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Rossi F, Santoro M, Perale G. Polymeric scaffolds as stem cell carriers in bone repair. J Tissue Eng Regen Med 2013; 9:1093-119. [PMID: 24668819 DOI: 10.1002/term.1827] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 07/29/2013] [Accepted: 08/30/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering; 'Giulio Natta' Politecnico di Milano; Milan Italy
| | - Marco Santoro
- Department of Chemical and Biomolecular Engineering; Rice University; Houston TX USA
| | - Giuseppe Perale
- Department of Chemistry, Materials and Chemical Engineering; 'Giulio Natta' Politecnico di Milano; Milan Italy
- Department of Innovative Technologies; University of Southern Switzerland; Manno Switzerland
- Swiss Institute for Regenerative Medicine; Taverne Switzerland
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Wang B, Huang S, Pan L, Jia S. Enhancement of bone formation by genetically engineered human umbilical cord-derived mesenchymal stem cells expressing osterix. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e221-9. [PMID: 22819334 DOI: 10.1016/j.oooo.2011.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 11/14/2011] [Accepted: 12/13/2011] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study was to investigate if overexpression of osterix (Osx) in human umbilical cord-derived mesenchymal stem cells (UC-MSCs) would facilitate osteogenic differentiation in bone regeneration. STUDY DESIGN UC-MSCs were isolated from UCs. A pEGFP-Osx plasmid was constructed and applied to transfect UC-MSCs. Cell proliferation, alkaline phosphatase (ALP) activity, and expression of bone-related genes were examined to evaluate the osteogenic potential of UC-MSCs. Bone regeneration in vivo was evaluated in nude mice using PLGA as a carrier. RESULTS Reverse-transcription polymerase chain reaction showed that pEGFP-Osx transfection enhanced expression of bone matrix proteins. Overexpression of Osx in UC-MSCs enhanced ALP activity, while not inhibited their proliferation rate. The Osx-transduced group formed significantly more bone at 4 weeks. CONCLUSIONS Concerning their simple isolation and proliferation, it is believed that genetically engineered UC-MSCs could play important roles in the study and application of bone tissue engineering.
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Affiliation(s)
- Bin Wang
- Attending Physician, Department of Orthodontics, Hefei Stomatologic Hospital, Hefei, China
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53
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Chen W, Liu J, Manuchehrabadi N, Weir MD, Zhu Z, Xu HHK. Umbilical cord and bone marrow mesenchymal stem cell seeding on macroporous calcium phosphate for bone regeneration in rat cranial defects. Biomaterials 2013; 34:9917-25. [PMID: 24054499 DOI: 10.1016/j.biomaterials.2013.09.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/02/2013] [Indexed: 02/08/2023]
Abstract
Human umbilical cord mesenchymal stem cells (hUCMSCs) are inexhaustible and can be harvested at a low cost without an invasive procedure. However, there has been no report on comparing hUCMSCs with human bone marrow MSCs (hBMSCs) for bone regeneration in vivo. The aim of this study was to investigate hUCMSC and hBMSC seeding on macroporous calcium phosphate cement (CPC), and to compare their bone regeneration in critical-sized cranial defects in rats. Cell attachment, osteogenic differentiation and mineral synthesis on RGD-modified macroporous CPC were investigated in vitro. Scaffolds with cells were implanted in 8-mm defects of athymic rats. Bone regeneration was investigated via micro-CT and histological analysis at 4, 12, and 24 weeks. Three groups were tested: CPC with hUCMSCs, CPC with hBMSCs, and CPC control without cells. Percentage of live cells and cell density on CPC in vitro were similarly good for hUCMSCs and hBMSCs. Both cells had high osteogenic expressions of alkaline phosphatase, osteocalcin, collagen I, and Runx2. Bone mineral density and trabecular thickness in hUCMSC and hBMSC groups in vivo were greater than those of CPC control group. New bone amount for hUCMSC-CPC and hBMSC-CPC constructs was increased by 57% and 88%, respectively, while blood vessel density was increased by 15% and 20%, than CPC control group at 24 weeks. hUCMSC-CPC and hBMSC-CPC groups generally had statistically similar bone mineral density, new bone amount and vessel density. In conclusion, hUCMSCs seeded on CPC were shown to match the bone regeneration efficacy of hBMSCs in vivo for the first time. Both hUCMSC-CPC and hBMSC-CPC constructs generated much more new bone and blood vessels than CPC without cells. Macroporous RGD-grafted CPC with stem cell seeding is promising for craniofacial and orthopedic repairs.
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Affiliation(s)
- Wenchuan Chen
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China; Biomaterials & Tissue Engineering Division, Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, MD 21201, USA
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Xiang L, Ma L, Wang T, Wei N, Gong P. Proper size of the 3-dimensional periodontal ligament stem cell (3D PDLSC) sphere is vital for cell viability. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:121-2. [PMID: 23992959 DOI: 10.1016/j.oooo.2013.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 02/05/2023]
Affiliation(s)
- Lin Xiang
- Faculty, State Key Laboratory of Oral Diseases and Dental Implant Center, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin Nan Road, Chengdu, Sichuan 610041, China
| | - Li Ma
- Faculty, State Key Laboratory of Oral Diseases and Dental Implant Center, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin Nan Road, Chengdu, Sichuan 610041, China
| | - Tianlu Wang
- Faculty, State Key Laboratory of Oral Diseases and Dental Implant Center, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin Nan Road, Chengdu, Sichuan 610041, China
| | - Na Wei
- Faculty, State Key Laboratory of Oral Diseases and Dental Implant Center, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin Nan Road, Chengdu, Sichuan 610041, China
| | - Ping Gong
- Faculty, State Key Laboratory of Oral Diseases and Dental Implant Center, West China Hospital of Stomatology, Sichuan University, No. 14, Third Section, Renmin Nan Road, Chengdu, Sichuan 610041, China
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55
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Wang Q, Gu Z, Jamal S, Detamore MS, Berkland C. Hybrid hydroxyapatite nanoparticle colloidal gels are injectable fillers for bone tissue engineering. Tissue Eng Part A 2013; 19:2586-93. [PMID: 23815275 DOI: 10.1089/ten.tea.2013.0075] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Injectable bone fillers have emerged as an alternative to the invasive surgery often required to treat bone defects. Current bone fillers may benefit from improvements in dynamic properties such as shear thinning during injection and recovery of material stiffness after placement. Negatively charged inorganic hydroxyapatite (HAp) nanoparticles (NPs) were assembled with positively charged organic poly(d,l-lactic-co-glycolic acid) (PLGA) NPs to create a cohesive colloidal gel. This material is held together by electrostatic forces that may be disrupted by shear to facilitate extrusion, molding, or injection. Scanning electron micrographs of the dried colloidal gels showed a well-organized, three-dimensional porous structure. Rheology tests revealed that certain colloidal gels could recover after being sheared. Human umbilical cord mesenchymal stem cells were also highly viable when seeded on the colloidal gels. HAp/PLGA NP colloidal gels offer an attractive scheme for injectable filling and regeneration of bone tissue.
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Affiliation(s)
- Qun Wang
- 1 Department of Chemical and Biological Engineering, Iowa State University , Ames, Iowa
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56
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Reprogramming of mesenchymal stem cells derived from iPSCs seeded on biofunctionalized calcium phosphate scaffold for bone engineering. Biomaterials 2013; 34:7862-72. [PMID: 23891395 DOI: 10.1016/j.biomaterials.2013.07.029] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/08/2013] [Indexed: 12/24/2022]
Abstract
Human induced pluripotent stem cell-derived mesenchymal stem cells (iPSC-MSCs) are a promising choice of patient-specific stem cells with superior capability of cell expansion. There has been no report on bone morphogenic protein 2 (BMP2) gene modification of iPSC-MSCs for bone tissue engineering. The objectives of this study were to: (1) genetically modify iPSC-MSCs for BMP2 delivery; and (2) to seed BMP2 gene-modified iPSC-MSCs on calcium phosphate cement (CPC) immobilized with RGD for bone tissue engineering. iPSC-MSCs were infected with green fluorescence protein (GFP-iPSC-MSCs), or BMP2 lentivirus (BMP2-iPSC-MSCs). High levels of GFP expression were detected and more than 68% of GFP-iPSC-MSCs were GFP positive. BMP2-iPSC-MSCs expressed higher BMP2 levels than iPSC-MSCs in quantitative RT-PCR and ELISA assays (p < 0.05). BMP2-iPSC-MSCs did not compromise growth kinetics and cell cycle stages compared to iPSC-MSCs. After 14 d in osteogenic medium, ALP activity of BMP2-iPSC-MSCs was 1.8 times that of iPSC-MSCs (p < 0.05), indicating that BMP2 gene transduction of iPSC-MSCs enhanced osteogenic differentiation. BMP2-iPSC-MSCs were seeded on CPC scaffold biofunctionalized with RGD (RGD-CPC). BMP2-iPSC-MSCs attached well on RGD-CPC. At 14 d, COL1A1 expression of BMP2-iPSC-MSCs was 1.9 times that of iPSC-MSCs. OC expression of BMP2-iPSC-MSCs was 2.3 times that of iPSC-MSCs. Bone matrix mineralization by BMP2-iPSC-MSCs was 1.8 times that of iPSC-MSCs at 21 d. In conclusion, iPSC-MSCs seeded on CPC were suitable for bone tissue engineering. BMP2 gene-modified iPSC-MSCs on RGD-CPC underwent osteogenic differentiation, and the overexpression of BMP2 in iPSC-MSCs enhanced differentiation and bone mineral production on RGD-CPC. BMP2-iPSC-MSC seeding on RGD-CPC scaffold is promising to enhance bone regeneration efficacy.
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57
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Lima AC, Batista P, Valente TAM, Silva AS, Correia IJ, Mano JF. Novel methodology based on biomimetic superhydrophobic substrates to immobilize cells and proteins in hydrogel spheres for applications in bone regeneration. Tissue Eng Part A 2013; 19:1175-87. [PMID: 23249253 DOI: 10.1089/ten.tea.2012.0249] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cell-based therapies for regenerative medicine have been characterized by the low retention and integration of injected cells into host structures. Cell immobilization in hydrogels for target cell delivery has been developed to circumvent this issue. In this work mesenchymal stem cells isolated from Wistar rats bone marrow (rMSCs) were immobilized in alginate beads fabricated using an innovative approach involving the gellification of the liquid precursor droplets onto biomimetic superhydrophobic surfaces without the need of any precipitation bath. The process occurred in mild conditions preventing the loss of cell viability. Furthermore, fibronectin (FN) was also immobilized inside alginate beads with high efficiency in order to mimic the composition of the extracellular matrix. This process occurred in a very fast way (around 5 min), at room temperature, without aggressive mechanical strengths or particle aggregation. The methodology employed allowed the production of alginate beads exhibiting a homogenous rMSCs and FN distribution. Encapsulated rMSCs remained viable and were released from the alginate for more than 20 days. In vivo assays were also performed, by implanting these particles in a calvarial bone defect to evaluate their potential for bone tissue regeneration. Microcomputed tomography and histological analysis results showed that this hybrid system accelerated bone regeneration process. The methodology employed had a dual role by preventing cell and FN loss and avoiding any contamination of the beads or exchange of molecules with the surrounding environment. In principle, the method used for cell encapsulation could be extended to other systems aimed to be used in tissue regeneration strategies.
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Affiliation(s)
- Ana Catarina Lima
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, Caldas das Taipas 4806-909, Portugal
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58
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Man Y, Wang P, Guo Y, Xiang L, Yang Y, Qu Y, Gong P, Deng L. Angiogenic and osteogenic potential of platelet-rich plasma and adipose-derived stem cell laden alginate microspheres. Biomaterials 2012; 33:8802-11. [PMID: 22981779 DOI: 10.1016/j.biomaterials.2012.08.054] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/23/2012] [Indexed: 12/25/2022]
Abstract
Improving vascularization of tissue-engineered bone can advance cell performance in vivo and further promote bone regeneration. How to achieve a functional vascular network within the construct is one of the biggest challenges so far. We hypothesized that a mixture of platelet-rich plasma (PRP) and adipose-derived stem cells (ADSCs) could endue the alginate microspheres with osteogenic and angiogenic potential. In vitro and in vivo studies were performed to investigate the potential of the PRP-ADSC-laden microspheres. Two intriguing observations were made in this study. First, we demonstrated that PRP sustained cell viability and meanwhile promoted cell migration from the interior of alginate microspheres to the surface. This phenomenon indicated that encapsulated cells have the potential to directly and actively participate into the regeneration process. Second, in vivo, a blood vessel network was found within the 10% PRP and 15% PRP-ADSC implants, which was associated with a significant increase in mineralization. It suggested that the PRP-ADSC-laden microspheres did enhance the vascularization and mineralization. In summary, this strategy not only provides a micro-invasive therapy for bone regeneration, but also could be incorporated with other matrices for extended application.
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Affiliation(s)
- Yi Man
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China
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59
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Liu J, Zhou H, Weir MD, Xu HHK, Chen Q, Trotman CA. Fast-degradable microbeads encapsulating human umbilical cord stem cells in alginate for muscle tissue engineering. Tissue Eng Part A 2012; 18:2303-14. [PMID: 22697426 DOI: 10.1089/ten.tea.2011.0658] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Human umbilical cord mesenchymal stem cells (hUCMSCs) are inexhaustible and can be obtained without an invasive surgery. To date, there has been no report on seeding hUCMSCs in three-dimensional scaffolds for muscle tissue engineering. The objectives of this study were to (1) investigate hUCMSC seeding in a scaffold for muscle engineering and (2) develop a novel construct consisting of hUCMSC-encapsulating and fast-degradable microbeads inside a hydrogel matrix. The rationale was that the hydrogel matrix would maintain the defect volume, while the microbeads would degrade to release the cells and concomitantly create macropores in the matrix. hUCMSCs were encapsulated in alginate-fibrin microbeads, which were packed in an Arg-Gly-Asp (RGD)-modified alginate matrix (AM). This construct is referred to as hUCMSC-microbead-AM. The control consisted of the usual cell encapsulation in AM without microbeads (referred to as hUCMSC-AM). In the hUCMSC-AM construct, the hUCMSCs showed as round dots with no spreading at 1-14 days. In contrast, cells in the hUCMSC-microbead-AM construct had a healthy spreading and elongated morphology. The microbeads successfully degraded and released the cells at 8 days. Myogenic expressions for hUCMSC-microbead-AM were more than threefold those of hUCMSC-AM (p<0.05). Immunofluorescence for myogenic markers was much stronger for hUCMSC-microbead-AM than hUCMSC-AM. Muscle creatine kinase of hUCMSC-microbead-AM at 14 days was twofold that of hUCMSC-AM (p<0.05). In conclusion, hUCMSC encapsulation in novel fast-degradable microbeads inside a hydrogel matrix was investigated for muscle engineering. Compared to the usual method of seeding cells in a hydrogel matrix, hUCMSC-microbead-AM construct had greatly improved cell viability and myogenic differentiation, and hence, is promising to enhance muscle regeneration.
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Affiliation(s)
- Jun Liu
- Biomaterials and Tissue Engineering Division, Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, Maryland 21201, USA
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60
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Calcium phosphate cement with biofunctional agents and stem cell seeding for dental and craniofacial bone repair. Dent Mater 2012; 28:1059-70. [PMID: 22809583 DOI: 10.1016/j.dental.2012.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 05/14/2012] [Accepted: 06/25/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Calcium phosphate cement (CPC) can be injected to harden in situ and is promising for dental and craniofacial applications. However, human stem cell attachment to CPC is relatively poor. The objectives of this study were to incorporate biofunctional agents into CPC, and to investigate human umbilical cord mesenchymal stem cell (hUCMSC) seeding on biofunctionalized CPC for osteogenic differentiation for the first time. METHODS Five types of biofunctional agents were used: RGD (Arg-Gly-Asp) peptides, human fibronectin (Fn), fibronectin-like engineered polymer protein (FEPP), extracellular matrix Geltrex, and human platelet concentrate. Five biofunctionalized CPC scaffolds were fabricated: CPC-RGD, CPC-Fn, CPC-FEPP, CPC-Geltrex, and CPC-Platelets. The hUCMSC attachment, proliferation, osteogenic differentiation and mineral synthesis were measured. RESULTS The hUCMSCs on biofunctionalized CPCs had much better cell attachment, proliferation, actin fiber expression, osteogenic differentiation and mineral synthesis, compared to the traditional CPC control. Cell proliferation was increased by an order of magnitude via incorporation of biofunctional agents in CPC (p<0.05). Mineral synthesis on biofunctionalized CPCs was 3-5 folds of those of control (p<0.05). hUCMSCs differentiated with high alkaline phosphatase, Runx2, osteocalcin, and collagen I gene expressions. Mechanical properties of biofunctionalized CPC matched the reported strength and elastic modulus of cancellous bone. SIGNIFICANCE A new class of biofunctionalized CPCs was developed, including CPC-RGD, CPC-Fn, CPC-FEPP, CPC-Geltrex, and CPC-Platelets. hUCMSCs on biofunctionalized CPCs had cell density, cell proliferation, actin fiber density, and bone mineralization that were dramatically better than those on traditional CPC. Novel biofunctionalized CPC scaffolds with greatly enhanced human stem cell proliferation and differentiation are promising to facilitate bone regeneration in a wide range of dental, craniofacial and orthopedic applications.
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61
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Karadas O, Yucel D, Kenar H, Torun Kose G, Hasirci V. Collagen scaffolds with in situ-grown calcium phosphate for osteogenic differentiation of Wharton's jelly and menstrual blood stem cells. J Tissue Eng Regen Med 2012; 8:534-45. [PMID: 22744919 DOI: 10.1002/term.1555] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 05/25/2012] [Indexed: 01/22/2023]
Abstract
The aim of this research was to investigate the osteogenic differentiation potential of non-invasively obtained human stem cells on collagen nanocomposite scaffolds with in situ-grown calcium phosphate crystals. The foams had 70% porosity and pore sizes varying in the range 50-200 µm. The elastic modulus and compressive strength of the calcium phosphate containing collagen scaffolds were determined to be 234.5 kPa and 127.1 kPa, respectively, prior to in vitro studies. Mesenchymal stem cells (MSCs) obtained from Wharton's jelly and menstrual blood were seeded on the collagen scaffolds and proliferation and osteogenic differentiation capacities of these cells from two different sources were compared. The cells on the composite scaffold showed the highest alkaline phosphatase activity compared to the controls, cells on tissue culture polystyrene and cells on collagen scaffolds without in situ-formed calcium phosphate. MSCs isolated from both Wharton's jelly and menstrual blood showed a significant level of osteogenic activity, but those from Wharton's jelly performed better. In this study it was shown that collagen nanocomposite scaffolds seeded with cells obtained non-invasively from human tissues could represent a potential construct to be used in bone tissue engineering.
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Affiliation(s)
- Ozge Karadas
- Department of Biotechnology, METU, Ankara, Turkey; METU Centre of Excellence in Biomaterials and Tissue Engineering, BIOMATEN, Ankara, Turkey
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62
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Gamie Z, Tran GT, Vyzas G, Korres N, Heliotis M, Mantalaris A, Tsiridis E. Stem cells combined with bone graft substitutes in skeletal tissue engineering. Expert Opin Biol Ther 2012; 12:713-29. [DOI: 10.1517/14712598.2012.679652] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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63
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Ambrosio L, Guarino V, Sanginario V, Torricelli P, Fini M, Ginebra MP, Planell JA, Giardino R. Injectable calcium-phosphate-based composites for skeletal bone treatments. Biomed Mater 2012; 7:024113. [PMID: 22456083 DOI: 10.1088/1748-6041/7/2/024113] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Alpha-tricalcium-phosphate-based bone cements hydrolyze and set, producing calcium-deficient hydroxyapatite. They can result in an effective solution for bone defect reconstruction due to their biocompatibility, bioactivity and adaptation to shape and bone defect sizes, together with an excellent contact between bone and graft. Moreover, the integration of hydrogel phase based on poly(vinyl alcohol) (PVA) to H-cem-composed of α-tricalcium phosphate (98% wt) and hydroxyapatite (2% wt)-allows improving the mechanical and biological properties of the cement. The aim of this work was to evaluate the influence of the PVA on relevant properties for the final use of the injectable bone substitute, such as setting, hardening, injectability and in vivo behaviour. It was shown that by using PVA it is possible to modulate the setting and hardening properties: large increase in injectability time (1 h) in relation with the plain cement (few minutes) was achieved. Moreover, in vivo tests confirmed the ability of the composite to enhance bone healing in trabecular tissue. Histological results from critical size defects produced in rabbit distal femoral condyles showed after 12 weeks implantation a greater deposition of new tissue on bone-composite interfaces in comparison to bone-cement interfaces. The quality of bone growth was confirmed through histomorphometric and microhardness analysis. Bone formation in the composite implantation sites was significantly higher than in H-cem implants at both times of evaluation.
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Affiliation(s)
- L Ambrosio
- Institute of Composite and Biomedical Materials, National Research Council of Italy, P.le V. Tecchio 80, 80125, Naples, Italy.
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64
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Perez RA, Kim HW, Ginebra MP. Polymeric additives to enhance the functional properties of calcium phosphate cements. J Tissue Eng 2012; 3:2041731412439555. [PMID: 22511991 PMCID: PMC3324842 DOI: 10.1177/2041731412439555] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The vast majority of materials used in bone tissue engineering and regenerative medicine are based on calcium phosphates due to their similarity with the mineral phase of natural bone. Among them, calcium phosphate cements, which are composed of a powder and a liquid that are mixed to obtain a moldable paste, are widely used. These calcium phosphate cement pastes can be injected using minimally invasive surgery and adapt to the shape of the defect, resulting in an entangled network of calcium phosphate crystals. Adding an organic phase to the calcium phosphate cement formulation is a very powerful strategy to enhance some of the properties of these materials. Adding some water-soluble biocompatible polymers in the calcium phosphate cement liquid or powder phase improves physicochemical and mechanical properties, such as injectability, cohesion, and toughness. Moreover, adding specific polymers can enhance the biological response and the resorption rate of the material. The goal of this study is to overview the most relevant advances in this field, focusing on the different types of polymers that have been used to enhance specific calcium phosphate cement properties.
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Affiliation(s)
- Roman A Perez
- Biomaterials, Biomechanics, and Tissue Engineering Group, Department of Materials Science and Metallurgy, Technical University of Catalonia (UPC), Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, South Korea
| | - Hae-Won Kim
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, South Korea
- Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan, South Korea
- Department of Nanobiomedical Science and WCU Research Center, Dankook University, Cheonan, South Korea
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics, and Tissue Engineering Group, Department of Materials Science and Metallurgy, Technical University of Catalonia (UPC), Barcelona, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
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Cheng Y, Lin Y, Xiong X, Wu S, Lu J, Cheng N. The human umbilical cord: A novel substitute for reconstruction of the extrahepatic bile duct. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2012. [DOI: 10.1016/j.jmhi.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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66
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Chen W, Zhou H, Tang M, Weir MD, Bao C, Xu HHK. Gas-foaming calcium phosphate cement scaffold encapsulating human umbilical cord stem cells. Tissue Eng Part A 2011; 18:816-27. [PMID: 22011243 DOI: 10.1089/ten.tea.2011.0267] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tissue engineering approaches are promising to meet the increasing need for bone regeneration. Calcium phosphate cement (CPC) can be injected and self-set to form a scaffold with excellent osteoconductivity. The objectives of this study were to develop a macroporous CPC-chitosan-fiber construct containing alginate-fibrin microbeads encapsulating human umbilical cord mesenchymal stem cells (hUCMSCs) and to investigate hUCMSC release from the degrading microbeads and proliferation inside the porous CPC construct. The hUCMSC-encapsulated microbeads were completely wrapped inside the CPC paste, with the gas-foaming porogen creating macropores in CPC to provide for access to culture media. Increasing the porogen content in CPC significantly increased the cell viability, from 49% of live cells in CPC with 0% porogen to 86% of live cells in CPC with 15% porogen. The alginate-fibrin microbeads started to degrade and release the cells inside CPC at 7 days. The released cells started to proliferate inside the macroporous CPC construct. The live cell number inside CPC increased from 270 cells/mm(2) at 1 day to 350 cells/mm(2) at 21 days. The pore volume fraction of CPC increased from 46.8% to 78.4% using the gas-foaming method, with macropore sizes of approximately 100 to 400 μm. The strength of the CPC-chitosan-fiber scaffold at 15% porogen was 3.8 MPa, which approximated the reported 3.5 MPa for cancellous bone. In conclusion, a novel gas-foaming macroporous CPC construct containing degradable alginate-fibrin microbeads was developed that encapsulated hUCMSCs. The cells had good viability while wrapped inside the porous CPC construct. The degradable microbeads in CPC quickly released the cells, which proliferated over time inside the porous CPC. Self-setting, strong CPC with alginate-fibrin microbeads for stem cell delivery is promising for bone tissue engineering applications.
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Affiliation(s)
- Wenchuan Chen
- Biomaterials and Tissue Engineering Division, Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, Maryland 21201, USA
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67
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Canal C, Ginebra M. Fibre-reinforced calcium phosphate cements: A review. J Mech Behav Biomed Mater 2011; 4:1658-71. [DOI: 10.1016/j.jmbbm.2011.06.023] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 06/18/2011] [Accepted: 06/23/2011] [Indexed: 12/01/2022]
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68
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Ding SJ, Shie MY, Wei CK. In vitro physicochemical properties, osteogenic activity, and immunocompatibility of calcium silicate-gelatin bone grafts for load-bearing applications. ACS APPLIED MATERIALS & INTERFACES 2011; 3:4142-4153. [PMID: 21942767 DOI: 10.1021/am201017v] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The use of a composite made of natural polymer gelatin and bioactive calcium silicate resembling the morphology and properties of natural bone may provide a solution to the problem of ceramic brittleness for load-bearing applications. The in vitro bioactivity, degradability, osteogenic activity, and immunocompatibility of three types of calcium silicate-gelatin composite bone grafts were characterized. The osteogenic activity and immunocompatibility were evaluated by incubating the bone grafts with human dental pulp cells. After soaking in a simulated body fluid (SBF) for 1 day, all materials were covered with clusters of "bone-like" apatite spherulites. The control material without gelatin exhibited an insignificant change in strength, degradability, and porosity and a small weight loss of 6% after 180 days of soaking in the SBF solution. In contrast, the soaking time imposed in this study did have a statistically significant effect on compressive strength, porosity, and weight loss of the gelatin-containing composites. After 180 days of soaking, the composite with 10 wt % gelatin lost 47% and 10% in compressive strength and weight, respectively, with a porosity of 23%. However, the presence of gelatin promoted greater cell attachment and proliferation on the composite bone grafts. Pulp cells on the calcium silicate-gelatin bone grafts expressed higher levels of osteocalcin, osteopontin, and bone sialoprotein. The inhibition of inducible nitric oxide synthase and interleukin-1 expression and the activation of interleukin-10 were increased with increasing gelatin content. Overall, these findings provide evidence that composite bone grafts containing 10 wt % gelatin with a high initial strength were bioactive, nontoxic, and osteogenic and may be able to promote bone healing for load-bearing applications.
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Affiliation(s)
- Shinn-Jyh Ding
- Institute of Oral Biology and Biomaterials Science, Chung Shan Medical University, Taichung City 402, Taiwan.
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69
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Zhou H, Xu HHK. The fast release of stem cells from alginate-fibrin microbeads in injectable scaffolds for bone tissue engineering. Biomaterials 2011; 32:7503-13. [PMID: 21757229 DOI: 10.1016/j.biomaterials.2011.06.045] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/19/2011] [Indexed: 10/17/2022]
Abstract
Stem cell-encapsulating hydrogel microbeads of several hundred microns in size suitable for injection, that could quickly degrade to release the cells, are currently unavailable. The objectives of this study were to: (1) develop oxidized alginate-fibrin microbeads encapsulating human umbilical cord mesenchymal stem cells (hUCMSCs); (2) investigate microbead degradation, cell release, and osteogenic differentiation of the released cells for the first time. Three types of microbeads were fabricated to encapsulate hUCMSCs: (1) Alginate microbeads; (2) oxidized alginate microbeads; (3) oxidized alginate-fibrin microbeads. Microbeads with sizes of about 100-500 μm were fabricated with 1 × 10(6) hUCMSCs/mL of alginate. For the alginate group, there was little microbead degradation, with very few cells released at 21 d. For oxidized alginate, the microbeads started to slightly degrade at 14 d. In contrast, the oxidized alginate-fibrin microbeads started to degrade at 4 d and released the cells. At 7 d, the number of released cells greatly increased and showed a healthy polygonal morphology. At 21 d, the oxidized alginate-fibrin group had a live cell density that was 4-fold that of the oxidized alginate group, and 15-fold that of the alginate group. The released cells had osteodifferentiation, exhibiting highly elevated bone marker gene expressions of ALP, OC, collagen I, and Runx2. Alizarin staining confirmed the synthesis of bone minerals by hUCMSCs, with the mineral concentration at 21 d being 10-fold that at 7 d. In conclusion, fast-degradable alginate-fibrin microbeads with hUCMSC encapsulation were developed that could start to degrade and release the cells at 4 d. The released hUCMSCs had excellent proliferation, osteodifferentiation, and bone mineral synthesis. The alginate-fibrin microbeads are promising to deliver stem cells inside injectable scaffolds to promote tissue regeneration.
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Affiliation(s)
- Hongzhi Zhou
- Biomaterials & Tissue Engineering Division, Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, MD 21201, USA
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70
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Zhou H, Weir MD, Xu HHK. Effect of cell seeding density on proliferation and osteodifferentiation of umbilical cord stem cells on calcium phosphate cement-fiber scaffold. Tissue Eng Part A 2011; 17:2603-13. [PMID: 21745111 DOI: 10.1089/ten.tea.2011.0048] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Calcium phosphate cement (CPC) can fill complex-shaped bone defects and set in situ to form a scaffold with intimate adaptation to neighboring bone. The objectives of this study were to determine (1) the effects of fiber length and alginate microbead volume fraction on CPC mechanical properties, and (2) the effect of cell seeding density of human umbilical cord mesenchymal stem cells (hUCMSCs) on their proliferation and osteodifferentiation on CPC. Adding microbeads to CPC degraded the strength. However, increasing the fiber length improved the mechanical properties. Strength and elastic modulus of CPC-microbead-fiber scaffold matched those reported for cancellous bone. When the cell seeding density was increased from 50k to 300k, the cell viability, osteodifferentiation, and bone mineral synthesis also increased. When the seeding density was further increased to 500k, the osteodifferentiation and mineralization decreased. Hence, the 300k seeding density was optimal for CPC-microbead-fiber under the specified conditions. At day 8, alkaline phosphatase (ALP) gene expression of hUCMSCs with seeding density of 300k was threefold the ALP at 150k, and 200-fold the ALP at 50k. At day 14, osteocalcin and runt-related transcription factor 2 with cell seeding density of 300k was fourfold those at 50k. At day 14, mineralization by hUCMSCs at seeding density of 300k was 5-fold the mineralization at 150k, and 25-fold that at 50k. In conclusion, the effect of stem cell seeding density on CPC was determined for the first time. At low cell densities, cell viability and mineralization increased with seeding density. However, a higher seeding density was not necessarily better, and an optimal seeding density on CPC resulted in the best osteodifferentiation and mineralization. The stem cell-seeded CPC-fiber scaffold with excellent osteodifferentiation and mineralization is promising for orthopedic and craniofacial applications.
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Affiliation(s)
- Hongzhi Zhou
- Department of Endodontics, Prosthodontics, and Operative Dentistry, Biomaterials and Tissue Engineering Division, University of Maryland Dental School, Baltimore, Maryland 21201, USA
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71
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Tang M, Weir MD, Xu HHK. Mannitol-containing macroporous calcium phosphate cement encapsulating human umbilical cord stem cells. J Tissue Eng Regen Med 2011; 6:214-24. [PMID: 21442765 DOI: 10.1002/term.419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 02/17/2011] [Indexed: 11/07/2022]
Abstract
Stem cell-based tissue engineering offers immense promise for bone regeneration. The objective of this study was to develop a self-setting, mannitol-containing calcium phosphate cement (CPC) encapsulating human umbilical cord mesenchymal stem cells (hUCMSCs) for bone tissue engineering. hUCMSCs could be an inexhaustible and low-cost alternative to the gold-standard bone marrow MSCs, which require an invasive procedure to harvest. hUCMSCs were encapsulated in alginate beads and mixed into the CPC paste. Water-soluble mannitol porogen was incorporated into CPC to create macropores. The porosity was increased from 49% for the hUCMSC-encapsulating CPC to 64% after adding mannitol and absorbable-fibres (p < 0.05). Flexural strength of the construct was increased from 0.3 MPa to 2.0 MPa via fibres. Live cell percentage was > 80% for all constructs. The ALP and OC gene expressions were low at 1 day and greatly increased at 14 days. The constructs that contained mannitol had significantly higher ALP and OC expressions than that without mannitol. ALP activity of hUCMSCs inside CPC with mannitol and fibre was significantly higher than that without mannitol. At 14 days, mineralization by the encapsulated hUCMSCs was eight-fold higher than that at 1 day. In conclusion, a novel mannitol-containing porous CPC-hUCMSC construct was developed for bone tissue engineering. Its advantages include cell delivery inside a load-bearing CPC that has injectable and in situ setting capabilities. hUCMSCs inside CPC had good viability and successfully osteodifferentiated. The self-setting and strong hUCMSC-encapsulating CPC scaffold is promising for bone tissue engineering in a wide range of orthopaedic and craniofacial applications.
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Affiliation(s)
- Minghui Tang
- Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, MD 21201, USA
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72
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Roberts SJ, Geris L, Kerckhofs G, Desmet E, Schrooten J, Luyten FP. The combined bone forming capacity of human periosteal derived cells and calcium phosphates. Biomaterials 2011; 32:4393-405. [PMID: 21421268 DOI: 10.1016/j.biomaterials.2011.02.047] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 02/12/2011] [Indexed: 12/12/2022]
Abstract
Current knowledge suggests that the periosteum, a fibrous tissue which covers the surface of all bones, contains a population of progenitor cells which mediate the repair of bone defects. In an effort to optimise the utilisation of this source of cells for bone engineering, herein we describe the rational selection of calcium phosphate (CaP) containing materials, based on biomaterial properties, and evaluation of their combined bone forming capacity. Five different commercially available orthopaedic 3D matrices composed of CaP particles in an open collagen network (NuOss™, CopiOs™, Bio-Oss(®), Collagraft™ and Vitoss(®)) were evaluated in vitro and in vivo with human periosteal derived cells (hPDCs). It was found that the cell-material combinations behaved quite differently in vivo, despite apparent in vitro similarities in gene expression profiles. Bone formation was highest within the NuOss™/hPDC implant at 13.03%, which also contained the highest incidence of bone marrow formation. The bone formed in this implant was chimeric with approximately 65% originating from implanted cells. Upon analysis of human specific gene expression, although it was found that predominantly osteogenic differentiation was observed within NuOss™/hPDC implants, a lesser induction of chondrogenic genes was also observed. The formation of a cartilage intermediate was confirmed by histology. Additionally the NuOss™/hPDC implant integrated into the mouse environment with apparent active scaffold resorption. This study demonstrates the importance of matching a cell support/biological matrix with a cell type and subsequently has outlined parameters which can be used for the rational selection of biomaterials for bone engineering.
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Affiliation(s)
- Scott J Roberts
- Laboratory for Skeletal Development and Joint Disorders, Katholieke Universiteit Leuven, Belgium
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73
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Human Umbilical Cord-Derived Schwann-Like Cell Transplantation Combined with Neurotrophin-3 Administration in Dyskinesia of Rats with Spinal Cord Injury. Neurochem Res 2011; 36:783-92. [DOI: 10.1007/s11064-011-0402-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 10/25/2022]
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74
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Zhao L, Tang M, Weir MD, Detamore MS, Xu HHK. Osteogenic media and rhBMP-2-induced differentiation of umbilical cord mesenchymal stem cells encapsulated in alginate microbeads and integrated in an injectable calcium phosphate-chitosan fibrous scaffold. Tissue Eng Part A 2011; 17:969-79. [PMID: 21091340 DOI: 10.1089/ten.tea.2010.0521] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The need for bone tissue engineering has increased as the world population ages. The objectives of this study were to (1) develop a novel human umbilical cord mesenchymal stem cell (hUCMSC)-encapsulating, fiber-reinforced injectable calcium phosphate cement (CPCF) scaffold, and (2) investigate the effects of osteogenic media delivery, preosteodifferentiation, and bone morphogenetic protein-2 (BMP-2) delivery on hUCMSC osteodifferentiation inside CPCF for the first time. CPCF was developed using calcium phosphate powders, chitosan, and absorbable fibers. Four types of hUCMSC-encapsulating constructs were fabricated: control media in alginate hydrogel microbeads in CPCF; osteogenic media in microbeads; preosteodifferentiation; and recombinant human BMP-2 (rhBMP-2) in microbeads. The hUCMSCs inside CPCF maintained good viability, successfully differentiated into the osteogenic lineage, and synthesized bone minerals. The preosteodifferentiation method yielded high gene expressions of alkaline phosphatase, osteocalcin, collagen, and osterix, as well as alkaline phosphatase protein synthesis. The mineralization for the preosteodifferentiation constructs exceeded those of the rhBMP-2 group at 1-7 days, and was slightly lower than the rhBMP-2 group at 21 days. Mineralization of the rhBMP-2 group was 12-fold that of the control constructs at 21 days. In conclusion, although the BMP-2 delivery promoted osteodifferentiation, the preosteodifferentiation method and the ostegenic media method with hUCMSCs in CPCF were also promising for bone regeneration. hUCMSCs may be an effective alternative to the gold-standard bone marrow MSCs, which require an invasive procedure to harvest. The novel injectable stem cell-CPCF construct may be useful in minimally invasive and other orthopedic surgeries.
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Affiliation(s)
- Liang Zhao
- Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, Maryland 21201, USA
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75
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Xu HHK, Zhao L, Weir MD. Stem cell-calcium phosphate constructs for bone engineering. J Dent Res 2010; 89:1482-8. [PMID: 20929721 DOI: 10.1177/0022034510384623] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While human bone-marrow-derived mesenchymal stem cells (hBMSCs) have been investigated, human umbilical cord mesenchymal stem cells (hUCMSCs) are a relatively new cell source. Little has been reported on hUCMSC encapsulation in scaffolds for bone tissue engineering. The objective of this study was to encapsulate hBMSCs and hUCMSCs in calcium phosphate cement (CPC) scaffolds for dental, craniofacial, and orthopedic applications. Stem-cell-encapsulating CPC construct with chitosan and fiber reinforcement reached the strength of cancellous bone, which was much stronger than previous injectable carriers for cell delivery. hUCMSCs and hBMSCs inside the constructs showed excellent viability and osteo-differentiation. The encapsulated hUCMSCs synthesized nearly three-fold more bone minerals than the hBMSCs in vitro. Hence, stem-cell-encapsulating CPC-chitosan-fiber construct may be promising for dental and orthopedic applications. This study indicated that the hUCMSCs were a potent alternative to the gold-standard hBMSCs, which may have a broad impact on regenerative medicine and dental tissue engineering.
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Affiliation(s)
- H H K Xu
- Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, 650 West Baltimore Street, Baltimore, MD 21201, USA.
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76
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Zhao L, Weir MD, Xu HHK. An injectable calcium phosphate-alginate hydrogel-umbilical cord mesenchymal stem cell paste for bone tissue engineering. Biomaterials 2010; 31:6502-10. [PMID: 20570346 DOI: 10.1016/j.biomaterials.2010.05.017] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 05/13/2010] [Indexed: 01/07/2023]
Abstract
The need for bone repair has increased as the population ages. Stem cell-scaffold approaches hold immense promise for bone tissue engineering. However, currently, preformed scaffolds for cell delivery have drawbacks including the difficulty to seed cells deep into the scaffold, and inability for injection in minimally-invasive surgeries. Current injectable polymeric carriers and hydrogels are too weak for load-bearing orthopedic applications. The objective of this study was to develop an injectable and mechanically-strong stem cell construct for bone tissue engineering. Calcium phosphate cement (CPC) paste was combined with hydrogel microbeads encapsulating human umbilical cord mesenchymal stem cells (hUCMSCs). The hUCMSC-encapsulating composite paste was fully injectable under small injection forces. Cell viability after injection matched that in hydrogel without CPC and without injection. Mechanical properties of the construct matched the reported values of cancellous bone, and were much higher than previous injectable polymeric and hydrogel carriers. hUCMSCs in the injectable constructs osteodifferentiated, yielding high alkaline phosphatase, osteocalcin, collagen type I, and osterix gene expressions at 7 d, which were 50-70 fold higher than those at 1 d. Mineralization by the hUCMSCs at 14 d was 100-fold that at 1 d. In conclusion, a fully injectable, mechanically-strong, stem cell-CPC scaffold construct was developed. The encapsulated hUCMSCs remained viable, osteodifferentiated, and synthesized bone minerals. The new injectable stem cell construct with load-bearing capability may enhance bone regeneration in minimally-invasive and other orthopedic surgeries.
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Affiliation(s)
- Liang Zhao
- Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland Dental School, Baltimore, MD 21201, USA
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