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Towards injectable cell-based tissue-engineered bone: the effect of different calcium phosphate microparticles and pre-culturing.

Bone tissue engineering by combining bone marrow stromal cells (BMSCs) with a porous scaffold is a promising technology. Current major challenges are to upscale the technique for clinical application and to improve the handling characteristics. With respect to minimal invasive surgery, moldable and/or injectable formulations are highly preferable. Ceramic microparticles of different HA/TCP formulations (100/0, 70/30, 60/40, 40/60, and 0/100) with varying surface roughness were sieved to select 200 microg aliquots of the 212-300 microm fraction. Goat BMSCs were seeded on different aliquots one week prior to in vivo implantation. These constructs and remaining cells were cultured for one week. By then, the remaining cells were harvested and resuspended in a specific binder: hyaluronic acid, alginate, or blood plasma, combined with aliquots of 60/40 microparticles peroperatively. All constructs were implanted in nude rats (n = 10) and analyzed for their bone yield histomorphometrically after 6 weeks. All precultured constructs showed consistent bone formation of comparable quantity. No significant differences were observed between the different material compositions. Peroperatively prepared constructs hardly showed any bone formation. The present study demonstrated the osteogenic potential of a tissue- engineered bone substitute made of microparticles of various HA/TCP compositions. There was an obvious advantage when the constructs were pre-cultured.

Alginates↗

Normal and osteopenic bone-derived osteoblast response to a biomimetic gelatin-calcium phosphate bone cement.

We have recently developed a new calcium phosphate bone cement enriched with gelatin (GEL-CP), which exhibits improved mechanical properties with respect to the control cement (C-CP). In a previous study, we demonstrated the good response of osteoblast-like cells to the new biomimetic bone cement. Herein, we extend the investigation to primary culture of osteoblasts derived from healthy and pathological bones. Osteoblasts derived from normal (N-OB) and osteopenic (O-OB) sheep bones were cultured on samples of GEL-CP, and their behavior was compared with that of cells cultured on C-CP as control. Cell morphology, proliferation, and differentiation were evaluated at 3 and 7 days. SEM analysis revealed that both N-OB and O-OB showed a normal morphology when cultured on GEL-CP. Biological tests demonstrated that the gelatin-enriched cement improves osteoblasts' activity and differentiation of O-OB cultures, with respect to the control samples. The data indicate that the new composite cement positively stimulates alkaline phosphatase activity, collagen type I, and osteocalcin production, not only in N-OB, but also in O-OB culture. The improvement due to the presence of gelatin suggests that the biomimetic composite material could be successfully applied as bone substitute also in the presence of osteopenic bone.

Animals↗

[Custom moldable hydroxyapatite collagen composite for repair of osseous defects].

AIM: In the following study we evaluated the biological response of a new freely moldable bone substitute in an animal model. MATERIAL AND METHODS: Critically sized defects were created surgically in the lower jaw of ten adult minipigs. The drill defects were filled with hydroxyapatite collagen paste. After observation periods of 1, 3, 6, 12, and 18 months the mandibles were harvested without wound healing defects for histological evaluation of resorption and bone ingrowth with a sawing and grinding technique. RESULTS: The result of the remodeling process was a complete degradation of hydroxyapatite collagen implants after 12-18 months with reorganization of vital trabeculae oriented in a mature pattern. CONCLUSION: The hydroxyapatite collagen cement works as an osteoconductor and shows signs of direct osseointegration and resorption.

Animals↗

Osteoblastic phenotype expression of MC3T3-E1 cells cultured on polymer surfaces.

BACKGROUND: Current efforts in bone tissue engineering have as one focus the search for a scaffold material that will support osteoblast proliferation, matrix mineralization, and, ultimately, bone formation. The goal is to develop a bone substitute that is functionally equivalent to autograft bone. Previously published reports have shown that osteoblasts exhibit varying rates and degrees of proliferation and mineralization when grown on different surfaces. METHODS: This study presents a histologic and biomolecular analysis of MC3T3-E1 murine preosteoblast cells grown on poly(lactide-co-glycolide) (PLGA) versus poly(-caprolactone) (PCL), two commonly studied scaffold polymers. MC3T3-E1 cells were cultured on slides coated with either PLGA or PCL, and on uncoated glass slides as control, with six slides in each group. After 6 weeks in culture, the cells were stained for osteocalcin, alkaline phosphatase activity, and matrix mineralization. In addition, to assess the effects of the surface material on phenotypic expression at the molecular level, MC3T3-E1 cells were cultured on polymer-coated 24-well plates for 4 days, and analyzed by reverse transcription polymerase chain reaction for the expression of osteocalcin and alkaline phosphatase. RESULTS: The results showed that three groups of slides stained positively for osteocalcin at 6 weeks. However, markedly less alkaline phosphatase activity and mineralization were observed on the cells grown on PCL. Real-time polymerase chain reaction assays subsequently revealed decreased expression of both markers by cells cultured on PCL compared with PLGA. CONCLUSIONS: These results suggest that PCL does not support the full expression of an osteoblastic phenotype by MC3T3-E1 cells. PCL, therefore, is less desirable as a scaffold polymer in bone tissue engineering in so far as supporting bone formation is concerned. However, because PCL has favorable handling characteristics and strength, modifications of PCL may prompt further investigation.

3T3 Cells↗

[The use of ceramics in osteoplastic operations in onco-orthopedics].

Hydroxilapatite-base ceramics was made use of in 70 cases in bone-plastic operations as a material to substitute bone defects following excision of osteal neoplasms. In all cases, the ceramic material was made contact with the bone bed. There were no ceramics-related adverse local or generalized reactions. Zones of a ceramics-to-bone contacts showed consolidation in 68 cases for up to 3 months as per X-ray techniques. No bone fracture was to be seen in the site of implantation or a fragmentation of the ceramic material employed. Based on the results obtained, the hydroxilapatite-base ceramics can be made use of as an alternative to auto- and allotransplants.

Adolescent↗

Histologic analyses of human mineralized bone grafting material in sinus elevation procedures: a case series.

Human mineralized bone allograft is a solvent-preserved allograft and is therefore composed of a unique bone substitute that differs from other forms of bone allograft processed via standard cryopreservation. During solvent preservation, the mineral and collagen structures appear to remain intact, thus possibly facilitating bony ingrowth when the mineral is used as a bone graft. This case series illustrates the histologic and clinical effects of this bone graft material for sinus elevation procedures. Histology from bone biopsy core samples of four patients revealed newly formed bone with a well-organized lamellar bone structure in general, and in some cases, remaining particles were observed in contact with surrounding newly formed bone. Histomorphometric analysis demonstrated a mean of 73.3% of bone formation (range, 66.1% to 85.0%) in the grafted sites, resulting in bone density that was similar to that of the original host bone (mean, 73.2%; range, 64.4% to 84.8%). Clinically, no complications were observed, and all implants were considered clinically osseointegrated after 6 months (range, 4 to 8 months). The results of this study suggest that human mineralized bone allograft could be successfully used in sinus lifting procedures and encourage further research of this solvent-preserved bone allograft material in oral reconstruction for future implant placement.

Adult↗

Reconstruction of extensive long bone defects in sheep using resorbable bioceramics based on silicon stabilized tricalcium phosphate.

In this study we evaluated the performance of Skelite, a resorbable bioceramic based on silicon stabilized tricalcium phosphate (Si-TCP), in promoting the repair of a large-sized, experimentally induced defect in a weight-bearing long bone sheep model. Eighteen 2-year-old ewes were used in this study. Animals were sacrificed at 3, 6, and 12 months. One animal entered a very prolonged followup and was sacrificed 2 years after surgery. Bone formation and scaffold resorption were evaluated by sequential x-ray studies, CT scans, histology, immunohistology, microradiography, and quantitative analysis of x-ray studies (optical density) and microradiographs (percentage of bone and scaffold area). Our data show an excellent implant integration and significant bone regeneration within the bone substitute over the course of the experiment. Progressive osteoclastic resorption of the biomaterial was also evident. At 1 year from surgery, the remaining scaffold was approximately 10-20% of the scaffold initially implanted, while after 2 years it was essentially completely resorbed. At the end of the observation period, the segmental defect was filled with newly formed, highly mineralized, lamellar bone.

Absorbable Implants↗

[Mechanical study of potential ceramic implant materials for minimal invasive anterior lumbar interbody fusion].

While autologous bone grafts are highly suitable for use in spinal arthrodesis, their use is also associated with problems (traumatization, complications). Ceramic bone substitute materials provide an attractive alternative for lumbar interbody spinal fusion. The aim of the present study was to investigate the mechanical properties of various types of ceramic using a specific fusion method. Ten specimens each of 7 different types of ceramic were tested using a hydraulic testing machine with two different sample holders: polyurethane foam (mechanical properties similar to cancellous bone) and aluminium. The parameters axial compression and axial torque were investigated. With the polyurethane foam holders, none of the ceramic implants failed under compression, while under axial rotation, two types of ceramic failed. With the aluminium holders, 3 ceramics showed no failure up to 25 kN under compression, while under torsion all the ceramics failed. One type of ceramic showed specific fracture properties with a higher load-bearing capacity after failure in comparison with all the other types studied.

Biomechanical Phenomena↗

[Obliteration of the maxillary sinuses with ionomer cement in the rabbit].

Ionogran is both a solid and porous bone substitute. It is based on ionomer cement, a material obtained by a neutralization reaction between a glass powder and a polymaleic acid. This material has already been used for reconstruction of large bony defects following tumor surgery. In an experimental study, the maxillary sinuses in 12 rabbits were obliterated using the ionomer-based microimplant. This granulate was placed on the intact mucosa or immediately on bone after removal of the mucoperiostal lining. After its application to intact sinus mucosa no bone regeneration was detected. In contrast, after application to exposed bone osteoneogenesis was observed 28 days later, starting from the bony sinus wall. After periods of 56-84 days, a continued increase in new bone was seen inside the obliterated cavity. These results indicate that Ionogran is suitable for obliteration of the paranasal sinuses after complete removal of the mucosal lining.

Aluminum Silicates↗

Differential growth factor retention by platelet-rich plasma composites.

PURPOSE: This study evaluates the temporal sequence and growth factor release from platelet-rich plasma (PRP) combined with different bone substitutes (BS), to identify an optimal substrate for extended growth factor retention. MATERIALS AND METHODS: PRP was clotted with bovine thrombin or thrombin receptor activator peptide-6 (TRAP). In addition, PRP was clotted using Allogro (Ceramed, Lakewood, CO), BioGlass (Mo-Sci, Rolla, MN), or BioOss (Osteohealth, Shirley, NY). The effects of media exchange and BS on platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF beta) release were quantified via enzyme-linked immunosorbent assay. RESULTS: At day 1, the thrombin group released 36% more PDGF than the TRAP group and 80% more than the BS groups. At 7 days, PDGF release was the greatest for the TRAP group. PDGF release was minimal for all groups at day 14, with BS groups retaining 60% more PDGF than thrombin clots. Similarly, the thrombin group released the greatest amount of TGF beta (81.4% of the total), whereas TRAP and BS groups released significantly less TGF beta at day 1. Compared with thrombin, TRAP retained 39.2% more TGF beta, whereas BS groups retained even greater levels (Allogro, 54.3%; BioOss, 45.8%; BioGlass, 67.0%). No significant difference in TGF beta release was observed among the substitutes after day 1. The BS groups continued to retain TGF beta after 14 days, whereas all TGF beta in the thrombin clots was depleted. CONCLUSIONS: PRP preparation with thrombin results in a large, immediate release of growth factors that could be lost into the interstitium in vivo. TRAP-BS may prove more efficacious than thrombin in sustaining growth factor levels critical for the cascade of events leading to bone formation.

Adult↗

Influence of the structure of three corals on their resorption kinetics.

The aim of this study was to investigate the influence of the structure of corals on their resorption kinetics after implantation in subcutaneous areas. Three types of coral (Porites astreoides, Montastrea annularis and Dichocoenia stokesi) identical in composition but different in structure were implanted for periods of 1 and 2 months in subcutaneous sites in OF1 mice. The resorption of the implants was studied by means of qualitative (histology, scanning electron microscopy, fluorochrome labelling method) and quantitative approaches (gravimetric method). The results of the qualitative study revealed a process of irregular deterioration of the coral, linked to the detachment of crystals at the surface of the implant. The results of the quantitative study showed that the speed of resorption increases with the implantation time and the open porosity of the coral. These reactions are explained by the increase of the surface exchange area in contact with factors responsible for resorption: biological medium and cells. When considering the choice of coral as a bone substitute, these factors must be taken into account to allow the in situ maintenance of the implant over a sufficiently long period of time according to the clinical situation.

Animals↗

The effect of surface modification of a porous TiO2/perlite composite on the ingrowth of bone tissue in vivo.

The porous TiO2/perlite composite Ecopore is a synthetic biomaterial with possible clinical application in bone substitution. In our previous work, we demonstrated that surface modification of Ecopore with fibronectin (FN) enhanced spreading and growth of human osteoblasts in vitro. In the present study, we implanted untreated, alkaline-etched and FN-coated Ecopore cylinders into critical size defects of rabbit femora and applied pulsed polychrome sequence staining. After 6 weeks, sections of the implants were investigated via conventional and fluorescence microscopy. A partial ingrowth of bone matrix into the pore system of the Ecopore implants was observed. At the contact zones, the bone appeared to be directly connected to the implant without detectable gaps. Defect healing was complete within 6 weeks, while fibrous tissue generation or inflammation were absent in the implant modification groups, demonstrating basic Ecopore biocompatibility. The mean bone apposition rates within the implant cross-section were 4.1+/-0.6 microm/day (p<0.001) in the FN-coated group and 3.3+/-0.5 microm/day (p<0.05) in the NaOH-etched group. In both treated Ecopore modification groups, the apposition rates were significantly higher than in the non-modified control (2.9+/-0.6 microm/day), indicating bone growth stimulation by pre-treatment. Energy-dispersive X-ray analysis confirmed that significantly more bone tissue was formed inside the pores of the FN-coated implants compared to the unmodified control. The cross-sectional areas identified as ingrown bone amounted to 18.5+/-6.1% (p<0.05) in the FN group, 13.4+/-5.1% (p>0.05) in the NaOH-etched group and 10.2+/-5.5% in the unmodified group. In summary, we conclude that bone tissue tolerates Ecopore well and that tissue ingrowth can be enhanced by etching and coating with FN.

Animals↗

In vivo experimental study on bone regeneration in critical bone defects using an injectable biodegradable PLA/PGA copolymer.

OBJECTIVES: An assessment was done of the bone-healing rate after implantation of a polylactide/polyglycolide copolymer (PLA-PGA) 50/50 dispersed in aqueous solution of PGA and dextran, used as bone substitutes in an animal model. STUDY DESIGN: Two groups of 5 rabbits each were used. In both the femoral condyles, a critical size defect of 6x10 mm was made. On the right side PLA/PGA was inserted; the left side remained empty. Thirty and 90 days after surgery the animals were killed. RESULTS: Defects left unfilled showed no spontaneous healing after 30 and 90 days. Sites filled with experimental materials showed new bone ranging between 11.46% and 76.82% after 30 days, and 75.98% and 95.34% after 90 days. Histomorphometry showed an increase in bone maturation between day 30 and 90 in experimental sites. At day 90, no statistical difference was seen as compared to normal bone. CONCLUSION: PLA/PGA copolymer dispersed in hydrosoluble matrix seems to be suitable as osteoconductive material in critical size defects.

Absorbable Implants↗

Carbonate-containing hydroxyapatite derived from calcium tripolyphosphate gel with urea.

Carbonate containing hydroxyapatite (CO3HAp) is one of the candidate materials as a bioresorbable bone substitute. In the present work, CO3HAp was efficiently prepared by a hydrothermal treatment of calcium tripolyphosphate gel with urea at 140 degrees C for 24 h. Chemical potential plots of the CO3HAp for estimation of its dissolution behavior suggested that the CO3HAp is more soluble than hydroxyapatite (HAp) and is as soluble as octacalcium phosphate (OCP) and/or beta -tricalcium phosphate (TCP). This material is expected to be applied to bioresorbable materials such as bone fillers.

Absorbable Implants↗

Repair of a critical size defect in the rat mandible using allogenic type I collagen.

Mandibular fractures, resulting from either trauma or reconstructive surgery, can be challenging craniofacial problems. The morbidity of failed fracture healing is significant and may require bone grafting. Donor site morbidity and finite amounts of autogenous bone are major drawbacks of autogenous bone grafting. Similarly, the use of allografts and xenografts may be associated with an increased risk of rejection, infection, and nonunion. To circumvent the limitations of bone grafting, research efforts have focused on formulating a suitable bone substitute. The purpose of our study was to evaluate the efficacy of type I collagen implants in repairing critical sized mandibular defects in rats. Twelve male Sprague-Dawley rats (200-300g) were divided equally into control and experimental groups. Full thickness, round, four millimeter in diameter defects were created in the ramus of the right mandible of all rats using an electrical burr at low speed. The defects were irrigated of all bone chips, and either filled with a precisely fitted disk of allogenic collagen type I gel (experimental animals) or left empty (control animals). Animals were killed 6 weeks after surgery and healing of the bone defects was assessed in a blinded fashion using radiologic and histologic analysis. Radiologic analysis of the control group revealed a clear circular right mandibular defect in all animals, whereas the collagen disk implant group revealed an indistinct to nonexistent right mandibular defect in all animals. Densitometric analysis revealed a significant difference between these groups (* P = 0.01). Similarly, gross analysis of control mandibles revealed a 4mm round, soft-tissue filled defect, while implanted defects demonstrated gross bone spanning the defect. Finally, histologic analysis of all control mandibles revealed clearly demarcated bony edges at the defect border with connective tissue spanning the defect. In contrast, histological analysis of all implanted mandibles revealed indistinct bony edges at the defect border with a thin layer of osteoblasts and viable bone spanning the defects. We have demonstrated the ability of type I collagen to promote healing of a membranous bony defect that would not otherwise heal at 6 weeks. The suitability of type I collagen as a carrier matrix provides ample opportunity for tissue-engineered approaches to further facilitate bony defect healing. Promoting bone formation through tissue engineering matrices offers great promise for skeletal healing and reconstruction.

Absorptiometry, Photon↗

[The value of beta-tricalcium-phosphate (CERASORB) in pre-prosthetic surgery].

Short- and medium-term experience with a pure-phase beta-tricalcium phosphate bone-substitute material (Cerasorb) is reported on the basis of clinical, radiological (panorama, 2-3D CT records) and histological examination on 52 patients. The treatment modes on these patients included the filling of cysts, sinus grafting, augmentation and the filling of parodontal lesions. Disturbance of wound healing was not observed in any of the cases, and both the radiological and the histological examinations revealed that transformation of the implanted beta-tricalcium phosphate into bone could be detected as early as in the second month. During the 10-month follow-up period, this transformation was continuous, but was not complete; completion is to be expected only after 12 months. It is important that load-bearing tissue had already developed after 4-6 months. Studies to date suggest that autologous bone is not necessary for either sinus grafting or the filling of large cysts: Cerasorb alone is suitable for this purpose.

Adult↗

rhPDGF-BB promotes healing of periodontal defects: 24-month clinical and radiographic observations.

A new therapeutic system using purified recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with a biocompatible, osteoconductive, synthetic scaffold beta-tricalcium phosphate (beta-TCP) has recently been shown in a large-scale, prospective, blinded, randomized clinical trial to safely and effectively treat advanced periodontal osseous defects. A significant gain in clinical attachment level was observed 3 months postsurgery for sites treated with 0.3 mg/mL rhPDGF-BB + beta-TCP versus beta-TCP + buffer (active control), with this trend continuing at 6 months postsurgery. Additionally, sites treated with 0.3 mg/mL rhPDGF-BB + beta-TCP also had significantly greater radiographic linear bone gain and percent defect fill at 6 months postsurgery than sites that received bone substitute with buffer. Representative cases from the clinical trial were followed to assess their ability to maintain the initial effect of treatment observed at 6 months. At 18 or 24 months postsurgery, with the same clinical and radiographic measurement techniques used as were performed at the 6-month time point for the clinical trial, these cases demonstrated maintenance of the clinical attachment level for all but one case, with all cases demonstrating substantial increases in linear bone gain and percent bone fill versus measurements obtained at 6 months postsurgery. Substantial radiographic changes in the appearance of the defect fill were observed for both rhPDGF-BB treatment groups, consisting of increased radiopacity and bone trabeculation, indicative of increased mineralization and maturation of the bone observed 6 months postsurgery.

Adult↗

[Implants and transplants in bone replacement].

Implants and grafts are employed in the fields of orthopaedic surgery to fill osseous defects and to restore destroyed joints. These bone substitute materials may be derived from different biological and technical sources. In this overview-paper the various methods of bone and joint substitution are discussed concerning their advantages and their disadvantages in comparison to the alternative methods. The decision, which way to go, which implant or graft should be employed in each individual case must be based on the specific medical, economical and social situation of every single patient. Finally future aspects of allogeneic bone and joint grafting are discussed, an hopeful experimental approach for a biological form of joint replacement.

Bone Lengthening↗