Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion Healing
Fracture healing and nonunion development are influenced by a range of biological factors. Adequate amino acid concentrations, especially arginine, are known to be important during normal bone healing. We hypothesize that bone arginine availability in autologous bone marrow grafting, when using the...
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MDPI AG
2022-10-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/10/10/2474 |
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| author | Dennis M. Meesters Karolina A. P. Wijnands Hans M. H. van Eijk Martijn Hofman Frank Hildebrand Jan P. A. M. Verbruggen Peter R. G. Brink Martijn Poeze |
| author_facet | Dennis M. Meesters Karolina A. P. Wijnands Hans M. H. van Eijk Martijn Hofman Frank Hildebrand Jan P. A. M. Verbruggen Peter R. G. Brink Martijn Poeze |
| author_sort | Dennis M. Meesters |
| collection | DOAJ |
| description | Fracture healing and nonunion development are influenced by a range of biological factors. Adequate amino acid concentrations, especially arginine, are known to be important during normal bone healing. We hypothesize that bone arginine availability in autologous bone marrow grafting, when using the reamer-irrigator-aspirator (RIA) procedure, is a marker of bone healing capacity in patients treated for nonunion. Seventeen patients treated for atrophic long bone nonunion by autologous bone grafting by the RIA procedure were included and divided into two groups, successful treatment of nonunion and unsuccessful, and were compared with control patients after normal fracture healing. Reamed bone marrow aspirate from a site distant to the nonunion was obtained and the amino acids and enzymes relevant to arginine metabolism were measured. Arginine and ornithine concentrations were higher in patients with successful bone healing after RIA in comparison with unsuccessful healing. Ornithine concentrations and arginase-1 expression were lower in all nonunion patients compared to control patients, while citrulline concentrations were increased. Nitric oxide synthase 2 (<i>Nos2</i>) expression was significantly increased in all RIA-treated patients, and higher in patients with a successful outcome when compared with an unsuccessful outcome. The results indicate an influence of the arginine–nitric oxide metabolism in collected bone marrow, on the outcome of nonunion treatment, with indications for a prolonged inflammatory response in patients with unsuccessful bone grafting therapy. The determination of arginine concentrations and <i>Nos2</i> expression could be used as a predictor for the successful treatment of autologous bone grafting in nonunion treatment. |
| first_indexed | 2024-03-09T20:38:47Z |
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| language | English |
| last_indexed | 2024-03-09T20:38:47Z |
| publishDate | 2022-10-01 |
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| series | Biomedicines |
| spelling | doaj.art-4babd6b2117d4ad49c752ca2a84123642023-11-23T23:03:38ZengMDPI AGBiomedicines2227-90592022-10-011010247410.3390/biomedicines10102474Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion HealingDennis M. Meesters0Karolina A. P. Wijnands1Hans M. H. van Eijk2Martijn Hofman3Frank Hildebrand4Jan P. A. M. Verbruggen5Peter R. G. Brink6Martijn Poeze7Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center +, 6200 MD Maastricht, The NetherlandsDepartment of Surgery, Division of Trauma Surgery, Maastricht University Medical Center +, 6200 MD Maastricht, The NetherlandsDepartment of Surgery, Division of Trauma Surgery, Maastricht University Medical Center +, 6200 MD Maastricht, The NetherlandsDepartment of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, 52074 Aachen, GermanyDepartment of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, 52074 Aachen, GermanyDepartment of Surgery, Division of Trauma Surgery, Maastricht University Medical Center +, 6200 MD Maastricht, The NetherlandsDepartment of Surgery, Division of Trauma Surgery, Maastricht University Medical Center +, 6200 MD Maastricht, The NetherlandsDepartment of Surgery, Division of Trauma Surgery, Maastricht University Medical Center +, 6200 MD Maastricht, The NetherlandsFracture healing and nonunion development are influenced by a range of biological factors. Adequate amino acid concentrations, especially arginine, are known to be important during normal bone healing. We hypothesize that bone arginine availability in autologous bone marrow grafting, when using the reamer-irrigator-aspirator (RIA) procedure, is a marker of bone healing capacity in patients treated for nonunion. Seventeen patients treated for atrophic long bone nonunion by autologous bone grafting by the RIA procedure were included and divided into two groups, successful treatment of nonunion and unsuccessful, and were compared with control patients after normal fracture healing. Reamed bone marrow aspirate from a site distant to the nonunion was obtained and the amino acids and enzymes relevant to arginine metabolism were measured. Arginine and ornithine concentrations were higher in patients with successful bone healing after RIA in comparison with unsuccessful healing. Ornithine concentrations and arginase-1 expression were lower in all nonunion patients compared to control patients, while citrulline concentrations were increased. Nitric oxide synthase 2 (<i>Nos2</i>) expression was significantly increased in all RIA-treated patients, and higher in patients with a successful outcome when compared with an unsuccessful outcome. The results indicate an influence of the arginine–nitric oxide metabolism in collected bone marrow, on the outcome of nonunion treatment, with indications for a prolonged inflammatory response in patients with unsuccessful bone grafting therapy. The determination of arginine concentrations and <i>Nos2</i> expression could be used as a predictor for the successful treatment of autologous bone grafting in nonunion treatment.https://www.mdpi.com/2227-9059/10/10/2474nonunionautologous bone graftingnitric oxideargininecitrulline |
| spellingShingle | Dennis M. Meesters Karolina A. P. Wijnands Hans M. H. van Eijk Martijn Hofman Frank Hildebrand Jan P. A. M. Verbruggen Peter R. G. Brink Martijn Poeze Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion Healing Biomedicines nonunion autologous bone grafting nitric oxide arginine citrulline |
| title | Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion Healing |
| title_full | Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion Healing |
| title_fullStr | Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion Healing |
| title_full_unstemmed | Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion Healing |
| title_short | Arginine Availability in Reamed Intramedullary Aspirate as Predictor of Outcome in Nonunion Healing |
| title_sort | arginine availability in reamed intramedullary aspirate as predictor of outcome in nonunion healing |
| topic | nonunion autologous bone grafting nitric oxide arginine citrulline |
| url | https://www.mdpi.com/2227-9059/10/10/2474 |
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