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Angiogenesis-osteogenesis coupling: a key element in bone physiology and regeneration

Bone represents a well vascularized structure which is remodelled and renewed continuously. It consists of osteoblasts, osteoclasts and osteocytes which have a precise role in the context of endochondral and intramembranous ossification. While the link between the bone tissue, bone marrow and the haematopoiesis is crucial for the generation of progenitor bone forming cells, recent research indicates that bone physiology as well as bone healing, repair and regeneration is directly dependent on bone angiogenesis. Experimental research suggest that angiogenesis and osteogenesis are directly coupled through a mechanism in which type H endothelial cells have a role of paramount importance. Apart from type H endothelial cells, other molecular elements such as HIF and Notch as well as CD31-endomucin capillaries and miR-497∼195 endothelial clusters may have a significant role in angiogenesis-osteogenesis coupling. The number of type H endothelial cells decreases significantly in elderly and is paralleled by a significant drop in the supply of progenitor cells. This would explain the bone loss and the decreased bone regeneration potential seen in elderly patients. Overall, it is suggested that endothelial cells and bone angiogenesis would represent therapeutic targets in various pathological conditions characterized by bone loss and impaired regeneration.

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Vascular Tumors Result from Adeno-Associated Virus-9 Angiogenic Gene Therapy of Bone Allografts

Background: Cryopreserved bone allografts are often used to reconstruct segmental bone defects. They are non-viable, which can result in infection, non-union and stress-fractures. We aimed to revascularize allografts in porcine and rat models using vascular endothelial growth factor (VEGF), combined with platelet derived growth factor (PDGF) administered through an adeno-associated viral vector. We report the development of vascular tumors resulting from this treatment. Methods: In two separate studies, an identical AAV.VEGF.PDGF vector was used to promote angiogenesis in cryopreserved bone allografts. In 8 Yucatan minipigs, a 3.5 cm segmental tibial defect was reconstructed with a matched allograft, revascularized by placement of a transfected arteriovenous (AV) bundle within the medullary canal. In another experiment, cryopreserved femoral bone allografts coated with AAV.VEGF.PDGF were placed across a 10 mm segmental femoral gap in 10 Lewis rats. Results: Vascular tumors developed in skin and subcutaneous tissues in 5 out of 8 pigs and all of the rats. Histology revealed changes essentially identical to those seen in pyogenic granuloma (lobular capillary hemangioma) in humans. Polymerase chain reaction (PCR) identified the sequence of human VEGF-DNA in all of the sampled tumor tissues. Conclusion: Recombinant AAV gene therapy used to promote angiogenesis in avascular bone risks the development of vascular cutaneous lesions. Gene therapy using an identical AAV.VEGF.PDGF vector should not be considered clinically until safe use can be demonstrated and.concerns regarding chromosomal integration, dose effect and species differences are addressed.

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Multidisciplinary approach to maximize angiogenesis and wound healing using piezoelectric surgery, concentrated growth factors and photobiomodulation for dental implant placement surgery involving lateral wall sinus lift: two case reports.

Background: The application of Photobiomodulation (PBM), Piezoelectric Surgery (PES) and Concentrated Growth Factors (CGF) in dental implant sinus lift procedure has gained popularity. Aim: To detail a two cases report on the use of PMB, PES, and CGF as a means of enhanced angiogenesis in tissue regeneration in dental implant lateral wall sinus lift procedure. Materials and Methods: This paper presents two cases report on the multi-disciplined approach using PBM, PES, and CGF as a method of enriched angiogenesis in tissue regeneration in dental implant sinus lift technique. In both patients, the sinus lateral windows were created using PES and the sinus membrane was raised to make a new partition. Surface modified dental implants (average 8 mm long) were inserted concurrently, packed with autologous fibrin-rich CGF, and then lastly induced PBM using Multiwave Locked System (MLS) laser. Radiographic and clinical evaluation was implemented to validate the efficacy of this multi-disciplined approach. Results and discussion: Postoperative revival was ordinary with no noteworthy postoperative complications. Wound closure/angiogenesis occurred shortly after day one. New bone formation in all augmented maxillary sinuses was detected alongside the implants on plain radiographs and on cone-beam computed tomograms. The patients were very happy with the overall treatment (>80%) and the success rate of implant was 100% after a usual 10 months loading period. PBM, PES, and CGF enhance angiogenesis/wound healing by speeding up wound approximation/healing, lessening the followings: postoperative pain, swelling, bleeding, speech impairment, analgesic use, and trismus. Conclusion: Using PBM, PES, and CGF as a method to enrich angiogenesis/wound healing in sinus lift rendered initial phase of satisfaction, simplicity, effectiveness, minimal complication, enhanced angiogenesis/wound healing with no cross infection and allergic reaction. Keywords photobiomodulation - piezoelectric surgery - concentrated growth factors - sinus augmentation - angiogenesis/wound healing

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An Improved In Vivo Angiogenesis Model of Chicken Chorioallantoic Membranes in Surrogate Shells Revealed the Pro-angiogenesis Effects of Chylomicrons

Chicken chorioallantoic membrane (CAM) models have been applied as an affordable and efficient angiogenesis model for many years in relevant areas such as cancer angiogenesis and cardiovascular sciences. However, this model has intrinsic weaknesses such as the difficulty of operation and the limited size of the viewing windows. Efforts of trying to improve this model, such as transferring the embryos into petri dishes, has led to compromised survival rate of the embryos. In this study we improve the workflow by using surrogate egg shells. The images obtained from the viewing windows of the surrogate shells allow us to apply automated image analysis. This CAM model in surrogate shells combined with automated image analysis significantly decreases the labour whilst also increasing the data quality, when compared to traditional CAM models. Furthermore, to demonstrate the potential of our model, we have investigated the effects of a range of chylomicrons, extracted from murine and human samples, using the improved CAM model, to seek clues to elucidate the controversial roles of high level chylomicrons (CMs) in hypertriglyceridaemia (HTG) on atherosclerosis. We show that both native and modified chylomicrons (CMs) promote in vitro and in vivo angiogenesis. As angiogenesis is a risk factor in atherosclerosis our results provide a new mechanism for the effect of hypertriglyceridaemia (HTG) on atherosclerosis development. In summary, we demonstrate an improved CAM model aided by automated image analysis, we demonstrate the potential of this model by demonstrating interfered angiogenesis caused by HTG and discuss the impact this could potentially cause other pathological processes, such as atherosclerosis or carcinogenesis. Furthermore, the significantly low cost of CAM models compared with traditional murine models for cardiovascular research will have potential 3Rs (replacement, reduction and refinement) significance for the research communities, especially for laboratories with limited budgets or regulatory restrictions.

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