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Rezaie ES, Visser NJ, van den Berg C, Shin AY, Bishop AT. Vasculogenic gene therapy: No role for revitalization of structural bone allografts. J Orthop Res 2023; 41:1014-1021. [PMID: 36058614 PMCID: PMC9984671 DOI: 10.1002/jor.25438] [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: 05/09/2022] [Revised: 08/08/2022] [Accepted: 08/29/2022] [Indexed: 02/04/2023]
Abstract
Segmental bone defects are often performed with cryopreserved allografts. They provide immediate stability, but risk nonunion, infection and late stress fracture. Improving the rate and extent of bone revitalization may improve results. Angiogenesis from surgically placed arteriovenous (AV) bundles improves bone blood flow and vitality in cryopreserved rat femora, augmented by vasculogenic growth factors. This study tests the same principal in Yucatan mini-pigs with a tibial diaphyseal defect, combining surgical angiogenesis with angiogenic gene therapy within cryopreserved orthotopically-placed allografts. Tibial diaphyseal defects were reconstructed with cryopreserved allografts and rigid internal fixation in 16 mini pigs. Half of the cranial tibial AV bundles placed within the allograft medullary canal were transfected with an adeno-associated virus containing vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) genes (AAV9.VEGF.PDGF). Bone remodeling, angiogenesis, and allograft healing were assessed. During the postoperative survival period 5 of 8 transfected animals developed cutaneous benign vascular lesions at sites remote from the operated hindlimb, causing excessive bleeding. Within the allograft, both medullary (p = 0.013) and cortical (p = 0.009) vascular volumes were higher and vessels more mature than nontransfected allografts. Bone turnover (p = 0.013), bone mineralization (p = 0.018), bone healing (p = 0.008) and graft incorporation (p = 0.006) were all significantly higher in the gene therapy group. In a large animal tibial defect model, gene therapy of implanted AV bundles improved revascularization, remodeling and healing of cryopreserved allografts used for limb reconstruction. However, benign vascular lesions causing excessive bleeding developed in 5 out of 8 pigs transfected with AAV containing genes for VEGF and PDGF. This unforeseen complication makes vasculogenic gene therapy unacceptable for clinical use.
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Affiliation(s)
- Elisa S Rezaie
- Department of Plastic-Reconstructive and Hand Surgery, Amsterdam University Medical Centre-Academic Medical Centre, Amsterdam, The Netherlands
| | - Noortje J Visser
- Department of Plastic-Reconstructive and Hand Surgery, Amsterdam University Medical Centre-Academic Medical Centre, Amsterdam, The Netherlands
| | - Catherine van den Berg
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Y Shin
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen T Bishop
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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2
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Visser N, Rezaie E, Ducharme A, Shin AY, Bishop AT. The effect of surgical revascularization on the mechanical properties of cryopreserved bone allograft in a porcine tibia model. J Orthop Res 2023; 41:815-822. [PMID: 35880353 DOI: 10.1002/jor.25422] [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] [Received: 04/23/2021] [Revised: 06/06/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Cryopreserved bone allografts(CBA) are susceptible to infection, nonunion, and late stress fracture. Although surgical revascularization by intramedullary implantation of an arteriovenous bundle (AV bundle) generates a neoangiogenic blood supply, there is potential for vascular ingrowth-mediated bone resorption to weaken the graft. For this reason, we have evaluated changes in CBA mechanical properties of structural tibial allografts with and without surgically induced angiogenesis. Cryopreserved tibia bone allografts were transplanted to reconstruct a 3.5 cm segmental tibial defect in 16 Yucatan mini pigs. Surgical revascularization was performed in half by implantation of a cranial tibial AV bundle, (revascularization group). A control group of identical size had a ligated AV bundle implanted, (ligated group). At 20 weeks micro-computed tomography (CT) measured bone mineral density (BMD) as well as bone union. Reference point indentation (RPI) compared cortex material properties, and axial compression determined the allotransplant compressive modulus. Seven of eight tibiae in the angiogenesis group were healed at both junction points at 20 weeks. Only four of eight tibiae healed in the ligated control group. There was no significant difference between the revascularization and ligated control groups in BMD and axial compression test. Similarly, RPI parameters were statistically equal. In paired comparisons with contralateral tibias, however, some RPI values were significantly worse in the ligated control group tibiae. This study demonstrates no adverse effect of surgical angiogenesis on cryopreserved structural bone allograft biomechanical properties in a large animal orthotopic segmental tibial defect model. These data suggest the potential value of surgical angiogenesis in clinical limb-sparing reconstructive surgery.
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Affiliation(s)
- Noortje Visser
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic and Reconstructive Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisa Rezaie
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic and Reconstructive Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexandra Ducharme
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Y Shin
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen T Bishop
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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3
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Pagnotta A, Formica VM, Ascione A, Covello R, Zoccali C. Massive bone allograft engineered with autologous vessels: A new perspective for the future. HAND SURGERY & REHABILITATION 2022; 41:648-653. [PMID: 35700916 DOI: 10.1016/j.hansur.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Reconstruction is very important to ensure good function and quality of life after bone tumor resection. For metacarpals and phalanges, amputation and toe transfer are the gold-standard indications; nevertheless, allograft reconstruction must also be taken into account. Unfortunately, because of its inert biological behavior, it undergoes progressive resorption, with frequent fracture. Several attempts have been made to induce new vascularization in massive bone allograft, with poor results. However, neo-angiogenesis was reported with vascular loops, and we therefore hypothesized that heterologous graft integration could be enhanced by creating a vascular loop through the graft. A 50-year-old male with chondrosarcoma of the ring finger of the left hand underwent wide resection. An allogenic middle phalanx of comparable size was then prepared to fill the defect. Two small windows were performed proximally and distally on the radial surface of the allogenic phalanx, and a 4 cm-long vein graft was inserted inside the medullary canal. Metacarpophalangeal joint stability was achieved by collateral ligament reconstruction with micro-anchors. The distal part of the allograft was then stabilized to the middle phalanx with a 1.5 mm-thick micro-plate and screws. The radial proper palmar digital artery was proximally and distally sutured end-to-end to the vein graft, under microscopy. At 12-month follow-up, the allograft was fused, and histology performed at plate removal at 18 months revealed viable spindle cells with osteoblastic differentiation, without evidence of atypia, in a dense fibrous stroma. At 22 months' follow-up, the patient was apparently disease-free, and satisfied with his manual function.
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Affiliation(s)
- A Pagnotta
- Hand and Microsurgery Unit, Jewish Hospital, Via Fulda 14, 00148 Rome, Italy
| | - V M Formica
- Hand and Microsurgery Unit, Jewish Hospital, Via Fulda 14, 00148 Rome, Italy
| | - A Ascione
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, 00161 Rome, Italy
| | - R Covello
- Oncological Orthopedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - C Zoccali
- Oncological Orthopedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedic Science, University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
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4
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Nielsen MS, Mikkelsen MD, Ptak SH, Hejbøl EK, Ohmes J, Thi TN, Nguyen Ha VT, Fretté X, Fuchs S, Meyer A, Schrøder HD, Ding M. Efficacy of marine bioactive compound fucoidan for bone regeneration and implant fixation in sheep. J Biomed Mater Res A 2021; 110:861-872. [PMID: 34792851 DOI: 10.1002/jbm.a.37334] [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: 07/20/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022]
Abstract
The need for a substitute for allograft and autograft is rising as bone graft surgeries exceed available supplies. We investigated the efficacy of the low-molecular weight marine bioactive compound fucoidan (FUC) on bone regeneration and implant fixation in seven female sheep, as FUC has shown great promise as a bone substitute. Titanium implants were inserted bilaterally in the distal femurs to test three hydroxyapatite/fucoidan (HA/FUC) groups and compared to allograft. The HA was coated with either 500 or 1500 μg of FUC, obtained by microwave-assisted chemical extraction, or 500 μg of FUC obtained by an enzyme-assisted extraction method. The concentric 2-mm gap around the implant was filled with either one of the HA/FUCs or allograft from the donor sheep. After 12 weeks, implant-bone blocks were harvested and divided into three parts for mechanical push-out testing, immunohistochemistry, and micro-CT and histomorphometry. Pronounced bone formations were observed by micro-CT and histomorphometry in all groups, but higher bone volume fractions were seen in the allograft group compared to the three HA/FUC groups. The trabecular thickness, trabecular separation, and architectural anisotropy were all significantly higher in the allograft group compared to the three HA/FUC groups. In conclusion, adequate bone formation was observed in all groups, although the bone formation was significantly greater in the allograft group. Also, no significant differences existed in the shear mechanical properties between groups, suggesting that the combination of HA and FUC can achieve a similar fixation strength to allograft in this model.
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Affiliation(s)
- Mads Suhr Nielsen
- Orthopedic Research laboratory, Department of Orthopedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Dalgaard Mikkelsen
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Signe Helle Ptak
- SDU Chemical Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense, Denmark
| | - Eva Kildall Hejbøl
- Department of Pathology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julia Ohmes
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thuan Nguyen Thi
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Vy Tran Nguyen Ha
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Xavier Fretté
- SDU Chemical Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Technology, University of Southern Denmark, Odense, Denmark
| | - Sabine Fuchs
- Experimental Trauma Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Anne Meyer
- DTU Bioengineering, Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Henrik Daa Schrøder
- Department of Pathology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ming Ding
- Orthopedic Research laboratory, Department of Orthopedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Saffari TM, Mathot F, Bishop AT, Shin AY. New methods for objective angiogenesis evaluation of rat nerves using microcomputed tomography scanning and conventional photography. Microsurgery 2019; 40:370-376. [PMID: 31758730 DOI: 10.1002/micr.30537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/01/2019] [Accepted: 11/08/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Nerve regeneration involves multiple processes, which enhance blood supply that can be promoted by growth factors. Currently, tools are lacking to visualize the vascularization patterns in transplanted nerves in vivo. The purpose of this study was to describe three-dimensional visualization of the vascular system in the rat sciatic nerve and to quantify angiogenesis of nerve reconstruction. MATERIALS AND METHODS In 12 Lewis rats (weighing 250-300 g), 10 mm sciatic nerve gaps were repaired with ipsilateral reversed autologous nerve grafts. At 12 and 16 weeks of sacrifice, Microfil® contrast compound was injected in the aorta. Nerve autografts (N = 12) and contralateral untreated nerves (N = 12) were harvested and cleared while preserving the vasculature. The amount of vascularization was measured by quantifying the vascular surface area using conventional photography (two-dimensional) and the vascular volume was calculated with microcomputed tomography (three-dimensional). For each measurement, a vessel/nerve area ratio was calculated and expressed in percentages (vessel%). RESULTS The vascular volume measured 3.53 ± 0.43% in autografts and 4.83 ± 0.45% vessels in controls at 12 weeks and 4.95 ± 0.44% and 6.19 ± 0.29% vessels at 16 weeks, respectively. The vascular surface area measured 25.04 ± 2.77% in autografts and 26.87 ± 2.13% vessels in controls at 12 weeks, and 28.11 ± 3.47% and 33.71 ± 2.60% vessels at 16 weeks, respectively. The correlation between both methods was statistically significant (p = .049). CONCLUSIONS Both methods are considered to successfully reflect the degree of vascularization. Application of this technique could be used to visualize and objectively quantify angiogenesis of the transplanted nerve graft. Moreover, this simple method is easily reproducible and could be extrapolated to any other desired target organ ex vivo in small animals to investigate the vascular network.
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Affiliation(s)
- Tiam M Saffari
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Plastic-, Reconstructive- and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Femke Mathot
- Department of Plastic Surgery, Radboud University, Nijmegen, The Netherlands
| | - Allen T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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6
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Visser NJ, Rezaie ES, Friedrich PF, Kotsougiani D, Shin AY, Bishop AT. Effects of Surgical Angiogenesis on Segmental Bone Reconstruction With Cryopreserved Massive-Structural Allografts in a Porcine Tibia Model. J Orthop Res 2019; 37:1698-1708. [PMID: 31042307 PMCID: PMC6824922 DOI: 10.1002/jor.24318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/12/2019] [Indexed: 02/04/2023]
Abstract
Cryopreserved bone allografts (CBA) used to reconstruct segmental bone defects provide immediate structural stability, but are vulnerable to infection, non-union and late stress fracture as the majority of the allograft remains largely avascular. We sought to improve the bone vascularity and bone formation of CBAs by surgical angiogenesis with an implanted arteriovenous (AV) bundle, using a porcine tibial defect model. Cryopreserved tibial bone allografts were transplanted in swine leukocyte antigen (SLA) mismatched Yucatan minipigs to reconstruct a 3.5 cm segmental tibial defect. A cranial tibial AV-bundle was placed within its intramedullary canal to induce angiogenesis. The AV bundle was patent in eight pigs and ligated in a control group of eight pigs. At 20 weeks neo-angiogenesis was evaluated by micro-angiography. Bone formation was measured by quantitative histomorphometry and micro-computed tomography. Seven of eight AV-bundles in the revascularized group were patent. One had thrombosed due to allograft displacement. Total vascular volume was higher in the revascularized allografts compared to the ligated group (p = 0.015). Revascularized allografts had increased levels of bone formation on the allograft endosteal surface compared to the ligated control group (p = 0.05). Surgical angiogenesis of porcine tibial CBAs by intramedullary implantation of an AV-bundle creates an enhanced autogenous neoangiogenic circulation and accelerates active bone formation on allograft endosteal surfaces. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1698-1708, 2019.
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Affiliation(s)
- Noortje J Visser
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Elisa S Rezaie
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Patricia F Friedrich
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Dimitra Kotsougiani
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA,Department of Hand-, Plastic- and Reconstructive Surgery,
-Burn Center-, BG Trauma Center Ludwigshafen, Department of Plastic Surgery,
University of Heidelberg, Heidelberg, Germany
| | - Alexander Y Shin
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Allen T Bishop
- Microvascular Research Laboratory, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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7
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Hochreiter J, Mattiassich G, Hitzl W, Weber G, Beheshti M, Ortmaier R. Quantitative in vivo assessment of bone allograft viability using 18F-fluoride PET/CT after glenoid augmentation in reverse shoulder arthroplasty: a pilot study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1399-1404. [PMID: 31172286 DOI: 10.1007/s00590-019-02463-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Success after glenoid bone augmentation in total shoulder arthroplasty depends on osseous integration and non-resorption. Standard imaging techniques, such as computed tomography (CT) and X-rays, cannot quantify bone viability. Therefore, we introduce a new technique to assess graft viability using 18F-sodium fluoride (18F-NaF) PET-CT for femoral allografts in reverse total shoulder arthroplasty (RSA). MATERIALS AND METHODS Patient charts were reviewed following glenoid augmentation using femoral allografts in reverse total shoulder arthroplasty. A total of seven patients were included in this study. 18F-NaF PET-CT was used to assess graft viability and graft fusion. Semiquantitative assessment of 18F-NaF uptake was performed by means of a standardized uptake value (SUV). Radiographs were used to assess fusion. The mean age of the patients at the time of follow-up was 83.4 years (range 79-92), and the mean follow-up was 44.4 months. RESULTS Viability and fusion were confirmed in all allografts using semiquantitative analysis of 18F-NaF PET-CT by means of standardized uptake value (SUVmax). Metabolic activity of medullary region of a vertebral spine was defined as a reference background. The mean value of maximum tracer activity in the allograft was not statistically different from native bone in the reference vertebrae (p = 0.14). CONCLUSIONS 18F-NaF PET-CT is a practicable tool to quantitatively assess viability in large bone allografts after glenoid augmentation in RSA. The study shows viability and fusion in all allografts. LEVEL OF EVIDENCE Level IV, treatment study.
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Affiliation(s)
- Josef Hochreiter
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - Georg Mattiassich
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - Wolfgang Hitzl
- Department of Biostatistics, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Georg Weber
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria
| | - Mohsen Beheshti
- Department of Nuclear Medicine, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe, Seilerstätte 4, 4020, Linz, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020, Linz, Austria. .,Research Unit for Orthopedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria.
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8
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Kotsougiani D, Hundepool CA, Bulstra LF, Friedrich PF, Shin AY, Bishop AT. Recipient-derived angiogenesis with short term immunosuppression increases bone remodeling in bone vascularized composite allotransplantation: A pilot study in a swine tibial defect model. J Orthop Res 2017; 35:1242-1249. [PMID: 27471833 DOI: 10.1002/jor.23378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/26/2016] [Indexed: 02/04/2023]
Abstract
Current vascularized composite allotransplantation (VCA) transplantation protocols rely upon life-long immune modulation to maintain tissue perfusion. Alternatively, bone-only VCA viability may be maintained in small animal models using surgical angiogenesis from implanted autogenous vessels to develop a neoangiogenic bone circulation that will not be rejected. This study tests the method's efficacy in a large animal model as a bridge to clinical practice, quantifying the remodeling and mechanical properties of porcine tibial VCAs. A segmental tibial defect was reconstructed in Yucatan miniature swine by transplantation of a matched tibia segment from an immunologically mismatched donor. Microsurgical repair of nutrient vessels was performed in all pigs, with simultaneous intramedullary placement of an autogenous arteriovenous (AV) bundle in Group 2. Group 1 served as a no-angiogenesis control. All received 2 weeks of immunosuppression. After 16 weeks, micro-CT and histomorphometric analyses were used to evaluate healing and remodeling. Axial compression and nanoindentation studies evaluated bone mechanical properties. Micro-CT analysis demonstrated significantly more new bone formation and bone remodeling at the distal allotransplant/recipient junction and on the endosteal surfaces of Group 2 tibias (p = 0.03). Elastic modulus and hardness were not adversely affected by angiogenesis. The combination of 2 weeks of immunosuppression and autogenous AV-bundle implantation within a microsurgically transplanted tibial allotransplant permitted long-term allotransplant survival over the study period of 16 weeks in this large animal model. Angiogenesis increased bone formation and remodeling without adverse mechanical effects. The method may allow future composite-tissue allotransplantation of bone without the risks associated with long-term immunosuppression. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1242-1249, 2017.
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Affiliation(s)
- Dimitra Kotsougiani
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota.,Department of Hand-, Plastic- and Reconstructive Surgery, -Burn Center-, BG Trauma Center Ludwigshafen, Department of Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Caroline A Hundepool
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota.,Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Liselotte F Bulstra
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota.,Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Patricia F Friedrich
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Alexander Y Shin
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Allen T Bishop
- Microvascular Research Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
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9
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Russo A, Bianchi M, Sartori M, Boi M, Giavaresi G, Salter DM, Jelic M, Maltarello MC, Ortolani A, Sprio S, Fini M, Tampieri A, Marcacci M. Bone regeneration in a rabbit critical femoral defect by means of magnetic hydroxyapatite macroporous scaffolds. J Biomed Mater Res B Appl Biomater 2017; 106:546-554. [DOI: 10.1002/jbm.b.33836] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 02/04/2023]
Affiliation(s)
- A. Russo
- Rizzoli Orthopaedic Institute; NanoBiotechnology Laboratory (NaBi); Bologna 40136 Italy
| | - M. Bianchi
- Rizzoli Orthopaedic Institute; NanoBiotechnology Laboratory (NaBi); Bologna 40136 Italy
| | - M. Sartori
- Rizzoli Orthopaedic Institute; Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies; Bologna 40136 Italy
| | - M. Boi
- Rizzoli Orthopaedic Institute; NanoBiotechnology Laboratory (NaBi); Bologna 40136 Italy
| | - G. Giavaresi
- Rizzoli Orthopaedic Institute; Laboratory of Preclinical and Surgical Studies; Bologna 40136 Italy
| | - D. M. Salter
- Institute of Genetics and Molecular Medicine; , University of Edinburgh; EH4 2XU Edinburgh United Kingdom
| | - M. Jelic
- Department of Orthopaedic Surgery; Medical School University of Zagreb; Zagreb Croatia
| | - M. C. Maltarello
- Rizzoli Orthopaedic Institute; Laboratory of Musculoskeletal Cell Biology; 40136 Bologna Italy
| | - A. Ortolani
- Rizzoli Orthopaedic Institute; NanoBiotechnology Laboratory (NaBi); Bologna 40136 Italy
| | - S. Sprio
- Institute for Science and Technology for Ceramics; , National Research Council; Faenza 48018 Italy
| | - M. Fini
- Rizzoli Orthopaedic Institute; Laboratory of Preclinical and Surgical Studies; Bologna 40136 Italy
| | - A. Tampieri
- Institute for Science and Technology for Ceramics; , National Research Council; Faenza 48018 Italy
| | - M. Marcacci
- Rizzoli Orthopaedic Institute; NanoBiotechnology Laboratory (NaBi); Bologna 40136 Italy
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10
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ORTOLANI ALESSANDRO, BIANCHI MICHELE, MOSCA MASSIMILIANO, CARAVELLI SILVIO, FUIANO MARIO, MARCACCI MAURILIO, RUSSO ALESSANDRO. The prospective opportunities offered by magnetic scaffolds for bone tissue engineering: a review. JOINTS 2016; 4:228-235. [PMID: 28217659 PMCID: PMC5297347 DOI: 10.11138/jts/2016.4.4.228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Magnetic scaffolds are becoming increasingly attractive in tissue engineering, due to their ability to enhance bone tissue formation by attracting soluble factors, such as growth factors, hormones and polypeptides, directly to the implantation site, as well as their potential to improve the fixation and stability of the implant. Moreover, there is increasing evidence that the synergistic effects of magnetic scaffolds and magnetic fields can promote bone repair and regeneration. In this manuscript we review the recent innovations in bone tissue engineering that exploit magnetic biomaterials combined with static magnetic fields to enhance bone cell adhesion and proliferation, and thus bone tissue growth.
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Affiliation(s)
- ALESSANDRO ORTOLANI
- Laboratory of Nano Biotechnology (NaBi), Istituto Ortopedico Rizzoli, Bologna, Italy
| | - MICHELE BIANCHI
- Laboratory of Nano Biotechnology (NaBi), Istituto Ortopedico Rizzoli, Bologna, Italy
| | - MASSIMILIANO MOSCA
- I Orthopaedic and Traumatological Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - SILVIO CARAVELLI
- I Orthopaedic and Traumatological Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - MARIO FUIANO
- I Orthopaedic and Traumatological Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - MAURILIO MARCACCI
- Laboratory of Nano Biotechnology (NaBi), Istituto Ortopedico Rizzoli, Bologna, Italy
- I Orthopaedic and Traumatological Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - ALESSANDRO RUSSO
- Laboratory of Nano Biotechnology (NaBi), Istituto Ortopedico Rizzoli, Bologna, Italy
- I Orthopaedic and Traumatological Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
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Sun D, Chen Y, Tran RT, Xu S, Xie D, Jia C, Wang Y, Guo Y, Zhang Z, Guo J, Yang J, Jin D, Bai X. Citric acid-based hydroxyapatite composite scaffolds enhance calvarial regeneration. Sci Rep 2014; 4:6912. [PMID: 25372769 PMCID: PMC4220725 DOI: 10.1038/srep06912] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/15/2014] [Indexed: 12/17/2022] Open
Abstract
Citric acid-based polymer/hydroxyapatite composites (CABP-HAs) are a novel class of biomimetic composites that have recently attracted significant attention in tissue engineering. The objective of this study was to compare the efficacy of using two different CABP-HAs, poly (1,8-octanediol citrate)-click-HA (POC-Click-HA) and crosslinked urethane-doped polyester-HA (CUPE-HA) as an alternative to autologous tissue grafts in the repair of skeletal defects. CABP-HA disc-shaped scaffolds (65 wt.-% HA with 70% porosity) were used as bare implants without the addition of growth factors or cells to renovate 4 mm diameter rat calvarial defects (n = 72, n = 18 per group). Defects were either left empty (negative control group), or treated with CUPE-HA scaffolds, POC-Click-HA scaffolds, or autologous bone grafts (AB group). Radiological and histological data showed a significant enhancement of osteogenesis in defects treated with CUPE-HA scaffolds when compared to POC-Click-HA scaffolds. Both, POC-Click-HA and CUPE-HA scaffolds, resulted in enhanced bone mineral density, trabecular thickness, and angiogenesis when compared to the control groups at 1, 3, and 6 months post-trauma. These results show the potential of CABP-HA bare implants as biocompatible, osteogenic, and off-shelf-available options in the repair of orthopedic defects.
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Affiliation(s)
- Dawei Sun
- 1] Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China [2] Department of Orthopaedics &Microsurgery, Guangdong No. 2 Provincial People's Hospital, Guangzhou, 510317, China
| | - Yuhui Chen
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China
| | - Richard T Tran
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of The Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, 16802, U.S.A
| | - Song Xu
- 1] Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China [2] State Key Laboratory of Organ Failure Research, Department of Cell Biology, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Denghui Xie
- 1] Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China [2] Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of The Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, 16802, U.S.A
| | - Chunhong Jia
- State Key Laboratory of Organ Failure Research, Department of Cell Biology, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Yuchen Wang
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China
| | - Ying Guo
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China
| | - Zhongmin Zhang
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China
| | - Jinshan Guo
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of The Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, 16802, U.S.A
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of The Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, 16802, U.S.A
| | - Dadi Jin
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China
| | - Xiaochun Bai
- 1] Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510665, China [2] State Key Laboratory of Organ Failure Research, Department of Cell Biology, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
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