腰椎间盘内 BMP 基因转染诱导 Lewis 大鼠前脊柱融合。

Lumbar spine intervertebral disc gene delivery of BMPs induces anterior spine fusion in lewis rats.

机构信息

HSS Research Institute, Hospital for Special Surgery, 515 E 71st Street, New York, NY, 10021, USA.

Weill Cornell Medical College, 1300 York Avenue, Lc501, New York, NY, 10065, USA.

出版信息

Sci Rep. 2022 Oct 7;12(1):16847. doi: 10.1038/s41598-022-21208-1.

Abstract

Minimally invasive techniques and biological autograft alternatives such as the bone morphogenetic proteins (BMPs) can reduce morbidity associated with spinal fusions. This study was a proof-of-concept for gene-therapy-mediated anterior spine fusion that could be adapted to percutaneous technique for clinical use. Isogeneic bone marrow stromal cells genetically programmed to express b-galactosidase (LACZ, a marker gene), BMP2, BMP7, a mixture of BMP2 and BMP7 infected cells (homodimers, HM), or BMP2/7 heterodimers (HT) were implanted into the discs between lumbar vertebrae 4 and 5 (L4/5) and L5/6 of male Lewis rats. Spine stiffening was monitored at 4, 8 and 12 weeks using noninvasive-induced angular displacement (NIAD) testing. At 12 weeks isolated spines were assessed for fusion and bone formation by palpation, biomechanical testing [four-point bending stiffness, moment to failure in extension, and in vitro angular displacement (IVAD)], faxitron x-rays, microCT, and histology. Progressive loss of NIAD occurred in only the HT group (p < 0.001), and biomechanical tests correlated with the NIAD results. Significant fusion occurred only in the HT group (94% of animals with one or both levels) as assessed by palpation (p < 0.001), which predicted HT bone production assessed by faxitron (p ≤ 0.001) or microCT (p < 0.023). Intervertebral bridging bone was consistently observed only in HT-treated specimens. Induced bone was located anterior and lateral to the disc space, with no bone formation noted within the disc. Percutaneous anterior spine fusions may be possible clinically, but induction of bone inside the disc space remains a challenge.

摘要

微创技术和生物同种移植物替代物,如骨形态发生蛋白(BMPs),可以降低脊柱融合相关的发病率。本研究是基因治疗介导的前路脊柱融合的概念验证,可适应于临床使用的经皮技术。同种异体骨髓基质细胞经过基因编程表达β-半乳糖苷酶(LACZ,标记基因)、BMP2、BMP7、感染细胞的 BMP2 和 BMP7 混合物(同源二聚体,HM)或 BMP2/7 异源二聚体(HT),被植入雄性 Lewis 大鼠第 4 和第 5 腰椎(L4/5)和第 5 腰椎/骶椎(L5/S1)之间的椎间盘内。使用非侵入性诱导的角度位移(NIAD)测试,在 4、8 和 12 周监测脊柱僵硬度。在 12 周时,通过触诊、生物力学测试[四点弯曲刚度、伸展时失效力矩和体外角度位移(IVAD)]、传真射线照相术、microCT 和组织学评估分离脊柱的融合和骨形成情况。仅在 HT 组中观察到 NIAD 逐渐丧失(p<0.001),生物力学测试与 NIAD 结果相关。只有在 HT 组中才发生显著融合(94%的动物在一个或两个水平上),通过触诊评估(p<0.001),这预测了 HT 骨生成的传真射线照相术(p≤0.001)或 microCT(p<0.023)评估。仅在 HT 治疗标本中观察到椎间桥接骨。诱导骨位于椎间盘空间的前侧和外侧,椎间盘内无骨形成。经皮前路脊柱融合在临床上可能是可行的,但在椎间盘空间内诱导骨仍然是一个挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2a6/9547004/f22cfa6b8f88/41598_2022_21208_Fig1_HTML.jpg

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