Cigarette smoke inhalation impairs angiogenesis in early bone healing processes and delays fracture union

Chao-Jui Chang; I-Ming Jou; Tung-Tai Wu; Fong-Chin Su; Ta-Wei Tai

doi:10.1302/2046-3758.93.BJR-2019-0089.R1

Cigarette smoke inhalation impairs angiogenesis in early bone healing processes and delays fracture union

Bone Joint Res. 2020 May 16;9(3):99-107. doi: 10.1302/2046-3758.93.BJR-2019-0089.R1. eCollection 2020 Mar.

Authors

Chao-Jui Chang¹, I-Ming Jou², Tung-Tai Wu³, Fong-Chin Su⁴, Ta-Wei Tai¹

Affiliations

¹ Department of Orthopaedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Orthopaedics, E-Da Hospital, Kaohsiung, Taiwan; Great East Gate Clinic, Tainan, Taiwan.
³ Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Great East Gate Clinic, Tainan, Taiwan.
⁴ National Cheng Kung University, Tainan, Taiwan.

PMID: 32435462
PMCID: PMC7229299
DOI: 10.1302/2046-3758.93.BJR-2019-0089.R1

Abstract

Aims: Cigarette smoking has a negative impact on the skeletal system, causes a decrease in bone mass in both young and old patients, and is considered a risk factor for the development of osteoporosis. In addition, it disturbs the bone healing process and prolongs the healing time after fractures. The mechanisms by which cigarette smoking impairs fracture healing are not fully understood. There are few studies reporting the effects of cigarette smoking on new blood vessel formation during the early stage of fracture healing. We tested the hypothesis that cigarette smoke inhalation may suppress angiogenesis and delay fracture healing.

Methods: We established a custom-made chamber with airflow for rats to inhale cigarette smoke continuously, and tested our hypothesis using a femoral osteotomy model, radiograph and microCT imaging, and various biomechanical and biological tests.

Results: In the smoking group, Western blot analysis and immunohistochemical staining revealed less expression of vascular endothelial growth factor (VEGF) and von Willebrand factor (vWF). The smoking group also had a lower microvessel density than the control group. Image and biochemical analysis also demonstrated delayed bone healing.

Conclusion: Cigarette smoke inhalation was associated with decreased expression of angiogenic markers in the early bone healing phase and with impaired bone healing.Cite this article: Bone Joint Res. 2020;9(3):99-107.

Keywords: Angiogenesis; Bone healing; Cigarette; Fracture union; Smoking.