Use Of Coral Calcium For Human Bone Transplants -- Studies
The search term was: "coral calcium bone transplants" using the following
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The below studies are useful, unexpectedly for me, in that
they are dealing with the use of "coral" in a transplant to a human. In
any such usage you would expect to find "marine grade calcium" as a term in use,
would you not? There is NOT ONE instance of that phrase anywhere in the
eleven studies published below!
Natural coral exoskeleton as a bone graft substitute: a
review.
Demers C, Hamdy CR, Corsi K, Chellat F, Tabrizian M, Yahia L.
Ecole Polytechnique, Montreal, Quebec H3C 3A7, Canada.
Natural coral graft substitutes are derived from the exoskeleton of marine
madreporic corals. Researchers first started evaluating corals as potential bone
graft substitutes in the early 1970s in animals and in 1979 in humans. The
structure of the commonly used coral, Porites, is similar to that of cancellous
bone and its initial mechanical properties resemble those of bone. The
exoskeleton of these high content calcium carbonate scaffolds has since been
shown to be biocompatible, osteoconductive, and biodegradable at variable rates
depending on the exoskeleton porosity, the implantation site and the species.
Although not osteoinductive or osteogenic, coral grafts act as an adequate
carrier for growth factors and allow cell attachment, growth, spreading and
differentiation. When applied appropriately and when selected to match the
resorption rate with the bone formation rate of the implantation site, natural
coral exoskeletons have been found to be impressive bone graft substitutes. The
purpose of this article is to review and summarize all the pertinent work that
has been published on natural coral as a bone graft including in vitro, animal
and clinical human studies. Preliminary report of our own experiments as well as
our recommendations on the use of coral are also included.
Publication Types:
PMID: 11847406 [PubMed - indexed for MEDLINE]
[Osteogenesis induced by the combination of growth factor,
fibrin glue and coral; towards a substitute of autologous bone graft. An
experimental study on the rabbit]
[Article in French]
Arnaud E, Morieux C, Wybier M, de Vernejoul MC.
Unite de Chirurgie Cranio-Faciale, Hopital Necker-Enfants
Malades, Paris, France.
A triple mixture of TGF-beta, fibrin glue and natural coral skeleton granules (madreporic
calcium carbonate) was tested in a rabbit bilateral cranioplasty model.
Three-dimensional CT scan and histomorphometry demonstrated that, at one month
and at two months, this association produced significantly more bone tissue than
other associations, especially growth factor or coral alone. The rate of
mineralization was significantly increased bilaterally in all animals having
received TGF-beta. Coral resorption was also accelerated by growth factor and
was replaced by histologically normal bone after two months. We emphasize the
potentiation of TGF-beta by fibrin glue and natural coral skeleton and its
potential application as a bone substitute.
PMID: 7755332 [PubMed - indexed for MEDLINE]
[Natural coral calcium carbonate as alternative substitute in
bone defects of the skull]
[Article in German]
Soost F, Reisshauer B, Herrmann A, Neumann HJ.
Klinik und Poliklinik fur Mund-, Kiefer- und Gesichtschirurgie/Plastische
Operationen, Universitatsklinikum Charite, Medizinische Fakultat, Humboldt-Universitat
Berlin.
A biomaterial derived from natural corals
with surgical applications is the calcium carbonate Biocoral. Since 1992 the
author has been using this material as a bone graft substitute in maxillofacial
surgery. Eighty-nine clinical implantations were done in 68 patients for
different indications. The results suggested that coral grafts are well
tolerated and are simultaneously partially ossified as the calcified skeleton is
resorbed. Clinical cases show that use of this material has been successful.
PMID: 9567065 [PubMed - indexed for MEDLINE]
Formation of a calcium phosphate-rich layer on absorbable
calcium carbonate bone graft substitutes.
Damien CJ, Ricci JL, Christel P, Alexander H, Patat JL.
Intermedics Orthopedics/Denver, Inc., Wheat Ridge, Colorado.
The use of natural coral as a bone graft substitute is common in Europe.
However, the bone-coral bonding mechanism remains elusive. A rat subcutaneous
model was used to demonstrate changes at the surface of resorbable calcium
carbonate in the form of natural coral. Histological results indicated in vivo
formation of a calcium phosphate (CaP)-rich layer on the surface of the coral
confirmed by backscattered electron imaging and X-ray microanalysis. There
appears to be a combination solution-mediated dissolution/cell-mediated
degradation of the natural coral with subsequent surface conversion or
precipitation. The end result is a CaP-rich layer on the coral. Though this
layer has been observed previously, it was originally thought to be a
histological artifact. This result is similar, however, to what is seen with
Bioglass and glass ceramics and may also explain the good bonding of bone to
hydroxyapatite. The fact that this layer is also present on natural coral after
implantation in soft tissue sites may explain the intimate bone apposition
observed when natural coral is placed in bony sites.
PMID: 7953981 [PubMed - indexed for MEDLINE]
Evaluation of bovine-derived bone protein with a natural
coral carrier as a bone-graft substitute in a canine segmental defect model.
Sciadini MF, Dawson JM, Johnson KD.
Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville,
Tennessee 37232-2550, USA. sciadimf@ctrvax.vanderbilt.edu
The efficacy of a bone-graft substitute (bovine-derived bone protein in a
carrier of natural coral) in the healing of a segmental defect of a
weight-bearing long bone was evaluated. Twenty dogs, divided into two groups,
underwent bilateral radial osteotomies with creation of a 2.5 cm defect. On one
side of each dog, the defect was filled with autogenous cancellous bone graft.
Contralateral defects received, in a blinded randomized fashion, cylindrical
implants consisting of natural coral (calcium carbonate) or calcium carbonate
enhanced with a standard dose of bovine-derived bone protein (3.0 mg/implant;
0.68 mg bone protein/cm3). The limbs were stabilized with external fixators, and
all animals underwent monthly radiographs. They were killed at 12 (group 1) or
24 (group 2) weeks, and regenerated bone was studied by biomechanical testing
and histology. Radiographic union developed in all 20 radii with autogenous
cancellous bone grafts and in all 10 of the radii with the composite implants.
None of the radii with implants of calcium carbonate alone showed radiographic
evidence of union. This represented a statistically significant difference
between implant types. In addition, calcium carbonate implants both with and
without bone protein demonstrated radiographic evidence of near total resorption
of the radiodense carrier by 12 weeks. This resorption facilitated radiographic
evaluation of healing. Mean values for biomechanical parameters of radii with
the composite implants exceeded those for the contralateral controls at 12 and
24 weeks; the difference was statistically significant at 12 weeks. Histology
revealed scant residual calcium carbonate carrier at either time in the defects
with calcium carbonate implants; however, a moderate amount was present in
defects with the composite implants. In these specimens, the residual carrier
was completely surrounded by newly formed bone that may have insulated the
calcium carbonate from further degradation. The present study used a carrier of
granular calcium carbonate reconstituted with bovine type-I collagen to deliver
an osteoinductive protein to the defect site. This carrier is of nonhuman origin
(eliminating the risk of disease transmission or antigenicity) and resorbs
rapidly. In this model, bovine-derived bone protein in a natural coral carrier
performed consistently better than the gold standard autogenous cancellous bone
graft in terms of the amount of bone formation and strength of the healed
defect. This may have implications for removal of hardware or resumption of
weight-bearing in certain clinical situations. These data also indicate that
coralline calcium carbonate alone represents a poor option as a bone-graft
substitute in this critical-sized segmental defect model.
PMID: 9497809 [PubMed - indexed for MEDLINE]
Comparative study of the osteoinductive properties of
bioceramic, coral and processed bone graft substitutes.
Begley CT, Doherty MJ, Mollan RA, Wilson DJ.
Schools of Biomedical Sciences/Anatomy, Queens University of Belfast, Northern
Ireland, UK.
This study compared the osteoinductive properties of six different bone graft
substitutes: Pyrost, natural coral, Callopat, Surgibone, demineralized Surgibone
and demineralized rat bone. The materials were implanted heterotopically, in the
abdominal musculature of rats, and the results evaluated histologically at 3 and
6 wk post-implantation. Surprisingly, the results showed that both the
demineralized rat bone and demineralized Surgibone were less osteoinductive than
might be believed from the literature. Mineralized grafts showed no sign of new
bone formation and exhibited variable resorption patterns. A layer of what
appeared as dense calcification was seen around the coral implant. The most
intense inflammatory reactions were exhibited with the xenografts Surgibone and
demineralized Surgibone, indicating persistent immune responses. Coral and
Pyrost elicited no marked inflammatory response, and this was attributed to the
negligible amounts of protein present in these materials.
PMID: 8562796 [PubMed - indexed for MEDLINE]
Madreporic coral for cranial base reconstruction. 8 years
experience.
Roux FX, Brasnu D, Menard M, Devaux B, Nohra G, Loty B.
Neurosurgical Department, Centre Hospitalier Sainte Anne, Paris, France.
The authors, since 1985, have used 587 Madreporic Coral grafts as bone
substitute in a total of 183 patients, among them in 80 cases for repair of
cranial base bone defects. They report their long-term results. Partial
resorption to about 40% of the initial volume occurred in almost all cases
within 8 to 10 months, with complete resorption after about one year. 20% of the
coral blocks moved spontaneously or split into pieces, but could easily be
withdrawn rhinoscopically through the nostrils. No CSF leakage was noticed
afterwards. The local infection rate was only 4%, always close to the basal
coral graft. This is lower than the infection rate after using autologous bone
harvested from the inner table of the bone flap (20%). Infections were cured by
removal of the coral graft. Despite the mentioned draw backs, Madreporic Coral
graft implants can be recommended as bone substitute in cranial base surgery: 1.
The material simplifies the surgical procedure; 2. Harvesting of autologous bone
is no longer necessary; 3. Transmission of infections like AIDS, Hepatitis C or
Creutzfeld-Jacob-disease can be avoided with certainty.
PMID: 8748767 [PubMed - indexed for MEDLINE]
[Biocoral--an alternative bone substitute]
[Article in German]
Soost F.
Klinik fur Mund-, Kiefer- und Gesichtschirurgie/Plastische Operationen,
Universitatsklinikum Charite der Humboldt-Universitat zu Berlin.
Biocoral is a biomaterial derived from natural corals, and it has surgical
applications. Since 1992 the author has been using this material as a bone graft
substitute in maxillofacial surgery. Seventy-seven clinical implantations were
done for different indications. The results suggest that coral grafts are well
tolerated and become partially ossified when the calcified skeleton is resorbed.
This material has been demonstrated to be successful.
PMID: 9035959 [PubMed - indexed for MEDLINE]
Current understanding of osteoconduction in bone
regeneration.
Cornell CN, Lane JM.
Division of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, USA.
Bone tissue is osteoconductive. In particular, cancellous bone with its porous
and highly interconnected trabecular architecture allows easy ingrowth of
surrounding tissues. When placed in an osseous environment, living tissue for
the host bed migrates into the cancellous structure, which results in new bone
formation and incorporation of that structure. This is the process of
osteoconduction. The mineral and collagenous components of bone are
osteoconductive. Osteoconduction also is observed in fabricated materials that
have porosity similar to that of bone structure. Corallin ceramics,
hydroxyapatite beads, and combinations of hydroxyapatite and collagen all have
osteoconductive properties, and porous metals and biodegradable polymers.
Osteoconduction appears to be optimized in devices that mimic not only bone
structure, but also bone chemistry. The incorporation of calcium salts and
collagen by osteoconductive matrices leads to more complete ingrowth with new
bone formation.
Publication Types:
PMID: 9917646 [PubMed - indexed for MEDLINE]
Influence of the structure of three corals on their
resorption kinetics.
Fricain JC, Roudier M, Rouais F, Basse-Cathalinat B, Dupuy B.
U.F.R. Odontologie, Universite de Bordeaux II, France.
The aim of this study was to investigate the influence of the structure of
corals on their resorption kinetics after implantation in subcutaneous areas.
Three types of coral (Porites astreoides, Montastrea annularis and Dichocoenia
stokesi) identical in composition but different in structure were implanted for
periods of 1 and 2 months in subcutaneous sites in OF1 mice. The resorption of
the implants was studied by means of qualitative (histology, scanning electron
microscopy, fluorochrome labelling method) and quantitative approaches
(gravimetric method). The results of the qualitative study revealed a process of
irregular deterioration of the coral, linked to the detachment of crystals at
the surface of the implant. The results of the quantitative study showed that
the speed of resorption increases with the implantation time and the open
porosity of the coral. These reactions are explained by the increase of the
surface exchange area in contact with factors responsible for resorption:
biological medium and cells. When considering the choice of coral as a bone
substitute, these factors must be taken into account to allow the in situ
maintenance of the implant over a sufficiently long period of time according to
the clinical situation.
PMID: 8915948 [PubMed - indexed for MEDLINE]
Coralline bone graft substitutes.
Shors EC.
Research and New Technology, Interpore Cross International, Irvine, California,
USA. eshors@interpore.com
Coralline porous ceramics are biocompatible and osteoconductive implants. They
have proven to be effective as bone graft substitutes in large animal models and
in humans. Bone and supporting soft tissue grow into and throughout their
porosity if the implant is placed in direct apposition to viable bone and the
interfaces are stabilized. The bone within the implant remodels in response to
Wolff's law. Both the implant properties (chemistry and porosity) and the
biologic environment modulate the rate of implant resorption. Composite
technology with resorbable polymers can improve the mechanical properties of
these ceramics.
Publication Types:
PMID: 10471765 [PubMed - indexed for MEDLINE]
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