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Bioactivation of scaffolds in osteonecrosis

Bioaktivierung von Scaffolds bei Osteonekrose

Abstract

Avascular osteonecrosis (AVN) due to local ischemia leads to an inhomogeneous osseous defect, which can be treated by resection and with bone substitute materials in a joint-preserving treatment. Due to the underlying risk profile of AVN, the mostly subchondral localization and the size of the local bone defect, bone regeneration is impaired. Therefore, bioactivation of the applied bone substitute materials prior to application is highly desirable. Apart from the use of growth factors and other soluble substances, the autologous application of location-typical cells and tissue is a useful alternative to support the bone healing properties of scaffolds. This article presents various methods to activate scaffolds for bone stimulation and discusses these techniques with respect to recent data from the literature.

Zusammenfassung

Knochennekrosen entstehen durch eine ossäre Minderperfusion und führen zu einer inhomogenen ossären Defektzone, die im Fall einer gelenkerhaltenden Therapie entfernt und mit Knochenersatzstoffen behandelt werden kann. Aufgrund des zugrunde liegenden Risikoprofils der AVN,, der meist subchondralen Lokalisation und der Defektgröße wird knöcherne Heilung beeinträchtigt. Daher ist eine Bioaktivierung der verwendeten Knochenersatzmaterialien erstrebenswert. Neben dem Einsatz von Wachstumsfaktoren und anderen löslichen Substanzen stellt die autologe Applikation von lokotypischen Zellen und Geweben eine weitere Möglichkeit dar, die Knochenheilungspotenz von Scaffolds zu erhöhen. In der vorliegenden Arbeit werden die verschiedenen Möglichkeiten der Osteostimulation vorgestellt und diese unter dem Hintergrund der wissenschaftlichen Literatur diskutiert.

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Abbreviations

ARCO:

Association Research Circulation Osseous classification

AVN:

Avascular osteonecrosis

BMP:

Bone morphogenetic proteins

CD40 :

Cluster of differentiation 40

ECM:

Extracellular matrix

EPR:

Endoplasmic reticulum

EV:

Extracellular vesicles

HA:

Hydroxyapatite

IFU:

Instruction for use

IGF:

Insulin-like growth factor

IL:

Interleukin

MFGE8:

Human Milk Fat Globule EGF Factor 8

MMP:

Matrix-Metalloprotease

MSC:

Mesenchymale Stromazelle

MTT:

3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide

PCL:

Poly(ε-caprolactone)

PDCD6IP:

Programmed Cell Death 6 Interacting Protein

PDGF:

Platelet-derived growth factor

PEGMC:

Poly(ethylene glycol) maleate citrate

PLA:

Polylactide

PLGA:

Poly(lactide-co-glycolide)

PLGA-mPEG:

PLGA-methoxy poly(ethylene glycol)

PMMA:

Polymethylmethacrylat

PRF:

Platelet-rich fibrin

PRP:

Platelet-rich plasma

rhBMP‑2:

Recombinant human BMP

SEM:

Scanning electron microscope

TCP:

Tricalcium phosphate

TGF:

Transforming growth factor

TNF:

Tumor necrosis factor

TSG101:

Tumor Susceptibility Gene 101

VEGF:

Vascular endothelial growth factor

XACB:

Xenogeneic antigen-extracted cancellous bone

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Correspondence to M. Jäger.

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Conflict of interest

M. Jäger, A. Busch and A. Sowislok declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Jäger, M., Busch, A. & Sowislok, A. Bioactivation of scaffolds in osteonecrosis. Orthopädie 51, 808–814 (2022). https://doi.org/10.1007/s00132-022-04303-z

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Keywords

  • Growth factors
  • Osseointegration
  • Bone substitutes
  • Biocompatible materials
  • Bone regeneration

Schlüsselwörter

  • Wachstumsfaktoren
  • Osseointegration
  • Knochenersatz
  • Biokompatible Materialien
  • Knochenheilung