Un os long est composé de tissus osseux cortical et spongieux. Ces tissus ont des structures et des caractéristiques physiques différentes mais ont tous deux la capacité de se régénérer de façon naturelle suite à une lésion. Cette régénération ou réparation implique une séquence bien caractérisée d’événements contrôlés par l’interaction étroite entre des facteurs de croissance, des cellules, l’environnement chimique et dynamique, ainsi que par la matrice extracellulaire. L’ostéopontine (OPN) et la sialoprotéine osseuse (BSP) sont des protéines de la matrice extracellulaire exerçant des fonctions importantes dans le tissu osseux. Le but de ce travail a été d’étudier le rôle de l’OPN et de la BSP dans la réparation osseuse par génétique expérimentale. Les modèles utilisés dans cette études consistent en des lésions, l’un diaphysaire et purement cortical, l’autre région épi-métaphysaire mêlant destruction de l’os cortical, trabéculaire et de la plaque de croissance. La réparation de ces lésions a été analysée par microtomographie haute résolution aux rayons X et par histomorphométrie. Dans un premier temps, la réparation d’une perforation épi-métaphysaire dans le fémur chez la souris, a été caractérisée et comparée à celle de même diamètre réalisée dans la diaphyse. Dans cette étude comparative, des profils distincts de réparation ont été mis en évidence bien que tous deux mettent en place un mécanisme d’ossification intramembranaire. Ainsi, le défect cortical diaphysaire est comblé par une formation osseuse centripète restreinte à la zone corticale. Dans le modèle épi-métaphysaire, la formation osseuse est initiée au fond du défect et se propager vers le cortex. Ce processus aboutit à une restauration des travées mais à une réparation incompléte du cortex. Ainsi, le premier modèle apparaît comme pertinent pour l’étude de la réparation corticale alors que le modèle épi-métaphysaire se présente plus adapté à l’étude de la réparation de l’os trabéculaire. L’OPN et la BSP n’ont pas de fonctions redondantes dans la réparation de ces lésions. En effet, l’OPN intervient principalement dans la réparation de l’os trabéculaire, son absence entraîne un retard lié à un défaut de progression de l’os au sein de la cavité. L’absence de BSP quant à elle, semble intervenir uniquement dans le processus de réparation de l’os cortical diaphysaire, provoquant un retard de réparation dû à un défaut de minéralisation de l’ostéoïde. Les travaux réalisés au cours de cette thèse ont permis de caractériser des modèles de lésions osseuses pertinents pour l’étude de la réparation de l’os cortical et spongieux. L’utilisation de ces modèles a permis d’améliorer la compréhension du rôle de deux protéines de la matrice extracellulaire osseuse dans la réparation de cortical et trabéculaire grâce aux modèles de génétique expérimentale. / Long bones consist of cortical and spongious bone tissue, which have different structures and physiological characteristics. Both can heal spontaneously. Bone healing is a complex multi-step process which depends on cells, soluble factors, mechanical environment and bone matrix. Osteopontin (OPN) and Bone Sialoportein (BSP) are extracellular matrix proteins, which have been shown to exert important functions in bone. The aim of this study is to address the role of OPN and BSP in bone repair using experimental genetic strategies. Injured bone models are drilled-hole defects performed in diaphyseal cortical bone or in the epi-metaphyseal region. Bone healing was analyzed by micro-tomography and histomorphometry. Epi-metaphyseal defect healing was characterized and compared to cortical bone repair. In this comparative study, distinct patterns of bone repair have been shown while in both models repair occurs through intramembranous ossification. Diaphyseal defect was rapidly filled with newly bone formed in a centripetal manner within the cortical gap. In contrast, bone formation within the epi-metaphyseal defect was initiated from the depth of the cavity and spread towards the cortical edges, regenerating cancellous bone and albeit not completely cortical wall. Therefore, diaphyseal drill defects appear pertinent for the study of spontaneous cortical healing whereas epi-metaphyseal drill defects appear as appropriate models to investigate spongy bone regeneration. OPN and BSP do not show redundancy in the bone repair process of these two models. Indeed, OPN is mainly involved in trabecular bone repair; its deficiency induced a delay due to impaired bone progression within the epi-metaphyseal cavity. The lack of BSP only delayed cortical bone repair due to an impaired mineralization of the bone matrix. This study permits to characterize pertinent models of cortical and trabecular bone repair. Application of these models added new insights on the involvement of matrix proteins in cortical defect healing and trabecular bone repair using experimental genetic models.

The aim of the thesis was development of an innovative treatment of bone defects. Human multipotent mesenchymal stromal cells (MSC) play a crucial role in bone healing. Clinical applications of MSC require large amount of cells, which could be obtained by autologous expansion of MSC harvested from bone marrow. As a first step, the standard protocol of MSC expansion based on αMEM medium and fetal bovine serum (FBS) was used. Experiments replacing FBS by pooled human serum (HS) in the culture medium concluded in patenting of a new MSC cultivation protocol (EU 1999250, CR 301141). This one-step cultivation protocol and xenogeneic protein-free cultivation medium is based on CellGro® for Hematopoietic Cells' Medium, HS, human recombinant growth factors, dexamethasone, insulin and ascorbic acid. The preclinical in vitro and in vivo experiments with MSC from both expansion protocols were carried out. Fibrillar polylactic scaffolds were seeded with MSC, cultured, differentiated and implanted in immunodeficient mice (NOD/LtSz-Rag1-). Bone-like mineralized tissue containing vessels was observed. The MSC cultured according to patented method were classified as Advanced-therapy Medicinal Product and has to fulfil the European Medicines Agency regulations to enter the clinical trials. Nevertheless the use of MSC seems...

Introduction: Congenital short femur, or proximal femoral focal deficiency (PFFD), is a rare complex deformity of the lower extremity with femoral dominance. The clinical findings cover wide range of variety, from femoral absence till inconspicuous shortening of the femur. Aim of the study: 1. Molecular analysis of pseudoarthrosis tissue in congenital short femur with focusing on osteogenic and angiogenic gene expression in comparison with physiological bone. The differences in gene expression were expected. 2. Retrospective analysis of femoral healing after prolongation calculating the severity of affection, age, distance of elongation and complication. The extended healing according to severity type and age was expected compared to control group. Material and methods: The RNA from piece of one was isolated and transcription profile of possible 113 genes of osteogenesis and angiogenesis was detected by biochip technology (SuperArray Bioscience Corporation). 10 samples analyses were performed (7 of PFFD, 3 controls). The data of 57 PFFD patients indicated for elongation of the femur with the types Pappas III, IV, VII, VIII and IX and 12 patients in control group were evaluated retrospectively and statistically by GLS method. Results: The expected differences in gene expression in PFFD tissue...

Endosseous implants have notably high success rates, yet a small percentage of implants still fail for unidentified reasons. Recent literature points to hyperglycemia, resulting from untreated or undiagnosed diabetes, as a possible contraindication in an otherwise apparently healthy population. To investigate the effect of surface design on peri-implant healing in the presence of hyperglycemia, STZ-treated rats were implanted with custom rectangular implants of two surface topographies: grit blasted (GB) and grit-blast with a calcium phosphate nanotopography (GB-DCD). Tensile testing was conducted at 5, 7, and 9 days post-operative. Results demonstrated hyperglycemia to delay early stages of the peri-implant healing. Contact osteogenesis was increased along the GB-DCD surface, even in an environment of uncontrolled hyperglycemia, and the GB-DCD surface outperformed the GB surface in both healthy and hyperglycemic animals, showing peri-implant bone matured more rapidly on nanotopographically complex surfaces, even in the presence of uncontrolled hyperglycemia.

Healthy bone is bombarded with many different mechanical strain derived signals during normal daily activities. One of these signals is present as a direct connective tissue strain on the cells. However, there is also the presence of an electrically charged streaming potential during this straining. The electrical potential is created from the movement of charged fluid through the small bone porosities. To date, little focus has been applied to elucidating the possible synergistic effects of these two stimulants. The aim of this project was to evaluate the effects of mechanical strain and indirect electrical stimulation upon the development of bone forming osteoblast cells and any possible synergistic effects of the two stimulants. This aim was achieved by using a novel device, designed and developed with the capability of creating a cell substrate surface strain along with an exogenous electrical stimulant individually or at the same time. Proliferation and differentiation were determined as a measure of cellular development. The indirect electrical stimulation was achieved through the use of a pulsed electromagnetic field (PEMF) while the mechanical strain was produced from dynamic stretching of a deformable cell substrate. Strain and strain rate were modelled from recent studies proposing that relatively high frequency, low strain osteogenic mechanical stimulants are more indicative of what healthy bone would be experiencing during normal activities. The PEMF signal mimicked a clinically available bone growth stimulator signal. Results showed a PEMF stimulus on monolayers of SaOS-2 and MG-63 osteoblast-like cells leads to a depression in proliferation. A concomitant increase in alkaline phosphatase production was also observed for the SaOS-2 cultures, but not for the MG-63 cell line. It was hypothesised that this was due to the MG-63's lack of phenotypic maturity compared to the SaOS-2 cells. Mechanical strain of the cell substrate alone, at a relatively high frequency (5Hz) but small strain, did not significantly effect either cell proliferation or differentiation for the MG-63 cells. However, when the electrical and mechanical stimulants were combined a significant increase in cellular differentiation occurred with MG-63 cultures, revealing a possible synergistic effect of these two stimulants on the development of bone cells.

The aim of this pilot study was to evaluate the bioactive, surface-coated polycaprolactone-co-lactide scaffolds as bone implants in a tibia critical size defect model. Polycaprolactone-co-lactide scaffolds were coated with collagen type I and chondroitin sulfate and 30 piled up polycaprolactone-co-lactide scaffolds were implanted into a 3 cm sheep tibia critical size defect for 3 or 12 months (n¼5 each). Bone healing was estimated by quantification of bone volume in the defects on computer tomography and microcomputer tomography scans, plain radiographs, biomechanical testing as well as by histological evaluations. New bone formation occurred at the proximal and distal ends of the tibia in both groups. The current pilot study revealed a mean new bone formation of 63% and 172% after 3 and 12 months, respectively. The bioactive, surface coated, highly porous three-dimensional polycaprolactone-co-lactide scaffold stack itself acted as a guide rail for new bone formation along and into the implant. These preliminary data are encouraging for future experiments with a larger group of animals.

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