1. Towards understanding therapeutic failures in Masquelet surgery: First evidences that defective induced membrane properties are associated with clinical failures
- Author
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Jean-Marc Collombet, Thomas Demoures, Marjorie Durand, Laurent Mathieu, Jean-Baptiste Souraud, Alain-Charles Masquelet, Laure Barbier, and Thomas Poyot
- Subjects
Pathology ,medicine.medical_specialty ,induced membrane ,lcsh:Diseases of the musculoskeletal system ,Angiogenesis ,Endocrinology, Diabetes and Metabolism ,lcsh:Medicine ,Matrix metalloproteinase ,Article ,Extracellular matrix ,03 medical and health sciences ,masquelet technique ,0302 clinical medicine ,Gene expression ,medicine ,Macrophage ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,030222 orthopedics ,business.industry ,Mesenchymal stem cell ,lcsh:R ,General Medicine ,bone defect repair ,Surgery ,medicine.anatomical_structure ,Immunohistochemistry ,lcsh:RC925-935 ,Induced membrane ,business ,Cancellous bone - Abstract
The two-stage Masquelet induced-membrane technique (IMT) consists of cement spacer-driven membrane induction followed by an autologous cancellous bone implantation in this membrane to promote large bone defect repairs. For the first time, this study aims at correlating IMT failures with physiological alterations of the induced membrane (IM) in patients. For this purpose, we compared various histological, immunohistochemical and gene expression parameters obtained from IM collected in patients categorized lately as successfully (Responders, n = 8) or unsuccessfully (Non-responders, n = 3) treated with the Masquelet technique (6 month clinical and radiologic post-surgery follow-up). While angiogenesis or macrophage distribution pattern remained unmodified in non-responder IM as compared to responder IM, we evidenced an absence of mesenchymal stem cells and reduced density of fibroblast-like cells in non-responder IM. Furthermore, non-responder IM exhibited altered extracellular matrix (ECM) remodeling parameters such as a lower expression ratio of metalloproteinase-9 (MMP-9)/tissue inhibitor of metalloproteinases (TIMP-1) mRNA as well as an important collagen overexpression as shown by picrosirius red staining. In summary, this study is the first to report evidence that IMT failure can be related to defective IM properties while underlining the importance of ECM remodeling parameters, particularly the MMP-9/TIMP-1 gene expression ratio, as early predictive biomarkers of the IMT outcome regardless of the type of bone, fracture or patient characteristics.
- Published
- 2020