Roland Steck

Bone Regeneration Based on Tissue Engineering Conceptions - A 21st Century Perspective.

The role of Bone Tissue Engineering in the field of Regenerative Medicine has been the topic of substantial research over the past two decades. Technological advances have improved orthopaedic implants and surgical techniques for bone reconstruction. However, improvements in surgical techniques to reconstruct bone have been limited by the paucity of autologous materials available and donor site morbidity. Recent advances in the development of biomaterials have provided attractive alternatives to bone grafting expanding the surgical options for restoring the form and function of injured bone. Specifically, novel bioactive (second generation) biomaterials have been developed that are characterised by controlled action and reaction to the host tissue environment, whilst exhibiting controlled chemical breakdown and resorption with an ultimate replacement by regenerating tissue. Future generations of biomaterials (third generation) are designed to be not only osteoconductive but also osteoinductive, i.e. to stimulate regeneration of host tissues by combining tissue engineering and in situ tissue regeneration methods with a focus on novel applications. These techniques will lead to novel possibilities for tissue regeneration and repair. At present, tissue engineered constructs that may find future use as bone grafts for complex skeletal defects, whether from post-traumatic, degenerative, neoplastic or congenital/developmental “origin” require osseous reconstruction to ensure structural and functional integrity. Engineering functional bone using combinations of cells, scaffolds and bioactive factors is a promising strategy and a particular feature for future development in the area of hybrid materials which are able to exhibit suitable biomimetic and mechanical properties. This review will discuss the state of the art in this field and what we can expect from future generations of bone regeneration concepts.

β-Glucan triggers spondylarthritis and Crohn's disease-like ileitis in SKG mice

OBJECTIVE The spondylarthritides (SpA), including ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis, and arthritis associated with inflammatory bowel disease, cause chronic inflammation of the large peripheral and axial joints, eyes, skin, ileum, and colon. Genetic studies reveal common candidate genes for AS, PsA, and Crohns disease, including IL23R, IL12B, STAT3, and CARD9, all of which are associated with interleukin-23 (IL-23) signaling downstream of the dectin 1 β-glucan receptor. In autoimmune-prone SKG mice with mutated ZAP-70, which attenuates T cell receptor signaling and increases the autoreactivity of T cells in the peripheral repertoire, IL-17-dependent inflammatory arthritis developed after dectin 1-mediated fungal infection. This study was undertaken to determine whether SKG mice injected with 1,3-β-glucan (curdlan) develop evidence of SpA, and the relationship of innate and adaptive autoimmunity to this process. METHODS SKG mice and control BALB/c mice were injected once with curdlan or mannan. Arthritis was scored weekly, and organs were assessed for pathologic features. Anti-IL-23 monoclonal antibodies were injected into curdlan-treated SKG mice. CD4+ T cells were transferred from curdlan-treated mice to SCID mice, and sera were analyzed for autoantibodies. RESULTS After systemic injection of curdlan, SKG mice developed enthesitis, wrist, ankle, and sacroiliac joint arthritis, dactylitis, plantar fasciitis, vertebral inflammation, ileitis resembling Crohns disease, and unilateral uveitis. Mannan triggered spondylitis and arthritis. Arthritis and spondylitis were T cell- and IL-23-dependent and were transferable to SCID recipients with CD4+ T cells. SpA was associated with collagen- and proteoglycan-specific autoantibodies. CONCLUSION Our findings indicate that the SKG ZAP-70W163C mutation predisposes BALB/c mice to SpA, resulting from innate and adaptive autoimmunity, after systemic β-glucan or mannan exposure.

Small animal bone healing models: Standards, tips, and pitfalls results of a consensus meeting

Small animal fracture models have gained increasing interest in fracture healing studies. To achieve standardized and defined study conditions, various variables must be carefully controlled when designing fracture healing experiments in mice or rats. The strain, age and sex of the animals may influence the process of fracture healing. Furthermore, the choice of the fracture fixation technique depends on the questions addressed, whereby intra- and extramedullary implants as well as open and closed surgical approaches may be considered. During the last few years, a variety of different, highly sophisticated implants for fracture fixation in small animals have been developed. Rigid fixation with locking plates or external fixators results in predominantly intramembranous healing in both mice and rats. Locking plates, external fixators, intramedullary screws, the locking nail and the pin-clip device allow different degrees of stability resulting in various amounts of endochondral and intramembranous healing. The use of common pins that do not provide rotational and axial stability during fracture stabilization should be discouraged in the future. Analyses should include at least biomechanical and histological evaluations, even if the focus of the study is directed towards the elucidation of molecular mechanisms of fracture healing using the largely available spectrum of antibodies and gene-targeted animals to study molecular mechanisms of fracture healing. This review discusses distinct requirements for the experimental setups as well as the advantages and pitfalls of the different fixation techniques in rats and mice.

A finite difference model of load-induced fluid displacements within bone under mechanical loading.

Load-induced fluid flow in the lacunocanalicular network, induced by the mechanical loading of bone, is believed to play an important role in bone modelling, remodelling and adaptation processes. There are strong indications that this fluid flow is responsible for the mechanotransduction from external mechanical loads to the cells responsible for bone apposition or removal. Since direct flow measurements (especially in compact bone, in vivo and in situ) are not yet possible, theoretical modelling offers an alternative approach to determine the fluid flow velocities, displacements and effects of interstitial fluid flow. In this model, the fluid displacements in a middiaphyseal slab of a rat tibia under a cyclic four-point-bending load were calculated by applying Biots theory of poroelasticity. The resulting differential equations were solved numerically for the fluid displacement vectors using the finite difference method. Thereby, the cross section located in the middle between the two inner points of force application was chosen for examination, such that the problem, although formulated in three dimensions, reduced itself to an essentially planar form. The maximal fluid displacements for the vector components in the cross sectional plane were found in the proximity of the neutral axis of bending. The direction of the displacement vectors was from the lateral aspect, which was in compression in the examined loading situation, towards the medial aspect in tension. In a parameter study it was found that the fluid displacement pattern and the distribution of fluid displacements remained constant for all the examined parameters, while the magnitude was influenced by the model parameters Youngs modulus, Poissons ratio and porosity. This study represents a further step in the examination of load-induced fluid displacements in loaded bone using theoretical models, aiming to understand the relationship between mechanical loading and bone modelling, remodelling and functional adaptation.

Melt-electrospun polycaprolactone strontium-substituted bioactive glass scaffolds for bone regeneration: Melt-Electrospun Polycaprolactone-Strontium

Polycaprolactone (PCL) is a resorbable polymer used extensively in bone tissue engineering owing to good structural properties and processability. Strontium-substituted bioactive glass (SrBG) has the ability to promote osteogenesis and may be incorporated into scaffolds intended for bone repair. Here, we describe for the first time, the development of a PCL-SrBG composite scaffold incorporating 10% (weight) of SrBG particles into PCL bulk, produced by the technique of melt electrospinning. We show that we are able to reproducibly manufacture composite scaffolds with an interconnected porous structure and, furthermore, these scaffolds were demonstrated to be noncytotoxic in vitro. Ions present in the SrBG component were shown to dissolve into cell culture media and promoted precipitation of a calcium phosphate layer on the scaffold surface which in turn led to noticeably enhanced alkaline phosphatase activity in MC3T3-E1 cells compared to PLC-only scaffolds. These results suggest that melt-electrospun PCL-SrBG composite scaffolds show potential to become effective bone graft substitutes.

Melt‐electrospun polycaprolactone strontium‐substituted bioactive glass scaffolds for bone regeneration

Polycaprolactone (PCL) is a resorbable polymer used extensively in bone tissue engineering owing to good structural properties and processability. Strontium substituted bioactive glass (SrBG) has the ability to promote osteogenesis and may be incorporated into scaffolds intended for bone repair. Here we describe for the first time, the development of a PCL-SrBG composite scaffold incorporating 10% (weight) of SrBG particles into PCL bulk, produced by the technique of melt-electrospinning. We show that we are able to reproducibly manufacture composite scaffolds with an interconnected porous structure and, furthermore, these scaffolds were demonstrated to be non-cytotoxic in vitro. Ions present in the SrBG component were shown to dissolve into cell culture media and promoted precipitation of a calcium phosphate layer on the scaffold surface which in turn led to noticeably enhanced alkaline phosphatase activity in MC3T3-E1 cells compared to PLC-only scaffolds. These results suggest that melt-electrospun PCL-SrBG composite scaffolds show potential to become effective bone graft substitutes.

Composites for Delivery of Therapeutics: Combining Melt Electrospun Scaffolds with Loaded Electrosprayed Microparticles

A novel strategy is reported to produce biodegradable microfiber-scaffolds layered with high densities of microparticles encapsulating a model protein. Direct electrospraying on highly porous melt electrospun scaffolds provides a reproducible scaffold coating throughout the entire architecture. The burst release of protein is significantly reduced due to the immobilization of microparticles on the surface of the scaffold and release mechanisms are dependent on protein-polymer interactions. The composite scaffolds have a positive biological effect in contact with precursor osteoblast cells up to 18 days in culture. The scaffold design achieved with the techniques presented here endorses these new composite scaffolds as promising templates for growth factor delivery.

Bone as an inspiration for a novel class of mechanoactive materials

Fortuitous combinations of anisotropic stiffness and permeability coefficients in a poroelastic structure (e.g. bone) result in counterintuitive flow when the structure is subjected to tension or compression. Nonlinearities in flow and transport result when loading is asymmetrical (tension and compression are not balanced over the course of a cycle), boundary conditions are asymmetrical (area available for inflow or outflow) or uptake of the transported agent is factored in (ratchet effect). These properties can be exploited for the development of flow directing materials, e.g. wound dressings that prevent development of stress concentrators while augmenting transport of pharmaceuticals to the wound site, as well as transport of drainage away from the wound site, via convective flow. The dressings are designed as carriers of pharmaceutical agents. Normally, the delivery of these agents is diffusion driven, e.g. as in nicotine, pain abatement, and hormone replacement therapy patches. However, by designing the structure of the pharmaceutical doped dressings to mimic the relationship between stiffness and permeability coefficients shown to produce counterintuitive flow in bone, it is possible to deliver the pharmaceuticals to the wound site and imbibe exudant from the wound in an accelerated fashion via convective transport. This unprecedented approach harnesses the mass and movement of the patient to provide the impetus for flow to and from the wound. It has a range of further applications in not only the medical sector but also the textile industry as well as in microfluidics.

More is not necessarily better. A biomechanical study on distal screw numbers in volar locking distal radius plates.

INTRODUCTION Currently available volar locking plates for the treatment of distal radius fractures incorporate at least two distal screw rows for fixation of the metaphyseal fragment and have a variable-angle locking mechanism which allows placement of the screws in various directions There is, however no evidence that these plates translate into better outcomes or have superior biomechanical properties to first generation plates, which had a single distal screw row and fixed-angle locking. The aim of our biomechanical study was to compare fixed-angle single-row plates with variable-angle multi-row plates to clarify the optimal number of locking screws. MATERIALS AND METHODS Five different plate-screw combinations of three different manufacturers were tested, each group consisting of five synthetic fourth generation distal radius bones. An AO type C2 fracture was created and the fractures were plated according to each manufacturers recommendations. The specimens then underwent cyclic and load-to-failure testing. An optical motion analysis system was used to detect displacement of fragments. RESULTS No significant differences were detected after cyclic loading as well as after load-to-failure testing, neither in regard to axial deformation, implant rigidity or maximum displacement. The fixed-angle single-row plate showed the highest pre-test rigidity, least increase in post-testing rigidity and highest load-to-failure rigidity and least radial shortening. The radial shortening of plates with two distal screw rows was 3.1 and 4.3 times higher, respectively, than that of the fixed-angle single-row plate. CONCLUSION The results of our study indicate that two distal screw rows do not add to construct rigidity and resistance against loss of reduction. Well conducted clinical studies based on the findings of biomechanical studies are necessary to determine the optimal number of screws necessary to achieve reproducibly good results in the treatment of distal radius fractures.

In silico stochastic network models that emulate the molecular sieving characteristics of bone

Recent studies implicate bone’s extracellular matrix as a “living electrophoresis and ion exchange column’’ with low pass filter function at the matrix level; whereas small molecules pass through the matrix microporosity, larger molecules penetrate the tissue through the pericellular space. In this study, stochastic network modeling principles were applied, for the first time to our knowledge, to build in silico, nano- to microscale models of bone. Small volumes of bone were modeled to include hierarchical levels of porosity comprising the bone matrix microporosity and the pericellular network. Flow and transport through the network was calculated for molecules from 1,000 to 100,000 datons (Da). On the basis of this study, two contrasting effects determine the rate and direction of transport of different size molecules through the hierarchical porous network of bone. Whereas diffusivity of a given molecule decreases with increasing molecular size, the size exclusion effects of bone’s low pass molecular sieve translate into increasing flow velocities for large molecular species along transport paths located in the immediate vicinity of the cells. Both phenomena are expected to have a profound effect on the formation of molecular gradients at a tissue level, providing cues for tissue generation and repair by cellular “micromachines,’’ i.e., osteoclasts and osteoblasts.