Effect of autoclave devitalization on autograft incorporation and bone morphogenetic protein of tibia in Sprague-Dawley rats
Background: Heating process with autoclave is one of limb salvage modalities that are widely used. but the results are not satisfying, due to mechanical bone fragility. However, considering this treatment modality is widely accepted in terms of financial, religion and sociocultural aspects, we conducted a on study rats treated with resection and reconstruction with autoclave heating method to assess bone healing by sequential radiology, histopathologic osteoblasts count, and bone morphogenetic protein (BMP).
Methods: Thirty six Sprague-Dawley rats were divided into two groups with one group being the autoclave group and others served as control group. In both groups, the tibial diaphysis was extracted en bloc for 7 mm. All groups were kept for 8 weeks and treated under the same condition except the autoclave group, where the extracted bones were put into autoclave at 134°C for 15 minutes and refixed again with k-wire. We performed radiological examination at 5th and 8th week using Lane and Sandhu radiological score. After extraction, the tibial bones were inspected for histological pattern using Salked modified score, osteoblast quantity counting and BMP-2 values.
Results: There were statistically significant diffences between control and autoclave group on radiological score at 5th (5.12 ± 1.6 g vs 3.21 ± 2.42, p = 0.023) and 8th week (6.06 ± 1.71 vs 4.29 ± 2.53, p = 0.040), histological score between groups (6.06 ± 1.14 vs 4.14 ± 1.99, p = 0.005), osteoblast count (p < 0.001), and BMP-2 expression, respectively.
Conclusion: Autoclave recycling autograft lowered the speed of graft incorporation and BMP-2 expression. Therefore, autoclave recycling autograft as a method of limb salvage surgery must be reevaluated and not considered to be applied for treatment in bone malignancy.
Lewis VO. What's new in musculoskeletal oncology. J Bone Joint Surg Am. 2007;89(6):1399-1407. http://dx.doi.org/10.2106/JBJS.G.00075
Unni KK. Osteosarcoma. In: Dahlin's bone tumors - general aspects and data on 11,087 cases. 5th ed. Philadelphia: Lippincott-Raven; 1996. p. 143-83.
Raymond AK, Ayala AG, Knuutila S. Conventional Osteosarcoma. In: Fletcher CDM, Unni KK, Mertens F, editors. World Health Organization Classification of Tumours. Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press; 2002. p. 264-70.
Köhler P, Glas JE, Larsson S, Kreicbergs A. Incorporation of nonviable bone grafts. Autoclaved autogeneic and frozen allogeneic bone grafts compared in the rabbit. Acta Orthop Scand. 1987;58(1):54-60. http://dx.doi.org/10.3109/17453678709146343
Lane JM, Sandhu HS. Current approaches to experimental bone grafting. Orthop Clin North Am. 1987;18(2):213-25.
Salkeld SL, Patron LP, Barrack RL, Cook SD. The effect of osteogenic protein-1 on the healing of segmental bone defects treated with autograft or allograft bone. J Bone Joint Surg Am. 2001;83-A(6):803-16.
Rauch F, Lauzier D, Croteau S, Travers R, Glorieux FH, Hamdy R. Temporal and spatial expression of bone morphogenetic protein-2, -4, and -7 during distraction osteogenesis in rabbits. Bone. 2000;27(3):453-9. http://dx.doi.org/10.1016/S8756-3282(00)00337-9
Manabe J. Experimental studies on pasteurized autogenous bone graft. Nippon Seikeigeka Gakkai Zasshi. 1993;67(4):255-66. Japanese.
Vural R, Akesen B, Karakayalı M, Yalçınkaya U, Aydınlı U. The comparison of the negative effect of autoclaving and pasteurization on bone healing. Acta Orthop Traumatol Turc. 2010;44(4):322-7. http://dx.doi.org/10.3944/AOTT.2010.2382
Zoricic S, Bobinac D, Lah B, Maric I, Cvijanovic O, Bajek S, et al. Study of the healing process after transplantation of pasteurized bone grafts in rabbits. Acta Med Okayama. 2002;56(3):121-8.
Salter RB. Neoplasms of musculosketal tissues. In: Textbook of disorders and injuries of the musculoskeletal system. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 379-92.
Dimitriou R, Tsiridis E, Giannoudis PV. Current concepts of molecular aspects of bone healing. Injury. 2005;36(12):1392-404. http://dx.doi.org/10.1016/j.injury.2005.07.019
Brinker MR, O'Connor DP. Basic Sciences. In: Miller MD, editor. Review of Orthopaedics. 5th ed. Philadelphia: Saunders; 2008. p. 1-36. http://dx.doi.org/10.1016/B978-1-4160-4093-4.10001-6
Ohta H, Wakitani S, Tensho K, Horiuchi H, Wakabayashi S, Saito N, et al. The effects of heat on the biological activity of recombinant human bone morphogenetic protein-2. J Bone Miner Metab. 2005;23(6):420-5. http://dx.doi.org/10.1007/s00774-005-0623-6
Vangsness CT Jr, Mitchell W 3rd, Nimni M, Erlich M, Saadat V, Schmotzer H. Collagen shortening. An experimental approach with heat. Clin Orthop Relat Res. 1997;337:267-71. http://dx.doi.org/10.1097/00003086-199704000-00030
Urist MR, Silverman BF, Buring K, Dubuc FL, Rosenberg JM. The bone induction principle. Clin Orthop Relat Res. 1967, 53:243-83. http://dx.doi.org/10.1097/00003086-196707000-00026
Copyright (c) 2014 Anak A.G.Y. Asmara, Achmad F. Kamal, Nurjati C. Siregar, Marcel Prasetyo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.