title: World's First Clinical Case of Gene-Activated Bone Substitute Application.
abstract: Treatment of patients with large bone defects is a complex clinical problem. We have initiated the first clinical study of a gene-activated bone substitute composed of the collagen-hydroxyapatite scaffold and plasmid DNA encoding vascular endothelial growth factor. The first patient with two nonunions of previously reconstructed mandible was enrolled into the study. Scar tissues were excised; bone defects (5-14 mm) between the mandibular fragments and nonvascularized rib-bone autograft were filled in with the gene-activated bone substitute. No adverse events were observed during 12 months of follow-up. In 3 months, the average density of newly formed tissues within the implantation zone was 402.21 ± 84.40 and 447.68 ± 106.75 HU in the frontal and distal regions, respectively, which correlated with the density of spongy bone. Complete distal bone defect repair with vestibular and lingual cortical plates formation was observed in 6 and 12 months after surgery; thereby the posterior nonunion was successfully eliminated. However, there was partial resorption of the proximal edge of the autograft entailed to relapse of the anterior nonunion. Thus, the first clinical data on the safety and efficacy of the gene-activated bone substitute were obtained. Given a high complexity of the clinical situation the treatment, results might be considered as promising. NCT02293031.
authors.affiliation: Department of Maxillofacial and Plastic Surgery, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia; Human Stem Cells Institute, Moscow, Russia; Department of Maxillofacial Surgery, A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia.
authors.forename: I Y
authors.identifier: 0000-0002-0138-5614
authors.initials: IY
authors.lastname: Bozo
authors.affiliation: Human Stem Cells Institute, Moscow, Russia; I.P. Pavlov Ryazan State Medical University, Ryazan, Russia.
authors.forename: R V
authors.initials: RV
authors.lastname: Deev
authors.affiliation: Department of Maxillofacial and Plastic Surgery, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: A Y
authors.initials: AY
authors.lastname: Drobyshev
authors.affiliation: Human Stem Cells Institute, Moscow, Russia.
authors.forename: A A
authors.initials: AA
authors.lastname: Isaev
authors.affiliation: Central Clinical Hospital with Outpatient Health Center of the Business Administration for the President of the Russian Federation, Moscow, Russia.
authors.forename: I I
authors.initials: II
authors.lastname: Eremin