Abstract
Background: Given the increasing use of waterpipe tobacco smoking in the world and its unknown effects on bone healing, this study investigated the repairing of femoral bone fractures in rats exposed to waterpipe tobacco smoking (WTS).Main Methods: This study involved 40 male Wistar rats that were divided into two groups, including the femoral fracture (Fx) and the Fx + WTS groups. Each group was divided into two subgroups that were evaluated for bone healing 28 and 42 days after femoral fracture. After fixing the fractured femur, the healing process was evaluated by radiography, pathological indicators, and a measurement of the blood levels of vascular endothelial growth factor (VEGF), parathyroid hormone (PTH), Ca ++, transforming growth factor-beta (TGF-β), and insulin-like growth factor 1 (IGF-1). Additionally, the density of VEGF and CD34 in fracture tissue was investigated by immunohistochemistry.Key Findings: Radiographic findings showed that factors related to the earlier stages of bone healing had higher scores in the Fx + WTS28 and 42 subgroups in comparison to the Fx groups. The density of VEGF and CD34 showed that the angiogenesis processes were different in the bone fracture area and callus tissue in the Fx +WTS subgroups. The serum levels of VEGF, TGF-β, and IGF-1 were significantly lower in the Fx +WTS42 group, and PTH in the Fx +WTS28 group was higher than that in the other groups.Significance: The findings showed the disturbance and delay in the femoral fracture union in rats exposed to hookah smoke. This is partly due to the reduction of molecular stimuli of bone synthesis and the attenuation of quantitative angiogenesis.
Highlights
Tobacco consumption is one of the most important effective factors in causing disease, especially cardiovascular and pulmonary diseases, disability, and premature death [1]
40 male Wistar rats were randomly divided into two main groups of 20, including the femoral fracture (Fx) group, which was exposed to room air after a femoral bone fracture, and the Fx + waterpipe tobacco smoking (WTS) group, which was exposed to hookah smoke after a femoral bone fracture during the study
In the presence of WTS, decreasing the amount of some factors, such as Vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), and Insulin-like growth factor-1 (IGF-1), that are involved in the healing process of bone fractures and reducing the amount of angiogenesis is probably the reason for the reduction and delay in bone healing
Summary
Tobacco consumption is one of the most important effective factors in causing disease, especially cardiovascular and pulmonary diseases, disability, and premature death [1]. Cigarette smoking is more common among smokers, hookah use is on the rise in many parts of the world, especially among young people. Studies show that smoking tobacco in the form of hookah can have more toxic effects and harms. Hookah users are about 56 times more exposed to smoke and 4 times more to carbon monoxide (CO) than cigarette smokers [2]. Clinical studies and animal models indicate that cigarette smoke and nicotine delay the healing of bone fractures [3, 4]. Given the increasing use of waterpipe tobacco smoking in the world and its unknown effects on bone healing, this study investigated the repairing of femoral bone fractures in rats exposed to waterpipe tobacco smoking (WTS)
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