Abstract
BackgroundHypoxia is the critical driving force for angiogenesis and can trigger the osteogenic-angiogenic coupling followed by the enhancement of bone regeneration. While lots of studies showed that hypoxia administration can accelerate bone formation during distraction osteogenesis (DO), the therapeutic timing for the osteogenic purpose was concentrated on the distraction phase. The outcomes of hypoxia administration in the consolidation phase stay uncertain. The purpose of this study was to determine the osteogenic effectiveness of hypoxia therapy during the consolidation phase, if any, to enhance bone regeneration in a rat femoral DO model.MethodsA total of 42 adult male Sprague-Dawley rats underwent right femoral mid-diaphysis transverse osteotomy and were randomly divided into Control (NS administration, n = 21) and Group1 (deferoxamine therapy, n = 21) after distraction. During the consolidation phase, Group1 was treated with local deferoxamine (DFO) injection into the distraction zone, while the Control underwent the same dosage of NS. Animals were sacrificed after 2, 4, and 6 weeks of consolidation. The process of bone formation and remodeling was monitored by digital radiographs, and the regenerated bone was evaluated by micro-computed tomography (micro-CT), biomechanical test, and histological analysis. The serum content of hypoxia-inducible factor 1α (HIF-1α) and vascular endothelial growth factor (VEGF) were measured by enzyme linked immunosorbent assay (ELISA) for further analysis.ResultsBone regeneration was significantly enhanced after hypoxia therapy during the consolidation phase. The digital radiograph, micro-CT, and biomechanical evaluation showed better effects regarding volume, continuity, and mechanical properties of the regenerated bone in Group1. The histomorphological evaluation also revealed the hypoxia treatment contributed to accelerate bone formation and remodeling during DO. The higher positive expression of angiogenic and osteogenic markers were observed in Group1 after hypoxia administration according to the immunohistochemical analysis. The serum content of HIF-1α and VEGF was also increased after hypoxia therapy as evidenced from ELISA.ConclusionHypoxia administration during the consolidation phase of distraction osteogenesis has benefits in enhancing bone regeneration, including accelerates the bone formation and remodeling.
Highlights
Distraction osteogenesis (DO), described by Ilizarov in the 1950s (Ilizarov, 1989a,b, 1990), has become a widely practiced technique in orthopedic and reconstructive surgery for limb lengthening, deformity correction, and bone defect treatment (Spiegl et al, 2013; Borzunov et al, 2015; Rohilla et al, 2016; El-Alfy et al, 2021; Liu et al, 2021)
While lots of studies showed that hypoxia administration can accelerate bone formation during distraction osteogenesis (DO), the therapeutic timing for the osteogenic purpose was concentrated on the distraction phase
Bone regeneration was significantly enhanced after hypoxia therapy during the consolidation phase
Summary
Distraction osteogenesis (DO), described by Ilizarov in the 1950s (Ilizarov, 1989a,b, 1990), has become a widely practiced technique in orthopedic and reconstructive surgery for limb lengthening, deformity correction, and bone defect treatment (Spiegl et al, 2013; Borzunov et al, 2015; Rohilla et al, 2016; El-Alfy et al, 2021; Liu et al, 2021). Compared with other alternative reconstructive methods, this technique provides advantages including avoidance of donor site morbidity and tissue concurrent generation using local endogenous substrate (Ai-Aql et al, 2008). Despite these clinical benefits, one of the limitations is the slow callus formation in the distraction gap. While lots of studies showed that hypoxia administration can accelerate bone formation during distraction osteogenesis (DO), the therapeutic timing for the osteogenic purpose was concentrated on the distraction phase. The purpose of this study was to determine the osteogenic effectiveness of hypoxia therapy during the consolidation phase, if any, to enhance bone regeneration in a rat femoral DO model
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