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Yao S, Yang Y, Li C, Yang K, Song X, Li C, Cao Z, Zhao H, Yu X, Wang X, Wang LN. Axon-like aligned conductive CNT/GelMA hydrogel fibers combined with electrical stimulation for spinal cord injury recovery. Bioact Mater 2024; 35:534-548. [PMID: 38414842 PMCID: PMC10897856 DOI: 10.1016/j.bioactmat.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/18/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
Rehabilitation and regenerative medicine are two promising approaches for spinal cord injury (SCI) recovery, but their combination has been limited. Conductive biomaterials could bridge regenerative scaffolds with electrical stimulation by inducing axon regeneration and supporting physiological electrical signal transmission. Here, we developed aligned conductive hydrogel fibers by incorporating carbon nanotubes (CNTs) into methacrylate acylated gelatin (GelMA) hydrogel via rotating liquid bath electrospinning. The electrospun CNT/GelMA hydrogel fibers mimicked the micro-scale aligned structure, conductivity, and soft mechanical properties of neural axons. For in vitro studies, CNT/GelMA hydrogel fibers supported PC12 cell proliferation and aligned adhesion, which was enhanced by electrical stimulation (ES). Similarly, the combination of aligned CNT/GelMA hydrogel fibers and ES promoted neuronal differentiation and axon-like neurite sprouting in neural stem cells (NSCs). Furthermore, CNT/GelMA hydrogel fibers were transplanted into a T9 transection rat spinal cord injury model for in vivo studies. The results showed that the incorporating CNTs could remain at the injury site with the GelMA fibers biodegraded and improve the conductivity of regenerative tissue. The aligned structure of the hydrogel could induce the neural fibers regeneration, and the ES enhanced the remyelination and axonal regeneration. Behavioral assessments and electrophysiological results suggest that the combination of aligned CNT/GelMA hydrogel fibers and ES could significantly restore motor function in rats. This study demonstrates that conductive aligned CNT/GelMA hydrogel fibers can not only induce neural regeneration as a scaffold but also support ESto promote spinal cord injury recovery. The conductive hydrogel fibers enable merging regenerative medicine and rehabilitation, showing great potential for satisfactory locomotor recovery after SCI.
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Affiliation(s)
- Shenglian Yao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yongdong Yang
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Chenyu Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Kaitan Yang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Xin Song
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Chuanhong Li
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Zheng Cao
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - He Zhao
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Xing Yu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Xiumei Wang
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - Lu-Ning Wang
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
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Liu D, Tian H, Li H, Nie J, Han Z, Tang G, Gao P, Cheng H, Dai X. Radiotherapy Resistance of 3D Bioprinted Glioma via ITGA2/p-AKT Signaling Pathway. Adv Healthc Mater 2024; 13:e2303394. [PMID: 38288911 DOI: 10.1002/adhm.202303394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/19/2024] [Indexed: 02/13/2024]
Abstract
Due to the inherent radiation tolerance, patients who suffered from glioma frequently encounter tumor recurrence and malignant progression within the radiation target area, ultimately succumbing to treatment ineffectiveness. The precise mechanism underlying radiation tolerance remains elusive due to the dearth of in vitro models and the limitations associated with animal models. Therefore, a bioprinted glioma model is engineered, characterized the phenotypic traits in vitro, and the radiation tolerance compared to 2D ones when subjected to X-ray radiation is assessed. By comparing the differential gene expression profiles between the 2D and 3D glioma model, identify functional genes, and analyze distinctions in gene expression patterns. Results showed that 3D glioma models exhibited substantial alterations in the expression of genes associated with the stromal microenvironment, notably a significant increase in the radiation tolerance gene ITGA2 (integrin subunit A2). In 3D glioma models, the knockdown of ITGA2 via shRNA resulted in reduced radiation tolerance in glioma cells and concomitant inhibition of the p-AKT pathway. Overall, 3D bioprinted glioma model faithfully recapitulates the in vivo tumor microenvironment (TME) and exhibits enhanced resistance to radiation, mediated through the ITGA2/p-AKT pathway. This model represents a superior in vitro platform for investigating glioma radiotherapy tolerance.
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Affiliation(s)
- Dongdong Liu
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Haotian Tian
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Huaixu Li
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Jianyu Nie
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Zhenyu Han
- Department of Medical Imaging Technology, the First Clinical College of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Guozhang Tang
- Department of Clinical Medicine, the Second Clinical College of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Peng Gao
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Hongwei Cheng
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
| | - Xingliang Dai
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230001, China
- Department of Research & Development, East China Institute of Digital Medical Engineering, Shangrao, Jiangxi, 334000, China
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Yang J, Wang H, Huang W, Peng K, Shi R, Tian W, Lin L, Yuan J, Yao W, Ma X, Chen Y. A natural polymer-based hydrogel with shape controllability and high toughness and its application to efficient osteochondral regeneration. MATERIALS HORIZONS 2023; 10:3797-3806. [PMID: 37416948 DOI: 10.1039/d3mh00544e] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Hydrogels prepared from sustainable natural polymers have broad prospects in the biological field. However, their poor mechanical properties and challenges in achieving shape control have limited their application. Herein, a novel preforming dual-effect post-enhancing method is proposed to address these issues. The method utilizes the hydrogen bonding of agar to obtain a shape-controllable preformed hydrogel at low polymer concentrations using casting, injection, or 3D printing techniques. Subsequently, the preformed hydrogel was subjected to a permeation process to form a post-enhanced multi-network (PEMN) hydrogel with hierarchical chain entanglements to ensure its high toughness, which exhibits tensile and compressive strengths of up to 0.51 MPa and 1.26 MPa with solely physically crosslinking networks. The excellent biocompatibility of the PEMN hydrogel prepared without the need for additional initiator agents under mild conditions was confirmed by both in vitro and in vivo experiments. Furthermore, the adaptability for irregular defects, suitable toughness, adhesive properties, and degradability of PEMN hydrogels are beneficial to provide mechanical support, induce endogenous cell mineralization, and accelerate the regeneration of cartilage and subchondral bone with more than 40% bone regeneration in 12 weeks. Our work has provided a novel solution to simultaneously achieve shape controllability and high toughness based on natural polymers among the already well-explored strategies for osteochondral regeneration.
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Affiliation(s)
- Jueying Yang
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Hui Wang
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Weiting Huang
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Kelin Peng
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
- Yangtze Delta Region Academy of Beijing Institute of Technology, Jiaxing 314019, China
| | - Rui Shi
- Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Tian
- Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Lizhi Lin
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing 10081, China
| | - Jingjing Yuan
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Weishang Yao
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Xilan Ma
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
| | - Yu Chen
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing 100081, China.
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing 10081, China
- Sports & Medicine Integration Research Center (SMIRC), Capital University of Physical Education and Sports, Beijing 100191, China
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Asim S, Tabish TA, Liaqat U, Ozbolat IT, Rizwan M. Advances in Gelatin Bioinks to Optimize Bioprinted Cell Functions. Adv Healthc Mater 2023; 12:e2203148. [PMID: 36802199 PMCID: PMC10330013 DOI: 10.1002/adhm.202203148] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/31/2023] [Indexed: 02/21/2023]
Abstract
Gelatin is a widely utilized bioprinting biomaterial due to its cell-adhesive and enzymatically cleavable properties, which improve cell adhesion and growth. Gelatin is often covalently cross-linked to stabilize bioprinted structures, yet the covalently cross-linked matrix is unable to recapitulate the dynamic microenvironment of the natural extracellular matrix (ECM), thereby limiting the functions of bioprinted cells. To some extent, a double network bioink can provide a more ECM-mimetic, bioprinted niche for cell growth. More recently, gelatin matrices are being designed using reversible cross-linking methods that can emulate the dynamic mechanical properties of the ECM. This review analyzes the progress in developing gelatin bioink formulations for 3D cell culture, and critically analyzes the bioprinting and cross-linking techniques, with a focus on strategies to optimize the functions of bioprinted cells. This review discusses new cross-linking chemistries that recapitulate the viscoelastic, stress-relaxing microenvironment of the ECM, and enable advanced cell functions, yet are less explored in engineering the gelatin bioink. Finally, this work presents the perspective on the areas of future research and argues that the next generation of gelatin bioinks should be designed by considering cell-matrix interactions, and bioprinted constructs should be validated against currently established 3D cell culture standards to achieve improved therapeutic outcomes.
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Affiliation(s)
- Saad Asim
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931 USA
| | - Tanveer A. Tabish
- Cardiovascular Division, Radcliff Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Usman Liaqat
- Department of Materials Engineering, School of Chemical and Materials Engineering (SCME), National University of Sciences & Technology (NUST), Pakistan
| | - Ibrahim T. Ozbolat
- Engineering Science and Mechanics, Penn State, University Park, PA 16802, USA
- Department of Biomedical Engineering, Penn State, University Park, PA 16802, USA
- Department of Neurosurgery, Penn State, Hershey, PA 16802, USA
- Department of Medical Oncology, Cukurova University, Adana 01330, Turkey
| | - Muhammad Rizwan
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931 USA
- Health Research Institute, Michigan Technological University, Houghton, MI, 49931 USA
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Barrejón M, Zummo F, Mikhalchan A, Vilatela JJ, Fontanini M, Scaini D, Ballerini L, Prato M. TEGylated Double-Walled Carbon Nanotubes as Platforms to Engineer Neuronal Networks. ACS APPLIED MATERIALS & INTERFACES 2023; 15:77-90. [PMID: 36270018 PMCID: PMC9837783 DOI: 10.1021/acsami.2c16808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 05/27/2023]
Abstract
In the past two decades, important results have been obtained on the application of carbon nanotubes (CNTs) as components of smart interfaces promoting neuronal growth and differentiation. Different forms of CNTs have been employed as scaffolds, including raw CNTs and functionalized CNTs, characterized by a different number of walls, mainly single-walled CNTs (SWCNTs) or multiwalled CNTs (MWCNTs). However, double-walled carbon nanotubes (DWCNTs), which present interesting electronic and transport properties, have barely been studied in the field. Apart from the electrical conductivity, the morphology, shape, porosity, and corresponding mechanical properties of the scaffold material are important parameters when dealing with neuronal cells. Thus, the presence of open porous and interconnected networks is essential for cell growth and differentiation. Here, we present an easy methodology to prepare porous self-standing and electrically conductive DWCNT-based scaffolds and study the growth of neuro/glial networks and their synaptic activity. A cross-linking approach with triethylene glycol (TEG) derivatives is applied to improve the tensile performance of the scaffolds while neuronal growth and differentiation are promoted. By testing different DWCNT-based constructs, we confirm that the manufactured structures guarantee a biocompatible scaffold, while favoring the design of artificial networks with high complexity.
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Affiliation(s)
- Myriam Barrejón
- Department
of Chemical and Pharmaceutical Sciences, INSTM, UdR Trieste, University of Trieste, Via L. Giorgieri 1, Trieste34127, Italy
- Neural
Repair and Biomaterials Laboratory, Hospital
Nacional de Parapléjicos (SESCAM), Finca la Peraleda s/n, Toledo45071, Spain
| | - Francesca Zummo
- International
School for Advanced Studies (SISSA/ISAS), Trieste34136, Italy
| | | | | | - Mario Fontanini
- International
School for Advanced Studies (SISSA/ISAS), Trieste34136, Italy
| | - Denis Scaini
- International
School for Advanced Studies (SISSA/ISAS), Trieste34136, Italy
- Basque
Foundation for Science, Ikerbasque, Bilbao48013, Spain
- University
of Basque Country, Faculty of Pharmacy, Paseo de la Universidad 7, Vitoria-Gasteiz01006, Spain
| | - Laura Ballerini
- International
School for Advanced Studies (SISSA/ISAS), Trieste34136, Italy
| | - Maurizio Prato
- Department
of Chemical and Pharmaceutical Sciences, INSTM, UdR Trieste, University of Trieste, Via L. Giorgieri 1, Trieste34127, Italy
- Basque
Foundation for Science, Ikerbasque, Bilbao48013, Spain
- Center for
Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramon 194, Donostia
San Sebastián20014, Spain
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6
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Nadine S, Chung A, Diltemiz SE, Yasuda B, Lee C, Hosseini V, Karamikamkar S, de Barros NR, Mandal K, Advani S, Zamanian BB, Mecwan M, Zhu Y, Mofidfar M, Zare MR, Mano J, Dokmeci MR, Alambeigi F, Ahadian S. Advances in microfabrication technologies in tissue engineering and regenerative medicine. Artif Organs 2022; 46:E211-E243. [PMID: 35349178 DOI: 10.1111/aor.14232] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tissue engineering provides various strategies to fabricate an appropriate microenvironment to support the repair and regeneration of lost or damaged tissues. In this matter, several technologies have been implemented to construct close-to-native three-dimensional structures at numerous physiological scales, which are essential to confer the functional characteristics of living tissues. METHODS In this article, we review a variety of microfabrication technologies that are currently utilized for several tissue engineering applications, such as soft lithography, microneedles, templated and self-assembly of microstructures, microfluidics, fiber spinning, and bioprinting. RESULTS These technologies have considerably helped us to precisely manipulate cells or cellular constructs for the fabrication of biomimetic tissues and organs. Although currently available tissues still lack some crucial functionalities, including vascular networks, innervation, and lymphatic system, microfabrication strategies are being proposed to overcome these issues. Moreover, the microfabrication techniques that have progressed to the preclinical stage are also discussed. CONCLUSIONS This article aims to highlight the advantages and drawbacks of each technique and areas of further research for a more comprehensive and evolving understanding of microfabrication techniques in terms of tissue engineering and regenerative medicine applications.
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Affiliation(s)
- Sara Nadine
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA.,CICECO - Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Ada Chung
- Department of Psychology, University of California-Los Angeles, Los Angeles, California, USA
| | | | - Brooke Yasuda
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA.,Department of Psychology, University of California-Los Angeles, Los Angeles, California, USA
| | - Charles Lee
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA.,Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA.,Station 1, Lawrence, Massachusetts, USA
| | - Vahid Hosseini
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
| | - Solmaz Karamikamkar
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
| | | | - Kalpana Mandal
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
| | - Shailesh Advani
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
| | | | - Marvin Mecwan
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
| | - Yangzhi Zhu
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
| | - Mohammad Mofidfar
- Department of Chemistry, Stanford University, Palo Alto, California, USA
| | | | - João Mano
- CICECO - Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Mehmet Remzi Dokmeci
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
| | - Farshid Alambeigi
- Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, Texas, USA
| | - Samad Ahadian
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, California, USA
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Song Y, Chen W, Gai K, Lin F, Sun W. Culture models produced via biomanufacturing for neural tissue-like constructs based on primary neural and neural stem cells. BRAIN SCIENCE ADVANCES 2021. [DOI: 10.26599/bsa.2021.9050021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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8
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Sudhadevi T, Vijayakumar HS, Hariharan EV, Sandhyamani S, Krishnan LK. Optimizing fibrin hydrogel toward effective neural progenitor cell delivery in spinal cord injury. Biomed Mater 2021; 17. [PMID: 34736245 DOI: 10.1088/1748-605x/ac3680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/04/2021] [Indexed: 11/12/2022]
Abstract
Transplantation of neural progenitor cell (NPC) possessing the potential to differentiate into neurons may guard against spinal cord injury (SCI)- associated neuronal trauma. We propose that autologous-like NPC may reduce post-transplant immune response. The study used the rat SCI model to prove this concept. For isolation and expansion of rat NPC for cell-based SCI therapy, thein vitroprotocol standardized with human NPC seemed suitable. The primary aim of this study is to select a cell/neural tissue-compatible biomaterial for improving NPC survivalin vivo. The composition of the fibrin hydrogel is adjusted to obtain degradable, porous, and robust fibrin strands for supporting neural cell attachment, migration, and tissue regeneration. This study employed NPC culture to evaluate the cytocompatibility and suitability of the hydrogel, composed by adding graded concentrations of thrombin to a fixed fibrinogen concentration. The microstructure evaluation by scanning electron microscope guided the selection of a suitable composition for delivering the embedded cells. On adding more thrombin, fibrinogen clotted quickly but reduced porosity, pore size, and fiber strand thickness. The high activity of thrombin also affected NPC morphology and thein vitrocell survival. The selected hydrogel carried viable NPC and retained them at the injury site post-transplantation. The fibrin hydrogel played a protective role throughout the transfer process by providing cell attachment sites and survival signals. The fibrin and NPC together regulated the immune response at the SCI site reducing ED1+ve/ED2+vemacrophages in the early period of 8-16 d after injury. Migration ofβ-III tubulin+veneural-like cells into the fibrin-injected control SCI is evident. The continuous use of a non-neurotoxic fibrin matrix could be a convenient strategy forin vitroNPC preparation, minimally invasive cell delivery, and better transplantation outcome.
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Affiliation(s)
- Tara Sudhadevi
- Retd. Senior Grade Scientist G, Division of Thrombosis Research, Department of Applied Biology, Biomedical Technology Wing, Thrombosis Research Unit, SCTIMST, Trivandrum 695 012, India
| | - Harikrishnan S Vijayakumar
- Laboratory for Animal Science, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum 695012 Kerala, India
| | - Easwer V Hariharan
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum 695012 Kerala, India
| | - Samavedam Sandhyamani
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum 695012 Kerala, India
| | - Lissy K Krishnan
- Retd. Senior Grade Scientist G, Division of Thrombosis Research, Department of Applied Biology, Biomedical Technology Wing, Thrombosis Research Unit, SCTIMST, Trivandrum 695 012, India
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