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The goal was to establish a reliable and reproducible method to study the molecular and cellular processes governing bone repair, focusing on the direct conversion of skeletal stem and progenitor cells (SSPCs) into bone-depositing osteoblasts in the bone marrow space/cavity. The mechanical bone marrow ablation method described here is an optimized and validated protocol for bone marrow ablation by mechanical injury, which allows for the investigation of intramembranous bone formation. Several steps in this protocol are critical to ensure robust bone formation post-injury and reproducibility of the technique. First is the precise insertion of the needle into the femoral medullary cavity. Misalignment in this step can lead to incomplete marrow injury and damage to surrounding tissues, leading to outcome variability. To ensure proper needle placement, X-ray imaging must be utilized to visualize needle placement before reaming the marrow cavity. Another critical step is flushing the bone marrow cavity with saline to remove BM remnants and unpack the marrow, creating space for subsequent new bone formation. Modifications to this protocol may be needed depending on the specific research question, mouse strain, genotype, or mouse age and weight11. For example, to assess bone regeneration potential, bones can be harvested on day 7 post ablation. However, to probe how inflammatory responses contribute to bone formation, the femurs should be harvested around day 3 post ablation injury, when inflammation peaks15. The size of the needles and volume of saline flush may be adjusted based on the animal's size and age. Common issues related to this surgical technique may include resistance when flushing the marrow cavity or animals not waking up post-surgery. If resistance to saline flushing is encountered, the needle can be repositioned or pulled out halfway. If this does not resolve resistance to flushing, marrow reaming may need to be repeated to ensure the BM cavity is clear of bone remnants.
The intramembranous bone formation has been studied using various injury models16,17,18. Among commonly used models are the calvarial defect model and the critical size defect model17,19. The calvarial defect model allows for ease of access and the ability to test a variety of biomaterials to assess osteogenic potential20. However, this model includes flat bone healing, which differs from long bones, where the mechanical environment and cellular dynamics are distinct. The critical size defect model involves creating a defect in the femur or tibia that is too large to heal spontaneously, mimicking clinical scenarios like trauma or tumor resection, which require intervention to achieve healing. Significant limitations of this model are the invasive surgical procedure to create critical size defects, the requirement of specialized screws and plates, and the extended healing period, which can be a disadvantage to studying early cellular events in bone repair18,21. Additionally, endochondral ossification can sometimes occur in healing critical size defects22. In contrast to these injury models, the mechanical BM ablation model provides a more controlled environment and reproducible injury responses that facilitate the study of intramembranous bone formation, specifically in long bones. This model targets the intramembranous pathway (evidenced by a lack of cartilage formation visualized by Safranin O staining; Figure 3C), allowing for more precise studies of SSPC contributions to bone healing. This is particularly beneficial for studies aimed at understanding the early stages of bone regeneration, where the dynamics of SSPC recruitment and differentiation are most critical. Additionally, using fluorescent reporter mice with this model enables a detailed analysis of SSPC contributions.
Another advantage of this model is the range of downstream applications and imaging modalities that can be used to assess qualitative and quantitative bone formation and cellular responses to injury. Early cellular responses can be assessed on Day 3 after the surgery, using EdU labeling for proliferation, flow cytometry for skeletal and immune cell surface markers, RNAscope for spatial visualization of gene expression patterns, and single-cell RNA sequencing to evaluate responses of different cell types. New bone formation can be assessed as early as Day 7 after the procedure, using dynamic histomorphometry, qualitative and quantitative µCT analysis, frozen section histology and immunofluorescent labeling, and calcein labeling. Additionally, this model can be used to study bone resorption starting on Day 10 post-surgery and tartrate-resistant acid phosphatase (TRAP) staining to visualize osteoclasts.
While this injury model is highly effective for studying intramembranous bone formation, there are some limitations. One such limitation is the dependence on the surgical skill of the surgeon performing the technique, which can introduce variability in outcome. However, the learning curve for this protocol is relatively small and is aided by the validation of needle placement using X-ray imaging. Another key challenge is the inherent heterogeneity of the bone marrow microenvironment. The BM comprises multiple distinct niches, including hematopoietic, stromal, vascular, and osteoblastic compartments, which may participate in crosstalk to regulate the homeostasis of the bone and marrow23,24. This can make it difficult to distinguish the specific contributions of individual compartments and cell types to the bone repair process. Additionally, the surgical procedure in this model disrupts the growth plate, which harbors chondrocyte-derived progenitors that contribute to bone development. A small subset of these chondrocytes can transform into osteoblasts and marrow stromal cells, even at the postnatal stages25,26,27. This could complicate the interpretation of bone marrow-derived progenitor responses to injury. Particularly, disruption of the growth plate can be an issue in younger mice, where there is higher activity of progenitor cells in a growing bone.
The BM ablation injury model has significant implications for research areas focused on bone repair and regeneration. It is beneficial for studies investigating the contributions of SSPCs in bone healing and novel therapeutic strategies to target these cells. This model can be used in translational studies to evaluate the efficacy of novel small molecules and drugs in promoting bone healing in a controlled setting. Clinically, insights gained from the use of this model can contribute to the development of improved treatments for conditions requiring intramembranous bone formation, such as fracture non-union, large bone defects, bone loss associated with tumor resection, or osseointegration in joint replacement.
In summary, the BM ablation injury model is a valuable and versatile tool for studying intramembranous bone formation. While there is a small learning curve in the surgical technique, with experience, the method provides reproducible outcomes. Insights into mechanisms of bone repair using this model make it a powerful tool for orthopedic research.