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Mahapatra C, Kumar P, Paul MK, Kumar A. Angiogenic stimulation strategies in bone tissue regeneration. Tissue Cell 2022; 79:101908. [DOI: 10.1016/j.tice.2022.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/24/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
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Wagner JM, Schmidt SV, Dadras M, Huber J, Wallner C, Dittfeld S, Becerikli M, Jaurich H, Reinkemeier F, Drysch M, Lehnhardt M, Behr B. Inflammatory processes and elevated osteoclast activity chaperon atrophic non-union establishment in a murine model. J Transl Med 2019; 17:416. [PMID: 31831031 PMCID: PMC6909450 DOI: 10.1186/s12967-019-02171-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/05/2019] [Indexed: 01/09/2023] Open
Abstract
Background Delayed bone healing, especially in long bones poses one of the biggest problems in orthopeadic and reconstructive surgery and causes tremendous costs every year. There is a need for exploring the causes in order to find an adequate therapy. Earlier investigations of human scaphoid non-union revealed an elevated osteoclast activity, accompanied by upregulated levels of TGF-beta and RANKL. Interestingly, scaphoid non-union seemed to be well vascularized. Methods In the current study, we used a murine femur-defect model to study atrophic non unions over a time-course of 10 weeks. Different time points were chosen, to gather insights into the dynamic processes of non-union establishment. Results Histological analyses as well as western blots and qRT-PCR indicated enhanced osteoclast activity throughout the observation period, paralleled by elevated levels of TGF-beta, TNF-alpha, MMP9, MMP13 and RANKL, especially during the early phases of non-union establishment. Interestingly, elevated levels of these mediators decreased markedly over a period of 10 weeks, as inflammatory reaction during non-union establishment seemed to wear out. To our surprise, osteoblastogenesis seemed to be unaffected during early stages of non-union establishment. Conclusion Taken together, we gained first insights into the establishment process of atrophic non unions, in which inflammatory processes accompanied by highly elevated osteoclast activity seem to play a leading role.
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Affiliation(s)
- Johannes M Wagner
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Sonja V Schmidt
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Mehran Dadras
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Julika Huber
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Christoph Wallner
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Stephanie Dittfeld
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Mustafa Becerikli
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Henriette Jaurich
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Felix Reinkemeier
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Marius Drysch
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Marcus Lehnhardt
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Björn Behr
- University Hospital BG Bergmannsheil Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
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3
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Walters G, Pountos I, Giannoudis PV. The cytokines and micro-environment of fracture haematoma: Current evidence. J Tissue Eng Regen Med 2017; 12:e1662-e1677. [PMID: 29047220 DOI: 10.1002/term.2593] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/31/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022]
Abstract
Fracture haematoma formation is the first and foremost important stage of fracture healing. It orchestrates the inflammatory and cellular processes leading to the formation of callus and the restoration of the continuity of the bone. Evidence suggests that blocking this initial stage could lead to an impairment of the overall bone healing process. This review aims to analyse the existing evidence of molecular contributions to bone healing within fracture haematoma and to determine the potential to modify the molecular response to fracture in the haematoma with the aim of improving union times. A comprehensive search of literature documenting fracture haematoma cytokine content was performed. Suitable papers according to prespecified criteria were identified and analysed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A total of 89 manuscripts formed the basis of this analysis. Low oxygen tension, high acidity, and high calcium characterised initially the fracture haematoma micro-environment. In addition, a number of cytokines have been measured with concentrations significantly higher than those found in peripheral circulation. Growth factors have also been isolated, with an observed increase in bone morphogenetic proteins, platelet-derived growth factor, and transforming growth factor. Although molecular modification of fracture haematoma has been attempted, more research is required to determine a suitable biological response modifier leading to therapeutic effects. The cytokine content of fracture haematoma gives insight into processes occurring in the initial stages of fracture healing. Manipulation of signalling molecules represents a promising pathway to target future therapies aiming to upregulate the osteogenesis.
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Affiliation(s)
- Gavin Walters
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - Ippokratis Pountos
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
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Zhang M, Wang GL, Zhang HF, Hu XD, Shi XY, Li S, Lin W. Repair of segmental long bone defect in a rabbit radius nonunion model: comparison of cylindrical porous titanium and hydroxyapatite scaffolds. Artif Organs 2013; 38:493-502. [PMID: 24372398 DOI: 10.1111/aor.12208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A segmental long bone defect in a rabbit radius nonunion model was repaired using cylindrical porous titanium (Ti) and hydroxyapatite (HA) scaffolds. Each scaffold was produced using the same method, namely, a slurry foaming method. Repairing ability was characterized using x-radiographic score 12 and 24 weeks postprocedure; failure load of the radius-ulna construct, under three-point bending, 12 weeks postprocedure; and the percentage of newly formed bone within the implant, 12 and 24 weeks after postprocedure. For each of these parameters, the difference in the results when porous Ti scaffold was used compared with when HA scaffolds were used was not significant; both porous scaffolds showed excellent repairing ability. Because the trabecular bone is a porous tissue, the interconnected porous scaffolds have the advantages of natural bone, and vasculature can grow into the porous structure to accelerate the osteoconduction and osteointegration between the implant and bone. The porous Ti scaffold not only enhanced the bone repair process, similar to porous HA scaffolds, but also has superior biomechanical properties. The present results suggest that porous Ti scaffolds may have promise for use in the clinical setting.
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Affiliation(s)
- Ming Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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5
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Pountos I, Georgouli T, Pneumaticos S, Giannoudis PV. Fracture non-union: Can biomarkers predict outcome? Injury 2013; 44:1725-32. [PMID: 24075219 DOI: 10.1016/j.injury.2013.09.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 02/02/2023]
Abstract
Delayed bone healing and non-union occurs in approximately 10-15% of long bone fractures. Both pathologies may result in prolonged period of pain, disability and repetitive operative interventions. Despite intense investigations and progress done in understanding the pathophysiologic processes governing bone healing, the diagnostic tools have not been altered. The clinical findings and radiographic features remain the two important landmarks of diagnosing non-union and even when the diagnosis is established there is debate on the ideal timing and mode of intervention. Emerging evidence suggest that there are certain molecules and genes that can serve as predictors of potentially unsuccessful fracture union. This article summarises the current evidence on the available 'bio-markers'to predict fracture non-union.
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Affiliation(s)
- I Pountos
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, UK; Leeds Biomedical Research Unit, Leeds, UK
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6
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Lozada-Gallegos AR, Letechipia-Moreno J, Palma-Lara I, Montero AA, Rodríguez G, Castro-Muñozledo F, Cornejo-Cortés MA, Juárez-Mosqueda ML. Development of a bone nonunion in a noncritical segmental tibia defect model in sheep utilizing interlocking nail as an internal fixation system. J Surg Res 2013; 183:620-8. [DOI: 10.1016/j.jss.2013.02.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/20/2013] [Accepted: 02/28/2013] [Indexed: 11/25/2022]
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Ismail HD, Phedy P, Kholinne E, Kusnadi Y, Sandhow L, Merlina M. Existence of mesenchymal stem cellsin sites of atrophic nonunion. Bone Joint Res 2013; 2:112-5. [PMID: 23836475 PMCID: PMC3690404 DOI: 10.1302/2046-3758.26.2000165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Nonunion is one of the most troublesome complications to treat
in orthopaedics. Former authors believed that atrophic nonunion
occurred as a result of lack of mesenchymal stem cells (MSCs). We
evaluated the number and viability of MSCs in site of atrophic nonunion compared
with those in iliac crest. Methods We enrolled five patients with neglected atrophic nonunions of
long bones confirmed by clinical examinations and plain radiographs
into this study. As much as 10 ml bone marrow aspirate was obtained
from both the nonunion site and the iliac crest and cultured for
three weeks. Cell numbers were counted using a haemocytometer and
vitality of the cells was determined by trypan blue staining. The
cells were confirmed as MSCs by evaluating their expression marker
(CD 105, CD 73, HLA-DR, CD 34, CD 45, CD 14, and CD 19). Cells number and
viability were compared between the nonunion and iliac creat sites. Results After three weeks, numbers of 6.08×106 cells (sd 2.07)
and 4.98×106 cells (sd 1.15) were obtained from
the nonunion site and the iliac crest, respectively, with viability
of 87.1% (81.7% to 90.8%) and 89.8% (84.7% to 94.5%), respectively.
No differences was found between the two sources of MSCs regarding
cells number (p = 0.347) and viability (p = 0.175). Conclusions Our findings showed the existence of MSCs in the site of atrophic
nonunion, at a similar number and viability to those isolated from
the iliac crest.
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Affiliation(s)
- H D Ismail
- Universitas Indonesia Faculty of Medicine- Cipto Mangunkusumo Hospital, Departmentof Orthopaedics and Traumatology, Salemba 6, Jakarta, Indonesia
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Mathieu M, Rigutto S, Ingels A, Spruyt D, Stricwant N, Kharroubi I, Albarani V, Jayankura M, Rasschaert J, Bastianelli E, Gangji V. Decreased pool of mesenchymal stem cells is associated with altered chemokines serum levels in atrophic nonunion fractures. Bone 2013; 53:391-8. [PMID: 23318974 DOI: 10.1016/j.bone.2013.01.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 01/21/2023]
Abstract
Nonunion fractures can cause severe dysfunction and are often difficult to treat mainly due to a poor understanding of their physiopathology. Although many aspects of impaired fracture healing have been extensively studied, little is known about the cellular and molecular mechanisms leading to atrophic nonunion. Therefore, the aim of the present study was to assess the pools and biological functions of bone marrow-derived mesenchymal stem cells (hMSCs) and circulating endothelial progenitor cells (EPCs) in atrophic nonunion patients compared to healthy subjects, and the systemic levels of growth factors involved in the recruitment, proliferation and differentiation of these cells. In nonunions, the pool of hMSCs was decreased and their proliferation delayed. However, once committed, hMSCs from nonunions were able to proliferate, differentiate into osteoblastic cells and mineralize in vitro as efficiently as hMSCs from healthy subjects. In parallel, we found altered serum levels of chemokines and growth factors involved in the chemotaxis and proliferation of hMSCs such as leptin, interleukin-6 (IL-6) and its soluble receptor, platelet-derived growth factor-BB (PDGF-BB), stem cell factor (SCF) and insulin-like growth factor-1 (IGF-1). Moreover, we showed that the number of EPCs and their regulating growth factors were not affected in nonunion patients. If nonunion is generally attributed to a vascular defect, our results also support a role for a systemic mesenchymal and osteogenic cell pool defect that might be related to alterations in systemic levels of factors implicated in their chemotaxis and proliferation.
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Affiliation(s)
- Myrielle Mathieu
- Laboratory of Bone and Metabolic Biochemistry, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium.
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Abstract
We present a case illustrating the successful use of a conventional intramedullary rod and vascularized iliac crest graft in atrophic nonunion combined with severe osteoporosis of the femoral shaft in a child, in whom classical osteosynthesis failed after two operations. The conventional intramedullary rod offered excellent purchase in the severely porotic, partially destroyed bone. Combined with a vascularized iliac crest grafted laterally, mechanical support and an osteoinductive stimulus were provided. The atrophic nonunion healed completely after this revision surgery.
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Geris L, Gerisch A, Schugart RC. Mathematical modeling in wound healing, bone regeneration and tissue engineering. Acta Biotheor 2010; 58:355-67. [PMID: 20676732 DOI: 10.1007/s10441-010-9112-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 07/05/2010] [Indexed: 01/11/2023]
Abstract
The processes of wound healing and bone regeneration and problems in tissue engineering have been an active area for mathematical modeling in the last decade. Here we review a selection of recent models which aim at deriving strategies for improved healing. In wound healing, the models have particularly focused on the inflammatory response in order to improve the healing of chronic wound. For bone regeneration, the mathematical models have been applied to design optimal and new treatment strategies for normal and specific cases of impaired fracture healing. For the field of tissue engineering, we focus on mathematical models that analyze the interplay between cells and their biochemical cues within the scaffold to ensure optimal nutrient transport and maximal tissue production. Finally, we briefly comment on numerical issues arising from simulations of these mathematical models.
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Geris L, Reed AAC, Vander Sloten J, Simpson AHRW, Van Oosterwyck H. Occurrence and treatment of bone atrophic non-unions investigated by an integrative approach. PLoS Comput Biol 2010; 6:e1000915. [PMID: 20824125 PMCID: PMC2932678 DOI: 10.1371/journal.pcbi.1000915] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 08/03/2010] [Indexed: 12/15/2022] Open
Abstract
Recently developed atrophic non-union models are a good representation of the clinical situation in which many non-unions develop. Based on previous experimental studies with these atrophic non-union models, it was hypothesized that in order to obtain successful fracture healing, blood vessels, growth factors, and (proliferative) precursor cells all need to be present in the callus at the same time. This study uses a combined in vivo-in silico approach to investigate these different aspects (vasculature, growth factors, cell proliferation). The mathematical model, initially developed for the study of normal fracture healing, is able to capture essential aspects of the in vivo atrophic non-union model despite a number of deviations that are mainly due to simplifications in the in silico model. The mathematical model is subsequently used to test possible treatment strategies for atrophic non-unions (i.e. cell transplant at post-osteotomy, week 3). Preliminary in vivo experiments corroborate the numerical predictions. Finally, the mathematical model is applied to explain experimental observations and identify potentially crucial steps in the treatments and can thereby be used to optimize experimental and clinical studies in this area. This study demonstrates the potential of the combined in silico-in vivo approach and its clinical implications for the early treatment of patients with problematic fractures. In light of the ageing population, the occurrence of bone fractures is expected to rise substantially in the near future. In 5 to 10% of these cases, the healing process does not succeed in repairing the bone, leading to the formation of delayed unions or even non-unions. In this study we used a combination of an animal model mimicking a clinical non-union situation and a mathematical model developed for normal fracture healing to investigate both the causes of non-union formation and potential therapeutic strategies that can be applied to restart the healing process. After showing that the mathematical model is able to simulate key aspects of the non-union formation, we have used it to investigate several treatment strategies. One of these strategies, the treatment of a non-union involving a transplantation of cells from the bone marrow to the fracture site, was also tested in a pilot animal experiment. Both the simulations and the experiments showed the formation of a bony union between the fractured bone ends. In addition, we used the mathematical model to explain some unexpected experimental observations. This study demonstrates the added value of using a combination of mathematical modelling and experimental research as well the potential of using cell transplantation for the treatment of non-unions.
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Affiliation(s)
- Liesbet Geris
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium.
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Geris L, Schugart R, Van Oosterwyck H. In silico design of treatment strategies in wound healing and bone fracture healing. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2010; 368:2683-2706. [PMID: 20439269 DOI: 10.1098/rsta.2010.0056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Wound and bone fracture healing are natural repair processes initiated by trauma. Over the last decade, many mathematical models have been established to investigate the healing processes in silico, in addition to ongoing experimental work. In recent days, the focus of the mathematical models has shifted from simulation of the healing process towards simulation of the impaired healing process and the in silico design of treatment strategies. This review describes the most important causes of failure of the wound and bone fracture healing processes and the experimental models and methods used to investigate and treat these impaired healing cases. Furthermore, the mathematical models that are described address these impaired healing cases and investigate various therapeutic scenarios in silico. Examples are provided to illustrate the potential of these in silico experiments. Finally, limitations of the models and the need for and ability of these models to capture patient specificity and variability are discussed.
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Affiliation(s)
- L Geris
- Division of Biomechanics and Engineering Design, Department of Mechanical Engineering, Katholieke Universiteit Leuven, , Celestijnenlaan 300C (2419), 3001 Leuven, Belgium.
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14
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Leiggener C, Jaquiéry C, Kunz C, Westermark A. Transparotid approach for tumor excision from the infratemporal space in temporomandibular joint reconstruction: a 3-year follow-up. ACTA ACUST UNITED AC 2010; 109:e1-4. [DOI: 10.1016/j.tripleo.2009.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 08/01/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
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Levels of expression for BMP-7 and several BMP antagonists may play an integral role in a fracture nonunion: a pilot study. Clin Orthop Relat Res 2009; 467:3071-8. [PMID: 19597895 PMCID: PMC2772945 DOI: 10.1007/s11999-009-0981-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 06/29/2009] [Indexed: 01/31/2023]
Abstract
Delays in bone healing or even the development of a nonunion could be related to the concentrations and/or functions of the bone morphogenetic proteins (BMPs). The RNA expression profile of the BMPs within fracture nonunion tissue is unknown. This preliminary descriptive study was performed to define the RNA profiles of the BMPs, their receptors, and their inhibitors within human fracture nonunion tissue and correlate them to matched healing bone. All patients had hypertrophic nonunions. Tissue samples taken from the nonunion site of 15 patients undergoing surgical treatment for an established nonunion were analyzed. The RNA expression patterns of BMP-2, BMP-4, BMP-5, BMP-6, BMP-7, BMP-8; BMP receptor Types IA, IB, and II; and the BMP inhibitors chordin, Noggin, Drm (Gremlin), and follistatin were determined in the nonunion (fibrous tissue) and healing bone (callus tissue) using quantitative real-time PCR. Comparison between the nonunion and healing bone samples revealed substantially elevated concentrations of BMP-4, Drm/Gremlin, follistatin, and Noggin in nonunion tissue when compared to healing bone. In contrast, BMP-7 concentration was higher in the healing bone. Our data suggest inhibition of BMP-7, by Drm (Gremlin), follistatin, and Noggin and upregulation of BMP-4 may play an integral role in the development of nonunions.
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Marchelli D, Piodi LP, Corradini C, Parravicini L, Verdoia C, Ulivieri FM. Increased serum OPG in atrophic nonunion shaft fractures. J Orthop Traumatol 2009; 10:55-8. [PMID: 19484355 PMCID: PMC2688591 DOI: 10.1007/s10195-009-0047-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 02/13/2009] [Indexed: 11/28/2022] Open
Abstract
Background Bone repair alteration is hypothesized for nonunion fracture pathogenesis. Since it is involved in osteoclast regulation, the RANK/RANKL/OPG system (receptor activator of nuclear factor kB/its ligand/osteoprotegerin) may play a role. Materials and methods Serum OPG, free RANKL, bone alkaline phosphatase (BAP), osteocalcin (OC), and urinary deoxypyridinoline (DPD) were determined in 16 male patients (20–39 years) with long bone atrophic nonunion fractures. Serum markers were also measured in 18 age-matched male controls who healed from the same type of fractures within six months, and in 14 age-matched male controls who were healing from the same fractures one month after injury. One-way ANOVA and Bonferroni’s test were used for statistical analysis. Results Only OPG was significantly higher (0.56 sd 0.11 ng/ml) in the patients compared to healed (0.26 sd 0.04 ng/ml; P < 0.001) and healing (0.29 sd 0.09 ng/ml; P < 0.001) controls. The patients’ DPD levels were normal. No correlations were found between bone markers and the characteristics of the subjects in all groups. Conclusions A normal steady state of bone metabolism seems to be present in patients with atrophic nonunion fractures, despite the high serum OPG. The reason for the inability of the patients’ OPG to inhibit osteoclastic activity is unknown. Osteoblast activity also appears normal, so another cellular source of OPG can be hypothesized.
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Affiliation(s)
- Daniele Marchelli
- U.O. Medicina Nucleare, Centro per la Diagnosi e la Terapia delle Osteoporosi, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via F. Sforza 35, 20122, Milan, Italy
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Ai-Aql ZS, Alagl AS, Graves DT, Gerstenfeld LC, Einhorn TA. Molecular mechanisms controlling bone formation during fracture healing and distraction osteogenesis. J Dent Res 2008; 87:107-18. [PMID: 18218835 DOI: 10.1177/154405910808700215] [Citation(s) in RCA: 461] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Fracture healing and distraction osteogenesis have important applications in orthopedic, maxillofacial, and periodontal treatment. In this review, the cellular and molecular mechanisms that regulate fracture repair are contrasted with bone regeneration that occurs during distraction osteogenesis. While both processes have many common features, unique differences are observed in the temporal appearance and expression of specific molecular factors that regulate each. The relative importance of inflammatory cytokines in normal and diabetic healing, the transforming growth factor beta superfamily of bone morphogenetic mediators, and the process of angiogenesis are discussed as they relate to bone repair. A complete summary of biological activities and functions of various bioactive factors may be found at COPE (Cytokines & Cells Online Pathfinder Encyclopedia), http://www.copewithcytokines.de/cope.cgi.
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Affiliation(s)
- Z S Ai-Aql
- Orthopaedic Surgical Research Laboratory, Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA 02118, USA
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18
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AI-Aql Z, Alagl A, Graves D, Gerstenfeld L, Einhorn T. Molecular Mechanisms Controlling Bone Formation during Fracture Healing and Distraction Osteogenesis. J Dent Res 2008. [DOI: 10.1177/154405910808700215 (in engl)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fracture healing and distraction osteogenesis have important applications in orthopedic, maxillofacial, and periodontal treatment. In this review, the cellular and molecular mechanisms that regulate fracture repair are contrasted with bone regeneration that occurs during distraction osteogenesis. While both processes have many common features, unique differences are observed in the temporal appearance and expression of specific molecular factors that regulate each. The relative importance of inflammatory cytokines in normal and diabetic healing, the transforming growth factor beta superfamily of bone morphogenetic mediators, and the process of angiogenesis are discussed as they relate to bone repair. A complete summary of biological activities and functions of various bioactive factors may be found at COPE (Cytokines & Cells Online Pathfinder Encyclopedia), http://www.copewithcytokines.de/cope.cgi .
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Affiliation(s)
- Z.S. AI-Aql
- Orthopaedic Surgical Research Laboratory, Department of Orthopaedic Surgery, Boston University Medical Center, Doctors’ Office Building, Suite 808, 720 Harrison Avenue, Boston, MA 02118, USA
- Department of Orthodontics and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston, MA 02118, USA; and
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Alkhobar, Saudi Arabia, 31952
| | - A.S. Alagl
- Orthopaedic Surgical Research Laboratory, Department of Orthopaedic Surgery, Boston University Medical Center, Doctors’ Office Building, Suite 808, 720 Harrison Avenue, Boston, MA 02118, USA
- Department of Orthodontics and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston, MA 02118, USA; and
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Alkhobar, Saudi Arabia, 31952
| | - D.T. Graves
- Orthopaedic Surgical Research Laboratory, Department of Orthopaedic Surgery, Boston University Medical Center, Doctors’ Office Building, Suite 808, 720 Harrison Avenue, Boston, MA 02118, USA
- Department of Orthodontics and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston, MA 02118, USA; and
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Alkhobar, Saudi Arabia, 31952
| | - L.C. Gerstenfeld
- Orthopaedic Surgical Research Laboratory, Department of Orthopaedic Surgery, Boston University Medical Center, Doctors’ Office Building, Suite 808, 720 Harrison Avenue, Boston, MA 02118, USA
- Department of Orthodontics and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston, MA 02118, USA; and
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Alkhobar, Saudi Arabia, 31952
| | - T.A. Einhorn
- Orthopaedic Surgical Research Laboratory, Department of Orthopaedic Surgery, Boston University Medical Center, Doctors’ Office Building, Suite 808, 720 Harrison Avenue, Boston, MA 02118, USA
- Department of Orthodontics and
- Department of Periodontology and Oral Biology, Boston University School of Dental Medicine, Boston, MA 02118, USA; and
- Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, Alkhobar, Saudi Arabia, 31952
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19
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Garcia P, Holstein JH, Maier S, Schaumlöffel H, Al-Marrawi F, Hannig M, Pohlemann T, Menger MD. Development of a reliable non-union model in mice. J Surg Res 2007; 147:84-91. [PMID: 18061614 DOI: 10.1016/j.jss.2007.09.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Revised: 09/10/2007] [Accepted: 09/14/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the growing knowledge of the mechanisms of fracture healing, non-unions remain a substantial clinical problem. There is increasing interest in murine fracture models because they would allow studying molecular mechanisms of healing with the help of specific antibodies and gene-targeted animals. However, until now it has not been possible to reproducibly create non-unions in mice. Thus, the aim of this study was to develop a reliable non-union model in mice. METHODS After creating segmental defects of 0.8 mm and 1.8 mm, mice femora were stabilized with a pin-clip fixation. Additionally, the influence of periosteal resection on the development of non-unions was studied. Histological and radiological healing was analyzed 5, 10, and 15 wk after surgery. RESULTS After 10 wk all animals showed poor healing with predominantly atrophic non-unions. Whereas the 0.8 mm and the 1.8 mm gap with intact periosteum showed radiologically in 4/6 and 3/6 cases possible healing, only the gap of 1.8 mm with additional periosteal resection resulted in 100% (6/6) non-unions. The non-unions were confirmed also after 15 wk and appeared atrophic with typical histological and radiological features. These included lack of fracture bridging with abundant fibrous tissue in the gap, absence of callus formation, and rounded bone ends. Of interest, the non-unions were not avascular, but demonstrated a considerable vascularity within the fibrous tissue. CONCLUSION Taken together, we herein demonstrate for the first time a reliable non-union model in mice. This allows us to study molecular aspects of non-union formation and analyze different therapeutical strategies in these animals.
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Affiliation(s)
- Patric Garcia
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg/Saar, Germany.
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20
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Zimmermann G, Müller U, Wentzensen A. The value of laboratory and imaging studies in the evaluation of long-bone non-unions. Injury 2007; 38 Suppl 2:S33-7. [PMID: 17920416 DOI: 10.1016/s0020-1383(07)80007-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Delayed union and non-union are common but definitive diagnosis is difficult. Few studies have evaluated imaging methods and laboratory parameters in the distinction between normal and prolonged heating specifically of long-bone fractures. The values of newer imaging methods have been analysed in some cases and should be the subject of further clinical trials. Biological markers may facilitate the earliest diagnosis of delayed union. Preliminary studies of these are limited and more trials are needed. To date it is still difficult to predict accurately a normal consolidation of bone.
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Affiliation(s)
- G Zimmermann
- Klinik for Unfall- und Wiederherstellungschirurgie an der Universität Heidelberg, Berufsgenossenschaltliche Unlallklinik, 67071 Ludwigshalen, Germany.
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21
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Simpson AHRW, Mills L, Noble B. The role of growth factors and related agents in accelerating fracture healing. ACTA ACUST UNITED AC 2006; 88:701-5. [PMID: 16720758 DOI: 10.1302/0301-620x.88b6.17524] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- A H R W Simpson
- The Musculoskeletal Tissue Engineering Consortium, Room SU304, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
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22
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Kobayashi M, Itoi E, Minagawa H, Miyakoshi N, Takahashi S, Tuoheti Y, Okada K, Shimada Y. Expression of growth factors in the early phase of supraspinatus tendon healing in rabbits. J Shoulder Elbow Surg 2006; 15:371-7. [PMID: 16679241 DOI: 10.1016/j.jse.2005.09.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Revised: 08/16/2005] [Accepted: 09/12/2005] [Indexed: 02/01/2023]
Abstract
Growth factors are known to appear during wound healing. We hypothesized that growth factors would also appear during the healing process of a rotator cuff tear. We determined the expression of various growth factors during healing of acute rotator cuff tears in the rabbit. We made a full-thickness defect in the supraspinatus tendon of 27 Japanese white rabbits. The shoulders were harvested on days 1, 3, 5, 7, 9, 11, 14, 21, and 28 postoperatively (n = 3 at each time point). We assessed the expression of basic fibroblast growth factor, insulin-like growth factor 1, platelet-derived growth factor, and transforming growth factor beta. Basic fibroblast growth factor appeared with its peak on days 7 and 9, insulin-like growth factor 1 appeared with its peak on day 5, platelet-derived growth factor appeared with a mild expression between days 7 and 14, and transforming growth factor beta appeared with constant mild expression throughout the observation period. It is likely that each of these growth factors plays a role in the early phase of healing of the supraspinatus tendon in rabbits.
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Affiliation(s)
- Moto Kobayashi
- Department of Orthopedic Surgery, Akita University School of Medicine, Akita, Japan
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23
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Polyzois VD, Papakostas I, Stamatis ED, Zgonis T, Beris AE. Current concepts in delayed bone union and non-union. Clin Podiatr Med Surg 2006; 23:445-53, viii. [PMID: 16903161 DOI: 10.1016/j.cpm.2006.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Healing of a fracture is a continuous process that involves various types of histologic regeneration at different sites. This article describes current approaches to managing delayed union and non-union of fracture.
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24
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Southwood LL, Frisbie DD, Kawcak CE, McIlwraith CW. Delivery of Growth Factors Using Gene Therapy to Enhance Bone Healing. Vet Surg 2004; 33:565-78. [PMID: 15659011 DOI: 10.1111/j.1532-950x.2004.04080.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review the delivery of growth factors using gene therapy for enhancing long-bone fracture healing. STUDY DESIGN Literature review. METHODS MEDLINE and CAB Abstracts literature search (1980-2004). RESULTS Non-union and infected non-union are relatively common complications of long-bone fractures in human and veterinary patients. Growth factors are cytokines that regulate many cell functions important in fracture healing. Exogenous growth factors can be delivered to the fracture site as recombinant proteins or using gene therapy. Recombinant human bone morphogenetic protein-2 and -7 (rhBMP-2 and -7), in particular, enhance fracture healing in numerous experimental and clinical studies. Some limitations with use of recombinant proteins may be overcome by use of gene therapy. Gene therapy involves delivery of the growth factor gene to cells at the fracture site using a viral or non-viral vector. The gene is then expressed (protein synthesis) by cells at the fracture site. Delivery of the BMP gene to the fracture site using gene therapy has been evaluated in laboratory animal models of non-union, with favorable results and without complications. CONCLUSION Delivery of growth factors, particularly members of BMP family, to the fracture site using gene therapy may be a method to enhance fracture healing. Use of this technology may improve the prognosis for patients with long-bone fractures. CLINICAL RELEVANCE Clinical application of gene therapy could improve the prognosis for human and veterinary patients with long-bone fractures, but has not been evaluated clinically.
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Affiliation(s)
- Louise L Southwood
- Orthopaedic Research Center, Colorado State University, Fort Collins, CO, USA.
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Ghazal G, Jaquiéry C, Hammer B. Non-surgical treatment of mandibular fractures—survey of 28 patients. Int J Oral Maxillofac Surg 2004; 33:141-5. [PMID: 15050069 DOI: 10.1054/ijom.2003.0458] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2003] [Indexed: 11/18/2022]
Abstract
Between January 1996 and January 2001 28 patients (nine females, nineteen males) with 35 fractures were treated by observation and soft diet only. Patients with isolated high condylar neck fractures were not included. The mean age at time of trauma was 35.6 years (5/80). Only patients with normal occlusion and radiologically undisplaced fractures were included. The follow-up time was 15 weeks on average (8/33). The patients did not undergo any active treatment. They just received the instruction to reduce mouth opening and to take a soft diet for 4 weeks. During the first 2 weeks after the trauma the patients were seen twice a week. Follow-up X-rays were performed after 4 and after 8 to 12 weeks. As a preemptive therapy antibiotics (amoxicillin plus clavulanic acid 2 x 1g/day) were given for 5 days. Spontaneous healing of all fractures was observed. In two patients a tooth had to be removed out of the fracture line. One patient complained about an occlusal problem after 1 week. In his case intermaxillary fixation was installed for 2 weeks. For forensic reasons the patients have to be fully informed about possible complications before indicating this type of management. Patient selection is crucial and requires a highly experienced surgeon. Patient inconvenience due to frequent consultations must be taken into consideration. This type of treatment can be recommended only in selected cases.
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Affiliation(s)
- G Ghazal
- Department of Reconstructive Surgery, Clinic for Maxillofacial Surgery, University Hospital, Basle, Switzerland
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