engleski

Bone regeneration on steroids: from bench to bed

Clinical management of delayed healing or non-union of long bone fractures and segmental bone defects poses a substantial orthopedic challenge. Surgical advances and bone tissue engineering are providing new avenues to stimulate bone growth in cases of bone loss and non-union. The Reamer-Irrigator-Aspirator (RIA) device allows surgeons to aspirate the medullary contents of long bones and utilize the progenitor-rich “flow through” fraction in autologous bone grafting. Dexamethasone (DEX) is a synthetic steroid that has been shown to be a powerful inducer of osteoblastic differentiation. The aim of this lecture is to present a novel, intraoperative, one-step procedure that utilizes the RIA system to recover autologous bone along with progenitor cells from bone marrow. The recovered materials are treated with a high concentration of DEX and then implanted into the fracture site. The lecture will follow complete development of the method, starting with initial in vitro experiments with human bone marrow derived-mesenchymal stem cells (hMSCs), all the way until the method was successfully applied in the treatment of difficult clinical cases of delayed bone healing and established non-unions. Preliminary clinical results will be presented as well. Bone regeneration is a hot topic in translational clinical orthopedics research with both basic physiology and therapeutic implications. The ultimate goal of this paper is to present this novel method as an excellent example of the basic science information being adequately used in clinical applications, and vice versa, to show how clinical needs and observations are recognized and exploited by basic scientists.

bone regeneration; stereoids

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