Autogenous Transplantation Research Articles

Implantate für die rekonstruktive Chirurgie der Nase und des Ohres

Implants shorten reconstruction, reduce trauma for the patients, are, in principle, of unlimited availability and can be given definable qualities that outnumber those of biological transplants. Lots of sometimes exotic materials have already been suggested for facial surgery and most of them have turned out to be unsuitable in the short or long term, because they did not satisfactorily fulfil the requirements of a "perfect implant". However, transplants obviously cannot be regarded as ideal either because they often involve the necessity of a second intervention for removal, they are only available to a limited extent and some are at risk of postoperative deflection, shrinkage and absorption. This article is concerned with current knowledge about implant materials for rhinoplasty and ear reconstruction. Autogenous transplants will also be briefly discussed. The repetition of known facts should be largely avoided. In relation to this reference will be made to earlier papers [1].

Unclear prognosis for the autogenous tooth transplant

Article Title and Bibliographic Information Evaluation of the prognosis and causes of failure in 182 cases of autogenous tooth transplantation. Kim E, Jung JY, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100(1):112-9. Level of Evidence 4 Purpose/Question What is the success rate of autogenous tooth transplantation where the teeth are root treated at the time of transplantation and donor site preparation is simulated on a CT-generated model? Source of Funding Not stated Type of Study/Design Case series with 2 internal statistical comparisons

Reconstruction of anterior cruciate ligament by transplantation of autogenous hamstring and fixation with double crossbar (Rigidfix) at the femoral side under arthroscopy

Objective To introduce a new technique in reconstruction of anterior cruciate ligament (ACL) by transplantation of autogenous hamstring and fixation with double crossbar (Rigidfix) under arthroscopy. Methods From July 2003 to Spetember 2005, 32 patients with ACL injury were treated with ACL reconstruction. Autogenous semitendinous and gracilis tendons were transplanted, fixed by double crossbar at the femoral end and an Intrafix screw in the tibial tunnel. Knee joint function and stability before and after operation as well as X-ray radiographs were evaluated according to the Lysholm scoring scale and International Knee Documentation Committee (IKDC) rating scale. The reliability of the fixation and its short term effect were analyzed. Results Twenty-eight patients were available for follow-up with duration from 6 to 28 months. The function of knee joint improved greatly. Four cases had unconscious positive findings in physical examination. The average Lysholm scores before and after opration were 53. 0±6. 3 and 90. 0±5. 2, respectively ( P 0. 01). X-ray revealed enlarged bone tunnels in four cases. Articular cavity hydrops occurred in two cases one week post-operatively but responded to treatment. Conclusion The short term effect shows that autogenous hamstring transplantation and femoral double crossbar (Rigidfix) fixation with tibial Intrafix screw under arthroscopy is a fine way of ACL reconstruction, due to its stable fixation, few complications and easy procedures.

Side Population Cells Isolated from Porcine Dental Pulp Tissue with Self‐Renewal and Multipotency for Dentinogenesis, Chondrogenesis, Adipogenesis, and Neurogenesis

Dental pulp has the potential to form dentin as a regenerative response to caries. This regeneration is mediated by stem/progenitor cells. Thus, stem cell therapy might be of potential utility in induction of reparative dentin. We isolated side population (SP) cells from dental pulp based on the exclusion of the DNA binding dye Hoechst 33342 by flow cytometry and compared its self-renewal capacities and multipotency with non-SP cells and primary pulp cells. The cumulative cell number of the SP cells was greater than the non-SP cells and primary pulp cells. Bmi1 was continuously expressed in SP cells, suggesting longer proliferative lifespan and self-renewal capacity of SP cells. Next, the maintenance of the multilineage differentiation potential of pulp SP cells was investigated. Expression of type II collagen and aggrecan confirmed chondrogenic conversion (30%) of SP cells. SP cells expressed peroxisome proliferator-activated receptor gamma and adaptor protein 2, showing adipogenic conversion. Expression of mRNA and proteins of neurofilament and neuromodulin confirmed neurogenic conversion (90%). These results demonstrate that pulp SP cells maintain multilineage differentiation potential. We further examined whether bone morphogenetic protein 2 (BMP2) could induce differentiation of pulp SP cells into odontoblasts. BMP2 stimulated the expression of dentin sialophosphoprotein (Dspp) and enamelysin in three-dimensional pellet cultures. Autogenous transplantation of the Bmp2-supplemented SP cells on the amputated pulp stimulated the reparative dentin formation. Thus, adult pulp contains SP cells, which are enriched for stem cell properties and useful for cell therapy with BMP2 for dentin regeneration.

Autogenous transplantation of teeth with complete root formation: two case reports

Autotransplantation is an alternative treatment for replacing lost teeth when suitable donor teeth are available. This paper presents two cases of successful autogenous tooth transplantation. Two third molars with complete root development were autogenously transplanted from their original sockets into new recipient sites on the same side of the mouth, one in the maxilla and one in the mandible. In both cases, the third molars were transplanted immediately after the first molar extractions. To provide better adaptation of the donor teeth, the recipient alveolar sites were remodelled using surgical burs. Semi-rigid splints were maintained for 45 and 15 days, respectively. Root canal treatment commenced one a week after transplantation and the canals were medicated with a calcium hydroxide paste before they were filled. Clinical and radiographic findings after 5 and 3 years of follow-up, respectively, are discussed in relation to the literature. Autogenous transplantation of teeth with complete root formation may be considered as a viable treatment option to conventional prosthetic and implant rehabilitation for both therapeutic and economic reasons. Careful surgical and endodontic procedure, together with careful case selection may lead to satisfactory aesthetic and functional outcomes.

Tooth survival and periodontal tissues healing of allogenic‐transplanted teeth in the mice

For the successful organ transplantation, immune rejection has to be considered. Autogenic transplantation of human teeth is generally carried out free of clinical difficulty because of the lack of immune reaction, whereas allogenic tooth transplantations easily induce host immune rejection to donor tissues. The aim of the present study was to evaluate the replacement of donor tissue by host cells after allogenic tooth transplantation. First molars extracted from lacZ transgenic ROSA26 mice were transplanted into the alveolar socket and the tongue of host wildtype mice, where the first molar had existed. Donor cells from lacZ transgenic mice were not detected in the periodontal ligament space, but rather in the pulp chamber of the donor tooth. Furthermore, if the pulp chamber was widely open to an affluent blood supply, odontoblasts and fibroblasts in the donor tissue survived in the dental pulp. Our experimental models using lacZ transgenic ROSA26 mice clearly demonstrate that donor periodontal tissue cells are replaced by host cells and that periodontal tissue can regenerate after allogenic tooth transplantation. Furthermore, our models suggest that donor pulpal cells can survive if the vascular supply into the pulp chamber is sufficient.

The morphology and biomechanical characteristics of subcutaneously implanted tissue-engineered human septal cartilage

The purpose of the study was to examine the morphology and biomechanical characteristics of in vivo cultured tissue-engineered human septal cartilage as a prospective autogenous transplant material for subcutaneous implantation in reconstructive procedures. Chondrocytes were enzymatically isolated from human septal cartilage biopsies. The cell number was expanded in monolayer culture. Chondrocytes were then fixed on a non-woven poly-lactide-poly-glycolide (PGLA) polymer scaffold by means of fibrin glue. The PGLA-polymer construct was implanted subcutaneously on the back of athymic mice and allowed to mature for 6 or 12 weeks. After killing the mice, the formed cartilage was tested on a material testing machine with a highly standardized reproducible setting. Biomechanical testing consisted of an indentation test, which revealed the failure load and compressive modulus of the neocartilage. The failure load shows the upper limit of supported stress. The compressive modulus is a measure of the templates' stiffness. After testing, the templates were histologically stained. Native human septal cartilage served as a control group. Histological and macroscopic examination showed cartilage formation of a hyaline-like morphology. Histological staining revealed the synthesis of abundant mucopolysaccharid matrix. The biomechanical characteristics of neocartilage proved to be of no statistical difference compared to native human septal cartilage. The failure load and compressive modulus were initially somewhat lower and reached the control group's results after 12 weeks in-vivo. Summarizing, tissue engineered nasal cartilage matches typical mechanical characteristics of native hyaline cartilage. Its elasticity and failure load are of sufficient quality to meet the clinical requirements for reconstructive surgery.

Osteochondral autogenous transplantation for an osteochondral defect of the first metatarsal head: A case report

A case of an isolated, traumatic, osteochondral injury to the articular surface of the first metatarsal head, which was successfully treated with an autogenous transplant of an osteochondral plug from the ipsilateral knee, is reported. After a 2-year follow-up, the patient reported no persistent symptoms, full resumption of preinjury activities, and was satisfied with her outcome.

Effects of Small Incongruities in a Sheep Model of Osteochondral Autografting

Background Exact reconstruction of an osteochondral defect by autogenous transplantation (mosaicplasty) is difficult given the variation in joint surface contour. Clinical and experimental studies do not show the extent to which incongruity can be tolerated in autografting. Hypothesis Grafted articular cartilage will hypertrophy to correct the incongruity created by recession of the transplanted surface. Study Design Controlled laboratory study. Methods To test the response of grafts to incongruities, osteochondral autografts were transplanted from the trochlea to the femoral condyle in adult male sheep stifle joints. In groups of 6 animals, graft surfaces were placed flush, countersunk 1 mm or countersunk 2 mm, then histologically analyzed 6 weeks after surgery. Cartilage thickness, condition of the articular surfaces, and preservation of hyaline characteristics were the primary features compared. Results Bony union, vascularization, and new bone formation were present in all grafts. Cartilage-to-cartilage healing did not occur. In flush specimens, cartilage changed minimally in thickness and histologic architecture. The specimens countersunk 1 mm demonstrated significant cartilage thickening (54.7% increase, P < .05). Chondrocyte hyperplasia, tidemark advancement, and vascular invasion occurred at the chondroosseous junction, and the surface remained smooth. Cartilage necrosis and fibrous overgrowth were observed in all grafts countersunk 2 mm. Conclusions Minimally countersunk autografts possess a capacity for remodeling that can correct initial incongruities while preserving hyaline characteristics. Grafts placed deeper do not restore the contour or composition of the original articular surface. Clinical Relevance If preservation of normal hyaline cartilage is the objective, thin grafted articular cartilage can remodel, but the tolerance for incongruity is limited and probably less than that reported for an intra-articular fracture.

Materialien in der rekonstruktiven Orbitachirurgie

Orbital traumas and tumour operations may cause defects the operative management of which sets high requirements on the surgeon. For covering defects, transplants or implants are available. There is a risk of inflammation due to the free contact of the implants to the cavity of the inner nose or the sinus. Today, implants made from titanium, porous polyethylene, PDS (poly-p-dioxanon) foils, and ceramic materials are preferred. Alternatively, autogenous transplants can be used. These are immunologically harmless but they are of only limited availability. Moreover, a second operation for taking the transplants with creation of a donor defect is necessary.

Stimulation of Reparative Dentin Formation byEx VivoGene Therapy Using Dental Pulp Stem Cells Electrotransfected withGrowth/differentiation factor 11 (Gdf11)

Dental pulp progenitor/stem cells have the capacity to differentiate into odontoblasts and they provide a potential for dentin repair and regeneration by gene therapy. To develop a successful ex vivo gene therapy to induce reparative dentin formation rapidly and effectively after treatment of caries, we developed a three-dimensional pellet culture system of pulp cells electrotransfected with growth/differentiation factor 11 (Gdf11). The viability after electrotransfection was more than 85%, and the efficiency was about 70% as determined by flow cytometry. After 10 days of culture, the total amount of type I and type III collagen was 3-fold higher in the pEGFP-Gdf11-transfected pellet than in the control. Real-time RT-PCR analysis demonstrated that the expression of markers of odontoblast differentiation (alkaline phosphatase, dentin matrix protein 1 [Dmp1], dentin sialophosphoprotein [Dspp], enamelysin, and phosphate-regulating gene with homologies to endopeptidases on X-chromosome [Phex]) was increased in the pEGFP-Gdf11-transfected pellet compared with the control on day 14. On the basis of this in vitro evaluation, an in vivo investigation in the dog was performed. Autogenous transplantation of Gdf11-transfected cells cultured as a pellet on amputated pulp stimulated reparative dentin formation. Thus, Gdf11 gene therapy may be potentially used in endodontic treatment in dentistry.

Follow-Up of Osteochondral Plug Transfers in a Goat Model

Background Osteochondral transfer procedures are increasingly used to resurface full-thickness articular cartilage defects. There has not been long-term assessment/description of autogenous donor and recipient sites. Hypothesis The healing process occurs at the donor/host cartilage and bone interfaces. Study Design Histologic, biochemical, and biomechanical changes were assessed 6 months after an osteochondral transfer in a goat model. Methods Eight adult goats were studied. In the 6 osteochondral transfer goats, 2 autogenous plugs were transferred from the femoral trochlea to defects in the weightbearing portion of the medial femoral condyle. The goats were allowed free range for 6 months. Randomly assigned plugs were assessed. Results Knees of the sacrificed animals had preservation of the joint space with mild chondromalacic changes in both transfer and contralateral control groups. Histologically, no evidence of cartilage (host/donor) healing was seen. Subchondral bone of the plug was contiguous with the surrounding recipient bone. Cellular viability in the autogenous osteochondral plug was seen, and 35SO4 uptake of the articular cartilage was not statistically different from the contralateral control condyle. The indentation stiffness of the transfer plug (mosaicplasty) and the contralateral donor site were similar—much stiffer than normal cartilage including surrounding condylar cartilage. Large structural stiffness of transferred cores and donor sites appeared to be related to their thinner cartilage layer. Conclusions At 6-month follow-up, a cleft between host and transferred articular regions remained, with no integration between the two. Clinical Relevance Autogenous transplantation of osteochondral plugs is possible with integration of subchondral bone and preservation of chondral viability.

Autogenous hair transplantation in treatment of seborrheic hair loss: an analysis of 3 000 cases

目的 探讨和分析运用自体毛发移植术治疗脂溢性脱发的效果和特点.方法对3 000例脂溢性脱发的患者运用自体毛发移植术进行修复.结果移植的头发均生长良好,但因每个人脱发面积不同、供发区头发密度不同,移植后头发生长密度不同.结论自体毛发移植术可以运用于脂溢性脱发的修复,移植时,要按自身的特点及需要设计不同的发际线;按自身头发的正常生长方向移植;移植后的头发随周围正常头发的生长而生长;因脱发面积的不同及供发区头发密度的不同,移植后头发生长密度不同。

Dentin regeneration by dental pulp stem cell therapy with recombinant human bone morphogenetic protein 2.

Regenerative medicine is based on stem cells, signals, and scaffolds. Dental pulp tissue has the potential to regenerate dentin in response to noxious stimuli, such as caries. The progenitor/stem cells are responsible for this regeneration. Thus, stem cell therapy has considerable promise in dentin regeneration. Culture of porcine pulp cells, as a three-dimensional pellet, promoted odontoblast differentiation compared with monolayers. The expression of dentin sialophosphoprotein (Dspp) and enamelysin/matrix metalloproteinase 20 (MMP20) mRNA confirmed the differentiation of pulp cells into odontoblasts and was stimulated by the morphogenetic signal, bone morphogenetic protein 2 (BMP2). Based on the in vitro experiments, an in vivo evaluation of pulp progenitor/stem cells in the dog was performed. The autogenous transplantation of the BMP2-treated pellet culture onto the amputated pulp stimulated reparative dentin formation. In conclusion, BMP2 can direct pulp progenitor/stem cell differentiation into odontoblasts and result in dentin formation.

Osteochondritis dissecans of the knee

BACKGROUND: Osteochondritis dissecans is a localized condition or injury affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. METHODS: This article discusses the etiology, anatomy, evaluation, classification and treatment of osteochondritis dissecans lesions in the knee joint. RESULTS: Osteochondritis dissecans is primarily found in the knee, ankle and elbow joints. Various theories about its etiology have been proposed, but none has been accepted universally or has adequately explained its occurrence. It is believed that repetitive microtrauma may interrupt the tenuous epiphyseal blood supply in the growing child and contribute to the development of osteochondritis dissecans lesions. Patients typically present with vague complaints and a gradual onset of symptoms. The treatment of osteochondritis dissecans is dependent upon age at presentation, fragment size, fragment location and fragment stability. The vast majority of stable lesions in the skeletally immature patient can be successfully treated with nonoperative management. Unstable lesions or those that have failed conservative management may require surgical treatment primarily in the form of drilling with or without mechanical stabilization. Treatment has further evolved with the use of osteochondral autogenous grafts and autologous chondrocyte transplantation. CONCLUSIONS: Well-designed prospective studies with long-term follow-up are necessary to determine the adequacy of these techniques in preventing the development of degenerative arthritis.

Arthroscopically assisted osteochondral autogenous transplantation for osteochondral lesion of the talus using a transmalleolar approach

Osteochondral autogenous transplantation for osteochondral lesions of the talar dome is usually performed through a miniarthrotomy approach, and a medial malleolus osteotomy approach is selected if the lesion is located posteromedially. Recently, we used a transmalleolar approach without osteotomy of the medial malleolus to perform osteochondral autogenous transplantation for a lesion located in the posteromedial portion of the talar dome. We report on this technique and discuss its advantages, disadvantages, and indications.

Bone ingrowth in bFGF-coated hydroxyapatite ceramic implants

This experimental study was performed to evaluate angiogenesis, bone formation, and bone ingrowth in response to osteoinductive implants of bovine-derived hydroxyapatite (HA) ceramics either uncoated or coated with basic fibroblast growth factor (bFGF) in miniature pigs. A cylindrical bone defect was created in both femur condyles of 24 miniature pigs using a saline coated trephine. Sixteen of the 48 defects were filled with HA cylinders coated with 50 μg rhbFG, uncoated HA cylinders, and with autogenous transplants, respectively. Fluorochrome labelled histological analysis, histomorphometry, and scanning electron microscopy were performed to study angiogenesis, bone formation and bone ingrowth. Complete bone ingrowth into bFGF-coated HA implants and autografts was seen after 34 days compared to 80 days in the uncoated HA group. Active ring-shaped areas of fluorochrome labelled bone deposition with dynamic bone remodelling were found in all cylinders. New vessels could be found in all cylinders. Histomorphometric analysis showed no difference in bone ingrowth over time between autogenous transplants and bFGF-coated HA implants. The current experimental study revealed comparable results of bFGF-coated HA implants and autogenous grafts regarding angiogenesis, bone synthesis and bone ingrowth.

Detrimental effects of controlled reperfusion on renal function after porcine autotransplantation are fully compensated by the use of Carolina rinse solution.

Despite extensive efforts in the fields of donor selection and management, standardisation of organ retrieval procedures, storage solutions, and novel immunosuppressive protocols, the rates of delayed graft function (DGF) after renal transplantation have been stagnating between 30% and 50%. As DGF exerts negative influences on acute rejection episodes and long-term organ function, the early phase of transplantation immediately following reperfusion deserves special interest. Several studies on machine-controlled reperfusion showed promising results in various organs, in experimental and clinical settings. Moreover, the flushing of organs with Carolina rinse solution (CR) immediately prior to reperfusion has been proven beneficial and is being clinically applied in human liver transplantation in recognised departments. In our study, we set up an autogenic porcine kidney transplantation model and assessed the normal values (control group) for creatinine clearance (ClCr) and urine output per hour (U/h) after "standard" reperfusion similar to clinical transplantation. Subsequently, kidneys of the experimental group 1 were reperfused at a blood pressure (RR) under the systemic level by means of a roller pump. Group 2 kidneys were rinsed with CR before controlled reperfusion, analogous to group 1. Both groups were compared with each other and with the assessed normal values. Our findings for Group 1 are that pressure-reduced reperfusion negatively affected immediate graft function. ClCr was reduced from 9.9 (control group) to 3.4 ml/min, U/h from 233 to 132 ml ( P<0.05). Group 2 showed that rinsing the kidneys with CR before reperfusion improved functional parameters highly significantly, compared with group 1 (ClCr: 13.5 vs 3.4 ml/min, U/h: 384 vs 132 ml; P<0.05) and even showed a positive trend compared with the control group (ClCr: 13.5 vs 9.9 ml/min, U/h: 384 vs 233 ml; P=0.0546). We can conclude that in a model of porcine renal autotransplantation, pressure-reduced reperfusion via a roller pump is detrimental to early kidney graft function. The flushing of organs with CR prior to controlled reperfusion significantly improves ClCr as well as urine output.

Experimental autogenous tooth transplantation in the dog: a comparison between one- and two-stage surgical techniques

Crucial if tooth transplantation is to succeed is preservation of the vitality of the cells of the periodontium and cementum of the tooth graft. Poor contact between the tissues of the recipient site and the root surface when teeth are transplanted to recipient sites prepared immediately prior to transplantation (one-stage technique) could, after transplantation, result in insufficient nutrition to the cells of the root surface and contribute to necrosis of the cells. To improve nutrition, tooth transplantation to recipient beds left to heal for 14 days was performed (two-stage technique). Clinical trials of tooth transplantation by the two-stage technique resulted in a low incidence of tooth graft loss and root resorption. The different results between these two methods, as well as difficulties in evaluating clinical trials, called for an experimental model to be established. In 5 beagle dogs, fully developed autogenous teeth were transplanted using both one-stage and two-stage surgical techniques. The control teeth were transplanted by the one-stage method to recipient beds prepared immediately before transplantation. The test teeth were transplanted using the two-stage method to recipient beds prepared and left to heal for 5 days prior to transplantation. Four pairs of teeth (1 test and 1 control) were transplanted in each dog. One pair of incisors and one pair of premolars were transplanted in the maxilla and in the mandible. Altogether 20 pairs of teeth were included in the study. One pair of teeth fractured during extraction and was therefore excluded from the study. Two pairs of teeth were lost in the first hours after transplantation. Evaluation of the remaining 17 pairs of teeth was made by routine histological examinations after a 6-month period of healing. The blinded examination failed to show a difference between the two surgical methods in terms of frequency of various types of root resorption. The differences between the results after long-term observation of human teeth transplanted by the one- and two-stage tooth transplantation techniques were not found by this experimental model.

Mesenchymal bone marrow stem cells more effectively stimulate regeneration of deep burn wounds than embryonic fibroblasts.

Regeneration of deep burn wounds after transplantation of allogenic and autogenic fibroblast-like bone marrow mesenchymal stem cells and embryonic fibroblasts on burn surface was studied in 40 Wistar rats. Transplantation of allogenic and autogenic fibroblast-like bone marrow mesenchymal stem cells and transplantation of embryonic fibroblasts decreased cell infiltration of the wound and accelerated the formation of new vessels and granulation tissue in the wound in comparison with the control (burn wounds without cell transplantation). Regeneration processes were most active after transplantation of fibroblast-like bone marrow mesenchymal stem cells, in particular, autogenic cells, which was confirmed by more rapid decrease in burn surface area. Wound healing after transplantation of fibroblast-like bone marrow mesenchymal cells and embryonic fibroblasts was associated with long functioning of transplanted cells (as was shown by staining for beta-galactosidase, the cells were transfected with an adenovirus vector carrying the marker gene). It is hypothesized that more rapid regeneration of burn wounds after transplantation of fibroblast-like bone marrow mesenchymal stem cells was due to low differentiation of these cells in comparison with embryonic fibroblasts.