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NPJ Regen Med. 2019 May 21;4:11. doi: 10.1038/s41536-019-0072-9. eCollection 2019.

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

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1Craniofacial Research Laboratory, Plastic Surgery Section, University of Michigan, Ann Arbor, MI 48109 USA.
2Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66047 USA.
3Department of Surgery, University of Michigan, Ann Arbor, MI 48109 USA.


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.


Fracture repair; Regenerative medicine; Translational research

Conflict of interest statement

Competing interestsS.R.B., M.S.C, A.D, N.S.N, L.F., T.Z. and Q.Y. are listed on the following patent assigned to University of Michigan: Composition and Methods for Accelerating and Enhancing Bone Repair (UM-34678/US-1/PRO). The remaining authors declare no competing interests.

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