WO2005048885A1 - Bioabsorbable plug implants and method for bone tissue regeneration - Google Patents

Bioabsorbable plug implants and method for bone tissue regeneration Download PDF

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Publication number
WO2005048885A1
WO2005048885A1 PCT/SG2004/000380 SG2004000380W WO2005048885A1 WO 2005048885 A1 WO2005048885 A1 WO 2005048885A1 SG 2004000380 W SG2004000380 W SG 2004000380W WO 2005048885 A1 WO2005048885 A1 WO 2005048885A1
Authority
WO
WIPO (PCT)
Prior art keywords
plug implant
plug
implant
bone
plc
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/SG2004/000380
Other languages
English (en)
French (fr)
Inventor
Swee Hin Teoh
Kim Cheng Tan
Dietmar Hutmacher
Thiam Chye Lim
Jan-Thorsten Schantz
Ning Chou
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
National University of Singapore
Osteopore International Pte Ltd
Original Assignee
National University of Singapore
Osteopore International Pte Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by National University of Singapore, Osteopore International Pte Ltd filed Critical National University of Singapore
Priority to HK07100619.4A priority Critical patent/HK1098037B/en
Priority to AU2004291022A priority patent/AU2004291022C1/en
Priority to US10/579,946 priority patent/US20070083268A1/en
Priority to CN2004800405322A priority patent/CN1972644B/zh
Priority to EP04800445A priority patent/EP1691726B1/en
Priority to JP2006541104A priority patent/JP5086642B2/ja
Publication of WO2005048885A1 publication Critical patent/WO2005048885A1/en
Anticipated expiration legal-status Critical
Priority to US14/223,737 priority patent/US9492279B2/en
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017—Angular shapes
    • A61F2230/0021—Angular shapes square
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0067—Three-dimensional shapes conical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0069—Three-dimensional shapes cylindrical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2430/00—Materials or treatment for tissue regeneration
    • A61L2430/02—Materials or treatment for tissue regeneration for reconstruction of bones; weight-bearing implants

Definitions

  • the present invention relates to an expandable bioabsorbable implant for bone tissue regeneration and a to a method for bone tissue reparation and regeneration.
  • Trephination burr holes often result in small but undesirable scalp and skin depression.
  • Subdural hematoma is a common problem especially if patient has head injuries related to accidents or due to blood clogging in the brain as a result of stroke. It is usually treated by burr hole drainage or irrigation.
  • the trephined burr hole procedure involves drilling a hole typically 14 to 19 mm in diameter on to the patient's skull.
  • autologous graft material Another possibility using autologous graft material is to collect the bone dust during the craniotomy procedure and mix it with a hydrogel like fibrin glue and use that paste to fill out the defect after the procedure (Matsumoto, 1998).
  • Yamashina has designed hydroxyapatite plates which are domed and elliptic in shape so that they fit the convexity of the occipital region.
  • the author has also designed HA-buttons to fit burr hole defects as well as apatite granules for linear skull defects.
  • a specially designed "key-hole button" based on hydroxyapatite was designed by Koyama et al (2000) for trephination defects.
  • US patent No.6,350,284 ('284) describes a bioabsorbable cranial implant consisting of a rigid plate and a fibrous web layer containing pores between 30 and 1000 ⁇ m in diameter. This implant, however, requires to be fixed to the bone by means for attachment, for example, sutures, tacks, or screws, and it is therefore not practical.
  • the present invention addresses the problems above and, in particular, provides new and improved implant, suitable for tissue bone regeneration and bone restoration, easy to be use and which does not require means for attachment to the bone.
  • Tissue bone regeneration of an osseous defect or gap can be partial or complete; in the latter case, for the purpose of the present application it will be indicated as bone restoration.
  • the present invention discloses a bioabsorbable plug implant suitable for bone tissue regeneration, wherein the implant comprises a first portion, and a second portion extending outwardly from the first portion, the first and second portions formed from expandable material.
  • the plug implant of the invention may have any shape suitable to be inserted into a defect of a bone, for example, the plug implant may be shaped like a cone, truncated-cone, a pentahedron, a truncated-pentahedron, and/or a button mushroom.
  • the first portion comprises a first surface
  • the second portion comprises a second surface, opposite to the first, the first surface having an area smaller than the area of the second surface.
  • the first and the second surfaces of the plug implant may have circular, square or rectangular shapes.
  • the first and second surfaces may be plane surfaces.
  • the plug implant of the invention has a tapered shape.
  • the plug implant comprises a the first portion having a thickness X, and the second portion having a thickness Y, the ratio X:Y being from 1 :1 to 10:1.
  • the plug implant of the invention is made of a material which expands in contact with hydrophilic solution, hydrophilic liquid and/or body fluid.
  • the expandable material may be formed from porous material.
  • the plug implant of the invention may preferably be made of an expandable material comprising bioresorbable polycaprolactone (PLC). For example, 20% TCP-PCL.
  • PLC bioresorbable polycaprolactone
  • the plug implant may be prepared by layering PLC filaments layer by layer using, for example, the Fused Deposition Modeling (FDM) technology.
  • FDM Fused Deposition Modeling
  • the PLC filament layers of the plug implant may have an orientation of 0 degree, 60 degree and/or 120 degree.
  • the plug implant comprises an opening for placement and removal of a catheter for drainage.
  • the plug implant is suitable to be inserted into a defect or a gap of a bone and the plug implant does not require means for fixing the plug to the external surface of the bone.
  • the plug implant may further comprise a bioactive agent.
  • the invention further provides a method for bone tissue regeneration comprising the steps of: providing a bioabsorbable plug implant, wherein the implant comprises a first portion and a second portion extending outwardly from the first portion, the first and second portions formed from expandable material; inserting the second portion into a defect or gap of a bone, the first surface engaging the outside contour of the defect or gap; allowing the plug implant to contact body fluids, thereby expanding the size of the plug implant so that the plug fits into the defect or gap.
  • the implant may comprise a first and a second surface, opposite to each other, the first surface having an area smaller than the area of the second surface.
  • the plug implant may be formed from a porous material allowing the bone cells to penetrate into the plug implant and to regenerate the bone tissue.
  • the method may be used for any bone tissue regeneration.
  • it may be a method for performing cranioplasty.
  • the plug implant is inserted into a defect of the bone, in a way that the plug implant and the bone defect have an initial tolerance of less than 1 mm, less than 0.5 mm, or less than 0.2 mm.
  • the method according to the invention can be used for therapeutic treatment of restoration of osseous defects or can be used for non therapeutic treatment for the cosmetic restoration of undesirable osseous gaps.
  • the method can be applied for the bone tissue regeneration and/or osseous restoration.
  • Figure 1 show a typical burr hole or defect (2) created for drainage/irrigation and neurological examination on a phantom skull (1 ).
  • FIG. 2 is an orthographic view of Case 1 Burr Plug (3) design.
  • the plug implant (3) comprises a first or upper surface (5) and a second of lower surface (4).
  • Figure 3 is an isometric view of the case 1 Burr Plug (2) design of Fig.2.
  • Figure 4A shows an embodiment wherein the first or lower surface (50) of the plug implant (30) is inserted into a defect of the bone, and wherein the plug implant has a tapered shape.
  • Figure 4B shows the embodiment of Figures 2 and 3.
  • Figure 5 (A,B) shows the embodiments of Figure 4 (a, b), further comprising an opening for the insertion and/or removal of a catheter for drainage.
  • Figure 6 shows the 0/60/120° layer orientation of the PCL filament in the Burr Plug design, (a) 0 degree orientation of the PCL filament layer; (b) 60 degree orientation of the PCL filament layer; (c) 120 degree orientation of the PCL filament layer.
  • Figure 7 is an orthographic and isometric view of the Case 2 Centre Hole Burr Plug Design that allows easy placement and removal of a catheter.
  • Figure 8 shows one wk postoperative CT showing the two bur holes (Left); after 3 mth postoperative CT Implants were well integrated and started to mineralise (Right) on human subjects.
  • Figure 9 is a postoperative view of two patients showing hair has grown on the skin covering the defect.
  • Figure 10 show the structure of a 20% TPC PCL scaffold. SEM of empty TPC- PCL scaffolds revealed interconnecting pores of 400-600 ⁇ m in diameter.
  • Figures 11 and 12 show the construction of sheet-scaffolds.
  • FIG. 13 Cell attachment (phalloidin stain)(200x) of an in vitro culture at 3 weeks.
  • Figure 14 (A, B). Cell proliferation (FDA-PI stain inside). A) In vitro 1 week (100x). B) In vitro 5 weeks (200x). Figure 15(A, B). Cell sheet - scaffold constructs. The photos (A) (top view) and (B)(side view) show cell sheets covering the scaffolds and collagen fibers formed after three weeks in vitro culture under induction.
  • Cell sheet - scaffold constructs (Inside scaffolds). A) is the side view, and B) is the top view.
  • the photos (A)(100x) and (B)(400x) show mineral nodules formed in the scaffolds, 5 weeks after induction.
  • FIG. 20 ALPase released in media by ELISA.
  • FIG. 21 RT-PCR Assay.
  • In vitro RT-PCR profiles show osterix, osteocalcin and osteopontin mRNA expression level of sheet-scaffolds constructs significantly increased after induction, while collagen type I and Cbfal expression level are slightly increased.
  • FIG. 22 RT-PCR assay on expression level of osterix and osteocalcin.
  • the expression level of osteorix and osteocalcin are up-regulated to 10 to 5 times after osteogenic induction. Data were calculated according to the density of PCR products.
  • FIGs 23 and 24 Protein profiles show that osteocalcin in sheet-scaffolds constructs is specifically observed after osteogenic induction, and osteopontin expression level is sharply up-regulated 4-5 times after induction.
  • Figure 25(A, B) Implantation of sheet-scaffolds constructs.
  • FIG. 27 (A, B, C). Soft X-ray. Bone formation visualised by X-ray at 25KV, 6.3Mas. (A): 4 weeks after implantation in nude rat. (B): 8 weeks. (C): 12 weeks. The bone was mainly formed around the scaffolds.
  • Figure 28 Micro CT analysis of cortical bone formation. Both the volume and surface of bone formed by implanted sheet-scaffolds constructs decreased over time.
  • FIG. 30 (A, B, C). H/E stain after 8 weeks of implantation. H/E stain shows that the bone formation of sheet-scaffolds may experience endochondry process since some chondrocyte like cells were observed under the bone tissue. (A) 25x; (B) 100x; and (C) 400x.
  • FIG 31 (A, B). Fluorescence label cells formed the bone. (A) 4 weeks; (B) 8 weeks. Both 400x. Most of the new formed bone tissue was composed of green-fluorescence labelled PMSCs. Detailed description of the invention
  • Tissue bone regeneration of an osseous defect or gap can be partial or complete; in the latter case, for the purpose of the present application it will be indicated as bone restoration.
  • the bioresorbable plug implant and method for bone tissue regeneration can be applied to any type of osseous defect or gaps.
  • a particular application of the plug implant of the invention is for example cranioplasty.
  • the implant according to the invention has the shape of a plug.
  • a plug implant suitable for bone tissue regeneration and/or bone restoration is defined as an implant which fits substantially tightly into a bone defect or gap, for example a bone hole, used to fill the defect or gap or act as a wedge or stopper.
  • a defect or a gap refer to a cavity of the bone.
  • the term defect it is referred a condition which may be considered a disease and needs to be treated therapeutically, whilst with the term gap it is referred to a condition which is not a disease and may be treated non therapeutically for cosmetic purpose.
  • the term "burr hole” will be used to generally indicate the defect and/or gap.
  • the plug implant of the invention may also be addressed as "burr plug”.
  • the structure of the expandable material from which the plug implant is made may also be indicated as "scaffold”.
  • the present invention discloses a bioabsorbable plug implant suitable for bone tissue regeneration, wherein the implant comprises a first portion, and a second portion extending outwardly from the first portion, the first and second portions formed from expandable material.
  • the plug implant of the invention may have any shape suitable to be inserted into a defect of a bone, for example, the plug implant may be shaped like a cone, truncated-cone, a pentahedron, a truncated-pentahedron, and/or a button mushroom.
  • the first portion comprises a first surface
  • the second portion comprises a second surface, opposite to the first, the first surface having an area smaller than the area of the second surface.
  • the first and the second surfaces of the plug implant may have circular, square or rectangular shapes.
  • the first and second surfaces may be plane surfaces.
  • the plug implant of the invention is made of a material which expand in contact with hydrophilic solution, hydrophilic liquid and/or body fluid.
  • Figure 1 show, a skull (1 ) phantom comprising a burr hole (2), which for the purpose of the invention may be distinguished as defect (2) or gap (2).
  • the plug implant can be shape like a "button mushroom" (3), comprising a first portion (5), and a second portion (4) extending outwardly from the first portion, the first and second portions formed from expandable material.
  • the plug implant of the invention is not limited to the shape of a button mushroom but may have any shape suitable to be inserted into a defect of a bone, for example, the plug implant may be shaped like a cone,- truncated-cone, a pentahedron, a truncated-pentahedron, and/or a button mushroom.
  • the first portion (5) comprises a first surface (5)
  • the second portion (4) comprises a second surface (4), opposite to the first, the first surface having an area smaller than the area of the second surface.
  • the first and the second surfaces of the plug implant have circular shapes.
  • the first and second surfaces have plane surfaces.
  • the shape is not limited to a circular one, but may be for example, a square or rectangular shape.
  • the surfaces is not limited to a place surface but may have any surface suitable for the purpose of the present invention, for example, an irregular, conical, acute, or elliptical shape may be within the scope of the present invention.
  • the first and second portions may also be characterized according to their thickness.
  • the first portion (5) comprises the first surface and has a thickness X
  • the second portion (4) comprises the second surface and has a thickness Y
  • the ratio X:Y being from 1 :1 to 1 :10.
  • the ratio X:Y is 11 :4
  • the first portion (5) comprises 11 layers
  • the second portion (4) comprises 4 layers.
  • the number of layers may be chosen by the skilled person according to the particular shape of the plug implant and according to the type of bone, burr hole, and particular conditions of the patient, human or animal.
  • the plug implant can be designed in such a way to such that a second portion may have thickness of 1 mm and the first portion thickness 3 mm.
  • Figure 2 is an isometric view of the embodiment of Figure 1. More in particular, Figure 2 shows the layered-scaffold structure made formed from biodegradable polymer filaments.
  • the plug implant of the invention has a tapered shape or may have any shape suitable to be inserted into a defect of a bone, for example, the plug implant may be shaped like a cone, truncated- cone, a pentahedron, a truncated-pentahedron, and/or a button mushroom.
  • Figure 2(A) shows a plug implant having a tapered shape comprising a first portion (50) comprising a first surface (50), and the second portion (40) comprising a second surface (40), opposite to the first surface, the first surface (50) having an area smaller than the area of the second surface (50).
  • the first portion (50) plug implant is inserted into the bone defect or gap whilst the second portion (40) engages with the contour of the defect or gap avoiding the plug implant to penetrate into the bone cavity.
  • the first and the second surfaces of the plug implant may have circular, square or rectangular shapes.
  • the first and second surfaces may be plane surfaces.
  • Figure 2(B) shows the embodiment of Figures 1 and 2.
  • the size of the plug implant according to any embodiment of the invention as well as the first and second portion can be chosen by the skilled person according to the size of the bone defect or gap.
  • the plug implant can be designed in such a way to such that a second portion may have thickness of 1 mm and the first portion thickness 3 mm.
  • the plug implant may have for example a diameter of the first portion of 15 mm and the diameter of the second portion of 20 mm (see Figures 1 and 2).
  • the particular shape of the plug of the invention in combination with the material which is a material which is expandable or swell (for example polycaprolactone (PCL)) at contact with at contact with hydrophilic solution, hydrophilic liquid and/or body fluid allows the plug implant to 'snap fit' into the defect or gap without the need of means for attaching the plug to the bone.
  • the plug implant of the invention therefore can be used without requiring means for attachment like screws, which are instead used for titanium plates for cranioplasty or which are necessary for the implant described in US 6,350,284. Accordingly, the plug implant of the invention does not requires holes for insertion of means for attachment to the bone surface, like screws. The absence of screws meant one important advantage - it allows an easy placement of the burr plug in the shortest possible time.
  • initial tolerance of no more than 1.0 mm, no more than 0.5 mm or no more of 0.2 mm between the plug implant and the defect or gap on the bone (for example, on the cranium), allows the 'snap fit' design to operate effectively.
  • the larger second portion ensures that the plug implant remains in the contoured position of the defect or gap of the bone not accidentally pushed too far below the thickness of the bone of the structure (for example, of the skull).
  • the expandable material may be of porous material.
  • 20% TCP-PCL More in particular, 20% TCP-PCL with 60-70% of porosity.
  • 20% TCP-PCL Preferably, 20% TCP-PCL with 65% of porosity.
  • the scaffolds of the plug implant may have a completely interconnected porous architecture and a porosity of approximately 60 to 70%. This morphology allowed cells to be trapped and proliferate when the scaffolds are implanted in the body (Hutraum et al, 2001).
  • FIGS 5 (A) and (B) and Figure 7 show a further embodiment wherein the plug implant comprises and opening (600, 610) for placing catheter for performing drainage.
  • the plug implant comprises and opening (600, 610) for placing catheter for performing drainage. This design allows an easy placement and removal of a catheter which can be inserted at an angle in the scaffold for drainage purposes.
  • any bioabsorbable material known in the art suitable for the construction of the plug implant of the present invention can be used.
  • any bioabsorbable polymer or copolymer can be used.
  • a bioresobable polycaprolactone (PCL) polymer which has been proven to be biocompatible, degrades slowly and allows bone cells to attach and proliferate, has been proven particularly suitable for the purpose of the present invention. With time the cells expressed they own extra cellular matrices and bone like structures results as the PCL is reabsorbed and metabolised by the body.
  • TCP-PCL (20% weight per volume) hybrid scaffold using a solid-free form fabrication technology, known as fused deposition modeling (FDM), in combination tricalcium phosphate (TCP) with PCL may be prepared according to (Dennis et al., 2003). More in particular, 20% TCP-PCL having 60-7-% of porosity, preferably 65% of porosity may be used. Most importantly, the computer-controlled FDM process permits the design and fabrication of porous scaffolds with suitable mechanical strength that mimics the in vivo bone architecture. The approach embraces the concept of tissue engineering.
  • the scaffold design of the plug implant may be constructed according to any methodology known in the art.
  • PCL filaments layer by layer via a rapid prototyping process, like the so called “Fused Deposition Modeling” (FDM) (Iwan Zein et al, 2002).
  • FDM Fusion Deposition Modeling
  • the filaments may be deposited according to any suitable orientation, for example the PLC filament layers may have an orientation of 0 degree, 60 degree and/or 120 degree (see Figure 6A, B, C). Design and Fabrication of PCL Scaffolds
  • the biodegradable polymer implants are fabricated from a medical grade polycaprolactone (PCL, Viscosity 1.0-1.3; Birmingham, Al) using FDM rapid prototyping technology's (FDM 3D Modeller from Stratasys Inc., Eden Prairie, MN).
  • the scaffolds have a completely interconnected porous architecture and a porosity of approximately 60 to 70%.
  • the biodegradable polymer is TCP- PCL.
  • This morphology allowed cells to be trapped and proliferate when the scaffolds are implanted in the body (Hutmacher et al, 2001 ).
  • the scaffold geometric models were first created in the Unigraphics CAD software and then exported into the Stratasys QuickSliceTM software in ".STL file " format. For all the layers, a single contour and raster-fill pattern was adopted. A lay-down pattern of 0/60/120° were used to form the patterns of triangular pores (Fig. 6A,B,C).
  • the method for producing the FDM filament is known in the art.
  • MSC mesenchymal stem cell
  • Numerous studies have been undertaken to repair bone defects using MSCs seeded on porous scaffolds with either osteoconductive or osteoinductive properties.
  • Caplan and Bruder (1997) were the first to describe a technique where large numbers of cells were cultured on to ceremaic scaffolds prior to being surgically implanted into bone defects.
  • problems with culture technique and scaffold properties must be overcome.
  • Improved techniques to expand MSCs in culture to achieve more reliable mineralization and bone formation rates were the first to be developed.
  • This cell-sheet cluster technique has proven effective for tissue engineering in a number of contexts. Firstly, transplanting single cell-sheets for skin and cornea reconstruction has proven more successful compared with enzymatic treatments (Kushida et al., 2001). Secondly, layers of differing cell-sheets can be utilized for reconstructing complex tissues with multiple cell types. Using this technique, blood vessels have been engineered by culturing human cells, without synthetic or exogenous biological materials that demonstrate sufficient mechanical strength to warrant in vivo grafting (Nicolas, 1998). Lastly, by layering several types of cell-sheets, laminar structures can be fabricated including liver, kidney and vascular organs (Shimizu et al., 2001 ).
  • the plug implant is suitable to be inserted into a defect or a gap of a bone and the plug implant does not require means for fixing the plug to the external surface of the bone.
  • the plug implant may further comprise a bioactive agent.
  • the invention further provides a method for bone tissue regeneration comprising the steps of: providing a bioabsorbable plug implant, wherein the implant comprises a first portion and a second portion extending outwardly from the first portion, the first and second portions formed from expandable material; inserting the second portion into a defect or gap of a bone, the first surface engaging the outside contour of the defect or gap; allowing the plug implant to contact body fluids, thereby expanding the size of the plug implant so that the plug fits into the defect or gap.
  • the implant may comprise a first and a second surface, opposite to each other, the first surface having an area smaller than the area of the second surface.
  • the plug implant may be formed from a porous material allowing the bone cells to penetrate into the plug implant and to regenerate the bone tissue.
  • the plug implant may be shaped like a cone, truncated-cone, a pentahedron, a truncated-pentahedron, and/or a button mushroom.
  • the first and second surface may have plane surfaces.
  • the first and the second surfaces may have circular, square or rectangular shapes
  • the plug implant may be formed from a porous material allowing the bone cells to penetrate into the plug implant and to regenerate the bone tissue.
  • the method of the invention can be used for bone tissue regeneration and bone reparation for any kind of bone structure, however, it is particularly suitable for performing cranioplasty.
  • plug implant and the bone defect or gap have an initial tolerance of less than 1 mm.
  • the initial tolerance is less than 0.5 mm.
  • the initial tolerance is less than 0.2 mm.
  • the method of the invention may also comprises placing catheter into an opening of the plug implant for performing drainage.
  • a characteristic of the method of the invention is that insertion of the plug implant into the bone defect does not require means for fixing the plug to the external surface of the bone surrounding the defect.
  • the method of the invention may be a therapeutic method for tissue bone regeneration and bone restoration of defects in animals, including humans.
  • the method may also be a non therapeutic method for the cosmetic restoration of undesirable osseous gaps.
  • a (Left) shows a CT scan of two burr holes.
  • a postoperative CT scan taken at day 3 revealed that the FDM PCL scaffold/cell graft was fixed in place and the 3D shape of the cranium had been well reconstructed. There were no mass effects or fluid collections present.
  • the slow degradation kinetics of the PCL provides a stabile template and conforms to the shape of the skull. No swellings were present.
  • porcine bone mesenchymal stem cells seeded into and around three-dimensional TCP-PCL scaffolds for augmenting bone formation.
  • PMSCs After 8 culture in osteoinductive media, PMSCs remained viable with mineralized nodules visible both inside and outside the scaffold.
  • Intracellular alkaline phosphatase (ALP) activity increased > 50 times following induction, with soluble ALP continuing to increase throughout the culture period.
  • mRNA expression for the osteogenic-related transcripts osterix, osteopontin (OPN), and osteocalcin (OCN) increased 4 - 10 times following induction, whilst core DNA binding factor 1 (Cbfal ) and collagen type I transcripts were slightly up regulated.
  • OCN increased 10 fold whilst OPN levels were elevated two to four fold.
  • Scaffold porosity is defined as the ratio between true scaffold volume and apparent scaffold volume.
  • the true volume is the volume of the material that makes up the scaffold, whereas, apparent volume is the scaffolds overall geometric volume, including air spaces within it.
  • Scaffold porosity was measured as reported elsewhere, and the scaffold morphology and pore size were determined via scanning electron microscopy (SEM). Scaffold surfaces were gold-sputtered and examined using 15 kV accelerating voltage (Phillips XL30 FEG, Netherlands).
  • the average molecular weight of the PCL was determined by high performance liquid chromatography utilizing a gel permeation chromatography (GPC) apparatus. Sections of the PCL scaffolds were cut and dissolved in tetrahydrofuran (THF) at a concentration of 0.1% ( 1 mg/ml). The sample solution was further filtered through a 0.2 ⁇ m inorganic membrane filter and the polymer molecular weight distribution determined using a GPC equipped with a differential refractor (Waters 410) and an absorbance detector refractor (Waters 2690). The samples were eluted through a Styragel column refractor at a flow rate of 1 ml/min, using THF as the mobile phase.
  • GPC gel permeation chromatography
  • Porcine mescenchymal stem cells were isolated and cultured as reported previously (Hutmacher, et al., 2001 ). Pigs were obtained from the Animal Holding Unit of the National University of Singapore (NUS) after appropriate ethical clearance was granted and samples of bone marrow removed according to the NUS animal ethics guidelines.
  • MSCs were aspirated from the bone marrow and gradient centrifugated, prior to being cultured in Dulbecco's Modified Eagle's medium (DMEM) low glucose (GIBCO, Invitrogen, CA, USA) containing 2% fungizone (Sigma, MO, USA) and 2% antibiotics (200 ⁇ g/ml penicillium and 200 ⁇ g/ml streptomycin), herein referred to as standard media, at 37 °C and 5% CO2 in a humidified environment.
  • DMEM Dulbecco's Modified Eagle's medium
  • GOBCO Dulbecco's Modified Eagle's medium
  • GIBCO Dulbecco's Modified Eagle's medium
  • fungizone Sigma, MO, USA
  • antibiotics 200 ⁇ g/ml penicillium and 200 ⁇ g/ml streptomycin
  • culture media was changed to osteogenic media consisting of standard media plus L-ascorbic acid-2-phosphate (50u g/ml), ⁇ - glycerophophate (10 mM) and dexamethasone (100 nM) (Sigma, USA) to induce osteogenic differentation (induced).
  • Control cultures were maintained in standard media. All media was changed every two days.
  • TCP-PCL (20:80%) scaffolds were fabricated by fused deposition modeling (FDM) according to our previous methods (Hutmacher et al 2001) ( Figures 10, 11 and 12).
  • FDM fused deposition modeling
  • TCP-PCL scaffolds were cut into 4 mm x 5 mm x 5 mm blocks and treated with 5M NaOH for 1 h to improve the hydrophobic property of the scaffold surface. Scaffolds were then thoroughly rinsed with PBS to wash away NaOH residues and soaked in75% EtoH for at least half an hour and allowed to air dry. Cells (5 x 1O 5 in 20 ⁇ l) in standard media were then seeded into the scaffolds and allowed to adhere for 2 h at 37°C before additional media was added.
  • Confluent induced (Group A) and non-induced (Group B) MSCs sheets were gently peeled from the flasks using sterile fine forceps and wrapped over the pre-seeded scaffolds and cultured for one week. These constructs were then divided into three groups a) induced cell sheet-scaffolds construct; b) un-induced construct; maintained for up to 8 weeks; c) 2D plates.
  • the scaffold size was 10 mm x10 mm x4 mm and seeded inside with 1 million MSCs then wrapped with cell sheet form 75 square centimeter flask. All the cells used in implantation were cultured in vitro for 4 weeks.
  • Implantation was classified into two groups: a) induced; b) un-induced sheet-scaffolds constructs.
  • the induced constructs were confirmed to have undergone ostegenic process and mineralization before implantation.
  • Cell viability was assessed by a live-dead assay using a combination of fluorescein diacetate (FDA) and propidium iodide (PI) (Molecular Probes Inc., Oregon, USA). Fluoresent photomicrographs were taken of each group using confocal laser microscopy (CLM) (Leica, Germany). Prior to FDA/PI treatment, constructs were removed from the culture wells, rinsed in PBS and incubated at 37°C with 2 ⁇ g/ml FDA in PBS for 15 min. After washing with non-sterile PBS, specimens were then placed in 0.1 mg/ml propidium iodide solution in PBS for 2 min at room temperature. The specimens were then washed again in PBS, placed on a microscopical cover glass, and viewed by confocal microscopy.
  • FDA fluorescein diacetate
  • PI propidium iodide
  • MSCs were labeled with cFDA (Molecular Probes) then washed with PBS and labeled with green fluorescence at 37°C for 15 min according the manufacturers instructions, prior to implantation.
  • cFDA Molecular Probes
  • alamar blue Probes, OR, USA
  • % (v/v) was added to cultures containing cell/scaffold constructs at various timepoints and incubated for3 h.Assay media was then transferred to a 96-well plate and the absorbance at 570 nm and 600 nm were determined with a microplate reader (Brand, CA, USA). Reduction rate was calculated according to the products instruction.
  • Cellular alkaline phosphatase (AP) activity was determined using a kinetic assay based on measuring the rate of p-nitrophenol formation from p- nitrophenyl phosphate (procedure no. 104, Sigma). Briefly, cell lysates were prepared by removing the media and adding ice-cold buffer (5 mM MgCI 2 , 150 mM NaCI, 1% triton-100, pH 7.5) containing a protease inhibitor cocktail (Calbiochem, UK). Protein supernatant was then collected by centrifugation at 12,000 x g for 5 min and the protein content determined using a Protein Assay Kit (Cat No. 500-0002, Bio-Rad).
  • AP activity in the lysates was expressed as nanomoles of p- nitrophenol produced per minute per microgram of protein.
  • Primer sequences were designed with the Primer express® program v 2.0 from Applied Biosystems and were blasted for their specificity at the National Centre for Biotechnology Information (NCBI). Measuring the increase in fluorescence caused by the binding of SYBR Green to double-stranded DNA directly during PCR cycles monitored the increase in reaction products during PCR. Reaction mixtures were setup following the manufacturer's instructions. Following a 8 min Taq Polymerase activation step at 95 °C, the reactions were cycled by denaturing for 30 sec at 95 °C and annealing and elongation for 1 min at 60 °C (same for each primer) and extension at 72 °C for 1 min and repeated for 35 cycles, before a final extension period of 72 °C for 7 min. Target gene C ⁇ values were expressed as Relative Expression Units (REU) and standardized against GAPDH. The reaction products were also cloned into pGEM-TEasy vector (Promega) and sequenced for confirmation.
  • REU Re
  • Cell lysates were prepared by using ice-cold lysis buffer (1% Triton X100, 150 mM NaCI, 10 mM Tris pH 7.4, 2 mM EDTA, 0.5% NP 40, 0.1% SDS) containing protease inhibitors (1 mM sodium orthovanadate, 10 ug/mL leupeptin, 1 ug/mL aprotinin and 1 mM PMSF). The protein concentrations in the supernatant were determined using a Protein Assay Kit (Bio-Rad) according to the manufacturers recommendations.
  • Sections were then treated with 5% (w/v) sodium carbonate solution for 8 minutes; rewashed with UPW and treated with 5% (w/v) sodium thiosulfate (Sigma) and bone nodules photographed using a dissection microscope (Zeiss, Jena, Germany) equipped with a digital camera (AxioCam; Zeiss) using AxioVision Software version 3.1 (Zeiss).
  • a Skyscan in vivo microtomograph 1076 ⁇ CT scanner was used to determine bone growth occurring in the cells / scaffolds constructs. Specimens were placed on 68 mm wide sample holders and the constructs placed with the height and width parallel to the scanning plane. A scanning resolution of 35 ⁇ m, with an averaging of 5 was used together with a 1 mm aluminum filter and a rotation step of 0.8° and a rotation angle of 180°. Approximately 500 scan slices were taken and the files reconstructed at a step size of 4 using a modified Feldkamp algorithm according to the manufactures recommendations (Skyscan). The output was a series of 120 serial 1968 x 1968 bitmap images which were later reconstructed into 3D stacks using Mimics 7.3.
  • Mimics enabled the volume and surface area of the bone growth to be calculated.
  • the degree of new bone growth within the cell / scaffold construct was also assessed based on thresholding standards. These standards (cancellous and cortical bone) were calculated from newly harvested samples of procine bone using the profiling function of Mimics. Thecalculated thresholds used in this study were 68 to 1732 HU (Housefield units) for cortical bone and -70 to 67 HU for cancellous bone.
  • Transplants were recovered 4, 8 and 12-weeks post-transplantation, fixed in 4% formalin, and either decalcified in 10% EDTA (pH 8.0) for paraffin embedding or fixed in 70% ethanol and resin embedded in Technovit 8100 embedded in resin (Technovit 8100, Kulzer, Germany) according to the manufactures recommendations.
  • Paraffin sections (10 ⁇ m) were deparaffinized, hydrated, and stained with hematoxylin and eosin (H&E). Plastic sections were processed with H&E and von Kossa staining. For quantitation of new bone formation in vivo, NIH Image was used to calculate five representative areas at 5 x magnification from either induced or 2 non-induced transplants.
  • Figure 15A,B of SEM images revealed that the collagen fibers formed by MSCs.
  • the sheet formed on the surface of scaffolds and cell layers formed within constructs after osteogenic induction (Figure 16A,B).
  • Mineral nodules formed in induced constructs were firstly detected in 3 weeks by von Kossa staining ( Figure 17A,B).
  • the metabolic rate of constructs at different point was measured using alamar blue dye conversion ratio as shown in Figure 18.
  • the reduced ratio of constructs under osteogenic induction was slightly higher than that of constructs without induction.
  • the reduced ratio of constructs increased at week 2 and remained stable up to 7 weeks.
  • the ratio was higher than cell sheet-scaffolds constructs.
  • Figure 19 shows the ALP released into media increased with the time of culture after induction. At 49 days, the ALPase activity of induced constructs was 10 times over the un- induced. For the intracellular ALPase, its activity was sharply increased over 30 folds at weekl and peaked at week 3 ( Figure 20). Its level remained over the whole culture period up to week 8.
  • RNA of constructs were extracted and RT-PCR was applied to monitor the temporal expression levels of osteo-related molecules, namely two important transcription factors, Cbfal and osterix, osteocalcin (OCN),osteopontin (OPN) and collagen type I (Col l)( Figure 21 ).
  • Figure 22 shows that osterix and ocn expression level were significantly up-regulated at least 10 and 5 times respectively after induction and kept the high level over the culture period. OPN expression level was up regulated as well and the levels of cbfal and Col I were slightly increased in induced constructs.
  • OCN and OPN protein synthesis were also measured through western blots (Figure 23, 24). As shown in Figure 24, OCN was specifically expressed at induced constructs and its expression remained stable over 7 weeks culture. OPN expression increased around 3-4 times at week 3 and then slightly decreased.
  • Figure 30A,B shows fluroresence cells mainly habited in the bone area, implying that most of osteoblasts were derived form implanted cells.
  • H/E staining in Figure 31A,B,C indicated that MSCs in the constructs histological resembled growth plate -like structure at the interface of chondrocytes and bone area. It shows the MSCs within constructs experienced endochondry bone formation process.

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CN2004800405322A CN1972644B (zh) 2003-11-21 2004-11-22 用于骨组织再生的生物可吸收插销式植入体和方法
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JP2006541104A JP5086642B2 (ja) 2003-11-21 2004-11-22 骨組織再生のための生体吸収性プラグインプラントおよび方法
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