Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated Fields

Background:. The incidence of cancer worldwide is expected to be more than 22 million annually by 2030. Approximately half of these patients will likely require radiation therapy. Although radiotherapy has been shown to improve disease control and increase survivorship, it also results in damage to...

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Main Authors: Melissa Daniel, MD, Alexandra O. Luby, MD, MS, Lauren Buchman, Steven R. Buchman, MD
Format: Article
Language:English
Published: Wolters Kluwer 2021-06-01
Series:Plastic and Reconstructive Surgery, Global Open
Online Access:http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003605
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author Melissa Daniel, MD
Alexandra O. Luby, MD, MS
Lauren Buchman
Steven R. Buchman, MD
author_facet Melissa Daniel, MD
Alexandra O. Luby, MD, MS
Lauren Buchman
Steven R. Buchman, MD
author_sort Melissa Daniel, MD
collection DOAJ
description Background:. The incidence of cancer worldwide is expected to be more than 22 million annually by 2030. Approximately half of these patients will likely require radiation therapy. Although radiotherapy has been shown to improve disease control and increase survivorship, it also results in damage to adjacent healthy tissues, including the bone, which can lead to devastating skeletal complications, such as nonunion, pathologic fractures, and osteoradionecrosis. Pathologic fractures and osteoradionecrosis are ominous complications that can result in large bone and soft tissue defects requiring complex reconstruction. Current clinical management strategies for these conditions are suboptimal and dubious at best. The gold standard in treatment of severe radiation injury is free tissue transfer; however, this requires a large operation that is limited to select candidates. Methods:. With the goal to expand current treatment options and to assuage the devastating sequelae of radiation injury on surrounding normal tissue, our laboratory has performed years of translational studies aimed at remediating bone healing and regeneration in irradiated fields. Three therapeutics (amifostine, deferoxamine, and adipose-derived stem cells) have demonstrated great promise in promoting healing and regeneration of irradiated bone. Results:. Amifostine confers prophylactic protection, whereas deferoxamine and adipose-derived stem cells function to remediate postradiation associated injury. Conclusions:. These prospective therapeutics exploit a mechanism attributed to increasing angiogenesis and ultimately function to protect or restore cellularity, normal cellular function, osteogenesis, and bone healing to nonirradiated metrics. These discoveries may offer innovative treatment alternatives to free tissue transfer with the added benefit of potentially preventing and treating osteoradionecrosis and pathologic fractures
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spelling doaj.art-f5362b5032f14ba7a8c4d1394199926c2022-12-21T18:29:58ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-06-0196e360510.1097/GOX.0000000000003605202106000-00048Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated FieldsMelissa Daniel, MD0Alexandra O. Luby, MD, MS1Lauren Buchman2Steven R. Buchman, MD3From the Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Mich.From the Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Mich.From the Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Mich.From the Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Mich.Background:. The incidence of cancer worldwide is expected to be more than 22 million annually by 2030. Approximately half of these patients will likely require radiation therapy. Although radiotherapy has been shown to improve disease control and increase survivorship, it also results in damage to adjacent healthy tissues, including the bone, which can lead to devastating skeletal complications, such as nonunion, pathologic fractures, and osteoradionecrosis. Pathologic fractures and osteoradionecrosis are ominous complications that can result in large bone and soft tissue defects requiring complex reconstruction. Current clinical management strategies for these conditions are suboptimal and dubious at best. The gold standard in treatment of severe radiation injury is free tissue transfer; however, this requires a large operation that is limited to select candidates. Methods:. With the goal to expand current treatment options and to assuage the devastating sequelae of radiation injury on surrounding normal tissue, our laboratory has performed years of translational studies aimed at remediating bone healing and regeneration in irradiated fields. Three therapeutics (amifostine, deferoxamine, and adipose-derived stem cells) have demonstrated great promise in promoting healing and regeneration of irradiated bone. Results:. Amifostine confers prophylactic protection, whereas deferoxamine and adipose-derived stem cells function to remediate postradiation associated injury. Conclusions:. These prospective therapeutics exploit a mechanism attributed to increasing angiogenesis and ultimately function to protect or restore cellularity, normal cellular function, osteogenesis, and bone healing to nonirradiated metrics. These discoveries may offer innovative treatment alternatives to free tissue transfer with the added benefit of potentially preventing and treating osteoradionecrosis and pathologic fractureshttp://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003605
spellingShingle Melissa Daniel, MD
Alexandra O. Luby, MD, MS
Lauren Buchman
Steven R. Buchman, MD
Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated Fields
Plastic and Reconstructive Surgery, Global Open
title Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated Fields
title_full Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated Fields
title_fullStr Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated Fields
title_full_unstemmed Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated Fields
title_short Overcoming Nuclear Winter: The Cutting-edge Science of Bone Healing and Regeneration in Irradiated Fields
title_sort overcoming nuclear winter the cutting edge science of bone healing and regeneration in irradiated fields
url http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003605
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