Bone-inductive efficacy of recombinant human bone morphogenetic protein-2 expressed in Escherichia coli: an experimental study in rat mandibular defects.

Because to our knowledge the efficacy of prokaryotically expressed recombinant human bone morphogenetic proteins (rhBMP) to promote orthotopic osteogenesis has not previously been investigated, our aim was to test the efficacy of rhBMP-2 produced in Escherichia coli to promote bone healing in a standardised experimental bone healing model in rat mandibles. Different doses of rhBMP-2 were delivered in an absorbable collagen sponge carrier, and microporous barrier membranes were placed over half the number of defects in each treatment group, thereby making intraosseous cells the only recruitment source for new osteogenic cells. Results were evaluated by computerised image analysis after 12 and 24 days. The relative efficacy of rhBMP-2 preparations of different purity was also compared. E coli-produced rhBMP-2 stimulated bone healing, but its efficacy was estimated to be about one order of magnitude less than that of rhBMP-2 expressed in eukaryotic cells. We conclude that bacterially expressed rhBMP-2 is osteogenic in vivo, although higher doses will be required than of rhBMP-2 expressed in mammalian cell lines.     

Recombinant bone morphogenetic protein-2 enhances bone healing,guided by osteopromotive e-PTFE membranes: An experimental study in rats

It has been shown earlier that it is possible to improve bone healing, to regenerate previously existing bone, and to create new bone by means of an osteopromotive membrane technique. The present study addresses the question of whether it is possible to combine this technique with a locally applied factor, stimulatory to osteogenesis. Circular transosseous critical size defects in mandibles of rats were either implanted with recombinant human bone morphogenetic protein type 2 (rhBMP-2) or were left empty; half the number of implanted and half the number of empty defects were covered with an expanded polytetrafluoroethylene (e-PTFE) membrane (GORE-TEX^®). Results were evaluated after 12 and 24 days of healing by a histomorphological scoring system. Implantation of rhBMP-2 alone resulted in bony bridging of the defect after only 12 days, but also in voluminous amounts of new bone outside the original defect area. When rhBMP-2 was combined with membrane, newly formed woven bone bridged the defect and the bone contour was maintained by the membrane. The combined treatment with membrane and rhBMP-2 demonstrated a significantly better bone healing than with e-PTFE membrane alone at both 12 days and 24 days of healing. It was concluded that rhBMP-2 has a strong osteoinductive potential and, in contrast to what was found earlier with other types of BMP preparations, this potential was retained when combining the rhBMP-2 with the osteopromotive membrane technique, yielding better bone healing than with the membrane alone, and at the same time maintaining the bone contour. This combination may have important therapeutic applications for osseous healing and in reconstructive surgery. The study also shows the importance of an appropriate carrier material when applying stimulatory substances to enhance bone formation in combination with a membrane.     

Isolation, characterisation and osteogenic potential of human bone marrow stromal cells derived from the medullary cavity of the femur

Marrow stromal cells (MSC) are increasingly being introduced in orthopaedic practice as potentially powerful effectors of bone regeneration. Since cell recovery of MSC is affected by a high degree of individual variability, sources for collecting adequate amounts of safe and effective MSC under routine conditions are needed. We analysed if femoral bone marrow, which is usually discarded during total hip arthroplasty procedures, is a reliable source of MSC to enhance bone healing and regeneration. Mononuclear cells were isolated, assayed for typical MSC markers, harvested under appropriate culture conditions and evaluated for their ability to differentiate into osteoblasts. Cell recovery and osteogenic potential were independent from donor gender or age, suggesting that elderly individuals are eligible for autologous cell therapy. Although heterogeneous, the pool of MSC recoveredfrom femoral marrow without further in vitro selection or manipulation proved highly effective in proliferating and differentiating along the osteogenic lineage. In conclusion, this source of MSC offers a valuable tool to be used to promote osteogenesis and implant fixation.     

Combined effects of recombinant human BMP-2 and Nell-1 on bone regeneration in rapid distraction osteogenesis of rabbit tibia

Distraction osteogenesis (DO) has been accepted as an effective technique for bone lengthening. However, the long treatment period and possible fibrous union or nonunion hampers its further clinical application. Bone regeneration in DO involves multiple stages of repair and coordinated action of multiple cell types. Consequently, it may be possible to enhance bone regeneration through treatment strategies that target more than one repair process or cell types. The goal of this study was to determine the combined effects of recombinant human bone morephogenetic protein 2 (rhBMP-2) and NEL-like molecule-1 (NELL-1) on bone formation in DO. Unilateral tibiae in 48 rabbits were lengthened for 7 days at a rate of 2 mm/day after 3-day lag. At the end of distraction, the animals were randomly divided into four groups (n = 12) and received phosphate-buffered saline, 50 μg rhNell-1 or 50 μg rhBMP-2, or both 25 μg rhBMP-2 and 25 μg rhNell-1 at the lengthened segment, respectively. After 4-week consolidation bony healing was assessed using histology, radiography, dual energy X-ray absorptiometry, micro-CT, and three-point bend testing. Treatment with rhNell-1 and/or rhBMP-2 resulted in better bone formation and higher BMD and BMC than the saline group, whilst excellent bone formation and the highest BMD and BMC was observed in the combined treatment group. Both rhNell-1 and rhBMP-2 groups presented more mature characteristics in the micro-architecture than the saline group, whereas the combined treatment group presented the highest BV/TV, Tb.Th and Tb.N as well as the lowest Tb.Sp. The peak load of the lengthened tibia increased by 71% in the combined treatment group, 54% in the rhBMP-2 group, and 25% in the rhNell-1 group compared to the control group, respectively. This work suggests that BMP-2 and Nell-1 enhance each other's ability and dual delivery of two agents can significantly improve bony healing in tibial DO.     

pHEMA-nHA Encapsulation and Delivery of Vancomycin and rhBMP-2 Enhances its Role as a Bone Graft Substitute

Background

Bone grafts are widely used in orthopaedic procedures. Autografts are limited by donor site morbidity while allografts are known for considerable infection and failure rates. A synthetic composite bone graft substitute poly(2-hydroxyethyl methacrylate)-nanocrystalline hydroxyapatite (pHEMA-nHA) was previously developed to stably press-fit in and functionally repair critical-sized rat femoral segmental defects when it was preabsorbed with a single low dose of 300 ng recombinant human bone morphogenetic protein-2/7 (rhBMP-2/7).

Questions/purposes

To facilitate clinical translation of pHEMA-nHA as a synthetic structural bone graft substitute, we examined its ability to encapsulate and release rhBMP-2 and the antibiotic vancomycin.

Methods

We analyzed the compressive behavior and microstructure of pHEMA-nHA as a function of vancomycin incorporation doses using a dynamic mechanical analyzer and a scanning electron microscope. In vitro release of vancomycin was monitored by ultraviolet-visible spectroscopy. Release of rhBMP-2 from pHEMA-nHA-vancomycin was determined by ELISA. Bioactivity of the released vancomycin and rhBMP-2 was examined by bacterial inhibition and osteogenic transdifferentiation capabilities in cell culture, respectively.

Results

Up to 4.8 wt% of vancomycin was incorporated into pHEMA-nHA without compromising its structural integrity and compressive modulus. Encapsulated vancomycin was released in a dose-dependent and sustained manner in phosphate-buffered saline over 2 weeks, and the released vancomycin inhibited Escherichia coli culture. The pHEMA-nHA-vancomycin composite released preabsorbed rhBMP-2 in a sustained manner over 8 days and locally induced osteogenic transdifferentiation of C2C12 cells in culture.

Conclusions

pHEMA-nHA can encapsulate and deliver vancomycin and rhBMP-2 in a sustained and localized manner with reduced loading doses.

Clinical Relevance

The elasticity, osteoconductivity, and rhBMP-2/vancomycin delivery characteristics of pHEMA-nHA may benefit orthopaedic reconstructions or fusions with enhanced safety and efficiency and reduced infection risk.     

Complications with the use of bone morphogenetic protein 2 (BMP-2) in spine surgery

Background contextRecombinant human bone morphogenetic protein 2 (rhBMP-2) is a very potent osteogenic growth factor that has been used successfully in various spine fusions, obviating the need for autologous iliac crest bone graft harvest and therefore avoiding the associated morbidities.PurposeIn the past few years, a tremendous increase in rhBMP-2 usage was noted, and concerns regarding costs, benefits, and safety issues were raised by many. The goal of this work was to provide a comprehensive review of the adverse events and complications associated with use of rhBMP-2.Study designLiterature review.MethodsThis is a review of the current literature on the reported adverse events, complications, and concerns associated with rhBMP-2 use.ResultsThis article discusses the wide spectrum of adverse outcomes related to rhBMP-2 use in the lumbar and the cervical spine; retrograde ejaculation, antibodies formation, postoperative radiculitis, postoperative nerve root injury, ectopic bone formation, vertebral osteolysis/edema, dysphagia and neck swelling, hematoma formation, interbody graft lucency, and wound healing complications are reviewed. Cost-related concerns, dosage considerations, carrier types, and theoretical carcinogenesis concerns were also presented.ConclusionsDespite the excellent spinal fusion rates promoted by this powerful molecule, the increasingly reported adverse outcomes associated with bone morphogenetic protein usage have created real concerns. This article will provide the reader with a good understanding of the reported complications associated with rhBMP-2 use and ultimately help recognize its safety spectrum and limits for better clinical application.     

rhBMP-2对兔骨髓基质细胞VEGF表达及成骨潜能的影响

目的：观察经不同剂量重组人骨形态发生蛋白-2(recombinant human bone morphogeneti protein-2，rhBMP-2)刺激后的兔骨髓基质细胞(marrow stromal cell，MSC)，其血管内皮生长因子(vascular endothelial growth factor，VEGF)表达及成骨潜能变化的情况。方法：取兔双侧股骨骨髓基质细胞体外培养，分别以不同剂量rhBMP-一2刺激细胞，并设立空白对照组。培养5d后，进行细胞形态(胍染色)、增殖情况(细胞记数法与MTT法)、碱性磷酸酶(组化染色与活性测定)、钙化结节(图像分析)、VEGF阳性细胞率(免疫组化染色)等项目的检测。结果：不同剂量组间在碱性磷酸酶活性、矿化面积百分率、VEGF阳性细胞率三项观测指标上差异显著，rhBMP-2剂量为100ng／ml左右时效果最佳；在细胞记数与MTT检测上各组差别不显著。结论：应用rhBMP-2在促进基质细胞成骨潜能的同时，还可促进VEGF的表达，其应用剂量与效果之间存在明显相关关系，应用剂量为100ng／ml左右时，其促进VEGF表达及成骨潜能作用同时达到最佳效果，超过此应用剂量，两者则有下降趋势。应用rhBMP-2对促进骨髓基质细胞增殖无明显影响。     

骨形态发生蛋白和碱性成纤维细胞生长因子激发纤维环细胞成骨的潜能

目的研究联合使用重组人骨形态发生蛋白（recombinant human bone morphogenetic protein-2,rhBMP-2）和碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF）椎间盘纤维环细胞成骨潜能的激发作用。方法向体外培养的纤维环细胞中分别及联合加入rhBMP-2和bFGF,观察纤维环细胞的表型表达特点。结果联合使用rh-BMP-2和bFGF能够明显促进椎间盘细胞增殖,提高细胞内碱性磷酸酶活力,增加I型胶原分泌,提高钙盐沉积程度,提高骨钙素的表达水平。结论联用rhBMP-2和bFGF能够诱导纤维环细胞向成骨细胞方向分化,分泌钙盐并形成钙结节。     

纤维蛋白凝胶复合rhBMP-2及骨髓基质干细胞应用于兔脊柱融合的实验研究

目的观察纤维蛋白凝胶（fibrin glue，FG）复合rhBMP-2及骨髓基质干细胞（mesenchymal stem cells，MSCs）用于兔横突间脊柱融合的效果。方法取1月龄日本大耳白兔股骨MSCs体外原代培养，传代培养时加入成骨诱导物向成骨方向诱导分化。40只1岁龄日本大耳白兔随机分为4组，根据植入的材料分别为：MSCs／rhBMP-2／FG组，MSCs／FG组，rhBMP-2／FG组，FG组。复合物置于皮质已打磨的左侧k-6横突上。脊柱标本均于术后6周取材，应用手法检测、DR拍片、CT扫描三维重建、灰度分析、生物力学检测、组织学染色等方法观察各组脊柱融合效果。结果手法检测和DR片示MSCs/rhBMP-2/FG组融合率分别为70％和80％，rhBMP-2/FG组经两种方法检测融合率均为40％。MSCs/FG组和FG组无脊柱融合标本。MSCs／rhBMP-2／FG组与rhBMP-2／FG组在融合率上虽无统计学差异，但在成骨密度和面积上存在显著差异，生物力学检测结果示MSCs，rhBMP-2/FG组在各方向上的融合强度均显著高于其他三组。CT扫描三维重建显示MSCs／rhBMP-2／FG组k-6横突间有连续骨组织生成。组织学染色示MSCs／rhBMP-2／FG组和rhBMP-2/FG组融合标本横突间为成熟骨组织。结论MSCs／rhBMP-2／FG复合物应用于兔横突间脊柱融合可以取得良好成骨质量。     

The effect of recombinant human bone morphogenetic protein-2 on the osteogenic potential of rat mesenchymal stem cells after several passages

Background Since the osteogenic potential of bone marrow derived mesenchymal stem cells (BMSCs) becomes reduced with passage, establishment of culture condition that permit the rapid expansion of BMSCs while retaining their potential for differentiation is needed for clinical application. Bone morphogenetic proteins stimulate osteogenic differentiation in mesenchymal progenitor cells as well as increase stem cell numbers. Thus, we analyzed the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the osteogenic potential of rat BMSCs over several passages.

Material and methods Osteogenic differentiation in vitro was evaluated in terms of the alkaline phosphatase (ALP) activity and the osteocalcin (OC) concentration in the supernatants, and the expression of ALP and OC mRNA in the cultured cells. For in-vivo osteogenesis, BMSCs cultured with and without rhBMP-2 through all passages were implanted into athymic mice.

Results  The levels of osteogenic markers were significantly higher in the cells of the BMP(+) group than in the cells of the BMP(-) group, although they decreased with passage irrespective of whether or not rhBMP-2 was added. Similar to the in-vitro experiments, there was a greater degree of bone and cartilage tissue formation in the BMP(+) group over all passages.

Interpretation  From our results, osteogenic potential can be maintained even in BMSCs that have been passaged several times in the presence of rhBMP-2. These cells are capable of inducing and participating in bone formation and can be used for clinical applications.     

Calcium Phosphate Cement with BMP-2-loaded Gelatin Microspheres Enhances Bone Healing in Osteoporosis: A Pilot Study

Background

The capacity for bone healing reportedly is limited in osteoporosis with a less than ideal environment for healing of bone grafts. We therefore developed a composite bone substitute with rhBMP-2 loaded gelatin microsphere (GM) and calcium phosphate cement (CPC) to use in osteoporosis.

Questions/purposes

We asked whether (1) controlled release of rhBMP-2 could be improved in this composite bone substitute and (2) increasing factors released from the bone substitute could accelerate osteoporotic bone healing.

Methods

We soaked rhBMP-2/GM/CPC and rhBMP-2/CPC composites in simulated body fluid for 28 days and then determined the amount of rhBMP-2 released. Both composites were implanted in bone defects of osteoporotic goats and left in place for 45 and 140 days; the specimens then were evaluated mechanically (pushout test) and morphologically (CT scanning, histology).

Results

The in vitro study showed the new composite released more rhBMP-2 compared with rhBMP-2/CPC. CT showed the defects healed more quickly with new grafts. The bone mineralization rate was greater in rhBMP-2/GM/CPC than in rhBMP-2/CPC after 45 days of implantation and the pushout test was stronger after 45 and 140 days of implantation.

Conclusions

The new graft composite released more loaded factors and appeared to repair osteoporotic bone defects.

Clinical Relevance

These preliminary data suggest the new composite can be used as a bone substitute to accelerate healing of fractures and bone defects in osteoporosis.     

Reindeer BMP extract in the healing of critical-size bone defects in the radius of the rabbit

Background?Native BMP extracts from reindeer effectively induce ectopic new bone formation in vivo, but their bone healing properties have not yet been evaluated. We investigated the effect of reindeer BMP extracts on the healing of long bone defects.

Methods?The implants tested contained 5?mg or 10?mg of unsterilized BMP extract from reindeer and 10?mg of gamma-sterilized BMP extract administered with collagen carrier (Lyostypt, B. Braun, Germany). 70 μg of rhBMP-2 with collagen carrier (InductOs; Wyeth Europa) served as positive control, and collagen implants (Lyostypt) and untreated defects served as negative controls. New Zealand White rabbits with 1.5?cm of critical-size radius bone defects were used, with 8 weeks of follow-up.

Results?Radiographic analysis showed bone formation (BF) to be higher in all groups containing BMPs than in the untreated controls. BF was also higher in the rhBMP-2 group, and marginally higher in the group treated with 10?mg of unsterilized reindeer BMP extract (p = 0.06) as compared to the collagen controls. Bone union (BU) was better in the unsterilized BMP extract groups and rhBMP-2 group than in the untreated controls. BU was also better in the implants with 10?mg of unsterilized reindeer BMP extract and rhBMP-2 than in the collagen-treated implants. The mean area of new bone at the site of the defect proved to be higher in all implants containing BMP than in the untreated defects. It was also higher in the groups with 10?mg of unsterilized reindeer BMP extract and rhBMP-2 than in the collagen-treated controls. Mechanical tests showed torsional stiffness of the bones to be higher in the group with 10?mg of unsterilized BMP extract than in the collagen group. The mean cross-sectional bone area measured by pQCT densitometry was higher in the rhBMP-2 group than in the collagen group. The mean bone density at the defect area was higher in the group with 10?mg of unsterilized BMP than in the rhBMP-2 group.

Interpretation?We conclude that both reindeer BMP extract and rhBMP-2 induced improved healing of the rabbit radius bone defects at the doses used. Gamma sterilization of reindeer BMP extract reduced osteoinductivity slightly, but not significantly.     

The effect of noncoherent red light irradiation on proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells

Mesenchymal stem cells (MSCs) are promising for use in regenerative medicine. Low-level light irradiation (LLLI) has been shown to modulate various processes in different biological systems. The aim of our study was to investigate the effect of red light emitted from a light-emitting diode (LED) on bone marrow MSCs with or without osteogenic supplements. MSCs both with and without osteogenic supplements were divided into four groups, and each group was irradiated at doses of 0, 1, 2 and 4 J/cm². Cellular proliferation was evaluated using WST-8 and 5-ethynyl-2′-deoxyuridine (EdU) fluorescence staining. The alkaline phosphatase activity, mineralization, and expression of osteoblast master genes (Col1α1, Alpl, Bglap and Runx2) were monitored as indicators of MSC differentiation towards osteoblasts. In groups without osteogenic supplements, red light at all doses significantly stimulated cellular proliferation, whereas the osteogenic phenotype of the MSCs was not enhanced. In groups with osteogenic supplements, red light increased alkaline phosphatase activity and mineralized nodule formation, and stimulated the expression of Bglap and Runx2, but decreased cellular proliferation. In conclusion, nonconherent red light can promote proliferation but cannot induce osteogenic differentiation of MSCs in normal media, while it enhances osteogenic differentiation and decreases proliferation of MSCs in media with osteogenic supplements.     

慢病毒介导siRNA hsa-circ-0000885转染BMSCs与破骨细胞共培养体系对细胞分化、增殖和凋亡相关研究

目的:探究将siRNA hsa-circ-0000885修饰的骨髓间充质干细胞(bone marrow mesenchymal stem cells,BMSCs)后与破骨细胞共培养对BMSCs的成骨分化、细胞增殖和凋亡的影响,为临床上骨质疏松症(osteoporosis,OP)的治疗提供新的思路和方法。方法:选择自2018年9月至2020年2月收治的13例骨质疏松患者为研究对象,其中女11例,男2例,年龄(65.45±10.77)岁;取得患者知情同意后,抽取患者外周血组织。然后用circ RNA芯片检测外周血单个核细胞(peripheral blood mononuclear cell,PBMC)的circRNA的表达水平,用siRNA技术沉默circ RNA的表达,通过慢病毒转染BMSCs,根据是否转染hsa-circ-0000885的siRNA干扰质粒,将细胞分成空白组,空载体组和siRNA干扰组。各组细胞处理72 h后,用流式细胞仪检测细胞的周期,用AV-PI试剂盒检测细胞的凋亡水平,用ALP染色检测BMSCs的成骨分化能力。结果 :OP患者外周血PBMC中hsa-circ-0000885的表达量明显高于健康对照组患者(t=2.119,P0.05)。ALP染色结果表明,siRNA hsa-circ-0000885质粒可以促进BMSCs的成骨分化,明显高于空白组和空白质粒组(F=9.132,q=2.995,2.897;P=0.009,0.0120.05)。CCK-8试剂盒检测结果显示,siRNA hsa-circ-0000885干扰组BMSCs的细胞增殖率明显高于空白组和空白质粒组(F=9.881,q=2.457,2.904;P=0.032,0.0160.05)。而AV-PI试剂盒检测结果显示,siRNA干扰组细胞的凋亡率明显低于空白组和空白质粒组(F=10.208;q=2.885,3.001;P=0.019,0.0110.05)。结论:慢病毒介导siRNA hsa-circ-0000885质粒转染BMSCs与破骨细胞共培养体系可以促进细胞增殖,抑制细胞凋亡,促进BMSCs的成骨分化,可以作为OP患者潜在的治疗靶点。     

含重组人碱性成纤维细胞生长因子和重组人骨形态发生蛋白-2骨水泥在骨质疏松性腰椎压缩性骨折治疗的应用价值

目的:探讨含重组人碱性成纤维细胞生长因子(recombinant human basic fibroblast growth factor,rhbFGF)和重组人骨形态发生蛋白-2(recombinant human bone morphogenetic protein-2,rhBMP-2)骨水泥在骨质疏松性腰椎压缩性骨折(osteoporotic vertebral compression fracture,OVCF)患者经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的应用价值。方法:回顾性分析2018年1月至2021年1月收治的103例行PKP手术治疗的OVCF患者,男40例,女63例;年龄61~78(65.72±3.29)岁。受伤原因:滑倒33例,跌倒42例,提重物受伤28例。根据填充骨水泥不同分为3组:磷酸钙组34例,男14例,女20例,年龄(65.1±3.3)岁,填充磷酸钙骨水泥;rhBMP-2组34例,男12例,女22例,年龄(64.8±3.2)岁,填充含rhBMP-2的骨水泥;rhbFGF+rhBMP-2组35例,男14例,女21例,年龄(65.1±3.6)岁,填充含rhbFGF和rhBMP-2的骨水泥。比较3组Oswestry 功能障碍指数(Oswestry dysfunction index,ODI)、骨密度、椎体前缘丢失高度、伤椎前缘压缩率、疼痛视觉模拟评分(visual simulation score,VAS)及再骨折发生率。结果:所有患者获得12个月随访。3组术后ODI、VAS呈下降(P<0.001),骨密度增高(P<0.001),椎体前缘丢失高度、伤椎前缘压缩率呈先下降后缓慢上升趋势(P<0.001),rhbFGF+rhBMP-2组术后第1、6、12个月ODI、VAS均低于rhBMP-2组和磷酸钙组(P<0.05),术后第6、12个月骨密度大于rhBMP-2组和磷酸钙组(P<0.05)。rhbFGF+rhBMP-2组术后第6、12个月椎体前缘丢失高度、伤椎前缘压缩率均低于rhBMP-2组和磷酸钙组(P<0.05)。3组再骨折发生率比较差异无统计学意义(P>0.05)。结论:含rhbFGF和rhBMP-2骨水泥可更有效地增加OVCF患者骨密度,获得术后满意的临床和放射学效果,显著改善临床症状。     

Low-intensity pulsed ultrasound affects RUNX2 immunopositive osteogenic cells in delayed clinical fracture healing

IntroductionOsteogenic cell proliferation and differentiation play an important role in adequate fracture healing, and is target for osteoinductive therapies in delayed fracture healing. The aim of this study was to investigate whether low-intensity pulsed ultrasound enhances fracture healing at the tissue level in patients with a delayed union of the osteotomized fibula through an effect on the presence of RUNX2 immunopositive osteogenic cells. The effect was studied in both atrophic and hypertrophic delayed unions.Materials and methodsBiopsies were obtained from 6 female and 1 male patient (age 43–63) with a delayed union of the osteotomized fibula after a high tibial osteotomy treated for 2–4 months with or without low-intensity pulsed ultrasound in a randomized prospective double-blind placebo-controlled trial. Immunolocalization of RUNX2 protein was performed to identify osteogenic cells. Histomorphometrical analysis was performed to determine the number of cells expressing RUNX2 located within and around the newly formed woven bone at the fracture end (area of new bone formation), and up to 3 mm distant from the fracture end.ResultsCells expressing RUNX2 were present in all histological sections of control and low-intensity pulsed ultrasound-treated bone evaluated. Within the area of new bone formation, RUNX2 immunopositive cells were found in the undifferentiated soft connective tissue, at the bone surface (presumably osteoblasts), and within the newly formed woven bone. Low-intensity pulsed ultrasound treatment of fibula delayed unions significantly reduced the number of RUNX2 immunopositive cells within the soft connective tissue at the fracture ends, whereas the number of RUNX2 immunopositive cells at the bone surface was not affected. The number of RUNX2 immunopositive cells was similar for the atrophic and hypertrophic delayed unions.ConclusionsImmunolocalization of RUNX2 positive cells in delayed unions of the fibula reveals that delayed clinical fracture healing does not result in impairment of osteogenic cell proliferation and/or differentiation at the tissue level, even if delayed unions are clinically regarded as atrophic. Reduced number of osteogenic RUNX2 immunopositive cells within the soft connective tissue, and unchanged number of RUNX2 immunopositive cells at the bone surface, implicate that low-intensity pulsed ultrasound does not increase osteogenic cell presence, but likely affects osteogenic cell differentiation.     

rhBMP-2体外诱导骨质疏松大鼠BMSCs成骨及VEGF表达的研究

目的:观察骨形态发生蛋白-2对骨质疏松时骨髓基质干细胞(BMSCs)体外成骨及成骨因子VEGF表达的影响,为骨质疏松证的防治提供新的方法。方法:将20只6月龄,体重(300±20) g雌性SD大鼠双侧卵巢切除,术后3个月利用双能X线骨密度仪测量大鼠全身骨密度并与术前比较,确保造模成功,并运用全骨髓贴壁法培养骨质疏松大鼠BMSCs,倒置相差显微镜下观察BMSCs形态。随机把骨质疏松大鼠BMSCs 第2代(p2)细胞分成实验组和对照组,分别加入完全培养基(含rhBMP-2)、成骨诱导液进行成骨诱导。2周后茜素红染色法检测各组细胞钙结节的形成,酶标仪测定碱性磷酸酶活性及RT-PCR法检测VEGF的表达量。结果:(1)大鼠全身骨密度:手术前后大鼠全身骨密度分别为(0.179±0.007),(0.158±0.006) g/cm²,差异有统计学意义(t=4.180,P<0.05).(2)茜素红染色:BMSCs(P2)成骨诱导2周后实验组染色效果明显强与对照组。(3)碱性磷酸酶活性:BMSCs(P2)成骨诱导2周后碱性磷酸酶活性实验组明显高于对照组,分别为(15.62±1.27),(8.62±0.93) μg/prot,差异有统计学意义(t=7.709,P<0.01).(4)BMSCs(P2)成骨诱导2周后VEGF表达:实验组明显高于对照组,分别为3.723±0.143,0.950±0.072,差异有统计学意义(t=29.462,P<0.01).结论:rhBMP-2能提高去卵巢骨质疏松大鼠BMSCs的体外成骨能力,可促进成骨因子VEGF的表达,调控VEGF的表达可能是骨形态发生蛋白-2参与骨代谢的机制之一。     

Manipulation of the anabolic and catabolic responses with BMP-2 and zoledronic acid in a rat femoral fracture model

Bone repair involves a complex set of regulated signaling pathways that control the formation of new bone matrix and the resorption of damaged bone matrix at the fracture site. It has been reported that the optimal time point for single-dose zoledronic acid (ZA) administration systemically increased the strength of bone morphogenetic protein (BMP)-7-mediated callus. However, its repair mechanism during bone fracture healing remains unknown. We aimed to investigate the synergic effect of recombinant human (rh) BMP-2 and ZA in a rat femoral fracture model. Fifty-eight rats were divided into 4 groups. Group I (n = 14) animals were implanted with a carrier alone. Group II (n = 15) animals were implanted with a carrier containing 1-μg rhBMP-2. Group III (n = 14) animals were implanted with a carrier and a subcutaneous systemic ZA injection 2 weeks after surgery. Group IV (n = 15) animals were implanted with a carrier containing 1-μg rhBMP-2 and ZA subcutaneous injection 2 weeks after surgery. The rats were euthanized after 6 weeks and their fractured femurs were explanted and assessed by manual palpation, radiographs, and high-resolution micro-computerized tomography (micro-CT) and were subjected to biomechanical and histological analysis. The fusion rates in Group IV (93.3%) were considerably higher than those in Groups I (28.6%), II (53.3%), and III (57.1%). Additionally, the radiographic scores of Group IV were higher than those in Groups I, II, and III. In micro-CT analysis, the tissue volume (TV) of the callus was higher in Group IV than in Groups I and II (p < 0.05). New bone volume (BV) and trabecular spacing (Tb.Sp) also showed essentially the same trend as that of TV. The ratio of BV to TV (BV/TV), the trabecular number (Tb.N), and the trabecular thickness (Tb.Th) was higher in Groups III and IV than in Groups I and II (p < 0.05). In biomechanical analysis, the ultimate loads at failure and stiffness in Groups III and IV were on average higher than those in Groups I and II (p < 0.05), while the energy absorption of Group IV was higher than those of Groups I and II (p < 0.05). The synergic effect of rhBMP-2 and ZA given systemically as a single dose at the optimal time was efficacious for fracture repair and significantly enhanced bone fusion. Our results suggest that this combination facilitates bone healing and has potential clinical application.     

Association of ex-vivo expanded human mesenchymal stem cells and rhBMP-7 is highly effective in treating critical femoral defect in rats

Mesenchymal stem cells (MSC), easily culture-expanded from bone marrow, can significantly enhance bone defect healing. Several proteins, such as the bone morphogenetic proteins (BMPs) and in particular BMP-7, are involved in bone formation in vitro and in vivo. In this preclinical study, we evaluated if the association of human MSC (hMSC) with BMP-7 had synergic action on bone healing. Rat femoral defects (n=12) were treated with: autoclaved bone and mononucleated cells (MNC) as control group G1; bone and hMSC, group G2; bone with BMP-7, group G3; bone and hMSC plus BMP-7, group G4. Defect regeneration was evaluated with plain radiographs after 2, 4, 8 and 12 weeks and with histological analysis. We observed organized trabeculae bridging between the osteotomic ends of the host bone in rats treated with the association of hMSC and rhBMP-7. These trabeculae, formed by a core of devitalized tissue surrounded by osteoblasts, osteocytes and osteoclasts, were continuous with a cortical-like structure of bony tissue. Such new bone formation of the group treated with the association of hMSC and rhBMP-7 (G4) was clearly superior compared to rats treated with rhBMP-7 (G2) or hMSC (G3) alone, as shown by radiographic analysis and histological study. The present study suggests that the association of hMSC and BMP-7 is more effective than hMSC or BMP-7 alone in the healing of femoral defects in rats. Further studies with larger samples are required to confirm these results and to evaluate the best dosage.     

The vertebral interbody grafting site’s low concentration in osteogenic progenitors can greatly benefit from addition of iliac crest bone marrow

The ability of bone substitutes to promote bone fusion is contigent upon the presence of osteoinductive factors in the bone environment at the fusion site. Osteoblast progenitor cells are among these environmental osteoinductive factors, and one of the most abundant and available sources of osteoblastic cells is the bone marrow. As far as biological conditions are concerned, the vertebral interbody space appears as a favorable site for fusion, as it is surrounded by spongy bone, theoretically rich in osteogenic cells. This site may, however, not be as rich in osteogenic precursor cells especially at the time of grafting, because decortication of the vertebral end plates during the grafting process may modifiy cell content of the surrounding spongy bone. We tested this hypothesis by comparing the abundance of human osteogenic precursor cells in bone marrow derived from the iliac crest, the vertebral body, and the decorticated intervertebral body space. The number of potential osteoblast progenitors in each site was estimated by counting the alkaline phosphatase–expressing colony-forming units (CFU-AP). The results, however, demonstrate that the vertebral interbody space is actually poorer in osteoprogenitor cells than the iliac crest (P<0.001) and vertebral body (P<0.01), especially at the time of graft implantation. In light of our results, we advocate addition of iliac crest bone marrow aspirate to increase the success rate of vertebral interbody fusion.