ABSTRACT
BACKGROUND: It is known that the application of growth factors can enhance fracture healing in defect fractures. The role of bone marrow aspirate (BMA) in combination with BMP-7 and the dosage of rh BMP-7 are still under discussion. Our hypothesis was that the combination of rh-BMP-7 with BMA can heal bone defects more effectively than rh-BMP-7 alone. METHODS: Twenty-eight rats obtained a 5 mm critical size defect in the diaphysis of the right femur which was stabilized by a plate. Rh-BMP-7 was applied at 10 and 200 µg either with collagen or together with collagen and BMA. Collagen only and collagen with BMA served as control groups. Blood flow was assessed by laser Doppler flowmetry in regular time intervals until euthanasia. Callus formation and bone density were measured by micro-computed tomography and biomechanical stability was evaluated by torsional testing at 4 weeks, postoperatively. RESULTS: Blood flow increased at the operated side after surgery until the second postoperative week independent of treatment. Animals treated with high dose BMP-7 showed significantly (p = 0.001) increased mechanical stiffness independent of BMA treatment. Failure loads were lowest for the two control groups (p = 0.001). The reduction of the BMP-7 dose led to less callus tissue and lower biomechanical stability. BMA did not show significant influence on bone healing. CONCLUSION: The combination of an rhBMP-7 dose that would be equivalent to a dose used clinically in humans with bone marrow aspirate does not heal a critical bone defect more effectively than the same rhBMP-7 dose alone.
Subject(s)
Bone Marrow , Bone Morphogenetic Protein 7/pharmacology , Femoral Fractures/drug therapy , Fracture Healing/physiology , Animals , Biomechanical Phenomena , Blood Flow Velocity/physiology , Bone Morphogenetic Protein 7/administration & dosage , Femur/blood supply , Femur/physiology , Male , Rats, Inbred F344 , X-Ray MicrotomographyABSTRACT
The direct, local, administration of adenovirus carrying human BMP-2 cDNA (Ad.BMP-2) heals critical-sized femoral bone defects in rabbit and rat models. However, the outcome is suboptimal and the technology needs to provide a more reliable and uniform outcome. To this end, we investigated whether the timing of Ad.BMP-2 administration influenced the formation of mineralized tissue within the defect. Critical-sized defects were created in the femora of 28 Sprague-Dawley rats. Animals were injected intralesionally with a single, percutaneous injection of Ad.BMP-2 (4 x 10(8) plaque-forming units) either intraoperatively (day 0) or 24 h (day 1), 5 days or 10 days after surgery. The femora were evaluated 8 weeks after surgery by X-ray, microcomputed tomography, dual-energy X-ray absorptiometry and biomechanical testing. The incidence of radiological union was markedly increased when administration of Ad.BMP-2 was delayed until days 5 and 10, at which point 86% of the defects healed. These time points also provided greater bone mineral content within the defect site and improved the average mechanical strength of the healed bone. Thus, delaying the injection of Ad.BMP-2 until 5 or 10 days after surgery enables a greater percentage of critical-sized, segmental defects to achieve radiological union, producing a repair tissue with enhanced mineralization and greater mechanical strength.
Subject(s)
Adenoviridae/genetics , Bone Morphogenetic Proteins/genetics , Fractures, Bone/therapy , Genetic Therapy/methods , Genetic Vectors/administration & dosage , Transduction, Genetic/methods , Transforming Growth Factor beta/genetics , Animals , Bone Morphogenetic Protein 2 , Bone Morphogenetic Proteins/metabolism , Bone Regeneration , Bone and Bones/metabolism , Bone and Bones/pathology , Fracture Fixation/methods , Fracture Healing , Fractures, Bone/metabolism , Fractures, Bone/pathology , Male , Models, Animal , Rats , Rats, Sprague-Dawley , Transforming Growth Factor beta/metabolismABSTRACT
Advances in understanding the biology of rheumatoid arthritis (RA) have opened new therapeutic avenues. One of these, gene therapy, involves the delivery to patients of genes encoding anti-arthritic proteins. This approach has shown efficacy in animal models of RA, and the first human, phase I trial has just been successfully completed. Hand surgery featured prominently in this pioneering study, as a potentially anti-arthritic gene encoding the interleukin-1 receptor antagonist was transferred to the metacarpophalangeal joints of subjects with RA one week before total joint arthroplasty. This study has confirmed that it is possible to transfer genes safely to human joints. It should pave the way for additional application of gene therapy to arthritis and other orthopaedic conditions.
