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CC BY 4.0 · VCOT Open 2023; 06(01): e41-e51
DOI: 10.1055/s-0043-1762900
Clinical Communication

Bioengineering an Osteoinductive Treatment for Bone Healing Disorders: A Small Animal Case Series

William G. Marshall
1   Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, United Kingdom
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
,
Cristina Gonzalez-Garcia
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
,
Sara Trujillo
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
,
Andres Alba-Perez
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
,
Peter Childs
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
,
David W. Shields
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
3   Queen Elizabeth University Hospital, Glasgow, United Kingdom
,
Andrew Tomlinson
4   Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, United Kingdom
,
Rob Pettitt
4   Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, United Kingdom
,
Barbro Filliquist 
5   Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, California, United States
,
Po-Yen Chou 
5   Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, California, United States
,
Matthew J. Dalby
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
,
Sandra A. Corr
1   Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, United Kingdom
,
Manuel Salmeron-Sanchez
2   Centre for the Cellular Microenvironment, University of Glasgow, United Kingdom
› Author Affiliations Funding All or part of the treatment costs were covered by grant funding, but no other incentive was provided to animal owners. European Research Council Proof of Concept Grant (HEALIGRAFT, 790380), Sir Bobby Charlton Foundation (SBCF) (synthetic bone project), The Vet Fund, University of Glasgow; UK Regenerative Medicine Platform (MR/R015651/1), University of Glasgow; and the Engineering and Physical Sciences Research Council (EPSRC EP/P001114/1).
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Abstract

The aim of this article was to study clinical and radiographic outcomes following treatment of bone healing disorders with a novel osteoinductive system that utilizes poly (ethyl acrylate), fibronectin and an ultra-low concentration of recombinant human bone morphogenetic protein-2. A case series of nine dogs and two cats were treated, and clinical records and radiographs were reviewed. Radiographs were scored by two blinded observers using the modified Radiographic Union Score for Tibial Fractures. Long-term follow-up was obtained using the Canine Orthopaedic Index and Feline Musculoskeletal Pain Index. Follow-up data were available for 11 treatments (10 cases). Complications: three minor, three major, one catastrophic (non-union requiring amputation). Lameness median 320 (range: 42–1,082) days postoperatively: ‘sound’ (three cases), ‘subtle’ (two), ‘mild’ (three), ‘moderate’ (one), and ‘non-weightbearing’ (one). The attending clinician judged 9 of 11 treatments achieved radiographic union; modified Radiographic Union Score for Tibial Fractures observers 1 and 2 agreed with the clinician in 8/9 and 5/9 treatments respectively. Long-term Canine Orthopaedic Index scores for five dogs median 650 (range: 544–1,724) days postoperatively: 15/64 (median) for four dogs with acceptable outcomes, 30/64 in one dog with a poor outcome. Feline Musculoskeletal Pain Index scores for two cats 433 and 751 days postoperatively: 48/60 and 60/60. Eight of 10 cases were sound or showed subtle or mild lameness in the short- or long-term, and radiographic union occurred in the majority of treatments.

Keywords

bioengineering - bone morphogenetic protein - cats - dogs - fracture healing

Ethical Approval

The Veterinary Medicines Directorate, Royal College of Veterinary Surgeons (RCVS) and UK Home Office provided guidance. After considering experimental in vivo data,[16] [19] the RCVS agreed clinical cases could be treated, though a formal controlled clinical trial was not permitted. The University of Glasgow Ethics Committee granted approval (application 37a/17, date of approval November 28, 2018).


Informed Consent

All owners gave fully informed consent.


Authors' Contributions

Marshall WG, BVMS, DECVS: HEALIGRAFT grant preparation, FN/ rhBMP-2 adsorption and surgical procedures, was involved in clinical follow-up, record and radiograph review, descriptive statistics, manuscript preparation and submission. Gonzalez-Garcia C, PhD: FN/ rhBMP-2 adsorption procedures, reviewed and approved the manuscript. Trujillo S, PhD: FN/ rhBMP-2 adsorption procedures, reviewed and approved the manuscript. Alba-Perez A, PhD: HEALIGRAFT grant preparation and submission, reviewed and approved the manuscript. Childs P, PhD: plasma-enhanced chemical vapour deposition, reviewed and approved the manuscript. Shields DW, MBChB, DipMedEd, MSc, PhD, FRCS, developed EO sterilization protocol, assisted with surgical procedures, reviewed and approved the manuscript. Tomlinson A, BVSc, DECVS: surgical procedure (case 5), was involved in clinical follow-up, record and radiograph review, reviewed and approved the manuscript. Pettitt R, BVSc, DSAS (Orth): surgical procedure (case 5) reviewed and approved the manuscript. Filliquist B, DVM, DACVS-SA, DECVS: mRUST scoring, reviewed and approved the manuscript. Chou P-Y, BVM, MVM, MS, DACVS-SA: mRUST scoring, reviewed and approved the manuscript. Dalby MJ, PhD: co-inventor of novel system and development of clinical protocol, SBCF and HEALIGRAFT grant preparation, reviewed and approved the manuscript. Corr SA, BVMS, PhD, DECVS: Vet Fund grant preparation and submission, development of HealiOst clinical protocol, administered long-term follow-up questionnaires, reviewed and approved the manuscript. Salmeron-Sanchez M, PhD: co-inventor of novel system and development of clinical protocol, SBCF and HEALIGRAFT grant preparation, reviewed and approved the manuscript.




Publication History

Received: 04 February 2022

Accepted: 05 January 2023

Article published online:
21 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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