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Elmounedi N, Keskes H. Establishment of intervertebral disc degeneration models; A review of the currently used models. J Orthop 2024; 56:50-56. [PMID: 38784950 PMCID: PMC11109335 DOI: 10.1016/j.jor.2024.05.020] [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] [Received: 04/29/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
One of the frequent causes of low back pain is intervertebral disc degeneration (IDD), which is followed by discogenic pain. Some significant risk factors that have been linked to the onset and progression of IDD include age, mechanical imbalance, changes in nutrition and inflammation. According to recent studies, five types of animal models are established for producing IDD: the spontaneous models, the puncture models, the biomechanical models, the chemical models and the hybrid models. These models are crucial in studying and understanding IDD's natural history and identifying potential treatment targets for IDD. In our study, we'll talk about the technical aspects of these models, the time between model establishment and the apparition of observable degradation, and their potential in various research. Each animal model should be compared to the human natural IDD pathogenesis to guide future research efforts in this area. By improving knowledge and appropriate application of various animal models, we seek to raise awareness of this illness and further translational research.
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Affiliation(s)
- Najah Elmounedi
- Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP1 Lab, Faculty of Medicine, Sfax, Tunisia
| | - Hassib Keskes
- Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP1 Lab, Faculty of Medicine, Sfax, Tunisia
- Department of Orthopedics and Traumatology, CHU Habib Bourguiba, Sfax, Tunisia
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Co M, Raterman B, Klamer B, Kolipaka A, Walter B. Nucleus pulposus structure and function assessed in shear using magnetic resonance elastography, quantitative MRI, and rheometry. JOR Spine 2024; 7:e1335. [PMID: 38741919 PMCID: PMC11089841 DOI: 10.1002/jsp2.1335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Background In vivo quantification of the structure-function relationship of the intervertebral disc (IVD) via quantitative MRI has the potential to aid objective stratification of disease and evaluation of restorative therapies. Magnetic resonance elastography (MRE) is an imaging technique that assesses tissue shear properties and combined with quantitative MRI metrics reflective of composition can inform structure-function of the IVD. The objectives of this study were to (1) compare MRE- and rheometry-derived shear modulus in agarose gels and nucleus pulposus (NP) tissue and (2) correlate MRE and rheological measures of NP tissue with composition and quantitative MRI. Method MRE and MRI assessment (i.e., T1ρ and T2 mapping) of agarose samples (2%, 3%, and 4% (w/v); n = 3-4/%) and of bovine caudal IVDs after equilibrium dialysis in 5% or 25% PEG (n = 13/PEG%) was conducted. Subsequently, agarose and NP tissue underwent torsional mechanical testing consisting of a frequency sweep from 1 to 100 Hz at a rotational strain of 0.05%. NP tissue was additionally evaluated under creep and stress relaxation conditions. Linear mixed-effects models and univariate regression analyses evaluated the effects of testing method, %agarose or %PEG, and frequency, as well as correlations between parameters. Results MRE- and rheometry-derived shear moduli were greater at 100 Hz than at 80 Hz in all agarose and NP tissue samples. Additionally, all samples with lower water content had higher complex shear moduli. There was a significant correlation between MRE- and rheometry-derived modulus values for homogenous agarose samples. T1ρ and T2 relaxation times for agarose and tissue were negatively correlated with complex shear modulus derived from both techniques. For NP tissue, shear modulus was positively correlated with GAG/wet-weight and negatively correlated with %water content. Conclusion This work demonstrates that MRE can assess hydration-induced changes in IVD shear properties and further highlights the structure-function relationship between composition and shear mechanical behaviors of NP tissue.
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Affiliation(s)
- Megan Co
- Department of Biomedical EngineeringThe Ohio State UniversityColumbusOhioUSA
| | - Brian Raterman
- Department of RadiologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Brett Klamer
- Department of Biomedical Informatics, Center for BiostatisticsThe Ohio State UniversityColumbusOhioUSA
| | - Arunark Kolipaka
- Department of RadiologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Benjamin Walter
- Department of Biomedical EngineeringThe Ohio State UniversityColumbusOhioUSA
- Department of OrthopaedicsThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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Co M, Pack C, Osborn-King Z, Raterman B, Kolipaka A, Bentil SA, Walter BA. Modeling the effects of hydration on viscoelastic properties of nucleus pulposus tissue in shear using the fractional Zener model. J Biomech 2024; 164:111965. [PMID: 38354514 PMCID: PMC11097896 DOI: 10.1016/j.jbiomech.2024.111965] [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: 08/29/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
Nucleus pulposus (NP) tissue in the intervertebral disc (IVD) is a viscoelastic material exhibiting both solid- and fluid-like mechanical behaviors. Advances in viscoelastic models incorporating fractional calculus, such as the Fractional Zener (FZ) model, have potential to describe viscoelastic behaviors. The objectives of this study were to determine whether the FZ model can accurately describe the shear viscoelastic properties of NP tissue and determine if the fractional order (α) is related to tissue hydration. 30 caudal IVDs underwent equilibrium dialysis in 5% or 25% polyethylene glycol solutions to alter tissue hydration. Excised NP tissue underwent stress relaxation testing in shear and unconfined compression. Stress relaxation data was fitted to the FZ model to obtain viscoelastic properties. In both loading modes, the initial modulus was greater for the less hydrated 25% equilibrated samples compared to 5% with no change in the equilibrium modulus. Samples with lower water content (25% samples) had shorter relaxation times in shear and longer time constants in compression, highlighting the different interactions between the fluid and solid matrix in loading modes. Samples with lower water content had α values closer to 0, indicating that less hydrated samples behaved more solid-like on the viscoelastic spectrum. Tissue hydration correlated with α values for 25% samples in shear. This study demonstrates that the FZ model may be used to describe IVD tissue behavior under both loading modes; however, the greatest utility of the FZ model is in describing flow-independent shear behaviors, and α may inform tissue hydration in shear.
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Affiliation(s)
- Megan Co
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Chelsea Pack
- Department of Biomedical Engineering, West Virginia University, Morgantown, WV, United States
| | - Zachary Osborn-King
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Brian Raterman
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Arunark Kolipaka
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States; Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Sarah A Bentil
- Department of Mechanical Engineering, Iowa State University, Ames, IA, United States
| | - Benjamin A Walter
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
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Muir VG, Fainor M, Orozco BS, Hilliard RL, Boyes M, Smith HE, Mauck RL, Schaer TP, Burdick JA, Gullbrand SE. Injectable Radiopaque Hyaluronic Acid Granular Hydrogels for Intervertebral Disc Repair. Adv Healthc Mater 2023:e2303326. [PMID: 38142300 PMCID: PMC11193841 DOI: 10.1002/adhm.202303326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/10/2023] [Indexed: 12/25/2023]
Abstract
Injectable hydrogels offer minimally-invasive treatment options for degenerative disc disease, a prevalent condition affecting millions annually. Many hydrogels explored for intervertebral disc (IVD) repair suffer from weak mechanical integrity, migration issues, and expulsion. To overcome these limitations, an injectable and radiopaque hyaluronic acid granular hydrogel is developed. The granular structure provides easy injectability and low extrusion forces, while the radiopacity enables direct visualization during injection into the disc and non-invasive monitoring after injection. The radiopaque granular hydrogel is injected into rabbit disc explants to investigate restoration of healthy disc mechanics following needle puncture injury ex vivo and then delivered in a minimally-invasive manner into the intradiscal space in a clinically-relevant in vivo large animal goat model of IVD degeneration initiated through degradation by chondroitinase. The radiopaque granular hydrogel successfully halted loss of disc height due to degeneration. Further, the hydrogel not only enhanced proteoglycan content and reduced collagen content in the nucleus pulposus (NP) region compared to degenerative discs, but also helped to maintain the structural integrity of the disc and promote healthy segregation of the NP and annulus fibrosus regions. Overall, this study demonstrates the great potential of an injectable radiopaque granular hydrogel for treatment of degenerative disc disease.
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Affiliation(s)
- Victoria G Muir
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Matthew Fainor
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
| | - Brianna S Orozco
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
| | - Rachel L Hilliard
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Madeline Boyes
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Harvey E Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
| | - Robert L Mauck
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jason A Burdick
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, 19104, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, 80303, USA
- Department of Chemical and Biological Engineering, College of Engineering and Applied Science, University of Colorado Boulder, Boulder, CO, 80303, USA
| | - Sarah E Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
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Fainor M, Orozco BS, Muir VG, Mahindroo S, Gupta S, Mauck RL, Burdick JA, Smith HE, Gullbrand SE. Mechanical crosstalk between the intervertebral disc, facet joints, and vertebral endplate following acute disc injury in a rabbit model. JOR Spine 2023; 6:e1287. [PMID: 38156057 PMCID: PMC10751980 DOI: 10.1002/jsp2.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
Background Vertebral endplate sclerosis and facet osteoarthritis have been documented in animals and humans. However, it is unclear how these adjacent pathologies engage in crosstalk with the intervertebral disc. This study sought to elucidate this crosstalk by assessing each compartment individually in response to acute disc injury. Methods Eleven New Zealand White rabbits underwent annular disc puncture using a 16G or 21G needle. At 4 and 10 weeks, individual compartments of the motion segment were analyzed. Discs underwent T 1 relaxation mapping with MRI contrast agent gadodiamide as well T 2 mapping. Both discs and facets underwent mechanical testing via vertebra-disc-vertebra tension-compression creep testing and indentation testing, respectively. Endplate bone density was quantified via μCT. Discs and facets were sectioned and stained for histology scoring. Results Intervertebral discs became more degenerative with increasing needle diameter and time post-puncture. Bone density also increased in endplates adjacent to both 21G and 16G punctured discs leading to reduced gadodiamide transport at 10 weeks. The facet joints, however, did not follow this same trend. Facets adjacent to 16G punctured discs were less degenerative than facets adjacent to 21G punctured discs at 10 weeks. 16G facets were more degenerative at 4 weeks than at 10, suggesting the cartilage had recovered. The formation of severe disc osteophytes in 16G punctured discs between 4 and 10 weeks likely offloaded the facet cartilage, leading to the recovery observed. Conclusions Overall, this study supports that degeneration spans the whole spinal motion segment following disc injury. Vertebral endplate thickening occurred in response to disc injury, which limited the diffusion of small molecules into the disc. This work also suggests that altered disc mechanics can induce facet degeneration, and that extreme bony remodeling adjacent to the disc may promote facet cartilage recovery through offloading of the articular cartilage.
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Affiliation(s)
- Matthew Fainor
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Brianna S. Orozco
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Victoria G. Muir
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sonal Mahindroo
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BiologySt. Bonaventure UniversitySt. BonaventureNew YorkUSA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason A. Burdick
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- BioFrontiers Institute and Department of Chemical and Biological EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sarah E. Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
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6
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Peredo AP, Gullbrand SE, Friday CS, Orozco BS, Dehghani B, Jenk AC, Bonnevie ED, Hilliard RL, Zlotnick HM, Dodge GR, Lee D, Engiles JB, Hast MW, Schaer TP, Smith HE, Mauck RL. Tension-activated nanofiber patches delivering an anti-inflammatory drug improve repair in a goat intervertebral disc herniation model. Sci Transl Med 2023; 15:eadf1690. [PMID: 37967202 PMCID: PMC10812087 DOI: 10.1126/scitranslmed.adf1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
Conventional microdiscectomy treatment for intervertebral disc herniation alleviates pain but does not repair the annulus fibrosus, resulting in a high incidence of recurrent herniation and persistent dysfunction. The lack of repair and the acute inflammation that arise after injury can further compromise the disc and result in disc-wide degeneration in the long term. To address this clinical need, we developed tension-activated repair patches (TARPs) for annulus fibrosus repair and local delivery of the anti-inflammatory factor anakinra (a recombinant interleukin-1 receptor antagonist). TARPs transmit physiologic strain to mechanically activated microcapsules embedded within the patch, which release encapsulated bioactive molecules in direct response to spinal loading. Mechanically activated microcapsules carrying anakinra were loaded into TARPs, and the effects of TARP-mediated annular repair and anakinra delivery were evaluated in a goat model of annular injury in the cervical spine. TARPs integrated with native tissue and provided structural reinforcement at the injury site that prevented aberrant disc-wide remodeling resulting from detensioning of the annular fibrosus. The delivery of anakinra by TARP implantation increased matrix deposition and retention at the injury site and improved maintenance of disc extracellular matrix. Anakinra delivery additionally attenuated the inflammatory response associated with TARP implantation, decreasing osteolysis in adjacent vertebrae and preserving disc cellularity and matrix organization throughout the annulus fibrosus. These results demonstrate the therapeutic potential of TARPs for the treatment of intervertebral disc herniation.
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Affiliation(s)
- Ana P. Peredo
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Sarah E. Gullbrand
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Chet S. Friday
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
| | - Briana S. Orozco
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Bijan Dehghani
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Austin C. Jenk
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Edward D. Bonnevie
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Rachel L. Hilliard
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
| | - Hannah M. Zlotnick
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - George R. Dodge
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Daeyeon Lee
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania; Philadelphia, 19104, USA
| | - Julie B. Engiles
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
- Department of Pathobiology, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
| | - Michael W. Hast
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Thomas P. Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania; Philadelphia, PA 19348, USA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
| | - Robert L. Mauck
- Department of Bioengineering, University of Pennsylvania; Philadelphia, 19104, USA
- Department of Orthopaedic Surgery, University of Pennsylvania; Philadelphia, 19104, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center; Philadelphia, 19104, USA
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Lee W, Miller EY, Zhu H, Schneider SE, Reiter DA, Neu CP. Multi-frame biomechanical and relaxometry analysis during in vivo loading of the human knee by spiral dualMRI and compressed sensing. Magn Reson Med 2023; 90:995-1009. [PMID: 37213087 PMCID: PMC10330244 DOI: 10.1002/mrm.29690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Knee cartilage experiences repetitive loading during physical activities, which is altered during the pathogenesis of diseases like osteoarthritis. Analyzing the biomechanics during motion provides a clear understanding of the dynamics of cartilage deformation and may establish essential imaging biomarkers of early-stage disease. However, in vivo biomechanical analysis of cartilage during rapid motion is not well established. METHODS We used spiral displacement encoding with stimulated echoes (DENSE) MRI on in vivo human tibiofemoral cartilage during cyclic varus loading (0.5 Hz) and used compressed sensing on the k-space data. The applied compressive load was set for each participant at 0.5 times body weight on the medial condyle. Relaxometry methods were measured on the cartilage before (T1ρ , T2 ) and after (T1ρ ) varus load. RESULTS Displacement and strain maps showed a gradual shift of displacement and strain in time. Compressive strain was observed in the medial condyle cartilage and shear strain was roughly half of the compressive strain. Male participants had more displacement in the loading direction compared to females, and T1ρ values did not change after cyclic varus load. Compressed sensing reduced the scanning time up to 25% to 40% when comparing the displacement maps and substantially lowered the noise levels. CONCLUSION These results demonstrated the ease of which spiral DENSE MRI could be applied to clinical studies because of the shortened imaging time, while quantifying realistic cartilage deformations that occur through daily activities and that could serve as biomarkers of early osteoarthritis.
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Affiliation(s)
- Woowon Lee
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Emily Y. Miller
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
| | - Hongtian Zhu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Stephanie E. Schneider
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - David A. Reiter
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Corey P. Neu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
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Yang L, Sun C, Gong T, Li Q, Chen X, Zhang X. T1ρ, T2 and T2* mapping of lumbar intervertebral disc degeneration: a comparison study. BMC Musculoskelet Disord 2022; 23:1135. [PMID: 36575488 PMCID: PMC9793566 DOI: 10.1186/s12891-022-06040-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Early and accurate assessment of lumbar intervertebral disc degeneration (IVDD) is very important to therapeutic strategy. This study aims to correlate and compare the performances of T1ρ, T2 and T2* mapping for Pfirrmann grades and morphologic changes in the IVDD. METHODS This prospective study included 39 subjects with 195 lumbar discs. T1ρ, T2 and T2* mapping were performed, and T1ρ, T2 and T2* values of nucleus pulposus (NP), and anterior and posterior annulus fibrosus were measured. IVDD was assessed with Pfirrmann grading and morphologic changes (normal, bulging, herniation and annular fissure). The performances of T1ρ, T2 and T2* relaxation times were compared for detecting early (Pfirrmann grade II-III) and advanced degeneration (Pfirrmann grade IV-V), as well as for morphologic changes. RESULTS T2 relaxation times was strongly corelated with T1ρ and T2* relaxation times. Areas under the curves (AUCs) of T1ρ, T2 and T2* relaxation times of NP were 0.70, 0.87 and 0.80 for early degeneration, and 0.91, 0.95 and 0.82 for advanced degeneration, respectively. AUCs of T1ρ, T2 and T2* relaxation times of NP were 0.78, 0.83 and 0.64 for bulging discs, 0.87, 0.89 and 0.69 for herniated discs, and 0.79, 0.82 and 0.69 for annular tearing, respectively. The AUC of T2 relaxation time was significantly higher than those of T1ρ relaxation times (both P < 0.01) for early IVDD, and the AUCs of T1ρ and T2 relaxation times for assessing advanced degeneration and morphologic changes were similar (P > 0.05) but significantly higher than that of T2*relaxation time (P < 0.01). CONCLUSIONS T2 mapping performed better than T1ρ mapping for the detection of early IVDD. T1ρ and T2 mapping performed similarly but better than T2* mapping for advanced degeneration and morphologic changes of IVDD.
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Affiliation(s)
- Li Yang
- grid.413087.90000 0004 1755 3939Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Cong Sun
- grid.414350.70000 0004 0447 1045Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing, 100730 China
| | - Tao Gong
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Quanlin Li
- grid.479672.9Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250012 Shandong China
| | - Xin Chen
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Xinjuan Zhang
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
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9
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Poletto DL, Crowley JD, Tanglay O, Walsh WR, Pelletier MH. Preclinical in vivo animal models of intervertebral disc degeneration. Part 1: A systematic review. JOR Spine 2022; 6:e1234. [PMID: 36994459 PMCID: PMC10041387 DOI: 10.1002/jsp2.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 12/24/2022] Open
Abstract
Intervertebral disc degeneration (IVDD), a widely recognized cause of lower back pain, is the leading cause of disability worldwide. A myriad of preclinical in vivo animal models of IVDD have been described in the literature. There is a need for critical evaluation of these models to better inform researchers and clinicians to optimize study design and ultimately, enhance experimental outcomes. The purpose of this study was to conduct an extensive systematic literature review to report the variability of animal species, IVDD induction method, and experimental timepoints and endpoints used in in vivo IVDD preclinical research. A systematic literature review of peer-reviewed manuscripts featured on PubMed and EMBASE databases was conducted in accordance with PRISMA guidelines. Studies were included if they reported an in vivo animal model of IVDD and included details of the species used, how disc degeneration was induced, and the experimental endpoints used for analysis. Two-hundred and fifty-nine (259) studies were reviewed. The most common species, IVDD induction method and experimental endpoint used was rodents(140/259, 54.05%), surgery (168/259, 64.86%) and histology (217/259, 83.78%), respectively. Experimental timepoint varied greatly between studies, ranging from 1 week (dog and rodent models), to >104 weeks in dog, horse, monkey, rabbit, and sheep models. The two most common timepoints used across all species were 4 weeks (49 manuscripts) and 12 weeks (44 manuscripts). A comprehensive discussion of the species, methods of IVDD induction and experimental endpoints is presented. There was great variability across all categories: animal species, method of IVDD induction, timepoints and experimental endpoints. While no animal model can replicate the human scenario, the most appropriate model should be selected in line with the study objectives to optimize experimental design, outcomes and improve comparisons between studies.
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Affiliation(s)
- Daniel L. Poletto
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine University of New South Wales (UNSW) Sydney, Prince of Wales Hospital Sydney Australia
| | - James D. Crowley
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine University of New South Wales (UNSW) Sydney, Prince of Wales Hospital Sydney Australia
| | - Onur Tanglay
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine University of New South Wales (UNSW) Sydney, Prince of Wales Hospital Sydney Australia
| | - William R. Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine University of New South Wales (UNSW) Sydney, Prince of Wales Hospital Sydney Australia
| | - Matthew H. Pelletier
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine University of New South Wales (UNSW) Sydney, Prince of Wales Hospital Sydney Australia
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10
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Role of Pyroptosis in Intervertebral Disc Degeneration and Its Therapeutic Implications. Biomolecules 2022; 12:biom12121804. [PMID: 36551232 PMCID: PMC9775394 DOI: 10.3390/biom12121804] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Intervertebral disc degeneration (IDD), a progressive and multifactorial pathological process, is predominantly associated with low back pain and permanent disability. Pyroptosis is a type of lytic programmed cell death triggered by the activation of inflammasomes and caspases. Unlike apoptosis, pyroptosis is characterized by the rupture of the plasma membrane and the release of inflammatory mediators, accelerating the destruction of the extracellular matrix (ECM). Recent studies have shown that pyrin domain-containing 3 (NLRP3) inflammasome-mediated pyroptosis in nucleus pulposus (NP) cells is activated in the progression of IDD. Furthermore, targeting pyroptosis in IDD demonstrates the excellent capacity of ECM remodeling and its anti-inflammatory properties, suggesting that pyroptosis is involved in the IDD process. In this review, we briefly summarize the molecular mechanism of pyroptosis and the pathogenesis of IDD. We also focus on the role of pyroptosis in the pathological progress of IDD and its targeted therapeutic application.
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11
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The Radial Bulging and Axial Strains of Intervertebral Discs during Creep Obtained with the 3D-DIC System. Biomolecules 2022; 12:biom12081097. [PMID: 36008991 PMCID: PMC9405674 DOI: 10.3390/biom12081097] [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: 06/12/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
Creep-associated changes in disc bulging and axial strains are essential for the research and development of mechano-bionic biomaterials and have been assessed in various ways in ex vivo creep studies. Nonetheless, the reported methods for measurement were limited by location inaccuracy, a lack of synchronousness, and destructiveness. To this end, this study focuses on the accurate, synchronous, and noninvasive assessment of bugling and strains using the 3D digital image correlation (3D-DIC) system and the impact of creep on them. After a preload of 30 min, the porcine cervical discs were loaded with different loads for 4 h of creep. Axial strains and lateral bulging of three locations on the discs were synchronously measured. The three-parameter solid model and the newly proposed horizontal asymptote models were used to fit the acquired data. The results showed that the load application reduced disc strains by 6.39% under 300 N, 11.28% under 400 N, and 12.59% under 500 N. Meanwhile, the largest protrusion occurred in the middle of discs with a bugling of 1.50 mm, 1.67 mm, and 1.87 mm. Comparison of the peer results showed that the 3D-DIC system could be used in ex vivo biomechanical studies with reliability and had potential in the assessment of the mechanical behavior of novel biomaterials. The phenomenon of the largest middle protrusion enlightened further the strength of spinal implants in this area. The mathematical characterizations of bulging and strains under different loads yielded various model parameters, which are prerequisites for developing implanted biomaterials.
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12
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Tang L, Xu C, Xuan A, Zhu Z, Ruan D. Functionalized self-assembling peptide RADKPS hydrogels promote regenerative repair of degenerated intervertebral discs. Biomater Sci 2022; 10:5134-5145. [PMID: 35820128 DOI: 10.1039/d2bm00634k] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: the aim of this study was to investigate whether the functionalized self-assembling peptide hydrogel RADKPS is safe and effective for regenerative repair of degenerative intervertebral discs. Methods: an in vitro degenerative model of human nucleus pulposus cells was constructed by serum starvation culture, and their proliferation, apoptosis and viability were examined after three-dimensional culture with the RADKPS hydrogel. An in vivo degenerative model of the rabbit intervertebral disc was constructed by annulus fibrosus puncture, and the degeneration of the intervertebral disc was evaluated by imaging, histology, immunohistochemistry, and biomechanics after RADKPS hydrogel intervention. Results: through in vitro cell experiments it is shown that human degenerated nucleus pulposus cells after three-dimensional culture with the RADKPS hydrogel still exhibited better proliferation, viability, and low apoptosis rate. Through in vivo animal experiments we found that rabbit degenerated intervertebral discs intervened with the RADKPS hydrogel had higher water content, better histological morphology, more extracellular matrix synthesis, and better biomechanical properties. It is demonstrated that the RADKPS hydrogel may initiate the endogenous repair process through the sustained recruitment and enrichment of nucleus pulposus progenitor cells. Conclusion: it is verified from both in vitro cellular experiments and in vivo animal experiments that the regenerative repair effect of RADKPS, a functionalized self-assembling peptide hydrogel, on degenerated intervertebral discs is safe and effective. It is shown that it would be a new therapeutic approach for the regenerative repair action of intervertebral discs.
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Affiliation(s)
- Liang Tang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China. .,Department of Orthopedic Surgery, Hengyang Central Hospital, Hunan, 421001, China
| | - Cheng Xu
- Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China.
| | - Anwu Xuan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Zhenbiao Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Orthopedic Surgery, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China.
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13
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Martin JT, Wesorick B, Oldweiler AB, Kosinski AS, Goode AP, DeFrate LE. In vivo fluid transport in human intervertebral discs varies by spinal level and disc region. JOR Spine 2022; 5:e1199. [PMID: 35783907 PMCID: PMC9238288 DOI: 10.1002/jsp2.1199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/25/2022] Open
Abstract
Background The lumbar discs are large, dense tissues that are primarily avascular, and cells residing in the central region of the disc are up to 6-8 mm from the nearest blood vessel in adults. To maintain homeostasis, disc cells rely on nutrient transport between the discs and adjacent vertebrae. Thus, diminished transport has been proposed as a factor in age-related disc degeneration. Methods In this study, we used magnetic resonance imaging (MRI) to quantify diurnal changes in T2 relaxation time, an MRI biomarker related to disc hydration, to generate 3D models of disc fluid distribution and determine how diurnal changes in fluid varied by spinal level. We recruited 10 participants (five males/five females; age: 21-30 years; BMI: 19.1-29.0 kg/m2) and evaluated the T2 relaxation time of each disc at 8:00 AM and 7:00 PM, as well as degeneration grade (Pfirrmann). We also measured disc height, volume, and perimeter in a subset of individuals as a preliminary comparison of geometry and transport properties. Results We found that the baseline (AM) T2 relaxation time and the diurnal change in T2 relaxation time were greatest in the cranial lumbar discs, decreasing along the lumbar spine from cranial to caudal. In cranial discs, T2 relaxation times decreased in each disc region (nucleus pulposus [NP], inner annulus fibrosus [IAF], and outer annulus fibrosus [OAF]), whereas in caudal discs, T2 relaxation times decreased in the NP but increased in the AF. Conclusions Fluid transport varied by spinal level, where transport was greatest in the most cranial lumbar discs and decreased from cranial to caudal along the lumbar spine. Future work should evaluate what level-dependent factors affect transport.
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Affiliation(s)
- John T. Martin
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Benjamin Wesorick
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
| | - Alexander B. Oldweiler
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Andrzej S. Kosinski
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Adam P. Goode
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Louis E. DeFrate
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
- Department of Mechanical Engineering and Materials ScienceDuke UniversityDurhamNorth CarolinaUSA
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14
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Yang M, Xiang D, Wang S, Liu W. In Vitro Studies for Investigating Creep of Intervertebral Discs under Axial Compression: A Review of Testing Environment and Results. MATERIALS 2022; 15:ma15072500. [PMID: 35407833 PMCID: PMC9000064 DOI: 10.3390/ma15072500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 01/06/2023]
Abstract
Creep responses of intervertebral discs (IVDs) are essential for spinal biomechanics clarification. Yet, there still lacks a well-recognized investigation protocol for this phenomenon. Current work aims at providing researchers with an overview of the in vitro creep tests reported by previous studies, specifically specimen species, testing environment, loading regimes and major results, based on which a preliminary consensus that may guide future creep studies is proposed. Specimens used in creep studies can be simplified as a “bone–disc–bone” structure where three mathematical models can be adopted for describing IVDs’ responses. The preload of 10–50 N for 30 min or three cycles followed by 4 h-creep under constant compression is recommended for ex vivo simulation of physiological condition of long-time sitting or lying. It is worth noticing that species of specimens, environment temperature and humidity all have influences on biomechanical behaviors, and thus are summarized and compared through the literature review. All factors should be carefully set according to a guideline before tests are conducted to urge comparable results across studies. To this end, this review also provides a guideline, as mentioned before, and specific steps that might facilitate the community of biomechanics to obtain more repeatable and comparable results from both natural specimens and novel biomaterials.
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Affiliation(s)
- Mengying Yang
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China;
- State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China;
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
| | - Dingding Xiang
- State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China;
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Song Wang
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Correspondence: (S.W.); (W.L.)
| | - Weiqiang Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China;
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
- Correspondence: (S.W.); (W.L.)
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15
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Lumbar intervertebral disc diurnal deformations and T2 and T1rho relaxation times vary by spinal level and disc region. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:746-754. [PMID: 35072794 DOI: 10.1007/s00586-021-07097-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/16/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) is routinely used to evaluate spine pathology; however, standard imaging findings weakly correlate to low back pain. Abnormal disc mechanical function is implicated as a cause of back pain but is not assessed using standard clinical MRI. Our objective was to utilize our established MRI protocol for measuring disc function to quantify disc mechanical function in a healthy cohort. METHODS We recruited young, asymptomatic volunteers (6 male/6 female; age 18-30 years; BMI < 30) and used MRI to determine how diurnal deformations in disc height, volume, and perimeter were affected by spinal level, disc region, MRI biomarkers of disc health (T2, T1rho), and Pfirrmann grade. RESULTS Lumbar discs deformed by a mean of -6.1% (95% CI: -7.6%, -4.7%) to -8.0% (CI: -10.6%, -5.4%) in height and -5.4% (CI: -7.6%, -3.3%) to -8.5% (CI: -11.0%, -6.0%) in volume from AM to PM across spinal levels. Regional deformations were more uniform in cranial lumbar levels and concentrated posteriorly in the caudal levels, reaching a maximum of 13.1% at L5-S1 (CI:-16.1%, -10.2%). T2 and T1rho relaxation times were greatest in the nucleus and varied circumferentially within the annulus. T2 relaxation times were greatest at the most cranial spinal levels and decreased caudally. In this young healthy cohort, we identified a weak association between nucleus T2 and the diurnal change in the perimeter. CONCLUSIONS Spinal level is a key factor in determining regional disc deformations. Interestingly, deformations were concentrated in the posterior regions of caudal discs where disc herniation is most prevalent.
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16
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Cheng F, Yang H, Cheng Y, Liu Y, Hai Y, Zhang Y. The role of oxidative stress in intervertebral disc cellular senescence. Front Endocrinol (Lausanne) 2022; 13:1038171. [PMID: 36561567 PMCID: PMC9763277 DOI: 10.3389/fendo.2022.1038171] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
With the aggravation of social aging and the increase in work intensity, the prevalence of spinal degenerative diseases caused by intervertebral disc degeneration(IDD)has increased yearly, which has driven a heavy economic burden on patients and society. It is well known that IDD is associated with cell damage and degradation of the extracellular matrix. In recent years, it has been found that IDD is induced by various mechanisms (e.g., genetic, mechanical, and exposure). Increasing evidence shows that oxidative stress is a vital activation mechanism of IDD. Reactive oxygen species (ROS) and reactive nitrogen species (RNS) could regulate matrix metabolism, proinflammatory phenotype, apoptosis, autophagy, and aging of intervertebral disc cells. However, up to now, our understanding of a series of pathophysiological mechanisms of oxidative stress involved in the occurrence, development, and treatment of IDD is still limited. In this review, we discussed the oxidative stress through its mechanisms in accelerating IDD and some antioxidant treatment measures for IDD.
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Affiliation(s)
| | | | | | - Yuzeng Liu
- *Correspondence: Yuzeng Liu, ; Yong Hai, ; ; Yangpu Zhang,
| | - Yong Hai
- *Correspondence: Yuzeng Liu, ; Yong Hai, ; ; Yangpu Zhang,
| | - Yangpu Zhang
- *Correspondence: Yuzeng Liu, ; Yong Hai, ; ; Yangpu Zhang,
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17
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Tavakoli J, Geargeflia S, Tipper JL, Diwan AD. Magnetic resonance elastography: A non-invasive biomarker for low back pain studies. BIOMEDICAL ENGINEERING ADVANCES 2021. [DOI: 10.1016/j.bea.2021.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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18
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Oldweiler AB, Martin JT. In vivo relationships between lumbar facet joint and intervertebral disc composition and diurnal deformation. Clin Biomech (Bristol, Avon) 2021; 88:105425. [PMID: 34289433 PMCID: PMC8490326 DOI: 10.1016/j.clinbiomech.2021.105425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spinal motion is facilitated by a "three joint complex", two facet joints and one intervertebral disc at each spinal level. Both the intervertebral discs and facet joints are subject to natural age-related degeneration, and while these processes may be linked it is not clear how. As instability in the disc could underlie facet arthritis, we evaluated the hypothesis that the discs and facet joints are mechanically coupled. METHODS We recruited young, asymptomatic volunteers (n = 10; age: mean 25, range 21-30 years; BMI: mean 23.1, range 19.1-29.0 kg/m2) and applied magnetic resonance imaging (MRI) and three-dimensional (3D) modeling to measure facet and disc composition (MRI T1rho relaxation time) and facet and disc function (diurnal changes in facet space width, disc height) in the lumbar spine. FINDINGS We found that facet space width was positively associated with facet T1rho relaxation time (fluid content) and negatively associated with disc T1rho, and that facets adjacent to degenerated discs were significantly thicker and had significantly higher T1rho. Furthermore, the diurnal change in wedge angle was positively associated the diurnal change in facet space width, while disc degeneration, the diurnal change in disc height, and facet T1rho were not. INTERPRETATION These data demonstrate an interdependence between disc and facet health, but not between disc and facet mechanical function. Furthermore, the weak relationship between facet cartilage composition and in vivo function suggests that other factors, like spinal curvature, determine in vivo spine mechanics. Future work in symptomatic or aged populations are warranted to confirm these findings.
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19
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Din RU, Cheng X, Yang H. Diagnostic Role of Magnetic Resonance Imaging in Low Back Pain Caused by Vertebral Endplate Degeneration. J Magn Reson Imaging 2021; 55:755-771. [PMID: 34309129 DOI: 10.1002/jmri.27858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Low back pain (LBP) is a common health issue worldwide with a huge economic burden on healthcare systems. In the United States alone, the cost is estimated to be $100 billion each year. Intervertebral disc degeneration is considered one of the primary causes of LBP. Moreover, the critical role of the vertebral endplates in disc degeneration and LBP is becoming apparent. Endplate abnormalities are closely correlated with disc degeneration and pain in the lumbar spine. Imaging modalities such as plain film radiography, computed tomography, and fluoroscopy are helpful but not very effective in detecting the causes behind LBP. Magnetic resonance imaging (MRI) can be used to acquire high-quality three-dimensional images of the lumbar spine without using ionizing radiation. Therefore, it is increasingly being used to diagnose spinal disorders. However, according to the American College of Radiology, current referral and justification guidelines for MRI are not sufficiently clear to guide clinical practice. This review aimed to evaluate the role of MRI in diagnosing LBP by considering the correlative contributions of vertebral endplates. The findings of the review indicate that MRI allows for fine evaluations of endplate morphology, endplate defects, diffusion and perfusion properties of the endplate, and Modic changes. Changes in these characteristics of the endplate were found to be closely correlated with disc degeneration and LBP. The collective evidence from the literature suggests that MRI may be the imaging modality of choice for patients suffering from LBP. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Rahman Ud Din
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | | | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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20
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Ashinsky BG, Gullbrand SE, Wang C, Bonnevie ED, Han L, Mauck RL, Smith HE. Degeneration alters structure-function relationships at multiple length-scales and across interfaces in human intervertebral discs. J Anat 2020; 238:986-998. [PMID: 33205444 DOI: 10.1111/joa.13349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/19/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022] Open
Abstract
Intervertebral disc (IVD) degeneration and associated back pain place a significant burden on the population. IVD degeneration is a progressive cascade of cellular, compositional, and structural changes, which results in a loss of disc height, disorganization of extracellular matrix architecture, tears in the annulus fibrosus which may involve herniation of the nucleus pulposus, and remodeling of the bony and cartilaginous endplates (CEP). These changes to the IVD often occur concomitantly, across the entire motion segment from the disc subcomponents to the CEP and vertebral bone, making it difficult to determine the causal initiating factor of degeneration. Furthermore, assessments of the subcomponents of the IVD have been largely qualitative, with most studies focusing on a single attribute, rather than multiple adjacent IVD substructures. The objective of this study was to perform a multiscale and multimodal analysis of human lumbar motion segments across various length scales and degrees of degeneration. We performed multiple assays on every sample and identified several correlations between structural and functional measurements of disc subcomponents. Our results demonstrate that with increasing Pfirrmann grade there is a reduction in disc height and nucleus pulposus T2 relaxation time, in addition to alterations in motion segment macromechanical function, disc matrix composition and cellular morphology. At the cartilage endplate-vertebral bone interface, substantial remodeling was observed coinciding with alterations in micromechanical properties. Finally, we report significant relationships between vertebral bone and nucleus pulposus metrics, as well as between micromechanical properties of the endplate and whole motion segment biomechanical parameters, indicating the importance of studying IVD degeneration as a whole organ.
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Affiliation(s)
- Beth G Ashinsky
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Drexel University School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Sarah E Gullbrand
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Chao Wang
- Drexel University School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, USA
| | - Edward D Bonnevie
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Lin Han
- Drexel University School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, USA
| | - Robert L Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Harvey E Smith
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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21
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Zhang C, Gullbrand SE, Schaer TP, Lau YK, Jiang Z, Dodge GR, Elliott DM, Mauck RL, Malhotra NR, Smith LJ. Inflammatory cytokine and catabolic enzyme expression in a goat model of intervertebral disc degeneration. J Orthop Res 2020; 38:2521-2531. [PMID: 32091156 PMCID: PMC7483272 DOI: 10.1002/jor.24639] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 02/04/2023]
Abstract
Intervertebral disc degeneration is implicated as a leading cause of low back pain. Persistent, local inflammation within the disc nucleus pulposus (NP) and annulus fibrosus (AF) is an important mediator of disc degeneration and negatively impacts the performance of therapeutic stem cells. There is a lack of validated large animal models of disc degeneration that recapitulate clinically relevant local inflammation. We recently described a goat model of disc degeneration in which increasing doses of chondroitinase ABC (ChABC) were used to reproducibly induce a spectrum of degenerative changes. The objective of this study was to extend the clinical relevance of this model by establishing whether these degenerative changes are associated with the local expression of inflammatory cytokines and catabolic enzymes. Degeneration was induced in goat lumbar discs using ChABC at different doses. After 12 weeks, degeneration severity was determined histologically and using quantitative magnetic resonance imaging (MRI). Expression levels of inflammatory cytokines (tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], and IL-6) and catabolic enzymes (matrix metalloproteinases-1 [MMPs-1] and 13, and a disintegrin and metalloproteinase with thrombospondin type-1 motifs-4 [ADAMTS-4]) were assessed as the percentage of immunopositive cells in the NP and AF. With the exception of MMP-1, cytokine, and enzyme expression levels were significantly elevated in ChABC-treated discs in the NP and AF. Expression levels of TNF-α, IL1-β, and ADAMTS-4 were positively correlated with histological grade, while all cytokines and ADAMTS-4 were negatively correlated with MRI T2 and T1ρ scores. These results demonstrate that degenerate goat discs exhibit elevated expression of clinically relevant inflammatory mediators, and further validate this animal model as a platform for evaluating new therapeutic approaches for disc degeneration.
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Affiliation(s)
- Chenghao Zhang
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA, Philadelphia, PA, USA
| | - Sarah E. Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA, Philadelphia, PA, USA
| | - Thomas P. Schaer
- Comparative Orthopaedic Research Laboratory, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, 382 W Street Rd, Kennett Square, PA, USA
| | - Yian Khai Lau
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA, Philadelphia, PA, USA
| | - Zhirui Jiang
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA, Philadelphia, PA, USA
| | - George R. Dodge
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA, Philadelphia, PA, USA
| | - Dawn M. Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Robert L. Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA, Philadelphia, PA, USA
| | - Neil R. Malhotra
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA
| | - Lachlan J. Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, USA,Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, USA, Philadelphia, PA, USA,Correspondence Lachlan J. Smith, Ph.D., Associate Professor, Department of Neurosurgery, University of Pennsylvania, 371 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104, USA, Ph. 215 746 2169, Fax. 215 573 2133,
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22
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Kim DH, Martin JT, Gullbrand SE, Elliott DM, Smith LJ, Smith HE, Mauck RL. Fabrication, maturation, and implantation of composite tissue-engineered total discs formed from native and mesenchymal stem cell combinations. Acta Biomater 2020; 114:53-62. [PMID: 32505801 DOI: 10.1016/j.actbio.2020.05.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/09/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Low back pain arising from disc degeneration is one of the most common causes of limited function in adults. A number of tissue engineering strategies have been used to develop composite tissue engineered total disc replacements to restore native tissue structure and function. In this study we fabricated a composite engineered disc based on the combination of a porous polycaprolactone (PCL) foam annulus fibrosus (AF) and a hyaluronic acid (HA) hydrogel nucleus pulposus (NP). To evaluate whether native tissue cells or mesenchymal stem cells (MSCs) would perform better, constructs were seeded with native AF/NP cells or with MSCs in the foam and/or gel region. Maturation of these composite engineered discs was evaluated for 9 weeks in vitro culture by biochemical content, histological analysis and mechanical properties. To evaluate the performance of these constructs in the in vivo space, engineered discs were implanted into the caudal spines of athymic rats for 5 weeks. Our findings show that engineered discs comprised of AF/NP cells and MSCs performed similarly and maintained their structure after 5 weeks in vivo. However, for both cell types, loss of proteoglycan was evident in the NP region. These data support the continued development of the more clinically relevant MSCs population for disc replacement applications. STATEMENT OF SIGNIFICANCE: A number of tissue engineering strategies have emerged that are focused on the creation of a composite disc replacement. We fabricated a composite engineered disc based on the combination of a porous foam AF and a HA gel NP. We used these constructs to determine whether the combination of AF/NP cells or MSCs would mature to a greater extent in vitro and which cell type would best retain their phenotype after implantation. Engineered discs comprised of AF/NP cells and MSCs performed similarly, maintaining their structure after 5 weeks in vivo. These data support the successful fabrication and in vivo function of an engineered disc composed of a PCL foam AF and a hydrogel NP using either disc cells or MSCs.
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23
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Gullbrand SE, Kim DH, Ashinsky BG, Bonnevie ED, Smith HE, Mauck RL. Restoration of physiologic loading modulates engineered intervertebral disc structure and function in an in vivo model. JOR Spine 2020; 3:e1086. [PMID: 32613161 PMCID: PMC7323465 DOI: 10.1002/jsp2.1086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022] Open
Abstract
Tissue-engineered whole disc replacements are an emerging treatment strategy for advanced intervertebral disc degeneration. A challenge facing the translation of tissue-engineered disc replacement to clinical use are the opposing needs of initial immobilization to advantage integration contrasted with physiologic loading and its anabolic effects. Here, we utilize our established rat tail model of tissue engineered disc replacement with external fixation to study the effects of remobilization at two time points postimplantation on engineered disc structure, composition, and function. Our results suggest that the restoration of mechanical loading following immobilization enhanced collagen and proteoglycan content within the nucleus pulposus and annulus fibrosus of the engineered discs, in addition to improving the integration of the endplate region of the construct with native bone. Despite these benefits, angulation of the vertebral bodies at the implanted level occurred following remobilization at both early and late time points, reducing tensile failure properties in the remobilized groups compared to the fixed group. These results demonstrate the necessity of restoring physiologic mechanical loading to engineered disc implants in vivo, and the need to transition toward their evaluation in larger animal models with more human-like anatomy and motion compared to the rat tail.
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Affiliation(s)
- Sarah E. Gullbrand
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dong Hwa Kim
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Beth G. Ashinsky
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- School of Biomedical Engineering, Science and Health SystemsDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Edward D. Bonnevie
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Harvey E. Smith
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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24
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Ashinsky BG, Gullbrand SE, Bonnevie ED, Mandalapu SA, Wang C, Elliott DM, Han L, Mauck RL, Smith HE. Multiscale and multimodal structure-function analysis of intervertebral disc degeneration in a rabbit model. Osteoarthritis Cartilage 2019; 27:1860-1869. [PMID: 31419488 PMCID: PMC6875634 DOI: 10.1016/j.joca.2019.07.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The objective of this study was to perform a quantitative analysis of the structural and functional alterations in the intervertebral disc during in vivo degeneration, using emerging tools that enable rigorous assessment from the microscale to the macroscale, as well as to correlate these outcomes with noninvasive, clinically relevant imaging parameters. DESIGN Degeneration was induced in a rabbit model by puncturing the annulus fibrosus (AF) with a 16-gauge needle. 2, 4, 8, and 12 weeks following puncture, degenerative changes in the discs were evaluated via magnetic resonance imaging (MRI), whole motion segment biomechanics, atomic force microscopy, histology and polarized light microscopy, immunohistochemistry, biochemical content, and second harmonic generation imaging. RESULTS Following puncture, degeneration was evident through marked changes in whole disc structure and mechanics. Puncture acutely compromised disc macro and microscale mechanics, followed by progressive stiffening and remodeling. Histological analysis showed substantial anterior fibrotic remodeling and osteophyte formation, as well as an overall reduction in disc height, and disorganization and infolding of the AF lamellae into the NP space. Increases in NP collagen content and aggrecan breakdown products were also noted within 4 weeks. On MRI, NP T2 was reduced at all post-puncture time points and correlated significantly with microscale indentation modulus. CONCLUSION This study defined the time dependent changes in disc structure-function relationships during IVD degeneration in a rabbit annular injury model and correlated degeneration severity with clinical imaging parameters. Our findings identified AF infolding and occupancy of the space as a principle mechanism of disc degeneration in response to needle puncture, and provide new insights to direct the development of novel therapeutics.
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Affiliation(s)
- Beth G. Ashinsky
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA,Drexel University School of Biomedical Engineering, Philadelphia, PA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Sarah E. Gullbrand
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Edward D. Bonnevie
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Sai A. Mandalapu
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Chao Wang
- Drexel University School of Biomedical Engineering, Philadelphia, PA
| | - Dawn M. Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Lin Han
- Drexel University School of Biomedical Engineering, Philadelphia, PA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA,Address correspondence to: Harvey E. Smith, University of Pennsylvania School of Medicine, Department of Orthopaedic Surgery, 3737 Market Street, 6 Floor, Philadelphia, PA 19104, T: 215-662-3340,
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25
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Ying J, Han Z, Zeng Y, Du Y, Pei S, Su L, Ruan D, Chen C. Evaluation of intervertebral disc regeneration with injection of mesenchymal stem cells encapsulated in PEGDA-microcryogel delivery system using quantitative T2 mapping: a study in canines. Am J Transl Res 2019; 11:2028-2041. [PMID: 31105815 PMCID: PMC6511749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Intervertebral disc degeneration (IDD), the primary cause of low back pain, is still a great challenge to spinal surgeons and clinicians. T2 mapping, a biochemical magnetic resonance imaging (MRI) technique to calculate relaxation time, has the potential to offer a quantitative assessment of IDD. The aim of the study was to evaluate the regenerative effects of adipose-derived mesenchymal stem cells (MSCs) encapsulated in PEGDA-microcryogels (PMs) reinforced alginate hydrogel (AH) on the degenerative intervertebral disc (IVD) in a canine model using T2 mapping. Four degeneration-induced IVDs (L3-L4 to L6-L7) of 12 adult beagle dogs were injected with phosphate-buffered saline (PBS), MSCs, AH-PMs, and MSCs-laden AH-PMs, respectively. The intact IVD L7-S1 served as the normal control. IVD height change on plain radiograph, Pfirrmann grade and T2 relaxation time on MRI, histological change, and extracellular matrix (ECM)-associated proteins were evaluated during the 24-week follow-up period. Injection of MSCs-laden AH-PMs had the most satisfactory effects, having less decrease of IVD height, lower Pfirrmann grade, milder histological change, and longer T2 relaxation time (P < 0.05). T2 relaxation time was positively correlated with ECM content (proteoglycan: r = 0.85, P < 0.001; collagen II: r = 0.79, P < 0.001) and IVD height (r = 0.81, P < 0.001), but negatively correlated with Pfirrmann grade and histological grade (rho = -0.86, P < 0.001; rho = -0.95, P < 0.001). These results suggest that T2 mapping has the potential to quantitatively evaluate the repairing effects of cell-based engineering treatments on IDD for a long-term follow-up.
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Affiliation(s)
- Jinwei Ying
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
- Department of Orthopedic Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, China
| | - Zhihua Han
- Department of Trauma and Orthopedics, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
- Experimental Trauma and Orthopedic Surgery, JW Goethe-UniversityFrankfurt am Main, Germany
| | - Yang Zeng
- Department of Cancer Biology, Dana Farber Cancer Institute/Harvard Medical School360 Longwood Ave, Room 3316K, Boston, MA
| | - Yanan Du
- Department of Biomedical Engineering, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, Tsinghua UniversityBeijing 100084, China
| | - Shishen Pei
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
| | - Linghao Su
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
| | - Chun Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, China
- Engineering Research Center of Clinical Functional Materials and Diagnosis and Treatment Devices of Zhejiang Province, Wenzhou Institute of Biomaterials and EngineeringWenzhou 325011, China
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26
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Smith LJ, Silverman L, Sakai D, Le Maitre CL, Mauck RL, Malhotra NR, Lotz JC, Buckley CT. Advancing cell therapies for intervertebral disc regeneration from the lab to the clinic: Recommendations of the ORS spine section. JOR Spine 2018; 1:e1036. [PMID: 30895277 PMCID: PMC6419951 DOI: 10.1002/jsp2.1036] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
Intervertebral disc degeneration is strongly associated with chronic low back pain, a leading cause of disability worldwide. Current back pain treatment approaches (both surgical and conservative) are limited to addressing symptoms, not necessarily the root cause. Not surprisingly therefore, long-term efficacy of most approaches is poor. Cell-based disc regeneration strategies have shown promise in preclinical studies, and represent a relatively low-risk, low-cost, and durable therapeutic approach suitable for a potentially large patient population, thus making them attractive from both clinical and commercial standpoints. Despite such promise, no such therapies have been broadly adopted clinically. In this perspective we highlight primary obstacles and provide recommendations to help accelerate successful clinical translation of cell-based disc regeneration therapies. The key areas addressed include: (a) Optimizing cell sources and delivery techniques; (b) Minimizing potential risks to patients; (c) Selecting physiologically and clinically relevant efficacy metrics; (d) Maximizing commercial potential; and (e) Recognizing the importance of multidisciplinary collaborations and engaging with clinicians from inception through to clinical trials.
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Affiliation(s)
- Lachlan J. Smith
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
| | - Lara Silverman
- DiscGenics Inc.Salt Lake CityUtah
- Department of NeurosurgeryUniversity of Tennessee Health Science CenterMemphisTennessee
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | | | - Robert L. Mauck
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Neil R. Malhotra
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Conor T. Buckley
- Trinity Centre for BioengineeringTrinity Biomedical Sciences Institute, Trinity College Dublin, The University of DublinDublinIreland
- School of EngineeringTrinity College Dublin, The University of DublinDublinIreland
- Advanced Materials and Bioengineering Research (AMBER) CentreRoyal College of Surgeons in Ireland & Trinity College Dublin, The University of DublinDublinIreland
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27
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Gullbrand SE, Ashinsky BG, Bonnevie ED, Kim DH, Engiles JB, Smith LJ, Elliott DM, Schaer TP, Smith HE, Mauck RL. Long-term mechanical function and integration of an implanted tissue-engineered intervertebral disc. Sci Transl Med 2018; 10:eaau0670. [PMID: 30463917 PMCID: PMC7380504 DOI: 10.1126/scitranslmed.aau0670] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023]
Abstract
Tissue engineering holds great promise for the treatment of advanced intervertebral disc degeneration. However, assessment of in vivo integration and mechanical function of tissue-engineered disc replacements over the long term, in large animal models, will be necessary to advance clinical translation. To that end, we developed tissue-engineered, endplate-modified disc-like angle ply structures (eDAPS) sized for the rat caudal and goat cervical spines that recapitulate the hierarchical structure of the native disc. Here, we demonstrate functional maturation and integration of these eDAPS in a rat caudal disc replacement model, with compressive mechanical properties reaching native values after 20 weeks in vivo and evidence of functional integration under physiological loads. To further this therapy toward clinical translation, we implanted eDAPS sized for the human cervical disc space in a goat cervical disc replacement model. Our results demonstrate maintenance of eDAPS composition and structure up to 8 weeks in vivo in the goat cervical disc space and maturation of compressive mechanical properties to match native levels. These results demonstrate the translational feasibility of disc replacement with a tissue-engineered construct for the treatment of advanced disc degeneration.
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Affiliation(s)
- Sarah E Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beth G Ashinsky
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- School of Biomedical Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Edward D Bonnevie
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dong Hwa Kim
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Julie B Engiles
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19348, USA
| | - Lachlan J Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716, USA
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19348, USA
| | - Harvey E Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA.
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert L Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA.
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
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28
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Piazza M, Peck SH, Gullbrand SE, Bendigo JR, Arginteanu T, Zhang Y, Smith HE, Malhotra NR, Smith LJ. Quantitative MRI correlates with histological grade in a percutaneous needle injury mouse model of disc degeneration. J Orthop Res 2018; 36:2771-2779. [PMID: 29687490 PMCID: PMC6200662 DOI: 10.1002/jor.24028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/19/2018] [Indexed: 02/04/2023]
Abstract
Low back pain due to disc degeneration is a major cause of morbidity and health care expenditures worldwide. While stem cell-based therapies hold promise for disc regeneration, there is an urgent need to develop improved in vivo animal models to further develop and validate these potential treatments. The objectives of this study were to characterize a percutaneous needle injury model of intervertebral disc degeneration in the mouse caudal spine, and compare two non-invasive quantitative imaging techniques, microcomputed tomography and magnetic resonance imaging (MRI), as effective measures of disc degeneration in this model. Percutaneous needle injury of mouse caudal discs was undertaken using different needle sizes and injury types (unilateral or bilateral annulus fibrosus (AF) puncture). Mice were euthanized 4 weeks post-injury, and MRI and microcomputed tomography were used to determine T2 relaxation time of the NP and disc height index, respectively. Disc condition was then further assessed using semi-quantitative histological grading. Bilateral AF puncture with either 27 or 29G needles resulted in significantly lower T2 relaxation times compared to uninjured controls, while disc height index was not significantly affected by any injury type. There was a strong, inverse linear relationship between histological grade and NP T2 relaxation time. In this study, we demonstrated that quantitative MRI can detect disc degeneration in the mouse caudal spine 4 weeks following percutaneous needle injury, and may therefore serve as a surrogate for histology in longitudinal studies of both disc degeneration and cell-based therapies for disc regeneration using this model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2771-2779, 2018.
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Affiliation(s)
- Matthew Piazza
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sun H. Peck
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Sarah E. Gullbrand
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Justin R. Bendigo
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Toren Arginteanu
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yejia Zhang
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA,Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Neil R. Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Correspondence:, Lachlan J. Smith, Ph.D., Department of Neurosurgery, University of Pennsylvania, 110 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA, 19104; Neil R. Malhotra, M.D., Department of Neurosurgery, University of Pennsylvania, 3rd Floor Silverstein Pavilion, 3400 Spruce St, Philadelphia, PA, 19104
| | - Lachlan J. Smith
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA, USA,Correspondence:, Lachlan J. Smith, Ph.D., Department of Neurosurgery, University of Pennsylvania, 110 Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA, 19104; Neil R. Malhotra, M.D., Department of Neurosurgery, University of Pennsylvania, 3rd Floor Silverstein Pavilion, 3400 Spruce St, Philadelphia, PA, 19104
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29
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Buckley CT, Hoyland JA, Fujii K, Pandit A, Iatridis JC, Grad S. Critical aspects and challenges for intervertebral disc repair and regeneration-Harnessing advances in tissue engineering. JOR Spine 2018; 1:e1029. [PMID: 30895276 PMCID: PMC6400108 DOI: 10.1002/jsp2.1029] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 02/06/2023] Open
Abstract
Low back pain represents the highest burden of musculoskeletal diseases worldwide and intervertebral disc degeneration is frequently associated with this painful condition. Even though it remains challenging to clearly recognize generators of discogenic pain, tissue regeneration has been accepted as an effective treatment option with significant potential. Tissue engineering and regenerative medicine offer a plethora of exploratory pathways for functional repair or prevention of tissue breakdown. However, the intervertebral disc has extraordinary biological and mechanical demands that must be met to assure sustained success. This concise perspective review highlights the role of the disc microenvironment, mechanical and clinical design considerations, function vs mimicry in biomaterial‐based and cell engineering strategies, and potential constraints for clinical translation of regenerative therapies for the intervertebral disc.
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Affiliation(s)
- Conor T Buckley
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute Trinity College Dublin, The University of Dublin Dublin Ireland.,School of Engineering, Trinity College Dublin The University of Dublin Dublin Ireland.,Advanced Materials and Bioengineering Research (AMBER) Centre Royal College of Surgeons in Ireland & Trinity College Dublin, The University of Dublin Dublin Ireland
| | - Judith A Hoyland
- Division of Cell Matrix Biology and Regenerative Medicine University of Manchester Manchester UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust Manchester Academic Health Science Centre Manchester UK
| | - Kengo Fujii
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York New York USA.,Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - Abhay Pandit
- Centre for Research in Medical Devices (CÚRAM) National University of Ireland Galway Ireland
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York New York USA
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Abstract
The connective tissues of the musculoskeletal system can be grouped into fibrous, cartilaginous, and calcified tissues. While each tissue type has a distinct composition and function, the intersections between these tissues result in the formation of complex, composite, and graded junctions. The complexity of these interfaces is a critical aspect of their healthy function, but poses a significant challenge for their repair. In this review, we describe the organization and structure of complex musculoskeletal interfaces, identify emerging technologies for engineering such structures, and outline the requirements for assessing the complex nature of these tissues in the context of recapitulating their function through tissue engineering.
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Affiliation(s)
- Edward D Bonnevie
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
- Translational Musculoskeletal Research Center, Col. Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania 19104, USA
| | - Robert L Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
- Translational Musculoskeletal Research Center, Col. Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania 19104, USA
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Delayed onset of persistent discogenic axial and radiating pain after a single-level lumbar intervertebral disc injury in mice. Pain 2018; 159:1843-1855. [DOI: 10.1097/j.pain.0000000000001284] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Disney CM, Lee PD, Hoyland JA, Sherratt MJ, Bay BK. A review of techniques for visualising soft tissue microstructure deformation and quantifying strain Ex Vivo. J Microsc 2018; 272:165-179. [PMID: 29655273 DOI: 10.1111/jmi.12701] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 12/16/2022]
Abstract
Many biological tissues have a complex hierarchical structure allowing them to function under demanding physiological loading conditions. Structural changes caused by ageing or disease can lead to loss of mechanical function. Therefore, it is necessary to characterise tissue structure to understand normal tissue function and the progression of disease. Ideally intact native tissues should be imaged in 3D and under physiological loading conditions. The current published in situ imaging methodologies demonstrate a compromise between imaging limitations and maintaining the samples native mechanical function. This review gives an overview of in situ imaging techniques used to visualise microstructural deformation of soft tissue, including three case studies of different tissues (tendon, intervertebral disc and artery). Some of the imaging techniques restricted analysis to observational mechanics or discrete strain measurement from invasive markers. Full-field local surface strain measurement has been achieved using digital image correlation. Volumetric strain fields have successfully been quantified from in situ X-ray microtomography (micro-CT) studies of bone using digital volume correlation but not in soft tissue due to low X-ray transmission contrast. With the latest developments in micro-CT showing in-line phase contrast capability to resolve native soft tissue microstructure, there is potential for future soft tissue mechanics research where 3D local strain can be quantified. These methods will provide information on the local 3D micromechanical environment experienced by cells in healthy, aged and diseased tissues. It is hoped that future applications of in situ imaging techniques will impact positively on the design and testing of potential tissue replacements or regenerative therapies. LAY DESCRIPTION: The soft tissues in our bodies, such as tendons, intervertebral discs and arteries, have evolved to have complicated structures which deform and bear load during normal function. Small changes in these structures can occur with age and disease which then leads to loss of function. Therefore, it is important to image tissue microstructure in 3D and under functional conditions. This paper gives an overview of imaging techniques used to record the deformation of soft tissue microstructures. Commonly there are compromises between obtaining the best imaging result and retaining the samples native structure and function. For example, invasive markers and dissecting samples damages the tissues natural structure, and staining or clearing (making the tissue more transparent) can distort tissue structure. Structural deformation has been quantified from 2D imaging techniques (digital image correlation) to create surface strain maps which help identify local tissue mechanics. When extended to 3D (digital volume correlation), deformation measurement has been limited to bone samples using X-ray micro-CT. Recently it has been possible to image the 3D structure of soft tissue using X-ray micro-CT meaning that there is potential for internal soft tissue mechanics to be mapped in 3D. Future application of micro-CT and digital volume correlation will be important for soft tissue mechanics studies particularly to understand normal function, progression of disease and in the design of tissue replacements.
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Affiliation(s)
- C M Disney
- Centre for Doctoral Training in Regenerative Medicine, University of Manchester, Manchester, U.K.,Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, U.K
| | - P D Lee
- School of Materials, University of Manchester, Manchester, U.K
| | - J A Hoyland
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, U.K.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - M J Sherratt
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, U.K
| | - B K Bay
- School of Mechanical, Industrial and Manufacturing Engineering, Oregon State University, Corvallis, Oregon, U.S.A
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Gullbrand SE, Kim DH, Bonnevie E, Ashinsky BG, Smith LJ, Elliott DM, Mauck RL, Smith HE. Towards the scale up of tissue engineered intervertebral discs for clinical application. Acta Biomater 2018; 70:154-164. [PMID: 29427744 PMCID: PMC7593900 DOI: 10.1016/j.actbio.2018.01.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 12/21/2022]
Abstract
Replacement of the intervertebral disc with a viable, tissue-engineered construct that mimics native tissue structure and function is an attractive alternative to fusion or mechanical arthroplasty for the treatment of disc pathology. While a number of engineered discs have been developed, the average size of these constructs remains a fraction of the size of human intervertebral discs. In this study, we fabricated medium (3 mm height × 10 mm diameter) and large (6 mm height × 20 mm diameter) sized disc-like angle ply structures (DAPS), encompassing size scales from the rabbit lumbar spine to the human cervical spine. Maturation of these engineered discs was evaluated over 15 weeks in culture by quantifying cell viability and metabolic activity, construct biochemical content, MRI T2 values, and mechanical properties. To assess the performance of the DAPS in the in vivo space, pre-cultured DAPS were implanted subcutaneously in athymic rats for 5 weeks. Our findings show that both sized DAPS matured functionally and compositionally during in vitro culture, as evidenced by increases in mechanical properties and biochemical content over time, yet large DAPS under-performed compared to medium DAPS. Subcutaneous implantation resulted in reductions in NP cell viability and GAG content at both size scales, with little effect on AF biochemistry or metabolic activity. These findings demonstrate that engineered discs at large size scales will mature during in vitro culture, however, future work will need to address the challenges of reduced cell viability and heterogeneous matrix distribution throughout the construct. STATEMENT OF SIGNIFICANCE This work establishes, for the first time, tissue-engineered intervertebral discs for total disc replacement at large, clinically relevant length scales. Clinical translation of tissue-engineered discs will offer an alternative to mechanical disc arthroplasty and fusion procedures, and may contribute to a paradigm shift in the clinical care for patients with disc pathology and associated axial spine and neurogenic extremity pain.
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Affiliation(s)
- Sarah E Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Dong Hwa Kim
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Edward Bonnevie
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Beth G Ashinsky
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; School of Biomedical Engineering, Drexel Univeristy, Philadelphia, PA, United States
| | - Lachlan J Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Robert L Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Harvey E Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States.
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Hebelka H, Miron A, Kasperska I, Brisby H, Lagerstrand K. Axial loading during MRI induces significant T2 value changes in vertebral endplates-a feasibility study on patients with low back pain. J Orthop Surg Res 2018; 13:18. [PMID: 29378613 PMCID: PMC5789539 DOI: 10.1186/s13018-018-0727-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The function of the endplate (EP) is the most important factor influencing nutritional supply to the avascular intervertebral disc (IVD). It is desired to have a non-invasive method to assess functional EP characteristics in vivo. Assessment of functional EP characteristics is important in order to understand its relation to IVD degeneration, which in turn might deepen the understanding of the pathophysiology behind low back pain (LBP). It was hypothesized that, by comparing quantitative MRI of EPs performed with conventional supine MRI (unloaded MRI) with axial loading during MRI (alMRI), dynamical properties of the EP can be displayed. The aim was therefore to investigate the feasibility of axial loading during MRI (alMRI) to instantaneously induce quantitative EP changes. METHODS T2 mapping of 55 vertebral EPs (L1-S1) in five LBP patients was performed during conventional supine MRI (unloaded MRI) and subsequent alMRI. With T2 mapping, the cartilaginous EP and bony EP cannot be separated; hence, the visualized EP was termed EP zone (EPZ). Each EPZ was segmented at multiple midsagittal views, generating volumetric regions of interest. EPZs demonstrating signal inhomogeneity and/or adjacent Modic changes (MC) were termed abnormal EPZs. EPZ mean T2 values were compared between unloaded MRI and alMRI, and their relationship with abnormal EPZs was determined. RESULTS alMRI induced significantly higher (p = 0.01) EPZ mean T2 values compared with unloaded MRI. Significantly higher mean T2 values were seen in inferior EPZs compared with superior EPZs, both with unloaded MRI (35%, p < 0.001) and with alMRI (26%, p = 0.04). Significant difference between unloaded MRI and alMRI was seen in normal (p = 0.02), but not in abnormal EPZs (p = 0.5; n = 12). CONCLUSIONS alMRI induces changes in human EPZ characteristics in vivo. The T2 value significantly increased in normal EPZs, with lack of such in abnormal EPZs. Combining T2 mapping with alMRI provides a clinical feasible, non-invasive method with potential to reveal biochemical behavioral patterns, thus adding another dimension of the EPZs characteristics compared with information obtained with solely unloaded MRI.
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Affiliation(s)
- Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Andreia Miron
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Izabela Kasperska
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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In Vitro Maturation and In Vivo Integration and Function of an Engineered Cell-Seeded Disc-like Angle Ply Structure (DAPS) for Total Disc Arthroplasty. Sci Rep 2017; 7:15765. [PMID: 29150639 PMCID: PMC5693867 DOI: 10.1038/s41598-017-15887-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/30/2017] [Indexed: 12/15/2022] Open
Abstract
Total disc replacement with an engineered substitute is a promising avenue for treating advanced intervertebral disc disease. Toward this goal, we developed cell-seeded disc-like angle ply structures (DAPS) and showed through in vitro studies that these constructs mature to match native disc composition, structure, and function with long-term culture. We then evaluated DAPS performance in an in vivo rat model of total disc replacement; over 5 weeks in vivo, DAPS maintained their structure, prevented intervertebral bony fusion, and matched native disc mechanical function at physiologic loads in situ. However, DAPS rapidly lost proteoglycan post-implantation and did not integrate into adjacent vertebrae. To address this, we modified the design to include polymer endplates to interface the DAPS with adjacent vertebrae, and showed that this modification mitigated in vivo proteoglycan loss while maintaining mechanical function and promoting integration. Together, these data demonstrate that cell-seeded engineered discs can replicate many characteristics of the native disc and are a viable option for total disc arthroplasty.
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Calvo-Echenique A, Cegoñino J, Correa-Martín L, Bances L, Palomar APD. Intervertebral disc degeneration: an experimental and numerical study using a rabbit model. Med Biol Eng Comput 2017; 56:865-877. [DOI: 10.1007/s11517-017-1738-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
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Walter BA, Mageswaran P, Mo X, Boulter DJ, Mashaly H, Nguyen XV, Prevedello LM, Thoman W, Raterman BD, Kalra P, Mendel E, Marras WS, Kolipaka A. MR Elastography-derived Stiffness: A Biomarker for Intervertebral Disc Degeneration. Radiology 2017; 285:167-175. [PMID: 28471737 DOI: 10.1148/radiol.2017162287] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To determine the repeatability of magnetic resonance (MR) elastography-derived shear stiffness measurements of the intervertebral disc (IVD) taken throughout the day and their relationship with IVD degeneration and subject age. Materials and Methods In a cross-sectional study, in vivo lumbar MR elastography was performed once in the morning and once in the afternoon in 47 subjects without current low back pain (IVDs = 230; age range, 20-71 years) after obtaining written consent under approval of the institutional review board. The Pfirrmann degeneration grade and MR elastography-derived shear stiffness of the nucleus pulposus and annulus fibrosus regions of all lumbar IVDs were assessed by means of principal frequency analysis. One-way analysis of variance, paired t tests, concordance and Bland-Altman tests, and Pearson correlations were used to evaluate degeneration, diurnal changes, repeatability, and age effects, respectively. Results There were no significant differences between morning and afternoon shear stiffness across all levels and there was very good technical repeatability between the morning and afternoon imaging results for both nucleus pulposus (R = 0.92) and annulus fibrosus (R = 0.83) regions. There was a significant increase in both nucleus pulposus and annulus fibrosus MR elastography-derived shear stiffness with increasing Pfirrmann degeneration grade (nucleus pulposus grade 1, 12.5 kPa ± 1.3; grade 5, 16.5 kPa ± 2.1; annulus fibrosus grade 1, 90.4 kPa ± 9.3; grade 5, 120.1 kPa ± 15.4), and there were weak correlations between shear stiffness and age across all levels (R ≤ 0.32). Conclusion Our results demonstrate that MR elastography-derived shear stiffness measurements are highly repeatable, weakly correlate with age, and increase with advancing IVD degeneration. These results suggest that MR elastography-derived shear stiffness may provide an objective biomarker of the IVD degeneration process. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Benjamin A Walter
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Prasath Mageswaran
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Xiaokui Mo
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel J Boulter
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Hazem Mashaly
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Xuan V Nguyen
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Luciano M Prevedello
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - William Thoman
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brian D Raterman
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Prateek Kalra
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ehud Mendel
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - William S Marras
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Arunark Kolipaka
- From the Spine Research Institute (B.A.W., P.M., H.M., W.T., E.M., W.S.M., A.K.), Department of Biomedical Engineering (B.A.W., A.K.), Department of Integrated Systems Engineering (P.M., W.S.M.), and Department of Biomedical Informatics (X.M.), the Ohio State University, 395 W 12th Ave, 4th Floor Radiology, Columbus, OH 43210; and Departments of Radiology (D.J.B., X.V.N., L.M.P., B.D.R., P.K., A.K.) and Neurologic Surgery (H.M., W.T., E.M.), the Ohio State University Wexner Medical Center, Columbus, Ohio
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Martin JT, Gullbrand SE, Mohanraj B, Ashinsky BG, Kim DH, Ikuta K, Elliott DM, Smith LJ, Mauck RL, Smith HE. * Optimization of Preculture Conditions to Maximize the In Vivo Performance of Cell-Seeded Engineered Intervertebral Discs. Tissue Eng Part A 2017; 23:923-934. [PMID: 28426371 DOI: 10.1089/ten.tea.2016.0491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The development of engineered tissues has progressed over the past 20 years from in vitro characterization to in vivo implementation. For musculoskeletal tissue engineering in particular, the emphasis of many of these studies was to select conditions that maximized functional and compositional gains in vitro. However, the transition from the favorable in vitro culture environment to a less favorable in vivo environment has proven difficult, and, in many cases, engineered tissues do not retain their preimplantation phenotype after even short periods in vivo. Our laboratory recently developed disc-like angle-ply structures (DAPS), an engineered intervertebral disc for total disc replacement. In this study, we tested six different preculture media formulations (three serum-containing and three chemically defined, with varying doses of transforming growth factor β3 [TGF-β3] and varying strategies to introduce serum) for their ability to preserve DAPS composition and metabolic activity during the transition from in vitro culture to in vivo implantation in a subcutaneous athymic rat model. We assayed implants before and after implantation to determine collagen content, glycosaminoglycan (GAG) content, metabolic activity, and magnetic resonance imaging (MRI) characteristics. A chemically defined media condition that incorporated TGF-β3 promoted the deposition of GAG and collagen in DAPS in vitro, the maintenance of accumulated matrix in vivo, and minimal changes in the metabolic activity of cells within the construct. Preculture in serum-containing media (with or without TGF-β3) was not compatible with DAPS maturation, particularly in the nucleus pulposus (NP) region. All groups showed increased collagen production after implantation. These findings define a favorable preculture strategy for the translation of engineered discs seeded with disc cells.
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Affiliation(s)
- John T Martin
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania.,3 Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Sarah E Gullbrand
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania
| | - Bhavana Mohanraj
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania.,4 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Beth G Ashinsky
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania
| | - Dong Hwa Kim
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania
| | - Kensuke Ikuta
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania
| | - Dawn M Elliott
- 5 Department of Biomedical Engineering, University of Delaware , Newark, Delaware
| | - Lachlan J Smith
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania.,6 Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Robert L Mauck
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania.,3 Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania , Philadelphia, Pennsylvania.,4 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Harvey E Smith
- 1 Department of Orthopedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center , Philadelphia, Pennsylvania.,6 Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania
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39
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Hwang D, Kim S, Abeydeera NA, Statum S, Masuda K, Chung CB, Siriwanarangsun P, Bae WC. Quantitative magnetic resonance imaging of the lumbar intervertebral discs. Quant Imaging Med Surg 2016; 6:744-755. [PMID: 28090450 DOI: 10.21037/qims.2016.12.09] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Human lumbar spine is composed of multiple tissue components that serve to provide structural stability and proper nutrition. Conventional magnetic resonance (MR) imaging techniques have been useful for evaluation of IVD, but inadequate at imaging the discovertebral junction and ligamentous tissues due primarily to their short T2 nature. Ultrashort time to echo (UTE) MR techniques acquire sufficient MR signal from these short T2 tissues, thereby allowing direct and quantitative evaluation. This article discusses the anatomy of the lumbar spine, MR techniques available for morphologic and quantitative MR evaluation of long and short T2 tissues of the lumbar spine, considerations for T2 relaxation modeling and fitting, and existing and new techniques for spine image post-processing, focusing on segmentation. This article will be of interest to radiologic and orthopaedic researchers performing lumbar spine imaging.
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Affiliation(s)
- Dosik Hwang
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Sewon Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Nirusha A Abeydeera
- Department of Radiology, University of California-San Diego, La Jolla, CA, USA
| | - Sheronda Statum
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; Department of Radiology, University of California-San Diego, La Jolla, CA, USA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, University of California-San Diego, La Jolla, CA, USA
| | - Christine B Chung
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; Department of Radiology, University of California-San Diego, La Jolla, CA, USA
| | - Palanan Siriwanarangsun
- Department of Radiology, University of California-San Diego, La Jolla, CA, USA;; Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Won C Bae
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; Department of Radiology, University of California-San Diego, La Jolla, CA, USA
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40
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Iatridis JC, Kang J, Kandel R, Risbud MV. New Horizons in Spine Research: Disc biology, spine biomechanics and pathomechanisms of back pain. J Orthop Res 2016; 34:1287-8. [PMID: 27571441 PMCID: PMC5072778 DOI: 10.1002/jor.23375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- James C. Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - James Kang
- Department of Orthopedic
Surgery, Brigham and Women’s Hospital, Boston, MA 02115
| | - Rita Kandel
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Ontario, Canada M5G1X5
| | - Makarand V. Risbud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107
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