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Rudnik‐Jansen I, van Kruining Kodele S, Creemers L, Joosten B. Biomolecular therapies for chronic discogenic low back pain: A narrative review. JOR Spine 2024; 7:e1345. [PMID: 39114580 PMCID: PMC11303450 DOI: 10.1002/jsp2.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 05/01/2024] [Indexed: 08/10/2024] Open
Abstract
Chronic low back pain caused by intervertebral disc (IVD) degeneration, also termed chronic discogenic low back pain (CD-LBP), is one of the most prevalent musculoskeletal diseases. Degenerative processes in the IVD, such as inflammation and extra-cellular matrix breakdown, result in neurotrophin release. Local elevated neurotrophin levels will stimulate sprouting and innervation of sensory neurons. Furthermore, sprouted sensory nerves that are directly connected to adjacent dorsal root ganglia have shown to increase microglia activation, contributing to the maintenance and chronification of pain. Current pain treatments have shown to be insufficient or inadequate for long-term usage. Furthermore, most therapeutic approaches aimed to target the underlying pathogenesis of disc degeneration focus on repair and regeneration and neglect chronic pain. How biomolecular therapies influence the degenerative IVD environment, pain signaling cascades, and innervation and excitability of the sensory neurons often remains unclear. This review addresses the relatively underexplored area of chronic pain treatment for CD-LBP and summarizes effects of therapies aimed for CD-LBP with special emphasis on chronic pain. Approaches based on blocking pro-inflammatory mediators or neurotrophin activity have been shown to hamper neuronal ingrowth into the disc. Furthermore, the tissue regenerative and neuro inhibitory properties of extracellular matrix components or transplanted mesenchymal stem cells are potentially interesting biomolecular approaches to not only block IVD degeneration but also impede pain sensitization. At present, most biomolecular therapies are based on acute IVD degeneration models and thus do not reflect the real clinical chronic pain situation in CD-LBP patients. Future studies should aim at investigating the effects of therapeutic interventions applied in chronic degenerated discs containing established sensory nerve ingrowth. The in-depth understanding of the ramifications from biomolecular therapies on pain (chronification) pathways and pain relief in CD-LBP could help narrow the gap between the pre-clinical bench and clinical bedside for novel CD-LBP therapeutics and optimize pain treatment.
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Affiliation(s)
- Imke Rudnik‐Jansen
- Department of Anesthesiology and Pain ManagementMaastricht University Medical Center (MUMC+)Maastrichtthe Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience (MHeNs)University of MaastrichtMaastrichtthe Netherlands
| | - Sanda van Kruining Kodele
- Department of Translational Neuroscience, School of Mental Health and Neuroscience (MHeNs)University of MaastrichtMaastrichtthe Netherlands
| | - Laura Creemers
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Bert Joosten
- Department of Anesthesiology and Pain ManagementMaastricht University Medical Center (MUMC+)Maastrichtthe Netherlands
- Department of Translational Neuroscience, School of Mental Health and Neuroscience (MHeNs)University of MaastrichtMaastrichtthe Netherlands
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Xiang H, Zhao W, Jiang K, He J, Chen L, Cui W, Li Y. Progress in regulating inflammatory biomaterials for intervertebral disc regeneration. Bioact Mater 2024; 33:506-531. [PMID: 38162512 PMCID: PMC10755503 DOI: 10.1016/j.bioactmat.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/04/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Intervertebral disc degeneration (IVDD) is rising worldwide and leading to significant health issues and financial strain for patients. Traditional treatments for IVDD can alleviate pain but do not reverse disease progression, and surgical removal of the damaged disc may be required for advanced disease. The inflammatory microenvironment is a key driver in the development of disc degeneration. Suitable anti-inflammatory substances are critical for controlling inflammation in IVDD. Several treatment options, including glucocorticoids, non-steroidal anti-inflammatory drugs, and biotherapy, are being studied for their potential to reduce inflammation. However, anti-inflammatories often have a short half-life when applied directly and are quickly excreted, thus limiting their therapeutic effects. Biomaterial-based platforms are being explored as anti-inflammation therapeutic strategies for IVDD treatment. This review introduces the pathophysiology of IVDD and discusses anti-inflammatory therapeutics and the components of these unique biomaterial platforms as comprehensive treatment systems. We discuss the strengths, shortcomings, and development prospects for various biomaterials platforms used to modulate the inflammatory microenvironment, thus providing guidance for future breakthroughs in IVDD treatment.
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Affiliation(s)
- Honglin Xiang
- Department of Orthopaedics, Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 The South of Maoyuan Road, Nanchong, Sichuan, 637000, PR China
| | - Weikang Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Ke Jiang
- Department of Orthopaedics, Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 The South of Maoyuan Road, Nanchong, Sichuan, 637000, PR China
| | - Jiangtao He
- Department of Orthopaedics, Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 The South of Maoyuan Road, Nanchong, Sichuan, 637000, PR China
| | - Lu Chen
- Department of Orthopaedics, Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 The South of Maoyuan Road, Nanchong, Sichuan, 637000, PR China
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Yuling Li
- Department of Orthopaedics, Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 The South of Maoyuan Road, Nanchong, Sichuan, 637000, PR China
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Zhang H, Yang X, Huang Y, Li Y, Hu Q, Wei Q, Xu W, Ding W, Guo Y, Shen JW. Reviving Intervertebral Discs: Treating Degeneration Using Advanced Delivery Systems. Mol Pharm 2024; 21:373-392. [PMID: 38252032 DOI: 10.1021/acs.molpharmaceut.3c00579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Intervertebral disc degeneration (IVDD) is commonly associated with many spinal problems, such as low back pain, and significantly impacts a patient's quality of life. However, current treatments for IVDD, which include conservative and surgical methods, are limited in their ability to fully address degeneration. To combat IVDD, delivery-system-based therapy has received extensive attention from researchers. These delivery systems can effectively deliver therapeutic agents for IVDD, overcoming the limitations of these agents, reducing leakage and increasing local concentration to inhibit IVDD or promote intervertebral disc (IVD) regeneration. This review first briefly introduces the structure and function of the IVD, and the related pathophysiology of IVDD. Subsequently, the roles of drug-based and bioactive-substance-based delivery systems in IVDD are highlighted. The former includes natural source drugs, nonsteroidal anti-inflammatory drugs, steroid medications, and other small molecular drugs. The latter includes chemokines, growth factors, interleukin, and platelet-rich plasma. Additionally, gene-based and cell-based delivery systems are briefly involved. Finally, the limitations and future development of the combination of therapeutic agents and delivery systems in the treatment of IVDD are discussed, providing insights for future research.
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Affiliation(s)
- Hong Zhang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Xiaorong Yang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Yiheng Huang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Yue Li
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Quan Hu
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Qiaolin Wei
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Weixing Xu
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province 310012, China
| | - Weiguo Ding
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province 310012, China
| | - Yong Guo
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Jia-Wei Shen
- School of Pharmacy, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
- Key Laboratory of Elemene Class Anti-Cancer Chinese Medicines, Engineering Laboratory of Development and Application of Traditional Chinese Medicines, Collaborative Innovation Center of Traditional Chinese Medicines of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
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Han H, Zhao X, Ma H, Zhang Y, Lei B. Multifunctional injectable hydrogels with controlled delivery of bioactive factors for efficient repair of intervertebral disc degeneration. Heliyon 2023; 9:e21867. [PMID: 38027562 PMCID: PMC10665751 DOI: 10.1016/j.heliyon.2023.e21867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Millions of people worldwide suffer from intervertebral disc degeneration (IVDD), which imposes a significant socioeconomic burden on society. There is an urgent clinical demand for more effective treatments for IVDD because conventional treatments can only alleviate the symptoms rather than preventing the progression of IVDD. Hydrogels, a class of elastic biomaterials with good biocompatibility, are promising candidates for intervertebral disc repair and regeneration. In recent years, various hydrogels have been investigated in vitro and in vivo for the repair of intervertebral discs, some of which are ready for clinical testing. This review summarizes the latest findings and developments in using bioactive factors-released bioactive injectable hydrogels for the repair and regeneration of intervertebral discs. It focuses on the analysis and summary of the use of multifunctional injectable hydrogels to delivery bioactive factors (cells, exosomes, growth factors, genes, drugs) for disc regeneration, providing guidance for future study. Finally, we discussed and analyzed the optimal timing for the application of controlled-release hydrogels in the treatment of IVDD to meet the high standards required for intervertebral disc regeneration and precision medicine.
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Affiliation(s)
- Hao Han
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaoming Zhao
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hongyun Ma
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yingang Zhang
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Bo Lei
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710000, China
- Fronter Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, China
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Ma J, Häne S, Eglauf J, Pfannkuche J, Soubrier A, Li Z, Peroglio M, Hoppe S, Benneker L, Lang G, Wangler S, Alini M, Creemers LB, Grad S, Häckel S. Celecoxib alleviates nociceptor sensitization mediated by interleukin-1beta-primed annulus fibrosus cells. 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 2023; 32:2048-2058. [PMID: 37071156 DOI: 10.1007/s00586-023-07672-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/15/2023] [Accepted: 03/18/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE This study aims to analyze the effect of pro-inflammatory cytokine-stimulated human annulus fibrosus cells (hAFCs) on the sensitization of dorsal root ganglion (DRG) cells. We further hypothesized that celecoxib (cxb) could inhibit hAFCs-induced DRG sensitization. METHODS hAFCs from spinal trauma patients were stimulated with TNF-α or IL-1β. Cxb was added on day 2. On day 4, the expression of pro-inflammatory and neurotrophic genes was evaluated using RT-qPCR. Levels of prostaglandin E2 (PGE-2), IL-8, and IL-6 were measured in the conditioned medium (CM) using ELISA. hAFCs CM was then applied to stimulate the DRG cell line (ND7/23) for 6 days. Then, calcium imaging (Fluo4) was performed to evaluate DRG cell sensitization. Both spontaneous and bradykinin-stimulated (0.5 μM) calcium responses were analyzed. The effects on primary bovine DRG cell culture were performed in parallel to the DRG cell line model. RESULTS IL-1ß stimulation significantly enhanced the release of PGE-2 in hAFCs CM, while this increase was completely suppressed by 10 µM cxb. hAFCs revealed elevated IL-6 and IL-8 release following TNF-α and IL-1β treatment, though cxb did not alter this. The effect of hAFCs CM on DRG cell sensitization was influenced by adding cxb to hAFCs; both the DRG cell line and primary bovine DRG nociceptors showed a lower sensitivity to bradykinin stimulation. CONCLUSION Cxb can inhibit PGE-2 production in hAFCs in an IL-1β-induced pro-inflammatory in vitro environment. The cxb applied to the hAFCs also reduces the sensitization of DRG nociceptors that are stimulated by the hAFCs CM.
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Affiliation(s)
- Junxuan Ma
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Surya Häne
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- ETH Zurich, Zurich, Switzerland
| | - Janick Eglauf
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- ETH Zurich, Zurich, Switzerland
| | - Judith Pfannkuche
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Astrid Soubrier
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Zhen Li
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | | | - Sven Hoppe
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lorin Benneker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Spine Surgery, Sonnenhof Spital, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center-Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Sebastian Wangler
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Mauro Alini
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Laura B Creemers
- Department of Orthopaedics, University Medical Center Utrecht, Room G05.228, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
| | - Sibylle Grad
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
- ETH Zurich, Zurich, Switzerland
| | - Sonja Häckel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Alini M, Diwan AD, Erwin WM, Little CB, Melrose J. An update on animal models of intervertebral disc degeneration and low back pain: Exploring the potential of artificial intelligence to improve research analysis and development of prospective therapeutics. JOR Spine 2023; 6:e1230. [PMID: 36994457 PMCID: PMC10041392 DOI: 10.1002/jsp2.1230] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 02/03/2023] Open
Abstract
Animal models have been invaluable in the identification of molecular events occurring in and contributing to intervertebral disc (IVD) degeneration and important therapeutic targets have been identified. Some outstanding animal models (murine, ovine, chondrodystrophoid canine) have been identified with their own strengths and weaknesses. The llama/alpaca, horse and kangaroo have emerged as new large species for IVD studies, and only time will tell if they will surpass the utility of existing models. The complexity of IVD degeneration poses difficulties in the selection of the most appropriate molecular target of many potential candidates, to focus on in the formulation of strategies to effect disc repair and regeneration. It may well be that many therapeutic objectives should be targeted simultaneously to effect a favorable outcome in human IVD degeneration. Use of animal models in isolation will not allow resolution of this complex issue and a paradigm shift and adoption of new methodologies is required to provide the next step forward in the determination of an effective repairative strategy for the IVD. AI has improved the accuracy and assessment of spinal imaging supporting clinical diagnostics and research efforts to better understand IVD degeneration and its treatment. Implementation of AI in the evaluation of histology data has improved the usefulness of a popular murine IVD model and could also be used in an ovine histopathological grading scheme that has been used to quantify degenerative IVD changes and stem cell mediated regeneration. These models are also attractive candidates for the evaluation of novel anti-oxidant compounds that counter inflammatory conditions in degenerate IVDs and promote IVD regeneration. Some of these compounds also have pain-relieving properties. AI has facilitated development of facial recognition pain assessment in animal IVD models offering the possibility of correlating the potential pain alleviating properties of some of these compounds with IVD regeneration.
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Affiliation(s)
| | - Ashish D. Diwan
- Spine Service, Department of Orthopedic Surgery, St. George & Sutherland Campus, Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
| | - W. Mark Erwin
- Department of SurgeryUniversity of TorontoOntarioCanada
| | - Chirstopher B. Little
- Raymond Purves Bone and Joint Research LaboratoryKolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore HospitalSt. LeonardsNew South WalesAustralia
| | - James Melrose
- Raymond Purves Bone and Joint Research LaboratoryKolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore HospitalSt. LeonardsNew South WalesAustralia
- Graduate School of Biomedical EngineeringThe University of New South WalesSydneyNew South WalesAustralia
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Santifort KM, Glass EN, Meij BP, Bergknut N, Pumarola M, Gil VA. Anatomic description of the basivertebral nerve and meningeal branch of the spinal nerve in the dog. Ann Anat 2022; 245:152000. [PMID: 36183940 DOI: 10.1016/j.aanat.2022.152000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The existence of the basivertebral nerve and meningeal branch of the spinal nerve has not been proven in dogs to date. The objectives of this study are to 1) determine whether dogs have a meningeal branch of the spinal nerve (MBSN) and a basivertebral nerve (BVN) and to (2) describe anatomical characteristics of these two nerves. Authors also put forward a discussion on the possible clinical relevance of these findings. MATERIAL AND METHODS Dissections were performed on six embalmed dogs at the Veterinary Faculty of Barcelona with the use of stereomicroscopy and microsurgery equipment. RESULTS The MBSN (grossly) and BVN (grossly and histologically) were identified in the cervical, thoracic, and lumbar region in all dog specimens. In addition, other small fibers (suspected nerves) entering the vertebral body through small foramina close to the end plates were identified. Histological examination of the tissues confirmed the presence of nerve fibers (myelinated and unmyelinated) in suspected BVN samples. Results of the present study indicated that dogs have BVNs. Also, suspected nerve fibers were identified among the epidural fat, running from the intervertebral foramina, that likely represent the MBSN. CONCLUSION These findings open up the discussion on extrapolation of treatment options employed in human medicine for "low back pain", such as BVN ablation, which is discussed in this article. Further anatomic and clinical studies of the innervation for the vertebral body, periosteum, vasculature, dorsal longitudinal ligament and anulus fibrosus are necessary to elucidate possible anatomical variants and breed differences as well as potential clinical (e.g., therapeutic) relevance.
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Affiliation(s)
- K M Santifort
- Evidensia Small Animal Hospital Arnhem, Meander 10, 6825 MB Arnhem, the Netherlands; Evidensia Small Animal Hospital Hart van Brabant, Eerste Zeine 112, 5144 AM Arnhem, the Netherlands.
| | - E N Glass
- Red Bank Veterinary Hospital, Section of Neurology and Neurosurgery, 197 Hance Ave, Tinton Falls, NJ 07724
| | - B P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3508 TD Utrecht, the Netherlands
| | - N Bergknut
- Evidensia Small Animal Hospital Arnhem, Meander 10, 6825 MB Arnhem, the Netherlands; Evidensia Small Animal Hospital Hart van Brabant, Eerste Zeine 112, 5144 AM Arnhem, the Netherlands
| | - M Pumarola
- Unit of Compared and Murine Pathology, Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universitat Autònoma de Barcelona, Campus UAB, Travessera dels turons s/n, 08193 Bellaterra (Barcelona), Spain
| | - V Aige Gil
- Department of Sanitat i Anatomía Animal, Faculty of Veterinary Medicine, Universitat Autònoma de Barcelona Campus UAB, Travessera dels turons s/n, 08193, Bellaterra (Barcelona), Spain
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Laagland LT, Bach FC, Creemers LB, Le Maitre CL, Poramba-Liyanage DW, Tryfonidou MA. Hyperosmolar expansion medium improves nucleus pulposus cell phenotype. JOR Spine 2022; 5:e1219. [PMID: 36203869 PMCID: PMC9520765 DOI: 10.1002/jsp2.1219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Repopulating the degenerated intervertebral disc (IVD) with tissue-specific nucleus pulposus cells (NPCs) has already been shown to promote regeneration in various species. Yet the applicability of NPCs as cell-based therapy has been hampered by the low cell numbers that can be extracted from donor IVDs and their potentially limited regenerative capacity due to their degenerated phenotype. To optimize the expansion conditions, we investigated the effects of increasing culture medium osmolarity during expansion on the phenotype of dog NPCs and their ability to produce a healthy extracellular matrix (ECM) in a 3D culture model. Methods Dog NPCs were expanded in expansion medium with a standard osmolarity of 300 mOsm/L or adjusted to 400 or 500 mOsm/L in both normoxic and hypoxic conditions. Following expansion, NPCs were cultured in a 3D culture model in chondrogenic culture medium with a standard osmolarity. Read-out parameters included cell proliferaton rate, morphology, phenotype and healthy ECM production. Results Increasing the expansion medium osmolarity from 300 to 500 mOsm/L resulted in NPCs with a more rounded morphology and a lower cell proliferation rate accompanied by the expression of several healthy NPC and progenitor markers at gene (KRT18, ACAN, COL2, CD73, CD90) and protein (ACAN, PAX1, CD24, TEK, CD73) level. The NPCs expanded at 500 mOsm/L were able to retain most of their phenotypic markers and produce healthy ECM during 3D culture independent of the oxygen level used during expansion. Conclusions Altogether, our findings show that increasing medium osmolarity during expansion results in an NPC population with improved phenotype, which could enhance the potential of cell-based therapies for IVD regeneration.
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Affiliation(s)
- Lisanne T Laagland
- Department of Clinical Sciences, Faculty of Veterinary Medicine Utrecht University Utrecht The Netherlands
| | - Frances C Bach
- Department of Clinical Sciences, Faculty of Veterinary Medicine Utrecht University Utrecht The Netherlands
| | - Laura B Creemers
- Department of Orthopedics University Medical Centre Utrecht Utrecht The Netherlands
| | | | - Deepani W Poramba-Liyanage
- Department of Clinical Sciences, Faculty of Veterinary Medicine Utrecht University Utrecht The Netherlands
| | - Marianna A Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine Utrecht University Utrecht The Netherlands
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Mohd Isa IL, Mokhtar SA, Abbah SA, Fauzi MB, Devitt A, Pandit A. Intervertebral Disc Degeneration: Biomaterials and Tissue Engineering Strategies toward Precision Medicine. Adv Healthc Mater 2022; 11:e2102530. [PMID: 35373924 DOI: 10.1002/adhm.202102530] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/01/2022] [Indexed: 12/22/2022]
Abstract
Intervertebral disc degeneration is a common cause of discogenic low back pain resulting in significant disability. Current conservative or surgical intervention treatments do not reverse the underlying disc degeneration or regenerate the disc. Biomaterial-based tissue engineering strategies exhibit the potential to regenerate the disc due to their capacity to modulate local tissue responses, maintain the disc phenotype, attain biochemical homeostasis, promote anatomical tissue repair, and provide functional mechanical support. Despite preliminary positive results in preclinical models, these approaches have limited success in clinical trials as they fail to address discogenic pain. This review gives insights into the understanding of intervertebral disc pathology, the emerging concept of precision medicine, and the rationale of personalized biomaterial-based tissue engineering tailored to the severity of the disease targeting early, mild, or severe degeneration, thereby enhancing the efficacy of the treatment for disc regeneration and ultimately to alleviate discogenic pain. Further research is required to assess the relationship between disc degeneration and lower back pain for developing future clinically relevant therapeutic interventions targeted towards the subgroup of degenerative disc disease patients.
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Affiliation(s)
- Isma Liza Mohd Isa
- Department of Anatomy Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur 56000 Malaysia
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
| | - Sabarul Afian Mokhtar
- Department of Orthopaedics and Traumatology Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur 56000 Malaysia
| | - Sunny A. Abbah
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur 56000 Malaysia
| | - Aiden Devitt
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
- Department of Orthopedic Surgery University Hospital Galway Galway H91YR71 Ireland
| | - Abhay Pandit
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
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Zoetebier B, Schmitz T, Ito K, Karperien M, Tryfonidou MA, Paez J. Injectable hydrogels for articular cartilage and nucleus pulposus repair: Status quo and prospects. Tissue Eng Part A 2022; 28:478-499. [PMID: 35232245 DOI: 10.1089/ten.tea.2021.0226] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Osteoarthritis (OA) and chronic low back pain due to degenerative (intervertebral) disc disease (DDD) are two of the major causes of disabilities worldwide, affecting hundreds of millions of people and leading to a high socioeconomic burden. Although OA occurs in synovial joints and DDD occurs in cartilaginous joints, the similarities are striking, with both joints showing commonalities in the nature of the tissues and in the degenerative processes during disease. Consequently, repair strategies for articular cartilage (AC) and nucleus pulposus (NP), the core of the intervertebral disc, in the context of OA and DDD share common aspects. One of such tissue engineering approaches is the use of injectable hydrogels for AC and NP repair. In this review, the state-of-the-art and recent developments in injectable hydrogels for repairing, restoring, and regenerating AC tissue suffering from OA and NP tissue in DDD are summarized focusing on cell-free approaches. The various biomaterial strategies exploited for repair of both tissues are compared, and the synergies that could be gained by translating experiences from one tissue to the other are identified.
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Affiliation(s)
- Bram Zoetebier
- University of Twente Faculty of Science and Technology, 207105, Developmental BioEngineering , Drienerlolaan 5, Enschede, Netherlands, 7500 AE;
| | - Tara Schmitz
- Eindhoven University of Technology, 3169, Department of Biomedical Engineering, Eindhoven, Noord-Brabant, Netherlands;
| | - Keita Ito
- Eindhoven University of Technology, Department of Biomedical Engineering, P.O. Box 513, GEMZ 4.115, Eindhoven, Netherlands, 5600 MB;
| | | | - Marianna A Tryfonidou
- Utrecht University, Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Yalelaan 108, Utrecht, Netherlands, 3584 CM;
| | - Julieta Paez
- University of Twente Faculty of Science and Technology, 207105, Developmental Bioengineering, University of Twente P.O. Box 217, Enschede The Netherlands, Enschede, Netherlands, 7500 AE;
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11
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Applications of Functionalized Hydrogels in the Regeneration of the Intervertebral Disc. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2818624. [PMID: 34458364 PMCID: PMC8397561 DOI: 10.1155/2021/2818624] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
Intervertebral disc degeneration (IDD) is caused by genetics, aging, and environmental factors and is one of the leading causes of low back pain. The treatment of IDD presents many challenges. Hydrogels are biomaterials that possess properties similar to those of the natural extracellular matrix and have significant potential in the field of regenerative medicine. Hydrogels with various functional qualities have recently been used to repair and regenerate diseased intervertebral discs. Here, we review the mechanisms of intervertebral disc homeostasis and degeneration and then discuss the applications of hydrogel-mediated repair and intervertebral disc regeneration. The classification of artificial hydrogels and natural hydrogels is then briefly introduced, followed by an update on the development of functional hydrogels, which include noncellular therapeutic hydrogels, cellular therapeutic hydrogel scaffolds, responsive hydrogels, and multifunctional hydrogels. The challenges faced and future developments of the hydrogels used in IDD are discussed as they further promote their clinical translation.
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12
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Wiersema T, Tellegen AR, Beukers M, van Stralen M, Wouters E, van de Vooren M, Woike N, Mihov G, Thies JC, Creemers LB, Tryfonidou MA, Meij BP. Prospective Evaluation of Local Sustained Release of Celecoxib in Dogs with Low Back Pain. Pharmaceutics 2021; 13:1178. [PMID: 34452138 PMCID: PMC8398998 DOI: 10.3390/pharmaceutics13081178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
Back pain affects millions globally and in 40% of the cases is attributed to intervertebral disc degeneration. Oral analgesics are associated with adverse systemic side-effects and insufficient pain relief. Local drug delivery mitigates systemic effects and accomplishes higher local dosing. Clinical efficacy of intradiscally injected celecoxib (CXB)-loaded polyesteramide microspheres (PEAMs) was studied in a randomized prospective double-blinded placebo controlled veterinary study. Client-owned dog patients suffering from back pain were treated with CXB-loaded (n = 20) or unloaded PEAMs ("placebo") (n = 10) and evaluated by clinical examination, gait analysis, owners' questionnaires, and MRI at 6 and 12 weeks follow-up. At 6 and 12 weeks, CXB-treated dogs experienced significantly less pain interference with their daily life activities compared to placebo. The risk ratio for treatment success was 1.90 (95% C.I. 1.24-2.91, p = 0.023) at week 6 and 1.95 (95% C.I. 1.10-3.45, p = 0.036) at week 12. The beneficial effects of CXB-PEAMs were more pronounced for the subpopulation of male dogs and those with no Modic changes in MRI at inclusion in the study; disc protrusion did not affect the outcome. It remains to be determined whether intradiscal injection of CXB-PEAMs, in addition to analgesic properties, has the ability to halt the degenerative process in the long term or restore the disc.
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Affiliation(s)
- Tijn Wiersema
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Anna R. Tellegen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Martijn Beukers
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Marijn van Stralen
- Image Sciences Institute, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Erik Wouters
- Anicura Dierenziekenhuis Dordrecht, Jan Valsterweg 26, 3315 LG Dordrecht, The Netherlands;
| | - Mandy van de Vooren
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Nina Woike
- DSM Biomedical, Koestraat 1, 6167 RA Geleen, The Netherlands; (N.W.); (G.M.); (J.C.T.)
| | - George Mihov
- DSM Biomedical, Koestraat 1, 6167 RA Geleen, The Netherlands; (N.W.); (G.M.); (J.C.T.)
| | - Jens C. Thies
- DSM Biomedical, Koestraat 1, 6167 RA Geleen, The Netherlands; (N.W.); (G.M.); (J.C.T.)
| | - Laura B. Creemers
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Björn P. Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
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13
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Constantinou AP, Georgiou TK. Pre‐clinical and clinical applications of thermoreversible hydrogels in biomedical engineering: a review. POLYM INT 2021. [DOI: 10.1002/pi.6266] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Anna P Constantinou
- Department of Materials Imperial College London, South Kensington Campus, Royal School of Mines London UK
| | - Theoni K Georgiou
- Department of Materials Imperial College London, South Kensington Campus, Royal School of Mines London UK
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14
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Carvalho SG, Silvestre ALP, Martins Dos Santos A, Fonseca-Santos B, Rodrigues WD, Palmira Daflon Gremião M, Chorilli M, Villanova JCO. Polymeric-based drug delivery systems for veterinary use: State of the art. Int J Pharm 2021; 604:120756. [PMID: 34058307 DOI: 10.1016/j.ijpharm.2021.120756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
One of the challenges to the success of veterinary pharmacotherapy is the limited number of drugs and dosage forms available exclusively to this market, due to the interspecies variability of animals, such as anatomy, physiology, pharmacokinetics, and pharmacodynamics. For this reason, studies in this area have become a highlight, since they are still scarce in comparison with those on human drug use. To overcome many limitations related to the bioavailability, efficacy, and safety of pharmacotherapy in animals, especially livestock and domestic animals, polymers-based drug delivery systems are promising tools if they guarantee greater selectivity and less toxicity in dosage forms. In addition, these tools may be developed according to the great interspecies variability. To contribute to these discussions, this paper provides an updated review of the major polymer-based drug delivery systems projected for veterinary use. Traditional and innovative drug delivery systems based on polymers are presented, with an emphasis on films, microparticles, micelles, nanogels, nanoparticles, tablets, implants and hydrogel-based drug delivery systems. We discuss important concepts for the veterinarian about the mechanisms of drug release and, for the pharmacist, the advantages in the development of pharmaceutical forms for the animal population. Finally, challenges and opportunities are presented in the field of pharmaceutical dosage forms for veterinary use in response to the interests of the pharmaceutical industry.
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Affiliation(s)
- Suzana Gonçalves Carvalho
- School of Pharmaceutical Sciences, São Paulo State University, UNESP, Department of Drugs and Medicines, 14800-903 Araraquara, SP, Brazil.
| | - Amanda Letícia Polli Silvestre
- School of Pharmaceutical Sciences, São Paulo State University, UNESP, Department of Drugs and Medicines, 14800-903 Araraquara, SP, Brazil
| | - Aline Martins Dos Santos
- School of Pharmaceutical Sciences, São Paulo State University, UNESP, Department of Drugs and Medicines, 14800-903 Araraquara, SP, Brazil
| | - Bruno Fonseca-Santos
- Faculty of Pharmaceutical Sciences, University of Campinas (UNICAMP), 13083-871 Campinas, SP, Brazil
| | - Winner Duque Rodrigues
- School of Pharmaceutical Sciences, São Paulo State University, UNESP, Department of Drugs and Medicines, 14800-903 Araraquara, SP, Brazil
| | - Maria Palmira Daflon Gremião
- School of Pharmaceutical Sciences, São Paulo State University, UNESP, Department of Drugs and Medicines, 14800-903 Araraquara, SP, Brazil.
| | - Marlus Chorilli
- School of Pharmaceutical Sciences, São Paulo State University, UNESP, Department of Drugs and Medicines, 14800-903 Araraquara, SP, Brazil.
| | - Janaína Cecília Oliveira Villanova
- Laboratory of Pharmaceutical Production, Department of Pharmacy and Nutrition, Federal University of Espirito Santo (UFES), 29500-000 Alegre, ES, Brazil.
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15
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Kamali A, Ziadlou R, Lang G, Pfannkuche J, Cui S, Li Z, Richards RG, Alini M, Grad S. Small molecule-based treatment approaches for intervertebral disc degeneration: Current options and future directions. Theranostics 2021; 11:27-47. [PMID: 33391459 PMCID: PMC7681102 DOI: 10.7150/thno.48987] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023] Open
Abstract
Low back pain (LBP) is a major reason for disability, and symptomatic intervertebral disc (IVD) degeneration (IDD) contributes to roughly 40% of all LBP cases. Current treatment modalities for IDD include conservative and surgical strategies. Unfortunately, there is a significant number of patients in which conventional therapies fail with the result that these patients remain suffering from chronic pain and disability. Furthermore, none of the current therapies successfully address the underlying biological problem - the symptomatic degenerated disc. Both spinal fusion as well as total disc replacement devices reduce spinal motion and are associated with adjacent segment disease. Thus, there is an unmet need for novel and stage-adjusted therapies to combat IDD. Several new treatment options aiming to regenerate the IVD are currently under investigation. The most common approaches include tissue engineering, growth factor therapy, gene therapy, and cell-based treatments according to the stage of degeneration. Recently, the regenerative activity of small molecules (low molecular weight organic compounds with less than 900 daltons) on IDD was demonstrated. However, small molecule-based therapy in IDD is still in its infancy due to limited knowledge about the mechanisms that control different cell signaling pathways of IVD homeostasis. Small molecules can act as anti-inflammatory, anti-apoptotic, anti-oxidative, and anabolic agents, which can prevent further degeneration of disc cells and enhance their regeneration. This review pursues to give a comprehensive overview of small molecules, focusing on low molecular weight organic compounds, and their potential utilization in patients with IDD based on recent in vitro, in vivo, and pre-clinical studies.
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Affiliation(s)
- Amir Kamali
- AO Research Institute Davos, Davos, Switzerland
| | - Reihane Ziadlou
- AO Research Institute Davos, Davos, Switzerland
- Department of Biomedical Engineering, Medical Faculty of the University of Basel, Basel, CH
| | - Gernot Lang
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | | | - Shangbin Cui
- AO Research Institute Davos, Davos, Switzerland
- The first affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhen Li
- AO Research Institute Davos, Davos, Switzerland
| | | | - Mauro Alini
- AO Research Institute Davos, Davos, Switzerland
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16
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Mern DS, Walsen T, Beierfuß A, Thomé C. Animal models of regenerative medicine for biological treatment approaches of degenerative disc diseases. Exp Biol Med (Maywood) 2020; 246:483-512. [PMID: 33175609 DOI: 10.1177/1535370220969123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Degenerative disc disease (DDD) is a painful, chronic and progressive disease, which is characterized by inflammation, structural and biological deterioration of the intervertebral disc (IVD) tissues. DDD is specified as cell-, age-, and genetic-dependent degenerative process that can be accelerated by environmental factors. It is one of the major causes of chronic back pain and disability affecting millions of people globally. Current treatment options, such as physical rehabilitation, pain management, and surgical intervention, can provide only temporary pain relief. Different animal models have been used to study the process of IVD degeneration and develop therapeutic options that may restore the structure and function of degenerative discs. Several research works have depicted considerable progress in understanding the biological basis of disc degeneration and the therapeutic potentials of cell transplantation, gene therapy, applications of supporting biomaterials and bioactive factors, or a combination thereof. Since animal models play increasingly significant roles in treatment approaches of DDD, we conducted an electronic database search on Medline through June 2020 to identify, compare, and discuss publications regarding biological therapeutic approaches of DDD that based on intradiscal treatment strategies. We provide an up-to-date overview of biological treatment strategies in animal models including mouse, rat, rabbit, porcine, bovine, ovine, caprine, canine, and primate models. Although no animal model could profoundly reproduce the clinical conditions in humans; animal models have played important roles in specifying our knowledge about the pathophysiology of DDD. They are crucial for developing new therapy approaches for clinical applications.
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Affiliation(s)
| | - Tanja Walsen
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Anja Beierfuß
- Laboratory Animal Facility, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck A-6020, Austria
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17
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Tryfonidou MA, de Vries G, Hennink WE, Creemers LB. "Old Drugs, New Tricks" - Local controlled drug release systems for treatment of degenerative joint disease. Adv Drug Deliv Rev 2020; 160:170-185. [PMID: 33122086 DOI: 10.1016/j.addr.2020.10.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) and chronic low back pain (CLBP) caused by intervertebral disc (IVD) degeneration are joint diseases that have become major causes for loss of quality of life worldwide. Despite the unmet need, effective treatments other than invasive, and often ineffective, surgery are lacking. Systemic administration of drugs entails suboptimal local drug exposure in the articular joint and IVD. This review provides an overview of the potency of biomaterial-based drug delivery systems as novel treatment modality, with a focus on the biological effects of drug release systems that have reached translation at the level of in vivo models and relevant ex vivo models. These studies have shown encouraging results of biomaterial-based local delivery of several types of drugs, mostly inhibitors of inflammatory cytokines or other degenerative factors. Prevention of inflammation and degeneration and pain relief was achieved, although mainly in small animal models, with interventions applied at an early disease stage. Less convincing data were obtained with the delivery of regenerative factors. Multidisciplinary efforts towards tackling the discord between in vitro and in vivo release, combined with adaptations in the regulatory landscape may be needed to enhance safe and expeditious introduction of more and more effective controlled release-based treatments with the OA and CLBP patients.
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18
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Tran HD, Park KD, Ching YC, Huynh C, Nguyen DH. A comprehensive review on polymeric hydrogel and its composite: Matrices of choice for bone and cartilage tissue engineering. J IND ENG CHEM 2020. [DOI: 10.1016/j.jiec.2020.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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19
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Tang G, Zhou B, Li F, Wang W, Liu Y, Wang X, Liu C, Ye X. Advances of Naturally Derived and Synthetic Hydrogels for Intervertebral Disk Regeneration. Front Bioeng Biotechnol 2020; 8:745. [PMID: 32714917 PMCID: PMC7344321 DOI: 10.3389/fbioe.2020.00745] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022] Open
Abstract
Intervertebral disk (IVD) degeneration is associated with most cases of cervical and lumbar spine pathologies, amongst which chronic low back pain has become the primary cause for loss of quality-adjusted life years. Biomaterials science and tissue engineering have made significant progress in the replacement, repair and regeneration of IVD tissue, wherein hydrogel has been recognized as an ideal biomaterial to promote IVD regeneration in recent years. Aspects such as ease of use, mechanical properties, regenerative capacity, and their applicability as carriers for regenerative and anti-degenerative factors determine their suitability for IVD regeneration. This current review provides an overview of naturally derived and synthetic hydrogels that are related to their clinical applications for IVD regeneration. Although each type has its own unique advantages, it rarely becomes a standard product in truly clinical practice, and a more rational design is proposed for future use of biomaterials for IVD regeneration. This review aims to provide a starting point and inspiration for future research work on development of novel biomaterials and biotechnology.
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Affiliation(s)
- Guoke Tang
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya School of Medical CSU, Zhuzhou, China
| | - Bingyan Zhou
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya School of Medical CSU, Zhuzhou, China
| | - Feng Li
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya School of Medical CSU, Zhuzhou, China
| | - Weiheng Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yi Liu
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Chao Liu
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya School of Medical CSU, Zhuzhou, China
| | - Xiaojian Ye
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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20
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Hoang Thi TT, Sinh LH, Huynh DP, Nguyen DH, Huynh C. Self-Assemblable Polymer Smart-Blocks for Temperature-Induced Injectable Hydrogel in Biomedical Applications. Front Chem 2020; 8:19. [PMID: 32083052 PMCID: PMC7005785 DOI: 10.3389/fchem.2020.00019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/08/2020] [Indexed: 12/29/2022] Open
Abstract
Self-assembled temperature-induced injectable hydrogels fabricated via self-assembly of polymer smart-blocks have been widely investigated as drug delivery systems and platforms for tissue regeneration. Polymer smart-blocks that can be self-assembly play an important role in fabrication of hydrogels because they can self-assemble to induce the gelation of their copolymer in aqueous solution. The self-assembly occurs in response to an external stimulus change, such as temperature, pH, glucose, ionic strength, light, magnetic field, electric field, or their combination, which results in property transformations like hydrophobicity, ionization, and conformational change. The self-assembly smart-block based copolymers exist as a solution in aqueous media at certain conditions that are suitable for mixing with bioactive molecules and/or cells. However, this solution turns into a hydrogel due to the self-assembly of the smart-blocks under exposure to an external stimulus change in vitro or injection into the living body for a controllable release of loaded bioactive molecules or serving as a biomaterial scaffold for tissue regeneration. This work reports current scenery in the development of these self-assembly smart-blocks for fabrication of temperature-induced injectable physically cross-linked hydrogels and their potential application as drug delivery systems and platforms for tissue engineering.
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Affiliation(s)
- Thai Thanh Hoang Thi
- Biomaterials and Nanotechnology Research Group, Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Le Hoang Sinh
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
| | - Dai Phu Huynh
- Faculty of Materials Technology and Polymer Research Center, Ho Chi Minh City University of Technology, VNU HCM, Ho Chi Minh City, Vietnam
| | - Dai Hai Nguyen
- Institute of Applied Materials Science, Vietnam Academy of Science and Technology, Ho Chi Minh City, Vietnam
| | - Cong Huynh
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
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21
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NaPier Z, Kanim LEA, Arabi Y, Salehi K, Sears B, Perry M, Kim S, Sheyn D, Bae HW, Glaeser JD. Omega-3 Fatty Acid Supplementation Reduces Intervertebral Disc Degeneration. Med Sci Monit 2019; 25:9531-9537. [PMID: 31836696 PMCID: PMC6929565 DOI: 10.12659/msm.918649] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Intervertebral disc (IVD) degeneration is a common cause of lower back pain, which carries substantial morbidity and economic cost. Omega-3 fatty acids (n-3 FA) are known to reduce inflammatory processes with a relatively benign side effect profile. This study aimed to investigate the effect of n-3 FA supplementation on IVD degeneration. Material/Methods Two non-contiguous lumbar discs of 12 Sprague Dawley rats were needle-punctured to induce disc degeneration. Post-surgery, rats were randomly assigned to either a daily n-3 FA diet (530 mg/kg/day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in a 2: 1 ratio, administered in sucrose solution) or control diet (sucrose solution only), which was given for the duration of the study. After 1 month, blood serum arachidonic acid/eicosapentaenoic acid (AA/EPA) ratios were analyzed. After 2 months, micro-MRI (magnetic resonance imaging) analysis and histological staining of disc explants were performed to analyze the IVD. Results A reduction of blood AA/EPA ratios from 40 to 20 was demonstrated after 1 month of daily supplementation with n-3 FA. Micro-MRI analysis showed an injury-induced reduction of IVD hydration, which was attenuated in rats receiving n-3 FA. Histological evaluation demonstrated the destruction of nucleus pulposus tissue in response to needle puncture injury, which was less severe in the n-3 FA diet group. Conclusions The results of this study suggest that n-3 FA dietary supplementation reduces systemic inflammation by lowering AA/EPA ratios in blood serum and has potential protective effects on the progression of spinal disc degeneration, as demonstrated by reduced needle injury-induced dehydration of intervertebral discs and reduced histological signs of IVD degeneration.
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Affiliation(s)
- Zachary NaPier
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Linda E A Kanim
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Cedars-Sinai Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yasaman Arabi
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Khosrowdad Salehi
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Barry Sears
- Inflammation Research Foundation, Peabody, MA, USA
| | - Mary Perry
- Inflammation Research Foundation, Peabody, MA, USA
| | - Sang Kim
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dmitriy Sheyn
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hyun W Bae
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Cedars-Sinai Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Juliane D Glaeser
- Orthopaedic Stem Cell Research Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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22
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Bach FC, de Rooij KM, Riemers FM, Snuggs JW, de Jong WAM, Zhang Y, Creemers LB, Chan D, Le Maitre C, Tryfonidou MA. Hedgehog proteins and parathyroid hormone-related protein are involved in intervertebral disc maturation, degeneration, and calcification. JOR Spine 2019; 2:e1071. [PMID: 31891120 PMCID: PMC6920702 DOI: 10.1002/jsp2.1071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022] Open
Abstract
Parathyroid hormone-related protein (PTHrP) and hedgehog signaling play an important role in chondrocyte development, (hypertrophic) differentiation, and/or calcification, but their role in intervertebral disc (IVD) degeneration is unknown. Better understanding their involvement may provide therapeutic clues for low back pain due to IVD degeneration. Therefore, this study aimed to explore the role of PTHrP and hedgehog proteins in postnatal canine and human IVDs during the aging/degenerative process. The expression of PTHrP, hedgehog proteins and related receptors was studied during the natural loss of the notochordal cell (NC) phenotype during IVD maturation using tissue samples and de-differentiation in vitro and degeneration by real-time quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry. Correlations between their expression and calcification levels (Alizarin Red S staining) were determined. In addition, the effect of PTHrP and hedgehog proteins on canine and human chondrocyte-like cells (CLCs) was determined in vitro focusing on the propensity to induce calcification. The expression of PTHrP, its receptor (PTHR1) and hedgehog receptors decreased during loss of the NC phenotype. N-terminal (active) hedgehog (Indian hedgehog/Sonic hedgehog) protein expression did not change during maturation or degeneration, whereas expression of PTHrP, PTHR1 and hedgehog receptors increased during IVD degeneration. Hedgehog and PTHR1 immunopositivity were increased in nucleus pulposus tissue with abundant vs no/low calcification. In vitro, hedgehog proteins facilitated calcification in CLCs, whereas PTHrP did not affect calcification levels. In conclusion, hedgehog and PTHrP expression is present in healthy and degenerated IVDs. Hedgehog proteins had the propensity to induce calcification in CLCs from degenerated IVDs, indicating that in the future, inhibiting hedgehog signaling could be an approach to inhibit calcification during IVD degeneration.
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Affiliation(s)
- Frances C. Bach
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Kim M. de Rooij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Frank M. Riemers
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Joseph W. Snuggs
- Biomolecular Sciences Research Centre, Sheffield Hallam UniversitySheffieldUK
| | - Willem A. M. de Jong
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Ying Zhang
- School of Biomedical SciencesThe University of Hong KongPokfulamHong Kong
| | - Laura B. Creemers
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Danny Chan
- School of Biomedical SciencesThe University of Hong KongPokfulamHong Kong
| | - Christine Le Maitre
- Biomolecular Sciences Research Centre, Sheffield Hallam UniversitySheffieldUK
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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Worth A, Meij B, Jeffery N. Canine Degenerative Lumbosacral Stenosis: Prevalence, Impact And Management Strategies. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2019; 10:169-183. [PMID: 31819860 PMCID: PMC6875490 DOI: 10.2147/vmrr.s180448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 10/10/2019] [Indexed: 01/22/2023]
Abstract
Canine degenerative lumbosacral stenosis (DLSS) is a syndrome of low back pain with or without neurologic dysfunction associated with compression of the cauda equina. Most commonly occurring in medium- to large-breed dogs of middle to older age, German shepherd and working dogs are predisposed. Diagnosis is based on a combination of clinical signs, advanced imaging and ruling out other differential diagnoses. The volume of the intervertebral foramina at the lumbosacral junction is naturally reduced on extension but degenerative changes lead to a more marked reduction that can impinge the L7 nerve roots. Evidence is lacking on which to base decision-making for treatment of dogs with DLSS. However, surgical intervention may be indicated in dogs that do not respond to conservative management, or for dogs in which there is a requirement to work that prevents lifestyle adjustments. Improvements in electrodiagnosis and novel intra-discal treatments may improve the management of DLSS in the future.
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Affiliation(s)
- Andrew Worth
- Massey University Veterinary Teaching Hospital, School of Veterinary Science, Massey University, Palmerston North4442, New Zealand
| | - Björn Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht3508 TD, The Netherlands
| | - Nicholas Jeffery
- Texas A&M Veterinary Medical Teaching Hospital, College Station, TX77845, USA
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Darge HF, Andrgie AT, Tsai HC, Lai JY. Polysaccharide and polypeptide based injectable thermo-sensitive hydrogels for local biomedical applications. Int J Biol Macromol 2019; 133:545-563. [DOI: 10.1016/j.ijbiomac.2019.04.131] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 01/19/2023]
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Rudnik-Jansen I, Tellegen A, Beukers M, Öner F, Woike N, Mihov G, Thies J, Meij B, Tryfonidou M, Creemers L. Safety of intradiscal delivery of triamcinolone acetonide by a poly(esteramide) microsphere platform in a large animal model of intervertebral disc degeneration. Spine J 2019; 19:905-919. [PMID: 31056104 DOI: 10.1016/j.spinee.2018.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Local corticosteroids have been used to relieve symptoms of chronic low back pain, although treatment effects have been shown to wear off relatively fast. Prolonging corticosteroid presence by controlled release from biomaterials may allow for longer pain relief while circumventing adverse effects such as high bolus dosages. PURPOSE The purpose of this study was to evaluate the safety and efficacy of intradiscal controlled release of triamcinolone acetonide (TAA) by poly(esteramide) microspheres in a canine degenerated intervertebral disc (IVD) model. STUDY DESIGN In a preclinical experimental large animal model, the effect of prolonged glucocorticoid exposure on disc degeneration was evaluated. METHODS Degeneration was accelerated by nucleotomy of lumbar IVDs of Beagle dogs. After 4 weeks, microspheres loaded with 8.4 µg TAA, and 0.84mg TAA were administered to the degenerated IVDs by intradiscal injection (n=6 per group). Empty microspheres (n=6) and all adjacent non-nucleotomized noninjected IVDs were included as controls (n=24). Immediately prior to TAA administration and after 12 weeks, magnetic resonance imaging was performed. Degenerative changes were evaluated by disc height index, Pfirrmann grading, T1ρ and T2 mapping values, postmortem CT scans, macroscopic and microscopic grading, and biochemical/immunohistochemical analysis of inflammation and extracellular matrix content. In addition, nerve growth factor (NGF) protein expression, a biomarker for pain, was scored in nucleus pulposus (NP) tissues. The study was funded by a research grant from Health Holland (1.3million euros = 1.5million US dollars). RESULTS Macroscopic evaluation and CT images postmortem were consistent with mild disc degeneration. Other abnormalities were not observed. Nucleotomy-induced degeneration and inflammation was mild, reflected by moderate Pfirrmann grades and PGE2 levels. Regardless of TAA dosage, local sustained delivery did not affect disc height index nor Pfirrmann grading, T1ρ and T2 mapping values, PGE2 tissue levels, collagen, GAG, and DNA content. However, the low dosage of TAA microspheres significantly reduced NGF immunopositivity in degenerated NP tissue. CONCLUSIONS This is the first in vivo application in a preclinical large animal model of a controlled release formulation of corticosteroids in mild IVD degeneration. Sustained release of TAA locally in the IVD appeared safe and reduced NGF expression, suggesting its potential applicability for pain relief, although beneficial effects were absent on tissue degeneration. CLINICAL SIGNIFICANCE The present platform seems to be promising in extending the local controlled delivery of TAA with the potency to provide long-standing analgesia in the subset of LBP patients suffering from discogenic pain.
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Affiliation(s)
- Imke Rudnik-Jansen
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, Postbus 85500, Heidelberglaan 100, 3508GA Utrecht, The Netherlands
| | - Anna Tellegen
- Department of Clinical Sciences of Companion Animals, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Martijn Beukers
- Department of Clinical Sciences of Companion Animals, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Fetullah Öner
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, Postbus 85500, Heidelberglaan 100, 3508GA Utrecht, The Netherlands
| | - Nina Woike
- DSM Biomedical B.V., Koestraat 1, 6167 RA Geleen, The Netherlands
| | - George Mihov
- DSM Biomedical B.V., Koestraat 1, 6167 RA Geleen, The Netherlands
| | - Jens Thies
- DSM Biomedical B.V., Koestraat 1, 6167 RA Geleen, The Netherlands
| | - Björn Meij
- Department of Clinical Sciences of Companion Animals, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Marianna Tryfonidou
- Department of Clinical Sciences of Companion Animals, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - Laura Creemers
- Department of Orthopaedics, University Medical Center Utrecht, HP G05.228, Postbus 85500, Heidelberglaan 100, 3508GA Utrecht, The Netherlands.
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Isa ILM, Günay B, Joyce K, Pandit A. Tissue Engineering: Biomaterials for Disc Repair. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s40610-018-0106-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Thorpe AA, Bach FC, Tryfonidou MA, Le Maitre CL, Mwale F, Diwan AD, Ito K. Leaping the hurdles in developing regenerative treatments for the intervertebral disc from preclinical to clinical. JOR Spine 2018; 1:e1027. [PMID: 31463447 PMCID: PMC6686834 DOI: 10.1002/jsp2.1027] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/07/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022] Open
Abstract
Chronic back and neck pain is a prevalent disability, often caused by degeneration of the intervertebral disc. Because current treatments for this condition are less than satisfactory, a great deal of effort is being applied to develop new solutions, including regenerative strategies. However, the path from initial promising idea to clinical use is fraught with many hurdles to overcome. Many of the keys to success are not necessarily linked to science or innovation. Successful translation to clinic will also rely on planning and awareness of the hurdles. It will be essential to plan your entire path to clinic from the outset and to do this with a multidisciplinary team. Take advice early on regulatory aspects and focus on generating the proof required to satisfy regulatory approval. Scientific demonstration and societal benefits are important, but translation cannot occur without involving commercial parties, which are instrumental to support expensive clinical trials. This will only be possible when intellectual property can be protected sufficiently to support a business model. In this manner, commercial, societal, medical, and scientific partners can work together to ultimately improve patient health. Based on literature surveys and experiences of the co-authors, this opinion paper presents this pathway, highlights the most prominent issues and hopefully will aid in your own translational endeavors.
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Affiliation(s)
- Abbey A. Thorpe
- Biomolecular Sciences Research CentreSheffield Hallam UniversitySheffieldUK
| | - Frances C. Bach
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtthe Netherlands
| | | | - Fackson Mwale
- Department of SurgeryMcGill UniversityMontrealCanada
| | - Ashish D. Diwan
- Spine Service, Department of Orthopaedic SurgerySt. George & Sutherland Clinical School, University of New South WalesSydneyAustralia
| | - Keita Ito
- Orthopaedic Biomechanics Division, Department of Biomedical EngineeringEindhoven University of TechnologyEindhoventhe Netherlands
- Department of OrthopedicsUniversity Medical Centre UtrechtUtrechtthe Netherlands
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Intradiscal delivery of celecoxib-loaded microspheres restores intervertebral disc integrity in a preclinical canine model. J Control Release 2018; 286:439-450. [PMID: 30110616 DOI: 10.1016/j.jconrel.2018.08.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023]
Abstract
Low back pain, related to degeneration of the intervertebral disc (IVD), affects millions of people worldwide. Clinical studies using oral cyclooxygenase-2 (COX-2) inhibitors have shown beneficial effects, although side-effects were reported. Therefore, intradiscal delivery of nonsteroidal anti-inflammatory drugs can be an alternative treatment strategy to halt degeneration and address IVD-related pain. In the present study, the controlled release and biologic potency of celecoxib, a selective COX-2 inhibitor, from polyesteramide microspheres was investigated in vitro. In addition, safety and efficacy of injection of celecoxib-loaded microspheres were evaluated in vivo in a canine IVD degeneration model. In vitro, a sustained release of celecoxib was noted for over 28 days resulting in sustained inhibition of inflammation, as indicated by decreased prostaglandin E2 (PGE2) production, and anti-catabolic effects in nucleus pulposus (NP) cells from degenerated IVDs on qPCR. In vivo, there was no evidence of adverse effects on computed tomography and magnetic resonance imaging or macroscopic evaluation of IVDs. Local and sustained delivery of celecoxib prevented progression of IVD degeneration corroborated by MRI, histology, and measurement of NP proteoglycan content. Furthermore, it seemed to harness inflammation as indicated by decreased PGE2 tissue levels and decreased neuronal growth factor immunopositivity, providing indirect evidence that local delivery of a COX-2 inhibitor could also address pain related to IVD degeneration. In conclusion, intradiscal controlled release of celecoxib from polyesteramide microspheres prevented progression of IVD degeneration both in vitro and in vivo. Follow-up studies are warranted to determine the clinical efficacy of celecoxib-loaded PEAMs in chronic back pain.
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van Midwoud PM, Sandker M, Hennink WE, de Leede LGJ, Chan A, Weinans H. In vivo pharmacokinetics of celecoxib loaded endcapped PCLA-PEG-PCLA thermogels in rats after subcutaneous administration. Eur J Pharm Biopharm 2018; 131:170-177. [PMID: 30075312 DOI: 10.1016/j.ejpb.2018.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022]
Abstract
Injectable thermogels based on poly(ε-caprolactone-co-lactide)-b-poly(ethylene glycol)-b-poly(ε-caprolactone-co-lactide) (PCLA-PEG-PCLA) containing an acetyl- or propyl endcap and loaded with celecoxib were developed for local drug release. The aim of this study was to determine the effects of the composition of the celecoxib/PCLA-PEG-PCLA formulation on their in vivo drug release characteristics. Furthermore, we want to obtain insight into the in vitro-in vivo correlation. Different formulations were injected subcutaneously in rats and blood samples were taken for a period of 8 weeks. Celecoxib half-life in blood increased from 5 h for the bolus injection of celecoxib to more than 10 days for the slowest releasing gel formulation. Sustained release of celecoxib was obtained for at least 8 weeks after subcutaneous administration. The release period was prolonged from 3 to 6-8 weeks by increasing the injected volume from 100 to 500 µL, which also led to higher serum concentrations in time. Propyl endcapping of the polymer also led to a prolonged release compared to the acetyl endcapped polymer (49 versus 21 days) and at equal injected dose of the drug in lower serum concentrations. Increasing the celecoxib loading from 10 mg/mL to 50 mg/mL surprisingly led to prolonged release (28 versus 56 days) as well as higher serum concentrations per time point, even when corrected for the higher dose applied. The in vivo release was about twice as fast compared to the in vitro release for all formulations. Imaging of organs of mice, harvested 15 weeks after subcutaneous injection with polymer solution loaded with infrared-780 labelled dye showed no accumulation in any of these harvested organs except for traces in the kidneys, indicating renal clearance. Due to its simplicity and versatility, this drug delivery system has great potential for designing an injectable to locally treat osteoarthritis, and to enable tuning the gel to meet patient-specific needs.
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Affiliation(s)
| | - Marjan Sandker
- Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht University, The Netherlands
| | | | - Alan Chan
- Percuros BV, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics and Department of Rheumatology, UMC Utrecht, The Netherlands; Department of Biomechanical Engineering, TU Delft, The Netherlands
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Thompson K, Moore S, Tang S, Wiet M, Purmessur D. The chondrodystrophic dog: A clinically relevant intermediate-sized animal model for the study of intervertebral disc-associated spinal pain. JOR Spine 2018; 1:e1011. [PMID: 29984354 PMCID: PMC6018624 DOI: 10.1002/jsp2.1011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 12/16/2022] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide, with an estimated 80% of the American population suffering from a painful back condition at some point during their lives. The most common cause of LBP is intervertebral disc (IVD) degeneration (IVDD), a condition that can be difficult to treat, either surgically or medically, with current available therapies. Thus, understanding the pathological mechanisms of IVDD and developing novel treatments are critical for improving outcome and quality of life in people living with LBP. While experimental animal models provide valuable mechanistic insight, each model has limitations that complicate translation to the clinical setting. This review focuses on the chondrodystrophic canine clinical model of IVDD as a promising model to assess IVD-associated spinal pain and translational therapeutic strategies for LBP. The canine IVD, while smaller in size than human, goat, ovine, and bovine IVDs, is larger than most other small animal IVDD models and undergoes maturational changes similar to those of the human IVD. Furthermore, both dogs and humans develop painful IVDD as a spontaneous process, resulting in similar characteristic pathologies and clinical signs. Future exploration of the canine model as a model of IVD-associated spinal pain and biological treatments using the canine clinical model will further demonstrate its translational capabilities with the added ethical benefit of treating an existing veterinary patient population with IVDD.
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Affiliation(s)
- Kelly Thompson
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhio
| | - Sarah Moore
- Department of Veterinary Clinical SciencesThe Ohio State UniversityColumbusOhio
| | - Shirley Tang
- Department of Biomedical Engineering, College of EngineeringThe Ohio State UniversityColumbusOhio
| | - Matthew Wiet
- Department of Biomedical Engineering, College of EngineeringThe Ohio State UniversityColumbusOhio
| | - Devina Purmessur
- Department of Biomedical Engineering, College of EngineeringThe Ohio State UniversityColumbusOhio
- Department of Orthopedics, College of MedicineThe Ohio State UniversityColumbusOhio
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Notochordal-cell derived extracellular vesicles exert regenerative effects on canine and human nucleus pulposus cells. Oncotarget 2017; 8:88845-88856. [PMID: 29179481 PMCID: PMC5687651 DOI: 10.18632/oncotarget.21483] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 08/26/2017] [Indexed: 12/15/2022] Open
Abstract
During intervertebral disc ageing, chondrocyte-like cells (CLCs) replace notochordal cells (NCs). NCs have been shown to induce regenerative effects in CLCs. Since vesicles released by NCs may be responsible for these effects, we characterized NC-derived extracellular vesicles (EVs) and determined their effect on CLCs. EVs were purified from porcine NC-conditioned medium (NCCM) through size exclusion chromatography, ultracentrifugation or density gradient centrifugation. Additionally, the EVs were quantitatively analyzed by high-resolution flow cytometry. The effect of NCCM-derived EVs was studied on canine and human CLC micro-aggregates in vitro and compared with NCCM-derived proteins and unfractionated NCCM. Porcine NCCM contained a considerable amount of EVs. NCCM-derived EVs induced GAG deposition in canine CLCs to a comparable level as NCCM-derived proteins and unfractionated NCCM, and increased the DNA and glycosaminoglycan (GAG) content of human micro-aggregates, although to a lesser extent than unfractionated NCCM. The biological EV effects were not considerably influenced by ultracentrifugation compared with size exclusion-based purification. Upon ultracentrifugation, interfering GAGs, but not collagens, were lost. Nonetheless, collagen type I or II supplemented to CLCs in a concentration as present in NCCM induced no anabolic effects. Porcine NCCM-derived EVs exerted anabolic effects comparable to NCCM-derived proteins, while unfractionated NCCM was more potent in human CLCs. GAGs and collagens appeared not to mediate the regenerative EV effects. Thus, NC-derived EVs have regenerative potential, and their effects may be influenced by the proteins present in NCCM. The optimal combination of NC-secreted factors needs to be determined to fully exploit the regenerative potential of NC-based technology.
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