Kouji Naruse

Distinct Anabolic Response of Osteoblast to Low‐Intensity Pulsed Ultrasound

Low‐intensity pulsed ultrasound, a form of mechanical energy transmitted as high‐frequency acoustical pressure waves, provides noninvasive therapeutic treatment for accelerating fracture repair and distraction osteogenesis. Relatively young osteoblasts respond to ultrasound by transiently upregulating message levels of immediate‐early genes as well as that of osteocalcin and insulin‐like growth factor I (IGF‐I). Osteocytes derived from newborn rat tibia and calvaria responded to a lesser extent only in c‐fos and cyclooxygenase‐2 (COX‐2) messages. Compared with the stretched osteocytes, which use stretch‐activated and parathyroid hormone (PTH)‐potentiated Ca2+ influx as an entry route to the protein kinase A (PKA) signal transduction pathways, there was no evidence of Ca2+ internalization by any of the cells tested on exposure to the ultrasound. On the other hand, inhibitors of p38 mitogen‐activated protein kinase (MAPK) and upstream phosphoinositide 3‐kinase (PI3K) blocked COX‐2 and osteocalcin upregulation by the ultrasound‐exposed ST2, murine bone marrow‐derived cells. This is distinct from the aforementioned osteocytic response to low‐frequency stretching and implies the involvement of integrins. Our findings suggested that accelerated fracture repair and distraction osteogenesis by the low‐intensity pulsed ultrasound depend, at least in part, on the stimulation of osteoblastic cells at relatively early stages of osteogenic lineage. Bone is under control of multiple regulatory mechanisms so that diverse physical forces can be reflected to the microenvironment of each cell, in turn, to the entire bone.

In vitro comparison of elution characteristics of vancomycin from calcium phosphate cement and polymethylmethacrylate

BackgroundCalcium phosphate cement [CPC (Biopex®)] has been used as the drug delivery system of choice for treatment of infected joint replacement because of its good elution efficiency. The influence of CPC polymerization on the bactericidal activity of vancomycin (VCM) impregnated into CPC has not been investigated. We compared VCM concentration, bactericidal activity, and profile of eluates between CPC and polymethylmethacrylate (PMMA; Cemex RX®).MethodsTest specimens consisted of a powder composite of CPC or PMMA, VCM and solvent (10:0.25:3.3 g). Each test specimen was immersed in sterile phosphate-buffered saline. Eluates obtained on days 1, 3, 7, and 14 and weeks 4, 8, and 12 were evaluated by high performance liquid chromatography (HPLC) and by microbiological assay (MBA).ResultsThe elution level of VCM from CPC/VCM on day 1 was 8.1 fold greater than that from PMMA/VCM. The detection periods of VCM from CPC/VCM and PMMA/VCM were 8 weeks and 14 days, respectively. The values of eluates from CPC/VCM and PMMA/VCM obtained by HPLC were comparable to those obtained by MBA. HPLC chromatogram showed that the elution profiles of VCM from CPC/VCM and PMMA/VCM on day 1 were very close to those of standard solutions.ConclusionsCPC could release more VCM over a longer period than PMMA. The polymerization of CPC and PMMA did not alter the inhibitory activity of VCM and did not denature VCM.

PROLONGED ENDOCHONDRAL BONE HEALING IN SENESCENCE IS SHORTENED BY LOW-INTENSITY PULSED ULTRASOUND IN A MANNER DEPENDENT ON COX-2

To test whether mechanical loading produces faster healing in aged mice, fractured femurs of aged 1-year-old mice were subjected to low-intensity pulsed ultrasound (LIPUS), a treatment that is routinely used to help heal fractures in humans. Cyclooxygenase-2 knockout mice (COX-2(-/-)), which lack an immediate early mediator of mechanical stimulation, were also studied by histochemistry, microcomputed tomography and quantitative polymerase chain reaction to determine the role of COX-2. The healing in the aged COX-2(-/-) mice is slow during the endochondral bone remodeling (>30 d), a period generally prolonged in senescence. For aged wild-type mice, LIPUS halved the endochondral phase to about 10 d, whereas that was not the case for aged COX-2(-/-) mice, which showed no apparent shortening of the prolonged endochondral-phase healing time. Injecting prostaglandin E(2) receptor agonists, however, rescued the COX-2(-/-) callus from insensitivity to LIPUS. In conclusion, COX-2 is a limiting factor in the delayed endochondral bone healing and is induced by LIPUS, which normalizes healing rate to the wild-type level.

Acceleration of periosteal bone formation by human basic fibroblast growth factor containing a collagen‐binding domain from Clostridium histolyticum collagenase

Basic fibroblast growth factor 2 (bFGF) is a potent mitogen for mesenchymal cells, and the local application of recombinant bFGF accelerates bone union and defect repair. However, repeated dosing is required for sustained therapeutic effect as the efficacy of bFGF decreases rapidly following its diffusion from bone defect sites. Here, we attempted to develop a collagen-based bone formation system using a fusion protein (collagen binding-bFGF, CB-bFGF) consisting of bFGF and the collagen-binding domain (CBD) of Clostridium histolyticum collagenase. The addition of the CBD to bFGF did not modify its native biological activity, as shown by the capacity of the fusion protein to promote the in vitro proliferation of periosteal mesenchymal cells. The affinity of the fusion protein towards collagen and demineralized bone matrix (DBM) was also confirmed by collagen-binding assays. Moreover, in vivo periosteal bone formation assays showed that the combination of CB-bFGF with a collagen sheet induced periosteal bone formation at protein concentrations lower than those required for bFGF alone. In addition, grafts of DBM loaded with CB-bFGF accelerated new bone formation in rat femurs compared to the same concentration of bFGF administered alone. Taken together, these properties suggest that the CB-bFGF/collagen composite is a promising material for bone repair in the clinical setting.

Osteoarthritic Changes of the Patellofemoral Joint in STR/OrtCrlj Mice Are the Earliest Detectable Changes and may be Caused by Internal Tibial Torsion

STR/ort mice develop a naturally occurring osteoarthritis (OA) of the knee joints. However, the evaluation of early OA changes has been difficult due to variability caused by gender, individual differences, and differences between the right and left lower limbs. The objective of this study was to analyze the variability of the early OA changes with age in STR/ort mice and to identify the cause of onset. A total of 115 STR/OrtCrlj mice aged 10–45 weeks were examined. In addition to conventional radiological and histological evaluation of the knee joints, histological sections were used to examine the patellofemoral, femorotibial, and growth plate cartilage under similar conditions. A morphological evaluation of tibiae, including micro-3-dimensional computed tomography, was performed. Radiological evaluation showed OA changes in the joints of mice over 35 weeks old and histological evaluation showed early OA changes in the femorotibial joints of mice over 26 weeks old. However, these changes were not common in all individuals. In contrast, most common and reproducible OA changes were observed in the bilateral patellofemoral joints of all individuals, and even in subjects ranging from 10 to 20 weeks of age. Morphological evaluations also demonstrated an abnormal tibial internal torsion that increased with age and was associated with medial patellar dislocation. In conclusion, the earliest histological OA change was observed in the patellofemoral joint prior to similar observations in the femorotibial joint. Internal tibial torsion may be a cause of OA in the patellofemoral joints, which leads to the development of medial femorotibial OA.

Quality assessment for processed and sterilized bone using Raman spectroscopy

To eliminate the potential for infection, many tissue banks routinely process and terminally sterilize allografts prior to transplantation. A number of techniques, including the use of scanning electron microscopy, bone graft models, and mechanical property tests, are used to evaluate the properties of allograft bone. However, as these methods are time consuming and often destroy the bone sample, the quality assessment of allograft bones are not routinely performed after processing and sterilization procedures. Raman spectroscopy is a non-destructive, rapid analysis technique that requires only small sample volumes and has recently been used to evaluate the mineral content, mineral crystallinity, acid phosphate and carbonate contents, and collagen maturity in human and animal bones. Here, to establish a quality assessment method of allograft bones using Raman spectroscopy, the effect of several common sterilization and preservation procedures on rat femoral bones were investigated. We found that freeze–thawing had no detectable effects on the composition of bone minerals or matrix, although heat treatment and gamma irradiation resulted in altered Raman spectra. Our findings suggest Raman spectroscopy may facilitate the quality control of allograft bone after processing and sterilization procedures.

Repeated freeze–thaw cycles reduce the survival rate of osteocytes in bone-tendon constructs without affecting the mechanical properties of tendons

Frozen bone-patellar tendon bone allografts are useful in anterior cruciate ligament reconstruction as the freezing procedure kills tissue cells, thereby reducing immunogenicity of the grafts. However, a small portion of cells in human femoral heads treated by standard bone-bank freezing procedures survive, thus limiting the effectiveness of allografts. Here, we characterized the survival rates and mechanisms of cells isolated from rat bones and tendons that were subjected to freeze–thaw treatments, and evaluated the influence of these treatments on the mechanical properties of tendons. After a single freeze–thaw cycle, most cells isolated from frozen bone appeared morphologically as osteocytes and expressed both osteoblast- and osteocyte-related genes. Transmission electron microscopic observation of frozen cells using freeze-substitution revealed that a small number of osteocytes maintained large nuclei with intact double membranes, indicating that these osteocytes in bone matrix were resistant to ice crystal formation. We found that tendon cells were completely killed by a single freeze–thaw cycle, whereas bone cells exhibited a relatively high survival rate, although survival was significantly reduced after three freeze–thaw cycles. In patella tendons, the ultimate stress, Young’s modulus, and strain at failure showed no significant differences between untreated tendons and those subjected to five freeze–thaw cycles. In conclusion, we identified that cells surviving after freeze–thaw treatment of rat bones were predominantly osteocytes. We propose that repeated freeze–thaw cycles could be applied for processing bone-tendon constructs prior to grafting as the treatment did not affect the mechanical property of tendons and drastically reduced surviving osteocytes, thereby potentially decreasing allograft immunogenecity.

Therapeutic Ultrasound Induces Periosteal Ossification Without Apparent Changes in Cartilage

Low intensity pulsed ultrasound (LIPUS) is an extremely useful noninvasive treatment which halves the duration of fracture healing when the bone is exposed once a day for 20 min. To elucidate the direct reactions of bone and cartilage, dissected rat femora were immobilized in culture dish wells, exposed to LIPUS from a certain angle every day, and the local pattern of ossification was analyzed in relation to the ultrasound. Daily 20-min exposures were started 24 hr after isolation of the femora, and at days 5, 10, and 15, samples were harvested for measurements, morphological, and histochemical analyses. While the gross features of the samples were identical to the untreated controls, extended mineralization of the periosteum was observed with alizarin red staining, antiosteocalcin immunohistochemical staining, and micro-three dimensional computed tomography. Interestingly, the newly deposited mineral was found perpendicular to the ultrasound path, strongly suggesting that LIPUS accelerates periosteal bone formation. Zones of epiphyseal cartilage and hypertrophic and calcified cartilage did not exhibit any differences with and without this exposure. LIPUS also did not influence the secreted proteoglycan components or amounts in the culture medium. The absence of any additional longitudinal growth of the femur demonstrated that LIPUS did not accelerate endochondral bone formation. We conclude that cartilage alone does not directly respond to therapeutic ultrasound, whereas the periosteum does.

Increase of circulating CD11b(+)Gr1(+) cells and recruitment into the synovium in osteoarthritic mice with hyperlipidemia.

Although recent studies suggest that hyperlipidemia is a risk factor for osteoarthritis (OA), the link between OA and hyperlipidemia is not fully understood. As the number of activated, circulating myeloid cells is increased during hyperlipidemia, we speculate that myeloid cells contribute to the pathology of OA. Here, we characterized myeloid cells in STR/Ort mice, a murine osteoarthritis model, under hyperlipidemic conditions. Ratios of myeloid cells in bone marrow, the spleen, and peripheral blood were determined by flow cytometry. To examine the influence of the hematopoietic environment, including abnormal stem cells, on the hematopoietic profile of STR/Ort mice, bone marrow transplantations were performed. The relationship between hyperlipidemia and abnormal hematopoiesis was examined by evaluating biochemical parameters and spleen weight of F2 animals (STR/Ort x C57BL/6J). In STR/Ort mice, the ratio of CD11b+Gr1+ cells in spleens and peripheral blood was increased, and CD11b+Gr1+ cells were also present in synovial tissue. Splenomegaly was observed and correlated with the ratio of CD11b+Gr1+ cells. When bone marrow from GFP-expressing mice was transplanted into STR/Ort mice, no difference in the percentage of CD11b+Gr1+ cells was observed between transplanted and age-matched STR/Ort mice. Analysis of biochemical parameters in F2 mice showed that spleen weight correlated with serum total cholesterol. These results suggest that the increase in circulating and splenic CD11b+Gr1+ cells in STR/Ort mice originates from hypercholesterolemia. Further investigation of the function of CD11b+Gr1+ cells in synovial tissue may reveal the pathology of OA in STR/Ort mice.

The expense for one implantation of a banked bone allograft from a cadaveric donor and the issues affecting current advanced medical treatment in the Japanese orthopaedic field

Demand for banked bone allografts is increasing in Japan; however, there are too few bone banks and the bone bank network is not well-established. One reason for this was lack of funding for banks. Bone banks had to bear all material expenses of banked bone allografts themselves because this was not designated a covered expense. In December 2004, the Japanese government started a new “Advanced Medical Treatment” administration system which allowed an approved institution to charge the expense of authorized advanced medical treatments directly to patients. The treatment named “Cryopreserved allogenic bone and ligamentous tissue retrieved from cadaveric donor” was approved as an advanced medical treatment in March 2007. We present the calculation method and the expense per implantation of a banked bone allograft from a cadaveric donor under this treatment and raise issues which affect this advanced medical treatment and remain to be resolved in the Japanese orthopaedic field.