Introduction There is a lack of studies analyzing the molecular aspects of body functioning in purulent complications of bone tissue. The purpose of the review was to explore the serum vascular endothelial growth factor (VEGF) levels in patients with high-energy trauma complicated with infection. Material and methods The study included 36 individuals who sustained a high-energy injury. The participants were identified as no-infection patients (Group I) and those who developed infection during treatment (Group II). Enzyme immunoassay was employed to quantify VEGF with Thermofisher immunoassay analyzer (USA). The study was performed according to the methodology from the R & D Systems kit manual (Angiopoietin-1 and -2 (Ang-1, Ang-2)), platelet-derived growth factors (PDGF-AB, PDGF-BB), Invitrogen (epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), RayBiotech (macrophage stimulating protein (MSP), Biomerika Inc. (Calcitonin-calciotonin) USA) and Immunodiagnostic (bone sialoprotein (BSP) (Germany). HITACHI HI Vision Avius ultrasound scanner was used to explore vessels of the soft tissues and the periosteum at the site of regeneration (defect). Results There were no differences in the serum growth factor levels among the participants by gender. Patients of Group II showed 60% reduction in the Ang-2 and VEGF concentration as compared with that in the no-infection group. The serum EGF concentration was 1.6 times higher in individuals suffering from complications of high-energy trauma than in no-infection patients. There were no significant differences in platelet-derived growth factor PDGF-AB, PDGF-BB between the groups. Сhanges in the VEGF concentration were confirmed by the results of Doppler ultrasonography. Conclusion The findings suggest that the VEGFs examined can be additional diagnostic and prognostic markers for the cohort of patients.
В настоящее время потребность в костно-пластическом материале возрастает при проведении реконструктивно - восстановительных операций на костной ткани в травматологии и ортопедии, челюстно-лицевой хирургии, костной онкологии и в других случаях хирургической практики. Среди имплантационных материалов на основе костной ткани лидирующее место занимают импланты ауто- и аллогенного происхождения. Аутогенные импланты - лучшие с биологической точки зрения, но их достойной альтернативой являются материалы из ксенокости в силу своей доступности и биосовместимости. Цель исследования - изучение репаративных процессов в зоне регенерации при алло - и ксеноимплантации материала, полученного из костной ткани, в полуциркулярный дефект диафиза бедренной кости крыс. Материалы готовили по одинаковой технологии. Методика. Биохимические и морфологические исследования проведены на 18 крысах-самцах линии Вистар в возрасте 6-8 месяцев. Животные были распределены на 3 группы. Первая группа (n = 6) - ксеноимплантация, вторая (n = 6) - аллоимплантация, третья контроль (n = 6) - здоровые животные. Изучены биохимические показатели сыворотки крови на 60-е сут. эксперимента: активность общей щелочной фосфатазы и тартратрезистентного изофермента кислой фосфатазы, содержание кальция, фосфата, общего белка, С-реактивного белка, белковых фракций и проведены морфологические исследования. Результаты и обсуждение. Биохимические исследования белковых фракций и С-реактивного белка сыворотки крови свидетельствуют об отсутствии выраженной воспалительной реакции у крыс при алло - и ксеноимплантации внеклеточного матрикса костной ткани в области дефекта метафиза бедренной кости. В обеих опытных группах отмечена активация репаративных процессов. Гистологический анализ выявил остеоинтеграцию как аллогенных, так и ксеногенных фрагментов губчатой кости, имплантированных в область полуциркулярного дефекта бедренной кости крыс. При использовании аллоимплантатов отмечен более высокий темп их биодеградации и органотипическая перестройка оперированного участка кости реципиента. Во всех случаях показано отсутствие реакции отторжения либо инкапсуляции импланта и признаков воспаления в тканях реципиента. Полученные нами данные биохимического и гистологического исследований являются доказательством возможности использования внеклеточного матрикса ксеногенной природы для замещения дефектов костной ткани. The need for bone-plastic material is presently rapidly increasing, particularly for reconstructive and restorative surgeries on bone tissue in traumatology and orthopedics, maxillofacial surgery, bone oncology, and other cases of surgical practice. Among the implantation materials based on bone tissue the leading place is occupied by auto- and allogeneic implants. Autogenic implants are the best from the biological point of view but xenobone materials are their worthy alternative due to their availability and biocompatibility. The aim of this research was to study reparative processes in the regeneration zone during allo- and xenoimplantation of a material obtained from bone tissue into a semicircular defect in the rat femoral diaphysis. The materials were prepared using the same technology. Methods. Biochemical and morphological studies were performed on 18 male Wistar rats aged 6-8 months. The rats were divided into 3 groups. The first group (n = 6), xenoimplantation; the second group (n = 6), alloimplantation, and the third group, healthy control (n = 6). On the 60 day of experiment, biochemical indexes of blood serum were studied, including activities of total alkaline phosphatase (TCA) and tartrate-resistant isoenzyme of acid phosphatase (TrAP), calcium, phosphate, total protein (TP), C-reactive protein, protein fractions, and morphological studies. Results. Measuring serum protein fractions and C-reactive protein showed the absence of a significant inflammatory reaction to allo- and xenoimplantation of extracellular bone matrix into the defect of femoral metaphysis. Activation of reparative process was noted in both experimental groups. Histological analysis found osteointegration of both allogeneic and xenogenic fragments of the spongy bone implanted into the semicircular defect of rat femur. When alloimplants were used a high rate of their biodegradation and organotypic remodeling of the operated recipient’s bone were observed. However, in all cases, there was no evidence of a rejection reaction, encapsulation of the implant or inflammation in tissues of the maternal bed.
Background Vitamin D-resistant rickets is a systemic disease with impaired bone remodeling that interferes with orthopaedic treatment of musculoskeletal pathologies. There is a paucity of literature focusing on the content and dynamics in vascular endothelial growth factors (VEGF) that promote the transformation of cartilage to bone. Objective Explore blood serum concentration of VEGF and VEGF-А and their receptors VEGF-R2, VEGF-R3 at stages of combined osteosynthesis in patients with vitamin D-resistant rickets during correction of multiplanar deformities of lower limbs. Material and methods The study included 24 patients with multiplanar deformities of lower limbs secondary to vitamin D-resistant rickets. Patients were treated with combined Ilizarov external fixation and intramedullary nailing using hydroxyapatite-coated wires. Serum concentration of VEGF and VEGF-А and their receptors VEGF-R2, VEGF-R3 were measured during treatment. Values obtained in the patients were compared to reference levels measured in 180 somatically healthy individuals. The quantified results were presented in a percentage of the reference values. Results Preoperative serum VEGF and VEGF-R2 concentration was significantly higher in the patients than that in normal subjects: VEGF, by 1990 % (р = 0.0033); VEGF-A, by 450 % (р = 0.00042); VEGF-R2, by 392 % (р = 0.0052) while preoperative serum VEGF-R3 concentration was lower by 68 % (p < 0.05) in the patients than that in subjectively healthy individuals. Surgical treatment resulted in greater increase in VEGF, VEGF-A levels with maximal concentration observed at the distraction phase. The opposite dynamics was observed with VEGF-R2 receptor. Specific dynamics was noted with VEGF-R3 receptor during surgical correction. Nearly preoperative serum concentration of VEGF-R3 was seen at the first stage showing the lowest level (21% of the normal) during bone distraction with external fixator and regenerate formation. It was reduced by 25 % of the preoperative level at the end of treatment. Conclusion Patients with vitamin D-resistant rickets demonstrated strong imbalance in serum concentrations of VEGFs and their receptors. Phase opposition dynamics in serum concentrations of VEGFs and their receptors was detected during surgical correction of multiplanar deformities of lower limbs.
Наиболее важной задачей при дистракционном остеосинтезе является создание простых и эффективных способов контроля темпов дистракции позволяющих производить удлинение конечности в оптимальном режиме у различных групп пациентов. Цель исследования - анализ содержания сывороточных концентраций TGFb-1 и TGFb-2, BMP-4 и BMP-6 у лиц при увеличении роста с косметической целью и у пациентов с ахондроплазией на этапах дистракционного остеогенеза при удлинении голени методом Илизарова. Методика. Определение ростовых факторов проводили на комплексе оборудования фирмы Thermofisher (США): детектор Multiscan FC, встряхиватель iEMS, автоматический промыватель планшет WellWash. Для измерения концентрации факторов в сыворотке крови использовали наборы для иммуноферментного анализа (ИФА) eBioscience и RayBiotech Inc. (США). Результаты . Показано, что в сыворотке крови людей с ахондроплазией, еще до какого-либо ортопедического лечения концентрации TGF-b2 и ВМР-4, ниже, а TGF-b1 и ВМР-6, выше, чем концентрации этих факторов у людей при увеличении роста с косметической целью. У последних удлинение конечностей сопровождается возрастанием содержания в сыворотке крови факторов TGF-b1 и TGF-b2 на этапах начала и середины процесса дистракции. У пациентов с ахондроплазией, наблюдается обратная динамика: концентрация данных факторов (ВМР-4 и ВМР-3) в крови ахондропатов к концу дистракции увеличивается в 3,5 и 2 раза соответственно, снижаясь в периоде фиксации. Заключение. Таким образом, у пациентов с ахондроплазией происходит нарушение этапности процессов костного ремоделирования. Elaboration of simple and effective ways for managing the distraction rate to provide an optimum regimen of limb lengthening for different groups of patients is an important task in implementation of transosseous osteosynthesis. The aim of this study was to analyze blood serum concentrations of TGFb-1, TGFb-2, BMP-4, and BMP-6 in individuals undergoing cosmetic height increase and patients with achondroplasia at different stages of distraction osteogenesis in tibial lengthening using the Ilizarov method. Methods. Concentrations of growth factors were measured using a set of Thermofisher (USA) equipment, including a Multiscan FC detector, iEMS Shaker, and automatic WellWash Washer and ELISA kits (eBioscience and RayBiotech Inc., USA). Results. Serum concentrations of TGFb-2 and BMP-4 were lower and TGFb-1 and BMP-6 were higher in achondroplasia patients than in individuals with cosmetic height increase even before any orthopedic treatment. Long bone lengthening for cosmetic height increase was associated with increases in serum levels of TGFb-1 and TGFb-2 at the start and in the middle of distraction. In achondroplasia patients, opposite changes were observed; serum concentrations of BMP-4 and BMP-3 increased 3.5 and 2 times, respectively, by the end of distraction and decreased during fixation. Conclusion. Therefore, we observed a disorder of the stage-by-stage bone remodeling process in achondroplasia patients.
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