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Demineralized bone matrix and spinal arthrodesis.

Spinal fusion is a gold-standard treatment for many disorders of the spine with autogenous bone graft as the gold-standard source for augmenting fusion. However, the morbidity and limitations of autogenous bone grafting has motivated the search for bone graft alternatives. One such alternative is demineralized bone matrix (DBM). The purpose of this paper is to describe and characterize the properties of DBM in addition to reviewing the results of its use in animal and human studies of spinal fusion. A thorough and critical review of the English-language literature was conducted. DBM is both osteoconductive and osteoinductive. Studies have produced variable results with respect to spinal fusion rates. Various studies have demonstrated inferior, equal, or enhanced fusion rates. Some of the differences in these studies include the animal models used, the manner in which DBM was prepared, and the carrier with which DBM was combined. These differences may account for the dissimilar results. DBM is able to function as a graft extender in the human species.

Animals↗

Periodontal regeneration with peptide-enhanced anorganic bone matrix in particulate and putty form in dogs.

BACKGROUND: Peptide-enhanced (using the peptide 15 [P-15] synthetic peptide) anorganic bone matrix (ABM) particulate (PPart) grafts have demonstrated clinical and histologic success in human periodontal defects. Dispersion of ABM/P-15 in sodium hyaluronate carrier (PPutty) improves the handling properties of the graft material. The healing of ABM/P-15 particulate and ABM/P-15 putty was compared in critical-sized fenestration defects in 16 mongrel dogs. METHODS: After full thickness flap reflection, 7 mm diameter fenestrations were made with a trephine in the mid-root of both maxillary canines in each dog. Bone, periodontal ligament, and cementum were removed as completely as possible with hand root planing within the trephine-produced notches. By random allocation, each defect was filled with PPart or PPutty, and the flaps were closed with sutures. One dog contributing two defects served as a negative control. Block sections were retrieved at 3 and 8 weeks for histologic processing. Three 6-mu step serial sections in the center of the defects were used for analysis. Parameters measured included the original length of the wound, linear amount of periodontal regeneration including new cementum, bone and connective tissue, and area measurements of new bone and remaining particles. PPutty and PPart results were compared for significant differences using the Wilcoxon rank sum test. RESULTS: Clinical healing was uneventful in all cases. There was no evidence of inflammation or adverse tissue reactions with either material. The controls showed minimal regeneration at the periphery of the defect. Histomorphometric evaluation of the grafted defects revealed the following: at 3 weeks, there was minimal new bone formation (occupying 4.2% of the grafted area for the PPutty and 1.2% for the PPart). The grafted particles occupied 21.2% and 35.6% of the area for the PPutty and PPart, respectively (P = 0.039). At 8 weeks, there was a tendency for greater new bone formation compared to 3 weeks with both materials. There was significantly more new bone with the PPutty (49.3%) compared to the PPart (14.8%) (P = 0.045). The grafted particles occupied 7.9% and 17% of the grafted area for the PPutty and PPart, respectively (no significant difference). There were no significant differences for any of the linear measurements. ABM/P-15 PPutty had superior handling characteristics. CONCLUSIONS: Both ABM/P-15 materials yielded satisfactory healing and resulted in the greater regeneration of fenestration defects in dogs at 8 weeks compared to controls. In addition, AMB/P-15 putty resulted in more bone formation compared to ABM/P-15 particulate.

Animals↗

A potent small molecule, nonpeptide inhibitor of cathepsin K (SB 331750) prevents bone matrix resorption in the ovariectomized rat.

Inhibition of the cyteine proteinase, cathepsin K (E.C. 3.4.22.38) has been postulated as a means to control osteoclast-mediated bone resorption. The preferred animal models for evaluation of antiresorptive activity are in the rat. However, the development of compounds that inhibit rat cathepsin K has proven difficult because the human and rat enzymes differ in key residues in the active site. In this study, a potent, nonpeptide inhibitor of rat cathepsin K (K(i) = 4.7 nmol/L), 5-(2-morpholin-4-yl-ethoxy)-benzofuran-2-carboxylic acid ((S)-3-methyl-1-(3-oxo-1-[2-(3-pyridin-2-yl-phenyl)-ethenoyl]-azepan-4-ylcarbanoyl)-butyl)-amide (SB 331750), is described, which is efficacious in rat models of bone resorption. SB 331750 potently inhibited human cathepsin K activity in vitro (K(i) = 0.0048 nmol/L) and was selective for human cathepsin K vs. cathepsins B (K(i) = 100 nmol/L), L (0.48 nmol/L), or S (K(i) = 14.3 nmol/L). In an in situ enzyme assay, SB 331750 inhibited osteoclast-associated cathepsin activity in tissue sections containing human osteoclasts (IC(50) approximately 60 nmol/L) and this translated into potent inhibition of human osteoclast-mediated bone resorption in vitro (IC(50) approximately 30 nmol/L). In vitro, SB 331750 partially, but dose-dependently, prevented the parathyroid hormone-induced hypercalcemia in an acute rat model of bone resorption. To evaluate the ability of SB 331750 to inhibit bone matrix degradation in vivo, it was administered for 4 weeks at 3, 10, or 30 mg/kg, intraperitoneally (i.p.), u.i.d. in the ovariectomized (ovx) rat. Both 10 and 30 mg/kg doses of compound prevented the ovx-induced elevation in urinary deoxypyridinoline and prevented the ovx-induced increase in percent eroded perimeter. Histological evaluation of the bones from compound-treated animals indicated that SB 331750 retarded bone matrix degradation in vivo at all three doses. The inhibition of bone resorption at the 10 and 30 mg/kg doses resulted in prevention of the ovx-induced reduction in percent trabecular area, trabecular number, and increase in trabecular spacing. These effects on bone resorption were also reflected in inhibition of the ovx-induced loss in trabecular bone volume as assessed using microcomputerized tomography (microCT; approximately 60% at 30 mg/kg). Together, these data indicate that the cathepsin K inhibitor, SB 331750, prevented bone resorption in vivo and this inhibition resulted in prevention of ovariectomy-induced loss in trabecular structure.

Animals↗

Comparison of regenerative capacity elicited by demineralized bone matrix of different embryonic origins.

In the cranio-maxillo-facial field, extensive research has been conducted to find substitutes for autogeneic bone as a grafting material. The present study examined the effect of demineralized allogeneic bone material of membranous and enchondral origin compared with autogenous bone chips on the healing response in rabbit skull defects. The demineralized bone matrix (DBM) was bioassayed in a critical-size defect rat model. Four trephined calvarial defects were created in each of 14 adult rabbits and the experimental materials implanted into three defects leaving the fourth defect empty for control purposes. The results were assessed by light microscopy and contact radiography after periods of 4 and 15 weeks. The DBM of both origins displayed extensive osteoinductive capacity and early bone production significantly exceeded that of the two control groups. The embryological origin implied minor effects on the initial regenerative response and bone marrow redevelopment. The clinical significance of these findings is discussed.

Animals↗

Purification of water-soluble bone-inductive protein from bovine demineralized bone matrix.

The water-soluble fraction containing bone-inductive activity was purified from guanidine-hydrochloride extracts of bovine demineralized bone. The purification steps include ultrafiltration, dialysis, affinity chromatography on heparin-Sepharose and gel chromatography on Sephacryl S-200. Combination of these steps was proven to be an effective and rapid method for the purification of this protein. Subcutaneous implantation of the water-soluble protein with type I collagen was carried out in the thorax of rats. When alkaline phosphatase activity and calcium content in implants were used as indices for purification, the water-soluble bone-inductive protein was purified > 600-fold according to the enzyme activity and 64-fold according to the calcium content. A morphological examination revealed that many chondrocyte and osteoblast cells were seen in the location of the implanted material. Sodium dodecyl sulfate/gel electrophoresis of the protein produced in this way under non-reducing conditions revealed four protein bands of 18, 16, 14 and 11 kDa. None of the separated bands had any biological activity. This result suggests that the water-soluble bone-inductive activity depends on an associated form of various proteins in the range of 18 to 11 kDa.

Alkaline Phosphatase↗

Healing of a large nonossifying fibroma after grafting with bone matrix and marrow. A case report.

Healing of a large tibial nonossifying fibroma in a 12-year-old girl occurred following excision, curettage, and filling of the bony defect with human demineralized bone matrix powder mixed with a small quantity of the patient's bone marrow. The use of this graft composite was successful in the treatment of the lesion and reduced the potential risk and morbidity associated with pediatric orthopedic surgical procedures with autogeneic iliac crest and other bone grafts.

Bone Marrow Transplantation↗

[Bone matrix production in osteosarcoma].

Osteosarcomas produce an extracellular matrix (ECM), called tumor osteoid, which is also the microscopic hallmark of these tumors. It can be difficult to differentiate tumor osteoid from other formations of ECM in intra-and extraskeletal soft tissue tumors, so that problems in differential diagnosis arise. Conventional special stainings provide a means to increase the reliability of the differential diagnosis, but do not identify the type of tumor conclusively as they only reflect physiochemical features and do not identify the molecular components of the matrix. The key to the solution of this problem is the immunohistochemical use of antibodies against bone matrix components. Matrix-immunohistochemistry using polyclonal and monoclonal antibodies against COL-I-C-peptide, Osteopontin, Osteonectin, Osteocalcin, and Decorin have proved to be a useful tool for the differentiation of osteoid in a series of 20 osteosarcomas with different variants of osteoid formation. For the detection of undifferentiated tumors, however, this method has not proved useful, since the cytoplasmatic immunoreactivity is variable. Molecular methods appear to be a more promising tool. Since the expression of Osteocalcin is known to be the last step of the osteoblastic differentiation, we have established a method to detect osteocalcin mRNA by RT-PCR. First studies of our group on the identification of the osteoblastic differentiation at the molecular level have revealed that Osteocalcin mRNA can be detected both in osteosarcoma cells and in non-skeletal tumor cell lines. In order to provide a reliable means of molecular tumor characterisation, thorough comparative studies on fresh and paraffin material of larger tumor series are in progress.

Bone Matrix↗

An electron microscopic study of the origin of osteoblasts in implants of demineralized bone matrix.

Correlated light microscope and ultrastructural observations of allogeneic intramuscular implants of rat demineralized bone matrix demonstrate the interrelationships between various osteogenetic and non-osteogenetic cell types and suggest that the bone morphogenetic response is evoked from cells of a common origin. Endothelial cells may play a prominent, essential, as well as primary role in the bone morphogenetic response.

Animals↗

Lectin binding in bone matrix of adult rats with special reference to cement lines.

The present study was designed to localize glycoconjugates recognized by four lectins (LFA, MPA, WGA, and ConA) in adult rat bone, histochemically and biochemically. LFA, a lectin recognizing sialic acid, stained intensely the cement lines of calvariae and the interface between cartilage and bone of mandibular condyles, which were also stained with WGA, and intermittently stained with ConA. The irregular bone surface of calvariae displayed intense positive reaction with LFA and WGA, while the osteoid of mandibular condyles and the smooth bone surface of calvariae were intensely stained with WGA and ConA, but weakly stained with LFA and MPA. MPA recognized osteoclasts. At the superficial layer of mandibular condyles, the bone matrix appeared positive as granules with LFA and as patches with MPA, WGA and ConA. Lectin blotting analysis of bone extracts revealed two LFA positive bands at molecular weights of 18 kDa and 45 kDa. The former was positive with WGA, ConA, and MPA, while the latter was positive with MPA. The result suggests that the LFA-binding glycoconjugates, possibly 18 kDa and/or 45 kDa sialoglycoconjugates, may contribute to cementing mechanism of cement lines and/or to the bone formation in remodeling process as well as in intramembranous and intracartilaginous osteogenesis.

Animals↗

Use of cancellous bone chips and demineralized bone matrix in the treatment of acetabular osteolysis: preliminary 2-year follow-up.

Twenty patients (20 hips) who had cementless acetabular revision arthroplasty and were treated with cancellous bone chips mixed with demineralized bone matrix to fill the cavitary defects were studied. At 2-years' follow-up, the grafts were fully incorporated in 18 patients. In addition, the mean Harris Hip Score increased to 89 points from a mean preoperative score of 29 points for the surviving hips. These preliminary findings suggest that the prepackaged demineralized bone matrix and cancellous chips can provide acceptable radiographic and clinical results as an adjunct in the treatment of contained osteolytic acetabular defects.

Acetabulum↗

Initial bone matrix formation at the hydroxyapatite interface in vivo.

Dense, sintered, slip-cast hydroxyapatite rods were implanted transfemorally in young adult rats. The femora were excised after 2 and 4 weeks and, following fixation, either embedded in methyl methacrylate for light microscopy, decalcified and prepared for transmission electron microscopy, or freeze fractured in liquid nitrogen for scanning electron microscopic analysis. The latter was performed on the two tissue fragments that remained after freeze fracturing, from which the first contained the implants and the second comprised tissue that had been immediately adjacent to the hydroxyapatite rods. Undecalcified light microscopic sections revealed extensive bone tissue formation around and in contact with the hydroxyapatite rods. The initial bone matrix apposed to the implant surface, as demonstrated with scanning electron microscopy, was either composed of globular deposits or an organized network of collagen fibers. The deposits, which ranged in size from 0.1-1.1 microns, fused to form a cement-like matrix to which collagen fibers were attached. Degradation of the hydroxyapatite surface resulted in the presence of unidirectionally aligned crystallites, with which the newly formed bone matrix was closely associated. Ultrastructural analysis of the bone-hydroxyapatite interface with transmission electron microscopy revealed a 50-600-nm-wide collagen-free granular zone, comprising one or more 40-100-nm-thick electron-dense layer(s). These structural arrangements most probably partially represent the globular deposits and proteinaceous material adsorbed onto and partially in the degrading hydroxyapatite surface. Although the latter change in surface topography may have enhanced bonding of the cement-like matrix to the hydroxyapatite, the cause for this change in topography and the type of bond formed are, at present, unknown.

Animals↗

DMP1 mutations in autosomal recessive hypophosphatemia implicate a bone matrix protein in the regulation of phosphate homeostasis.

Hypophosphatemia is a genetically heterogeneous disease. Here, we mapped an autosomal recessive form (designated ARHP) to chromosome 4q21 and identified homozygous mutations in DMP1 (dentin matrix protein 1), which encodes a non-collagenous bone matrix protein expressed in osteoblasts and osteocytes. Intact plasma levels of the phosphaturic protein FGF23 were clearly elevated in two of four affected individuals, providing a possible explanation for the phosphaturia and inappropriately normal 1,25(OH)2D levels and suggesting that DMP1 may regulate FGF23 expression.

Adolescent↗

Use of osteopromotive growth factors, demineralized bone matrix, and ceramics to enhance spinal fusion.

Recently developed materials that can enhance fusion rates for posterolateral lumbar arthrodesis may be used alone or in combination with autogenous bone grafts. Novel osteopromotive growth factor preparations are currently under scrutiny; these include autogenous growth factor concentrate, bovine bone-derived osteoinductive protein, and recombinant human MP52. Demineralized bone matrix products may enhance or extend grafts. However, few studies, especially prospective randomized clinical trials, have assessed their efficacy, so it is difficult to compare formulations. Ceramics have been evaluated in animal studies and human clinical trials for a variety of applications in spinal surgery. These materials function best as bone graft extenders or as bioactive osteoinductive material carriers in posterolateral lumbar fusions. They have the advantage of variable porosity, low cost, and ease of manufacture. Hydroxyapatite/tricalcium phosphate ceramics have been shown to perform as well as autogenous bone grafts but with fewer complications.

Bone Matrix↗

Augmentation of demineralized bone matrix (DBM) mineralization by a synthetic growth factor mimetic.

These studies evaluated whether F2A4-K-NS, a peptide mimetic of FGF-2, could augment ectopic bone production following the subcutaneous implant of human demineralized bone matrix (DBM). DBM was formulated into a gel with and without F2A4-K-NS, and injected subcutaneously into athymic rats. After 28 days the resultant tissue was excised and fixed. The tissue was examined with soft X-rays and microcomputerized tomography (micro-CT), and by histological methods. Inclusion of F2A4-K-NS with DBM resulted in an increased mineral deposition as determined by soft X-ray and micro-CT analysis and von Kossa staining. DBM-containing tissues showed extensive mineralization compared to the carrier alone, which was poorly mineralized. The mineralization was qualitatively and quantitatively the most extensive in the samples containing F2A4-K-NS plus DBM. Additionally, the highest amount of von Kossa staining for calcium was observed in tissues from animals that had received DBM plus F2A4-K-NS. In these studies, 100 ng of peptide per 0.2 mL of injectable DBM gel generated the most optimal results. The synthetic peptide F2A4-K-NS augmented DBM-induced ectopic mineralization in athymic animals.

Animals↗

Effect of 1-hydroxyethane-1,1-diphosphonic acid (HEDP) on new bone formation induced by bone matrix gelatin (BMG).

The effect of the biphosphonate 1-hdroxyethane-1,1 diphosphonic acid (HEDP) on induced ectopic osteoneogenesis was studied by light and electron microscopy. Demineralized bone matrix gelatin (BMG) was implanted into the rectus abdominis muscle of 8-week-old Sprague-Dawley rats, HEDP was administered subcutaneously with a mini-osmotic pump, and histological changes were examined 4 days, 1, 2 and 3 weeks later. Four days after implantation, "acellular mineral deposition" in the control group was suppressed in the HEDP group. Two weeks after BMG implantation, cartilage formation was more intensive in the HEDP-treated group than in the control group. Three weeks after implantation, new lamellar bone with bone marrow was observed in the control group, while immature osteoid tissue detected by type II collagen in the central area was prominent in the HEDP-treated group. HEDP-treatment also suppressed the appearance and activity of osteoclast-like cell.

Animals↗

Percutaneous treatment of long bone nonunions: the use of autologous bone marrow and allograft bone matrix.

Sixty-six patients with 69 "stiff" nonunions (no gross motion) of long bones were entered into a prospective study. The only therapeutic intervention was the percutaneous administration of a mixture of autologous bone marrow and allograft demineralized bone matrix on an outpatient basis. Sixty-one of the percutaneous treatments (88%) resulted in union at an average of 8.1 months (range: 2 months to 3 years). This method of treating nonunions is as successful as standard iliac crest autologous bone grafting and offers the distinct advantages of decreased morbidity, reduced costs, and shorter hospital stay.

Adolescent↗

Bone matrix proteins: their function, regulation, and relationship to osteoporosis.

Bone is a unique tissue composed of numerous cell types entombed within a mineralized matrix each with its own unique functions. While the majority of the matrix is composed of inorganic materials, study of the organic components has yielded most of the insights into the roles and regulation of cell and tissue specific functions. The goal of this review will be to describe some of the major known organic components of the bone matrix and discuss their functions as currently perceived. The potential usefulness of bone matrix protein assays for diagnosing the status of bone diseases and our current understanding of how these proteins could be related to diseases such as osteoporosis will also be reviewed.

Animals↗