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Thursday, September 27, 2018 2:05 PM–3:05 PM Section on Biologics and Basic Research Abstract Presentations
The Spine Journal 18 (2018) S50 S69 environment induced by PPE. Additional examination may help to elucidate a mechanism by which cigarette smoking inhibits bone regeneration. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.392
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CBMs did not produce greater bone formation than the control and were very poor at forming a solid fusion. These results suggest that there may be large differences in the ability of different CBMs to elicit a successful fusion in the posterolateral spine. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.393
128. Comparative study of cellular bone matrices for posterolateral spinal fusion Clifford Lin, MDa, Paolo Antonio R. Punsalan, MDa, Nianli Zhang, PhDb, Jung U. Yoo, MDa, Eric Semler, PhDc, Erik I. Waldorff, PhDb, James T. Ryaby, PhDb, Brian Johnstone, PhDa; a Oregon Health & Science University, Portland, OR, USA; b Orthofix, Lewisville, TX, USA; c Musculoskeletal Transplant Foundation, Edison, NJ, USA BACKGROUND CONTEXT: Cellular bone matrices (CBM) are allograft products that combine demineralized bone with viable cancellous bone prepared to retain cells with skeletal tissue differentiation capabilities. Using an athymic rat model of posterolateral fusion, several commercially-available human CBMs were compared: Trinity ELITE (TEL; OrthoFix, Lewisville, TX, United States), ViviGen (VIV; DePuy Synthes, Raynham, MA, United States), Cellentra (CEL; Zimmer Biomet, Warsaw, IN, United States), Osteocel Pro (OCP; NuVasive, San Diego, CA, United States), Bio4 (BIO; Stryker, Kalamazoo, MI, United States) and map3 (MAP; RTI Surgical, Marquette, MI, United States). Iliac crest bone from syngeneic rats was used as a control to approximate the human gold standard. METHODS: To allow for lot-to-lot variability, three different lots of each implant type were procured and each was used to implant five rats, for a total of 15 9-10 week old male rats per implant type. Each implant was stored, thawed, and prepared according to the manufacturer's instructions and all implantations occurred within the manufacturers’ time allowance for use after preparation. After anesthesia and preparation, a single posterior midline longitudinal skin and subcutaneous incision and bilateral longitudinal paraspinal myofascial incisions were made to expose the transverse processes and intertransverse membranes at the L4-5 level. The processes were decorticated and 0.3 cc of allograft implant or freshly harvested syngeneic iliac bone graft was placed bilaterally. Surgeons were blinded as to which implant was which. Incisions were closed with sutures to avoid any interference with in vivo animal microCT scans performed within 48 hours of surgery on all rats. The rats were euthanized 6 weeks after surgery and the lumbar spines harvested. A second microCT scan was taken and compared with the microCT taken at the time of implantation to assess fusion and bone remodeling. Stable fusion was also evaluated by manual palpation by three independent, blinded reviewers. MicroCT analysis was performed by an independent CRO (ImageIQ, Cleveland, OH, USA). All assessments were done by experienced evaluators blinded to the treatments. Anonymity of implant type was rigorously kept to avoid any bias. RESULTS: By manual palpation, 5/15 (33%) rats of the syngeneic bone group were fused at 6 weeks. While TEL had 8/15 (53%) and CEL 11/15 (73%) rats with stable fusion, only 2/15 (13%) of VIV-implanted spines were fused and 0/15 (0%) of the OCP, BIO and MAP CBMs produced stable fusion. The TEL and CEL groups were significantly different from the other CBMs but not different from each other. MicroCT analysis indicated percentage increases in bone volume from the first measurement to the second for all groups, but only TEL and CEL had significant increases over the syngeneic bone control (TEL 65% and CEL 73% vs. syngeneic bone 21%, respectively). CONCLUSIONS: Because the CBMs tested have distinct formulations and are likely processed differently, it is not surprising that the results would be different between the groups. While map3 has cells added at the time of surgery, the other CBMs are processed with cells adherent to the bone matrix. The claimed live cell and stem cell contents differ between products. Trinity ELITE and Cellentra were found to be significantly better than other implants at forming new bone and achieving fusion. The other
129. Plastrum testudinis treating glucocorticoid-induce osteoporosis by down-regulating TNFR2 Xiang Yu, PhDa, Hui Rena, Gengyang Shena, Qi Shang, MDb, De Liang, MDc, Jiang Xiaobing, PhDd; a Guangzhou University of Chinese Medicine, Guangzhou, Guang dong Provence, China; b Guangzhou, China; c The First Affiliated Hospital of Guangzhou University of Chinese Medicine Department of Spinal Surgery, Guangzhou, China; d 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guang Zhou City, China BACKGROUND CONTEXT: Glucocorticoid-induced osteoporosis (GIOP) is a systemic bone diseaseinduced by glucocorticoid (GC). The incidence of GIOP continues to rise with the widely use of GC, and GIOP has been identified as the most common type of secondary osteoporosis. Emerging evidence has demonstrated that bone fragility induced by GIOP is much more serious than that induced by postmenopausal osteoporosis, and GIOP has higher disability rate and mortality. Excessive or prolonged GC treatment has been considered to play a major role in inhibiting bone formation. However, the underlying mechanism of GIOP has not been confirmed. Thus, it is still an important and urgent project to find out how to research the mechanism and treat GIOP. PURPOSE: To explore the effect of Plastrum Testudinis treating glucocorticoid-induce osteoporosis in Wnt/β-catenin pathway by downregulating TNFR2.To explore the effect of Plastrum Testudinis treating glucocorticoid-induce osteoporosis in Wnt/β-catenin pathway by downregulating TNFR2. STUDY DESIGN/SETTING: Animal experiment:thirty 4-month-old SD rats were randomly divided into three groups: blank group, model group and Plastrum Testudinis group. The model group and the Plastrum Testudinis group were subcutaneously injected with dexamethasone, and were successfully gavaged with 0.9% sodium chloride solution and Plastrum Testudinis respectively. The lumbar spine (L1-6) were taken after 12 weeks. PATIENT SAMPLE: No patients. Thirty 4-month-old SD rats were used in this study. OUTCOME MEASURES: The mRNA expression of TNFR2, β-cantenin and GSK3β in the lumbar vertebra were detected by qPCR. The protein expressions of TNFR2, p-β-cantenin and p-GSK3β were detected by Western blot. Cell expeiment:CCK8 was used to detect the proliferation of BMSCs at different concentrations for 1,3,5,7 and 14 days. Osteogenesis was induced by selecting the best concentration. ALP and alizarin red staining were used to detect the effect of PTE on osteogenic differentiation of BMSCs. The expression of TNFR2, Β-cantenin, GSK3β mRNA expression, TNFR2, p-β-cantenin, p-GSK3β protein expression of turtle plate were detected by Werstern blot. METHODS: Animal experiment: Thirty 4-month-old SD rats were randomly divided into three groups: blank group, model group and Plastrum Testudinis group. The model group and the Plastrum Testudinis group were subcutaneously injected with dexamethasone, and were successfully gavaged with 0.9% sodium chloride solution and Plastrum Testudinis respectively. The lumbar spine (L1-6) were taken after 12 weeks. The mRNA expression of TNFR2, β-cantenin and GSK3β in the lumbar vertebra were detected by qPCR. The protein expressions of TNFR2, p-β-cantenin and p-GSK3β were detected by Western blot. Cell expeiment:CCK8 was used to detect the proliferation of BMSCs at different concentrations for 1,3,5,7,14 days. Osteogenesis was induced by selecting the best concentration. ALP and alizarin red staining were used to detect the effect of PTE on osteogenic differentiation of BMSCs. The expression of TNFR2,
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
S63
CBMs did not produce greater bone formation than the control and were very poor at forming a solid fusion. These results suggest that there may be large differences in the ability of different CBMs to elicit a successful fusion in the posterolateral spine. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.393
128. Comparative study of cellular bone matrices for posterolateral spinal fusion Clifford Lin, MDa, Paolo Antonio R. Punsalan, MDa, Nianli Zhang, PhDb, Jung U. Yoo, MDa, Eric Semler, PhDc, Erik I. Waldorff, PhDb, James T. Ryaby, PhDb, Brian Johnstone, PhDa; a Oregon Health & Science University, Portland, OR, USA; b Orthofix, Lewisville, TX, USA; c Musculoskeletal Transplant Foundation, Edison, NJ, USA BACKGROUND CONTEXT: Cellular bone matrices (CBM) are allograft products that combine demineralized bone with viable cancellous bone prepared to retain cells with skeletal tissue differentiation capabilities. Using an athymic rat model of posterolateral fusion, several commercially-available human CBMs were compared: Trinity ELITE (TEL; OrthoFix, Lewisville, TX, United States), ViviGen (VIV; DePuy Synthes, Raynham, MA, United States), Cellentra (CEL; Zimmer Biomet, Warsaw, IN, United States), Osteocel Pro (OCP; NuVasive, San Diego, CA, United States), Bio4 (BIO; Stryker, Kalamazoo, MI, United States) and map3 (MAP; RTI Surgical, Marquette, MI, United States). Iliac crest bone from syngeneic rats was used as a control to approximate the human gold standard. METHODS: To allow for lot-to-lot variability, three different lots of each implant type were procured and each was used to implant five rats, for a total of 15 9-10 week old male rats per implant type. Each implant was stored, thawed, and prepared according to the manufacturer's instructions and all implantations occurred within the manufacturers’ time allowance for use after preparation. After anesthesia and preparation, a single posterior midline longitudinal skin and subcutaneous incision and bilateral longitudinal paraspinal myofascial incisions were made to expose the transverse processes and intertransverse membranes at the L4-5 level. The processes were decorticated and 0.3 cc of allograft implant or freshly harvested syngeneic iliac bone graft was placed bilaterally. Surgeons were blinded as to which implant was which. Incisions were closed with sutures to avoid any interference with in vivo animal microCT scans performed within 48 hours of surgery on all rats. The rats were euthanized 6 weeks after surgery and the lumbar spines harvested. A second microCT scan was taken and compared with the microCT taken at the time of implantation to assess fusion and bone remodeling. Stable fusion was also evaluated by manual palpation by three independent, blinded reviewers. MicroCT analysis was performed by an independent CRO (ImageIQ, Cleveland, OH, USA). All assessments were done by experienced evaluators blinded to the treatments. Anonymity of implant type was rigorously kept to avoid any bias. RESULTS: By manual palpation, 5/15 (33%) rats of the syngeneic bone group were fused at 6 weeks. While TEL had 8/15 (53%) and CEL 11/15 (73%) rats with stable fusion, only 2/15 (13%) of VIV-implanted spines were fused and 0/15 (0%) of the OCP, BIO and MAP CBMs produced stable fusion. The TEL and CEL groups were significantly different from the other CBMs but not different from each other. MicroCT analysis indicated percentage increases in bone volume from the first measurement to the second for all groups, but only TEL and CEL had significant increases over the syngeneic bone control (TEL 65% and CEL 73% vs. syngeneic bone 21%, respectively). CONCLUSIONS: Because the CBMs tested have distinct formulations and are likely processed differently, it is not surprising that the results would be different between the groups. While map3 has cells added at the time of surgery, the other CBMs are processed with cells adherent to the bone matrix. The claimed live cell and stem cell contents differ between products. Trinity ELITE and Cellentra were found to be significantly better than other implants at forming new bone and achieving fusion. The other
129. Plastrum testudinis treating glucocorticoid-induce osteoporosis by down-regulating TNFR2 Xiang Yu, PhDa, Hui Rena, Gengyang Shena, Qi Shang, MDb, De Liang, MDc, Jiang Xiaobing, PhDd; a Guangzhou University of Chinese Medicine, Guangzhou, Guang dong Provence, China; b Guangzhou, China; c The First Affiliated Hospital of Guangzhou University of Chinese Medicine Department of Spinal Surgery, Guangzhou, China; d 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guang Zhou City, China BACKGROUND CONTEXT: Glucocorticoid-induced osteoporosis (GIOP) is a systemic bone diseaseinduced by glucocorticoid (GC). The incidence of GIOP continues to rise with the widely use of GC, and GIOP has been identified as the most common type of secondary osteoporosis. Emerging evidence has demonstrated that bone fragility induced by GIOP is much more serious than that induced by postmenopausal osteoporosis, and GIOP has higher disability rate and mortality. Excessive or prolonged GC treatment has been considered to play a major role in inhibiting bone formation. However, the underlying mechanism of GIOP has not been confirmed. Thus, it is still an important and urgent project to find out how to research the mechanism and treat GIOP. PURPOSE: To explore the effect of Plastrum Testudinis treating glucocorticoid-induce osteoporosis in Wnt/β-catenin pathway by downregulating TNFR2.To explore the effect of Plastrum Testudinis treating glucocorticoid-induce osteoporosis in Wnt/β-catenin pathway by downregulating TNFR2. STUDY DESIGN/SETTING: Animal experiment:thirty 4-month-old SD rats were randomly divided into three groups: blank group, model group and Plastrum Testudinis group. The model group and the Plastrum Testudinis group were subcutaneously injected with dexamethasone, and were successfully gavaged with 0.9% sodium chloride solution and Plastrum Testudinis respectively. The lumbar spine (L1-6) were taken after 12 weeks. PATIENT SAMPLE: No patients. Thirty 4-month-old SD rats were used in this study. OUTCOME MEASURES: The mRNA expression of TNFR2, β-cantenin and GSK3β in the lumbar vertebra were detected by qPCR. The protein expressions of TNFR2, p-β-cantenin and p-GSK3β were detected by Western blot. Cell expeiment:CCK8 was used to detect the proliferation of BMSCs at different concentrations for 1,3,5,7 and 14 days. Osteogenesis was induced by selecting the best concentration. ALP and alizarin red staining were used to detect the effect of PTE on osteogenic differentiation of BMSCs. The expression of TNFR2, Β-cantenin, GSK3β mRNA expression, TNFR2, p-β-cantenin, p-GSK3β protein expression of turtle plate were detected by Werstern blot. METHODS: Animal experiment: Thirty 4-month-old SD rats were randomly divided into three groups: blank group, model group and Plastrum Testudinis group. The model group and the Plastrum Testudinis group were subcutaneously injected with dexamethasone, and were successfully gavaged with 0.9% sodium chloride solution and Plastrum Testudinis respectively. The lumbar spine (L1-6) were taken after 12 weeks. The mRNA expression of TNFR2, β-cantenin and GSK3β in the lumbar vertebra were detected by qPCR. The protein expressions of TNFR2, p-β-cantenin and p-GSK3β were detected by Western blot. Cell expeiment:CCK8 was used to detect the proliferation of BMSCs at different concentrations for 1,3,5,7,14 days. Osteogenesis was induced by selecting the best concentration. ALP and alizarin red staining were used to detect the effect of PTE on osteogenic differentiation of BMSCs. The expression of TNFR2,
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.