyroid-sheet scaffolds were shown to repair segmental defects with up to 38% of torsional strength and 54% torsional stiffness of the intact femur (control) at 12-weeks. Gyroid-sheet scaffolds carrying recombinant bone morphogenic protein-2 demonstrated bridging bone growth across the length of the defect, with torsional strength and stiffness superior to that of the intact controls.
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Affiliation(s)
- Cambre N Kelly
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Angela Sp Lin
- The Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
| | - Kelly Eh Leguineche
- The Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
| | - Sudhanshu Shekhar
- The Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
| | - William R Walsh
- Surgical and Orthopedic Research Laboratories, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert E Guldberg
- The Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
| | - Ken Gall
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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Bal Z, Kushioka J, Kodama J, Kaito T, Yoshikawa H, Korkusuz P, Korkusuz F. BMP and TGFβ use and release in bone regeneration. Turk J Med Sci 2020; 50:1707-1722. [PMID: 32336073 PMCID: PMC7672355 DOI: 10.3906/sag-2003-127] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
A fracture that does not unite in nine months is defined as nonunion. Nonunion is common in fragmented fractures and large bone defects where vascularization is impaired. The distal third of the tibia, the scaphoid bone or the talus fractures are furthermore prone to nonunion. Open fractures and spinal fusion cases also need special monitoring for healing. Bone tissue regeneration can be attained by autografts, allografts, xenografts and synthetic materials, however their limited availability and the increased surgical time as well as the donor site morbidity of autograft use, and lower probability of success, increased costs and disease transmission and immunological reaction probability of allografts oblige us to find better solutions and new grafts to overcome the cons. A proper biomaterial for regeneration should be osteoinductive, osteoconductive, biocompatible and mechanically suitable. Cytokine therapy, where growth factors are introduced either exogenously or triggered endogenously, is one of the commonly used method in bone tissue engineering. Transforming growth factor β (TGFβ) superfamily, which can be divided structurally into two groups as bone morphogenetic proteins (BMPs), growth differentiation factors (GDFs) and TGFβ, activin, Nodal branch, Mullerian hormone, are known to be produced by osteoblasts and other bone cells and present already in bone matrix abundantly, to take roles in bone homeostasis. BMP family, as the biggest subfamily of TGFβ superfamily, is also reported to be the most effective growth factors in bone and development, which makes them one of the most popular cytokines used in bone regeneration. Complications depending on the excess use of growth factors, and pleiotropic functions of BMPs are however the main reasons of why they should be approached with care. In this review, the Smad dependent signaling pathways of TGFβ and BMP families and their relations and the applications in preclinical and clinical studies will be briefly summarized.
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Affiliation(s)
- Zeynep Bal
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Junichi Kushioka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Joe Kodama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Petek Korkusuz
- Department of Histology and Embryology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Feza Korkusuz
- Department of Sports Medicine, Medical Faculty, Hacettepe University, Ankara, Turkey
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Dai K, Shen T, Yu Y, Deng S, Mao L, Wang J, Liu C. Generation of rhBMP-2-induced juvenile ossicles in aged mice. Biomaterials 2020; 258:120284. [DOI: 10.1016/j.biomaterials.2020.120284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/26/2020] [Accepted: 08/01/2020] [Indexed: 12/20/2022]
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Kamal AF, Siahaan OSH, Fiolin J. Various Dosages of BMP-2 for Management of Massive Bone Defect in Sprague Dawley Rat. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:498-505. [PMID: 31970254 PMCID: PMC6935524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 11/03/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND BMP-2 has a crucial role in the treatment of extensive bone defect. However, data about the optimal dosage of BMP-2 in the massive bone defect casesis rare. METHODS Twenty-five SD rats were randomly allocated into a control group of hydroxyapatite (HA) alone (Group I), HA+BMP-2 1µg/mL (Group II), HA+BMP-2 5 ug/mL (Group III), HA+BMP-2 10 µg/mL (Group IV), and HA+BMP-2 20 ug/mL (Group V). Osteotomies were performed in each group with 10 mm bone defect in the right femur, followed by fixation and filling the defect. The fracture healing was evaluated by histomorphometry, and radiographs using RUST score. RESULTS We found there were significant differences in the mean total area of callus between the treatment groups (P<0.001); there were significant differences in the mean area of woven bone between group II, III, IV, and V with the control group (respectively P=0.009, P=0.016, P=0.009 and P=0.016), the area of the cartilage between the treatment groups and control group (respectively P=0.009, P=0.009, P=0.009 and P=0.028). A statistically significant difference was found in the average area of fibrosis between group II and control group, group IV and control group (respectively P=0.047 and P=0.009). RUST scores showed significant differences between the control group and group II, III, IV, V (respectively P=0.005, P=0.006, P=0.005 and P=0.006). CONCLUSION The administration of BMP-2 stimulates the formation of bone bridging in a massive bone defect. The bone bridging filling massive bone defect depends on the dose or concentration of BMP-2. Administration of an optimal dose (10 µg/mL) of BMP-2 demonstrates better result than lower or higher dose for massive bone defect healing in SD rate.
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Research performed at Department of Nutrition and Department of Pathological Anatomy of Faculty of Medicine Universitas Indonesia /Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Othdeh Samuel Halomoan Siahaan
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Research performed at Department of Nutrition and Department of Pathological Anatomy of Faculty of Medicine Universitas Indonesia /Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Jessica Fiolin
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Research performed at Department of Nutrition and Department of Pathological Anatomy of Faculty of Medicine Universitas Indonesia /Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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10
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Cheng A, Krishnan L, Pradhan P, Weinstock LD, Wood LB, Roy K, Guldberg RE. Impaired bone healing following treatment of established nonunion correlates with serum cytokine expression. J Orthop Res 2019; 37:299-307. [PMID: 30480339 PMCID: PMC7605215 DOI: 10.1002/jor.24186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/06/2018] [Indexed: 02/04/2023]
Abstract
Delayed union and nonunion are a significant concern in long bone fractures and spinal fusions. Treatment of nonunion often entails multiple revision surgeries that further increase the financial, physical, and emotional burden on patients. The optimal treatment strategy for nonunions remains unclear in many cases, and the risk of complications after revision procedures remains high. This is in part due to our limited understanding of the biological mechanisms that inhibit proper bone healing and lead to nonunion. And yet, few preclinical models directly investigate how healing is impacted after establishment of nonunion, with most instead primarily focusing on treatment immediately after a fresh bone injury. Here, we utilized a critical size femoral defect model in rats where treatment was delayed 8 weeks post-injury, at which time nonunion was established. In this study, acute and delayed treatments with bone morphogenetic protein-2 (BMP-2) were assessed. We found that delayed treatment resulted in decreased bone formation and reduced mechanical strength compared to acute treatment, even when BMP-2 dose was increased by 2.5 times the acute treatment dose. Interestingly, serum cytokine analysis at 12 weeks post-treatment revealed signs of chronic immune dysregulation after delayed treatment. In particular, non-responders (rats that did not exhibit defect bridging) demonstrated higher overall expression of inflammatory cytokines, including TNFα and IL-1β, compared to responders. These findings suggest that re-establishing long-term immune homeostasis may be critical for successful bone healing, particularly after nonunion. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:299-307, 2019.
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Affiliation(s)
- Albert Cheng
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
| | - Laxminarayanan Krishnan
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
| | - Pallab Pradhan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Laura D. Weinstock
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Levi B. Wood
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Krishnendu Roy
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Robert E. Guldberg
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia,Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, Oregon
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