Towards engineering distinct multi-lamellated outer and inner annulus fibrosus tissues

Senescent response in inner annulus fibrosus cells in response to TNFα, H2O2, and TNFα-induced nucleus pulposus senescent secretome

Senescence, particularly in the nucleus pulposus (NP) cells, has been implicated in the pathogenesis of disc degeneration, however, the mechanism(s) of annulus fibrosus (AF) cell senescence is still not well understood. Both TNFα and H2O2, have been implicated as contributors to the senescence pathways, and their levels are increased in degenerated discs when compared to healthy discs. Thus, the objective of this study is to identify factor(s) that induces inner AF (iAF) cell senescence. Under TNFα exposure, at a concentration previously shown to induce senescence in NP cells, bovine iAF cells did not undergo senescence, indicated by their ability to continue to proliferate as demonstrated by Ki67 staining and growth curves and lack of expression of the senescent markers, p16 and p21. The lack of senescent response occurred even though iAF express higher levels of TNFR1 than NP cells. Interestingly, iAF cells showed no increase in intracellular ROS or secreted H2O2 in response to TNFα which contrasted to NP cells that did. Following TNFα treatment, only iAF cells had increased expression of the superoxide scavengers SOD1 and SOD2 whereas NP cells had increased NOX4 gene expression, an enzyme that can generate H2O2. Treating iAF cells with low dose H2O2 (50 μM) induced senescence, however unlike TNFα, H2O2 did not induce degenerative-like changes as there was no difference in COL2, ACAN, MMP13, or IL6 gene expression or number of COL2 and ACAN immunopositive cells compared to untreated controls. The latter result suggests that iAF cells may have distinct degenerative and senescent phenotypes. To evaluate paracrine signalling by senescent NP cells, iAF and TNFα-treated NP cells were co-cultured. In contact co-culture the NP cells induced iAF senescence. Thus, senescent NP cells may secrete soluble factors that induce degenerative and senescent changes within the iAF. This may contribute to a positive feedback loop of disc degeneration. It is possible these factors may include H2O2 and cytokines (such as TNFα). Further studies will investigate if human disc cells respond similarly.

Insights into the underlying pathogenesis and therapeutic potential of endoplasmic reticulum stress in degenerative musculoskeletal diseases

Degenerative musculoskeletal diseases are structural and functional failures of the musculoskeletal system, including osteoarthritis, osteoporosis, intervertebral disc degeneration (IVDD), and sarcopenia. As the global population ages, degenerative musculoskeletal diseases are becoming more prevalent. However, the pathogenesis of degenerative musculoskeletal diseases is not fully understood. Previous studies have revealed that endoplasmic reticulum (ER) stress is a stress response that occurs when impairment of the protein folding capacity of the ER leads to the accumulation of misfolded or unfolded proteins in the ER, contributing to degenerative musculoskeletal diseases. By affecting cartilage degeneration, synovitis, meniscal lesion, subchondral bone remodeling of osteoarthritis, bone remodeling and angiogenesis of osteoporosis, nucleus pulposus degeneration, annulus fibrosus rupture, cartilaginous endplate degeneration of IVDD, and sarcopenia, ER stress is involved in the pathogenesis of degenerative musculoskeletal diseases. Preclinical studies have found that regulation of ER stress can delay the progression of multiple degenerative musculoskeletal diseases. These pilot studies provide foundations for further evaluation of the feasibility, efficacy, and safety of ER stress modulators in the treatment of musculoskeletal degenerative diseases in clinical trials. In this review, we have integrated up-to-date research findings of ER stress into the pathogenesis of degenerative musculoskeletal diseases. In a future perspective, we have also discussed possible directions of ER stress in the investigation of degenerative musculoskeletal disease, potential therapeutic strategies for degenerative musculoskeletal diseases using ER stress modulators, as well as underlying challenges and obstacles in bench-to-beside research.

Importance of Matrix Cues on Intervertebral Disc Development, Degeneration, and Regeneration

Back pain is one of the leading causes of disability worldwide and is frequently caused by degeneration of the intervertebral discs. The discs’ development, homeostasis, and degeneration are driven by a complex series of biochemical and physical extracellular matrix cues produced by and transmitted to native cells. Thus, understanding the roles of different cues is essential for designing effective cellular and regenerative therapies. Omics technologies have helped identify many new matrix cues; however, comparatively few matrix molecules have thus far been incorporated into tissue engineered models. These include collagen type I and type II, laminins, glycosaminoglycans, and their biomimetic analogues. Modern biofabrication techniques, such as 3D bioprinting, are also enabling the spatial patterning of matrix molecules and growth factors to direct regional effects. These techniques should now be applied to biochemically, physically, and structurally relevant disc models incorporating disc and stem cells to investigate the drivers of healthy cell phenotype and differentiation. Such research will inform the development of efficacious regenerative therapies and improved clinical outcomes.

Development of a Perfusion Reactor for Intervertebral Disk Regeneration

A tissue-engineered biological disk replacement has been proposed as a promising approach for the treatment of degenerative disk disease. A perfusion bioreactor would be a logical consideration to facilitate this scale-up as such reactors have been shown to improve nutrient delivery and provide beneficial mechanical forces that support the cultivation of large three-dimensional constructs. It was hypothesized that perfusion culture of tissue-engineered intervertebral disk (IVD) tissues would be capable of generating outer annulus fibrosus (oAF) and nucleus pulposus (NP) tissues comparable with established spinner reactor or static cultures, respectively, without compromising cellular viability, nutrient delivery, and tissue formation. In this study, the perfusion grown oAF and NP tissues did not show a significant difference in extracellular matrix (ECM) quantity or cellular phenotype when compared with their control conditions. In addition, they maintained cellular viability at the center core of the tissues and received enhanced diffusion of medium throughout the tissue when compared with static conditions. This study lays the groundwork for future studies to grow an entire IVD tissue to a physiologically relevant size.

Recent Progress in Electrospun Nanofiber-Based Degenerated Intervertebral Disc Repair

Annulus fibrosus fissure and fibrosis of nucleus pulposus are severe morphological characteristics of intervertebral disc degeneration. Currently, surgery or drugs are used to relieve pain in such cases. Tissue engineering is a new multidisciplinary strategy with great potential for use in joint replacement and organ regeneration. Based on the natural anatomy of intervertebral discs, intervertebral disc scaffolds are fabricated by exploiting the special arrangement of extracellular matrix fibers. Electrospun nanofibers possess clear advantages in repairing degenerated intervertebral discs. This article reviews and summarizes recently developed methods for improving and fabricating electrospun nanofiber annulus fibrosus scaffolds in terms of nanofiber alignment, material selection, loading additives, and the progress made in combining other advanced technologies with electrospun nanofibers. In addition, the improvement in mechanical properties and biocompatibility of nucleus pulposus scaffolds by electrospun nanofiber-reinforced hydrogels is discussed. Finally, complete intervertebral disc scaffolds can be fabricated using the disc-like angle-ply structure and other emerging fabrication methods. Taken together, electrospun nanofiber intervertebral disc scaffolds are promising for clinical applications.

Three-Dimensional-Printed Flexible Scaffolds Have Tunable Biomimetic Mechanical Properties for Intervertebral Disc Tissue Engineering

The intervertebral disc (IVD) exhibits complex structure and biomechanical function, which supports the weight of the body and permits motion. Surgical treatments for IVD degeneration (e.g., lumbar fusion, disc replacement) often disrupt the mechanical environment of the spine which lead to adjacent segment disease. Alternatively, disc tissue engineering strategies, where cell-seeded hydrogels or fibrous biomaterials are cultured in vitro to promote matrix deposition, do not recapitulate the complex IVD mechanical properties. In this study, we use 3D printing of flexible polylactic acid (FPLA) to fabricate a viscoelastic scaffold with tunable biomimetic mechanics for whole spine motion segment applications. We optimized the mechanical properties of the scaffolds for equilibrium and dynamic moduli in compression and tension by varying fiber spacing or porosity, generating scaffolds with de novo mechanical properties within the physiological range of spine motion segments. The biodegradation analysis of the 3D printed scaffolds showed that FPLA exhibits lower degradation rate and thus has longer mechanical stability than standard PLA. FPLA scaffolds were biocompatible, supporting viability of nucleus pulposus (NP) cells in 2D and in FPLA+hydrogel composites. Composite scaffolds cultured with NP cells maintained baseline physiological mechanical properties and promoted matrix deposition up to 8 weeks in culture. Mesenchymal stromal cells (MSCs) cultured on FPLA adhered to the scaffold and exhibited fibrocartilaginous differentiation. These results demonstrate for the first time that 3D printed FPLA scaffolds have de novo viscoelastic mechanical properties that match the native IVD motion segment in both tension and compression and have the potential to be used as a mechanically stable and biocompatible biomaterial for engineered disc replacement.

Morphology Comparison Between Goat Bone Marrow Mesenchymal Stem Cells and Adhesive Fibrin for the Repair of Annulus Fibrosus Defect of Intervertebral Discs

Introduction: The purpose of this study was to compare the histological findings of goat bone marrow mesenchymal stem cell (BMSC) transplantation and adhesive fibrin repair for annulus fibrosus defects in intervertebral discs. Material and methods: The goats were spanided into three groups: the control group, the adhesive group and the transplantation group. In the control group, surgical instruments were used to create a fibrous ring defect in the intervertebral disc of the goats. In the adhesive group, a 1.5*1.5-cm defect was also created by surgical intervention, and the broken fiber ring was then bonded with adhesive fibrin. In the transplantation group, a gelatine sponge containing the goat BMSCs was implanted into the broken annulus fibrosus, and the wound was closed layer by layer. At 6 weeks and 12 weeks after the operation, the damaged tissues were removed, and haematoxylin and eosin (HE), trichrome gelatine (Masson), Alcian blue periodic acid-Schiff (AB-PAS) and Collagen II staining was performed. Then, the tissues from the different groups were histologically compared and analyzed. Results: Goat BMSCs have a better ability to repair defects in the fibrous ring than adhesive fibrin. Over time, the number of cells or the amount of tissue following cell transplantation was greater, indicating that the degree of repair is greater with BMSCs than with adhesive fibrin. Conclusion: Histologically, repair of the defect of the fibrous ring and prevention of nucleus pulposus protrusion were more effective in the cell transplantation group than in the other two groups.

Intervertebral disc degeneration and regeneration: a motion segment perspective

Back and neck pain have become primary reasons for disability and healthcare spending globally. While the causes of back pain are multifactorial, intervertebral disc degeneration is frequently cited as a primary source of pain. The annulus fibrosus (AF) and nucleus pulposus (NP) subcomponents of the disc are common targets for regenerative therapeutics. However, disc degeneration is also associated with degenerative changes to adjacent spinal tissues, and successful regenerative therapies will likely need to consider and address the pathology of adjacent spinal structures beyond solely the disc subcomponents. This review summarises the current state of knowledge in the field regarding associations between back pain, disc degeneration, and degeneration of the cartilaginous and bony endplates, the AF-vertebral body interface, the facet joints and spinal muscles, in addition to a discussion of regenerative strategies for treating pain and degeneration from a whole motion segment perspective.

Electrospinning and 3D bioprinting for intervertebral disc tissue engineering

Intervertebral disc (IVD) degeneration is a major cause of low back pain and represents a massive socioeconomic burden. Current conservative and surgical treatments fail to restore native tissue architecture and functionality. Tissue engineering strategies, especially those based on 3D bioprinting and electrospinning, have emerged as possible alternatives by producing cell-seeded scaffolds that replicate the structure of the IVD extracellular matrix. In this review, we provide an overview of recent advancements and limitations of 3D bioprinting and electrospinning for the treatment of IVD degeneration, focusing on future areas of research that may contribute to their clinical translation.

Generation of an in vitro model of the outer annulus fibrosus-cartilage interface

Current treatments for degenerative disc disease do not restore full biological functionality of the intervertebral disc (IVD). As a result, regenerative medicine approaches are being developed to generate a biological replacement that when implanted will restore form and function of the degenerated IVD. Tissue-engineered models to date have focused on the generation of nucleus pulposus and annulus fibrosus IVD components. However, these tissues need to be integrated with a cartilage endplate in order for successful implantation to occur. The purpose of this study was to generate an in vitro annulus fibrosus-cartilage interface model which would enable us to better understand the biological and biomechanical implications of such interfaces. It was hypothesized that in vitro-formed outer annulus fibrosus (OAF) and cartilage tissues would integrate in direct-contact coculture to yield an interface containing extracellular matrix with aspects resembling the native OAF-CEP interface. In vitro-formed tissues were generated using bovine OAF cell-seeded angle-ply, multi-lamellated polycarbonate urethane scaffolds and articular chondrocytes, which were then placed in direct-contact coculture. 2-week old OAF tissues integrated with 3-day old cartilage by 1 week of coculture. Immunohistochemical staining of 2-week interfaces showed that distributions of collagen type I, collagen type II, and aggrecan were similar to the native bovine interface. The apparent tensile strength of the in vitro interface increased significantly between 2 and 4 weeks of coculture. In summary, an annulus fibrosus-cartilage interface model can be formed in vitro which will facilitate the identification of conditions required to generate an entire tissue-engineered disc replacement suitable for clinical use.

Sirtuins and intervertebral disc degeneration: Roles in inflammation, oxidative stress, and mitochondrial function

Intervertebral disc degeneration (IDD) is one of the main causes of low back pain, which seriously reduces the quality of life of patients and places a heavy economic burden on their families. Cellular senescence is considered to be an important factor leading to IDD, and inflammatory response, oxidative stress, and mitochondrial dysfunction are closely related to intervertebral disc (IVD) senescence. Therefore, inhibition of the inflammatory response and oxidative stress, along with maintaining mitochondrial function, may be useful in treating IDD. The sirtuins are a family of evolutionarily conserved nicotinamide adenine dinucleotide (NAD⁺)-dependent histone deacetylases, which are the major molecules mediating life extension or delay of aging-related diseases. The sirtuin protein family consist of seven members (SIRT1 - 7), which are mainly involved in various aging-related diseases by regulating inflammation, oxidative stress, and mitochondrial function. Among them, SIRT1, SIRT2, SIRT3, and SIRT6 are closely related to IDD. In addition, some activators of sirtuin proteins, such as resveratrol, melatonin, magnolol, 1,4-dihydropyridine (DHP), SRT1720, and nicotinamide mononucleotide (NMN), have been evaluated in preclinical studies for their effects in preventing IDD. This review described the biological functions of sirtuins and the important roles of SIRT1, SIRT2, SIRT3, and SIRT6 in IDD by regulating oxidative stress, inflammatory response, and mitochondrial function. In addition, we introduce the status of some sirtuin activators in IDD preclinical studies. This review will provide a background for further clarification of the molecular mechanism underlying IDD and the development of potential therapeutic drugs.

Promise, progress, and problems in whole disc tissue engineering

Intervertebral disc degeneration is frequently implicated as a cause of back and neck pain, which are pervasive musculoskeletal complaints in modern society. For the treatment of end stage disc degeneration, replacement of the disc with a viable, tissue-engineered construct that mimics native disc structure and function is a promising alternative to fusion or mechanical arthroplasty techniques. Substantial progress has been made in the field of whole disc tissue engineering over the past decade, with a variety of innovative designs characterized both in vitro and in vivo in animal models. However, significant barriers to clinical translation remain, including construct size, cell source, culture technique, and the identification of appropriate animal models for preclinical evaluation. Here we review the clinical need for disc tissue engineering, the current state of the field, and the outstanding challenges that will need to be addressed by future work in this area.