Drug test chamber: a titanium implant for administration of biochemical agents to a standardized bone callus in situ

Modulation of allograft incorporation by continuous infusion of growth factors over a prolonged duration in vivo

Morselized cancellous allograft bone is frequently used in the reconstruction of bone defects in cases of revision total joint replacement, trauma, spine fusion and treated infection. However, the initial lack of viable bone cells in morselized allograft bone significantly slows the process of graft incorporation compared to autograft bone. This study examined the effects of prolonged local infusion of the growth factors bone morphogenic protein-7 (BMP-7 or OP-1) and fibroblast growth factor-2 (FGF-2 or basic FGF) in the process of allograft incorporation using a rabbit tibial chamber model. New bone formation was evaluated by two indices, the activity of alkaline phosphatase and the level of birefringence. The markers of osteoclast-like cells were also measured. Without the infusion of the growth factors, lower levels of new bone formation were observed in the allograft group, compared to the autograft group. Infusion of growth factors FGF-2 and OP-1, singly or in combination, for 4 weeks, diminished this difference. The numbers of osteoclast-like cells were much higher in the allograft group before the growth factors were delivered. The infusion of FGF, singly, diminished this difference. However, the infusion of OP-1 or the combination of FGF and OP-1 did not decrease the number of osteoclast-like cells to a level comparable to autograft only. Local infusion of growth factors appears to be a useful adjunct to promote the incorporation of allograft bone in vivo.

Effects of local infusion of OP-1 on particle-induced and NSAID-induced inhibition of bone ingrowth in vivo

Excessive polyethylene wear particles from joint replacements may lead to periprosthetic osteolysis and loosening. Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease fracture healing and bone ingrowth. We hypothesized that continuous local infusion of OP-1 (BMP-7) would increase local bone formation in the presence of two different adverse stimuli, polyethylene particles, and an oral NSAID. The Drug Test Chamber (DTC) was implanted in the proximal tibia of mature rabbits. The tissue growing into the chamber was exposed to OP-1 solution (110 ng/day), which was infused via an osmotic pump. Infusion of OP-1 alone for 6 weeks enhanced local bone formation in the chamber by 80% (p < 0.05) over infusion of carrier alone. In the presence of polyethylene particles, infusion of OP-1 increased local bone formation by 38% (p < 0.05) over treatment with particles and carrier. Oral administration of NSAID reduced local bone formation by 58% (p < 0.05); this suppressive effect caused by NSAIDS was completely reversed by the infusion of OP-1 (p < 0.05). These findings underline a potential role for local treatment with OP-1 to increase bone formation in the presence of potentially adverse stimuli such as polyethylene wear particles or NSAID use.

In vitro and in vivo biological responses to a novel radiopacifying agent for bone cement

Iodixanol (IDX) and iohexol (IHX) have been investigated as possible radiopacification agents for polymethylmethacrylate (PMMA) bone cement, to replace the currently used barium sulphate and zirconia. IDX and IHX are both water-soluble iodine-based contrast media and for the last 20 years have been used extensively in clinical diagnostic procedures such as contrast media enhanced computed tomography, angiography and urography. One of the major reasons to remove the current radiopacifying agents is their well-documented cytotoxicity and their potential to increase bone resorption. Using in vitro bone resorption assays, the effect of PMMA particles plus IDX or IHX to induce osteoclast formation and lacunar resorption on dentine slices has been investigated. These responses have been compared with the in vitro response to PMMA particles containing the conventional radiopacifying agents, that is, barium sulphate and zirconia. In parallel, the in vivo reaction, in terms of new bone formation, to particles of these materials has been tested using a bone harvest chamber in rabbit tibiae. In vitro cell culture showed that PMMA containing IHX resulted in significantly less bone resorption than PMMA containing the conventional opacifiers. In vivo testing, however, showed no significant differences between the amounts of new bone formed around cement samples containing the two iodine-based opacifying agents in particulate form, although both led to fewer inflammatory cells than particles of PMMA containing zirconia. Our results suggest that a non-ionic radiopacifier could be considered as an alternative to the conventional radiopacifying agents used in biomaterials in orthopaedic surgery.

Local infusion of FGF-2 enhances bone ingrowth in rabbit chambers in the presence of polyethylene particles

Osseointegration of porous-coated implants during revision arthroplasty procedures is often impeded due to the presence of residual granuloma, particulate debris, and a sclerotic, dysvascular bone bed. We hypothesized that local infusion of recombinant fibroblast growth factor (FGF-2) would increase bone ingrowth in an in vivo model of tissue differentiation in the rabbit tibia in the presence of phagocytosable polyethylene particles. A drug test chamber (DTC) was implanted in the proximal medial tibial metaphysis of mature rabbits unilaterally. The chamber contained a 1x 1 x 5-mm tunnel for tissue ingrowth, and was connected to an osmotic diffusion pump. FGF-2 was infused at dosages of 0, 0.5, 5, 50, or 500 ng/day for a 3-week period, with subsequent harvesting of the ingrown tissue after each 3-week treatment. The effects of ultrahigh molecular weight polyethylene particles (0.5-microm diameter) on tissue ingrowth were determined by adding particles to the chamber at concentrations of 5.8 x 10(11) (low dose) or 1.7 x 10(12) (high dose) particles/mL, with and without infusion of 50 ng/day of FGF for 3 weeks. The tissue forming in the chamber was harvested after each treatment for histologic processing and morphometric analysis of bone ingrowth. Statistical analysis was performed using parametric tests (ANOVA), nonparametric tests (Kruskal-Wallis test) and post hoc tests. In the absence of particles, infusion of 50 ng FGF-2 per day yielded the greatest amount of bone ingrowth. The high dose of particles suppressed bone ingrowth into the chamber, but the low dose particles did not (p = 0.0002, 95% confidence limits = 9.19-18.80). Infusion of 50 ng FGF-2 per day significantly increased net bone formation in the presence of high-dose UHMWPE particles (p = 0.039, 95% confidence limits = 1.41-6.79). There was a trend for decreased numbers of vitronectin-receptor positive (osteoclast-like) cells with the addition of FGF-2, compared to particles alone (p = 0.08). Local delivery of FGF-2 may prove useful in mitigating the adverse effects of wear debris (e.g., in treating early osteolytic lesions), and facilitating osseointegration of revision total joint replacements in situations where the bone bed is suboptimal and residual particles and granulomatous tissue are present.

Modulation of bone ingrowth and tissue differentiation by local infusion of interleukin-10 in the presence of ultra-high molecular weight polyethylene (UHMWPE) wear particles

Interleukin-10 (IL-10) is a cytokine that plays a major role in suppressing the inflammatory response, particularly cell-mediated immunity that is characteristic of the TH1 response. The purpose of this study was to determine whether local infusion of IL-10 could mitigate the suppression of bone ingrowth associated with polyethylene wear particles. Drug test chambers were implanted in the proximal tibia of 20 mature New Zealand White rabbits. The DTC provided a continuous 1 x 1 x 5-mm canal for tissue ingrowth. After a 6-week period for osseointegration, the DTC was then connected to an osmotic diffusion pump. IL-10 at doses of 0.1-100 ng/mL (0.25 microL/h) was infused with or without ultra-high molecular weight polyethylene particles (0.5 +/- 0.2 microm diameter, 10(12) particles/mL) present in the chamber for a 3- or 6-week period. The tissue in the chamber was harvested after each treatment; sections were stained with hematoxylin and eosin for morphometric analysis. Osteoclast-like cells were identified by immunohistochemical staining using a monoclonal antibody directed against the alpha chain of the vitronectin receptor, CD51. Osteoblasts were identified using alkaline phosphatase staining. In dose-response studies, infusion of 1 ng/mL IL-10 yielded the greatest bone ingrowth in the presence of particles. The addition of polyethylene particles evoked a marked foreign body reaction and fibrosis; bone ingrowth was significantly suppressed (p = 0.0003). Bone ingrowth was increased by over 48% with infusion of IL-10 for the final 3 weeks of a 6-week ultra-high molecular weight polyethylene particle exposure compared with particles alone (p = 0.027). IL-10 is a cytokine that plays a major role in suppressing the inflammatory response, especially cell-mediated immunity that is characteristic of the TH1 response. Local infusion of immune-modulating cytokines such as IL-10 may prove to be useful in abating particle-induced periprosthetic osteolysis.

A new approach to demonstrate cellular activity in bone formation adjacent to implants

Bone tissue repeatedly formed in titanium 6-aluminum 4-vanadium rabbit bone harvest implants was collected in vivo at various times between 12 days and 5 weeks. Qualitative and quantitative examinations on undecalcified thin sections were performed in the light microscope. The amount of bone tissue was calculated on routinely stained sections. Alkaline (ALP) and acid phosphatase (ACP) enzyme activities were investigated. We also performed immunohistological detection of bone matrix proteins. Increasing bone density as well as an increasing mineralization of the tissue was observed in the biopsies with increasing time. The ALP and ACP activities were similar at short times (12 days and 2 weeks). With increasing time the ALP activity was stronger than that of ACP. The results from the immunohistochemical detection of osteonectin, osteopontin, bone sialoprotein, and collagen I and II demonstrated changes in the tissue differentiation with time. The tissue formation in the canal became more mature with time of ingrowth, as observed with the various techniques used in this study. Owing to these methodical developments, undecalcified ground sections may be used for detailed analysis of various phases of tissue formation in close proximity to implants.

Bone-Tissue Formation and Integration of Titanium Implants: An Evaluation with Newly Developed Enzyme and Immunohistochemical Techniques

BACKGROUND

Examination of the tissue surrounding retrieved implants involve routine investigations on cut and ground sections. Undecalcified sections with implants in situ are histologically stained followed by qualitative and quantitative observations of the tissue response to the implants by light microscopy.

PURPOSE

A novel technique that allows for the accurate definition and quantification of enzymes involved in bone formation (alkaline phosphatase) and resorption (acid phosphatase) in the tissue is presented.

MATERIALS AND METHODS

Commercially pure titanium and titanium alloy (Ti6Al4V) implants were retrieved after 6 and 12 weeks of healing in rabbit bone. In addition, 4-week specimens from commercially pure titanium bone harvest chambers placed in rabbit bone were used. Undecalcified cut and ground sections were produced and evaluated with enzyme and immunohistochemical staining techniques.

RESULTS

The titanium implants retrieved after 6 weeks of insertion in rabbit bone revealed a higher activity of both alkaline phosphatase and acid phosphatase activity compared to the implants followed for 12 months. The former samples revealed ongoing bone-tissue remodeling in the interface, whereas the latter ones showed steady-state bone conditions. Applying the new technique allowed for investigation of various bone proteins present in the tissue that had formed inside titanium canals of harvest chambers at various times of follow-up.

CONCLUSIONS

The combination of routine histologic stainings with enzyme and immunohistochemical technique of cut and ground specimens is a valuable tool in the investigations of retrieved implants from humans and animals. This novel technique now may be used to describe the state of bone regeneration in the interface zone associated with implant research.

Basic fibroblast growth factor infused at different times during bone graft incorporation. Titanium chamber study in rats

We investigated the effect of applying basic fibroblast growth factor (bFGF) to a bone graft during different stages of incorporation in an infusion bone chamber model. Bone chambers were implanted bilaterally into rat tibiae. Both chambers were connected to an implanted osmotic minipump. Ingrowing bone could enter the cylindrical interior of the chamber only at one end. The distance which ingrowing bone had reached into the bone graft was then measured on histological slides. Specimens were also analyzed by 99mTc-MDP scintimetry. The infusion of buffer during 2 weeks from implantation had no effects on tissue ingrowth distance or quality. bFGF was infused during 2 weeks from implantation in a dose of either 1.2 or 12 ng/day. Bone ingrowth was measured 6 weeks after implantation. The higher dose had a more marked effect and was used for studying the effect of application at different times. The maximum stimulation of bFGF as measured at 6 weeks postimplantation was found after infusion during the first postimplantation week. Infusion during the third and fourth weeks had no effect at 6 weeks, but tended to increase the bone ingrowth distance at 8 weeks postimplantation. These findings suggest that bFGF infusion increases bone ingrowth into bone grafts when infused at both an early and a later stage, but the effect can be measured only several weeks later.

Marrow development and its relationship to bone formation in vivo: a histological study using an implantable titanium device in rabbits

During embryogenesis, the creation of marrow sinusoids is intimately related to the coupled processes of osteogenesis and osteoclastic resorption. We set out to further define the relationship between bone formation and marrow development by implanting an intraosseous titanium device into the tibiae of rabbits which permits the examination of bone formation under standardized and reproducible conditions as well as allowing repeated sampling of new bone. A hollow channel is incorporated into the device into which tissue can grow. The device was left in place for 6 weeks to allow osseous integration to occur, after which the initial rod of new tissue growth was removed and subsequent histological and immunohistological sequence of events observed over the next 7 weeks. Interpretation of its morphological changes was further aided by concurrent histomorphometric studies. Because the channel was in direct continuity with the marrow cavity and isolated from the endosteum, immediate marrow regeneration was expected, following dissolution of the blood clot. Instead, our studies indicated that hemopoietic marrow cells, including the erythroid and myeloid series as well as megakaryocytes, did not appear until 3 weeks after implantation of the chamber when the newly formed bone had been remodeled to form an expanded marrow cavity. This intraosseous device is a useful in vivo model for studying the development of bone marrow hemopoietic and nonhemopoietic stromal cells and our results confirm the previous observation that influx of marrow cellular elements follow the formation of bone during endochondral as well as intramembranous ossification.

Transforming growth factor beta 1 stimulates bone formation and resorption in an in-vivo model in rabbits

The influence of TGF beta 1 on bone was studied in a titanium device implanted into the tibia of rabbits. TGF beta 1 was infused via an Alzet osmotic pump calibrated to deliver at a rated of 200ng daily for 2 weeks before replacement. A hollow channel is incorporated into the device into which tissue can grow, and the histological sequence of events was observed over 6 weeks. In control samples, the rod-shaped piece of tissue at 2W consisted of spindle-shaped cells in the center, flanked at both ends by islands of trabecular bone lined by cuboidal osteoblasts and osteoclasts. By 4W, ingrowth of bone reached the center if the specimen, by which time, the bone surfaces were apposed by a single layer of flattened osteoblasts. However, osteoclastic resorption continued unabated so that by 6W, only a thin layer of cortical bone remained, enclosing a marrow cavity with hemopoietic elements. Significant differences were observed in samples continuously infused with TGF beta 1. At 2W, trabecular bone had reached further towards the center of the specimen and the granulation tissue was made up of cells that were more plump and cuboidal compared to the spindle cells of control sample. At 3W, there was increased bone volume and osteoid seams were thicker, covering a greater extent of the trabeculae surfaces. At 4W, the bony trabeculae were up to 3 times thicker than control trabeculae. There was very active bone resorption with many multinucleate osteoclasts and multilayered aggregates of cuboidal osteoblasts lining bony surfaces. Yet at 6W, the morphological appearance was similar to control samples.(ABSTRACT TRUNCATED AT 250 WORDS)

In situ hybridization to show sequential expression of osteoblast gene markers during bone formation in vivo

We investigated the sequence of expression of osteoblast gene markers during bone formation in vivo by in situ hybridization. Cylindrical lesions were induced in the femora of sheep with titanium analytic bone implants that allow removal of serial core samples to study bone formation. At 2 weeks (2W), granulation tissue made up of spindle-shaped cells had partially replaced the blood clot. Islands of osseous tissue, first noted in the periphery of the ingrowing tissue at 3W, became the predominant tissue by 6W. The surfaces of newly forming bone at 3W were apposed by cuboidal cells, which in some areas were several layers thick. By 6W, most of the cells lining bone trabeculae had assumed a flattened morphology. The temporal and spatial distribution of osteoblast gene markers was examined by in situ hybridization with nonradioactive digoxigenin probes for alpha 1(I) procollagen, alkaline phosphatase (ALP), osteopontin (OP), and bone Gla protein (BGP). The spindle-shaped cells in the granulation tissue expressed mRNA for alpha 1(I) procollagen, ALP, and OP but not BGP, suggesting that they may be osteoblast precursor cells. alpha 1(I) procollagen mRNA was strongly expressed by all cells on the surface of bone, with a peak intensity at 3W and then reducing sharply by 6W. Initially, only pockets of cuboidal cells on bone surfaces expressed ALP mRNA, with a peak intensity at 5W. Similarly, only a proportion of cuboidal cells expressed OP mRNA early in bone formation, but the number of cells expressing OP mRNA increased with time. Clumps of cuboidal cells expressed BGP mRNA only when bone was present, and the degree of expression increased with the amount of bone formed. This model allows the study of temporal and spatial sequence of gene expression in cells participating in osteogenesis. The temporal sequence is similar to that shown in vitro in other models of mineralization. The geographic localization of cells expressing mRNA for alpha 1(I) procollagen, ALP, OP, and BGP implies subspecialization of osteoblasts in bone formation.

Lipid extraction enhances bank bone incorporation. An experiment in rabbits

We implanted frozen allogeneic cancellous bone in rabbit skeletal defects and compared the bone-forming response with that from similar implants that had also been extracted with chloroform/methanol. The donor bone was harvested from a previously implanted titanium chamber that is spontaneously filled with reproducible amounts of cancellous bone. It was processed as frozen bank bone, then transferred to an identical, but empty, chamber in another rabbit. Extraction of lipids before implantation increased the ingrowth of new bone into the transferred bone, as measured by 45Ca and 99mTc-MDP activity. A simple treatment with fat solvents may reduce some of the drawbacks of ordinary bank bone.

Local application of growth-factor IGF-1 to healing bone. Experiments with a titanium chamber in rabbits

In order to study the effects of bone healing, insulin-like growth factor 1 (IGF-1) was continuously applied with a minipump to a healing bone callus located inside a titanium chamber in a rabbit tibia. After 2 weeks, 99mTc-MDP uptake and calcium content were measured. IGF-1 decreased 99mTc-MDP uptake, and thus the mineral turnover rate, but the amount of bone mineral was unchanged. Probably the normal endogenous production of IGF-1 is already optimal for healing in this model.