Bioelectric Stimulation of Bone Formation: Methods, Models, and Mechanisms

Bone formation near direct current electrodes with and without motion

The osteogenesis induced in the medullary canal of rabbits by the implantation of moving and stationary wire electrodes was studied with and without the simultaneous application of 20-microA constant direct cathodic current. After 3 weeks, the formation of new trabecular bone in the canal was studied and measured microscopically. Electrically stimulated osteogenesis was not observed at stationary electrodes. As in previous studies with this model, a movable electrode alone stimulated new bone formation whose area was 7-10% of the canal area. The amount of this bone was not statistically increased by the addition of cathode current. Movable, electrically active cathodes were associated, however, with fluid-filled spaces incorporated within the new trabecular bone. When mechanical stimuli were controlled, we were not able to demonstrate that the direct current stainless steel cathode acts either as an inducer or a substantial enhancer of medullary osteogenesis.

Effect of localized pulsed electromagnetic fields on tail-suspension osteopenia in growing mice

Pulsed magnetic fields (PEMFs) have been used effectively to treat bone fractures and sciatic-nerve-section-induced osteopenias. Properly applied PEMFs are presumed to stimulate osteogenesis. Mouse-tail suspension has been implemented as a means of inducing an osteopenic response in the long bones of the hind limbs. To evaluate localized PEMF effects, the mouse-suspension model was modified to accommodate the use of miniature wire coils affixed directly to the rear legs. Laterally and axially orientated PEMF effects were compared. Three test groups of mice included (C) control mice, (S) tail-suspended mice with treatment apparatus attached, and (SF) tail-suspended mice with apparatus attached and PEMFs delivered. The SF group was divided into mice receiving axial or lateral PEMFs. Significant bone changes occurred in suspended as compared with control mice after a 2-week test period. The PEMF mice showed significantly fewer osteopenic effects than did untreated, suspended mice. These findings are based on biomechanical measures of stiffness, strength, ductility, and energy as well as whole-bone mass and porosity. The effects of PEMFs on these properties differ for axial and lateral exposures. The results are discussed in terms of mechanisms underlying PEMF effects.

Electrophysiology of direct current stimulation of fracture healing in canine radius

Electrophysiological mechanisms involved in the electrical stimulation of fracture healing remain largely unknown. The purpose of the present study was to establish relationships between osteogenetic response and intraosseous measures of electrical dose in experimental fractures (osteotomies) of canine radii stimulated by direct currents. The response was determined postmortem at seven weeks after osteotomy by measuring the bending rigidity and four physicochemical properties: tissue density, mineral density, matrix density, and mineral-to-matrix ratio. The currents measured in bone ranged from 0.1 to 17 microA. Three regions of enhanced osteogenetic response were observed at approximately 1, 7, and 13 microA, separated by regions of unstimulated response. Evidence presented in this paper suggests that enhanced response resulted mainly from electrical modulation of early events in the fracture repair sequence.

Pulsing direct current-induced repair of articular cartilage in rabbit osteochondral defects

Osteochondral defects in the distal femoral condyles of rabbits exposed to a pulsing direct current exhibits an enhanced quality of repair. The signal, with a peak value of 2 microA repeating at 100 Hz, imposed an electric field in the tissue of 20-60 mV/cm2. Maximum efficacy was seen with a shorter period of exposure (40 vs. 160 h) initiated 48 h after surgery for 4 h/day. Repair tissue originated primarily from metaplasia of subchondral elements although hyperplasia of pre-existing chondrocytes at the margins of the defect could be detected. Defects in treated joints contained Safranin O staining material that was histologically similar to a disorganized hyaline cartilage. Central areas of the defects in control animals contained Safranin O-negative material that generally extruded over the surface as a pannus. The edges of nontreated defects also had characteristics of cartilaginous healing, stressing the importance of using serial sectioning techniques in this model of cartilage repair.

Preliminary study of quantitative aspects and the effect of pulsed electromagnetic field treatment on the incorporation of equine cancellous bone grafts

The quantitative aspects of equine cancellous bone graft incorporation and the possibility of influencing graft incorporation by daily exposure to a pulsed electromagnetic field (PEMF) was studied in eight yearling ponies. In order to be able to quantify formative aspects of graft remodelling, a double and treble tetracycline intravital labelling technique was used. Intravital radiographs were obtained at regular intervals throughout the trial, but were found to be of little assistance in assessing any differences between stimulated and non-stimulated grafts. The ponies were humanely destroyed at regular intervals between nine and 241 days after installation of the graft. Light microscopy and fluorescent light microscopy were used to evaluate quantitative aspects of graft incorporation and to compare PEMF-stimulated grafts with control grafts. There was a small but statistically significant effect of PEMF-stimulation on cancellous bone graft incorporation. In view of this, these observations can only be considered as indicative of a possible trend, but should encourage further studies using different signal modalities.

Pulsed subcutaneous electrical stimulation in spinal cord injury: preliminary results

The treatment of long-term, stable para- and quadriplegics with pulsed electrical stimulation for pain control resulted in, anecdotally, a significant number of these individuals showing increased motor function as well as sensory awareness. This small pilot study was conducted in order to assess the hypothesis that pulsed electrical fields can effect diseased neurological function. Thirteen para- and quadriplegic subjects with 18 months of stable neurological signs and symptoms were exposed daily to pulsed electrical stimulation for a 6-month period and assessed for any improvement in motor function or sensory perception. The hypothesis is that pulsed electromagnetic fields can normalize viable but dysfunctional neuronal structures. Results were encouraging.

Mechanical factors in electrode-induced osteogenesis

Previous experiments have suggested that mechanical activity of electrode implants may contribute to the observed bone formation that has been attributed to the electrical currents. This was tested by implanting movable and stationary wires in the medullary canal of the rabbit femora or tibiae. The moving implants uniformly showed significant medullary bone formation at the wire, whereas the stationary ones did not. This bone persisted for as long as 8 weeks and was mostly resorbed by 12 weeks as the implants became fixed. The new trabecular bone closely resembled that typically seen at electrically active implants. Implant motion may have a more important role in electrically induced osteogenesis than previously thought.

Time-dependent interfacial charging effects of electrical fields applied to biological systems

An important aspect of the interaction of a biological system with an externally produced electric field is that of charge separation and interfacial charging. This aspect has been ignored in some recent experimental and theoretical work. In the case of small regions of lower electrical resistivity imbedded in a higher resistivity medium, charge separation across the lower resistivity regions will result in charging of the interfaces between the lower and higher resistivity regions. The field produced by this charge separation will significantly affect the shape and the magnitude of the net electric field pulse within the lower resistivity regions. In particular, the field experienced by bone cells will be quite different from the externally produced field. The shape as well as the magnitude of the net electric field experienced by the cells depends on the time rate of change of the rising and falling phases of the externally produced electric field pulse.

Bone growth accelerated by stimulation of the epiphyseal plate with electric current

The effect of stimulation with continuous small amounts (20 microA) of electric current on the distal epiphyseal plate of rabbit femurs was examined. In contrast to control animals 6 weeks after the operation 18 of the 20 experimental animals showed an increased lengthening or broadening of the femur on the operated side. In 14 cases the increased growth resulted in varus or valgus deformities.

Response of amputated rat limbs to fetal nerve tissue implants and direct current

We have previously shown that implanted fetal nerve tissue stimulates the regeneration of amputated chick limbs. The purpose of this study was to determine whether a similar phenomenon would occur in amputated rat limbs and if addition of applied direct current (DC) would affect this process. Thus, fetal nerve tissue was implanted into amputated stumps of 3-week-old rats; variable tissue regeneration was induced that was dependent on the age of the donor implant and the presence of applied DC. Twelve or 14 day fetal neural implants induced new accessory bones containing epiphyseal plates and marrow cavities and occasionally formed joint-like structures with the host humerus. Addition of DC to 12 day neural implants increased the number of new bones formed. Eighteen day neural tissue with applied DC did not induce new bone formation but stimulated the maximal elongation of the host humerus and outgrowth of nerve fibers to the cut surface. Implantation of fetal heart tissue or implantation of fetal neural tissue into unamputated limbs failed to induce new bone formation. Although true limb regeneration was not achieved, formation of new skeletal elements did occur and this effect was enhanced by applied DC.

Piezoelectric properties of biological polymers

Piezoelectricity and pyroelectricity in wool and hair were observed by Martin early in 1941. The piezoelectric effect in wood was investigated in detail by Bazhenov (1961). Both converse and direct effect of shear piezoelectricity in wood was demonstrated by Fukada (1955). Bending piezoelectricity in bone was first discovered by Yasuda (1953). Shear and longitudinal piezoelectricity in bone and tendon was quantitatively investigatged by Fukada & Yasuda (1957, 1964).