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Bone grafts are used to treat more than 300,000 fracture patients yearly, as well as patients with congenital defects, bone tumors, and those undergoing spinal fusion. Given the established limitations of autograft and allograft bone, there is a substantial need for bone graft substitutes. Tissue engineering strategies employing the addition of osteogenic cells and/or osteoinductive factors to porous scaffolds represent a promising alternative to traditional bone grafts. While many bone defects are in load-bearing sites, very little is known about the response of bone grafts and their substitutes to mechanical loading, despite vast documentation on the ability of normal bone to adapt to its mechanical environment. The goal of this research was to quantify the effects of controlled in vivo mechanical stimulation on bone graft repair and bone graft substitutes and identify the local stress/strain environment associated with load-induced changes in bone formation. The global hypothesis that cyclic in vivo mechanical loading improves mineralized matrix formation within bone grafts and bone graft substitutes was addressed in this work using orthotopic and ectopic models specifically designed to facilitate modeling of local stresses and strains. In the first study, a bone defect repair model utilizing an orthotopic implant capable of supplying a controlled mechanical stimulus to a trabecular allograft showed a significant reduction in new bone formation with controlled in vivo mechanical loading. Although the reason remains unclear, loading conditions may not have been ideal for increased bone formation or potential micromotion may have influenced the results. A second study demonstrated for the first time that controlled in vivo mechanical stimulation enhances mineralized matrix production on a mesenchymal stem cell-seeded polymeric construct using a novel subcutaneous implant system. In addition, the local stresses and strains associated with this adaptive response were predicted. The novel subcutaneous implant represents technology which may be adapted for the preparation of tissue-engineered bone constructs, capitalizing on the benefits of mechanical loading and a vascularized in vivo environment. Such an approach may produce larger, stronger, and more homogeneous constructs than could be developed in a static culture system subject to diffusional limitations.

Un substitut fiable est nécessaire après résection circonférentielle étendue de la trachée. La transplantation trachéale (TT) s’est heurtée à l’impossibilité d’une revascularisation directe et au rejet. Ayant démontré chez l’animal la faisabilité du remplacement trachéal (RT) par allogreffe aortique (AA) sans immunosuppression, nous avons conduit une étude clinique à partir de 2005. Six patients atteints de cancer étaient inclus (27% des cas de la littérature) ; actuellement 3 sont en vie et en rémission (suivi moyen 81 mois). Cependant, contrairement à l’animal, nous n’avons pas observé chez l’homme de régénération trachéale des greffons, probable conséquence de leur ischémie initiale. Pour résoudre ce problème, nous avons conduit 5 séries d’investigations sur modèle lagomorphe : Etude de l’efficacité de l’enveloppement fascial (EF) sur la néo angiogenèse de l’AA. EF appliqué à un greffon composite (AA entourée d’anneaux cartilagineux allogéniques). RT avec ce greffon.Quarante neuf lapins étaient donneurs et 74 étaient receveurs de sexe opposé. Il n’y avait pas d’immunosuppression. Lors des EF, les greffons étaient enveloppés dans un lambeau de fascia latéro-thoracique, puis implantés sous la peau. Lors des RT et TT en 2 temps, la résection de la trachée du receveur était suivie d’une rotation au cou du greffon enveloppé, qui était suturé à la trachée native. Lors des RT en 1 temps, le greffon était directement interposé après résection de la trachée du receveur. Les lapins ont été suivis jusqu’au décès ou sacrifiés. Les études microscopiques, la détection des chromosomes X et Y (FISH) et des cellules en apoptose (APOSTAIN) ont permis d’étudier la revascularisation, la viabilité et le rejet des greffons.L’EF de l’AA (n=19) a permis de construire un nouvel organe tubulé et revascularisé. La FISH a démontré la migration de cellules de l’hôte au sein de l’AA, et la persistance de cellules du donneur, témoignant d’une ischémie minimale après EF. Mais ce greffon n’avait pas la rigidité requise pour un RT.• L’EF du greffon composite (n=9) a permis de construire un substitut trachéal rigide, à la structure cartilagineuse préservée. • Après RT avec greffon composite (n=10) les lapins sont décédés d’obstruction de la voie aérienne. Sept greffons sur 10 avaient une rigidité satisfaisante par calcification des cartilages, mais tous présentaient des lésions ischémiques (résultats insuffisants pour une application clinique).• Après EF, les segments d’ATDC (n=13) étaient viables. L’infiltration inflammatoire était minime, sans lymphocyte. L’apoptose observée évoquait une réaction de rejet à minima.• Après TT par longs segments d’ATDC (n=7), 6 lapins sont décédés de sténose par prolifération endoluminale fibroblastique de J3 à J48. Après TT par segments courts (n=7), 3 lapins sont décédés et 4, sacrifiés de J33 à J220, présentaient une perméabilité et une morphologie normale du greffon. Tous les greffons, présentaient des signes de néo angiogenèse. L’infiltration inflammatoire était variable, sans lymphocyte. Les cartilages se calcifiaient, de 90% à 100% après 30 jours. Enfin, la régénération épithéliale était observée dès J20. [...] / After extended circumferential resection of the trachea, a reliable substitute is needed. Tracheal transplantation (TT) failed because of impossibility for direct revascularization, and rejection. On the other hand, our animal studies have demonstrated the feasibility of tracheal replacement (TR) with aortic allografts (AA). Since 2005, we performed this procedure in 6 cancer patients (accounting for 27% of cases in the available literature), and 3 are alive with no evidence of disease (mean follow-up: 81 months). The graft of patients did not display, however, cartilage regeneration as shown in animal models, possibly due to critical ischemia prior to neoangiogenesis. To solve this issue, investigations were conducted in rabbit models: • Study of the efficacy of the lateral thoracic fascial flap wrap (FW) for neoangiogenesis of AA. FW applied to a composite graft (AA with external cartilage-ring support). Staged TR using the composite graft.FW applied to segments of tracheal allograft, epithelium-denuded and cryopreserved to reduce immunologic reaction. Staged, and then direct TT using these tracheal segments.Forty-nine rabbits were used as donors and 74 sex-mismatched as recipients. No immunosuppressive therapy was given. During FW, grafts were wrapped using a lateral thoracic fascial flap, and then implanted under the skin of the chest wall. During staged TR or TT, tracheal resection was followed by rotation of the flap-wrapped graft to the neck, and anastomosis to the native trachea. During direct TT, the allograft segment was interposed between the stumps of the resected trachea.Rabbits were followed-up to death or sacrifice. Microscopic examination, FISH analysis for detection of both X and Y chromosomes, and detecting apoptotic cells (APOSTAIN), were used to study the morphology, revascularization, viability, and determine rejection. The FW applied to AA (n=19) ensured the construction of a novel well-vascularized tube-shaped organ. FISH analysis showed migration of recipient cells into the AA, and persistence of normal cells from the donor suggestive of minimal ischemia. This construct, however, did not show stiffness sufficient to ensure TR. • The 9 animals in which FW was applied to composite graft showed a rigid tracheal substitute with preserved histological structure of cartilages.• The 10 rabbits undergoing TR with this composite graft died of central airway obstruction. Despite severe ischemic lesions, satisfactory graft stiffness was shown in 7 out of 10 animals, due to cartilage calcifications. The results did not allow, however, the use of the construct in the clinical setting.• The 13 animals in which FW was applied to epithelium-denuded-cryopreserved tracheal segments maintained viability. The inflammatory reaction was minimal, with no lymphocytes. Apoptosis events were suggestive of minimal immunological response.• The results of TT using long segments of epithelium-denuded-cryopreserved allografts were disappointing, since 6 rabbits sustained a graft stenosis because of intraluminal fibroblastic proliferation. Of 7 rabbits undergoing TT with short segments, 4 were euthanized between 33 and 220 days. They showed patency and satisfactory strain abilities of their graft due to cartilage calcification deposits; and microscopically, neoangiogenesis, non-specific inflammatory infiltrate with no lymphocytes and satisfactory epithelial cell ingrowths from day 20 [...]

Los aloinjertos óseos estructurales han supuesto una alternativa al tratamiento de los tumores óseos de miembros con posibilidad de cirugía de conservación del miembro. Presentamos un estudio retrospectivo observacional del manejo de los aloinjertos óseos estructurales en tumores óseos de huesos largos en nuestro hospital, durante los años 1993 a 2010, en el que obtenemos una muestra de 37 pacientes subsidiarios de esta técnica quirúrgica. Mediante la obtención de datos clínicos de la muestra aplicamos las escalas de funcionalidad de MANKIN y EVACOM HUVA con resultados excelentes, muy buenos o buenos del 84%, y con los datos radiológicos aplicamos la escala de osteointegración ISOLS con un 95,6% de resultados excelentes a los 24 meses. Estos resultados nos muestran que los aloinjertos óseos estructurales constituyen una técnica válida y reproducible en pacientes con tumores óseos destructivos de huesos largos. / Structural bone allografts have supposed an alternative in the treatment of limb bone tumors with a chance of limb-saving surgery. We present an observational retrospective study of the use of structural bone allografts in bone tumors of long bones in our hospital between January 1993 and January 2010, with a sample of 37 patients subsidiary of this surgical technique. Obtaining clinical information from our sample we apply Mankin and EVACOM HUVA functional scales with excellent, very good and good results in a 84%, and with the radiologic information we apply the ISOLS osteointegration scale, with a 95.6% of excellent results after 24 months. These results show us that structural bone allografts constitute a valid and reproducible technique in patients with destructive bone tumors of long bones.

O aloenxerto ósseo desmineralizado irradiado (ALD) e o aloenxerto ósseo congelado mineralizado (ACM) são alternativas ao osso autógeno para o aumento do rebordo ósseo alveolar. Individualmente, já foram testados quanto a eficiência, de certa forma, comparável aos autógenos e suas vantagens sobre eles. Entretanto, não há estudos padronizados comparando o desempenho clínico entre esses dois tipos de aloenxertos, quando utilizados em região de maxila atrófica para instalação e implantes. O objetivo deste estudo foi realizar um ensaio clínico randomizado controlado que envolve a elevação bilateral do seio maxilar empregando o osso alógeno liofilizado desmineralizado irradiado (ALD) ou o osso alógeno congelado mineralizado (ACM) e verificar comparativamente os desfechos clínicos para estabilidade de implantes, quantidade e qualidade de neoformação óssea. Dez pacientes foram submetidos a cirurgia de elevação do seio maxilar bilateral na qual foi utilizado um dos tipos de aloenxerto, de forma randômica em um dos lados. Seis a nove meses após o aumento do rebordo ósseo, no momento da instalação de implantes osseointegrados, foram obtidas amostras ósseas por meio de trefina de 2x10mm para análises microtomográficas e histológicas. A estabilidade dos implantes foi aferida por frequência de ressonância em dois momentos, imediato e após 6 meses da instalação dos implantes. Os resultados mostraram aumento do rebordo, radiograficamente detectável em todos os pacientes e grupos. Os implantes osseointegrados, inseridos em enxertos ACM, apresentaram melhor estabilidade primária, embora o acréscimo de estabilidade tenha sido mais significativo no ALD. As análises microtomográficas e histológicas revelaram mais formação óssea de melhor qualidade nos ALD do que nos ACM. Não houve resposta a corpo estranho para nenhum dos tipos de aloenxertos. Notou-se mais quantidade de material remanescente para ACM do que para ALD. Concluímos que os aloenxertos liofilizados desmineralizados irradiados (ALD) apresentaram melhor desempenho quanto aos parâmetros estudados. / Demineralized bone irradiated allograft (DFDBA) and fresh- frozen (FF) are alternative grafts to autogenous bone in alveolar ridge augmentation. Individually, these allografts have been tested for their efficiency, in a way comparable to autogenous, and so their advantages over autogenous grafts. However, there are no standardized clinical studies comparing the clinical and histological performance between these two allografts in atrophic maxilla bone augmentation for implants instalment. The aim of this study was to perform a randomized controlled clinical trial involving bilateral sinus floor elevation employing demineralized freeze-dried irradiated allograft (DFDBA) or fresh-frozen (FF) and to compare clinical and histological outcomes for stability of implants, quantity and quality of bone formation. Ten patients underwent bilateral maxillary sinus lifting surgery in which side was randomly used one of those allografts for alveolar ridge augmentation. Six to nine months after grafting, at the time of dental implants instalment, trephine 2x10mm bone core biopsies were obtained to micro computed tomographic and histological analyses. The stability of the implants was measured by resonance frequency in two stages, immediately and 6 months after implants installation. Results showed that there was an increase, radiographically detectable, in all patients and groups. The dental implants inserted in FF grafts showed better primary stability but implant stability, lately, increased significantly in DFDBA. Micro tomographic and histological analyses revealed that bone formation amount and quality was superior in DFDBA than in FF. There was no foreign body response for any of the allografts. There was a greater amount of persisting graft-materialin FF than in DFDBA. We conclude that demineralized freeze-dried irradiated allograft (DFDBA) presented a superior performance than mineralized FF.

Os transtornos que afetam a traqueia podem levar a graves complicações de saúde e reduzir significativamente a qualidade de vida das pessoas. Até o presente não existe uma opção clinicamente viável disponível para pacientes com distúrbios severos dessa via aérea. As técnicas de Engenharia de Tecidos apresentam um cenário promissor na tentativa de produzir um substituto traqueal satisfatório, com características mecânicas e biológicas compatíveis com os tecidos do paciente. Nesse trabalho, apresenta-se um sistema de aquisição de imagens de vídeo que permite medir as variações da área da projeção bidimensional de traqueias autotransplantadas de ratos, in vivo, com o objetivo de apresentar uma ferramenta que possa caracterizar as suas propriedades mecânicas e acelerar a avaliação das técnicas e dos tecidos gerados. Seis ratos, da linhagem Wistar, tiveram exposição de toda a traqueia cérvico-mediastinal, foram ventilados e submetidos a um protocolo experimental com diferentes cenários de broncoconstrição, a fim de se poder relacionar os dados obtidos a partir da ventilação mecânica com as imagens da movimentação das paredes da traqueia antes e depois de um autotransplante e aprofundar a discussão do sistema respiratório nas situações de maior broncoconstrição. Os resultados do pré-transplante, no cenário de maior broncoconstrição, mostraram um aumento médio da área da projeção da traqueia de 0,9 ± 0,24% nas fases inspiratórias das perturbações quasi-senoidais e, nas fases expiratórias, reduções de 5,2 ± 6,1%. No pós-transplante, o aumento médio foi de 0,7 ± 0,26% e a redução foi de 1,7 ± 0,73%, para o mesmo cenário de broncoconstrição. As diferenças das fases inspiratórias e expiratórias sugerem uma maior cautela para interpretar os parâmetros da mecânica ventilatória nos cenários de maior broncoconstrição das vias aéreas. Por intermédio das imagens da traqueia, também foi possível observar os diferentes instantes de tempos de resposta para a ação de um agente constritor da musculatura lisa. Pode-se concluir que essa técnica de aquisição de imagens apresenta resolução e frequência de aquisição suficientes para monitorar as variações do calibre de traqueias autotransplantadas de ratos e trazem uma boa perspectiva para o seu uso na avaliação das propriedades mecânicas de enxertos traqueais produzidos por Engenharia Tecidual. / Tracheal disorders can lead to serious health complications and significantly reduce the people life´s quality. There is no clinically feasible option available for patients with several airway disorders. Tissue Engineering techniques present a promising scenario to produce a satisfactory tracheal replacement, with compatible mechanical and biological characteristics with the patient\'s tissues. This work presents a video image acquisition system that allows measure in vivo two-dimensional projection area variations of auto transplanted rat\'s tracheas with the objective of presenting a tools that can characterize its mechanical properties and accelerate the evaluation of techniques and tissues. Six Wistar rats were exposed to the entire cervical-mediastinal trachea, ventilated and submitted to an experimental protocol in different bronchoconstriction scenarios, before and after an auto transplantation in order to correlate the data obtained from the mechanical ventilation and images of the trachea walls movement before and after the auto transplantation and improve the discussion about respiratory system in greater bronchoconstriction status. The pre-transplant results, in the greater bronchoconstriction scenario, showed an average increase of 0.9 ± 0.24% in the inspiratory phases of the quasi-sinusoidal perturbations and, in the expiratory phases, a reduction of 5.2 ± 6.1%. In the post-transplant, the mean increase was 0.7 ± 0.26% and the reduction was 1.7 ± 0.73%, for the same bronchoconstriction scenario. Differences between inspiratory and expiratory phases suggest caution in interpreting the parameters of the ventilatory mechanics in the scenarios of greater bronchoconstriction. Through the trachea\'s images it was also possible to observe different response times for the action of a smooth muscle constriction agent. It can be concluded that this technique of acquisition of images presents sufficient resolution and frequency of acquisition to monitor the calibers variations of auto transplanted rat´s tracheas and bring a good perspective for its use in the evaluation of the mechanical properties of tracheal grafts produced by Engineering Tissue.

Os transtornos que afetam a traqueia podem levar a graves complicações de saúde e reduzir significativamente a qualidade de vida das pessoas. Até o presente não existe uma opção clinicamente viável disponível para pacientes com distúrbios severos dessa via aérea. As técnicas de Engenharia de Tecidos apresentam um cenário promissor na tentativa de produzir um substituto traqueal satisfatório, com características mecânicas e biológicas compatíveis com os tecidos do paciente. Nesse trabalho, apresenta-se um sistema de aquisição de imagens de vídeo que permite medir as variações da área da projeção bidimensional de traqueias autotransplantadas de ratos, in vivo, com o objetivo de apresentar uma ferramenta que possa caracterizar as suas propriedades mecânicas e acelerar a avaliação das técnicas e dos tecidos gerados. Seis ratos, da linhagem Wistar, tiveram exposição de toda a traqueia cérvico-mediastinal, foram ventilados e submetidos a um protocolo experimental com diferentes cenários de broncoconstrição, a fim de se poder relacionar os dados obtidos a partir da ventilação mecânica com as imagens da movimentação das paredes da traqueia antes e depois de um autotransplante e aprofundar a discussão do sistema respiratório nas situações de maior broncoconstrição. Os resultados do pré-transplante, no cenário de maior broncoconstrição, mostraram um aumento médio da área da projeção da traqueia de 0,9 ± 0,24% nas fases inspiratórias das perturbações quasi-senoidais e, nas fases expiratórias, reduções de 5,2 ± 6,1%. No pós-transplante, o aumento médio foi de 0,7 ± 0,26% e a redução foi de 1,7 ± 0,73%, para o mesmo cenário de broncoconstrição. As diferenças das fases inspiratórias e expiratórias sugerem uma maior cautela para interpretar os parâmetros da mecânica ventilatória nos cenários de maior broncoconstrição das vias aéreas. Por intermédio das imagens da traqueia, também foi possível observar os diferentes instantes de tempos de resposta para a ação de um agente constritor da musculatura lisa. Pode-se concluir que essa técnica de aquisição de imagens apresenta resolução e frequência de aquisição suficientes para monitorar as variações do calibre de traqueias autotransplantadas de ratos e trazem uma boa perspectiva para o seu uso na avaliação das propriedades mecânicas de enxertos traqueais produzidos por Engenharia Tecidual. / Tracheal disorders can lead to serious health complications and significantly reduce the people life´s quality. There is no clinically feasible option available for patients with several airway disorders. Tissue Engineering techniques present a promising scenario to produce a satisfactory tracheal replacement, with compatible mechanical and biological characteristics with the patient\'s tissues. This work presents a video image acquisition system that allows measure in vivo two-dimensional projection area variations of auto transplanted rat\'s tracheas with the objective of presenting a tools that can characterize its mechanical properties and accelerate the evaluation of techniques and tissues. Six Wistar rats were exposed to the entire cervical-mediastinal trachea, ventilated and submitted to an experimental protocol in different bronchoconstriction scenarios, before and after an auto transplantation in order to correlate the data obtained from the mechanical ventilation and images of the trachea walls movement before and after the auto transplantation and improve the discussion about respiratory system in greater bronchoconstriction status. The pre-transplant results, in the greater bronchoconstriction scenario, showed an average increase of 0.9 ± 0.24% in the inspiratory phases of the quasi-sinusoidal perturbations and, in the expiratory phases, a reduction of 5.2 ± 6.1%. In the post-transplant, the mean increase was 0.7 ± 0.26% and the reduction was 1.7 ± 0.73%, for the same bronchoconstriction scenario. Differences between inspiratory and expiratory phases suggest caution in interpreting the parameters of the ventilatory mechanics in the scenarios of greater bronchoconstriction. Through the trachea\'s images it was also possible to observe different response times for the action of a smooth muscle constriction agent. It can be concluded that this technique of acquisition of images presents sufficient resolution and frequency of acquisition to monitor the calibers variations of auto transplanted rat´s tracheas and bring a good perspective for its use in the evaluation of the mechanical properties of tracheal grafts produced by Engineering Tissue.