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Troop LD, Puetzer JL. Intermittent Cyclic Stretch of Engineered Ligaments Drives Hierarchical Collagen Fiber Maturation in a Dose- and Organizational-Dependent Manner. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.06.588420. [PMID: 38645097 PMCID: PMC11030411 DOI: 10.1101/2024.04.06.588420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Hierarchical collagen fibers are the primary source of strength in tendons and ligaments, however these fibers do not regenerate after injury or with repair, resulting in limited treatment options. We previously developed a culture system that guides ACL fibroblasts to produce native-sized fibers and fascicles by 6 weeks. These constructs are promising ligament replacements, but further maturation is needed. Mechanical cues are critical for development in vivo and in engineered tissues; however, the effect on larger fiber and fascicle formation is largely unknown. Our objective was to investigate whether intermittent cyclic stretch, mimicking rapid muscle activity, drives further maturation in our system to create stronger engineered replacements and to explore whether cyclic loading has differential effects on cells at different degrees of collagen organization to better inform engineered tissue maturation protocols. Constructs were loaded with an established intermittent cyclic loading regime at 5 or 10% strain for up to 6 weeks and compared to static controls. Cyclic loading drove cells to increase hierarchical collagen organization, collagen crimp, and tissue mechanics, ultimately producing constructs that matched or exceeded immature ACL properties. Further, the effect of loading on cells varied depending on degree of organization. Specifically, 10% load drove early improvements in mechanics and composition, while 5% load was more beneficial later in culture, suggesting a cellular threshold response and a shift in mechanotransduction. This study provides new insight into how cyclic loading affects cell-driven hierarchical fiber formation and maturation, which will help to develop better rehabilitation protocols and engineer stronger replacements.
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Affiliation(s)
- Leia D. Troop
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, 23284, United States
| | - Jennifer L. Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, 23284, United States
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, 23284, United States
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2
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Djalali-Cuevas A, Rettel M, Stein F, Savitski M, Kearns S, Kelly J, Biggs M, Skoufos I, Tzora A, Prassinos N, Diakakis N, Zeugolis DI. Macromolecular crowding in human tenocyte and skin fibroblast cultures: A comparative analysis. Mater Today Bio 2024; 25:100977. [PMID: 38322661 PMCID: PMC10846491 DOI: 10.1016/j.mtbio.2024.100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
Although human tenocytes and dermal fibroblasts have shown promise in tendon engineering, no tissue engineered medicine has been developed due to the prolonged ex vivo time required to develop an implantable device. Considering that macromolecular crowding has the potential to substantially accelerate the development of functional tissue facsimiles, herein we compared human tenocyte and dermal fibroblast behaviour under standard and macromolecular crowding conditions to inform future studies in tendon engineering. Basic cell function analysis made apparent the innocuousness of macromolecular crowding for both cell types. Gene expression analysis of the without macromolecular crowding groups revealed expression of tendon related molecules in human dermal fibroblasts and tenocytes. Protein electrophoresis and immunocytochemistry analyses showed significantly increased and similar deposition of collagen fibres by macromolecular crowding in the two cell types. Proteomics analysis demonstrated great similarities between human tenocyte and dermal fibroblast cultures, as well as the induction of haemostatic, anti-microbial and tissue-protective proteins by macromolecular crowding in both cell populations. Collectively, these data rationalise the use of either human dermal fibroblasts or tenocytes in combination with macromolecular crowding in tendon engineering.
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Affiliation(s)
- Adrian Djalali-Cuevas
- Laboratory of Animal Science, Nutrition and Biotechnology, School of Agriculture, University of Ioannina, Arta, Greece
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland
| | - Mandy Rettel
- Proteomics Core Facility, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Frank Stein
- Proteomics Core Facility, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Mikhail Savitski
- Proteomics Core Facility, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | | | - Jack Kelly
- Galway University Hospital, Galway, Ireland
| | - Manus Biggs
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, University of Galway, Galway, Ireland
| | - Ioannis Skoufos
- Laboratory of Animal Science, Nutrition and Biotechnology, School of Agriculture, University of Ioannina, Arta, Greece
| | - Athina Tzora
- Laboratory of Animal Science, Nutrition and Biotechnology, School of Agriculture, University of Ioannina, Arta, Greece
| | - Nikitas Prassinos
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Diakakis
- School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios I. Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland
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3
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Chainani PH, Buzo Mena M, Yeritsyan D, Caro D, Momenzadeh K, Galloway JL, DeAngelis JP, Ramappa AJ, Nazarian A. Successive tendon injury in an in vivo rat overload model induces early damage and acute healing responses. Front Bioeng Biotechnol 2024; 12:1327094. [PMID: 38515627 PMCID: PMC10955762 DOI: 10.3389/fbioe.2024.1327094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/16/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction: Tendinopathy is a degenerative condition resulting from tendons experiencing abnormal levels of multi-scale damage over time, impairing their ability to repair. However, the damage markers associated with the initiation of tendinopathy are poorly understood, as the disease is largely characterized by end-stage clinical phenotypes. Thus, this study aimed to evaluate the acute tendon responses to successive fatigue bouts of tendon overload using an in vivo passive ankle dorsiflexion system. Methods: Sprague Dawley female rats underwent fatigue overloading to their Achilles tendons for 1, 2, or 3 loading bouts, with two days of rest in between each bout. Mechanical, structural, and biological assays were performed on tendon samples to evaluate the innate acute healing response to overload injuries. Results: Here, we show that fatigue overloading significantly reduces in vivo functional and mechanical properties, with reductions in hysteresis, peak stress, and loading and unloading moduli. Multi-scale structural damage on cellular, fibril, and fiber levels demonstrated accumulated micro-damage that may have induced a reparative response to successive loading bouts. The acute healing response resulted in alterations in matrix turnover and early inflammatory upregulations associated with matrix remodeling and acute responses to injuries. Discussion: This work demonstrates accumulated damage and acute changes to the tendon healing response caused by successive bouts of in vivo fatigue overloads. These results provide the avenue for future investigations of long-term evaluations of tendon overload in the context of tendinopathy.
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Affiliation(s)
- Pooja H. Chainani
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Department of Mechanical Engineering, Boston University, Boston, MA, United States
| | - Maria Buzo Mena
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jenna L. Galloway
- Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Joseph P. DeAngelis
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Arun J. Ramappa
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Department of Mechanical Engineering, Boston University, Boston, MA, United States
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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4
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Jenkins TL, Sarmiento Huertas PA, Umemori K, Guilak F, Little D. Tendon-derived matrix crosslinking techniques for electrospun multi-layered scaffolds. J Biomed Mater Res A 2023; 111:1875-1887. [PMID: 37489733 PMCID: PMC10592356 DOI: 10.1002/jbm.a.37588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023]
Abstract
Tendon tears are common and healing often occurs incompletely and by fibrosis. Tissue engineering seeks to improve repair, and one approach under investigation uses cell-seeded scaffolds containing biomimetic factors. Retention of biomimetic factors on the scaffolds is likely critical to maximize their benefit, while minimizing the risk of adverse effects, and without losing the beneficial effects of the biomimetic factors. The aim of the current study was to evaluate cross-linking methods to enhance the retention of tendon-derived matrix (TDM) on electrospun poly(ε-caprolactone) (PCL) scaffolds. We tested the effects of ultraviolet (UV) or carbodiimide (EDC:NHS:COOH) crosslinking methods to better retain TDM to the scaffolds and stimulate tendon-like matrix synthesis. Initially, we tested various crosslinking configurations of carbodiimide (2.5:1:1, 5:2:1, and 10:4:1 EDC:NHS:COOH ratios) and UV (30 s 1 J/cm2 , 60 s 1 J/cm2 , and 60 s 4 J/cm2 ) on PCL films compared to un-crosslinked TDM. We found that no crosslinking tested retained more TDM than coating alone (Kruskal-Wallis: p > .05), but that human adipose stem cells (hASCs) spread most on the 60 s 1 J/cm2 UV- and 2.5:1:1 EDC-crosslinked films (Kruskal-Wallis: p < .05). Next, we compared the effects of 60 s 1 J/cm2 UV- and 2.5:1:1 EDC-crosslinked to TDM-coated and untreated PCL scaffolds on hASC-induced tendon-like differentiation. UV-crosslinked scaffolds had greater modulus and stiffness than PCL or TDM scaffolds, and hASCs spread more on UV-crosslinked scaffolds (ANOVA: p < .05). Fourier transform infrared spectra revealed that UV- or EDC-crosslinking TDM did not affect the peaks at wavenumbers characteristic of tendon. Crosslinking TDM to electrospun scaffolds improves tendon-like matrix synthesis, providing a viable strategy for improving retention of TDM on electrospun PCL scaffolds.
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Affiliation(s)
- Thomas L. Jenkins
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | | | - Kentaro Umemori
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO
- Shriners Hospitals for Children – St. Louis, St. Louis, MO
| | - Dianne Little
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN
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5
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Brown ME, Puetzer JL. Enthesis maturation in engineered ligaments is differentially driven by loads that mimic slow growth elongation and rapid cyclic muscle movement. Acta Biomater 2023; 172:106-122. [PMID: 37839633 DOI: 10.1016/j.actbio.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Entheses are complex attachments that translate load between elastic-ligaments and stiff-bone via organizational and compositional gradients. Neither natural healing, repair, nor engineered replacements restore these gradients, contributing to high re-tear rates. Previously, we developed a culture system which guides ligament fibroblasts in high-density collagen gels to develop early postnatal-like entheses, however further maturation is needed. Mechanical cues, including slow growth elongation and cyclic muscle activity, are critical to enthesis development in vivo but these cues have not been widely explored in engineered entheses and their individual contribution to maturation is largely unknown. Our objective here was to investigate how slow stretch, mimicking ACL growth rates, and intermittent cyclic loading, mimicking muscle activity, individually drive enthesis maturation in our system so to shed light on the cues governing enthesis development, while further developing our tissue engineered replacements. Interestingly, we found these loads differentially drive organizational maturation, with slow stretch driving improvements in the interface/enthesis region, and cyclic load improving the ligament region. However, despite differentially affecting organization, both loads produced improvements to interface mechanics and zonal composition. This study provides insight into how mechanical cues differentially affect enthesis development, while producing some of the most organized engineered enthesis to date. STATEMENT OF SIGNIFICANCE: Entheses attach ligaments to bone and are critical to load transfer; however, entheses do not regenerate with repair or replacement, contributing to high re-tear rates. Mechanical cues are critical to enthesis development in vivo but their individual contribution to maturation is largely unknown and they have not been widely explored in engineered replacements. Here, using a novel culture system, we provide new insight into how slow stretch, mimicking ACL growth rates, and intermittent cyclic loading, mimicking muscle activity, differentially affect enthesis maturation in engineered ligament-to-bone tissues, ultimately producing some of the most organized entheses to date. This system is a promising platform to explore cues regulating enthesis formation so to produce functional engineered replacements and better drive regeneration following repair.
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Affiliation(s)
- M Ethan Brown
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, 23284, United States
| | - Jennifer L Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, 23284, United States; Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, 23284, United States.
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6
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Klahr B, Lanzendorf JZ, Thiesen JLM, Pinto OT, Müller LG, Carniel TA, Fancello EA. On the contribution of solid and fluid behavior to the modeling of the time-dependent mechanics of tendons under semi-confined compression. J Mech Behav Biomed Mater 2023; 148:106220. [PMID: 37944227 DOI: 10.1016/j.jmbbm.2023.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
The present work aims to investigate whether it is possible to identify and quantify the contributions of the interstitial fluid and the solid skeleton to the overall time-dependent behavior of tendons based on a single mechanical test. For this purpose, the capabilities of three different time-dependent models (a viscoelastic, a poroelastic and a poroviscoelastic) were investigated in the modeling of the experimental behavior obtained from semi-confined compression with stress relaxation tests transverse to collagen fibers. The main achieved result points out that the poroviscoelastic model was the only one capable to characterize both the experimental responses of the force and volume changes of the tissue samples. Moreover, further analysis of this model shows that while the kinematics of the sample are mainly governed by the fluid flow (pore pressure contribution of the model), the behavior intrinsically associated with the viscoelastic solid skeleton makes a significant contribution to the experimental force response. This study reinforces the importance of taking both the experimental kinematics and kinetics of tendon tissues into account during the constitutive characterization procedure.
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Affiliation(s)
- Bruno Klahr
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jonas Zin Lanzendorf
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - José Luís Medeiros Thiesen
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Otávio Teixeira Pinto
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Liz Girardi Müller
- Graduate Program in Environmental Sciences, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil
| | - Thiago André Carniel
- Graduate Program in Health Sciences, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil; Polytechnic School, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil.
| | - Eduardo Alberto Fancello
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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7
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Kim SH, Lee SH. Updates on ankylosing spondylitis: pathogenesis and therapeutic agents. JOURNAL OF RHEUMATIC DISEASES 2023; 30:220-233. [PMID: 37736590 PMCID: PMC10509639 DOI: 10.4078/jrd.2023.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
Ankylosing spondylitis (AS) is an autoinflammatory disease that manifests with the unique feature of enthesitis. Gut microbiota, HLA-B*27, and biomechanical stress mutually influence and interact resulting in setting off a flame of inflammation. In the HLA-B*27 positive group, dysbiosis in the gut environment disrupts the barrier to exogenous bacteria or viruses. Additionally, biomechanical stress induces inflammation through enthesial resident or gut-origin immune cells. On this basis, innate and adaptive immunity can propagate inflammation and lead to chronic disease. Finally, bone homeostasis is regulated by cytokines, by which the inflamed region is substituted into new bone. Agents that block cytokines are constantly being developed to provide diverse therapeutic options for preventing the progression of inflammation. In addition, some antibodies have been shown to distinguish disease selectively, which support the involvement of autoimmune immunity in AS. In this review, we critically analyze the complexity and uniqueness of the pathogenesis with updates on the findings of immunity and provide new information about biologics and biomarkers.
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Affiliation(s)
- Se Hee Kim
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang-Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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8
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Pierantoni M, Silva Barreto I, Hammerman M, Novak V, Diaz A, Engqvist J, Eliasson P, Isaksson H. Multimodal and multiscale characterization reveals how tendon structure and mechanical response are altered by reduced loading. Acta Biomater 2023; 168:264-276. [PMID: 37479155 DOI: 10.1016/j.actbio.2023.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
Tendons are collagen-based connective tissues where the composition, structure and mechanics respond and adapt to the local mechanical environment. Adaptation to prolonged inactivity can result in stiffer tendons that are more prone to injury. However, the complex relation between reduced loading, structure, and mechanical performance is still not fully understood. This study combines mechanical testing with high-resolution synchrotron X-ray imaging, scattering techniques and histology to elucidate how reduced loading affects the structural properties and mechanical response of rat Achilles tendons on multiple length scales. The results show that reduced in vivo loading leads to more crimped and less organized fibers and this structural inhomogeneity could be the reason for the altered mechanical response. Unloading also seems to change the fibril response, possibly by altering the strain partitioning between hierarchical levels, and to reduce cell density. This study elucidates the relation between in vivo loading, the Achilles tendon nano-, meso‑structure and mechanical response. The results provide fundamental insights into the mechanoregulatory mechanisms guiding the intricate biomechanics, tissue structural organization, and performance of complex collagen-based tissues. STATEMENT OF SIGNIFICANCE: Achilles tendon properties allow a dynamic interaction between muscles and tendon and influence force transmission during locomotion. Lack of physiological loading can have dramatic effects on tendon structure and mechanical properties. We have combined the use of cutting-edge high-resolution synchrotron techniques with mechanical testing to show how reduced loading affects the tendon on multiple hierarchical levels (from nanoscale up to whole organ) clarifying the relation between structural changes and mechanical performance. Our findings set the first step to address a significant healthcare challenge, such as the design of tailored rehabilitations that take into consideration structural changes after tendon immobilization.
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Affiliation(s)
- Maria Pierantoni
- Department of Biomedical Engineering, Lund University, Box 118, 221 00 Lund, Sweden.
| | | | - Malin Hammerman
- Department of Biomedical Engineering, Lund University, Box 118, 221 00 Lund, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| | | | - Ana Diaz
- Paul Scherrer Institute, 5232 Villigen PSI, Switzerland
| | - Jonas Engqvist
- Department of Solid Mechanics, Lund University, Box 118, 221 00 Lund, Sweden
| | - Pernilla Eliasson
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, 221 00 Lund, Sweden
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9
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Karimi E, Vahedi N, Sarbandi RR, Parandakh A, Ganjoury C, Sigaroodi F, Najmoddin N, Tabatabaei M, Tafazzoli-Shadpour M, Ardeshirylajimi A, Khani MM. Nanoscale vibration could promote tenogenic differentiation of umbilical cord mesenchymal stem cells. In Vitro Cell Dev Biol Anim 2023:10.1007/s11626-023-00780-4. [PMID: 37405626 DOI: 10.1007/s11626-023-00780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/24/2023] [Indexed: 07/06/2023]
Abstract
Regulation of mesenchymal stem cell (MSC) fate for targeted cell therapy applications has been a subject of interest, particularly for tissues such as tendons that possess a marginal regenerative capacity. Control of MSCs' fate into the tendon-specific lineage has mainly been achieved by implementation of chemical growth factors. Mechanical stimuli or 3-dimensional (D) scaffolds have been used as an additional tool for the differentiation of MSCs into tenocytes, but oftentimes, they require a sophisticated bioreactor or a complex scaffold fabrication technique which reduces the feasibility of the proposed method to be used in practice. Here, we used nanovibration to induce the differentiation of MSCs toward the tenogenic fate solely by the use of nanovibration and without the need for growth factors or complex scaffolds. MSCs were cultured on 2D cell culture dishes that were connected to piezo ceramic arrays to apply nanovibration (30-80 nm and 1 kHz frequency) over 7 and 14 d. We observed that nanovibration resulted in significant overexpression of tendon-related markers in both gene expression and protein expression levels, while there was no significant differentiation into adipose and cartilage lineages. These findings could be of assistance in the mechanoregulation of MSCs for stem cell engineering and regenerative medicine applications.
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Affiliation(s)
- Elahe Karimi
- Department of Tissue Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Negin Vahedi
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Reza Ramezani Sarbandi
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Azim Parandakh
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camellia Ganjoury
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faraz Sigaroodi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Najmoddin
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Tabatabaei
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | | | - Abdolreza Ardeshirylajimi
- Sina Cell Research and Product Center, Tehran, Iran
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Mohammad-Mehdi Khani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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10
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Carniel TA, Eckert JP, Atuatti EB, Klahr B, Thiesen JLM, Mentges J, Pinto OT, Müller LG, Fancello EA. Is the fluid volume fraction equal to the water content in tendons? Insights on biphasic modeling. J Mech Behav Biomed Mater 2023; 140:105703. [PMID: 36764169 DOI: 10.1016/j.jmbbm.2023.105703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023]
Abstract
The mass density of highly hydrated soft tissues is generally assumed to be very close to that of the water, resulting that the fluid mass fraction (water content) being equal to the fluid volume fraction. Within this context, the present study aims to investigate whether such an assumption actually holds for tendon tissues and to what extent it may affect the constitutive characterizations based on biphasic (poroelastic) models. Once the water content was assessed by a classical drying assay, the fluid volume fraction was obtained based on an image segmentation approach. The main achieved results point out that the fluid volume fraction is ∼20% higher than the water content in the studied tendons (flexor digitorum profundus bovine tendons). Based on this, it is shown that the use of the water content instead of the fluid volume fraction may considerably bias the results drawn by biphasic modeling of tendons. Accordingly, a proper measurement of the fluid volume fraction is then required.
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Affiliation(s)
- Thiago André Carniel
- Polytechnic School, Community University of Chapecó Region, Chapecó, SC, Brazil.
| | - João Paulo Eckert
- Polytechnic School, Community University of Chapecó Region, Chapecó, SC, Brazil
| | | | - Bruno Klahr
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | | | - Julia Mentges
- Polytechnic School, Community University of Chapecó Region, Chapecó, SC, Brazil
| | - Otávio Teixeira Pinto
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Liz Girardi Müller
- Graduate Program in Environmental Sciences, Community University of Chapecó Region, Chapecó, SC, Brazil
| | - Eduardo Alberto Fancello
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil; University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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11
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Pedaprolu K, Szczesny SE. Mouse Achilles tendons exhibit collagen disorganization but minimal collagen denaturation during cyclic loading to failure. J Biomech 2023; 151:111545. [PMID: 36944295 PMCID: PMC10069227 DOI: 10.1016/j.jbiomech.2023.111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
While overuse is a prominent risk factor for tendinopathy, the fatigue-induced structural damage responsible for initiating tendon degeneration remains unclear. Denaturation of collagen molecules and collagen fiber disorganization have been observed within certain tendons in response to fatigue loading. However, no studies have investigated whether these forms of tissue damage occur in Achilles tendons, which commonly exhibit tendinopathy. Therefore, the objective of this study was to determine whether mouse Achilles tendons undergo collagen denaturation and collagen fiber disorganization when cyclically loaded to failure. Consistent with previous testing of other energy-storing tendons, we found that cyclic loading of mouse Achilles tendons produced collagen disorganization but minimal collagen denaturation. To determine whether the lack of collagen denaturation is unique to mouse Achilles tendons, we monotonically loaded the Achilles and other mouse tendons to failure. We found that the patellar tendon was also resistant to collagen denaturation, but the flexor digitorum longus (FDL) tendon and tail tendon fascicles were not. Furthermore, the Achilles and patellar tendons had a lower tensile strength and modulus. While this may be due to differences in tissue structure, it is likely that the lack of collagen denaturation during monotonic loading in both the Achilles and patellar tendons was due to failure near their bony insertions, which were absent in the FDL and tail tendons. These findings suggest that mouse Achilles tendons are resistant to collagen denaturation in situ and that Achilles tendon degeneration may not be initiated by mechanically-induced damage to collagen molecules.
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Affiliation(s)
- Krishna Pedaprolu
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, United States
| | - Spencer E Szczesny
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, United States; Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, United States.
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12
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Ning C, Li P, Gao C, Fu L, Liao Z, Tian G, Yin H, Li M, Sui X, Yuan Z, Liu S, Guo Q. Recent advances in tendon tissue engineering strategy. Front Bioeng Biotechnol 2023; 11:1115312. [PMID: 36890920 PMCID: PMC9986339 DOI: 10.3389/fbioe.2023.1115312] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Tendon injuries often result in significant pain and disability and impose severe clinical and financial burdens on our society. Despite considerable achievements in the field of regenerative medicine in the past several decades, effective treatments remain a challenge due to the limited natural healing capacity of tendons caused by poor cell density and vascularization. The development of tissue engineering has provided more promising results in regenerating tendon-like tissues with compositional, structural and functional characteristics comparable to those of native tendon tissues. Tissue engineering is the discipline of regenerative medicine that aims to restore the physiological functions of tissues by using a combination of cells and materials, as well as suitable biochemical and physicochemical factors. In this review, following a discussion of tendon structure, injury and healing, we aim to elucidate the current strategies (biomaterials, scaffold fabrication techniques, cells, biological adjuncts, mechanical loading and bioreactors, and the role of macrophage polarization in tendon regeneration), challenges and future directions in the field of tendon tissue engineering.
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Affiliation(s)
- Chao Ning
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Pinxue Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Cangjian Gao
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Liwei Fu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiyao Liao
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Guangzhao Tian
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Han Yin
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Muzhe Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiang Sui
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuyun Liu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Quanyi Guo
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
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13
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Pringels L, Vanden Bossche L, Wezenbeek E, Burssens A, Vermue H, Victor J, Chevalier A. Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading: Implications for Achilles tendinopathy. Scand J Med Sci Sports 2022; 33:619-630. [PMID: 36517927 DOI: 10.1111/sms.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 10/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
Mechanical overload is considered the main cause of Achilles tendinopathy. In addition to tensile loads, it is believed that the Achilles tendon may also be exposed to compressive loads. However, data on intratendinous pressures are lacking, and consequently, their role in the pathophysiology of tendinopathy is still under debate. Therefore, we aimed to evaluate the intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading. Twelve pairs of human cadaveric legs were mounted in a testing rig, and a miniature pressure catheter was placed through ultrasound-guided insertion in four different regions of the Achilles tendon: the insertion (superficial and deep layers), mid-portion, and proximal portion. Intratendinous pressure was measured during three simulated loading conditions: a bent-knee calf stretch, a straight-knee calf stretch, and an eccentric heel-drop. It was found that the intratendinous pressure increased exponentially in both the insertion and mid-portion regions of the Achilles tendon during each loading condition (p < 0.001). The highest pressures were consistently found in the deep insertion region (p < 0.001) and during the eccentric heel-drop (p < 0.001). Pressures in the mid-portion were also significantly higher than in the proximal portion (p < 0.001). These observations offer novel insights and support a role for compression in the pathophysiology of Achilles tendinopathy by demonstrating high intratendinous pressures at regions where Achilles tendinopathy typically occurs. To what extent managing intratendinous pressure might be successful in patients with Achilles tendinopathy by, for example, avoiding excessive stretching, modifying exercise therapy, and offering heel lifts requires further investigation.
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Affiliation(s)
- Lauren Pringels
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Evi Wezenbeek
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Arne Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hannes Vermue
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Jan Victor
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Amelie Chevalier
- Department of Electromechanical, systems and metals engineering, Ghent University, Ghent, Belgium.,Department of Electromechanics, CoSysLab, University of Antwerp, Antwerp, Belgium.,AnSyMo/Cosys, Flanders Make, the strategic research centre for the manufacturing industry, Antwerp, Belgium
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14
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Inguito KL, Schofield MM, Faghri AD, Bloom ET, Heino M, West VC, Ebron KMM, Elliott DM, Parreno J. Stress deprivation of tendon explants or Tpm3.1 inhibition in tendon cells reduces F-actin to promote a tendinosis-like phenotype. Mol Biol Cell 2022; 33:ar141. [PMID: 36129771 PMCID: PMC9727789 DOI: 10.1091/mbc.e22-02-0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Actin is a central mediator between mechanical force and cellular phenotype. In tendons, it is speculated that mechanical stress deprivation regulates gene expression by reducing filamentous (F)-actin. However, the mechanisms regulating tenocyte F-actin remain unclear. Tropomyosins (Tpms) are master regulators of F-actin. There are more than 40 Tpm isoforms, each having the unique capability to stabilize F-actin subpopulations. We investigated F-actin polymerization in stress-deprived tendons and tested the hypothesis that stress fiber-associated Tpm(s) stabilize F-actin to regulate cellular phenotype. Stress deprivation of mouse tail tendon down-regulated tenogenic and up-regulated protease (matrix metalloproteinase-3) mRNA levels. Concomitant with mRNA modulation were increases in G/F-actin, confirming reduced F-actin by tendon stress deprivation. To investigate the molecular regulation of F-actin, we identified that tail, Achilles, and plantaris tendons express three isoforms in common: Tpm1.6, 3.1, and 4.2. Tpm3.1 associates with F-actin in native and primary tenocytes. Tpm3.1 inhibition reduces F-actin, leading to decreases in tenogenic expression, increases in chondrogenic expression, and enhancement of protease expression in mouse and human tenocytes. These expression changes by Tpm3.1 inhibition are consistent with tendinosis progression. A further understanding of F-actin regulation in musculoskeletal cells could lead to new therapeutic interventions to prevent alterations in cellular phenotype during disease progression.
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Affiliation(s)
- Kameron L. Inguito
- Departments of Biological Sciences, University of Delaware, Newark, DE 19716
| | - Mandy M. Schofield
- Departments of Biological Sciences, University of Delaware, Newark, DE 19716
| | - Arya D. Faghri
- Departments of Biological Sciences, University of Delaware, Newark, DE 19716
| | - Ellen T. Bloom
- Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Marissa Heino
- Departments of Biological Sciences, University of Delaware, Newark, DE 19716,Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Valerie C. West
- Biomedical Engineering, University of Delaware, Newark, DE 19716
| | | | - Dawn M. Elliott
- Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Justin Parreno
- Departments of Biological Sciences, University of Delaware, Newark, DE 19716,Biomedical Engineering, University of Delaware, Newark, DE 19716,*Address correspondence to: Justin Parreno ()
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15
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Huang YT, Wu YF, Wang HK, Yao CCJ, Chiu YH, Sun JS, Chao YH. Cyclic mechanical stretch regulates the AMPK/Egr1 pathway in tenocytes via Ca2+-mediated mechanosensing. Connect Tissue Res 2022; 63:590-602. [PMID: 35229695 DOI: 10.1080/03008207.2022.2044321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Mechanical stimuli are essential for the maintenance of tendon tissue homeostasis. The study aims to elucidate the mechanobiological mechanisms underlying the maintenance of tenocyte homeostasis by cyclic mechanical stretch under high-glucose (HG) condition. MATERIALS AND METHODS Primary tenocytes were isolated from rat Achilles tendon and 2D-cultured under HG condition. The in vitro effects of a single bout, 2-h cyclic biaxial stretch session (1 Hz, 8%) on primary rat tenocytes were explored through Flexcell system. Cell viability, tenogenic gene expression, intracellular calcium concentration, focal adhesion kinase (FAK) expression, and signaling pathway activation were analyzed in tenocytes with or without mechanical stretch. RESULTS Mechanical stretch increased tenocyte proliferation and upregulated early growth response protein 1 (Egr1) expression. An increase in intracellular calcium was observed after 30 min of stretching. Mechanical stretch phosphorylated FAK, calmodulin-dependent protein kinase kinase 2 (CaMKK2), and 5' adenosine monophosphate-activated protein kinase (AMPK) in a time-dependent manner, and these effects were abrogated after blocking intracellular calcium. Inhibition of FAK, CaMKK2, and AMPK downregulated the expression of Egr1. In addition, mechanical stretch reinforced cytoskeletal organization via calcium (Ca2+)/FAK signaling. CONCLUSIONS Our study demonstrated that mechanical stretch-induced calcium influx activated CaMKK2/AMPK signaling and FAK-cytoskeleton reorganization, thereby promoting the expression of Egr1, which may help maintain tendon cell characteristics and homeostasis in the context of diabetic tendinopathy.
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Affiliation(s)
- Yu-Ting Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Fu Wu
- Department of Kinesiology and Community Health, College of Applied Health Science, University of Illinois Urbana-Champaign, Illinois, USA
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry and Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Heng Chiu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedics, School of Medicine, China Medical University, Tai-Chung, Taiwan
| | - Yuan-Hung Chao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
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16
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Lazarczuk SL, Maniar N, Opar DA, Duhig SJ, Shield A, Barrett RS, Bourne MN. Mechanical, Material and Morphological Adaptations of Healthy Lower Limb Tendons to Mechanical Loading: A Systematic Review and Meta-Analysis. Sports Med 2022; 52:2405-2429. [PMID: 35657492 PMCID: PMC9474511 DOI: 10.1007/s40279-022-01695-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exposure to increased mechanical loading during physical training can lead to increased tendon stiffness. However, the loading regimen that maximises tendon adaptation and the extent to which adaptation is driven by changes in tendon material properties or tendon geometry is not fully understood. OBJECTIVE To determine (1) the effect of mechanical loading on tendon stiffness, modulus and cross-sectional area (CSA); (2) whether adaptations in stiffness are driven primarily by changes in CSA or modulus; (3) the effect of training type and associated loading parameters (relative intensity; localised strain, load duration, load volume and contraction mode) on stiffness, modulus or CSA; and (4) whether the magnitude of adaptation in tendon properties differs between age groups. METHODS Five databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE) were searched for studies detailing load-induced adaptations in tendon morphological, material or mechanical properties. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated and data were pooled using a random effects model to estimate variance. Meta regression was used to examine the moderating effects of changes in tendon CSA and modulus on tendon stiffness. RESULTS Sixty-one articles met the inclusion criteria. The total number of participants in the included studies was 763. The Achilles tendon (33 studies) and the patella tendon (24 studies) were the most commonly studied regions. Resistance training was the main type of intervention (49 studies). Mechanical loading produced moderate increases in stiffness (standardised mean difference (SMD) 0.74; 95% confidence interval (CI) 0.62-0.86), large increases in modulus (SMD 0.82; 95% CI 0.58-1.07), and small increases in CSA (SMD 0.22; 95% CI 0.12-0.33). Meta-regression revealed that the main moderator of increased stiffness was modulus. Resistance training interventions induced greater increases in modulus than other training types (SMD 0.90; 95% CI 0.65-1.15) and higher strain resistance training protocols induced greater increases in modulus (SMD 0.82; 95% CI 0.44-1.20; p = 0.009) and stiffness (SMD 1.04; 95% CI 0.65-1.43; p = 0.007) than low-strain protocols. The magnitude of stiffness and modulus differences were greater in adult participants. CONCLUSIONS Mechanical loading leads to positive adaptation in lower limb tendon stiffness, modulus and CSA. Studies to date indicate that the main mechanism of increased tendon stiffness due to physical training is increased tendon modulus, and that resistance training performed at high compared to low localised tendon strains is associated with the greatest positive tendon adaptation. PROSPERO registration no.: CRD42019141299.
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Affiliation(s)
- Stephanie L Lazarczuk
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia.
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Steven J Duhig
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Anthony Shield
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rod S Barrett
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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17
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Sander IL, Dvorak N, Stebbins JA, Carr AJ, Mouthuy PA. Advanced Robotics to Address the Translational Gap in Tendon Engineering. CYBORG AND BIONIC SYSTEMS 2022; 2022:9842169. [PMID: 36285305 PMCID: PMC9508494 DOI: 10.34133/2022/9842169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Tendon disease is a significant and growing burden to healthcare systems. One strategy to address this challenge is tissue engineering. A widely held view in this field is that mechanical stimulation provided to constructs should replicate the mechanical environment of native tissue as closely as possible. We review recent tendon tissue engineering studies in this article and highlight limitations of conventional uniaxial tensile bioreactors used in current literature. Advanced robotic platforms such as musculoskeletal humanoid robots and soft robotic actuators are promising technologies which may help address translational gaps in tendon tissue engineering. We suggest the proposed benefits of these technologies and identify recent studies which have worked to implement these technologies in tissue engineering. Lastly, key challenges to address in adapting these robotic technologies and proposed future research directions for tendon tissue engineering are discussed.
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Affiliation(s)
- Iain L. Sander
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Tebbit Centre, Windmill Road, Oxford OX3 7HE, UK
| | - Nicole Dvorak
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Julie A. Stebbins
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Tebbit Centre, Windmill Road, Oxford OX3 7HE, UK
| | - Andrew J. Carr
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Pierre-Alexis Mouthuy
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
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18
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Benage LG, Sweeney JD, Giers MB, Balasubramanian R. Dynamic Load Model Systems of Tendon Inflammation and Mechanobiology. Front Bioeng Biotechnol 2022; 10:896336. [PMID: 35910030 PMCID: PMC9335371 DOI: 10.3389/fbioe.2022.896336] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Dynamic loading is a shared feature of tendon tissue homeostasis and pathology. Tendon cells have the inherent ability to sense mechanical loads that initiate molecular-level mechanotransduction pathways. While mature tendons require physiological mechanical loading in order to maintain and fine tune their extracellular matrix architecture, pathological loading initiates an inflammatory-mediated tissue repair pathway that may ultimately result in extracellular matrix dysregulation and tendon degeneration. The exact loading and inflammatory mechanisms involved in tendon healing and pathology is unclear although a precise understanding is imperative to improving therapeutic outcomes of tendon pathologies. Thus, various model systems have been designed to help elucidate the underlying mechanisms of tendon mechanobiology via mimicry of the in vivo tendon architecture and biomechanics. Recent development of model systems has focused on identifying mechanoresponses to various mechanical loading platforms. Less effort has been placed on identifying inflammatory pathways involved in tendon pathology etiology, though inflammation has been implicated in the onset of such chronic injuries. The focus of this work is to highlight the latest discoveries in tendon mechanobiology platforms and specifically identify the gaps for future work. An interdisciplinary approach is necessary to reveal the complex molecular interplay that leads to tendon pathologies and will ultimately identify potential regenerative therapeutic targets.
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Affiliation(s)
- Lindsay G. Benage
- School of Chemical, Biological and Environmental Engineering, Oregon State University, Corvallis, OR, United States
| | - James D. Sweeney
- School of Chemical, Biological and Environmental Engineering, Oregon State University, Corvallis, OR, United States
| | - Morgan B. Giers
- School of Chemical, Biological and Environmental Engineering, Oregon State University, Corvallis, OR, United States
- *Correspondence: Morgan B. Giers,
| | - Ravi Balasubramanian
- School of Chemical, Biological and Environmental Engineering, Oregon State University, Corvallis, OR, United States
- School of Mechanical, Industrial and Manufacturing Engineering, Oregon State University, Corvallis, OR, United States
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19
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Dede Eren A, Vermeulen S, Schmitz TC, Foolen J, de Boer J. The loop of phenotype: Dynamic reciprocity links tenocyte morphology to tendon tissue homeostasis. Acta Biomater 2022; 163:275-286. [PMID: 35584748 DOI: 10.1016/j.actbio.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
Cells and their surrounding extracellular matrix (ECM) are engaged in dynamic reciprocity to maintain tissue homeostasis: cells deposit ECM, which in turn presents the signals that define cell identity. This loop of phenotype is obvious for biochemical signals, such as collagens, which are produced by and presented to cells, but the role of biomechanical signals is also increasingly recognised. In addition, cell shape goes hand in hand with cell function and tissue homeostasis. Aberrant cell shape and ECM is seen in pathological conditions, and control of cell shape in micro-fabricated platforms disclose the causal relationship between cell shape and cell function, often mediated by mechanotransduction. In this manuscript, we discuss the loop of phenotype for tendon tissue homeostasis. We describe cell shape and ECM organization in normal and diseased tissue, how ECM composition influences tenocyte shape, and how that leads to the activation of signal transduction pathways and ECM deposition. We further describe the use of technologies to control cell shape to elucidate the link between cell shape and its phenotypical markers and focus on the causal role of cell shape in the loop of phenotype. STATEMENT OF SIGNIFICANCE: The dynamic reciprocity between cells and their surrounding extracellular matrix (ECM) influences biomechanical and biochemical properties of ECM as well as cell function through activation of signal transduction pathways that regulate gene and protein expression. We refer to this reciprocity as Loop of Phenotype and it has been studied and demonstrated extensively by using micro-fabricated platforms to manipulate cell shape and cell fate. In this manuscript, we discuss this concept in tendon tissue homeostasis by giving examples in healthy and pathological tenson tissue. Furthermore, we elaborate this by showing how biomaterials are used to feed this reciprocity to manipulate cell shape and function. Finally, we elucidate the link between cell shape and its phenotypical markers and focus on the activation of signal transduction pathways and ECM deposition.
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Affiliation(s)
- Aysegul Dede Eren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Steven Vermeulen
- Maastricht University, MERLN Institute for Technology Inspired Regenerative Medicine, Instructive Biomaterial Engineering, Maastricht, the Netherlands
| | - Tara C Schmitz
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jasper Foolen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jan de Boer
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
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20
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Eisner LE, Rosario R, Andarawis-Puri N, Arruda EM. The Role of the Non-Collagenous Extracellular Matrix in Tendon and Ligament Mechanical Behavior: A Review. J Biomech Eng 2022; 144:1128818. [PMID: 34802057 PMCID: PMC8719050 DOI: 10.1115/1.4053086] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 12/26/2022]
Abstract
Tendon is a connective tissue that transmits loads from muscle to bone, while ligament is a similar tissue that stabilizes joint articulation by connecting bone to bone. The 70-90% of tendon and ligament's extracellular matrix (ECM) is composed of a hierarchical collagen structure that provides resistance to deformation primarily in the fiber direction, and the remaining fraction consists of a variety of non-collagenous proteins, proteoglycans, and glycosaminoglycans (GAGs) whose mechanical roles are not well characterized. ECM constituents such as elastin, the proteoglycans decorin, biglycan, lumican, fibromodulin, lubricin, and aggrecan and their associated GAGs, and cartilage oligomeric matrix protein (COMP) have been suggested to contribute to tendon and ligament's characteristic quasi-static and viscoelastic mechanical behavior in tension, shear, and compression. The purpose of this review is to summarize existing literature regarding the contribution of the non-collagenous ECM to tendon and ligament mechanics, and to highlight key gaps in knowledge that future studies may address. Using insights from theoretical mechanics and biology, we discuss the role of the non-collagenous ECM in quasi-static and viscoelastic tensile, compressive, and shear behavior in the fiber direction and orthogonal to the fiber direction. We also address the efficacy of tools that are commonly used to assess these relationships, including enzymatic degradation, mouse knockout models, and computational models. Further work in this field will foster a better understanding of tendon and ligament damage and healing as well as inform strategies for tissue repair and regeneration.
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Affiliation(s)
- Lainie E Eisner
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109; Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853
| | - Ryan Rosario
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Ellen M Arruda
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109; Professor Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109; Professor Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109
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21
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Pentzold S, Wildemann B. Mechanical overload decreases tenogenic differentiation compared to physiological load in bioartificial tendons. J Biol Eng 2022; 16:5. [PMID: 35241113 PMCID: PMC8896085 DOI: 10.1186/s13036-022-00283-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/10/2022] [Indexed: 01/18/2023] Open
Abstract
Background Tenocytes as specialised fibroblasts and inherent cells of tendons require mechanical load for their homeostasis. However, how mechanical overload compared to physiological load impacts on the tenogenic differentiation potential of fibroblasts is largely unknown. Methods Three-dimensional bioartificial tendons (BATs) seeded with murine fibroblasts (cell line C3H10T1/2) were subjected to uniaxial sinusoidal elongation at either overload conditions (0–16%, Ø 8%) or physiological load (0–8%, Ø 4%). This regime was applied for 2 h a day at 0.1 Hz for 7 days. Controls were unloaded, but under static tension. Results Cell survival did not differ among overload, physiological load and control BATs. However, gene expression of tenogenic and extra-cellular matrix markers (Scx, Mkx, Tnmd, Col1a1 and Col3a1) was significantly decreased in overload versus physiological load and controls, respectively. In contrast, Mmp3 was significantly increased at overload compared to physiological load, and significantly decreased under physiological load compared to controls. Mkx and Tnmd were significantly increased in BATs subjected to physiological load compared to controls. Proinflammatory interleukin-6 showed increased protein levels comparing load (both over and physiological) versus unloaded controls. Alignment of the cytoskeleton in strain direction was decreased in overload compared to physiological load, while other parameters such as nuclear area, roundness or cell density were less affected. Conclusions Mechanical overload decreases tenogenic differentiation and increases ECM remodelling/inflammation in 3D-stimulated fibroblasts, whereas physiological load may induce opposite effects. Supplementary Information The online version contains supplementary material available at 10.1186/s13036-022-00283-y.
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Affiliation(s)
- Stefan Pentzold
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
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22
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Liu K, Wiendels M, Yuan H, Ruan C, Kouwer PH. Cell-matrix reciprocity in 3D culture models with nonlinear elasticity. Bioact Mater 2022; 9:316-331. [PMID: 34820573 PMCID: PMC8586441 DOI: 10.1016/j.bioactmat.2021.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/24/2021] [Accepted: 08/03/2021] [Indexed: 01/17/2023] Open
Abstract
Three-dimensional (3D) matrix models using hydrogels are powerful tools to understand and predict cell behavior. The interactions between the cell and its matrix, however is highly complex: the matrix has a profound effect on basic cell functions but simultaneously, cells are able to actively manipulate the matrix properties. This (mechano)reciprocity between cells and the extracellular matrix (ECM) is central in regulating tissue functions and it is fundamentally important to broadly consider the biomechanical properties of the in vivo ECM when designing in vitro matrix models. This manuscript discusses two commonly used biopolymer networks, i.e. collagen and fibrin gels, and one synthetic polymer network, polyisocyanide gel (PIC), which all possess the characteristic nonlinear mechanics in the biological stress regime. We start from the structure of the materials, then address the uses, advantages, and limitations of each material, to provide a guideline for tissue engineers and biophysicists in utilizing current materials and also designing new materials for 3D cell culture purposes.
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Affiliation(s)
- Kaizheng Liu
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, PR China
- Radboud University, Institute for Molecules and Materials, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
| | - Maury Wiendels
- Radboud University, Institute for Molecules and Materials, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
| | - Hongbo Yuan
- Institute of Biophysics, Hebei University of Technology, Tianjin, 300401, PR China
- Molecular Imaging and Photonics, Chemistry Department, KU Leuven, Celestijnenlaan 200F, 3001, Heverlee, Belgium
| | - Changshun Ruan
- Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, PR China
| | - Paul H.J. Kouwer
- Radboud University, Institute for Molecules and Materials, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
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23
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Russo V, El Khatib M, Prencipe G, Citeroni MR, Faydaver M, Mauro A, Berardinelli P, Cerveró-Varona A, Haidar-Montes AA, Turriani M, Di Giacinto O, Raspa M, Scavizzi F, Bonaventura F, Stöckl J, Barboni B. Tendon Immune Regeneration: Insights on the Synergetic Role of Stem and Immune Cells during Tendon Regeneration. Cells 2022; 11:cells11030434. [PMID: 35159244 PMCID: PMC8834336 DOI: 10.3390/cells11030434] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/11/2022] Open
Abstract
Tendon disorders represent a very common pathology in today’s population, and tendinopathies that account 30% of tendon-related injuries, affect yearly millions of people which in turn cause huge socioeconomic and health repercussions worldwide. Inflammation plays a prominent role in the development of tendon pathologies, and advances in understanding the underlying mechanisms during the inflammatory state have provided additional insights into its potential role in tendon disorders. Different cell compartments, in combination with secreted immune modulators, have shown to control and modulate the inflammatory response during tendinopathies. Stromal compartment represented by tenocytes has shown to display an important role in orchestrating the inflammatory response during tendon injuries due to the interplay they exhibit with the immune-sensing and infiltrating compartments, which belong to resident and recruited immune cells. The use of stem cells or their derived secretomes within the regenerative medicine field might represent synergic new therapeutical approaches that can be used to tune the reaction of immune cells within the damaged tissues. To this end, promising opportunities are headed to the stimulation of macrophages polarization towards anti-inflammatory phenotype together with the recruitment of stem cells, that possess immunomodulatory properties, able to infiltrate within the damaged tissues and improve tendinopathies resolution. Indeed, the comprehension of the interactions between tenocytes or stem cells with the immune cells might considerably modulate the immune reaction solving hence the inflammatory response and preventing fibrotic tissue formation. The purpose of this review is to compare the roles of distinct cell compartments during tendon homeostasis and injury. Furthermore, the role of immune cells in this field, as well as their interactions with stem cells and tenocytes during tendon regeneration, will be discussed to gain insights into new ways for dealing with tendinopathies.
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Affiliation(s)
- Valentina Russo
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Mohammad El Khatib
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Giuseppe Prencipe
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
- Correspondence:
| | - Maria Rita Citeroni
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Melisa Faydaver
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Annunziata Mauro
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Paolo Berardinelli
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Adrián Cerveró-Varona
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Arlette A. Haidar-Montes
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Maura Turriani
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Oriana Di Giacinto
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Marcello Raspa
- National Research Council (CNR), Campus International Development (EMMA-INFRAFRONTIER-IMPC), Institute of Biochemistry and Cellular Biology (IBBC), 00015 Monterotondo Scalo, Italy; (M.R.); (F.S.); (F.B.)
| | - Ferdinando Scavizzi
- National Research Council (CNR), Campus International Development (EMMA-INFRAFRONTIER-IMPC), Institute of Biochemistry and Cellular Biology (IBBC), 00015 Monterotondo Scalo, Italy; (M.R.); (F.S.); (F.B.)
| | - Fabrizio Bonaventura
- National Research Council (CNR), Campus International Development (EMMA-INFRAFRONTIER-IMPC), Institute of Biochemistry and Cellular Biology (IBBC), 00015 Monterotondo Scalo, Italy; (M.R.); (F.S.); (F.B.)
| | - Johannes Stöckl
- Centre for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Barbara Barboni
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (M.R.C.); (M.F.); (A.M.); (P.B.); (A.C.-V.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
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24
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He L, Yu T, Zhang W, Wang B, Ma Y, Li S. Causal Associations of Obesity With Achilles Tendinopathy: A Two-Sample Mendelian Randomization Study. Front Endocrinol (Lausanne) 2022; 13:902142. [PMID: 35774146 PMCID: PMC9238354 DOI: 10.3389/fendo.2022.902142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) is associated with severe pain and is the cause of dysfunction and disability that are associated with significant reduction in social and economic benefits. Several potential risk factors have been proposed to be responsible for AT development; however, the results of observational epidemiological studies remain controversial, presumably because the designs of these studies are subject to residual confounding and reverse causality. Mendelian randomization (MR) can infer the causality between exposure and disease outcomes using genetic variants as instrumental variables, and identification of the causal risk factors for AT is beneficial for early intervention. Thus, we employed the MR strategy to evaluate the causal associations between previously reported risk factors (anthropometric parameters, lifestyle factors, blood biomarkers, and systemic diseases) and the risk of AT. METHODS Univariable MR was performed to screen for potential causal associations between the putative risk factors and AT. Bidirectional MR was used to infer reverse causality. Multivariable MR was conducted to investigate the body mass index (BMI)-independent causal effect of other obesity-related traits, such as the waist-hip ratio, on AT. RESULTS Univariable MR analyses with the inverse-variance weighted method indicated that the genetically predicted BMI was significantly associated with the risk of AT (P=2.0×10-3), and the odds ratios (95% confidence intervals) is 1.44 (1.14-1.81) per 1-SD increase in BMI. For the other tested risk factors, no causality with AT was identified using any of the MR methods. Bidirectional MR suggested that AT was not causally associated with BMI, and multivariable MR indicated that other anthropometric parameters included in this study were not likely to causally associate with the risk of AT after adjusting for BMI. CONCLUSIONS The causal association between BMI and AT risk suggests that weight control is a promising strategy for preventing AT and alleviating the corresponding disease burden.
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Affiliation(s)
- Lijuan He
- DongFang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tingting Yu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Zhang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Baojian Wang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Yufeng Ma
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- *Correspondence: Sen Li, ; Yufeng Ma,
| | - Sen Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Sen Li, ; Yufeng Ma,
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25
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Egerbacher M, Gardner K, Caballero O, Hlavaty J, Schlosser S, Arnoczky SP, Lavagnino M. Stress-deprivation induces an up-regulation of versican and connexin-43 mRNA and protein synthesis and increased ADAMTS-1 production in tendon cells in situ. Connect Tissue Res 2022; 63:43-52. [PMID: 33467936 DOI: 10.1080/03008207.2021.1873302] [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: 02/03/2023]
Abstract
Purpose: The proper function of the tenocyte network depends on cell-matrix as well as intercellular communication that is mechanosensitive. Building on the concept that the etiopathogenic stimulus for tendon degeneration is the catabolic response of tendon cells to mechanobiologic under-stimulation, we studied the pericellular matrix rich in versican and its predominant proteolytic enzyme ADAMTS-1, as well as Connexin-43 (Cx43), a major gap junction forming protein in tendons, in stress-deprived rat tail tendon fascicles (RTTfs).Materials and Methods: RTTfs were stress-deprived for up to 7 days under tissue culture conditions. RT-qPCR was used to measure mRNA expression of versican, ADAMTS-1, and Cx43. Protein synthesis was determined using Western blotting and immunohistochemistry.Results: Stress-deprivation (SD) caused a statistically significant up-regulation of versican, ADAMTS-1, and Cx43 mRNA expression that was persistent over the 7-day test period. Western blot analysis and immunohistochemical assessment of protein synthesis revealed a marked increase of the respective proteins with SD. Inhibition of proteolytic enzyme activity with ilomastat prevented the increased versican degradation and Cx43 synthesis in 3 days stress-deprived tendons when compared with non-treated, stress-deprived tendons.Conclusion: In the absence of mechanobiological signaling the immediate pericellular matrix is modulated as tendon cells up-regulate their production of ADAMTS-1, and versican with subsequent proteoglycan degradation potentially leading to cell signaling cues increasing Cx43 gap junctional protein. The results also provide further support for the hypothesis that the cellular changes associated with tendinopathy are a result of decreased mechanobiological signaling and a loss of homeostatic cytoskeletal tension.
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Affiliation(s)
- Monika Egerbacher
- Histology & Embryology, Department of Pathobiology, University of Veterinary Medicine, Vienna, Austria
| | - Keri Gardner
- Laboratory for Comparative Orthopaedic Research, Michigan State University, East Lansing, MI, USA
| | - Oscar Caballero
- Laboratory for Comparative Orthopaedic Research, Michigan State University, East Lansing, MI, USA
| | - Juraj Hlavaty
- Histology & Embryology, Department of Pathobiology, University of Veterinary Medicine, Vienna, Austria
| | - Sarah Schlosser
- VetCORE Facility for Research, University of Veterinary Medicine, Vienna, Austria
| | - Steven P Arnoczky
- Laboratory for Comparative Orthopaedic Research, Michigan State University, East Lansing, MI, USA
| | - Michael Lavagnino
- Laboratory for Comparative Orthopaedic Research, Michigan State University, East Lansing, MI, USA.,Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
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26
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Shear-stress sensing by PIEZO1 regulates tendon stiffness in rodents and influences jumping performance in humans. Nat Biomed Eng 2021; 5:1457-1471. [PMID: 34031557 PMCID: PMC7612848 DOI: 10.1038/s41551-021-00716-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/17/2021] [Indexed: 01/31/2023]
Abstract
Athletic performance relies on tendons, which enable movement by transferring forces from muscles to the skeleton. Yet, how load-bearing structures in tendons sense and adapt to physical demands is not understood. Here, by performing calcium (Ca2+) imaging in mechanically loaded tendon explants from rats and in primary tendon cells from rats and humans, we show that tenocytes detect mechanical forces through the mechanosensitive ion channel PIEZO1, which senses shear stresses induced by collagen-fibre sliding. Through tenocyte-targeted loss-of-function and gain-of-function experiments in rodents, we show that reduced PIEZO1 activity decreased tendon stiffness and that elevated PIEZO1 mechanosignalling increased tendon stiffness and strength, seemingly through upregulated collagen cross-linking. We also show that humans carrying the PIEZO1 E756del gain-of-function mutation display a 13.2% average increase in normalized jumping height, presumably due to a higher rate of force generation or to the release of a larger amount of stored elastic energy. Further understanding of the PIEZO1-mediated mechanoregulation of tendon stiffness should aid research on musculoskeletal medicine and on sports performance.
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27
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Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
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Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
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28
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Ciardulli MC, Lovecchio J, Scala P, Lamparelli EP, Dale TP, Giudice V, Giordano E, Selleri C, Forsyth NR, Maffulli N, Della Porta G. 3D Biomimetic Scaffold for Growth Factor Controlled Delivery: An In-Vitro Study of Tenogenic Events on Wharton's Jelly Mesenchymal Stem Cells. Pharmaceutics 2021; 13:pharmaceutics13091448. [PMID: 34575523 PMCID: PMC8465418 DOI: 10.3390/pharmaceutics13091448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/25/2022] Open
Abstract
The present work described a bio-functionalized 3D fibrous construct, as an interactive teno-inductive graft model to study tenogenic potential events of human mesenchymal stem cells collected from Wharton’s Jelly (hWJ-MSCs). The 3D-biomimetic and bioresorbable scaffold was functionalized with nanocarriers for the local controlled delivery of a teno-inductive factor, i.e., the human Growth Differentiation factor 5 (hGDF-5). Significant results in terms of gene expression were obtained. Namely, the up-regulation of Scleraxis (350-fold, p ≤ 0.05), type I Collagen (8-fold), Decorin (2.5-fold), and Tenascin-C (1.3-fold) was detected at day 14; on the other hand, when hGDF-5 was supplemented in the external medium only (in absence of nanocarriers), a limited effect on gene expression was evident. Teno-inductive environment also induced pro-inflammatory, (IL-6 (1.6-fold), TNF (45-fold, p ≤ 0.001), and IL-12A (1.4-fold)), and anti-inflammatory (IL-10 (120-fold) and TGF-β1 (1.8-fold)) cytokine expression upregulation at day 14. The presented 3D construct opens perspectives for the study of drug controlled delivery devices to promote teno-regenerative events.
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Affiliation(s)
- Maria Camilla Ciardulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.C.); (P.S.); (E.P.L.); (V.G.); (C.S.); (N.M.)
| | - Joseph Lovecchio
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Via dell’Università 50, 47522 Cesena, Italy; (J.L.); (E.G.)
| | - Pasqualina Scala
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.C.); (P.S.); (E.P.L.); (V.G.); (C.S.); (N.M.)
| | - Erwin Pavel Lamparelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.C.); (P.S.); (E.P.L.); (V.G.); (C.S.); (N.M.)
| | - Tina Patricia Dale
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK; (T.P.D.); (N.R.F.)
| | - Valentina Giudice
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.C.); (P.S.); (E.P.L.); (V.G.); (C.S.); (N.M.)
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy
| | - Emanuele Giordano
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Via dell’Università 50, 47522 Cesena, Italy; (J.L.); (E.G.)
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Via Tolara di Sopra 41/E, 40064 Ozzano dell’Emilia, Italy
- Advanced Research Center on Electronic Systems (ARCES), University of Bologna, Via Vincenzo Toffano 2/2, 40125 Bologna, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.C.); (P.S.); (E.P.L.); (V.G.); (C.S.); (N.M.)
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy
- Clinical Pharmacology, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy
| | - Nicholas Robert Forsyth
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK; (T.P.D.); (N.R.F.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.C.); (P.S.); (E.P.L.); (V.G.); (C.S.); (N.M.)
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK; (T.P.D.); (N.R.F.)
- Centre for Sport and Exercise Medicine, Barts and The London School of Medicine, Queen Mary University of London, London E1 4NL, UK
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (M.C.C.); (P.S.); (E.P.L.); (V.G.); (C.S.); (N.M.)
- Research Centre for Biomaterials BIONAM, Università di Salerno, Via Giovanni Paolo II, 84084 Fisciano, Italy
- Correspondence: ; Tel.: +39-089-965-234
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Zhang X, Wang D, Mak KLK, Tuan RS, Ker DFE. Engineering Musculoskeletal Grafts for Multi-Tissue Unit Repair: Lessons From Developmental Biology and Wound Healing. Front Physiol 2021; 12:691954. [PMID: 34504435 PMCID: PMC8421786 DOI: 10.3389/fphys.2021.691954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022] Open
Abstract
In the musculoskeletal system, bone, tendon, and skeletal muscle integrate and act coordinately as a single multi-tissue unit to facilitate body movement. The development, integration, and maturation of these essential components and their response to injury are vital for conferring efficient locomotion. The highly integrated nature of these components is evident under disease conditions, where rotator cuff tears at the bone-tendon interface have been reported to be associated with distal pathological alterations such as skeletal muscle degeneration and bone loss. To successfully treat musculoskeletal injuries and diseases, it is important to gain deep understanding of the development, integration and maturation of these musculoskeletal tissues along with their interfaces as well as the impact of inflammation on musculoskeletal healing and graft integration. This review highlights the current knowledge of developmental biology and wound healing in the bone-tendon-muscle multi-tissue unit and perspectives of what can be learnt from these biological and pathological processes within the context of musculoskeletal tissue engineering and regenerative medicine. Integrating these knowledge and perspectives can serve as guiding principles to inform the development and engineering of musculoskeletal grafts and other tissue engineering strategies to address challenging musculoskeletal injuries and diseases.
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Affiliation(s)
- Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, China
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, China
| | - Dan Wang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, China
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
- Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, China
| | - King-Lun Kingston Mak
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health-Guangdong Laboratory), Guangzhou, China
| | - Rocky S. Tuan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, China
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, China
| | - Dai Fei Elmer Ker
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Shatin, China
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
- Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, China
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30
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Griffin C, Daniels K, Hill C, Franklyn-Miller A, Morin JB. A criteria-based rehabilitation program for chronic mid-portion Achilles tendinopathy: study protocol for a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:695. [PMID: 34391384 PMCID: PMC8364697 DOI: 10.1186/s12891-021-04553-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) is a common overuse injury in running-related sports where patients experience pain and impaired function which can persist. A graded rehabilitation program has been successful in reducing pain and improving function to enable a return to sport. The aim of this study is to compare the effectiveness of a criteria-based rehabilitation program including strength and reactive strength targets, with a previously successful rehabilitation program on changes in pain and function using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Secondary aims will be to assess changes in calf strength, reactive strength, and lower limb running and forward hop biomechanics over the course of a 12-week rehabilitation program, and long-term follow-up investigations. METHODS Sixty eligible participants with chronic mid-portion AT who train in running-based sports will be included in this study. They will be randomly assigned to a group that will follow an evidence-based rehabilitation program of daily exercises with progression guided by symptoms or a group performing 3 high-intensity rehabilitation sessions per week with individualised load targets progressing to reactive strength exercises. Testing will take place at baseline, week 6 and 12. Plantar flexor peak torque will be measured using isokinetic dynamometry, reactive strength will be measured using a drop jump and lower limb biomechanical variables will be measured during a single leg forward hurdle hop test and treadmill running using 3D motion analysis. Follow-up interviews will take place at 6, 12 and 24 months after beginning the program which will assess patient participation in sport and possible re-injury. DISCUSSION This is the first study to propose an individualised criteria-based graded rehabilitation program in patients in with chronic mid-portion Achilles tendinopathy where progression is guided by strength and reactive strength outcome measures. This study will provide a comprehensive assessment of plantar flexor strength, reactive strength and lower limb biomechanical variables in running and forward hopping with the VISA-A questionnaire as the primary outcome measure and long term post-intervention follow-up assessments performed. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT04384874 ). Registered retrospectively on April 23rd 2020.
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Affiliation(s)
- Colin Griffin
- Université Côte d'Azur, LAMHESS, Nice, France.
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland.
| | - Katherine Daniels
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland
- University of Bristol, Queen's School of Engineering, University Walk, Bristol, BS81TR, UK
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Caroline Hill
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland
| | - Andrew Franklyn-Miller
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jean-Benoît Morin
- Université Côte d'Azur, LAMHESS, Nice, France
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France
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31
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Wang T, Wagner A, Gehwolf R, Yan W, Passini FS, Thien C, Weissenbacher N, Lin Z, Lehner C, Teng H, Wittner C, Zheng Q, Dai J, Ni M, Wang A, Papadimitriou J, Leys T, Tuan RS, Senck S, Snedeker JG, Tempfer H, Jiang Q, Zheng MH, Traweger A. Load-induced regulation of tendon homeostasis by SPARC, a genetic predisposition factor for tendon and ligament injuries. Sci Transl Med 2021; 13:13/582/eabe5738. [PMID: 33627488 DOI: 10.1126/scitranslmed.abe5738] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/03/2021] [Indexed: 01/18/2023]
Abstract
Tendons and tendon interfaces have a very limited regenerative capacity, rendering their injuries clinically challenging to resolve. Tendons sense muscle-mediated load; however, our knowledge on how loading affects tendon structure and functional adaption remains fragmentary. Here, we provide evidence that the matricellular protein secreted protein acidic and rich in cysteine (SPARC) is critically involved in the mechanobiology of tendons and is required for tissue maturation, homeostasis, and enthesis development. We show that tendon loading at the early postnatal stage leads to tissue hypotrophy and impaired maturation of Achilles tendon enthesis in Sparc -/- mice. Treadmill training revealed a higher prevalence of spontaneous tendon ruptures and a net catabolic adaptation in Sparc -/- mice. Tendon hypoplasia was attenuated in Sparc -/- mice in response to muscle unloading with botulinum toxin A. In vitro culture of Sparc -/- three-dimensional tendon constructs showed load-dependent impairment of ribosomal S6 kinase activation, resulting in reduced type I collagen synthesis. Further, functional calcium imaging revealed that lower stresses were required to trigger mechanically induced responses in Sparc -/- tendon fascicles. To underscore the clinical relevance of the findings, we further demonstrate that a missense mutation (p.Cys130Gln) in the follistatin-like domain of SPARC, which causes impaired protein secretion and type I collagen fibrillogenesis, is associated with tendon and ligament injuries in patients. Together, our results demonstrate that SPARC is a key extracellular matrix protein essential for load-induced tendon tissue maturation and homeostasis.
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Affiliation(s)
- Tao Wang
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia.,Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People'sHospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000, China
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury and Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury and Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Wenjin Yan
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Fabian S Passini
- University Hospital Balgrist, University of Zurich, Zürich, Switzerland.,Institute for Biomechanics, ETH Zurich, 8008 Zürich, Switzerland
| | - Christine Thien
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia
| | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury and Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Zhen Lin
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia.,Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People'sHospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000, China
| | - Christine Lehner
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury and Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Huajian Teng
- Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing 210008, China
| | - Claudia Wittner
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, 4600 Wels, Austria
| | - Qiujian Zheng
- Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People'sHospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000, China
| | - Jin Dai
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Ming Ni
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia.,Department of Orthopaedics, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Allan Wang
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia
| | - John Papadimitriou
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia.,PathWest Laboratories, Nedlands, Western Australia 6009, Australia
| | - Toby Leys
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.,Institute for Tissue Engineering and Regenerative Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sasha Senck
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, 4600 Wels, Austria
| | - Jess G Snedeker
- University Hospital Balgrist, University of Zurich, Zürich, Switzerland.,Institute for Biomechanics, ETH Zurich, 8008 Zürich, Switzerland
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury and Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Ming H Zheng
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Western Australia 6009,Australia. .,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia 6009, Australia
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury and Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria. .,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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32
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Bramson MTK, Van Houten SK, Corr DT. Mechanobiology in Tendon, Ligament, and Skeletal Muscle Tissue Engineering. J Biomech Eng 2021; 143:1097189. [PMID: 33537704 DOI: 10.1115/1.4050035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 12/28/2022]
Abstract
Tendon, ligament, and skeletal muscle are highly organized tissues that largely rely on a hierarchical collagenous matrix to withstand high tensile loads experienced in activities of daily life. This critical biomechanical role predisposes these tissues to injury, and current treatments fail to recapitulate the biomechanical function of native tissue. This has prompted researchers to pursue engineering functional tissue replacements, or dysfunction/disease/development models, by emulating in vivo stimuli within in vitro tissue engineering platforms-specifically mechanical stimulation, as well as active contraction in skeletal muscle. Mechanical loading is critical for matrix production and organization in the development, maturation, and maintenance of native tendon, ligament, and skeletal muscle, as well as their interfaces. Tissue engineers seek to harness these mechanobiological benefits using bioreactors to apply both static and dynamic mechanical stimulation to tissue constructs, and induce active contraction in engineered skeletal muscle. The vast majority of engineering approaches in these tissues are scaffold-based, providing interim structure and support to engineered constructs, and sufficient integrity to withstand mechanical loading. Alternatively, some recent studies have employed developmentally inspired scaffold-free techniques, relying on cellular self-assembly and matrix production to form tissue constructs. Whether utilizing a scaffold or not, incorporation of mechanobiological stimuli has been shown to improve the composition, structure, and biomechanical function of engineered tendon, ligament, and skeletal muscle. Together, these findings highlight the importance of mechanobiology and suggest how it can be leveraged to engineer these tissues and their interfaces, and to create functional multitissue constructs.
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Affiliation(s)
- Michael T K Bramson
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180
| | - Sarah K Van Houten
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180
| | - David T Corr
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180
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33
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Salvatore L, Gallo N, Natali ML, Terzi A, Sannino A, Madaghiele M. Mimicking the Hierarchical Organization of Natural Collagen: Toward the Development of Ideal Scaffolding Material for Tissue Regeneration. Front Bioeng Biotechnol 2021; 9:644595. [PMID: 33987173 PMCID: PMC8112590 DOI: 10.3389/fbioe.2021.644595] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
Biological materials found in living organisms, many of which are proteins, feature a complex hierarchical organization. Type I collagen, a fibrous structural protein ubiquitous in the mammalian body, provides a striking example of such a hierarchical material, with peculiar architectural features ranging from the amino acid sequence at the nanoscale (primary structure) up to the assembly of fibrils (quaternary structure) and fibers, with lengths of the order of microns. Collagen plays a dominant role in maintaining the biological and structural integrity of various tissues and organs, such as bone, skin, tendons, blood vessels, and cartilage. Thus, "artificial" collagen-based fibrous assemblies, endowed with appropriate structural properties, represent ideal substrates for the development of devices for tissue engineering applications. In recent years, with the ultimate goal of developing three-dimensional scaffolds with optimal bioactivity able to promote both regeneration and functional recovery of a damaged tissue, numerous studies focused on the capability to finely modulate the scaffold architecture at the microscale and the nanoscale in order to closely mimic the hierarchical features of the extracellular matrix and, in particular, the natural patterning of collagen. All of these studies clearly show that the accurate characterization of the collagen structure at the submolecular and supramolecular levels is pivotal to the understanding of the relationships between the nanostructural/microstructural properties of the fabricated scaffold and its macroscopic performance. Several studies also demonstrate that the selected processing, including any crosslinking and/or sterilization treatments, can strongly affect the architecture of collagen at various length scales. The aim of this review is to highlight the most recent findings on the development of collagen-based scaffolds with optimized properties for tissue engineering. The optimization of the scaffolds is particularly related to the modulation of the collagen architecture, which, in turn, impacts on the achieved bioactivity.
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Affiliation(s)
- Luca Salvatore
- Department of Engineering for Innovation, University of Salento, Lecce, Italy
| | - Nunzia Gallo
- Department of Engineering for Innovation, University of Salento, Lecce, Italy
| | - Maria Lucia Natali
- Department of Engineering for Innovation, University of Salento, Lecce, Italy
| | - Alberta Terzi
- Institute of Crystallography, National Research Council, Bari, Italy
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento, Lecce, Italy
| | - Marta Madaghiele
- Department of Engineering for Innovation, University of Salento, Lecce, Italy
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34
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Akamatsu FE, Teodoro WR, Itezerote AM, da Silveira LKR, Saleh S, Martinez CAR, Ribeiro ML, Pereira JA, Hojaij F, Andrade M, Jacomo AL. Photobiomodulation therapy increases collagen II after tendon experimental injury. Histol Histopathol 2021; 36:663-674. [PMID: 33755188 DOI: 10.14670/hh-18-330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A tendon is a mechanosensitive tissue that transmits muscle-derived forces to bones. Photobiomodulation (PBM), also known as low-level laser therapy (LLLT), has been used in therapeutic approaches in tendon lesions, but uncertainties regarding its mechanisms of action have prevented its widespread use. We investigated the response of PBM therapy in experimental lesions of the Achilles tendon in rats. Thirty adult male Wistar rats weighing 250 to 300 g were surgically submitted to bilateral partial transverse section of the Achilles tendon. The right tendon was treated with PBM, whereas the left tendon served as a control. On the third postoperative day, the rats were divided into three experimental groups consisting of ten rats each, which were treated with PBM (Konf, Aculas - HB 750), 780 nm and 80 mW for 20 seconds, three times/week for 7, 14 and 28 days. The rats were sacrificed at the end of the therapeutic time period. The Sca-1 was examined by immunohistochemistry and histomorphometry, and COLA1, COLA2 and COLA3 gene expression was examined by qRT-PCR. COLA2 gene expression was higher in PBM treated tendons than in the control group. The histomorphometric analysis coincided with increased number of mesenchymal cells, characterized by Sca-1 expression in the lesion region (p<0.001). PBM effectively interferes in tendon tissue repair after injury by stimulating mesenchymal cell proliferation and the synthesis of collagen type II, which is suggested to provide structural support to the interstitial tissues during the healing process of the Achilles tendon. Further studies are needed to confirm the role of PBM in tendon healing.
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Affiliation(s)
- Flávia Emi Akamatsu
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil.
| | - Walcy Rosolia Teodoro
- Rheumatology Division of the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo-SP, Brazil.
| | - Ana Maria Itezerote
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | | | - Samir Saleh
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | - Carlos Augusto Real Martinez
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | - Marcelo Lima Ribeiro
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | - José Aires Pereira
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | - Flávio Hojaij
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | - Mauro Andrade
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | - Alfredo Luiz Jacomo
- Department of Surgery, Laboratory of Medical Research - Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
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35
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Siadat SM, Zamboulis DE, Thorpe CT, Ruberti JW, Connizzo BK. Tendon Extracellular Matrix Assembly, Maintenance and Dysregulation Throughout Life. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1348:45-103. [PMID: 34807415 DOI: 10.1007/978-3-030-80614-9_3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In his Lissner Award medal lecture in 2000, Stephen Cowin asked the question: "How is a tissue built?" It is not a new question, but it remains as relevant today as it did when it was asked 20 years ago. In fact, research on the organization and development of tissue structure has been a primary focus of tendon and ligament research for over two centuries. The tendon extracellular matrix (ECM) is critical to overall tissue function; it gives the tissue its unique mechanical properties, exhibiting complex non-linear responses, viscoelasticity and flow mechanisms, excellent energy storage and fatigue resistance. This matrix also creates a unique microenvironment for resident cells, allowing cells to maintain their phenotype and translate mechanical and chemical signals into biological responses. Importantly, this architecture is constantly remodeled by local cell populations in response to changing biochemical (systemic and local disease or injury) and mechanical (exercise, disuse, and overuse) stimuli. Here, we review the current understanding of matrix remodeling throughout life, focusing on formation and assembly during the postnatal period, maintenance and homeostasis during adulthood, and changes to homeostasis in natural aging. We also discuss advances in model systems and novel tools for studying collagen and non-collagenous matrix remodeling throughout life, and finally conclude by identifying key questions that have yet to be answered.
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Affiliation(s)
| | - Danae E Zamboulis
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Chavaunne T Thorpe
- Comparative Biomedical Sciences, The Royal Veterinary College, University of London, London, UK
| | - Jeffrey W Ruberti
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Brianne K Connizzo
- Department of Biomedical Engineering, Boston University, Boston, MA, USA.
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36
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Khayyeri H, Hammerman M, Turunen MJ, Blomgran P, Notermans T, Guizar-Sicairos M, Eliasson P, Aspenberg P, Isaksson H. Diminishing effects of mechanical loading over time during rat Achilles tendon healing. PLoS One 2020; 15:e0236681. [PMID: 33315857 PMCID: PMC7735574 DOI: 10.1371/journal.pone.0236681] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/23/2020] [Indexed: 01/07/2023] Open
Abstract
Mechanical loading affects tendon healing and recovery. However, our understanding about how physical loading affects recovery of viscoelastic functions, collagen production and tissue organisation is limited. The objective of this study was to investigate how different magnitudes of loading affects biomechanical and collagen properties of healing Achilles tendons over time. Achilles tendon from female Sprague Dawley rats were cut transversely and divided into two groups; normal loading (control) and reduced loading by Botox (unloading). The rats were sacrificed at 1, 2- and 4-weeks post-injury and mechanical testing (creep test and load to failure), small angle x-ray scattering (SAXS) and histological analysis were performed. The effect of unloading was primarily seen at the early time points, with inferior mechanical and collagen properties (SAXS), and reduced histological maturation of the tissue in unloaded compared to loaded tendons. However, by 4 weeks no differences remained. SAXS and histology revealed heterogeneous tissue maturation with more mature tissue at the peripheral region compared to the center of the callus. Thus, mechanical loading advances Achilles tendon biomechanical and collagen properties earlier compared to unloaded tendons, and the spatial variation in tissue maturation and collagen organization across the callus suggests important regional (mechano-) biological activities that require more investigation.
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Affiliation(s)
- Hanifeh Khayyeri
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Malin Hammerman
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mikael J. Turunen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Parmis Blomgran
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thomas Notermans
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Pernilla Eliasson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Aspenberg
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- * E-mail:
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37
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Randelli F, Sartori P, Carlomagno C, Bedoni M, Menon A, Vezzoli E, Sommariva M, Gagliano N. The Collagen-Based Medical Device MD-Tissue Acts as a Mechanical Scaffold Influencing Morpho-Functional Properties of Cultured Human Tenocytes. Cells 2020; 9:cells9122641. [PMID: 33302563 PMCID: PMC7763591 DOI: 10.3390/cells9122641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/27/2022] Open
Abstract
Mechanotransduction is the ability of cells to translate mechanical stimuli into biochemical signals that can ultimately influence gene expression, cell morphology and cell fate. Tenocytes are responsible for tendon mechanical adaptation converting mechanical stimuli imposed during mechanical loading, thus affecting extracellular matrix homeostasis. Since we previously demonstrated that MD-Tissue, an injectable collagen-based medical compound containing swine-derived collagen as the main component, is able to affect tenocyte properties, the aim of this study was to analyze whether the effects triggered by MD-Tissue were based on mechanotransduction-related mechanisms. For this purpose, MD-Tissue was used to coat Petri dishes and cytochalasin B was used to deprive tenocytes of mechanical stimulation mediated by the actin cytoskeleton. Cell morphology, migration, collagen turnover pathways and the expression of key mechanosensors were analyzed by morphological and molecular methods. Our findings confirm that MD-Tissue affects collagen turnover pathways and favors cell migration and show that the MD-Tissue-induced effect represents a mechanical input involving the mechanotransduction machinery. Overall, MD-Tissue, acting as a mechanical scaffold, could represent an effective medical device for a novel therapeutic, regenerative and rehabilitative approach to favor tendon healing in tendinopathies.
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Affiliation(s)
- Filippo Randelli
- Hip Department (CAD) Gaetano Pini—CTO Orthopedic Institute, Università degli Studi di Milano, Piazza Cardinal Ferrari 1, 20122 Milan, Italy;
| | - Patrizia Sartori
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
| | - Cristiano Carlomagno
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; (C.C.); (M.B.)
| | - Marzia Bedoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; (C.C.); (M.B.)
| | - Alessandra Menon
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Elena Vezzoli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
| | - Michele Sommariva
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
| | - Nicoletta Gagliano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milan, Italy; (P.S.); (A.M.); (E.V.); (M.S.)
- Correspondence: ; Tel.: +39-02-50315374
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Xiao S, Shao Y, Li B, Feng XQ. A micromechanical model of tendon and ligament with crimped fibers. J Mech Behav Biomed Mater 2020; 112:104086. [DOI: 10.1016/j.jmbbm.2020.104086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
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Neph A, Schroeder A, Enseki KR, Everts PA, Wang JHC, Onishi K. Role of Mechanical Loading for Platelet-Rich Plasma-Treated Achilles Tendinopathy. Curr Sports Med Rep 2020; 19:209-216. [PMID: 32516191 DOI: 10.1249/jsr.0000000000000719] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is no consensus on the optimal rehabilitation protocol after platelet-rich plasma (PRP) treatment for tendinopathy despite basic science studies showing the critical role of mechanical loading in the restoration of tendon structure and function posttreatment. In this article, we will review tendon mechanobiology, platelet biology, and review levels I and II Achilles tendon clinical studies paying particular attention to the role of mechanical loading in rehabilitation of injured tendons. Animal studies emphasize the synergistic effect of mechanical tendon loading and PRP to treat tendon injury while clinical studies described minimal details on loading protocols.
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Affiliation(s)
- Alyssa Neph
- Department of Physical Medicine and Rehabilitation at University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Allison Schroeder
- Department of Physical Medicine and Rehabilitation at University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Keelen R Enseki
- University of Pittsburgh Medical Center Centers for Rehab Services, Pittsburgh, PA
| | - Peter A Everts
- Scientific and Research Department at Gulf Coast Biologics, Fort Myers, FL
| | - James H-C Wang
- Department of Orthopedic Surgery at University of Pittsburgh School of Medicine, Pittsburgh, PA
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Suwanno P, Omokawa S, Nakanishi Y, Kira T, Tanaka Y. Safe zone of pin insertion for nonbridging external fixators in distal radial fractures: MRI analysis. J Orthop Sci 2020; 25:1003-1007. [PMID: 31959381 DOI: 10.1016/j.jos.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/07/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Of the anatomical reduction and fixation methods used to treat distal radius fracture, non-bridging external fixation has the advantage of enabling early wrist motion. The surgical technique relies on successful placement of the pin in individual fracture fragments. The present study aimed to identify the safe zone of pin insertion for a non-bridging external fixator into the distal radius that avoids metal impingement of extensor tendons. METHODS The width and length of the septal attachments of the extensor retinaculum were measured on axial MR images of 62 wrists. RESULTS The 2-3 septum was the widest and longest, with a width of 2-7 mm and a location 0-36 mm proximal to the wrist joint. The width of the 1-2 septum was 2-6 mm, and was widest at 10 mm proximal to the joint. The 1-2 septum was triangular-shaped, while the 2-3 septum was oval-shaped. The 3-4 and 4-5 septa had narrow attachments and were adequate for pin insertion (with a pin 1-2 mm in width) at a position less than 8 mm proximal to the wrist. The width of the 1 R septum (radial to the 1st septum) was 2-6 mm at the radiovolar aspect of the wrist. CONCLUSIONS There were two safe pin insertion sites; the first was safe at the distal aspect only (8-10 mm proximal to the wrist) and included the 1-2, 3-4, and 4-5 septa, while the second was safe from 0 mm to 32-38 mm proximal to the wrist and included the 1 R and the 2-3 septa. The 1 R septum had adequate size for use as a new pin insertion site that aligns in the internervous plane and has minimal risk of superficial radial nerve injury.
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Affiliation(s)
- Pormes Suwanno
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University 15 Karnjanavanich Rd., Hat Yai, Songkhla, 90110, Thailand
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yasuaki Nakanishi
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tsutomu Kira
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Wang HN, Huang YC, Ni GX. Mechanotransduction of stem cells for tendon repair. World J Stem Cells 2020; 12:952-965. [PMID: 33033557 PMCID: PMC7524696 DOI: 10.4252/wjsc.v12.i9.952] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/06/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Tendon is a mechanosensitive tissue that transmits force from muscle to bone. Physiological loading contributes to maintaining the homeostasis and adaptation of tendon, but aberrant loading may lead to injury or failed repair. It is shown that stem cells respond to mechanical loading and play an essential role in both acute and chronic injuries, as well as in tendon repair. In the process of mechanotransduction, mechanical loading is detected by mechanosensors that regulate cell differentiation and proliferation via several signaling pathways. In order to better understand the stem-cell response to mechanical stimulation and the potential mechanism of the tendon repair process, in this review, we summarize the source and role of endogenous and exogenous stem cells active in tendon repair, describe the mechanical response of stem cells, and finally, highlight the mechanotransduction process and underlying signaling pathways.
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Affiliation(s)
- Hao-Nan Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Yong-Can Huang
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
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Citeroni MR, Ciardulli MC, Russo V, Della Porta G, Mauro A, El Khatib M, Di Mattia M, Galesso D, Barbera C, Forsyth NR, Maffulli N, Barboni B. In Vitro Innovation of Tendon Tissue Engineering Strategies. Int J Mol Sci 2020; 21:E6726. [PMID: 32937830 PMCID: PMC7555358 DOI: 10.3390/ijms21186726] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Tendinopathy is the term used to refer to tendon disorders. Spontaneous adult tendon healing results in scar tissue formation and fibrosis with suboptimal biomechanical properties, often resulting in poor and painful mobility. The biomechanical properties of the tissue are negatively affected. Adult tendons have a limited natural healing capacity, and often respond poorly to current treatments that frequently are focused on exercise, drug delivery, and surgical procedures. Therefore, it is of great importance to identify key molecular and cellular processes involved in the progression of tendinopathies to develop effective therapeutic strategies and drive the tissue toward regeneration. To treat tendon diseases and support tendon regeneration, cell-based therapy as well as tissue engineering approaches are considered options, though none can yet be considered conclusive in their reproduction of a safe and successful long-term solution for full microarchitecture and biomechanical tissue recovery. In vitro differentiation techniques are not yet fully validated. This review aims to compare different available tendon in vitro differentiation strategies to clarify the state of art regarding the differentiation process.
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Affiliation(s)
- Maria Rita Citeroni
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Maria Camilla Ciardulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (G.D.P.); (N.M.)
| | - Valentina Russo
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (G.D.P.); (N.M.)
- Interdepartment Centre BIONAM, Università di Salerno, via Giovanni Paolo I, 84084 Fisciano (SA), Italy
| | - Annunziata Mauro
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Mohammad El Khatib
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Miriam Di Mattia
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
| | - Devis Galesso
- Fidia Farmaceutici S.p.A., via Ponte della Fabbrica 3/A, 35031 Abano Terme (PD), Italy; (D.G.); (C.B.)
| | - Carlo Barbera
- Fidia Farmaceutici S.p.A., via Ponte della Fabbrica 3/A, 35031 Abano Terme (PD), Italy; (D.G.); (C.B.)
| | - Nicholas R. Forsyth
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Stoke on Trent ST4 7QB, UK;
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (G.D.P.); (N.M.)
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST5 5BG, UK
| | - Barbara Barboni
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.E.K.); (M.D.M.); (B.B.)
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Kim YH, Park GY, Rabinovitch N, Tarafder S, Lee CH. Effect of local anesthetics on viability and differentiation of various adult stem/progenitor cells. Stem Cell Res Ther 2020; 11:385. [PMID: 32894184 PMCID: PMC7487635 DOI: 10.1186/s13287-020-01905-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/11/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local anesthetics (LAs) are widely used to control pain during various clinical treatments. One of the side effects of LAs, cytotoxicity, has been investigated in various cells including stem/progenitor cells. However, our understanding of the effects of LAs on the differentiation capacity of stem/progenitor cells still remains limited. Therefore, a comparative study was conducted to investigate the effects of multiple LAs on viability and multi-lineage differentiation of stem/progenitor cells that originated from various adult tissues. METHOD Multiple types of stem/progenitor cells, including bone marrow mesenchymal stem/progenitor cells (MSCs), dental pulp stem/progenitor cells (DPSCs), periodontal ligament stem/progenitor cells (PDLSCs), and tendon-derived stem/progenitor cells, were either obtained from a commercial provider or isolated from adult human donors. Lidocaine (LD) and bupivacaine (BP) at various doses (1×, 0.75×, 0.5×, and 0.25× of each physiological dose) were applied to the different stem/progenitor cells for an hour, followed by induction of fibrogenic, chondrogenic, osteogenic, and adipogenic differentiation. Live/dead and MTT assays were performed at 24 h after the LD or BP treatment. At 2 weeks, qRT-PCR was conducted to evaluate the gene expressions associated with differentiation. After 4 weeks, multiple biochemical staining was performed to evaluate matrix deposition. RESULTS At 24 h after LD or BP treatment, 1× and 0.75× physiological doses of LD and BP showed significant cytotoxicity in all the tested adult stem/progenitor cells. At 0.5×, BP resulted in higher viability than the same dose LD, with variance between cell types. Overall, the gene expressions associated with fibrogenic, chondrogenic, osteogenic, and adipogenic differentiation were attenuated in LD or BP pre-treated stem/progenitor cells, with notable dose-effect and dependence on types. In contrast, certain doses of LD and/or BP were found to increase specific gene expression, depending on the cell types. CONCLUSION Our data suggest that LAs such as LD and BP affect not only the viability but also the differentiation capacity of adult stem/progenitor cells from various anatomical sites. This study sheds light on stem cell applications for tissue regeneration in which isolation and transplantation of stem cells frequently involve LA administration.
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Affiliation(s)
- Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ga Young Park
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, 630 West 168th Street, VC12-211, New York, NY, 10032, USA
| | - Nechama Rabinovitch
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, 630 West 168th Street, VC12-211, New York, NY, 10032, USA
| | - Solaiman Tarafder
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, 630 West 168th Street, VC12-211, New York, NY, 10032, USA
| | - Chang H Lee
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, 630 West 168th Street, VC12-211, New York, NY, 10032, USA.
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Jaiswal D, Yousman L, Neary M, Fernschild E, Zolnoski B, Katebifar S, Rudraiah S, Mazzocca AD, Kumbar SG. Tendon tissue engineering: biomechanical considerations. Biomed Mater 2020; 15:052001. [DOI: 10.1088/1748-605x/ab852f] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kuznetsov S, Pankow M, Peters K, Huang HYS. A structural-based computational model of tendon-bone insertion tissues. Math Biosci 2020; 327:108411. [PMID: 32623027 DOI: 10.1016/j.mbs.2020.108411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/28/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
Tendon-to-bone insertion provides a gradual transition from soft tendon to hard bone tissue, functioning to alleviate stress concentrations at the junction of these tissues. Such macroscopic mechanical properties are achieved due to the internal structure in which collagen fibers and mineralization levels are key ingredients. We develop a structural-based model of tendon-to-bone insertion incorporating such details as fiber preferred orientation, fiber directional dispersion, mineralization level, and their inhomogeneous spatial distribution. A python script is developed to alter the tapered tendon-bone transition zone and to provide spatial grading of material properties, which may be rather complex as experiments suggest. A simple linear interpolation between tendon and bone material properties is first used to describe the graded property within the insertion region. Stress distributions are obtained and compared for spatially graded and various piece-wise materials properties. It is observed that spatial grading results in more smooth stress distributions and significantly reduces maximum stresses. The geometry of the tissue model is optimized by minimizing the peak stress to mimic in-vivo tissue remodeling. The in-silico elastic models constructed in this work are verified and modified by comparing to our in-situ biaxial mechanical testing results, thereby serving as translational tools for accurately predicting the material behavior of the tendon-to-bone insertions. This model will be useful for understanding how tendon-to-bone insertion develops during tissue remodeling, as well as for developing orthopedic implants.
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Affiliation(s)
| | - Mark Pankow
- North Carolina State University, United States of America
| | - Kara Peters
- North Carolina State University, United States of America
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Safa BN, Bloom ET, Lee AH, Santare MH, Elliott DM. Evaluation of transverse poroelastic mechanics of tendon using osmotic loading and biphasic mixture finite element modeling. J Biomech 2020; 109:109892. [PMID: 32807341 DOI: 10.1016/j.jbiomech.2020.109892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
Tendon's viscoelastic behaviors are important to the tissue mechanical function and cellular mechanobiology. When loaded in longitudinal tension, tendons often have a large Poisson's ratio (ν>2) that exceeds the limit of incompressibility for isotropic material (ν=0.5), indicating that tendon experiences volume loss, inducing poroelastic fluid exudation in the transverse direction. Therefore, transverse poroelasticity is an important contributor to tendon material behavior. Tendon hydraulic permeability which is required to evaluate the fluid flow contribution to viscoelasticity, is mostly unavailable, and where available, varies by several orders of magnitude. In this manuscript, we quantified the transverse poroelastic material parameters of rat tail tendon fascicles by conducting transverse osmotic loading experiments, in both tension and compression. We used a multi-start optimization method to evaluate the parameters using biphasic finite element modeling. Our tendon samples had a transverse hydraulic permeability of 10-4 to 10-5 mm4. (Ns)-1 and showed a significant tension-compression nonlinearity in the transverse direction. Further, using these results, we predict hydraulic permeability during longitudinal (fiber-aligned) tensile loading, and the spatial distribution of fluid flow during osmotic loading. These results reveal novel aspects of tendon mechanics and can be used to study the physiomechanical response of tendon in response to mechanical loading.
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Affiliation(s)
- Babak N Safa
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Ellen T Bloom
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Andrea H Lee
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Michael H Santare
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States.
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Nguyen TD, Hu AC, Protsenko DE, Wong BJF. Effects of electromechanical reshaping on mechanical behavior of exvivo bovine tendon. Clin Biomech (Bristol, Avon) 2020; 73:92-100. [PMID: 31958703 DOI: 10.1016/j.clinbiomech.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/26/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electromechanical reshaping is a novel, minimally invasive means to induce mechanical changes in connective tissues, and has the potential to be utilized in lieu of current orthopedic therapies that involve tendons and ligaments. Electromechanical reshaping delivers an electrical current to tissues while under mechanical deformation, causing in situ redox changes that produce reliably controlled and spatially limited mechanical and structural changes. In this study, we examine the feasibility of altering Young's modulus and inducing a shape deformation using an ex vivo bovine Achilles tendon model. METHODS Tendon was mechanically deformed in two different modes: (1) elongation to assess for tensile modulus and (2) compression to assess for compressive modulus. Electromechanical reshaping was applied to tendon specimens via flat plate platinum electrodes (6 V, 3 min) while simultaneously under mechanical strain for 15 min. FINDINGS In elongation mode, post-electromechanical reshaping samples demonstrated a significant decrease in Young's modulus compared to pretreatment samples (66.02 and 45.12 MPa, respectively, p < 0.0049). In compression mode, posttreatment samples illustrated a significant shape change, with an increase in diameter (10.62 to 11.36 mm, p < 0.05) and decrease in thickness (4.13 to 3.62 mm, p < 0.05). INTERPRETATION Results demonstrated a tissue softening effect without lengthening deformation during elongation, and a shortening effect without compromising compressive stiffness during compression. Electromechanical reshaping's reliable, low-cost, and efficacious methodology in inducing mechanical and structural connective tissue modifications illustrates a potential for future alternative orthopedic applications. Future studies will optimize and refine electromechanical reshaping to address clinically relevant geometries and methods such as needle techniques.
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Affiliation(s)
- Tony D Nguyen
- Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, CA, USA; Beckman Laser Institute, University of California, Irvine, CA, USA.
| | - Allison C Hu
- Beckman Laser Institute, University of California, Irvine, CA, USA; Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
| | - Dmitry E Protsenko
- Beckman Laser Institute, University of California, Irvine, CA, USA; Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
| | - Brian J F Wong
- Beckman Laser Institute, University of California, Irvine, CA, USA; Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
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Tendon and ligament mechanical loading in the pathogenesis of inflammatory arthritis. Nat Rev Rheumatol 2020; 16:193-207. [PMID: 32080619 DOI: 10.1038/s41584-019-0364-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
Mechanical loading is an important factor in musculoskeletal health and disease. Tendons and ligaments require physiological levels of mechanical loading to develop and maintain their tissue architecture, a process that is achieved at the cellular level through mechanotransduction-mediated fine tuning of the extracellular matrix by tendon and ligament stromal cells. Pathological levels of force represent a biological (mechanical) stress that elicits an immune system-mediated tissue repair pathway in tendons and ligaments. The biomechanics and mechanobiology of tendons and ligaments form the basis for understanding how such tissues sense and respond to mechanical force, and the anatomical extent of several mechanical stress-related disorders in tendons and ligaments overlaps with that of chronic inflammatory arthritis in joints. The role of mechanical stress in 'overuse' injuries, such as tendinopathy, has long been known, but mechanical stress is now also emerging as a possible trigger for some forms of chronic inflammatory arthritis, including spondyloarthritis and rheumatoid arthritis. Thus, seemingly diverse diseases of the musculoskeletal system might have similar mechanisms of immunopathogenesis owing to conserved responses to mechanical stress.
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In Vivo and In Vitro Mechanical Loading of Mouse Achilles Tendons and Tenocytes-A Pilot Study. Int J Mol Sci 2020; 21:ijms21041313. [PMID: 32075290 PMCID: PMC7072865 DOI: 10.3390/ijms21041313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022] Open
Abstract
Mechanical force is a key factor for the maintenance, adaptation, and function of tendons. Investigating the impact of mechanical loading in tenocytes and tendons might provide important information on in vivo tendon mechanobiology. Therefore, the study aimed at understanding if an in vitro loading set up of tenocytes leads to similar regulations of cell shape and gene expression, as loading of the Achilles tendon in an in vivo mouse model. In vivo: The left tibiae of mice (n = 12) were subject to axial cyclic compressive loading for 3 weeks, and the Achilles tendons were harvested. The right tibiae served as the internal non-loaded control. In vitro: tenocytes were isolated from mice Achilles tendons and were loaded for 4 h or 5 days (n = 6 per group) based on the in vivo protocol. Histology showed significant differences in the cell shape between in vivo and in vitro loading. On the molecular level, quantitative real-time PCR revealed significant differences in the gene expression of collagen type I and III and of the matrix metalloproteinases (MMP). Tendon-associated markers showed a similar expression profile. This study showed that the gene expression of tendon markers was similar, whereas significant changes in the expression of extracellular matrix (ECM) related genes were detected between in vivo and in vitro loading. This first pilot study is important for understanding to which extent in vitro stimulation set-ups of tenocytes can mimic in vivo characteristics.
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50
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Connizzo BK, Piet JM, Shefelbine SJ, Grodzinsky AJ. Age-associated changes in the response of tendon explants to stress deprivation is sex-dependent. Connect Tissue Res 2020; 61:48-62. [PMID: 31411079 PMCID: PMC6884684 DOI: 10.1080/03008207.2019.1648444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose of the Study: The incidence of tendon injuries increases dramatically with age, which presents a major clinical burden. While previous studies have sought to identify age-related changes in extracellular matrix structure and function, few have been able to explain fully why aged tissues are more prone to degeneration and injury. In addition, recent studies have also demonstrated that age-related processes in humans may be sex-dependent, which could be responsible for muddled conclusions in changes with age. In this study, we investigate short-term responses through an ex vivo explant culture model of stress deprivation that specifically questions how age and sex differentially affect the ability of tendons to respond to altered mechanical stimulus.Materials and Methods: We subjected murine flexor explants from young (4 months of age) and aged (22-24 months of age) male and female mice to stress-deprived culture conditions for up to 1 week and investigated changes in viability, cell metabolism and proliferation, matrix biosynthesis and composition, gene expression, and inflammatory responses throughout the culture period.Results and Conclusions: We found that aging did have a significant influence on the response to stress deprivation, demonstrating that aged explants have a less robust response overall with reduced metabolic activity, viability, proliferation, and biosynthesis. However, age-related changes appeared to be sex-dependent. Together, this work demonstrates that the aging process and the subsequent effect of age on the ability of tendons to respond to stress-deprivation are inherently different based on sex, where male explants favor increased activity, apoptosis, and matrix remodeling while female explants favor reduced activity and tissue preservation.
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Affiliation(s)
- Brianne K. Connizzo
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Correspondence: Brianne K. Connizzo, 70 Massachusetts Avenue, NE47-377, Cambridge, MA 02139, T: 617-253-2469,
| | - Judith M. Piet
- Department of Bioengineering, Northeastern University, Boston, MA 02115, United States
| | - Sandra J. Shefelbine
- Department of Bioengineering, Northeastern University, Boston, MA 02115, United States,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, United States
| | - Alan J. Grodzinsky
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Center for Biomedical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
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