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Machado A, Pereira I, Costa F, Brandão A, Pereira JE, Maurício AC, Santos JD, Amaro I, Falacho R, Coelho R, Cruz N, Gama M. Randomized clinical study of injectable dextrin-based hydrogel as a carrier of a synthetic bone substitute. Clin Oral Investig 2023; 27:979-994. [PMID: 36707442 PMCID: PMC9985577 DOI: 10.1007/s00784-023-04868-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 01/14/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study aimed to improve the performance and mode of administration of a glass-reinforced hydroxyapatite synthetic bone substitute, Bonelike by Biosckin® (BL®), by association with a dextrin-based hydrogel, DEXGEL, to achieve an injectable and moldable device named DEXGEL Bone. METHODS Twelve participants requiring pre-molar tooth extraction and implant placement were enrolled in this study. BL® granules (250-500 µm) were administered to 6 randomized participants whereas the other 6 received DEXGEL Bone. After 6 months, a bone biopsy of the grafted area was collected for histological and histomorphometric evaluation, prior to implant placement. The performance of DEXGEL Bone and BL® treatments on alveolar preservation were further analyzed by computed tomography and Hounsfield density analysis. Primary implant stability was analyzed by implant stability coefficient technique. RESULTS The healing of defects was free of any local or systemic complications. Both treatments showed good osseointegration with no signs of adverse reaction. DEXGEL Bone exhibited increased granule resorption (p = 0.029) accompanied by a tendency for more new bone ingrowth (although not statistically significant) compared to the BL® group. The addition of DEXGEL to BL® granules did not compromise bone volume or density, being even beneficial for implant primary stability (p = 0.017). CONCLUSIONS The hydrogel-reinforced biomaterial exhibited an easier handling, a better defect filling, and benefits in implant stability. CLINICAL RELEVANCE This study validates DEXGEL Bone safety and performance as an injectable carrier of granular bone substitutes for alveolar ridge preservation. TRIAL REGISTRATION European Databank on Medical Devices (EUDAMED) No. CIV-PT-18-01-02,705; Registo Nacional de Estudos Clínicos, RNEC, No. 30122.
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Affiliation(s)
- Alexandra Machado
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal
| | - Isabel Pereira
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal
| | - Filomena Costa
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal
| | - Ana Brandão
- Biosckin, Molecular and Cell Therapies S.A., TecMaia, Rua Engenheiro Frederico Ulrich 2650, 4470-605, Maia, Portugal
| | - José Eduardo Pereira
- CECAV, Animal and Veterinary Research Centre, University of Trás-os-Montes and Alto Douro, 5001-801, Vila Real, Portugal.,Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5001-801, Vila Real, Portugal
| | - Ana Colette Maurício
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, N° 228, 4050-313, Porto, Portugal.,Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401, Porto, Portugal
| | - José Domingos Santos
- REQUIMTE/LAQV, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-495, Porto, Portugal
| | - Inês Amaro
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-504, Coimbra, Portugal
| | - Rui Falacho
- Institute of Oral Implantology and Prosthodontics, Faculty of Medicine, University of Coimbra, 3004-504, Coimbra, Portugal
| | - Rui Coelho
- RESDEVMED, Unipessoal Lda., Travessa do Navega, 436 C, 3885-183, Ovar, Portugal
| | - Nuno Cruz
- Faculty of Dentistry, Universitat Internacional de Catalunya, 08017, Barcelona, Spain
| | - Miguel Gama
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. .,LABBELS, Associate Laboratory, Braga, Guimarães, Portugal.
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Vancomycin-Loaded, Nanohydroxyapatite-Based Scaffold for Osteomyelitis Treatment: In Vivo Rabbit Toxicological Tests and In Vivo Efficacy Tests in a Sheep Model. Bioengineering (Basel) 2023; 10:bioengineering10020206. [PMID: 36829700 PMCID: PMC9952702 DOI: 10.3390/bioengineering10020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
The treatment for osteomyelitis consists of surgical debridement, filling of the dead space, soft tissue coverage, and intravenous administration of antimicrobial (AM) agents for long periods. Biomaterials for local delivery of AM agents, while providing controllable antibiotic release rates and simultaneously acting as a bone scaffold, may be a valuable alternative; thus, avoiding systemic AM side effects. V-HEPHAPC is a heparinized nanohydroxyapatite (nHA)/collagen biocomposite loaded with vancomycin that has been previously studied and tested in vitro. It enables a vancomycin-releasing profile with an intense initial burst, followed by a sustained release with concentrations above the Minimum Inhibitory Concentration (MIC) for MRSA. In vitro results have also shown that cellular viability is not compromised, suggesting that V-HEPHAPC granules may be a promising alternative device for the treatment of osteomyelitis. In the present study, V-HEPHAPC (HEPHAPC with vancomycin) granules were used as a vancomycin carrier to treat MRSA osteomyelitis. First, in vivo Good Laboratory Practice (GLP) toxicological tests were performed in a rabbit model, assuring that HEPHAPC and V-HEPHAPC have no relevant side effects. Second, V-HEPHAPC proved to be an efficient drug carrier and bone substitute to control MRSA infection and simultaneously reconstruct the bone cavity in a sheep model.
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Pinto PO, Branquinho MV, Caseiro AR, Sousa AC, Brandão A, Pedrosa SS, Alvites RD, Campos JM, Santos FL, Santos JD, Mendonça CM, Amorim I, Atayde LM, Maurício AC. The application of Bonelike® Poro as a synthetic bone substitute for the management of critical-sized bone defects - A comparative approach to the autograft technique - A preliminary study. Bone Rep 2021; 14:101064. [PMID: 33981810 PMCID: PMC8082556 DOI: 10.1016/j.bonr.2021.101064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 12/26/2022] Open
Abstract
The effective treatment of non-unions and critical-sized defects remains a challenge in the orthopedic field. From a tissue engineering perspective, this issue can be addressed through the application bioactive matrixes to support bone regeneration, such as Bonelike®, as opposed to the widespread autologous grafting technique. An improved formulation of Bonelike® Poro, was assessed as a synthetic bone substitute in an ovine model for critical-sized bone defects. Bone regeneration was assessed after 5 months of recovery through macro and microscopic analysis of the healing features of the defect sites. Both the application of natural bone graft or Bonelike® Poro resulted in bridging of the defects margins. Untreated defect remained as fibrous non-unions at the end of the study period. The characteristics of the newly formed bone and its integration with the host tissue were assessed through histomorphometric and histological analysis, which demonstrated Bonelike® Poro to result in improved healing of the defects. The group treated with synthetic biomaterial presented bone bridges of increased thickness and bone features that more closely resembled the native spongeous and cortical bone. The application of Bonelike® Poro enabled the regeneration of critical-sized lesions and performed comparably to the autograph technique, validating its octeoconductive and osteointegrative potential for clinical application as a therapeutic strategy in human and veterinary orthopedics.
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Affiliation(s)
- P O Pinto
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal.,Vasco da Gama Research Center (CIVG), Vasco da Gama University School (EUVG), Av. José R. Sousa Fernandes 197, Campus Universitário, Lordemão, 3020-210 Coimbra, Portugal
| | - M V Branquinho
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - A R Caseiro
- Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal.,Vasco da Gama Research Center (CIVG), Vasco da Gama University School (EUVG), Av. José R. Sousa Fernandes 197, Campus Universitário, Lordemão, 3020-210 Coimbra, Portugal
| | - A C Sousa
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - A Brandão
- Biosckin, Molecular and Cell Therapies, SA, Parque de Ciência e Tecnologia da Maia, Rua Eng. Frederico Ulrich, 2650, 4470-605 Moreira da Maia, Portugal
| | - S S Pedrosa
- Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - R D Alvites
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - J M Campos
- Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal.,Vasco da Gama Research Center (CIVG), Vasco da Gama University School (EUVG), Av. José R. Sousa Fernandes 197, Campus Universitário, Lordemão, 3020-210 Coimbra, Portugal
| | - F L Santos
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - J D Santos
- Network of Chemistry and Technology - Associated Laboratory for Green Chemistry (REQUIMTE-LAQV), Department of Metallurgy and Materials, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias s/n, 4200-465 Porto, Portugal
| | - C M Mendonça
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - I Amorim
- Department of Pathology and Molecular Immunology, Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto (UP), Rua Jorge Viterbo Ferreira, n ° 228, 4050-313 Porto, Portugal.,Institute of Research and Innovation in Health (i3S), University of Porto (UP), Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - L M Atayde
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - A C Maurício
- Veterinary Clinics Department, Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto (UP), Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.,Animal Science Studies Centre (CECA), Agroenvironment, Technologies and Sciences Institute (ICETA), University of Porto, Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
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Pereira I, Pereira JE, Maltez L, Rodrigues A, Rodrigues C, Oliveira M, Silva DM, Caseiro AR, Prada J, Maurício AC, Santos JD, Gama M. Regeneration of critical-sized defects, in a goat model, using a dextrin-based hydrogel associated with granular synthetic bone substitute. Regen Biomater 2020; 8:rbaa036. [PMID: 33732486 PMCID: PMC7947577 DOI: 10.1093/rb/rbaa036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/27/2022] Open
Abstract
The development of injectable bone substitutes (IBS) have obtained great importance in the bone regeneration field, as a strategy to reach hardly accessible defects using minimally invasive techniques and able to fit to irregular topographies. In this scenario, the association of injectable hydrogels and bone graft granules is emerging as a well-established trend. Particularly, in situ forming hydrogels have arisen as a new IBS generation. An in situ forming and injectable dextrin-based hydrogel (HG) was developed, aiming to act as a carrier of granular bone substitutes and bioactive agents. In this work, the HG was associated to a granular bone substitute (Bonelike®) and implanted in goat critical-sized calvarial defects (14 mm) for 3, 6 and 12 weeks. The results showed that HG improved the handling properties of the Bonelike® granules and did not affect its osteoconductive features, neither impairing the bone regeneration process. Human multipotent mesenchymal stromal cells from the umbilical cord, extracellular matrix hydrolysates and the pro-angiogenic peptide LLKKK18 were also combined with the IBS. These bioactive agents did not enhance the new bone formation significantly under the conditions tested, according to micro-computed tomography and histological analysis.
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Affiliation(s)
- Isabel Pereira
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal
- Correspondence address. CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal. Tel: +351-253-604-418; E-mail:
| | - José Eduardo Pereira
- CECAV, Animal and Veterinary Research Centre, University of Trás-os-Montes e Alto Douro, Vila Real 5001-801, Portugal
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, Vila Real 5001-801, Portugal
| | - Luís Maltez
- CECAV, Animal and Veterinary Research Centre, University of Trás-os-Montes e Alto Douro, Vila Real 5001-801, Portugal
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, Vila Real 5001-801, Portugal
| | - Alexandra Rodrigues
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal
| | - Catarina Rodrigues
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal
| | - Manuela Oliveira
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal
| | - Dina M Silva
- Biosckin, Molecular and Cell Therapies S.A., Laboratório Criovida, TecMaia, Rua Engenheiro Frederico Ulrich 2650, Moreira da Maia 4470-605, Portugal
| | - Ana Rita Caseiro
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, Porto 4050-313, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, Porto 4051-401 Portugal
- Centro de Investigação Vasco da Gama (CIVG)/Escola Universitária Vasco da Gama (EUVG), Avenida José R. Sousa Fernandes, n.° 197 Lordemão, Coimbra 3020-210, Portugal
| | - Justina Prada
- CECAV, Animal and Veterinary Research Centre, University of Trás-os-Montes e Alto Douro, Vila Real 5001-801, Portugal
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, Vila Real 5001-801, Portugal
| | - Ana Colette Maurício
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n° 228, Porto 4050-313, Portugal
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, Porto 4051-401 Portugal
| | - José Domingos Santos
- REQUIMTE/LAQV, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia, Universidade do Porto, Rua Dr Roberto Frias, Porto 4200-495, Portugal
| | - Miguel Gama
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal
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Pereira I, Fraga S, Maltez L, Requicha J, Guardão L, Oliveira J, Prada J, Alves H, Santos JD, Teixeira JP, Pereira JE, Soares R, Gama FM. In vivo systemic toxicity assessment of an oxidized dextrin-based hydrogel and its effectiveness as a carrier and stabilizer of granular synthetic bone substitutes. J Biomed Mater Res A 2019; 107:1678-1689. [PMID: 30920095 DOI: 10.1002/jbm.a.36683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 11/11/2022]
Abstract
The worldwide incidence of bone disorders is raising, mainly due to aging population. The lack of effective treatments is pushing the development of synthetic bone substitutes (SBSs). Most ceramic-based SBSs commercially available display limited handling properties. Attempting to solve these issues and achieve wider acceptance by the clinicians, granular ceramics have been associated with hydrogels (HGs) to produce injectable/moldable SBSs. Dextrin, a low-molecular-weight carbohydrate, was used to develop a fully resorbable and injectable HG. It was first oxidized with sodium periodate and then cross-linked with adipic acid dihydrazide. The in vivo biocompatibility and safety of the dextrin-based HG was assessed by subacute systemic toxicity and skin sensitization tests, using rodent models. The results showed that the HG did not induce any systemic toxic effect, skin reaction, or genotoxicity, neither impaired the bone repair/regeneration process. Then, the HG was successfully combined with granular bone substitute, registered as Bonelike (250-500 μm) to obtain a moldable/injectable SBS, which was implanted in tibial fractures in goats for 3 and 6 weeks. The obtained results showed that HG allowed the stabilization of the granules into the defect, ensuring effective handling, and molding properties of the formulation, as well as an efficient cohesion of the granules. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1678-1689, 2019.
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Affiliation(s)
- Isabel Pereira
- CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
| | - Sónia Fraga
- Departamento de Saúde Ambiental, Instituto Nacional de Saúde Dr. Ricardo Jorge, 4000-053, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600, Porto, Portugal
| | - Luís Maltez
- CECAV - Animal and Veterinary Research Centre, University of Trás-os-Montes e Alto Douro, 5001-801, Vila Real, Portugal.,Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, 5001-801, Vila Real, Portugal
| | - João Requicha
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, 5001-801, Vila Real, Portugal
| | - Luísa Guardão
- Animal House Unit, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - Joana Oliveira
- Animal House Unit, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - Justina Prada
- CECAV - Animal and Veterinary Research Centre, University of Trás-os-Montes e Alto Douro, 5001-801, Vila Real, Portugal.,Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, 5001-801, Vila Real, Portugal
| | - Helena Alves
- Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge, 4000-053, Porto, Portugal
| | - José Domingos Santos
- REQUIMTE-LAQV, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, Porto, 4200-465, Portugal
| | - João Paulo Teixeira
- Departamento de Saúde Ambiental, Instituto Nacional de Saúde Dr. Ricardo Jorge, 4000-053, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 4050-600, Porto, Portugal
| | - José Eduardo Pereira
- CECAV - Animal and Veterinary Research Centre, University of Trás-os-Montes e Alto Douro, 5001-801, Vila Real, Portugal.,Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, 5001-801, Vila Real, Portugal
| | - Raquel Soares
- Department of Biomedicine, Unit of Biochemistry, Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, 4200-319, Portugal
| | - Francisco Miguel Gama
- CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
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Zeng JH, Liu SW, Xiong L, Qiu P, Ding LH, Xiong SL, Li JT, Liao XG, Tang ZM. Scaffolds for the repair of bone defects in clinical studies: a systematic review. J Orthop Surg Res 2018; 13:33. [PMID: 29433544 PMCID: PMC5809923 DOI: 10.1186/s13018-018-0724-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/17/2018] [Indexed: 01/06/2023] Open
Abstract
Background This systematic review aims to summarize the clinical studies on the use of scaffolds in the repair of bony defects. Methods The relevant articles were searched through PubMed database. The following keywords and search terms were used: “scaffolds,” “patient,” “clinic,” “bone repair,” “bone regeneration,” “repairing bone defect,” “repair of bone,” “osteanagenesis,” “osteanaphysis,” and “osteoanagenesis.” The articles were screened according to inclusion and exclusion criteria, performed by two reviewers. Results A total of 373 articles were obtained using PubMed database. After screening, 20 articles were identified as relevant for the purpose of this systematic review. We collected the data of biological scaffolds and synthetic scaffolds. There are eight clinical studies of biological scaffolds included collagen, gelatin, and cellular scaffolds for bone healing. In addition, 12 clinical studies of synthetic scaffolds on HAp, TCP, bonelike, and their complex scaffolds for repairing bone defects were involved in this systematic review. Conclusions There are a lot of clinical evidences showed that application of scaffolds had a good ability to facilitate bone repair and osteogenesis. However, the ideal and reliable guidelines are insufficiently applied and the number and quality of studies in this field remain to be improved.
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Affiliation(s)
- Jian-Hua Zeng
- Department of Orthopaedics, Jiangxi People's Hospital, No.152, Ai guo Road, Nanchang, 330006, China
| | - Shi-Wei Liu
- Department of Orthopaedics, Jiangxi medical college, Nanchang university, Nanchang, China
| | - Long Xiong
- Department of Orthopaedics, Jiangxi People's Hospital, No.152, Ai guo Road, Nanchang, 330006, China.
| | - Peng Qiu
- Department of Orthopaedics, Jiangxi medical college, Nanchang university, Nanchang, China
| | - Ling-Hua Ding
- Department of Orthopaedics, Jiangxi medical college, Nanchang university, Nanchang, China
| | | | - Jing-Tang Li
- Department of Orthopaedics, Jiangxi People's Hospital, No.152, Ai guo Road, Nanchang, 330006, China
| | - Xin-Gen Liao
- Department of Orthopaedics, Jiangxi People's Hospital, No.152, Ai guo Road, Nanchang, 330006, China
| | - Zhi-Ming Tang
- Department of Orthopaedics, Jiangxi People's Hospital, No.152, Ai guo Road, Nanchang, 330006, China
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7
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Torres J, Gutierres M, Atayde L, Cortez P, Lopes MA, Santos JD, Cabral AT, van Eck CF. The benefit of bone marrow concentrate in addition to a glass-reinforced hydroxyapatite for bone regeneration: An in vivo ovine study. J Orthop Res 2017; 35:1176-1182. [PMID: 25490876 DOI: 10.1002/jor.22800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/04/2014] [Indexed: 02/04/2023]
Abstract
This study evaluates the ability of a Glass Reinforced Hydroxyapatite Composite (GRHC), in a new microporous pellet formulation with autologous bone marrow concentrate (BMC), to enhance bone regeneration and new bone formation. Ninety non-critical sized bone defects were created in the femurs of nine Merino breed sheep and randomly left unfilled (group A), filled with GRHC pellets alone (group B) or filled with GRHC pellets combined with BMC (group C). The sheep were sacrificed at 3 weeks (three sheep), 6 weeks (three sheep) and 12 weeks (three sheep) and histological analysis (Light Microscopy-LM), scanning electron microscopy (SEM) and histomorphometric analysis (HM) were performed. At 3, 6, and 12 weeks, HM revealed an average percentage of new bone of 48, 72, 83%; 25, 73, 80%, and 16, 38, 78% for Groups C, B and A respectively (significantly different only at 3 weeks p < 0.05). LM and SEM evaluation revealed earlier formation of well-organized mature lamellar bone in Group C. This study demonstrates that the addition of a bone marrow concentrate to a glass reinforced hydroxyapatite composite in a pellet formulation promotes early bone healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1176-1182, 2017.
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Affiliation(s)
- Joao Torres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319, Porto, Portugal
| | - Manuel Gutierres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319, Porto, Portugal
| | - Luis Atayde
- Departamento de Clinicas Veterinarias, Instituto de Ciencias Biomedicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n228, 4050-313, Porto, Portugal
| | - Paulo Cortez
- Departamento de Clinicas Veterinarias, Instituto de Ciencias Biomedicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, n228, 4050-313, Porto, Portugal
| | - M Ascenção Lopes
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal
| | - J Domingos Santos
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465, Porto, Portugal
| | - Abel T Cabral
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319, Porto, Portugal
| | - Carola F van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufman building suite 1011, Pittsburgh, Pennsylvania, 15213
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Silva DM, Caseiro AR, Amorim I, Pereira I, Faria F, Pereira T, Santos JD, Gama FM, Maurício AC. Inflammatory response to dextrin-based hydrogel associated with human mesenchymal stem cells, urinary bladder matrix and Bonelike ® granules in rat subcutaneous implants. ACTA ACUST UNITED AC 2016; 11:065004. [PMID: 27786165 DOI: 10.1088/1748-6041/11/6/065004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increasing relevance has been attributed to hydrogels due to their ability to provide an extracellular matrix (ECM)-like environment for cellular adhesion and proliferation, acting as mechanical scaffolds for tissue remodeling or as delivery matrices. In vivo biocompatibility of a hybrid dextrin hydrogel produced from oxidized dextrin and adipic acid dihydrazide and its combinations with human mesenchymal stem cells (hMSCs), ECM from a porcine bladder (urinary bladder matrix) and ceramic granules (Bonelike®), was evaluated following ISO 10993 after subcutaneous implantation in a rat model. Histological analysis after 3 and 15 d showed typical acute and chronic inflammatory responses, respectively, with a more severe reaction exhibited whenever the ceramic granules were present. However, the dextrin hydrogel was able to stabilize granules in the implant site. Dextrin hydrogel was scored as slight irritant after 3 d, similar to its combination with UBM, and as non-irritant after 15 d. The presence of viable hMSCs in the subcutaneous tissue could be confirmed by the presence of anti-human nuclei antibody (HuNu+) cells. The production of growth factors and inflammatory and immunomodulatory cytokines by these cells was also quantified in peripheral blood confirming the successful encapsulation of hMSCs into the hydrogel matrix for cell survival promotion. The presence of hMSCs seemed to modulate the inflammatory response by accelerating its progression when compared to the acellular experimental groups. Dextrin hydrogel has proven to be a biocompatible multifunctional matrix for minimally invasive biomedical procedures, including orthopedic surgeries when associated with bone substitutes and also as a possible encapsulation matrix for cell-based therapies.
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Affiliation(s)
- Dina M Silva
- CEB-Centre of Biological Engineering, Universidade do Minho (UM), Campus de Gualtar, 4710-057 Braga, Portugal. Author to whom all correspondence should be addressed
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9
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Bellucci D, Sola A, Cannillo V. Hydroxyapatite and tricalcium phosphate composites with bioactive glass as second phase: State of the art and current applications. J Biomed Mater Res A 2015; 104:1030-56. [DOI: 10.1002/jbm.a.35619] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Devis Bellucci
- Department of Engineering “E. Ferrari,”; University of Modena and Reggio Emilia; via P. Vivarelli 10 Modena 41125 Italy
| | - Antonella Sola
- Department of Engineering “E. Ferrari,”; University of Modena and Reggio Emilia; via P. Vivarelli 10 Modena 41125 Italy
| | - Valeria Cannillo
- Department of Engineering “E. Ferrari,”; University of Modena and Reggio Emilia; via P. Vivarelli 10 Modena 41125 Italy
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10
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Torres J, Gutierres M, Lopes MA, Santos JD, Cabral AT, Pinto R, van Eck C. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures. BIOMED RESEARCH INTERNATIONAL 2014; 2014:451781. [PMID: 24955356 PMCID: PMC4052697 DOI: 10.1155/2014/451781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. MATERIAL AND METHODS 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A) during the surgical procedure, or fracture fixation alone (Group B). RESULTS There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS), at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P < 0.05). DISCUSSION These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates. CONCLUSION Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures.
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Affiliation(s)
- Joao Torres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Gutierres
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - M. Ascenção Lopes
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465 Porto, Portugal
| | - J. Domingos Santos
- CEMUC, Faculdade de Engenharia, Universidade do Porto, Rua Doutor Roberto Frias, 4200-465 Porto, Portugal
| | - A. T. Cabral
- Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, Portugal
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - R. Pinto
- Hospital S. Joao, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carola van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufman building suite 1011, Pittsburgh, PA 15213, USA
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Jones LC, Hungerford MW, Khanuja HS, Hungerford DS. Orthopaedic Implant Retrieval: An Interdisciplinary Approach. J Histotechnol 2013. [DOI: 10.1179/his.2006.29.4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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12
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Cortez PP, Silva MA, Santos M, Armada-da-Silva P, Afonso A, Lopes MA, Santos JD, Maurício AC. A glass-reinforced hydroxyapatite and surgical-grade calcium sulfate for bone regeneration: In vivo biological behavior in a sheep model. J Biomater Appl 2011; 27:201-17. [PMID: 21602251 DOI: 10.1177/0885328211399479] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A glass-reinforced hydroxyapatite (HA) composite (Bonelike®) was developed for bone grafting. This biomaterial is composed of a modified HA matrix with α- and β-tricalcium phosphate secondary phases, resulting in higher solubility than single HA type of materials. Several in vitro and in vivo studies demonstrated that Bonelike® has a highly bioactive behavior, which was also confirmed by employing granular forms of this biomaterial in orthopedics and dental applications. However, a fast consolidation vehicle was needed to promote the fixation of Bonelike® granules if applied in larger defects or in unstable sites. Surgical-grade calcium sulfate (CS), which is widely recognized as a well-tolerated and inexpensive bone graft material, was the chosen vehicle to improve the handling characteristics of Bonelike® as it can be used in the form of a powder that is mixed with a liquid to form a paste that sets in situ. After application in non-critical monocortical defects in sheep, histological, and scanning electron microscopy evaluations demonstrated that Bonelike® associated to CS functioned as a very satisfactory scaffold for bone regeneration as it achieved synchronization of the ingrowing bone with biomaterial resorption and subsequent preservation of the bone graft initial volume. Therefore, our results indicate that CS is an effective vehicle for Bonelike® granules as it facilitates their application and does not interfere with their proven highly osteoconductive properties. In the opposite way, the incorporation of Bonelike® improves the bone regeneration capabilities of CS.
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Affiliation(s)
- Paulo Pegado Cortez
- Centro de Estudos de Ciência Animal-CECA, Instituto de Ciências e Tecnologias Agrárias e Agro-Alimentares-ICETA, Universidade do Porto, Campus Agrário de Vairão, 4485-661 Vairão, Portugal.
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Silva Marques JM, Gomes PS, Silva MA, Silvério Cabrita AM, Santos JD, Fernandes MH. Growth and phenotypic expression of human endothelial cells cultured on a glass-reinforced hydroxyapatite. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2009; 20:725-731. [PMID: 18987948 DOI: 10.1007/s10856-008-3628-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 10/16/2008] [Indexed: 05/27/2023]
Abstract
Glass-reinforced hydroxyapatite composites (GR-HA) are bone regenerative materials that are characterized by their increased mechanical properties, when compared to synthetic hydroxyapatite. Bonelike is a GR-HA that is a result of the addition of a CaO-P(2)O(5) based glass to a HA matrix. This biomaterial has been successfully applied in clinical bone regenerative applications. This work aims to evaluate the ability of Bonelike to support the adhesion, proliferation and phenotypic expression of human endothelial cells, aiming to establish new bone tissue engineering pre-endothelialization strategies. Bonelike discs, regardless of being submitted to a pre-immersion treatment with culture medium, were seeded with first passage human umbilical vein endothelial cells, and characterized regarding proliferation and differentiation events. Pre-immersed Bonelike allowed the adhesion, proliferation and phenotype expression of endothelial cells. Seeded materials presented positive immunofluorescent staining for PECAM-1 and a tendency for the formation of cord-like arrangements under angiogenesis-stimulating conditions, although, compared to standard culture plates, a slight decreased cell growth was observed. In this way, Bonelike may be a suitable candidate for pre-endothelialization approaches in bone tissue engineering applications.
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Affiliation(s)
- J M Silva Marques
- Cooperativa de Ensino Superior Egas Moniz, Monte de Caparica, Portugal
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Gomes P, Santos J, Fernandes M. Cell-induced response by tetracyclines on human bone marrow colonized hydroxyapatite and Bonelike. Acta Biomater 2008; 4:630-7. [PMID: 18291737 DOI: 10.1016/j.actbio.2007.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 11/21/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
Abstract
Semi-synthetic tetracyclines are commonly used antibiotics that also seem to play an important role in the modulation of the immuno-inflammatory imbalance, verified in several bone diseases. The association of a therapeutic agent (that prevents bacterial infection and induces tissue formation) to a biomaterial aiming to repair/regenerate bone defects could contribute to a more predictable clinical outcome. The present study intends to evaluate the proliferation and functional activity of osteoblast-induced human bone marrow cells, cultured on the surface of hydroxyapatite (HA) and Bonelike, in the presence of therapeutic concentrations of doxycycline and minocycline. First passage bone marrow cells were cultured for 35 days on the surface of HA and Bonelike discs, in the absence or presence of 1 microg ml(-1) doxycycline and minocycline. Cultures performed in standard tissue culture plates were used as control. Doxycycline or minocycline induced cell proliferation and increased the extent of matrix mineralization in osteoblastic cell cultures established in the three substrates. Also, an improved biological behavior was verified in seeded Bonelike compared with HA. The results suggest that the local delivery of tetracyclines might associate the antimicrobial activity in implant-related bone infection with an eventual induction of osteoblastic proliferation and maintenance of the characteristic biological activity of these cells.
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Sousa RC, Lobato JV, Maurício AC, Hussain NS, Botelho CM, Lopes MA, Santos JD. A clinical report of bone regeneration in maxillofacial surgery using bonelike synthetic bone graft. J Biomater Appl 2007; 22:373-85. [PMID: 17494960 DOI: 10.1177/0885328207078260] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study is to evaluate the osteoconductivity and bioactivity of the Bonelike graft in repairing surgical cystic bone defects. Bonelike is implanted in 11 patients, aged between 24 and 53 years with a mean age of 36 years, consisting of 5 men and 6 women. According to the standard follow up protocols, radiological examinations are performed and Bonelike/bone retrieved samples have been analyzed histologically using non-decalcified sections obtained perpendicular to bone length axis. Radiographic examination and histological results clearly demonstrate an extensive new bone formation apposed on Bonelike granules with a significant degree of maturation. These clinical applications in maxillary bone defects indicate perfect bone bonding between new bone formed and Bonelike granules, along with partial surface biodegradation. This quick and effective osteoconductive response from Bonelike may reduce the time needed to reconstruct the bone defected area of patients.
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Affiliation(s)
- R C Sousa
- Serviço de Estomatologia e Cirurgia Maxilofacial, Hospital Geral de Santo António, Largo Abel Salazar, 4050, Porto, Portugal
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