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Khajuria DK, Reider I, Kamal F, Norbury CC, Elbarbary RA. Distinct defects in early innate and late adaptive immune responses typify impaired fracture healing in diet-induced obesity. Front Immunol 2023; 14:1250309. [PMID: 37854593 PMCID: PMC10579581 DOI: 10.3389/fimmu.2023.1250309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/25/2023] [Indexed: 10/20/2023] Open
Abstract
Bone fractures, the most common musculoskeletal injuries, heal through three main phases: inflammatory, repair, and remodeling. Around 10% of fracture patients suffer from impaired healing that requires surgical intervention, a huge burden on the healthcare system. The rate of impaired healing increases with metabolic diseases such as obesity-associated hyperglycemia/type 2 diabetes (T2D), an increasing concern given the growing incidence of obesity/T2D. Immune cells play pivotal roles in fracture healing, and obesity/T2D is associated with defective immune-cell functions. However, there is a gap in knowledge regarding the stoichiometry of immune cells that populate the callus and how that population changes during different phases of healing. Here, we used complementary global and single-cell techniques to characterize the repertoire of immune cells in the fracture callus and to identify populations specifically enriched in the fracture callus relative to the unfractured bone or bone marrow. Our analyses identified two clear waves of immune-cell infiltration into the callus: the first wave occurs during the early inflammatory phase of fracture healing, while the second takes place during the late repair/early remodeling phase, which is consistent with previous publications. Comprehensive analysis of each wave revealed that innate immune cells were activated during the early inflammatory phase, but in later phases they returned to homeostatic numbers and activation levels. Of the innate immune cells, distinct subsets of activated dendritic cells were particularly enriched in the inflammatory healing hematoma. In contrast to innate cells, lymphocytes, including B and T cells, were enriched and activated in the callus primarily during the late repair phase. The Diet-Induced Obesity (DIO) mouse, an established model of obesity-associated hyperglycemia and insulin resistance, suffers from multiple healing defects. Our data demonstrate that DIO mice exhibit dysregulated innate immune responses during the inflammatory phase, and defects in all lymphocyte compartments during the late repair phase. Taken together, our data characterize, for the first time, immune populations that are enriched/activated in the callus during two distinct phases of fracture healing and identify defects in the healing-associated immune response in DIO mice, which will facilitate future development of immunomodulatory therapeutics for impaired fracture healing.
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Affiliation(s)
- Deepak Kumar Khajuria
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Hershey, PA, United States
- Center for Orthopaedic Research and Translational Science (CORTS), The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Irene Reider
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Fadia Kamal
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Hershey, PA, United States
- Center for Orthopaedic Research and Translational Science (CORTS), The Pennsylvania State University College of Medicine, Hershey, PA, United States
- Department of Pharmacology, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Christopher C. Norbury
- Department of Microbiology and Immunology, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Reyad A. Elbarbary
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Hershey, PA, United States
- Center for Orthopaedic Research and Translational Science (CORTS), The Pennsylvania State University College of Medicine, Hershey, PA, United States
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, United States
- Center for RNA Molecular Biology, Pennsylvania State University, University Park, State College, PA, United States
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2
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Pagani S, Salerno M, Filardo G, Locs J, van Osch GJ, Vecstaudza J, Dolcini L, Borsari V, Fini M, Giavaresi G, Columbaro M. Human Osteoblasts' Response to Biomaterials for Subchondral Bone Regeneration in Standard and Aggressive Environments. Int J Mol Sci 2023; 24:14764. [PMID: 37834212 PMCID: PMC10573262 DOI: 10.3390/ijms241914764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Osteochondral lesions, when not properly treated, may evolve into osteoarthritis (OA), especially in the elderly population, where altered joint function and quality are usual. To date, a collagen/collagen-magnesium-hydroxyapatite (Col/Col-Mg-HAp) scaffold (OC) has demonstrated good clinical results, although suboptimal subchondral bone regeneration still limits its efficacy. This study was aimed at evaluating the in vitro osteogenic potential of this scaffold, functionalized with two different strategies: the addition of Bone Morphogenetic Protein-2 (BMP-2) and the incorporation of strontium (Sr)-ion-enriched amorphous calcium phosphate (Sr-ACP) granules. Human osteoblasts were seeded on the functionalized scaffolds (OC+BMP-2 and OC+Sr-ACP, compared to OC) under stress conditions reproduced with the addition of H2O2 to the culture system, as well as in normal conditions, and evaluated in terms of morphology, metabolic activity, gene expression, and matrix synthesis. The OC+BMP-2 scaffold supported a better osteoblast morphology and stimulated scaffold colonization, cell activity, and extracellular matrix secretion, especially in the stressed culture environment but also in normal culture conditions, with increased expression of genes related to osteoblast differentiation. In conclusion, the incorporation of BMP-2 into the Col/Col-Mg-HAp scaffold also represents an improvement of the osteochondral scaffold in more challenging conditions, supporting further preclinical studies to optimize it for use in clinical practice.
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Affiliation(s)
- Stefania Pagani
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.P.); (V.B.); (G.G.)
| | - Manuela Salerno
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Janis Locs
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre of RTU, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (J.L.); (J.V.)
| | - Gerjo J.V.M. van Osch
- Department of Orthopedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Jana Vecstaudza
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre of RTU, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (J.L.); (J.V.)
| | | | - Veronica Borsari
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.P.); (V.B.); (G.G.)
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Gianluca Giavaresi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.P.); (V.B.); (G.G.)
| | - Marta Columbaro
- Electron Microscopy Platform, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
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3
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Huang R, Balu AR, Molitoris KH, White JP, Robling AG, Ayturk UM, Baht GS. The role of Meteorin-like in skeletal development and bone fracture healing. J Orthop Res 2022; 40:2510-2521. [PMID: 35076116 PMCID: PMC9309188 DOI: 10.1002/jor.25286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Meteorin-like protein (Metrnl), homologous to the initially identified neurotrophic factor Meteorin, is a secreted, multifunctional protein. Here we used mouse models to investigate Metrnl's role in skeletal development and bone fracture healing. During development Metrnl was expressed in the perichondrium and primary ossification center. In neonates, single cell RNA-seq of diaphyseal bone demonstrated strongest expression of Metrnl transcript by osteoblasts. In vitro, Metrnl was osteoinductive, increasing osteoblast differentiation and mineralization in tissue culture models. In vivo, loss of Metrnl expression resulted in no change in skeletal metrics in utero, at birth, or during postnatal growth. Six-week-old Metrnl-null mice displayed similar body length, body weight, tibial length, femoral length, BV/TV, trabecular number, trabecular thickness, and cortical thickness as littermate controls. In 4-month-old mice, lack of Metrnl expression did not change structural stiffness, ultimate force, or energy to fracture of femora under 3-point-bending. Last, we investigated the role of Metrnl in bone fracture healing. Metrnl expression increased in response to tibial injury, however, loss of Metrnl expression did not affect the amount of bone deposited within the healing tissue nor did it change the structural parameters of healing tissue. This work identifies Metrnl as a dispensable molecule for skeletal development. However, the osteoinductive capabilities of Metrnl may be utilized to modulate osteoblast differentiation in cell-based orthopedic therapies.
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Affiliation(s)
- Rong Huang
- Department of MedicineDuke Molecular Physiology InstituteDurhamNorth CarolinaUSA,Department of Orthopaedic SurgeryDuke UniversityDurhamNorth CarolinaUSA
| | - Abhinav R. Balu
- Department of MedicineDuke Molecular Physiology InstituteDurhamNorth CarolinaUSA,Department of Orthopaedic SurgeryDuke UniversityDurhamNorth CarolinaUSA
| | - Kristin H. Molitoris
- Department of MedicineDuke Molecular Physiology InstituteDurhamNorth CarolinaUSA,Department of Orthopaedic SurgeryDuke UniversityDurhamNorth CarolinaUSA
| | - James P. White
- Department of MedicineDuke Molecular Physiology InstituteDurhamNorth CarolinaUSA
| | - Alexander G. Robling
- Department of Anatomy and Cell BiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Ugur M. Ayturk
- Department of ResearchHospital for Special SurgeryNew York CityNew YorkUSA,Department of Orthopaedic SurgeryWeill Cornell MedicineNew York CityNew YorkUSA
| | - Gurpreet S. Baht
- Department of MedicineDuke Molecular Physiology InstituteDurhamNorth CarolinaUSA,Department of Orthopaedic SurgeryDuke UniversityDurhamNorth CarolinaUSA,Department of PathologyDuke UniversityDurhamNorth CarolinaUSA
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Huang R, Vi L, Zong X, Baht GS. Maresin 1 resolves aged-associated macrophage inflammation to improve bone regeneration. FASEB J 2020; 34:13521-13532. [PMID: 32794246 PMCID: PMC7719599 DOI: 10.1096/fj.202001145r] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/19/2022]
Abstract
Inflammaging is associated with poor tissue regeneration observed in advanced age. Specifically, protracted inflammation after acute injury has been associated with decreased bone fracture healing and increased rates of nonunion in elderly patients. Here, we investigated the efficacy of using Maresin 1 (MaR1), an omega-3 fatty acid-derived pro-resolving agent, to resolve inflammation after tibial fracture injury and subsequently improving aged bone healing. Aged (24-month-old mice) underwent tibial fracture surgery and were either treated with vehicle or MaR1 3 days after injury. Fracture calluses were harvested 7 days, 14 days, 21 days, and 28 days after injury to investigate inflammatory response, cartilage development, bone deposition, and mechanical integrity, respectively. Healing bones from MaR1-treated mice displayed decreased cartilage formation and increased bone deposition which resulted in increased structural stiffness and increased force to fracture in the later stages of repair. In the early stages, MaR1 treatment decreased the number of pro-inflammatory macrophages within the fracture callus and decreased the level of inflammatory biomarkers in circulation. In tissue culture models, MaR1 treatment of bone marrow-derived macrophages from aged mice protected cells form a pro-inflammatory phenotype and induced an anti-inflammatory fate. Furthermore, the secretome of MaR1-treated bone marrow-derived macrophages was identified as osteoinductive, enhancing osteoblast differentiation of bone marrow stromal cells. Our findings here identify resolution of inflammation, and MaR1 itself, to be a point of intervention to improve aged bone healing.
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Affiliation(s)
- Rong Huang
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Linda Vi
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Xiaohua Zong
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Gurpreet S Baht
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA.,Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.,Department of Pathology, Duke University, Durham, NC, USA
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Young E, Westerberg B, Yanai A, Gregory-Evans K. The olfactory mucosa: a potential source of stem cells for hearing regeneration. Regen Med 2018; 13:581-593. [PMID: 30113240 DOI: 10.2217/rme-2018-0009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The olfactory mucosa contains cells that enable it to generate new neurons and other supporting cells throughout life, allowing it to replace cells of the mucosa that have been damaged by exposure to various insults. In this article, we discuss the different types of stem cell found within the olfactory mucosa and their properties. In particular, the mesenchymal-like cells found within the lamina propria will be reviewed in detail. In addition, we discuss potential applications of olfactory-derived stem cells toward hearing regeneration secondary to either inner hair cell loss or primary or secondary auditory nerve degeneration.
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Affiliation(s)
- Emily Young
- Department of Ophthalmology, Eye Care Centre, University of British Columbia, Vancouver, Canada
| | - Brian Westerberg
- Department of Otolaryngology, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Anat Yanai
- Department of Ophthalmology, Eye Care Centre, University of British Columbia, Vancouver, Canada
| | - Kevin Gregory-Evans
- Department of Ophthalmology, Eye Care Centre, University of British Columbia, Vancouver, Canada
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Abstract
PURPOSE OF REVIEW Bone fracture healing is a complex physiological process relying on numerous cell types and signals. Inflammatory factors secreted by immune cells help to control recruitment, proliferation, differentiation, and activation of hematopoietic and mesenchymal cells. Within this review we will discuss the functional role of immune cells as it pertains to bone fracture healing. In doing so, we will outline the cytokines secreted and their effects within the healing fracture callus. RECENT FINDINGS Macrophages have been found to play an important role in fracture healing. These immune cells signal to other cells of the fracture callus, modulating bone healing. Cytokines and cellular signals within fracture healing continue to be studied. The findings from this work have helped to reinforce the importance of osteoimmunity in bone fracture healing. Owing to these efforts, immunomodulation is emerging as a potential therapeutic target to improve bone fracture healing.
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Affiliation(s)
- Gurpreet S Baht
- Department of Orthopaedic Surgery, Duke Molecular Physiology Institute, Duke University, DUMC 104775, 300 North Duke Street, Durham, NC, 27701, USA.
- Duke Molecular Physiology Institute, Durham, NC, USA.
- Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Orange Zone 5th floor, Durham, NC, 27710, USA.
| | - Linda Vi
- University of Toronto, Toronto, Canada
| | - Benjamin A Alman
- Department of Orthopaedic Surgery, Duke Molecular Physiology Institute, Duke University, DUMC 104775, 300 North Duke Street, Durham, NC, 27701, USA.
- Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Orange Zone 5th floor, Durham, NC, 27710, USA.
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Martineau C, Najyb O, Signor C, Rassart É, Moreau R. Apolipoprotein D deficiency is associated to high bone turnover, low bone mass and impaired osteoblastic function in aged female mice. Metabolism 2016; 65:1247-58. [PMID: 27506732 PMCID: PMC7094319 DOI: 10.1016/j.metabol.2016.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/26/2016] [Accepted: 05/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Apolipoprotein D (ApoD) is a member of the lipocalin family known to transport small hydrophobic ligands. A major site of ApoD expression in mice is the central nervous system where evidence suggests that it plays a protective role. Gene expression of ApoD was reported in bone-forming osteoblasts but its impact on bone metabolism remains undocumented. METHODS We compared basic bone parameters of ApoD(-/-) (null) and transgenic (tg) mice to wild-type (wt) littermates through microCT and histochemistry, as well as ApoD expression and secretion in osteoblasts under various culture conditions through real-time PCR and immunoblotting. RESULTS ApoD-null females displayed progressive bone loss with aging, resulting in a 50% reduction in trabecular bone volume and a 23% reduction in cortical bone volume by 9months of age. Only cortical bone volume was significantly reduced in ApoD-null males by an average of 24%. Histochemistry indicated significantly higher osteoblast surface and number of osteoclasts in femora from ApoD-null females. ApoD gene expression was confirmed in primary cultures of bone marrow mesenchymal cells (MSC), with higher expression levels in MSC from females compared to males. ApoD-null MSC exhibited impaired proliferation and differentiation potentials. Moreover, exogenous ApoD partially rescued the osteogenic potential of null MSC, which were shown to readily uptake the protein from media. ApoD expression was upregulated under low proliferation conditions, by contact inhibition and osteoblastic differentiation in MC3T3-E1 osteoblast-like cells. CONCLUSION Our results indicate that ApoD influences bone metabolism in mice in a gender-specific manner, potentially through an auto-/paracrine pathway.
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Affiliation(s)
- Corine Martineau
- Laboratoire du Métabolisme Osseux, Centre BioMed, Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada.
| | - Ouafa Najyb
- Laboratoire de Biologie Moléculaire, Centre BioMed, Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Céline Signor
- Laboratoire du Métabolisme Osseux, Centre BioMed, Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Éric Rassart
- Laboratoire de Biologie Moléculaire, Centre BioMed, Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Robert Moreau
- Laboratoire du Métabolisme Osseux, Centre BioMed, Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
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Matic I, Matthews BG, Wang X, Dyment NA, Worthley DL, Rowe DW, Grcevic D, Kalajzic I. Quiescent Bone Lining Cells Are a Major Source of Osteoblasts During Adulthood. Stem Cells 2016; 34:2930-2942. [PMID: 27507737 DOI: 10.1002/stem.2474] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/15/2016] [Accepted: 07/05/2016] [Indexed: 12/23/2022]
Abstract
The in vivo origin of bone-producing osteoblasts is not fully defined. Skeletal stem cells, a population of mesenchymal stem cells resident in the bone marrow compartment, are thought to act as osteoprogenitors during growth and adulthood. Quiescent bone lining cells (BLCs) have been suggested as a population capable of activation into mature osteoblasts. These cells were defined by location and their morphology and studies addressing their significance have been hampered by their inaccessibility, and lack of markers that would allow for their identification and tracing. Using lineage tracing models, we have observed labeled osteoblasts at time points extending beyond the reported lifespan for this cell type, suggesting continuous reactivation of BLCs. BLCs also make a major contribution to bone formation after osteoblast ablation, which includes the ability to proliferate. In contrast, mesenchymal progenitors labeled by Gremlin1 or alpha smooth muscle actin do not contribute to bone formation in this setting. BLC activation is inhibited by glucocorticoids, which represent a well-established cause of osteoporosis. BLCs express cell surface markers characteristic of mesenchymal stem/progenitors that are largely absent in osteoblasts including Sca1 and Leptin Receptor. BLCs also show different gene expression profiles to osteoblasts, including elevated expression of Mmp13, and osteoclast regulators RANKL and macrophage colony stimulating factor, and retain osteogenic potential upon transplantation. Our findings provide evidence that bone lining cells represent a major source of osteoblasts during adulthood. Stem Cells 2016;34:2930-2942.
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Affiliation(s)
- Igor Matic
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Brya G Matthews
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Xi Wang
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Nathaniel A Dyment
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Daniel L Worthley
- Department of Medicine and Cancer Theme, University of Adelaide & SAHMRI, Adelaide, South Australia, Australia
| | - David W Rowe
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Danka Grcevic
- Department of Physiology and Immunology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivo Kalajzic
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
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Pellegrini G, Lambiase A, Macaluso C, Pocobelli A, Deng S, Cavallini GM, Esteki R, Rama P. From discovery to approval of an advanced therapy medicinal product-containing stem cells, in the EU. Regen Med 2016; 11:407-20. [PMID: 27091398 PMCID: PMC5561870 DOI: 10.2217/rme-2015-0051] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In 1997, the human corneal epithelium was reconstructed in vitro and transplanted on patients. Later, it became a routine treatment, before regulations considered advanced therapy medicinal products and drugs on the same lines. Manufacturing, before and after good manufacturing practice setting, was established in different facilities and the clinical application in several hospitals. Advanced therapy medicinal products, including stem cells, are unique products with different challenges than other drugs: some uncertainties, in addition to benefit, cannot be avoided. This review will focus on all recent developments in the stem cell-based corneal therapy.
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Affiliation(s)
- Graziella Pellegrini
- Centre for Regenerative Medicine "Stefano Ferrari", University of Modena and Reggio Emilia, via G.Gottardi 100, Modena, 41125, Italy; Holostem Terapie Avanzate, Modena, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, University of Rome "Sapienza", viale Regina Elena, Rome, Italy
| | - Claudio Macaluso
- Unit of Ophthalmology, University of Parma, Via Gramsci 14, 43126 Parma, Italy; IMEM - CNR (Italian National Reserach Council), Parco Area delle Scienze 37/A - 43124 Parma, Italy
| | - Augusto Pocobelli
- Ophthalmology Unit-Eye Bank, S. Giovanni Addolorata Hospital, via S. Stefano Rotondo 9, Rome, Italy
| | - Sophie Deng
- Cornea Division Stein Eye Institute, UCLA 100 Stein Plaza Los Angeles, CA 90095, USA
| | - Gian Maria Cavallini
- Ophthalmology Unit, Policlinico University Hospital, University of Modena & Reggio Emilia, via Del Pozzo 71, Modena, 41125, Italy
| | - Roza Esteki
- Centre for Regenerative Medicine "Stefano Ferrari", University of Modena and Reggio Emilia, via G.Gottardi 100, Modena, 41125, Italy; Holostem Terapie Avanzate, Modena, Italy
| | - Paolo Rama
- Cornea & Ocular Surface Unit San Raffaele Scientific Institute Via Olgettina, 60-20132 Milano, Italy
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