title: Transplantation of mesenchymal stem cells, recombinant human BMP-2,and their combination in accelerating the union after osteotomy and increasing, the mechanical strength of extracorporeally irradiated femoral autograft in rat models.
abstract: BACKGROUND
  Delayed union, nonunion, and mechanical failure is still problems encountered in limb salvage surgery (LSS) using extracorporeal irradiation (ECI). This study aimed to determine whether bone marrow mesenchymal stem cells (MSC) and recombinant human bone morphogenetic protein-2 (rhBMP-2) improve hostgraft union after osteotomy and also increase its mechanical strength.
  
  
  METHODS
  Thirty Sprague Dawley rats were randomly divided into five groups. Group I (control) underwent LSS using ECI method with 150 Gy single doses. Similar procedures were applied to other groups. Group II received hydroxyapatite (HA) scaffold. Group III received HA scaffold and MSC. Group IV received HA scaffold and rhBMP-2. Group V received HA scaffolds, MSC, and rhBMP-2. Radiograph were taken at week-2, 4, 6, and 8; serum alkaline phosphatase and osteocalcin were measured at week-2 and 4. Histopathological evaluation and biomechanical study was done at week-8.
  
  
  RESULTS
  The highest radiological score was found in group IV and V Similar result was obtained in histological score and ultimate bending force. These results were found to be statistically significant. There was no significant difference among groups in serum alkaline phosphatase and osteocalcin level.
  
  
  CONCLUSIONS
  Combination of MSC and rhBMP-2 was proven to accelerate union and improve mechanical strength of ECI autograft.
authors: 1. MD, PhD, SpOT, Musculoskeletal Oncologist, Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. fauzikamal6@gmail.com.
authors: Achmad
authors: A
authors: Fauzi Kamal
authors: 2. MD, PhD, SpOT, Orthopaedic Surgeon, Consultant of Adult Reconstruction, Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. ismailorthofkui@yahoo.co.id.
authors: Ismail
authors: I
authors: Hadisoebroto Dilogo
authors: 3. MD, SpOT, Musculoskeletal Oncologist, Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. erroluhuta6@gmail.com.
authors: Errol
authors: E
authors: Untung Hutagalung
authors: 4. PhD, Vet, Research Veterinarian, Primate Research Center, Bogor Agricultural University, Bogor, Indonesia. atie@indo.net.id.
authors: Diah
authors: D
authors: Iskandriati
authors: 5. MD, PhD, SpRad, Radiation Oncologist, Department of Radiotherapy, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. susworprof@gmail.com.
authors: R
authors: R
authors: Susworo
authors: 6. MD, PhD, SpPA, Pathologist, Department of Anatomical Pathology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. anisiregar@gmail.com.
authors: Nurjati
authors: N
authors: Chaerani Siregar
authors: 7. MD, PhD, Medical Epidemiologist, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia. adang.kantaatmadja6@gmail.com.
authors: Achmad
authors: A
authors: Aulia Yusuf
authors: 8. PhD, Medical Epidemiologist, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia. adang.kantaatmadja6@gmail.com.
authors: Adang
authors: A
authors: Bachtiar
keywords: Bone morphogenetic protein; Extracorporeal irradiation; Hydroxyapatite; Limb salvage surgery; Mesenchymal stem cell; Scaffold