Molecular mechanisms of poor osseointegration in irradiated bone: In vivo study in a rat tibia model

Abstract Aim Radiotherapy is associated with cell depletion and loss of blood supply, which are linked to compromised bone healing. However, the molecular events underlying these effects at the tissue–implant interface have not been fully elucidated. This study aimed to determine the major molecular mediators associated with compromised osseointegration due to previous exposure to radiation. Materials and Methods Titanium implants were placed in rat tibiae with or without pre‐exposure to 20 Gy irradiation. Histomorphometric, biomechanical, quantitative polymerase chain reaction (qPCR) and enzyme‐linked immunosorbent assay analyses were performed at 1 and 4 weeks after implantation. Results The detrimental effects of irradiation were characterized by reduced bone–implant contact and removal torque. Furthermore, pre‐exposure to radiation induced different molecular dysfunctions such as (i) increased expression of pro‐inflammatory ( Tnf ) and osteoclastic ( Ctsk ) genes and decreased expression of the bone formation ( Alpl ) gene in implant‐adherent cells; (ii) increased expression of bone formation ( Alpl and Bglap ) genes in peri‐implant bone; and (iii) increased expression of pro‐inflammatory ( Tnf ) and pro‐fibrotic ( Tgfb1 ) genes in peri‐implant soft tissue. The serum levels of pro‐inflammatory, bone formation and bone resorption proteins were greater in the irradiated rats. Conclusions Irradiation causes the dysregulation of multiple biological activities, among which perturbed inflammation seems to play a common role in hindering osseointegration.