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Jia G, Jia X, Yang J, Shi T, Qiang M, Chen Y. Pioglitazone Antagonized the Effects of Advanced Glycation End Products on Achilles Tendon Healing and Improved the Recovery of Tendon Biomechanical Properties. Cell Mol Bioeng 2024; 17:219-228. [PMID: 39050514 PMCID: PMC11263443 DOI: 10.1007/s12195-024-00800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/26/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Advanced glycation end products (AGEs) often accumulate in the Achilles tendon during the course of diabetes. This study aims to determine the impact of AGEs on tendon repair and explore the role of pioglitazone in mitigating this impact. Methods Forty-eight male 8 week-old Sprague Dawley rats were selected in this study. After transection of Achilles tendon, the rats were randomly divided into four groups. The Achilles tendons of rats were injected with 1000 mmol/L D-ribose to elevate the content of AGEs within the tendons in two groups, the remaining two groups received injections of phosphate buffered saline (PBS) solution. Subsequently, the first two groups were respectively received oral administration of pioglitazone (20 mg/kg/day) and PBS. The remaining two groups were given the same treatment. The expression of the collagen-I, TNF-α, IL-6 of the repaired tendon were detected. The macroscopic, pathologic and biomechanical aspects of tendon healing were also evaluated. Results AGEs accumulation in tendon during the healing process increases the expression of inflammatory factors such as TNF-α and IL-6, leading to insufficient synthesis of collagen-I and delayed recovery of the tendon's tensile strength. Pioglitazone significantly attenuated the damage caused by AGEs to the tendon healing process, effectively improving the recovery of tendon tensile strength. Pioglitazone could not inhibit the generation of AGEs in the tissue and also had no impact on the normal healing process of the tendon. Conclusions Pioglitazone could prevent the deleterious impact of AGEs on the Achilles tendon healing and improve the biomechanical properties of the tendon.
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Affiliation(s)
- Gengxin Jia
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China
| | - Xiaoyang Jia
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China
| | - Juan Yang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, 730000 Gansu China
| | - Tianhao Shi
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China
| | - Minfei Qiang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China
| | - Yanxi Chen
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China
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Zhang L, Zhang Q, Cui L, Wu L, Gao S. Kartogenin Combined Platelet-Rich Plasma (PRP) Promoted Tendon-Bone Healing for Anterior Cruciate Ligament (ACL) Reconstruction by Suppressing Inflammatory Response Via targeting AKT/PI3K/NF-κB. Appl Biochem Biotechnol 2023; 195:1284-1296. [PMID: 36346560 DOI: 10.1007/s12010-022-04178-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/10/2022]
Abstract
Anterior cruciate ligament (ACL) rupture is the most common sports injuries and PRP has the potential to be a kartogenin (KGN) carrier to promote collagen fibril organization and cartilage regenerative in the tendon-bone interface. This paper aimed to investigate co-injection of KGN-PRP into the bone tunnels of ACL reconstructions which could enhance tendon-bone healing graft osteointegration effectively. HPLC was used to measured release rate of KGN from KGN-PRP gel. Then, an ACL injury reconstruction model in rabbits was established and the rabbits received saline, PRP, and KGN-PRP injection onto the tendon-bone interface after reconstruction. The tissue was harvested from the tendon-bone interface at 4 weeks and 8 weeks post-surgery, and the sections were stained with Safranin O/fast green to detected tendon-bone healing. Immunochemistry staining was used to analyze VEGF, collagen I, and HIF-1α expression, and ELISA assay was used for detecting IL-6, TNF-α, and COX-2 concentrations. The expression levels of AKT/PI3K/NF-κB-related protein and mRNA were presented by Western blot and qPCR. The release rate of KGN was high within 4 h of KGN-PRP gel and followed by a slow release until 7 days. The Safranin O/fast green staining results indicated that tendon-bone interface in sham and mock group existed gap and tissue disorganization. The KGN + PRP group showed the positive color of the healing interface was more obvious and cartilage tissue began to be generated in large amounts at this interface. The maximum tensile force of KGN-PRP injection tendon-bone healing site was significantly higher than that of PRP group, and KGN-PRP effectively promoted fibro chondrogenesis and tendon-bone healing. The expression of collagen I, VEGF, and HIF-1α in regenerated tissues at the healing interface was significantly increased by KGN-PRP treatment compared with the mock and sham groups. The expressions of IL-6, TNF-α, and COX-2 after KGN-PRP treatment were significantly decreased in tendon-bone interface compared to the mock group. WB and qPCR results showed KGN-PRP treatment effectively inhibits AKT/PI3K/NF-κB activation of inflammatory pathways, thereby reducing the level of inflammation to promote wound healing. PRP is an effective carrier for KGN with the sustained release of KGN. After ACL reconstruction, injection of KGN-PRP gel significantly reduced the inflammatory response and inhibited AKT/PI3K/NF-κB activation in cartilage tissue, which promoted tendon-bone healing.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Qian Zhang
- Department of Orthopedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Lukuan Cui
- Department of Orthopedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Lijie Wu
- Department of Orthopedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Shijun Gao
- Department of Orthopedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Cetik RM, Yabanoglu Ciftci S, Arica B, Baysal I, Akarca Dizakar SO, Erbay Elibol FK, Gencer A, Demir T, Ayvaz M. Evaluation of the Effects of Transforming Growth Factor-Beta 3 (TGF-β3) Loaded Nanoparticles on Healing in a Rat Achilles Tendon Injury Model. Am J Sports Med 2022; 50:1066-1077. [PMID: 35188807 DOI: 10.1177/03635465211073148] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Achilles tendon (AT) midsubstance injuries may heal suboptimally, especially in athletes. Transforming growth factor-beta 3 (TGF-β3) shows promise because of its recently discovered tendinogenic effects. Using poly(lactic-co-glycolic acid)-b-poly(ethylene glycol) (PLGA-b-PEG) nanoparticles (NPs) may enhance the results by a sustained-release effect. HYPOTHESIS The application of TGF-β3 will enhance AT midsubstance healing, and the NP form will achieve better outcomes. STUDY DESIGN Controlled laboratory study. METHODS A total of 80 rats underwent unilateral AT transection and were divided into 4 groups: (1) control (C); (2) empty chitosan film (Ch); (3) chitosan film containing free TGF-β3 (ChT); and (4) chitosan film containing TGF-β3-loaded NPs (ChN). The animals were sacrificed at 3 and 6 weeks. Tendons were evaluated for morphology (length and cross-sectional area [CSA]), biomechanics (maximum load, stress, stiffness, and elastic modulus), histology, immunohistochemical quantification (types I and III collagen [COL1 and COL3]), and gene expression (COL1A1, COL3A1, scleraxis, and tenomodulin). RESULTS Morphologically, at 3 weeks, ChT (15 ± 2.7 mm) and ChN (15.6 ± 1.6 mm) were shorter than C (17.6 ± 1.8 mm) (P = .019 and = .004, respectively). At 6 weeks, the mean CSA of ChN (10.4 ± 1.9 mm2) was similar to that of intact tendons (6.4 ± 1.1 mm2) (P = .230), while the other groups were larger. Biomechanically, at 3 weeks, ChT (42.8 ± 4.9 N) had a higher maximum load than C (27 ± 9.1 N; P = .004) and Ch (29.2 ± 5.7 N; P = .005). At 6 weeks, ChN (26.9 ± 3.9 MPa) had similar maximum stress when compared with intact tendons (34.1 ± 7.8 MPa) (P = .121); the other groups were significantly lower. Histologically, at 6 weeks, the mean Movin score of ChN (4.5 ± 1.5) was lower than that of ChT (6.3 ± 1.8). Immunohistochemically, ChN had higher COL3 (1.469 ± 0.514) at 3 weeks and lower COL1 (1.129 ± 0.368) at 6 weeks. COL1A1 gene expression was higher in ChT and ChN at 3 weeks, but COL3A1 gene expression was higher in ChN. CONCLUSION The application of TGF-β3 had a positive effect on AT midsubstance healing, and the sustained-release NP form improved the outcomes, more specifically accelerating the remodeling process. CLINICAL RELEVANCE This study demonstrated the effectiveness of TGF-β3 on tendon healing on a rat model, which is an important step toward clinical use. The novel method of using PLGA-b-PEG NPs as a drug-delivery system with sustained-release properties had promising results.
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Affiliation(s)
- Riza Mert Cetik
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | | | - Betul Arica
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Ipek Baysal
- Hacettepe University Vocational School of Health Services, Ankara, Turkey
| | | | - Fatma Kubra Erbay Elibol
- TOBB ETÜ University of Economics and Technology, Department of Biomedical Engineering, Ankara, Turkey
| | - Ayse Gencer
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Teyfik Demir
- TOBB ETÜ University of Economics and Technology, Department of Mechanical Engineering, Ankara, Turkey
| | - Mehmet Ayvaz
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
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Mechanical Properties of Animal Tendons: A Review and Comparative Study for the Identification of the Most Suitable Human Tendon Surrogates. Processes (Basel) 2022. [DOI: 10.3390/pr10030485] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The mechanical response of a tendon to load is strictly related to its complex and highly organized hierarchical structure, which ranges from the nano- to macroscale. In a broader context, the mechanical properties of tendons during tensile tests are affected by several distinct factors, due in part to tendon nature (anatomical site, age, training, injury, etc.) but also depending on the experimental setup and settings. This work aimed to present a systematic review of the mechanical properties of tendons reported in the scientific literature by considering different anatomical regions in humans and several animal species (horse, cow, swine, sheep, rabbit, dog, rat, mouse, and foal). This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The literature research was conducted via Google Scholar, PubMed, PicoPolito (Politecnico di Torino’s online catalogue), and Science Direct. Sixty studies were selected and analyzed. The structural and mechanical properties described in different animal species were reported and summarized in tables. Only the results from studies reporting the strain rate parameter were considered for the comparison with human tendons, as they were deemed more reliable. Our findings showed similarities between animal and human tendons that should be considered in biomechanical evaluation. An additional analysis of the effects of different strain rates showed the influence of this parameter.
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He P, Ruan D, Huang Z, Wang C, Xu Y, Cai H, Liu H, Fei Y, Heng BC, Chen W, Shen W. Comparison of Tendon Development Versus Tendon Healing and Regeneration. Front Cell Dev Biol 2022; 10:821667. [PMID: 35141224 PMCID: PMC8819183 DOI: 10.3389/fcell.2022.821667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
Tendon is a vital connective tissue in human skeletal muscle system, and tendon injury is very common and intractable in clinic. Tendon development and repair are two closely related but still not fully understood processes. Tendon development involves multiple germ layer, as well as the regulation of diversity transcription factors (Scx et al.), proteins (Tnmd et al.) and signaling pathways (TGFβ et al.). The nature process of tendon repair is roughly divided in three stages, which are dominated by various cells and cell factors. This review will describe the whole process of tendon development and compare it with the process of tendon repair, focusing on the understanding and recent advances in the regulation of tendon development and repair. The study and comparison of tendon development and repair process can thus provide references and guidelines for treatment of tendon injuries.
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Affiliation(s)
- Peiwen He
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Dengfeng Ruan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Zizhan Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Canlong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Yiwen Xu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Honglu Cai
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Hengzhi Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Yang Fei
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Boon Chin Heng
- Central Laboratory, Peking University School of Stomatology, Bejing, China
| | - Weishan Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Weishan Chen, ; Weiliang Shen,
| | - Weiliang Shen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
- Institute of Sports Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou, China
- China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, China
- *Correspondence: Weishan Chen, ; Weiliang Shen,
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Microscopic characterisation of local strain field in healing tissue in the central third defect of mouse patellar tendon at early-phase of healing. J Mech Behav Biomed Mater 2021; 123:104702. [PMID: 34365097 DOI: 10.1016/j.jmbbm.2021.104702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/26/2021] [Accepted: 07/03/2021] [Indexed: 11/20/2022]
Abstract
Tendons exhibit a hierarchical collagen structure, wherein higher-level components, such as collagen fibres and fascicles, are elongated, slid, and rotated during macroscopic stretching. These mechanical behaviours of collagen fibres play important roles in stimulating tenocytes, imposing stretching, compression, and shear deformation. It was hypothesised that a lack of local fibre behaviours in healing tendon tissue may result in a limited application of mechanical stimuli to cells within the tissue, leading to incomplete recovery of tissue structure and functions in regenerated tendons. Therefore, the present study aimed to measure the microscopic strain field in the healing tendon tissue. A central third defect was created in the patellar tendon of mice, and the regenerated tissue in the defect was examined by tensile testing, collagen fibre analysis, and local strain measurement using confocal microscopy at 3 and 6 weeks after surgery. Healing tissue at 3 weeks exhibited a significantly lower strength and disorganised collagen fibre structure compared with the normal tendon. These characteristics at 6 weeks remained significantly different from those of the normal tendon. Moreover, the magnitude of local shear strain in the healing tissue under 4% tissue strain was significantly smaller than that in the normal tendon. Differences in the local strain field may be reflected in the cell nuclear shape and possibly the amount of mechanical stimuli applied to the cells during tendon deformation. Accordingly, restoration of a normal local mechanical environment in the healing tissue may be key to a better healing outcome of tendon injury.
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da Silva FS, Abreu BJ, Eriksson BI, Ackermann PW. Complete mid-portion rupture of the rat achilles tendon leads to remote and time-mismatched changes in uninjured regions. Knee Surg Sports Traumatol Arthrosc 2021; 29:1990-1999. [PMID: 32852566 DOI: 10.1007/s00167-020-06239-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/14/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To examine healing adaptations over 17 weeks post Achilles tendon (AT) rupture in the injured region (IR) compared to an uninjured region (UIR) of the AT. METHODS Twenty-four rats were subjected to a complete right-sided AT rupture, while the left side served as a control. ATs were harvested at 1, 2, 8 and 17 weeks post-rupture and stained with antibodies specific to Collagen type I (Col I) and II (Col II) as well as Alcian Blue and Picrosirius Red staining techniques. Histopathological changes, proteoglycan content, collagen alignment and immunoexpression were assessed. RESULTS Both regions examined, IR and UIR, exhibited over weeks 1-17 similar healing adaptations of increasing collagen alignment, decreasing Col I immunoexpression, as well as increasing proteoglycan content and Col II occurrence. Increased proteoglycan content was found already at week 2 in the UIR, while it first increased at week 8 in the IR. The area positive to Col II was increased compared to controls at week 8 in the UIR, whereas it first raised at week 17 in the IR. Collagen disorganization successively declined to reach control levels at week 17 in the UIR, but was still higher in the IR. CONCLUSION This study demonstrated that uninjured areas of the AT remote from the rupture site also undergo pronounced remodeling, although with time-span differences relative to injured AT portions. These changes including the pathologic heterotopic mineralization and chondrogenic differentiation observed in both regions may have implications in the choice of rehabilitation regimes in order to prevent secondary rupture.
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Affiliation(s)
- Flávio Santos da Silva
- Department of Health Sciences, Federal University of the Semiarid Region, Mossoró, Brazil
| | - Bento João Abreu
- Department of Morphology, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Orthopedic Surgery, Karolinska University Hospital, 17176, Stockholm, Sweden.
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Kobayashi Y, Saita Y, Takaku T, Yokomizo T, Nishio H, Ikeda H, Takazawa Y, Nagao M, Kaneko K, Komatsu N. Platelet-rich plasma (PRP) accelerates murine patellar tendon healing through enhancement of angiogenesis and collagen synthesis. J Exp Orthop 2020; 7:49. [PMID: 32642866 PMCID: PMC7343697 DOI: 10.1186/s40634-020-00267-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Although platelet-rich plasma (PRP) therapy has become an increasingly popular treatment for sports-related injuries, the molecular mechanisms of PRP on tissue healing process remain poorly understood. The aim of the present study was to develop an experimental method quantifying the efficacy of PRP with murine patellar tendon injury model, leading to future elucidation of the mechanisms of PRP on healing processes. METHODS Full-thickness defects were created in the central third of the murine patellar tendon. The prepared allogenic PRP gel was applied on the defect of the patellar tendon (PRP group), while the remaining mice served as the untreated control group. Mice were sacrificed at 2, 4, 6, 8, and 10 weeks after the operation, with histological sections obtained in each time point (n = 4 / time point / group). Semi-quantitative histological evaluation was performed in accordance with the Bonar score. The variables included in this scoring system were cell morphology, ground substance, collagen arrangement, and vascularity, with higher grades indicating worse tendon structures. In addition, the ratio of the collagen fibers to the entire tendon tissue (FT ratio) was measured using KS400 software as a quantitative histological evaluation. RESULTS The total Bonar score in the PRP group was significantly lower than in control group. With regard to the variables in the Bonar score, the vascularity score was significantly higher in the PRP group at 2 and 4 weeks, while the collagen arrangement score was significantly lower in the PRP group at 8 weeks. Based on a quantitative evaluation, the recovery speed of the patellar tendon determined by FT ratio was significantly faster in the PRP group than in the control group at 6 and 8 weeks. CONCLUSIONS We have developed an experimental method for histological and quantitative evaluation of the effects of PRP on tissue healing using murine patellar tendon injury model. The results of this study suggest that the local application of PRP could enhance the tissue-healing process both directly through action on localized cells and indirectly through the recruitment of reparative cells through the blood flow. Further investigations will be needed to confirm the mechanisms of PRP in tissue-healing processes with the development of this experimental model.
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Affiliation(s)
- Yohei Kobayashi
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshitomo Saita
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tomoiku Takaku
- Department of Hematology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Tomomasa Yokomizo
- International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Nishio
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroshi Ikeda
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuji Takazawa
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masashi Nagao
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Nishio H, Saita Y, Kobayashi Y, Takaku T, Fukusato S, Uchino S, Wakayama T, Ikeda H, Kaneko K. Platelet-rich plasma promotes recruitment of macrophages in the process of tendon healing. Regen Ther 2020; 14:262-270. [PMID: 32455156 PMCID: PMC7232040 DOI: 10.1016/j.reth.2020.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/24/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Researchers have investigated the use of platelet-rich plasma (PRP) therapy. However, the mechanisms through which PRP affects tissue repair remain unclear. We hypothesize that PRP promotes tissue repair through not only via direct manner on the local cells but also via indirect manner that encourage the recruitment of reparative cells such as macrophages (MPs), and it depends on the quality of PRP including the concentration of leukocytes. The aim of this study is to elucidate the actions of the MPs in the mechanisms of PRP on tissue repair processes. METHODS Leukocyte-rich (LR) PRP and leukocyte-poor (LP) PRP were prepared from 12-week-old C57BL6 mice. Full-thickness defects were created in central third of patellar tendons of 12-week-old C57BL/6 mice for histologic analysis (n = 36) and 12-week-old B6.129P-Cx3cr1tm1Litt/J mice for flow cytometry analysis (n = 108). B6.129P-Cx3cr1tm1Litt/J mouse is GFP-positive only in the MP-linage cells thus MPs recruited to the repair tissue can be distinguished whether it had originated from administrated PRP or recruited from host mouse. Mice were treated either with LR-PRP, LP-PRP, or without PRP (control group). Histological analyses were performed to evaluate the tendon healing using Bonar score as semi-quantitative histological scoring system. Flow cytometric analyses were performed to count the number of GFP-positive cells around repaired patellar tendon. In addition, the ratio of pro-inflammatory MPs (M1)/anti-inflammatory MPs (M2) were analyzed in those GFP-positive cells. The statistical analysis was performed using GraphPad Prism ver6. P values < 0.05 were considered statistically significant. RESULTS In LR-PRP and LP-PRP groups, all variables in Bonar score such as cell morphology, cellularity, vascularity, and collagen arrangement were significantly improved in comparison with control group, indicating that both PRPs promote tendon hearing. LP-PRP promoted the tendon healing significantly faster than that of LR-PRP on postoperative day 28 (P < 0.001). LR-PRP enhanced angiogenesis (vascularity: P < 0.001), while LP-PRP improved the collagen arrangement on postoperative day 28 (collagen arrangement: P < 0.01). In other variables such as cell morphology and cellularity score, there were no significant differences between LR-PRP and LP-PRP groups in any time points. Flow cytometric findings showed that recruitment of GFP-positive MPs in the LR and LP-PRP groups were significantly increased from postoperative day 4 compared with control group without PRP treatment (P < 0.001). The majority of GFP-positive MPs were M1 at the initiation of tendon healing phase, and M2 were gradually increased from postoperative day 4. The number of M1 was significantly high both in the LP- and LR-PRP groups (day 4 and 7, p < 0.001), but the number of M2 was high only in the LP-PRP group (day 7 and 14, P < 0.05) when it compared with control group. The M1/M2 ratio on postoperative day 7 was significantly lower in the LP-PRP group than those in the control group (P < 0.05). CONCLUSIONS This study demonstrated that PRP enhanced the tendon healing and promoted the recruitment of MPs to the injured tissue. The subtypes of MPs were different depends on the types of PRPs, suggesting that leukocytes in PRP influence the effect of PRP therapy.
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Affiliation(s)
- Hirofumi Nishio
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshitomo Saita
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yohei Kobayashi
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Tomoiku Takaku
- Department of Hematology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Cku, Tokyo, Japan
| | - Shin Fukusato
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sayuri Uchino
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takanori Wakayama
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Ikeda
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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10
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Looney AM, Leider JD, Horn AR, Bodendorfer BM. Bioaugmentation in the surgical treatment of anterior cruciate ligament injuries: A review of current concepts and emerging techniques. SAGE Open Med 2020; 8:2050312120921057. [PMID: 32435488 PMCID: PMC7222656 DOI: 10.1177/2050312120921057] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/22/2020] [Indexed: 12/27/2022] Open
Abstract
Injuries involving the anterior cruciate ligament are among the most common athletic injuries, and are the most common involving the knee. The anterior cruciate ligament is a key translational and rotational stabilizer of the knee joint during pivoting and cutting activities. Traditionally, surgical intervention in the form of anterior cruciate ligament reconstruction has been recommended for those who sustain an anterior cruciate ligament rupture and wish to remain active and return to sport. The intra-articular environment of the anterior cruciate ligament makes achieving successful healing following repair challenging. Historically, results following repair were poor, and anterior cruciate ligament reconstruction emerged as the gold-standard for treatment. While earlier literature reported high rates of return to play, the results of more recent studies with longer follow-up have suggested that anterior cruciate ligament reconstruction may not be as successful as once thought: fewer athletes are able to return to sport at their preinjury level, and many still go on to develop osteoarthritis of the knee at a relatively younger age. The four principles of tissue engineering (cells, growth factors, scaffolds, and mechanical stimuli) combined in various methods of bioaugmentation have been increasingly explored in an effort to improve outcomes following surgical treatment of anterior cruciate ligament injuries. Newer technologies have also led to the re-emergence of anterior cruciate ligament repair as an option for select patients. The different biological challenges associated with anterior cruciate ligament repair and reconstruction each present unique opportunities for targeted bioaugmentation strategies that may eventually lead to better outcomes with better return-to-play rates and fewer revisions.
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Affiliation(s)
| | - Joseph Daniel Leider
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Andrew Ryan Horn
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA
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Dyrna F, Zakko P, Pauzenberger L, McCarthy MB, Mazzocca AD, Dyment NA. Human Subacromial Bursal Cells Display Superior Engraftment Versus Bone Marrow Stromal Cells in Murine Tendon Repair. Am J Sports Med 2018; 46:3511-3520. [PMID: 30419176 PMCID: PMC6541409 DOI: 10.1177/0363546518802842] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bone marrow aspirate is a primary source for cell-based therapies with increasing value in the world of orthopaedic surgery, especially in revision cases of tendon and ligament repairs. However, cells within peritendinous structures, such as the paratenon and surrounding bursa, contribute to the native tendon-healing response and offer promising cell populations for cell-based repair strategies. Therefore, the purpose of this study is to investigate the efficacy of cells derived from human subacromial bursa as compared with the current gold standard, bone marrow stromal cells (BMSCs), for tendon repairs in an established in vivo immunodeficient murine patellar tendon defect model. HYPOTHESIS Subacromial bursal cells will show superior survival and engraftment into the host tissue as compared with BMSCs. STUDY DESIGN Controlled laboratory study. METHODS Human subacromial bursal and bone marrow aspirate were harvested from the same donor undergoing rotator cuff repair. Cells were transfected with a fluorescent lentiviral vector to permanently label the cells, encapsulated into fibrin gel, and implanted into bilateral full-length central-width patellar tendon defects of immunodeficient mice. Additional surgery was performed on control mice comparing fibrin without cells and natural healing. At the time of sacrifice, all limbs were scanned on a multiphoton microscope to monitor the engraftment of the human donor cells. Afterward, limbs were assigned to either immunohistochemical or biomechanical analysis. RESULTS As compared with BMSCs, implanted subacromial bursal cells displayed superior tissue engraftment and survival. The main healing response in this defect model was the creation of new healing tissue over the anterior surface of the defect space. The implantation of cells significantly increased the thickness of the anterior healing tissue as compared with control limbs that did not receive cells. Cell proliferation was also increased in limbs that received implanted cells, suggesting that the donor cells stimulated a more robust healing response. Finally, these changes in the healing response did not lead to significant changes in mechanical properties. CONCLUSION The subacromial bursa, while often removed during rotator cuff repair, may harbor a more suitable cell source for tendon repair than BMSCs, as bursal cells display superior engraftment and survival in tendon tissue. In addition, the subacromial bursa may be a more accessible cell source than bone marrow aspirate. CLINICAL RELEVANCE The subacromial bursa contains a cell population that responds to tendon injury and may provide a more optimal cell source for tendon repair and regeneration strategies. Therefore, cells could be harvested from this tissue in the future, as opposed to the current practice of bursectomy and debridement.
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Affiliation(s)
- Felix Dyrna
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Philip Zakko
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA
| | | | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA
| | | | - Nathaniel A. Dyment
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to Nathaniel A. Dyment, PhD, McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 109A Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104-6081, USA ()
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12
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Veeruraj A, Liu L, Zheng J, Wu J, Arumugam M. Evaluation of astaxanthin incorporated collagen film developed from the outer skin waste of squid Doryteuthis singhalensis for wound healing and tissue regenerative applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 95:29-42. [PMID: 30573252 DOI: 10.1016/j.msec.2018.10.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/26/2018] [Accepted: 10/15/2018] [Indexed: 11/26/2022]
Abstract
The present investigation was aimed to evaluate in vivo wound healing activity of astaxanthin incorporated collagen hydrogel film biomaterials extracted from the outer skin waste of squid Doryteuthis singhalensis, to releases antibiotic, delivering potentialities of excisional and incisional wound model in Wistar rats. These results suggested that the astaxanthin incorporated collagen film (ACF) and gentamicin incorporated collagen film (GCF) exhibited excellent wound healing activity (71%) in both full thickness excision and linear incision in rats. The in-vitro antioxidant abilities of extracted astaxanthin exhibited strongly significant 1,1‑diphenyl‑2‑picrylhydrazyl (DPPH) radical scavenging activity. In addition, tensile strength, epithelialization, hydroxyproline content and protein content in ACF and GCF treated groups were significantly increased. Histopathological assessment revealed an increase in collagen content, fibroblasts, granulation, thickness of scar formation, effective neovascularization and faster epithelialization within the short duration after the treatment of ACF and GCF compared to the control groups. The structure of prepared ACF and GCF biomaterials were characterized by SEM, EDS, and XRD. The in vivo biological study of the collagen-based film releases the antibiotic substance. The composite of collagen based biomaterials displays a promising biocompatibility through the dermal wound healing process as well as an evidence of biodegradability. Thus, the marine-derived biomaterials gave a substantial pledge for the development of biodegradable materials in drug delivery and soft tissue regeneration process.
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Affiliation(s)
- Anguchamy Veeruraj
- Fuli Institute of Food Science (FIFS), College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, PR China; Centre of Advanced Study in Marine Biology, Faculty of Marine Sciences, Annamalai University, Parangipettai 608 502, Tamilnadu, India; ZJU-UA Joint Lab for Molecular Nutrition and Bioactive Peptides, College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, PR China.
| | - Ling Liu
- Fuli Institute of Food Science (FIFS), College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, PR China
| | - Jiexia Zheng
- Fuli Institute of Food Science (FIFS), College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, PR China
| | - Jianping Wu
- Fuli Institute of Food Science (FIFS), College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, PR China; ZJU-UA Joint Lab for Molecular Nutrition and Bioactive Peptides, College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, PR China; Department of Agricultural, Food and Nutritional Science, 4-10 Ag/For Building, University of Alberta, Edmonton, Alberta T6G 2P5, Canada
| | - Muthuvel Arumugam
- Centre of Advanced Study in Marine Biology, Faculty of Marine Sciences, Annamalai University, Parangipettai 608 502, Tamilnadu, India
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Chan DD, Cai L, Butz KD, Nauman EA, Dickerson DA, Jonkers I, Neu CP. Functional MRI can detect changes in intratissue strains in a full thickness and critical sized ovine cartilage defect model. J Biomech 2018; 66:18-25. [PMID: 29169631 PMCID: PMC5767131 DOI: 10.1016/j.jbiomech.2017.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/02/2017] [Accepted: 10/27/2017] [Indexed: 02/07/2023]
Abstract
Functional imaging of tissue biomechanics can reveal subtle changes in local softening and stiffening associated with disease or repair, but noninvasive and nondestructive methods to acquire intratissue measures in well-defined animal models are largely lacking. We utilized displacement encoded MRI to measure changes in cartilage deformation following creation of a critical-sized defect in the medial femoral condyle of ovine (sheep) knees, a common in situ and large animal model of tissue damage and repair. We prioritized visualization of local, site-specific variation and changes in displacements and strains following defect placement by measuring spatial maps of intratissue deformation. Custom data smoothing algorithms were developed to minimize propagation of noise in the acquired MRI phase data toward calculated displacement or strain, and to improve strain measures in high aspect ratio tissue regions. Strain magnitudes in the femoral, but not tibial, cartilage dramatically increased in load-bearing and contact regions especially near the defect locations, with an average 6.7% ± 6.3%, 13.4% ± 10.0%, and 10.0% ± 4.9% increase in first and second principal strains, and shear strain, respectively. Strain heterogeneity reflected the complexity of the in situ mechanical environment within the joint, with multiple tissue contacts defining the deformation behavior. This study demonstrates the utility of displacement encoded MRI to detect increased deformation patterns and strain following disruption to the cartilage structure in a clinically-relevant, large animal defect model. It also defines imaging biomarkers based on biomechanical measures, in particular shear strain, that are potentially most sensitive to evaluate damage and repair, and that may additionally translate to humans in future studies.
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Affiliation(s)
- Deva D Chan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States; Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, United States
| | - Luyao Cai
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Kent D Butz
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States; School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States; BioRegeneration Technologies, Inc., West Lafayette, IN 47907, United States
| | - Darryl A Dickerson
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States; BioRegeneration Technologies, Inc., West Lafayette, IN 47907, United States
| | - Ilse Jonkers
- Kinesiology Department, KU Leuven, Leuven, Belgium
| | - Corey P Neu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States; Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO 80309, United States.
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Wu J, Yuan H, Li L, Fan K, Qian S, Li B. Viscoelastic shear lag model to predict the micromechanical behavior of tendon under dynamic tensile loading. J Theor Biol 2017; 437:202-213. [PMID: 29111420 DOI: 10.1016/j.jtbi.2017.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 12/26/2022]
Abstract
Owing to its viscoelastic nature, tendon exhibits stress rate-dependent breaking and stiffness function. A Kelvin-Voigt viscoelastic shear lag model is proposed to illustrate the micromechanical behavior of the tendon under dynamic tensile conditions. Theoretical closed-form expressions are derived to predict the deformation and stress transfer between fibrils and interfibrillar matrix while tendon is dynamically stretched. The results from the analytical solutions demonstrate that how the fibril overlap length and fibril volume fraction affect the stress transfer and mechanical properties of tendon. We find that the viscoelastic property of interfibrillar matrix mainly results in collagen fibril failure under fast loading rate or creep rupture of tendon. However, discontinuous fibril model and hierarchical structure of tendon ensure relative sliding under slow loading rate, helping dissipate energy and protecting fibril from damage, which may be a key reason why regularly staggering alignment microstructure is widely selected in nature. According to the growth, injury, healing and healed process of tendon observed by many researchers, the conclusions presented in this paper agrees well with the experimental findings. Additionally, the emphasis of this paper is on micromechanical behavior of tendon, whereas this analytical viscoelastic shear lag model can be equally applicable to other soft or hard tissues, owning the similar microstructure.
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Affiliation(s)
- Jiayu Wu
- MOE Key Laboratory of Disaster Forecast and Control in Engineering, Institute of Applied Mechanics, Jinan University, Guangzhou 510632, China; School of Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Hong Yuan
- MOE Key Laboratory of Disaster Forecast and Control in Engineering, Institute of Applied Mechanics, Jinan University, Guangzhou 510632, China.
| | - Longyuan Li
- School of Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Kunjie Fan
- School of Engineering, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Shanguang Qian
- Architecture Engineering Faculty, Kunming Metallurgy College, Kumming 650033, China
| | - Bing Li
- Blackett Laboratory, Imperial College London, South Kensington Campus, SW7 2AZ, UK
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15
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Yoshida R, Alaee F, Dyrna F, Kronenberg MS, Maye P, Kalajzic I, Rowe DW, Mazzocca AD, Dyment NA. Murine supraspinatus tendon injury model to identify the cellular origins of rotator cuff healing. Connect Tissue Res 2016; 57:507-515. [PMID: 27184388 PMCID: PMC5149426 DOI: 10.1080/03008207.2016.1189910] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED Purpose of this study: To elucidate the origin of cell populations that contribute to rotator cuff healing, we developed a mouse surgical model where a full-thickness, central detachment is created in the supraspinatus. MATERIALS AND METHODS Three different inducible Cre transgenic mice with Ai9-tdTomato reporter expression (PRG4-9, αSMA-9, and AGC-9) were used to label different cell populations in the shoulder. The defect was created surgically in the supraspinatus. The mice were injected with tamoxifen at surgery to label the cells and sacrificed at 1, 2, and 5 weeks postoperatively. Frozen sections were fluorescently imaged then stained with Toluidine Blue and re-imaged. RESULTS Three notable changes were apparent postoperatively. (1) A long thin layer of tissue formed on the bursal side overlying the supraspinatus tendon. (2) The tendon proximal to the defect initially became hypercellular and disorganized. (3) The distal stump at the insertion underwent minimal remodeling. In the uninjured shoulder, tdTomato expression was seen in the tendon midsubstance and paratenon cell on the bursal side in PRG4-9, in paratenon, blood vessels, and periosteum of acromion in SMA-9, and in articular cartilage, unmineralized fibrocartilage of supraspinatus enthesis, and acromioclavicular joint in AGC-9 mice. In the injured PRG4-9 and SMA-9 mice, the healing tissues contained an abundant number of tdTomato+ cells, while minimal contribution of tdTomato+ cells was seen in AGC-9 mice. CONCLUSIONS The study supports the importance of the bursal side of the tendon to rotator cuff healing and PRG4 and αSMA may be markers for these progenitor cells.
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Affiliation(s)
- Ryu Yoshida
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Farhang Alaee
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Felix Dyrna
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Mark S. Kronenberg
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | - Peter Maye
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | - Ivo Kalajzic
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | - David W Rowe
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
| | - Nathaniel A Dyment
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
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16
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Arble JR, Lalley AL, Dyment NA, Joshi P, Shin DG, Gooch C, Grawe B, Rowe D, Shearn JT. The LG/J murine strain exhibits near-normal tendon biomechanical properties following a full-length central patellar tendon defect. Connect Tissue Res 2016; 57:496-506. [PMID: 27552106 PMCID: PMC10552235 DOI: 10.1080/03008207.2016.1213247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 07/08/2016] [Indexed: 02/03/2023]
Abstract
PURPOSE OF THE STUDY Identifying biological success criteria is needed to improve therapies, and one strategy for identifying them is to analyze the RNA transcriptome for successful and unsuccessful models of tendon healing. We have characterized the MRL/MpJ murine strain and found improved mechanical outcomes following a central patellar tendon (PT) injury. In this study, we evaluate the healing of the LG/J murine strain, which comprises 75% of the MRL/MpJ background, to determine if the LG/J also exhibits improved biomechanical properties following injury and to determine differentially expressed transcription factors across the C57BL/6, MRL/MpJ and the LG/J strains during the early stages of healing. MATERIALS AND METHODS A full-length, central PT defect was created in 16-20 week old MRL/MpJ, LG/J, and C57BL/6 murine strains. Mechanical properties were assessed at 2, 5, and 8 weeks post surgery. Transcriptomic expression was assessed at 3, 7, and 14 days following injury using a novel clustering software program to evaluate differential expression of transcription factors. RESULTS Average LG/J structural properties improved to 96.7% and 97.2% of native LG/J PT stiffness and ultimate load by 8 weeks post surgery, respectively. We found the LG/J responded by increasing expression of transcription factors implicated in the inflammatory response and collagen fibril organization. CONCLUSIONS The LG/J strain returns to normal structural properties by 8 weeks, with steadily increasing properties at each time point. Future work will characterize the cell populations responding to injury and investigate the role of the differentially expressed transcription factors during healing.
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Affiliation(s)
- Jessica R. Arble
- Biomedical Engineering Program, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH, USA
| | - Andrea L. Lalley
- Engineered Skin Laboratories, Shriners Hospital for Children, Cincinnati, OH, USA
| | - Nathaniel A. Dyment
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Pujan Joshi
- Computer Science and Engineering, University of Connecticut, Storrs, CT, USA
| | - Dong-Guk Shin
- Computer Science and Engineering, University of Connecticut, Storrs, CT, USA
| | - Cynthia Gooch
- Biomedical Engineering Program, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH, USA
| | - Brian Grawe
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - David Rowe
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Jason T. Shearn
- Biomedical Engineering Program, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH, USA
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Lebaschi A, Deng XH, Zong J, Cong GT, Carballo CB, Album ZM, Camp C, Rodeo SA. Animal models for rotator cuff repair. Ann N Y Acad Sci 2016; 1383:43-57. [DOI: 10.1111/nyas.13203] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Amir Lebaschi
- Tissue Engineering; Repair, and Regeneration Program
| | | | - Jianchun Zong
- Tissue Engineering; Repair, and Regeneration Program
| | | | | | - Zoe M. Album
- Tissue Engineering; Repair, and Regeneration Program
| | - Christopher Camp
- Tissue Engineering; Repair, and Regeneration Program
- Sports Medicine and Shoulder Service; Hospital for Special Surgery; New York New York
| | - Scott A. Rodeo
- Tissue Engineering; Repair, and Regeneration Program
- Sports Medicine and Shoulder Service; Hospital for Special Surgery; New York New York
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18
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Meier Bürgisser G, Calcagni M, Bachmann E, Fessel G, Snedeker JG, Giovanoli P, Buschmann J. Rabbit Achilles tendon full transection model - wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery. Biol Open 2016; 5:1324-33. [PMID: 27635037 PMCID: PMC5051656 DOI: 10.1242/bio.020644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. Summary: The rabbit Achilles tendon full transection model can be used to study adhesion extent in a controlled way. It also mimics the biomechanics of human hand flexor tendons.
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Affiliation(s)
- Gabriella Meier Bürgisser
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Elias Bachmann
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland
| | - Gion Fessel
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland
| | - Jess G Snedeker
- Uniklinik Balgrist, Department of Orthopedics, Forchstrasse 340, Zurich 8008, Switzerland Laboratory for Orthopaedic Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Rämistrasse 101, Zurich CH-8092, Switzerland
| | - Pietro Giovanoli
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Johanna Buschmann
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
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19
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Lalley AL, Dyment NA, Kazemi N, Kenter K, Gooch C, Rowe DW, Butler DL, Shearn JT. Improved biomechanical and biological outcomes in the MRL/MpJ murine strain following a full-length patellar tendon injury. J Orthop Res 2015; 33:1693-703. [PMID: 25982892 PMCID: PMC5007538 DOI: 10.1002/jor.22928] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/10/2015] [Indexed: 02/06/2023]
Abstract
Musculoskeletal injuries greatly affect the U.S. population and current clinical approaches fail to restore long-term native tissue structure and function. Tissue engineering is a strategy advocated to improve tendon healing; however, the field still needs to establish biological benchmarks for assessing the effectiveness of tissue-engineered structures. Investigating superior healing models, such as the MRL/MpJ, offers the opportunity to first characterize successful healing and then apply experimental findings to tissue-engineered therapies. This study seeks to evaluate the MRL/MpJ's healing response following a central patellar tendon injury compared to wildtype. Gene expression and histology were assessed at 3, 7, and 14 days following injury and mechanical properties were measured at 2, 5, and 8 weeks. Native patellar tendon biological and mechanical properties were not different between strains. Following injury, the MRL/MpJ displayed increased mechanical properties between 5 and 8 weeks; however, early tenogenic expression patterns were not different between the strains. Furthermore, expression of the cyclin-dependent kinase inhibitor, p21, was not different between strains, suggesting an alternative mechanism may be driving the healing response. Future studies will investigate collagen structure and alignment of the repair tissue and characterize the complete healing transcriptome to identify mechanisms driving the MRL/MpJ response.
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Affiliation(s)
- Andrea L. Lalley
- Biomedical Engineering Program, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio
| | - Nathaniel A. Dyment
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Namdar Kazemi
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Keith Kenter
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Cynthia Gooch
- Biomedical Engineering Program, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio
| | - David W. Rowe
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - David L. Butler
- Biomedical Engineering Program, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio
| | - Jason T. Shearn
- Biomedical Engineering Program, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, Ohio
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Breidenbach AP, Aschbacher‐Smith L, Lu Y, Dyment NA, Liu C, Liu H, Wylie C, Rao M, Shearn JT, Rowe DW, Kadler KE, Jiang R, Butler DL. Ablating hedgehog signaling in tenocytes during development impairs biomechanics and matrix organization of the adult murine patellar tendon enthesis. J Orthop Res 2015; 33:1142-51. [PMID: 25807894 PMCID: PMC4706742 DOI: 10.1002/jor.22899] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 03/02/2015] [Indexed: 02/04/2023]
Abstract
Restoring the native structure of the tendon enthesis, where collagen fibers of the midsubstance are integrated within a fibrocartilaginous structure, is problematic following injury. As current surgical methods fail to restore this region adequately, engineers, biologists, and clinicians are working to understand how this structure forms as a prerequisite to improving repair outcomes. We recently reported on the role of Indian hedgehog (Ihh), a novel enthesis marker, in regulating early postnatal enthesis formation. Here, we investigate how inactivating the Hh pathway in tendon cells affects adult (12-week) murine patellar tendon (PT) enthesis mechanics, fibrocartilage morphology, and collagen fiber organization. We show that ablating Hh signaling resulted in greater than 100% increased failure insertion strain (0.10 v. 0.05 mm/mm, p<0.01) as well as sub-failure biomechanical deficiencies. Although collagen fiber orientation appears overtly normal in the midsubstance, ablating Hh signaling reduces mineralized fibrocartilage by 32%, leading to less collagen embedded within mineralized tissue. Ablating Hh signaling also caused collagen fibers to coalesce at the insertion, which may explain in part the increased strains. These results indicate that Ihh signaling plays a critical role in the mineralization process of fibrocartilaginous entheses and may be a novel therapeutic to promote tendon-to-bone healing.
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Affiliation(s)
- Andrew P. Breidenbach
- Department of BiomedicalBiomedical Engineering ProgramChemical and Environmental EngineeringUniversity of CincinnatiCincinnatiOhio
| | | | - Yinhui Lu
- Wellcome Trust Centre for Cell‐Matrix ResearchFaculty of Life SciencesUniversity of ManchesterManchesterUK
| | - Nathaniel A. Dyment
- Department of Reconstructive SciencesSchool of Dental MedicineUniversity of Connecticut Health CenterFarmingtonConnecticut
| | - Chia‐Feng Liu
- Department of Cellular & Molecular MedicineCleveland Clinic Lerner Research InstituteClevelandOhio
| | - Han Liu
- Division of Developmental BiologyCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Chris Wylie
- Division of Developmental BiologyCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Marepalli Rao
- Department of BiomedicalBiomedical Engineering ProgramChemical and Environmental EngineeringUniversity of CincinnatiCincinnatiOhio
| | - Jason T. Shearn
- Department of BiomedicalBiomedical Engineering ProgramChemical and Environmental EngineeringUniversity of CincinnatiCincinnatiOhio
| | - David W. Rowe
- Department of Reconstructive SciencesSchool of Dental MedicineUniversity of Connecticut Health CenterFarmingtonConnecticut
| | - Karl E. Kadler
- Wellcome Trust Centre for Cell‐Matrix ResearchFaculty of Life SciencesUniversity of ManchesterManchesterUK
| | - Rulang Jiang
- Division of Developmental BiologyCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - David L. Butler
- Department of BiomedicalBiomedical Engineering ProgramChemical and Environmental EngineeringUniversity of CincinnatiCincinnatiOhio
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21
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Dyment NA, Galloway JL. Regenerative biology of tendon: mechanisms for renewal and repair. ACTA ACUST UNITED AC 2015; 1:124-131. [PMID: 26389023 DOI: 10.1007/s40610-015-0021-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Understanding the molecular and cellular mechanisms underlying tissue turnover and repair are essential towards addressing pathologies in aging, injury and disease. Each tissue has distinct means of maintaining homeostasis and healing after injury. For some, resident stem cell populations mediate both of these processes. These stem cells, by definition, are self renewing and give rise to all the differentiated cells of that tissue. However, not all organs fit with this traditional stem cell model of regeneration, and some do not appear to harbor somatic stem or progenitor cells capable of multilineage in vivo reconstitution. Despite recent progress in tendon progenitor cell research, our current knowledge of the mechanisms regulating tendon cell homeostasis and injury response is limited. Understanding the role of resident tendon cell populations is of great importance for regenerative medicine based approaches to tendon injuries and disease. The goal of this review is to bring to light our current knowledge regarding tendon progenitor cells and their role in tissue maintenance and repair. We will focus on pressing questions in the field and the new tools, including model systems, available to address them.
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Affiliation(s)
- Nathaniel A Dyment
- Center for Regenerative Medicine and Skeletal Development, Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health Center
| | - Jenna L Galloway
- Center for Regenerative Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Harvard Stem Cell Institute
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22
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Dyment NA, Hagiwara Y, Jiang X, Huang J, Adams DJ, Rowe DW. Response of knee fibrocartilage to joint destabilization. Osteoarthritis Cartilage 2015; 23:996-1006. [PMID: 25680653 PMCID: PMC4757847 DOI: 10.1016/j.joca.2015.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/16/2015] [Accepted: 01/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A major challenge to understanding osteoarthritis (OA) pathology is identifying the cellular events that precede the onset of cartilage damage. The objective of this study is to determine the effect of joint destabilization on early changes to fibrocartilage in the joint. DESIGN/METHODS The anterior cruciate ligament was transected in collagen reporter mice (Col1CFP and ColXRFP). Mineralization labels were given every 2 weeks to measure new mineralized cartilage apposition. Novel fluorescent histology of mineralized tissue was used to characterize the changes in fibrocartilage at 2 and 4 weeks post-injury. RESULTS Changes in fibrocartilaginous structures of the joint occur as early as 2 weeks after injury and are well developed by 4 weeks. The alterations are seen in multiple entheses and in the medial surface of the femoral and tibial condyles. In the responding entheses, mineral apposition towards the ligament midsubstance results in thickening of the mineralize fibrocartilage. These changes are associated with increases in ColX-RFP, Col1-CFP reporter activity and alkaline phosphatase enzyme activity. Mineral apposition also occurs in the fibrocartilage of the non-articular regions of the medial condyles by 2 weeks and develops into osteophytes by 4 weeks post-injury. An unexpected observation is punctate expression of tartrate resistant acid phosphatase activity in unmineralized fibrochondrocytes adjacent to active appositional mineralization. DISCUSSION These observations suggest that fibrocartilage activates prior to degradation of the articular cartilage. Thus clinical and histological imaging of fibrocartilage may be an earlier indicator of disease initiation and may indicate a more appropriate time to start preventative treatment.
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Affiliation(s)
- N A Dyment
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - Y Hagiwara
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA; Department of Orthopedic Surgery, Nippon Medical School Hospital, Tokyo 113, Japan.
| | - X Jiang
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - J Huang
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - D J Adams
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - D W Rowe
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
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23
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Jacobsen E, Dart AJ, Mondori T, Horadogoda N, Jeffcott LB, Little CB, Smith MM. Focal experimental injury leads to widespread gene expression and histologic changes in equine flexor tendons. PLoS One 2015; 10:e0122220. [PMID: 25837713 PMCID: PMC4383631 DOI: 10.1371/journal.pone.0122220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 02/19/2015] [Indexed: 01/15/2023] Open
Abstract
It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3 cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re-injury in clinical cases. Our data suggest that successful treatments of focal injuries will need to address pathology in the entire tendon, and that better methods to monitor the development and resolution of tendinopathy are required.
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Affiliation(s)
- Else Jacobsen
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney, Camden, New South Wales, Australia
| | - Andrew J. Dart
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney, Camden, New South Wales, Australia
| | - Takamitsu Mondori
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research (University of Sydney) at Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Neil Horadogoda
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney, Camden, New South Wales, Australia
| | - Leo B. Jeffcott
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney, Camden, New South Wales, Australia
| | - Christopher B. Little
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research (University of Sydney) at Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Margaret M. Smith
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute of Medical Research (University of Sydney) at Royal North Shore Hospital, St. Leonards, New South Wales, Australia
- * E-mail:
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24
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Scaffolds for tendon and ligament repair and regeneration. Ann Biomed Eng 2015; 43:819-31. [PMID: 25650098 DOI: 10.1007/s10439-015-1263-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/20/2015] [Indexed: 02/07/2023]
Abstract
Enhanced tendon and ligament repair would have a major impact on orthopedic surgery outcomes, resulting in reduced repair failures and repeat surgeries, more rapid return to function, and reduced health care costs. Scaffolds have been used for mechanical and biologic reinforcement of repair and regeneration with mixed results. This review summarizes efforts made using biologic and synthetic scaffolds using rotator cuff and ACL as examples of clinical applications, discusses recent advances that have shown promising clinical outcomes, and provides insight into future therapy.
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25
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Bell R, Taub P, Cagle P, Flatow EL, Andarawis-Puri N. Development of a mouse model of supraspinatus tendon insertion site healing. J Orthop Res 2015; 33:25-32. [PMID: 25231092 DOI: 10.1002/jor.22727] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/08/2014] [Indexed: 02/04/2023]
Abstract
Supraspinatus (SS) tendon tears are common musculoskeletal injuries whose surgical repair exhibits the highest incidence of re-tear of any tendon. Development of therapeutics for improving SS tendon healing is impaired by the lack of a model that allows biological perturbations to identify mechanisms that underlie ineffective healing. The objective of this study was to develop a mouse model of supraspinatus insertion site healing by creating a reproducible SS tendon detachment and surgical repair which can be applied to a wide array of inbred mouse strains and genetic mutants. Anatomical and structural analyses confirmed that the rotator cuff of the mouse is similar to that of human, including the presence of a coracoacromial (CA) arch and an insertion site that exhibits a fibrocartilagenous transition zone. The surgical repair was successfully conducted on seven strains of mice that are commonly used in Orthopaedic Research suggesting that the procedure can be applied to most inbred strains and genetic mutants. The quality of the repair was confirmed with histology through 14 days after surgery in two mouse strains that represent the variation in mouse strains evaluated. The developed mouse model will allow us to investigate mechanisms involved in insertion site healing.
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Affiliation(s)
- Rebecca Bell
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, 10029, New York
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26
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De Aro AA, Esquisatto MAM, Nishan U, Perez MO, Rodrigues RAF, Foglio MA, De Carvalho JE, Gomes L, Vidal BDC, Pimentel ER. Effect ofAloe veraapplication on the content and molecular arrangement of glycosaminoglycans during calcaneal tendon healing. Microsc Res Tech 2014; 77:964-73. [DOI: 10.1002/jemt.22422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/31/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Andrea Aparecida De Aro
- Department of Structural and Functional Biology; Institute of Biology, State University of Campinas-UNICAMP; Campinas São Paulo Brazil
| | | | - Umar Nishan
- Department of Structural and Functional Biology; Institute of Biology, State University of Campinas-UNICAMP; Campinas São Paulo Brazil
- Department of Biochemistry; Bahauddin Zakariya University; Multan Pakistan
| | - Mylena Oliveira Perez
- Department of Structural and Functional Biology; Institute of Biology, State University of Campinas-UNICAMP; Campinas São Paulo Brazil
| | - Rodney Alexandre Ferreira Rodrigues
- Chemical, Biological and Agricultural Pluridisciplinary Research Center (CPQBA); State University of Campinas-UNICAMP; Campinas São Paulo Brazil
| | - Mary Ann Foglio
- Chemical, Biological and Agricultural Pluridisciplinary Research Center (CPQBA); State University of Campinas-UNICAMP; Campinas São Paulo Brazil
| | - João Ernesto De Carvalho
- Chemical, Biological and Agricultural Pluridisciplinary Research Center (CPQBA); State University of Campinas-UNICAMP; Campinas São Paulo Brazil
| | - Laurecir Gomes
- Department of Structural and Functional Biology; Institute of Biology, State University of Campinas-UNICAMP; Campinas São Paulo Brazil
| | - Benedicto De Campos Vidal
- Department of Structural and Functional Biology; Institute of Biology, State University of Campinas-UNICAMP; Campinas São Paulo Brazil
| | - Edson Rosa Pimentel
- Department of Structural and Functional Biology; Institute of Biology, State University of Campinas-UNICAMP; Campinas São Paulo Brazil
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27
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Abstract
Tendinopathy is a debilitating musculoskeletal
condition which can cause significant pain and lead to complete rupture
of the tendon, which often requires surgical repair. Due in part
to the large spectrum of tendon pathologies, these disorders continue
to be a clinical challenge. Animal models are often used in this
field of research as they offer an attractive framework to examine
the cascade of processes that occur throughout both tendon pathology and
repair. This review discusses the structural, mechanical, and biological
changes that occur throughout tendon pathology in animal models,
as well as strategies for the improvement of tendon healing. Cite this article: Bone Joint Res 2014;3:193–202.
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Affiliation(s)
- M W Hast
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - A Zuskov
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - L J Soslowsky
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
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28
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Dyment NA, Hagiwara Y, Matthews BG, Li Y, Kalajzic I, Rowe DW. Lineage tracing of resident tendon progenitor cells during growth and natural healing. PLoS One 2014; 9:e96113. [PMID: 24759953 PMCID: PMC3997569 DOI: 10.1371/journal.pone.0096113] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/02/2014] [Indexed: 02/07/2023] Open
Abstract
Unlike during embryogenesis, the identity of tissue resident progenitor cells that contribute to postnatal tendon growth and natural healing is poorly characterized. Therefore, we utilized 1) an inducible Cre driven by alpha smooth muscle actin (SMACreERT2), that identifies mesenchymal progenitors, 2) a constitutively active Cre driven by growth and differentiation factor 5 (GDF5Cre), a critical regulator of joint condensation, in combination with 3) an Ai9 Cre reporter to permanently label SMA9 and GDF5-9 populations and their progeny. In growing mice, SMA9+ cells were found in peritendinous structures and scleraxis-positive (ScxGFP+) cells within the tendon midsubstance and myotendinous junction. The progenitors within the tendon midsubstance were transiently labeled as they displayed a 4-fold expansion from day 2 to day 21 but reduced to baseline levels by day 70. SMA9+ cells were not found within tendon entheses or ligaments in the knee, suggesting a different origin. In contrast to the SMA9 population, GDF5-9+ cells extended from the bone through the enthesis and into a portion of the tendon midsubstance. GDF5-9+ cells were also found throughout the length of the ligaments, indicating a significant variation in the progenitors that contribute to tendons and ligaments. Following tendon injury, SMA9+ paratenon cells were the main contributors to the healing response. SMA9+ cells extended over the defect space at 1 week and differentiated into ScxGFP+ cells at 2 weeks, which coincided with increased collagen signal in the paratenon bridge. Thus, SMA9-labeled cells represent a unique progenitor source that contributes to the tendon midsubstance, paratenon, and myotendinous junction during growth and natural healing, while GDF5 progenitors contribute to tendon enthesis and ligament development. Understanding the mechanisms that regulate the expansion and differentiation of these progenitors may prove crucial to improving future repair strategies.
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Affiliation(s)
- Nathaniel A. Dyment
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Yusuke Hagiwara
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Brya G. Matthews
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Yingcui Li
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America
- Department of Biology, College of Arts and Sciences, University of Hartford, Hartford, Connecticut, United States of America
| | - Ivo Kalajzic
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - David W. Rowe
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America
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29
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Gilday SD, Casstevens EC, Kenter K, Shearn JT, Butler DL. Murine patellar tendon biomechanical properties and regional strain patterns during natural tendon-to-bone healing after acute injury. J Biomech 2013; 47:2035-42. [PMID: 24210849 DOI: 10.1016/j.jbiomech.2013.10.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 10/15/2013] [Indexed: 11/15/2022]
Abstract
Tendon-to-bone healing following acute injury is generally poor and often fails to restore normal tendon biomechanical properties. In recent years, the murine patellar tendon (PT) has become an important model system for studying tendon healing and repair due to its genetic tractability and accessible location within the knee. However, the mechanical properties of native murine PT, specifically the regional differences in tissue strains during loading, and the biomechanical outcomes of natural PT-to-bone healing have not been well characterized. Thus, in this study, we analyzed the global biomechanical properties and regional strain patterns of both normal and naturally healing murine PT at three time points (2, 5, and 8 weeks) following acute surgical rupture of the tibial enthesis. Normal murine PT exhibited distinct regional variations in tissue strain, with the insertion region experiencing approximately 2.5 times greater strain than the midsubstance at failure (10.80±2.52% vs. 4.11±1.40%; mean±SEM). Injured tendons showed reduced structural (ultimate load and linear stiffness) and material (ultimate stress and linear modulus) properties compared to both normal and contralateral sham-operated tendons at all healing time points. Injured tendons also displayed increased local strain in the insertion region compared to contralateral shams at both physiologic and failure load levels. 93.3% of injured tendons failed at the tibial insertion, compared to only 60% and 66.7% of normal and sham tendons, respectively. These results indicate that 8 weeks of natural tendon-to-bone healing does not restore normal biomechanical function to the murine PT following injury.
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Affiliation(s)
- Steven D Gilday
- Biomedical Engineering Program, University of Cincinnati, Cincinnati, OH, United States; Medical Scientist Training Program, University of Cincinnati, Cincinnati, OH, United States.
| | - E Chris Casstevens
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Keith Kenter
- Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Jason T Shearn
- Biomedical Engineering Program, University of Cincinnati, Cincinnati, OH, United States
| | - David L Butler
- Biomedical Engineering Program, University of Cincinnati, Cincinnati, OH, United States
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30
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Breidenbach AP, Gilday SD, Lalley AL, Dyment NA, Gooch C, Shearn JT, Butler DL. Functional tissue engineering of tendon: Establishing biological success criteria for improving tendon repair. J Biomech 2013; 47:1941-8. [PMID: 24200342 DOI: 10.1016/j.jbiomech.2013.10.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/12/2013] [Indexed: 11/24/2022]
Abstract
Improving tendon repair using Functional Tissue Engineering (FTE) principles has been the focus of our laboratory over the last decade. Although our primary goals were initially focused only on mechanical outcomes, we are now carefully assessing the biological properties of our tissue-engineered tendon repairs so as to link biological influences with mechanics. However, given the complexities of tendon development and healing, it remains challenging to determine which aspects of tendon biology are the most important to focus on in the context of tissue engineering. To address this problem, we have formalized a strategy to identify, prioritize, and evaluate potential biological success criteria for tendon repair. We have defined numerous biological properties of normal tendon relative to cellular phenotype, extracellular matrix and tissue ultra-structure that we would like to reproduce in our tissue-engineered repairs and prioritized these biological criteria by examining their relative importance during both normal development and natural tendon healing. Here, we propose three specific biological criteria which we believe are essential for normal tendon function: (1) scleraxis-expressing cells; (2) well-organized and axially-aligned collagen fibrils having bimodal diameter distribution; and (3) a specialized tendon-to-bone insertion site. Moving forward, these biological success criteria will be used in conjunction with our already established mechanical success criteria to evaluate the effectiveness of our tissue-engineered tendon repairs.
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Affiliation(s)
- Andrew P Breidenbach
- Biomedical Engineering Program, College of Engineering and Applied Science, 601 Engineering Research Center, ML 0048, University of Cincinnati, Cincinnati, OH 45221-0048, United States.
| | - Steven D Gilday
- Biomedical Engineering Program, College of Engineering and Applied Science, 601 Engineering Research Center, ML 0048, University of Cincinnati, Cincinnati, OH 45221-0048, United States; Medical Scientist Training Program, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Andrea L Lalley
- Biomedical Engineering Program, College of Engineering and Applied Science, 601 Engineering Research Center, ML 0048, University of Cincinnati, Cincinnati, OH 45221-0048, United States
| | - Nathaniel A Dyment
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - Cynthia Gooch
- Biomedical Engineering Program, College of Engineering and Applied Science, 601 Engineering Research Center, ML 0048, University of Cincinnati, Cincinnati, OH 45221-0048, United States
| | - Jason T Shearn
- Biomedical Engineering Program, College of Engineering and Applied Science, 601 Engineering Research Center, ML 0048, University of Cincinnati, Cincinnati, OH 45221-0048, United States
| | - David L Butler
- Biomedical Engineering Program, College of Engineering and Applied Science, 601 Engineering Research Center, ML 0048, University of Cincinnati, Cincinnati, OH 45221-0048, United States
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31
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Galloway MT, Lalley AL, Shearn JT. The role of mechanical loading in tendon development, maintenance, injury, and repair. J Bone Joint Surg Am 2013; 95:1620-8. [PMID: 24005204 PMCID: PMC3748997 DOI: 10.2106/jbjs.l.01004] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Tendon injuries often result from excessive or insufficient mechanical loading, impairing the ability of the local tendon cell population to maintain normal tendon function. The resident cell population composing tendon tissue is mechanosensitive, given that the cells are able to alter the extracellular matrix in response to modifications of the local loading environment. Natural tendon healing is insufficient, characterized by improper collagen fibril diameter formation, collagen fibril distribution, and overall fibril misalignment. Current tendon repair rehabilitation protocols focus on implementing early, well-controlled eccentric loading exercises to improve repair outcome. Tissue engineers look toward incorporating mechanical loading regimens to precondition cell populations for the creation of improved biological augmentations for tendon repair.
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Affiliation(s)
- Marc T. Galloway
- Cincinnati Sports Medicine and Orthopaedic Center, 7423 Mason Montgomery Road, Cincinnati, OH 45249
| | - Andrea L. Lalley
- Engineering Research Center, University of Cincinnati, 2901 Woodside Drive, ERC Room 701, Cincinnati, OH 45221. E-mail address for A.L. Lalley:
| | - Jason T. Shearn
- Engineering Research Center, University of Cincinnati, 2901 Woodside Drive, ERC Room 701, Cincinnati, OH 45221. E-mail address for A.L. Lalley:
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32
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Butler DL, Dyment NA, Shearn JT, Kinneberg KRC, Breidenbach AP, Lalley AL, Gilday SD, Gooch C, Rao MB, Liu CF, Wylie C. Evolving strategies in mechanobiology to more effectively treat damaged musculoskeletal tissues. J Biomech Eng 2013; 135:020301. [PMID: 23445046 DOI: 10.1115/1.4023479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper, we had four primary objectives. (1) We reviewed a brief history of the Lissner award and the individual for whom it is named, H.R. Lissner. We examined the type (musculoskeletal, cardiovascular, and other) and scale (organism to molecular) of research performed by prior Lissner awardees using a hierarchical paradigm adopted at the 2007 Biomechanics Summit of the US National Committee on Biomechanics. (2) We compared the research conducted by the Lissner award winners working in the musculoskeletal (MS) field with the evolution of our MS research and showed similar trends in scale over the past 35 years. (3) We discussed our evolving mechanobiology strategies for treating musculoskeletal injuries by accounting for clinical, biomechanical, and biological considerations. These strategies included studies to determine the function of the anterior cruciate ligament and its graft replacements as well as novel methods to enhance soft tissue healing using tissue engineering, functional tissue engineering, and, more recently, fundamental tissue engineering approaches. (4) We concluded with thoughts about future directions, suggesting grand challenges still facing bioengineers as well as the immense opportunities for young investigators working in musculoskeletal research. Hopefully, these retrospective and prospective analyses will be useful as the ASME Bioengineering Division charts future research directions.
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Affiliation(s)
- David L Butler
- Tissue Engineering and Biomechanics Laboratories, Biomedical Engineering Program, College of Engineering and Applied Sciences, University of Cincinnati; Cincinnati, OH 45221, USA.
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Guerquin MJ, Charvet B, Nourissat G, Havis E, Ronsin O, Bonnin MA, Ruggiu M, Olivera-Martinez I, Robert N, Lu Y, Kadler KE, Baumberger T, Doursounian L, Berenbaum F, Duprez D. Transcription factor EGR1 directs tendon differentiation and promotes tendon repair. J Clin Invest 2013; 123:3564-76. [PMID: 23863709 DOI: 10.1172/jci67521] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 05/21/2013] [Indexed: 12/27/2022] Open
Abstract
Tendon formation and repair rely on specific combinations of transcription factors, growth factors, and mechanical parameters that regulate the production and spatial organization of type I collagen. Here, we investigated the function of the zinc finger transcription factor EGR1 in tendon formation, healing, and repair using rodent animal models and mesenchymal stem cells (MSCs). Adult tendons of Egr1-/- mice displayed a deficiency in the expression of tendon genes, including Scx, Col1a1, and Col1a2, and were mechanically weaker compared with their WT littermates. EGR1 was recruited to the Col1a1 and Col2a1 promoters in postnatal mouse tendons in vivo. Egr1 was required for the normal gene response following tendon injury in a mouse model of Achilles tendon healing. Forced Egr1 expression programmed MSCs toward the tendon lineage and promoted the formation of in vitro-engineered tendons from MSCs. The application of EGR1-producing MSCs increased the formation of tendon-like tissues in a rat model of Achilles tendon injury. We provide evidence that the ability of EGR1 to promote tendon differentiation is partially mediated by TGF-β2. This study demonstrates EGR1 involvement in adult tendon formation, healing, and repair and identifies Egr1 as a putative target in tendon repair strategies.
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Liu CF, Breidenbach A, Aschbacher-Smith L, Butler D, Wylie C. A role for hedgehog signaling in the differentiation of the insertion site of the patellar tendon in the mouse. PLoS One 2013; 8:e65411. [PMID: 23762363 PMCID: PMC3677907 DOI: 10.1371/journal.pone.0065411] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 04/25/2013] [Indexed: 12/02/2022] Open
Abstract
Tendons are typically composed of two histologically different regions: the midsubstance and insertion site. We previously showed that Gli1, a downstream effector of the hedgehog (Hh) signaling pathway, is expressed only in the insertion site of the mouse patellar tendon during its differentiation. To test for a functional role of Hh signaling, we targeted the Smoothened (Smo) gene in vivo using a Cre/Lox system. Constitutive activation of the Hh pathway in the mid-substance caused molecular markers of the insertion site, e.g. type II collagen, to be ectopically expressed or up-regulated in the midsubstance. This was confirmed using a novel organ culture method in vitro. Conversely, when Smo was excised in the scleraxis-positive cell population, the development of the fibrocartilaginous insertion site was affected. Whole transcriptome analysis revealed that the expression of genes involved in chondrogenesis and mineralization was down-regulated in the insertion site, and expression of insertion site markers was decreased. Biomechanical testing of murine adult patellar tendon, which developed in the absence of Hh signaling, showed impairment of tendon structural properties (lower linear stiffness and greater displacement) and material properties (greater strain), although the linear modulus of the mutant group was not significantly lower than controls. These studies provide new insights into the role of Hh signaling during tendon development.
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Affiliation(s)
- Chia-Feng Liu
- Division of Developmental Biology, Cincinnati Children’s Hospital Research Foundation, Cincinnati, Ohio, United States of America
| | - Andrew Breidenbach
- Biomedical Engineering Program, School of Energy, Environment, Biological and Medical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Lindsey Aschbacher-Smith
- Division of Developmental Biology, Cincinnati Children’s Hospital Research Foundation, Cincinnati, Ohio, United States of America
| | - David Butler
- Biomedical Engineering Program, School of Energy, Environment, Biological and Medical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Christopher Wylie
- Division of Developmental Biology, Cincinnati Children’s Hospital Research Foundation, Cincinnati, Ohio, United States of America
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LaCroix AS, Duenwald-Kuehl SE, Lakes RS, Vanderby R. Relationship between tendon stiffness and failure: a metaanalysis. J Appl Physiol (1985) 2013; 115:43-51. [PMID: 23599401 DOI: 10.1152/japplphysiol.01449.2012] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Tendon is a highly specialized, hierarchical tissue designed to transfer forces from muscle to bone; complex viscoelastic and anisotropic behaviors have been extensively characterized for specific subsets of tendons. Reported mechanical data consistently show a pseudoelastic, stress-vs.-strain behavior with a linear slope after an initial toe region. Many studies report a linear, elastic modulus, or Young's modulus (hereafter called elastic modulus) and ultimate stress for their tendon specimens. Individually, these studies are unable to provide a broader, interstudy understanding of tendon mechanical behavior. Herein we present a metaanalysis of pooled mechanical data from a representative sample of tendons from different species. These data include healthy tendons and those altered by injury and healing, genetic modification, allograft preparation, mechanical environment, and age. Fifty studies were selected and analyzed. Despite a wide range of mechanical properties between and within species, elastic modulus and ultimate stress are highly correlated (R(2) = 0.785), suggesting that tendon failure is highly strain-dependent. Furthermore, this relationship was observed to be predictable over controlled ranges of elastic moduli, as would be typical of any individual species. With the knowledge gained through this metaanalysis, noninvasive tools could measure elastic modulus in vivo and reasonably predict ultimate stress (or structural compromise) for diseased or injured tendon.
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Affiliation(s)
- Andrew S LaCroix
- Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Effect of the Arrabidaea chica extract on collagen fiber organization during healing of partially transected tendon. Life Sci 2013; 92:799-807. [DOI: 10.1016/j.lfs.2013.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 01/31/2013] [Accepted: 02/13/2013] [Indexed: 11/23/2022]
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Buckley MR, Dunkman AA, Reuther KE, Kumar A, Pathmanathan L, Beason DP, Birk DE, Soslowsky LJ. Validation of an empirical damage model for aging and in vivo injury of the murine patellar tendon. J Biomech Eng 2013; 135:041005. [PMID: 24231900 PMCID: PMC3705855 DOI: 10.1115/1.4023700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 01/25/2013] [Accepted: 02/19/2013] [Indexed: 01/14/2023]
Abstract
While useful models have been proposed to predict the mechanical impact of damage in tendon and other soft tissues, the applicability of these models for describing in vivo injury and age-related degeneration has not been investigated. Therefore, the objective of this study was to develop and validate a simple damage model to predict mechanical alterations in mouse patellar tendons after aging, injury, or healing. To characterize baseline properties, uninjured controls at age 150 days were cyclically loaded across three strain levels and five frequencies. For comparison, damage was induced in mature (120 day-old) mice through either injury or aging. Injured mice were sacrificed at three or six weeks after surgery, while aged mice were sacrificed at either 300 or 570 days old. Changes in mechanical properties (relative to baseline) in the three week post-injury group were assessed and used to develop an empirical damage model based on a simple damage parameter related to the equilibrium stress at a prescribed strain (6%). From the derived model, the viscoelastic properties of the 300 day-old, 570 day-old, and six week post-injury groups were accurately predicted. Across testing conditions, nearly all correlations between predicted and measured parameters were statistically significant and coefficients of determination ranged from R² = 0.25 to 0.97. Results suggest that the proposed damage model could exploit simple in vivo mechanical measurements to predict how an injured or aged tendon will respond to complex physiological loading regimens.
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Affiliation(s)
| | | | | | | | | | - David P. Beason
- e-mail: McKay Orthopaedic Research Laboratory,424 Stemmler Hall,36th Street and Hamilton Walk,University of Pennsylvania,Philadelphia, PA 19104
| | - David E. Birk
- Department of Molecular Pharmacology and Physiology,Morsani College of Medicine,University of South Florida,12901 Bruce B. Downs Boulevard, MDC 8,Tampa, FL 33612e-mail:
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory,424 Stemmler Hall, 36th Street and Hamilton Walk, University of Pennsylvania,Philadelphia,PA 19104e-mail:
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Dyment NA, Liu CF, Kazemi N, Aschbacher-Smith LE, Kenter K, Breidenbach AP, Shearn JT, Wylie C, Rowe DW, Butler DL. The paratenon contributes to scleraxis-expressing cells during patellar tendon healing. PLoS One 2013; 8:e59944. [PMID: 23555841 PMCID: PMC3608582 DOI: 10.1371/journal.pone.0059944] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 02/19/2013] [Indexed: 01/27/2023] Open
Abstract
The origin of cells that contribute to tendon healing, specifically extrinsic epitenon/paratenon cells vs. internal tendon fibroblasts, is still debated. The purpose of this study is to determine the location and phenotype of cells that contribute to healing of a central patellar tendon defect injury in the mouse. Normal adult patellar tendon consists of scleraxis-expressing (Scx) tendon fibroblasts situated among aligned collagen fibrils. The tendon body is surrounded by paratenon, which consists of a thin layer of cells that do not express Scx and collagen fibers oriented circumferentially around the tendon. At 3 days following injury, the paratenon thickens as cells within the paratenon proliferate and begin producing tenascin-C and fibromodulin. These cells migrate toward the defect site and express scleraxis and smooth muscle actin alpha by day 7. The thickened paratenon tissue eventually bridges the tendon defect by day 14. Similarly, cells within the periphery of the adjacent tendon struts express these markers and become disorganized. Cells within the defect region show increased expression of fibrillar collagens (Col1a1 and Col3a1) but decreased expression of tenogenic transcription factors (scleraxis and mohawk homeobox) and collagen assembly genes (fibromodulin and decorin). By contrast, early growth response 1 and 2 are upregulated in these tissues along with tenascin-C. These results suggest that paratenon cells, which normally do not express Scx, respond to injury by turning on Scx and assembling matrix to bridge the defect. Future studies are needed to determine the signaling pathways that drive these cells and whether they are capable of producing a functional tendon matrix. Understanding this process may guide tissue engineering strategies in the future by stimulating these cells to improve tendon repair.
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Affiliation(s)
- Nathaniel A Dyment
- Department of Reconstructive Sciences, College of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America.
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Affiliation(s)
- Pramod B. Voleti
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081;
| | - Mark R. Buckley
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081;
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6081;
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