Short-term immunosuppression and surgical neoangiogenesis with host vessels maintains long-term viability of vascularized bone allografts
Short-term immunosuppression and surgical neoangiogenesis with host vessels maintains long-term viability of vascularized bone allografts
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DOI：
10.1002/jor.20313
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发表时间：
2007-03-01
影响因子：
2.8
通讯作者：
Bishop, Allen T.
中科院分区：
文献类型：
--
作者：
Pelzer, Michael;Larsen, Mikko;Bishop, Allen T.
目前可用的重建大型骨骼缺陷的方法有局限性。这些问题包括结构异体骨移植物的骨不愈合和应力性骨折，以及大多数带血管的自体腓骨移植物的大小、形状和/或强度无法匹配。假体骨干置换可能松动或产生假体周围骨折。活体同种异体骨移植将使供体骨与受体部位匹配，并结合活体骨的理想愈合和重塑特性。我们提出了一种新的方法，通过手术新生血管生成来发展新的宿主来源的骨性血液供应，这种方法可以在没有终身免疫抑制风险的情况下进行此类组织的移植。我们跨越主要的组织相容性屏障，将86只雌性黑鼠供体的带血管的股骨同种异体移植给雄性花斑病毒葛兰素（Piebald Virol gsk）受体。除了营养血管的微血管重建外，我们还通过手术将宿主动静脉束植入髓管内以促进宿主血管新生。独立变量包括植入的AV束的通畅程度，以及使用2周的FK-506免疫抑制。18周后测量骨血流量，定量新生血管毛细血管密度。在AV蒂未闭的瞬时免疫抑制受体中，骨血流量和毛细血管密度显著增加。我们得出结论，移植的宿主源性av束新生血管生成，结合短期免疫抑制，可维持血管化骨同种异体移植物的血流量，具有临床应用潜力。(c) 2006年骨科研究学会。Wiley期刊公司出版。
Currently available methods to reconstruct large skeletal defects have limitations. These include nonunion and stress fractures in structural allografts, and inability to match the size, shape, and/or strength of most recipient sites using vascularized fibular autografts. Prosthetic diaphyseal replacements may loosen or produce periprosthetic fractures. Transplantation of living allogenic bone would enable matching donor bone to the recipient site, combined with the desirable healing and remodeling properties of living bone. We propose a novel method by which the transplantation of such tissue might be done without the risks of life-long immunosuppression, using surgical neoangiogenesis to develop a new host-derived osseous blood supply. We performed vascularized femoral allografts from 86 female Dark Agouti donor rats to male Piebald Virol Glaxo recipients across a major histocompatibility (MHC) barrier. In addition to microvascular reconstruction of the nutrient vessel, we surgically implanted a host arteriovenous (AV) bundle into the medullary canal to promote host vessel neoangiogenesis. Independent variables included patency of the implanted AV bundle, and use of 2 weeks' FK-506 immunosuppression. After 18 weeks, bone blood flow was measured, and neoangiogenic capillary density quantified. Bone blood flow and capillary density were significantly greater in transiently immunosuppressed recipients with a patent AV pedicle. We conclude that neoangiogenesis from implanted host-derived AV-bundles, combined with short-term immunosuppression maintains blood flow in vascularized bone allografts, and offers potential for clinical application. (c) 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.