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Hosseini S, Parsaei H, Moosavifar M, Tavakoli N, Ahadi R, Roshanbinfar K. Static magnetic field enhances the bone remodelling capacity of human demineralized bone matrix in a rat animal model of cranial bone defects. J Mater Chem B 2024; 12:3774-3785. [PMID: 38535706 DOI: 10.1039/d3tb02299d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
The regeneration of bone defects that exceed 2 cm is a challenge for the human body, necessitating interventional therapies. Demineralized bone matrices (DBM) derived from biological tissues have been employed for bone regeneration and possess notable osteoinductive and osteoconductive characteristics. Nevertheless, their efficiency in regenerating critically sized injuries is limited, and therefore additional signaling cues are required. Thanks to the piezoelectric properties of the bone, external physical stimulation is shown to accelerate tissue healing. We have implanted human DBM in critically sized cranial bone defects in rat animal models and exposed them to an external magnetic field (1 T) to enhance endogenous bone formation. Our in vitro experiments showed the superior cytocompatibility of DBM compared to cell culture plates. Furthermore, alkaline phosphatase activity after 14 days and Alizarin red staining at 28 days demonstrated differentiation of rat bone marrow mesenchymal stem cells into bone lineage on DBM. Computer tomography images together with histological analyses showed that implanting DBM in the injured rats significantly enhanced bone regeneration. Notably, combining DBM transplantation with a 2 h daily exposure to a 1 T magnetic field for 2 weeks (day 7 to 21 post-surgery) significantly improved bone regeneration compared to DBM transplantation alone. This research indicates that utilizing external magnetic stimulation significantly enhances the potential of bone allografts to regenerate critically sized bone defects.
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Affiliation(s)
- SeyedJamal Hosseini
- Biomedical Engineering Department, Amirkabir University of Technology, 159163-4311, Tehran, Iran
- Cellular and Molecular Research Center, Faculty of Medicine, Iran University of Medical Sciences, 1449614535, Tehran, Iran
| | - Houman Parsaei
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, 3513138111, Semnan, Iran
| | - MirJavad Moosavifar
- Biomedical Engineering Department, Amirkabir University of Technology, 159163-4311, Tehran, Iran
- Cellular and Molecular Research Center, Faculty of Medicine, Iran University of Medical Sciences, 1449614535, Tehran, Iran
- Institut für experimentelle molekulare Bildgebung, RWTH Aachen University, Aachen 52074, Germany
| | - Narjes Tavakoli
- School of Industrial Design, College of Fine Arts, University of Tehran, 1415564583, Tehran, Iran
| | - Reza Ahadi
- Department of Anatomy, Faculty of Medicine, Iran University of Medical Sciences, 1449614535, Tehran, Iran
| | - Kaveh Roshanbinfar
- Experimental Renal and Cardiovascular Research, Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen 91058, Germany.
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Prinz RAD, da Rocha LR, Eirado TP, da Silva Pinto J, Guimarães JAM, Fogagnolo F, Dias RB. Biological parameters for quality evaluation of allografts from the Brazilian National Institute of Traumatology and Orthopedics tissue bank. Cell Tissue Bank 2024:10.1007/s10561-024-10125-4. [PMID: 38367054 DOI: 10.1007/s10561-024-10125-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/10/2024] [Indexed: 02/19/2024]
Abstract
Bone allografts are clinically used in a variety of surgical procedures, and tissue banks are responsible for harvesting, processing, quality testing, storing, and delivering these materials for transplantation. In tissue banks, the bone is processed for the removal of all organic content, remaining only the tissue structure (scaffold). However, several studies have shown that even after using different processing methods, viable cells, functional proteins, and DNA may still persist in the tissue, which constitute the main causes of graft rejection. Therefore, the objective of this study was to establish techniques and biological parameters for quality validation of allografts. To this end, we propose the use of 3 combined methods such as microscopy, histology, and molecular biology techniques to evaluate the quality of allografts harvested and processed by the Brazilian National Institute of Traumatology and Orthopedics (INTO) tissue bank according to the donation criteria of the Brazilian National Health Surveillance Agency and the Brazilian National Transplant System. Bone fragments from different processing stages showed no viable cells on histology, an intact extracellular matrix on scanning electron microscopy, and gradual reduction in DNA amount. Different techniques were used to demonstrate the quality of allografts produced by the INTO tissue bank and to establish biological parameters for ensuring the safety and quality of these products. Future studies need to be undertaken to assess and validate the efficacy of the decellularization process in larger bone grafts with diverse architectural configurations.
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Affiliation(s)
- Rafael A D Prinz
- Transplant Area and Tissue Bank, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Av. Brasil, 500, Rio de Janeiro, RJ, 0940-070, Brazil
- Director of the Institute of Medical Education, Campus Vista Carioca University of Estácio de Sá, Rio de Janeiro, RJ, Brazil
| | - Leonardo Rosa da Rocha
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - Thiago Penna Eirado
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - Jonathan da Silva Pinto
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - João Antônio Matheus Guimarães
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil
| | - Fabricio Fogagnolo
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Av. Bandeirantes, 3900, São Paulo, SP, 14049900, Brazil
| | - Rhayra Braga Dias
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO, Av. Brasil, 500, Rio de Janeiro, RJ, 20940-070, Brazil.
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373/J-10, Rio de Janeiro, RJ, 21941590, Brazil.
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Heimes D, Pabst A, Becker P, Hartmann A, Kloss F, Tunkel J, Smeets R, Kämmerer PW. Comparison of morbidity-related parameters between autologous and allogeneic bone grafts for alveolar ridge augmentation from patients' perspective-A questionnaire-based cohort study. Clin Implant Dent Relat Res 2024; 26:170-182. [PMID: 37438839 DOI: 10.1111/cid.13242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Alveolar ridge augmentation is often required before dental implant placement. In this context, autologous bone grafts are considered the biological gold standard. Still, bone block harvesting is accompanied by some serious potential disadvantages and possible complications, such as pain, bleeding, and nerve irritation. Several studies aimed to compare autologous to allogeneic bone grafts concerning bone quality and implant survival rates; this is the first prospective study analyzing and comparing morbidity-related parameters after alveolar ridge augmentation using autogenous and allogeneic bone blocks from patients' perspective. METHODS Using a questionnaire, 36 patients were asked to evaluate the surgery as well as the post-operative period concerning pain, stress, sensibility deficits, satisfaction with, and consequences from the surgery as well as the preferred procedure for future alveolar ridge augmentations. RESULTS No significant differences were shown regarding stress and pain during and after surgery, whereas the rate of nerve irritations was twice as high in the autologous group. The swelling was significantly higher in patients with autologous bone blocks (p = 0.001). Nevertheless, the overall satisfaction of patients of both groups was very high, with over 8/10 points. CONCLUSIONS The swelling was the main reason for patients' discomfort in both groups and was significantly higher after autologous bone augmentation. Since this side effect seems to be a highly relevant factor for patients' comfort and satisfaction, it needs to be discussed during preoperative consultation to allow shared decision-making considering the anticipated morbidity.
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Affiliation(s)
- Diana Heimes
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Koblenz, Germany
| | - Philipp Becker
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Koblenz, Germany
| | - Amely Hartmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
- Private Practice for Oral Surgery, Filderstadt, Germany
| | - Frank Kloss
- Private Practice for Oral and Maxillofacial Surgery, Lienz, Austria
| | - Jochen Tunkel
- Private Practice for Oral Surgery and Periodontology, Bad Oeynhausen, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
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Cruz P, Bortoli JD, Benalcázar-Jalkh EB, Boutros SM, Bhola M, Grande F, Nayak VV, Tovar N, Coelho PG, Witek L. Atypical histological presentation of bone regeneration after insertion of cryoprotected allogeneic bone graft. Med Oral Patol Oral Cir Bucal 2024; 29:e103-e110. [PMID: 37992144 PMCID: PMC10765327 DOI: 10.4317/medoral.26094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/05/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND To evaluate bone regenerative capacity of cryoprotected corticocancellous allogeneic bone graft performed in type II and III post-extraction sockets for ridge preservation after twelve weeks in-vivo. MATERIAL AND METHODS Twenty-seven type II or III bony-walled extraction sockets (mandible and maxilla) were selected for this study. Following atraumatic tooth-extraction a cryoprotected corticocancellous allogeneic bone graft material and a resorbable porcine-derived collagen membrane were used for ridge preservation. During re-entry surgery at approximately 12 weeks, bone core biopsies were obtained using a 3.2 mm trephine drill and samples were histologically processed and subjected to qualitative and quantitative histomorphometric analysis. Quantitative data was analyzed using a general linear mixed model with results presented as mean values with the corresponding 95% confidence interval values. RESULTS Healing without incident and ridge preservation allowed for the placement of dental implants after 12 weeks in 25 out of the 27 treated socket sites. Analyses yielded an average of ~21.0±7% of old/native bone, ~17±5.5% of newly regenerated bone (total of ~38±12.8% for all bone), 0.23±0.14% of new bone presenting with nucleating sites within the matrix, ~52±5.12% of soft tissue, and 3.6±2.09% of damaged bone. The average regenerated bone was statistically analogous to that of old/native bone (p=0.355). Furthermore, an atypical histological pattern of bone regeneration was observed, with newly formed bone exhibiting "infiltration-like" behavior and with new bone nucleating sites observed within the demineralized bone matrix. CONCLUSIONS Cryoprotected corticocancellous allogeneic bone-graft demonstrated osteoconductive, osteoinductive, and osteogenic properties, yielding unique healing patterns which does warrant further investigation.
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Affiliation(s)
- P Cruz
- Biomaterials Division New York University College of Dentistry 345 E. 24th St, Room 902D 10010, New York, NY, USA
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da Rocha LR, Dias RB, Fernandes MBC, Prinz R, Eirado TP, Costa IDS, Monteiro MJ, da Silva CER, Dos Santos CT, Fogagnolo F. A new option for bone regeneration: a rapid methodology for cellularization of allograft with human bone marrow stromal cells with in vivo bone-forming potential. Injury 2023; 54 Suppl 6:110777. [PMID: 38143129 DOI: 10.1016/j.injury.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 12/26/2023]
Abstract
The treatment of severe musculoskeletal injuries, such as loss of bone tissue and consolidation disorders, requires bone transplantation, and the success of this bone reconstruction depends on the grafts transplant's osteogenic, osteoconductive, and osteoinductive properties. Although the gold standard is autograft, it is limited by availability, morbidity, and infection risk. Despite their low capacity for osteoinduction and osteogenesis, decellularized bone allografts have been used in the search for alternative therapeutic strategies to improve bone regeneration. Considering that bone marrow stromal cells (BMSCs) are responsible for the maintenance of bone turnover throughout life, we believe that associating BMSCs with allograft could produce a material that is biologically similar to autologous bone graft. For this reason, this study evaluated the osteogenic potential of bone allograft cellularized with BMSCs. First, BMSC was characterized and allograft decellularization was confirmed by histology, scanning electron microscopy, and DNA quantification. Subsequently, the BMSCs and allografts were associated and evaluated for adhesion, proliferation, and in vitro and in vivo osteogenic potential. We demonstrated that, after 2 hours, BMSCs had already adhered to the surface of allografts and remained viable for 14 days. In vitro osteogenic assays indicated increased osteogenic potential of allografts compared with beta-tricalcium phosphate (β-TCP). In vivo transplantation assays in immunodeficient mice confirmed the allograft's potential to induce bone formation, with significantly better results than β-TCP. Finally, our results indicate that allograft can provide structural support for BMSC adhesion, offering a favorable microenvironment for cell survival and differentiation and inducing new bone formation. Taken together, our data indicate that this rapid methodology for cellularization of allograft with BMSCs might be a new therapeutic alternative in regenerative medicine and bone bioengineering.
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Affiliation(s)
- Leonardo Rosa da Rocha
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil.
| | - Rhayra Braga Dias
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | | | - Rafael Prinz
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | - Thiago Penna Eirado
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | - Isabela de Souza Costa
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | - Mauricio J Monteiro
- Materials Division, Instituto Nacional de Tecnologia (INT), Av. Venezuela 82, Rio de Janeiro, RJ 20081-312, Brazil.
| | | | | | - Fabricio Fogagnolo
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Av. Bandeirantes, 3900, São Paulo, SP 14049900, Brazil
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Hubbell PJ, Roth B, Block JE. Comparative Evaluation of Mineralized Bone Allografts for Spinal Fusion Surgery. J Funct Biomater 2023; 14:384. [PMID: 37504879 PMCID: PMC10381653 DOI: 10.3390/jfb14070384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
The primary objective of this review is to evaluate whether the degree of processing and the clinical utility of commercially available mineralized bone allografts for spine surgery meet the 2020 US Food and Drug Administration's (FDA) guideline definitions for minimal manipulation and homologous use, respectively. We also assessed the consistency of performance of these products by examining the comparative postoperative radiographic fusion rates following spine surgery. Based on the FDA's criteria for determining whether a structural allograft averts regulatory oversight and classification as a drug/device/biologic, mineralized bone allografts were judged to meet the Agency's definitional descriptions for minimal manipulation and homologous use when complying with the American Association of Tissue Banks' (AATB) accredited guidelines for bone allograft harvesting, processing, storing and transplanting. Thus, these products do not require FDA medical device clearance. Radiographic fusion rates achieved with mineralized bone allografts were uniformly high (>85%) across three published systematic reviews. Little variation was found in the fusion rates irrespective of anatomical location, allograft geometry, dimensions or indication, and in most cases, the rates were similar to those for autologous bone alone. Continued utilization of mineralized bone allografts should be encouraged across all spine surgery applications where supplemental grafts and/or segmental stability are required to support mechanically solid arthrodeses.
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Affiliation(s)
- Paul J Hubbell
- Southern Pain and Neurologic, 3939 Houma Blvd., Building 2, Suite 6, Metairie, LA 70006, USA
| | - Brandon Roth
- AZ Pain Doctors, 14420 W Meeker Blvd., Building A, Ste. 211, Sun City West, AZ 85375, USA
| | - Jon E Block
- Independent Consultant, 2210 Jackson Street, Suite 401, San Francisco, CA 94115, USA
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Choi SH, Lee K, Han H, Mo H, Jung H, Ryu Y, Nam Y, Rim YA, Ju JH. Prochondrogenic effect of decellularized extracellular matrix secreted from human induced pluripotent stem cell-derived chondrocytes. Acta Biomater 2023:S1742-7061(23)00317-3. [PMID: 37295627 DOI: 10.1016/j.actbio.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
Cartilage is mainly composed of chondrocytes and the extracellular matrix (ECM), which exchange important biochemical and biomechanical signals necessary for differentiation and homeostasis. Human articular cartilage has a low ability for regeneration because it lacks blood vessels, nerves, and lymphatic vessels. Currently, cell therapeutics, including stem cells, provide a promising strategy for cartilage regeneration and treatment; however, there are various hurdles to overcome, such as immune rejection and teratoma formation. In this study, we assessed the applicability of the stem cell-derived chondrocyte ECM for cartilage regeneration. Human induced pluripotent stem cell (hiPSC)-derived chondrocytes (iChondrocytes) were differentiated, and decellularized ECM (dECM) was successfully isolated from cultured chondrocytes. Isolated dECM enhanced in vitro chondrogenesis of iPSCs when recellularized. Implanted dECM also restored osteochondral defects in a rat osteoarthritis model. A possible association with the glycogen synthase kinase-3 beta (GSK3β) pathway demonstrated the fate-determining importance of dECM in regulating cell differentiation. Collectively, we suggested the prochondrogenic effect of hiPSC-derived cartilage-like dECM and offered a promising approach as a non-cellular therapeutic for articular cartilage reconstruction without cell transplantation. STATEMENT OF SIGNIFICANCE: Human articular cartilage has low ability for regeneration and cell culture-based therapeutics could aid cartilage regeneration. Yet, the applicability of human induced pluripotent stem cell-derived chondrocyte (iChondrocyte) extracellular matrix (ECM) has not been elucidated. Therefore, we first differentiated iChondrocytes and isolated the secreted ECM by decellularization. Recellularization was performed to confirm the pro-chondrogenic effect of the decellularized ECM (dECM). In addition, we confirmed the possibility of cartilage repair by transplanting the dECM into the cartilage defect in osteochondral defect rat knee joint. We believe that our proof-of-concept study will serve as a basis for investigating the potential of dECM obtained from iPSC-derived differentiated cells as a non-cellular resource for tissue regeneration and other future applications.
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Affiliation(s)
- Si Hwa Choi
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea
| | | | - Heeju Han
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea
| | - Hyunkyung Mo
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea
| | | | - YoungWoo Ryu
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea
| | | | - Yeri Alice Rim
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea.
| | - Ji Hyeon Ju
- Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea; YiPSCELL, Inc., Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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McVeigh LG, Zaazoue MA, Lane BC, Voorhies JM, Bradbury J. Management and outcomes of surgical site tuberculosis infection due to infected bone graft in spine surgery: a single-institution experience and 1-year postoperative follow-up. J Neurosurg Spine 2023; 38:281-292. [PMID: 36272124 DOI: 10.3171/2022.7.spine22534] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In 2021, several patients across the United States received bone allograft contaminated with Mycobacterium tuberculosis (TB). TB is typically a pulmonary infection with many possible extrapulmonary manifestations, including skeletal tuberculosis. However, TB is a rare causative organism of postoperative surgical site infection. Iatrogenic skeletal TB infections are not widely reported in the medical literature; therefore, treatment and associated outcomes are relatively unknown. In this series, the authors report 6 cases of patients who received a mesenchymal stem cell-enhanced bone graft infected with TB at their institution, including the clinical courses, imaging findings, management plans, and outcomes at 1 year postoperatively. METHODS A retrospective review was performed of 6 consecutive patients who underwent spinal fusion surgery at the authors' institution and received bone graft from a lot contaminated with TB. Collected data included patient demographic characteristics, indications for surgery, surgical procedures performed, timing of contamination discovery, medical treatment, and follow-up information including reoperation, healing progress, and imaging findings. RESULTS Five of 6 patients (83.3%) eventually tested positive for TB via interferon-gamma release assay or wound culture. They experienced significant complications, including surgical site infections with neck swelling, pain, dysphagia, and wound dehiscence. Extensive soft-tissue infection was common; however, significant bony involvement was not observed. Surgical wound debridement was required in 4 patients, and all patients received medical management with standard RIPE (rifampin, isoniazid pyrazinamide, pyridoxine, and ethambutol) therapy for 8 weeks with extension of rifampin and isoniazid for scheduled 12 months. All patients (excluding 1 patient who died of COVID-19) showed signs of improvement with adequately healing wounds at the most recent follow-up at a median (range) of 12 (6-13) months postoperatively. To date, no patients have developed pulmonary TB. CONCLUSIONS Direct inoculation with TB via contaminated bone grafts resulted in a high rate of severe soft-tissue infection, although extensive skeletal and pulmonary involvement has not been observed at 1 year postoperatively; this review includes the longest reported follow-up period for this TB outbreak. Medical management remains the mainstay of therapy for these patients, with most patients showing recovery with oral antibiotic therapy. The severity of these infections arising from mesenchymal stem cell-containing bone allografts that undergo an alternative sterilization process than standard allografts raises concerns regarding the added risks of infection, which should be weighed against the expected benefits of these grafts.
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Villatte G, Erivan R, Descamps S, Arque P, Boisgard S, Wittrant Y. In vitro osteoblast activity is decreased by residues of chemicals used in the cleaning and viral inactivation process of bone allografts. PLoS One 2022; 17:e0275480. [PMID: 36215295 PMCID: PMC9550034 DOI: 10.1371/journal.pone.0275480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/08/2022] Open
Abstract
Allograft bone tissue has a long history of use. There are two main ways of preserving allografts: by cold (freezing), or at room temperature after an additional cleaning treatment using chemicals. These chemicals are considered potentially harmful to humans. The aim of the study was (i) to assess the presence of chemical residues on processed bone allografts and (ii) to compare the in vitro biocompatibility of such allografts with that of frozen allografts. The presence of chemical residues on industrially chemically treated bone was assessed by high performance liquid chromatography (HPLC) after extraction. Biocompatibility analysis was performed on primary osteoblast cultures from Wistar rats grown on bone disks, either frozen (F-bone group) or treated with supercritical carbon dioxide with no added chemical (scCO2-bone group) or industrially treated with chemicals (CT-bone group). Cell viability (XTT) was measured after one week of culture. Osteoblastic differentiation was assessed after 1, 7 and 14 days of culture by measuring alkaline phosphatase (ALP) activity directly on the bone discs and indirectly on the cell mat in the vicinity of the bone discs. Residues of all the chemicals used were found in the CT-bone group. There was no significant difference in cell viability between the three bone groups. Direct and indirect ALP activities were significantly lower (-40% to -80%) in the CT-bone group after 7 and 14 days of culture (p < 0.05). Residues of chemical substances used in the cleaning of bone allografts cause an in vitro decrease in their biocompatibility. Tissue cleaning processes must be developed that limit or replace these chemicals to favor biocompatibility.
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Affiliation(s)
- Guillaume Villatte
- Clermont Auvergne University, CNRS, SIGMA Clermont, ICCF, Clermont–Ferrand, France
- Departement of Orthopaedic Surgery, CHU Montpied Clermont-Ferrand, Clermont–Ferrand, France
| | - Roger Erivan
- Clermont Auvergne University, CNRS, SIGMA Clermont, ICCF, Clermont–Ferrand, France
- Departement of Orthopaedic Surgery, CHU Montpied Clermont-Ferrand, Clermont–Ferrand, France
| | - Stéphane Descamps
- Clermont Auvergne University, CNRS, SIGMA Clermont, ICCF, Clermont–Ferrand, France
- Departement of Orthopaedic Surgery, CHU Montpied Clermont-Ferrand, Clermont–Ferrand, France
| | - Pierre Arque
- Clermont Auvergne University, CNRS, SIGMA Clermont, ICCF, Clermont–Ferrand, France
| | - Stéphane Boisgard
- Clermont Auvergne University, CNRS, SIGMA Clermont, ICCF, Clermont–Ferrand, France
- Departement of Orthopaedic Surgery, CHU Montpied Clermont-Ferrand, Clermont–Ferrand, France
| | - Yohann Wittrant
- INRAE, Clermont Auvergne University, UMR 1019 Human Nutrition, Clermont-Ferrand, France
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Sharifi M, Kheradmandi R, Salehi M, Alizadeh M, Ten Hagen TLM, Falahati M. Criteria, Challenges, and Opportunities for Acellularized Allogeneic/Xenogeneic Bone Grafts in Bone Repairing. ACS Biomater Sci Eng 2022; 8:3199-3219. [PMID: 35816626 DOI: 10.1021/acsbiomaterials.2c00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As bone grafts become more commonly needed by patients and as donors become scarcer, acellularized bone grafts (ABGs) are becoming more popular for restorative purposes. While autogeneic grafts are reliable as a gold standard, allogeneic and xenogeneic ABGs have been shown to be of particular interest due to the limited availability of autogeneic resources and reduced patient well-being in long-term surgeries. Because of the complete similarity of their structures with native bone, excellent mechanical properties, high biocompatibility, and similarities of biological behaviors (osteoinductive and osteoconductive) with local bones, successful outcomes of allogeneic and xenogeneic ABGs in both in vitro and in vivo research have raised hopes of repairing patients' bone injuries in clinical applications. However, clinical trials have been delayed due to a lack of standardized protocols pertaining to acellularization, cell seeding, maintenance, and diversity of ABG evaluation criteria. This study sought to uncover these factors by exploring the bone structures, ossification properties of ABGs, sources, benefits, and challenges of acellularization approaches (physical, chemical, and enzymatic), cell loading, and type of cells used and effects of each of the above items on the regenerative technologies. To gain a perspective on the repair and commercialization of products before implementing new research activities, this study describes the differences between ABGs created by various techniques and methods applied to them. With a comprehensive understanding of ABG behavior, future research focused on treating bone defects could provide a better way to combine the treatment approaches needed to treat bone defects.
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Affiliation(s)
- Majid Sharifi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran.,Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Rasoul Kheradmandi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran.,Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Majid Salehi
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran.,Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Morteza Alizadeh
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, 3614773955 Shahroud, Iran
| | - Timo L M Ten Hagen
- Laboratory Experimental Oncology, Department of Pathology, Erasmus MC, 3015GD Rotterdam, The Netherlands
| | - Mojtaba Falahati
- Laboratory Experimental Oncology, Department of Pathology, Erasmus MC, 3015GD Rotterdam, The Netherlands
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11
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Abstract
Decellularization of natural tissues to produce extracellular matrix is a promising method for three-dimensional scaffolding and for understanding microenvironment of the tissue of interest. Due to the lack of a universal standard protocol for tissue decellularization, recent investigations seek to develop novel methods for whole or partial organ decellularization capable of supporting cell differentiation and implantation towards appropriate tissue regeneration. This review provides a comprehensive and updated perspective on the most recent advances in decellularization strategies for a variety of organs and tissues, highlighting techniques of chemical, physical, biological, enzymatic, or combinative-based methods to remove cellular contents from tissues. In addition, the review presents modernized approaches for improving standard decellularization protocols for numerous organ types.
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Affiliation(s)
- Deana Moffat
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
| | - Kaiming Ye
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
- Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
| | - Sha Jin
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
- Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
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12
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Steijvers E, Ghei A, Xia Z. Manufacturing artificial bone allografts: a perspective. Biomater Transl 2022; 3:65-80. [PMID: 35837344 PMCID: PMC9255790 DOI: 10.12336/biomatertransl.2022.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
Bone grafts have traditionally come from four sources: the patients' own tissue (autograft), tissue from a living or cadaveric human donor (allograft), animal donors (xenograft) and synthetic artificial biomaterials (ceramics, cement, polymers, and metal). However, all of these have advantages and drawbacks. The most commercially successful bone grafts so far are allografts, which hold 57% of the current bone graft market; however, disease transmission and scarcity are still significant drawbacks limiting their use. Tissue-engineered grafts have great potential, in which human stem cells and synthetical biomaterials are combined to produce bone-like tissue in vitro, but this is yet to be approved for widespread clinical practice. It is hypothesised that artificial bone allografts can be mass-manufactured to replace conventional bone allografts through refined bone tissue engineering prior to decellularisation. This review article aims to review current literature on (1) conventional bone allograft preparation; (2) bone tissue engineering including the use of synthetic biomaterials as bone graft substitute scaffolds, combined with osteogenic stem cells in vitro; (3) potential artificial allograft manufacturing processes, including mass production of engineered bone tissue, osteogenic enhancement, decellularisation, sterilisation and safety assurance for regulatory approval. From these assessments, a practical route map for mass production of artificial allografts for clinical use is proposed.
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13
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Wang F, Saure LM, Schütt F, Lorich F, Rasch F, Nia AS, Feng X, Seekamp A, Klüter T, Naujokat H, Adelung R, Fuchs S. Graphene Oxide Framework Structures and Coatings: Impact on Cell Adhesion and Pre-Vascularization Processes for Bone Grafts. Int J Mol Sci 2022; 23. [PMID: 35328815 DOI: 10.3390/ijms23063379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023] Open
Abstract
Graphene oxide (GO) is a promising material for bone tissue engineering, but the validation of its molecular biological effects, especially in the context of clinically applied materials, is still limited. In this study, we compare the effects of graphene oxide framework structures (F-GO) and reduced graphene oxide-based framework structures (F-rGO) as scaffold material with a special focus on vascularization associated processes and mechanisms in the bone. Highly porous networks of zinc oxide tetrapods serving as sacrificial templates were used to create F-GO and F-rGO with porosities >99% consisting of hollow interconnected microtubes. Framework materials were seeded with human mesenchymal stem cells (MSC), and the cell response was evaluated by confocal laser scanning microscopy (CLSM), deoxyribonucleic acid (DNA) quantification, real-time polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay (ELISA), and alkaline phosphatase activity (ALP) to define their impact on cellular adhesion, osteogenic differentiation, and secretion of vascular growth factors. F-GO based scaffolds improved adhesion and growth of MSC as indicated by CLSM and DNA quantification. Further, F-GO showed a better vascular endothelial growth factor (VEGF) binding capacity and improved cell growth as well as the formation of microvascular capillary-like structures in co-cultures with outgrowth endothelial cells (OEC). These results clearly favored non-reduced graphene oxide in the form of F-GO for bone regeneration applications. To study GO in the context of a clinically used implant material, we coated a commercially available xenograft (Bio-Oss® block) with GO and compared the growth of MSC in monoculture and in coculture with OEC to the native scaffold. We observed a significantly improved growth of MSC and formation of prevascular structures on coated Bio-Oss®, again associated with a higher VEGF binding capacity. We conclude that graphene oxide coating of this clinically used, but highly debiologized bone graft improves MSC cell adhesion and vascularization.
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14
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Chen CF, Chen YC, Fu YS, Tsai SW, Wu PK, Chen CM, Chang MC, Chen WM. Characterization of Osteogenesis and Chondrogenesis of Human Decellularized Allogeneic Bone with Mesenchymal Stem Cells Derived from Bone Marrow, Adipose Tissue, and Wharton's Jelly. Int J Mol Sci 2021; 22:8987. [PMID: 34445692 DOI: 10.3390/ijms22168987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
Allogeneic bone grafts are a promising material for bone implantation due to reduced operative trauma, reduced blood loss, and no donor-site morbidity. Although human decellularized allogeneic bone (hDCB) can be used to fill bone defects, the research of revitalizing hDCB blocks with human mesenchymal stem cells (hMSCs) for osteochondral regeneration is missing. The hMSCs derived from bone marrow, adipose tissue, and Wharton’s jelly (BMMSCs, ADMSCs, and UMSCs, respectively) are potential candidates for bone regeneration. This study characterized the potential of hDCB as a scaffold for osteogenesis and chondrogenesis of BMMSCs, ADMSCs, and UMSCs. The pore sizes and mechanical strength of hDCB were characterized. Cell survival and adhesion of hMSCs were investigated using MTT assay and F-actin staining. Alizarin Red S and Safranin O staining were conducted to demonstrate calcium deposition and proteoglycan production of hMSCs after osteogenic and chondrogenic differentiation, respectively. A RT-qPCR was performed to analyze the expression levels of osteogenic and chondrogenic markers in hMSCs. Results indicated that BMMSCs and ADMSCs exhibited higher osteogenic potential than UMSCs. Furthermore, ADMSCs and UMSCs had higher chondrogenic potential than BMMSCs. This study demonstrated that chondrogenic ADMSCs- or UMSCs-seeded hDCB might be potential osteochondral constructs for osteochondral regeneration.
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15
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Wang TY, Mehta VA, Sankey EW, Shaffrey CI, Abd-El-Barr MM, Than KD. The Impact of Instrumentation and Implant Surface Technology on Cervical and Thoracolumbar Fusion. Oper Neurosurg (Hagerstown) 2021; 21:S12-S22. [PMID: 34128071 DOI: 10.1093/ons/opaa321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/23/2020] [Indexed: 11/12/2022] Open
Abstract
Spinal fusion has undergone significant evolution and improvement over the past 50 yr. Historically, spine fusion was noninstrumented and arthrodesis was based entirely on autograft. Improved understanding of spinal anatomy and materials science ushered in a new era of spinal fusion equipped with screw-based technologies and various interbody devices. Osteobiologics is another important realm of spine fusion, and the evolution of various osteobiologics has perhaps undergone the most change within the past 20 yr. A new element to spinal instrumentation has recently gained traction-namely, surface technology. New data suggest that surface treatments play an increasingly well-recognized role in inducing osteogenesis and successful fusion. Until now, however, there has yet to be a unified resource summarizing the existing data and a lack of consensus exists on superior technology. Here, authors provide an in-depth review on surface technology and its impact on spinal arthrodesis.
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Affiliation(s)
- Timothy Y Wang
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Vikram A Mehta
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Eric W Sankey
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Muhammad M Abd-El-Barr
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
| | - Khoi D Than
- Duke University Medical Center Department of Neurological Surgery, Durham, North Carolina, USA
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16
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Lipovka A, Kharchenko A, Dubovoy A, Filipenko M, Stupak V, Mayorov A, Fomenko V, Geydt P, Parshin D. The Effect of Adding Modified Chitosan on the Strength Properties of Bacterial Cellulose for Clinical Applications. Polymers (Basel) 2021; 13:1995. [PMID: 34207113 PMCID: PMC8234744 DOI: 10.3390/polym13121995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 12/01/2022] Open
Abstract
Currently, several materials for the closure of the dura mater (DM) defects are known. However, the long-term results of their usage reveal a number of disadvantages. The use of antibiotics and chitosan is one of the major trends in solving the problems associated with infectious after-operational complications. This work compares the mechanical properties of samples of bacterial nanocellulose (BNC) impregnated with Novochizol™ and vancomycin with native BNC and preserved and native human DM. An assessment of the possibility of controling the mechanical properties of these materials by changing their thickness has been performed by statistical analysis methods. A total of 80 specimens of comparable samples were investigated. During the analysis, the results obtained, the factor of Novochizol™ addition has provided a statistically significant impact on the strength properties (Fisher Criteria p-value 0.00509 for stress and 0.00112 for deformation). Moreover, a stronger relationship between the thickness of the samples and their ultimate load was shown: R2=0.236 for BNC + Novochizol™ + vancomycin, compared to R2=0.0405 for native BNC. Using factor analysis, it was possible to show a significant effect of modified chitosan (Novochizol™) on the ultimate stress (p-value = 0.005).
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Affiliation(s)
- Anna Lipovka
- Lavrentyev Institute of Hydrodynamics of the Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (A.D.); (D.P.)
| | - Alexey Kharchenko
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, 630090 Novosibirsk, Russia; (A.K.); (V.S.)
| | - Andrey Dubovoy
- Lavrentyev Institute of Hydrodynamics of the Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (A.D.); (D.P.)
- Federal Neurosurgical Center, 630048 Novosibirsk, Russia
| | - Maxim Filipenko
- Institute of Chemical Biology and Fundamental Medicine of the Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia;
| | - Vyacheslav Stupak
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, 630090 Novosibirsk, Russia; (A.K.); (V.S.)
| | - Alexander Mayorov
- Institute of Laser Physics of the Russian Academy of Sciences, 630090 Novosibirsk, Russia;
| | - Vladislav Fomenko
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry of the Russian Academy of Sciences, 630090 Novosibirsk, Russia;
| | - Pavel Geydt
- Novosibirsk State University, 630090 Novosibirsk, Russia;
| | - Daniil Parshin
- Lavrentyev Institute of Hydrodynamics of the Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (A.D.); (D.P.)
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17
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Bergin SM, Wang TY, Park C, Rajkumar S, Goodwin CR, Karikari IO, Abd-El-Barr MM, Shaffrey CI, Yarbrough CK, Than KD. Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis. Neurosurg Focus 2021; 50:E6. [PMID: 34062497 DOI: 10.3171/2021.3.focus2166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. METHODS The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. RESULTS A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51-16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04-4.83, p = 0.04) as independent predictors of pseudarthrosis. CONCLUSIONS In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.
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18
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Kang HP, Ihn H, Robertson DM, Chen X, Sugiyama O, Tang A, Hollis R, Skorka T, Longjohn D, Oakes D, Shah R, Kohn D, Jakus AE, Lieberman JR. Regional gene therapy for bone healing using a 3D printed scaffold in a rat femoral defect model. J Biomed Mater Res A 2021; 109:2346-2356. [PMID: 34018305 DOI: 10.1002/jbm.a.37217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/07/2022]
Abstract
At the present time there are no consistently satisfactory treatment options for some challenging bone loss scenarios. We have previously reported on the properties of a novel 3D-printed hydroxyapatite-composite material in a pilot study, which demonstrated osteoconductive properties but was not tested in a rigorous, clinically relevant model. We therefore utilized a rat critical-sized femoral defect model with a scaffold designed to match the dimensions of the bone defect. The scaffolds were implanted in the bone defect after being loaded with cultured rat bone marrow cells (rBMC) transduced with a lentiviral vector carrying the cDNA for BMP-2. This experimental group was compared against 3 negative and positive control groups. The experimental group and positive control group loaded with rhBMP-2 demonstrated statistically equivalent radiographic and histologic healing of the defect site (p > 0.9), and significantly superior to all three negative control groups (p < 0.01). However, the healed defects remained biomechanically inferior to the unoperated, contralateral femurs (p < 0.01). When combined with osteoinductive signals, the scaffolds facilitate new bone formation in the defect. However, the scaffold alone was not sufficient to promote adequate healing, suggesting that it is not substantially osteoinductive as currently structured. The combination of gene therapy with 3D-printed scaffolds is quite promising, but additional work is required to optimize scaffold geometry, cell dosage and delivery.
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Affiliation(s)
- H Paco Kang
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Hansel Ihn
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Djani M Robertson
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Xiao Chen
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Osamu Sugiyama
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Amy Tang
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | | | - Tautis Skorka
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Donald Longjohn
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | - Daniel Oakes
- Department of Orthopaedic Surgery, University of Southern California; Los Angeles, California, USA
| | | | - Donald Kohn
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, California, USA
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19
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Tournier P, Guicheux J, Paré A, Veziers J, Barbeito A, Bardonnet R, Corre P, Geoffroy V, Weiss P, Gaudin A. An Extrudable Partially Demineralized Allogeneic Bone Paste Exhibits a Similar Bone Healing Capacity as the "Gold Standard" Bone Graft. Front Bioeng Biotechnol 2021; 9:658853. [PMID: 33968916 PMCID: PMC8098662 DOI: 10.3389/fbioe.2021.658853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/29/2021] [Indexed: 01/05/2023] Open
Abstract
Autologous bone grafts (BGs) remain the reference grafting technique in various clinical contexts of bone grafting procedures despite their numerous peri- and post-operative limitations. The use of allogeneic bone is a viable option for overcoming these limitations, as it is reliable and it has been widely utilized in various forms for decades. However, the lack of versatility of conventional allogeneic BGs (e.g., blocks, powders) limits their potential for use with irregular or hard-to-reach bone defects. In this context, a ready- and easy-to-use partially demineralized allogeneic BG in a paste form has been developed, with the aim of facilitating such bone grafting procedures. The regenerative properties of this bone paste (BP) was assessed and compared to that of a syngeneic BG in a pre-clinical model of intramembranous bone healing in critical size defects in rat calvaria. The microcomputed tridimensional quantifications and the histological observations at 7 weeks after the implantation revealed that the in vivo bone regeneration of critical-size defects (CSDs) filled with the BP was similar to syngeneic bone grafts (BGs). Thus, this ready-to-use, injectable, and moldable partially demineralized allogeneic BP, displaying equivalent bone healing capacity than the “gold standard,” may be of particular clinical relevance in the context of oral and maxillofacial bone reconstructions.
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Affiliation(s)
- Pierre Tournier
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Université de Nantes, Nantes, France.,BIOBank SAS, Lieusaint, France
| | - Jérôme Guicheux
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, CHU Nantes, ONIRIS, Université de Nantes, Nantes, France.,SC3M Facility, CNRS, INSERM, UMS, Structure Fédérative de Recherche François Bonamy, Université de Nantes, Nantes, France
| | - Arnaud Paré
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Université de Nantes, Nantes, France.,Service de Chirurgie Maxillo-Faciale, Plastique et Brulés, Hôpital Trousseau, CHU de Tours, Tours, France
| | - Joëlle Veziers
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, CHU Nantes, ONIRIS, Université de Nantes, Nantes, France.,SC3M Facility, CNRS, INSERM, UMS, Structure Fédérative de Recherche François Bonamy, Université de Nantes, Nantes, France
| | | | | | - Pierre Corre
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, CHU Nantes, ONIRIS, Université de Nantes, Nantes, France
| | - Valérie Geoffroy
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Université de Nantes, Nantes, France
| | - Pierre Weiss
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, CHU Nantes, ONIRIS, Université de Nantes, Nantes, France
| | - Alexis Gaudin
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, CHU Nantes, ONIRIS, Université de Nantes, Nantes, France
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20
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Wang J, Chen J, Ran Y, He Q, Jiang T, Li W, Yu X. Utility of Air Bladder-Derived Nanostructured ECM for Tissue Regeneration. Front Bioeng Biotechnol 2020; 8:553529. [PMID: 33178669 PMCID: PMC7594528 DOI: 10.3389/fbioe.2020.553529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022] Open
Abstract
Exploration for ideal bone regeneration materials still remains a hot research topic due to the unmet clinical challenge of large bone defect healing. Bone grafting materials have gradually evolved from single component to multiple-component composite, but their functions during bone healing still only regulate one or two biological processes. Therefore, there is an urgent need to develop novel materials with more complex composition, which convey multiple biological functions during bone regeneration. Here, we report an naturally nanostructured ECM based composite scaffold derived from fish air bladder and combined with dicalcium phosphate (DCP) microparticles to form a new type of bone grafting material. The DCP/acellular tissue matrix (DCP/ATM) scaffold demonstrated porous structure with porosity over 65% and great capability of absorbing water and other biologics. In vitro cell culture study showed that DCP/ATM scaffold could better support osteoblast proliferation and differentiation in comparison with DCP/ADC made from acid extracted fish collagen. Moreover, DCP/ATM also demonstrated more potent bone regenerative properties in a rat calvarial defect model, indicating incorporation of ECM based matrix in the scaffolds could better support bone formation. Taken together, this study demonstrates a new avenue toward the development of new type of bone regeneration biomaterial utilizing ECM as its key components.
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Affiliation(s)
- Jianwei Wang
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Jiayu Chen
- Hangzhou Huamai Medical Devices Co., Ltd., Hangzhou, China
| | - Yongfeng Ran
- Hangzhou Huamai Medical Devices Co., Ltd., Hangzhou, China
| | - Qianhong He
- Hangzhou Huamai Medical Devices Co., Ltd., Hangzhou, China
| | - Tao Jiang
- Hangzhou Huamai Medical Devices Co., Ltd., Hangzhou, China
| | - Weixu Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Xiaohua Yu
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Ruijin Hospital, Shanghai Institute of Traumatology and Orthopaedics, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Nayakawde NB, Methe K, Premaratne GU, Banerjee D, Olausson M. Combined Use of Detergents and Ultrasonication for Generation of an Acellular Pig Larynx. Tissue Eng Part A 2020; 27:362-371. [PMID: 32723005 DOI: 10.1089/ten.tea.2020.0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The larynx is a fairly complex organ comprised of different muscles, cartilages, mucosal membrane, and nerves. Larynx cancer is generally the most common type of head and neck cancer. Treatment options are limited in patients with total or partial laryngectomy. Tissue-engineered organs have shown to be a promising alternative treatment for patients with laryngectomy. In this report we present an alternative and simple procedure to construct a whole pig larynx scaffold consisting of complete acellular structures of integrated muscle and cartilage. Larynges were decellularized (DC) using perfusion-agitation with detergents coupled with ultrasonication. DC larynges were then characterized to investigate the extracellular matrix (ECM) proteins, residual DNA, angiogenic growth factors, and morphological and ultrastructural changes to ECM fibers. After 17 decellularization cycles, no cells were observed in all areas of the larynx as confirmed by hematoxylin and eosin and DAPI (4',6-diamidino-2-phenylindole) staining. However, DC structures of dense thyroid and cricoid cartilage showed remnants of cells. All structures of DC larynges (epiglottis [p < 0.0001], muscle [p < 0.0001], trachea [p = 0.0045], and esophagus [p = 0.0008]) showed DNA <50 ng/mg compared with native larynx. Immunohistochemistry, Masson's trichrome staining, and Luminex analyses showed preservation of important ECM proteins and angiogenic growth factors in DC larynges. Compared with other growth factors, mostly retained growth factors in DC epiglottis, thyroid muscle, and trachea include granulocyte colony-stimulating factor, Leptin, fibroblast growth factor-1, Follistatin, hepatocyte growth factor, and vascular endothelial growth factor-A. Scanning electron microscopy and transmission electron microscopy analysis confirmed the structural arrangements of ECM fibers in larynges to be well preserved after DC. Our findings suggest that larynges can be effectively DC using detergent ultrasonication. ECM proteins and angiogenic growth factors appear to be better preserved using this method when compared with the native structures of larynges. This alternative DC method could be helpful in building scaffolds from dense tissue structures such as cartilage, tendon, larynx, or trachea for future in vitro recellularization studies or in vivo implantation studies in the clinic.
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Affiliation(s)
- Nikhil B Nayakawde
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ketaki Methe
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Goditha U Premaratne
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Debashish Banerjee
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Olausson
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Transplantation Surgery, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
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Iaquinta MR, Mazzoni E, Bononi I, Rotondo JC, Mazziotta C, Montesi M, Sprio S, Tampieri A, Tognon M, Martini F. Adult Stem Cells for Bone Regeneration and Repair. Front Cell Dev Biol 2019; 7:268. [PMID: 31799249 PMCID: PMC6863062 DOI: 10.3389/fcell.2019.00268] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
The regeneration of bone fractures, resulting from trauma, osteoporosis or tumors, is a major problem in our super-aging society. Bone regeneration is one of the main topics of concern in regenerative medicine. In recent years, stem cells have been employed in regenerative medicine with interesting results due to their self-renewal and differentiation capacity. Moreover, stem cells are able to secrete bioactive molecules and regulate the behavior of other cells in different host tissues. Bone regeneration process may improve effectively and rapidly when stem cells are used. To this purpose, stem cells are often employed with biomaterials/scaffolds and growth factors to accelerate bone healing at the fracture site. Briefly, this review will describe bone structure and the osteogenic differentiation of stem cells. In addition, the role of mesenchymal stem cells for bone repair/regrowth in the tissue engineering field and their recent progress in clinical applications will be discussed.
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Affiliation(s)
- Maria Rosa Iaquinta
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Elisa Mazzoni
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Ilaria Bononi
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - John Charles Rotondo
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Chiara Mazziotta
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Monica Montesi
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Italy
| | - Simone Sprio
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Italy
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics, National Research Council, Faenza, Italy
| | - Mauro Tognon
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Fernanda Martini
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
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