Development and characterization of an injectable dextrin-based hydrogel for bone regeneration

Bone is a dynamic, highly vascularized tissue that remodels itself continuously over an individual ́s lifetime. It plays several important roles in maintaining homeostasis of the body systems [ 1 , 2 ] . However, this regenerative capac ity is limited and, as in the case of large bone defects, where the template for an orchestrated regeneration is absent, surgical proce dures are needed [ 2 ] . In this respect , bone tissue engineering is a very challe nging and promising field given the need to mimic bone mechanical and biological functions and also due to the failure of current orthoped ic implants. The general concept consists in the development of three - dimensional scaffolds, from biocompatible materials (natu ral or synthetic), which confer temporary support for the regeneration of bone tissue, while the scaffold itself will be resorbed and replaced by new ly formed tissue [ 2 , 3 ] . Hydrogels are cross - linked networks made of natural or synthetic polymers, which are able to support high water contents [ 4 ] . These materials are usua lly biocompatible, have the ability to mimic physiological conditions, promote an environment that can protect cells or unstable drugs, their physical characteristics can be controlled to some extent and some can be injected in vivo . These features make th em attractive materials in the biomedical field for cell encapsulation, drug or gene delivery or to act as an interfa ce between tissue and materials [ 4 - 7 ] . Natural polymers are advantageous for this kind of applications since they are cheap raw materials, bear a great biocompatibility and are usually biodegradable [ 8 ] . Dextrin is low molecular weight carbohydrate, generally regarded as safe (GRAS), obtained from partial hydrolysis of starch or glycogen [ 9 ] . It is a glucose polymer linked by α - 1,4 glycosidic linkages with some degree of branching due to the presence of α - 1,6 bonds [ 10 ] . I t is biocompatible and non - immunogenic, degradable by α - amylases and can undergo renal clearance avoiding tissue accumulation [ 11 , 12 ] . This work describes the preparation and characterization of an injectable dextrin - bas ed hydrogel (oDex) able to incorporate nanoparticles , cells, biomolecules or Bonelike ® granules [ 13 ] . Bonelike ® is a Biosckin - molecular and cell therapies S.A. proprietary synthetic bone graft, and the outcome of the project will result in a novel injectable presentation of this product. The hydrogel was produced by dextrin oxidation with sodium periodate followed by cross - linking with a dihydrazide [ 14 ] . In vitro characterization of oDex hydrogel has shown acceptable m echanical properties, overall good biocompatibility and the ability to be combined with other materials such as a nanogel and urinary bladder matrix, without affecting its structure. The cytotoxicity of the free dihydrazide was evaluated and only a mild in hibitory effect on cell proliferation was observed for the concentration used in the hydrogel crosslinking. The biocompatibilit y of oDex hydrogels was confirmed through the encapsulation of cells, which were able to endure the gelation process. Subcutaneou s implants were performed in Sasco Sprague Dawley rats in order to evaluate the inflammatory response and systemic effects of oDex hydrogels and their combination with Bonelike ® and human mesenchymal stem cells isolated from umbilical cord’s Wharton jelly. After 3 and 15 days post - implantation, a quantitative evaluation of both responses was performed according to ISO 10993 by a scoring system leading to a classification of the implanted material as s light irritant even when associated to Bonelike ® or to the cellular system. The performance of oDex hydrogel combined with Bonelike granules and/or UBM in bone defects was investigated in New Zealand rabbits. Bone defects in several anatomical locations (t ibiae and cranium) of non - critical and critical size were filled with those materials. Histological analysis showed that oDex does not constitute a barrier for cellular colonization and proliferation since the defects that were filled with these materials presented a higher degree of regeneration and a higher amount of collagen fibers with higher organization degrees, when compared with the empty defects. Even though oDex hydrogels purpose is to act as an injectable carrier for osteoconductive materials, li ke Bonelike ® granules, the hydrogel itself seems to assists the regenerative pro cess when compared with the empty defects. This is due to the 3D supp ort conferred by hydrogels that facilitates cell migration to the defect site. Moreover, the presence of UB M strongly stimulates the bone regeneration, for levels comparable with the Bonelike ® conditions, since an increase in cellular colonization and organization in the defect site can be denoted. A sterilization protocol for oDex hydrogels by gamma and beta r adiation was investigated through irradiation of oxidized dextrin solutions. Despite b oth kinds of radiation induced slight differences in the storage modulus of the hydrogels, indicating the occurrence of chain scission/cross - linking effects on the dextri n cha in, all materials were gelable after the irradiation treatments . These effects seem to not be dose or temperature dependent and the irradiation process in liquid or solid state also does not induce major differences in the rheology of the final hydrog els. Due to its known advantages, gamma radiation seems to be a suitable sterilization method for oxidized dextrin solutions. The stability of gamma irradiated dextrin solutions was evaluated up to 8 months. Despite the increase of storage modulus of the h ydrogels over the time, this effect does not constitute a disadvantage since it improves elastic behavior of the hydrogels. oDex hydrogels provides a system that can carry and stabilize cells, nanogels, Bonelike ® granules and other biomolecules. It is a pr omising biomaterial due to its biocompatibility, and potential to promote an adequate environment for bone regeneration. Its injectability allows a minimal invasive surgical procedure with decreased patient morbidity, lower risk of infection and reduced sc ar formation. This work has been developed in the scope of an European project that allowed collaborations with research groups, which have complementary expertise. The tight collaboration between University of Minho and Bioskin S.A. company, envisioning t echnology transfer and product valorization, has resulted in a published international patent of the product ( WO2011070529A2 ) [ 15 ] . Currently, a new set of pre - clinical trials in sheep model s are being planned as well as the submission of a request for the authorization for the clinical trialsGrant SFRH/BD/64571/2009 from Fundação para a Ciência e Tecnologia (FCT), Portugal. We thank FCT funding through EuroNanoMed ENMED/0002/2

Primary myoepithelial carcinoma of the lung: a rare entity treated with parenchymal sparing resection

Primary lung myoepithelial carcinomas are rare neoplasms arising from the salivary glands of the respiratory epithelium. Given the rare occurrences and reports of these tumors, appropriate recommendations for resection are difficult to formulate. Although classified as low-grade neoplasms, these tumors have a significant rate of recurrence and distant metastasis

Clinical pattern of ocular toxoplasmosis treated in a referral centre in Serbia

Purpose To analyze the clinical pattern of ocular toxoplasmosis (OT) in a referral centre in Serbia. Patients and methods The medical records of consecutive patients admitted for OT to the single referral centre for uveitis in Serbia between 2006 and 2010 were retrospectively analyzed. OT was diagnosed on the basis of typical fundus lesions and positive serology for Toxoplasma. Results In a total of 457 uveitis patients, OT was the third leading cause, with 59 patients (12.9%). Most OT cases (73%) were monocular. An active primary retinal lesion was observed in 36% and recurrent OT in 64% patients. Localization of lesions was central/paracentral (44%), juxtapapillar (27%), peripheral (19%), and multifocal (10%). Other ocular manifestations of inflammation included vitritis (44%), anterior uveitis (19%), and retinal vasculitis (10%). Complications included choroidal neovascularization in two and exudative retinal detachment with cataract, glaucoma, and cystoid macular oedema in one patient each. The detection of Toxoplasma-specific IgM antibodies in a single patient indicates a low rate of OT concomitant with acute infection. After treatment, the mean best-corrected visual acuity (BCVA) increased significantly. However, 14 (24%) patients ended up legally blind in the affected eye, of which 2 (3%) with bilateral blindness, all with a very poor BCVA (0.047 +/- 0.055) at presentation. Visual impairment and treatment outcome were both associated with central localization of lesions (P lt 0.0001 and P = 0.006, respectively). Conclusion OT is a significant cause of posterior uveitis in Serbia. Patients should be aware of the recurring nature of OT and react immediately if symptoms occur. Eye (2012) 26, 723-728; doi: 10.1038/eye.2012.20; published online 24 February 201

Genomic profiling of primary and recurrent Adult Granulosa Cell Tumors of the Ovary

Adult-type granulosa cell tumor (aGCT) is a rare malignant ovarian sex cord-stromal tumor, harboring recurrent FOXL2 c.C402G/p.C134W hotspot mutations in 97% of cases. These tumors are considered to have a favorable prognosis, however aGCTs have a tendency for local spread and late recurrences, which are associated with poor survival rates. We sought to determine the genetic alterations associated with aGCT disease progression. We subjected primary non-recurrent aGCTs (n = 7), primary aGCTs that subsequently recurred (n = 9) and their matched recurrences (n = 9), and aGCT recurrences without matched primary tumors (n = 10) to targeted massively parallel sequencing of ≥410 cancer-related genes. In addition, three primary non-recurrent aGCTs and nine aGCT recurrences were subjected to FOXL2 and TERT promoter Sanger sequencing analysis. All aGCTs harbored the FOXL2 C134W hotspot mutation. TERT promoter mutations were found to be significantly more frequent in recurrent (18/28, 64%) than primary aGCTs (5/19, 26%, p = 0.017). In addition, mutations affecting TP53, MED12, and TET2 were restricted to aGCT recurrences. Pathway annotation of altered genes demonstrated that aGCT recurrences displayed an enrichment for genetic alterations affecting cell cycle pathway-related genes. Analysis of paired primary and recurrent aGCTs revealed that TERT promoter mutations were either present in both primary tumors and matched recurrences or were restricted to the recurrence and absent in the respective primary aGCT. Clonal composition analysis of these paired samples further revealed that aGCTs display intra-tumor genetic heterogeneity and harbor multiple clones at diagnosis and relapse. We observed that in a subset of cases, recurrences acquired additional genetic alterations not present in primary aGCTs, including TERT, MED12, and TP53 mutations and CDKN2A/B homozygous deletions. Albeit harboring relatively simple genomes, our data provide evidence to suggest that aGCTs are genetically heterogeneous tumors and that TERT promoter mutations and/or genetic alterations affecting other cell cycle-related genes may be associated with disease progression and recurrences

Novel high-grade endometrial stromal sarcoma: a morphologic mimicker of myxoid leiomyosarcoma

Endometrial stromal sarcomas (ESS) are often underpinned by recurrent chromosomal translocations resulting in the fusion of genes involved in epigenetic regulation. To date, only YWHAE-NUTM2 rearrangements are associated with distinctive high-grade morphology and aggressive clinical behavior. We identified 3 ESS morphologically mimicking myxoid leiomyosarcoma of the uterus and sought to describe their unique histopathologic features and identify genetic alterations using next-generation sequencing. All cases displayed predominantly spindled cells associated with abundant myxoid stroma and brisk mitotic activity. Tumors involved the endometrium and demonstrated tongue-like myometrial infiltration. All 3 were associated with an aggressive clinical course, including multisite bony metastases in 1 patient, progressive peritoneal disease after chemotherapy in another and metastases to the lung and skin in the last patient. All 3 ESS were found to harbor ZC3H7B-BCOR gene fusions by targeted sequencing and fluorescence in situ hybridization. On the basis of the review of these cases, we find that ESS with ZC3H7B-BCOR fusion constitutes a novel type of high-grade ESS and shares significant morphologic overlap with myxoid leiomyosarcoma

Pork as a source of human parasitic infection

Foodborne zoonoses have been estimated to annually affect 10% of the global population, among which zoonotic parasites constitute an important class of aetiological agents. The major meatborne parasites include the protozoa Toxoplasma gondii and Sarcocystis spp., and the helminths Trichinella spp. and Taenia spp., all of which may be transmitted by pork. The significance of zoonotic parasites transmitted by pork consumption is emphasized by the prediction by the Food and Agriculture Organization of an 18.5% increase in world pork production over the next 10years. Of all the porkborne parasites, the three T' parasites have been responsible for most porkborne illness throughout history; they are still endemic, and therefore are important public-health concerns, in developing countries. Although the risk of porkborne parasites, particularly helminths, may currently be considered insignificant in developed countries, the modern trend of consuming raw meat favours their re-emergence. This paper overviews the main parasites transmitted to humans by pork, and outlines the main lines of prevention

Synthetic lethal therapies for cancer: what's next after PARP inhibitors?

The genetic concept of synthetic lethality has now been validated clinically through the demonstrated efficacy of poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of cancers in individuals with germline loss-of-function mutations in either BRCA1 or BRCA2. Three different PARP inhibitors have now been approved for the treatment of patients with BRCA-mutant ovarian cancer and one for those with BRCA-mutant breast cancer; these agents have also shown promising results in patients with BRCA-mutant prostate cancer. Here, we describe a number of other synthetic lethal interactions that have been discovered in cancer. We discuss some of the underlying principles that might increase the likelihood of clinical efficacy and how new computational and experimental approaches are now facilitating the discovery and validation of synthetic lethal interactions. Finally, we make suggestions on possible future directions and challenges facing researchers in this field

Cross-sectional survey of parental barriers to participation in pediatric participant research registries.

Research registries are a powerful tool for boosting recruitment into clinical trials. However, little is known about how parents approach the decision to enroll their child in a pediatric participant research registry (PPRR). We conducted in-person, written, or telephone surveys with parents/guardians of children hospitalized at Children's Hospital of Omaha, Nebraska to identify attitudes towards and barriers to enrollment in PPRRs. Overall, our population (N = 36) had positive attitudes toward PPRRs, with 77.8% (CI: 61.6, 88.4) of participants stating they were "somewhat" or "very" likely to enroll their child. Likelihood to enroll differed between various recruitment and enrollment methods, with participants stating they would be more likely to enroll their child in a PPRR if they were recruited by their child's primary care provider or a nurse in clinic (p = 0.02) and less likely to enroll if they were recruited through social media (p<0.001). Additionally, over 90% of participants who were likely to enroll their child in a PPRR (N = 28) were also willing to provide demographic, medical, and lifestyle information. However, these participants remained concerned about inappropriate sharing of their information with insurance or for-profit companies (53.6%, CI: 35.8, 70.4) and about receiving unwanted telephone calls from the registry (78.6%, CI: 60.0, 90.0). Parents are generally willing to enroll their child in a PPRR. However, to optimize enrollment, investigators must understand parental preferences for and concerns surrounding enrollment in a PPRR

Synthesis and characterization of surface-cyanofunctionalized poly ( N -isopropylacrylamide) latexes

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