Implantable hyaluronic acid-deferoxamine conjugate prevents nonunions through stimulation of neovascularization

Alexis Donneys, Qiuhong Yang, Marcus Laird Forrest, Noah S. Nelson, Ti Zhang, Russell Ettinger, Kavitha Ranganathan, Alicia Snider, Sagar S. Deshpande, Mark S. Cohen, Steven R. Buchman

Research output: Contribution to journalArticlepeer-review

Abstract

Approximately 6.3 million fractures occur in the U.S. annually, with 5–10% resulting in debilitating nonunions. A major limitation to achieving successful bony union is impaired neovascularization. To augment fracture healing, we designed an implantable drug delivery technology containing the angiogenic stimulant, deferoxamine (DFO). DFO activates new blood vessel formation through iron chelation and upregulation of the HIF-1α pathway. However, due to its short half-life and rapid clearance, maintaining DFO at the callus site during peak fracture angiogenesis has remained challenging. To overcome these limitations, we composed an implantable formulation of DFO conjugated to hyaluronic acid (HA). This compound immobilizes DFO within the fracture callus throughout the angiogenic window, making it a high-capacity iron sponge that amplifies blood vessel formation and prevents nonunions. We investigated implanted HA-DFO’s capacity to facilitate fracture healing in the irradiated rat mandible, a model whereby nonunions routinely develop secondary to obliteration of vascularity. HA-DFO implantation significantly improved radiomorphometrics and metrics of biomechanical strength. In addition, HA-DFO treated mandibles exhibited a remarkable 91% bone union rate, representing a 3.5-fold improvement over non-treated/irradiated controls (20% bone union rate). Collectively, our work proposes a unique methodology for the targeted delivery of DFO to fracture sites in order to facilitate neovascularization. If these findings are successfully translated into clinical practice, millions of patients will benefit from the prevention of nonunions.

Original languageEnglish (US)
Article number11
Journalnpj Regenerative Medicine
Volume4
Issue number1
DOIs
StatePublished - Dec 1 2019

ASJC Scopus subject areas

  • Biomedical Engineering
  • Cell Biology
  • Developmental Biology
  • Medicine (miscellaneous)

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