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Elmounedi N, Keskes H. Establishment of intervertebral disc degeneration models; A review of the currently used models. J Orthop 2024; 56:50-56. [PMID: 38784950 PMCID: PMC11109335 DOI: 10.1016/j.jor.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
One of the frequent causes of low back pain is intervertebral disc degeneration (IDD), which is followed by discogenic pain. Some significant risk factors that have been linked to the onset and progression of IDD include age, mechanical imbalance, changes in nutrition and inflammation. According to recent studies, five types of animal models are established for producing IDD: the spontaneous models, the puncture models, the biomechanical models, the chemical models and the hybrid models. These models are crucial in studying and understanding IDD's natural history and identifying potential treatment targets for IDD. In our study, we'll talk about the technical aspects of these models, the time between model establishment and the apparition of observable degradation, and their potential in various research. Each animal model should be compared to the human natural IDD pathogenesis to guide future research efforts in this area. By improving knowledge and appropriate application of various animal models, we seek to raise awareness of this illness and further translational research.
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Affiliation(s)
- Najah Elmounedi
- Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP1 Lab, Faculty of Medicine, Sfax, Tunisia
| | - Hassib Keskes
- Cell Therapy and Experimental Surgery of Musculoskeletal System LR18SP1 Lab, Faculty of Medicine, Sfax, Tunisia
- Department of Orthopedics and Traumatology, CHU Habib Bourguiba, Sfax, Tunisia
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2
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Raftery K, Rahman T, Smith N, Schaer T, Newell N. The role of the nucleus pulposus in intervertebral disc recovery: Towards improved specifications for nucleus replacement devices. J Biomech 2024; 166:111990. [PMID: 38383232 DOI: 10.1016/j.jbiomech.2024.111990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
Nucleus replacement devices (NRDs) have potential to treat degenerated or herniated intervertebral discs (IVDs). However, IVD height loss is a post-treatment complication. IVD height recovery involves the nucleus pulposus (NP), but the mechanism of this in response to physiological loads is not fully elucidated. This study aimed to characterise the non-linear recovery behaviour of the IVD in intact, post-nuclectomy, and post-NRD treatment states, under physiological loading. 36 bovine IVDs (12 intact, 12 post-nuclectomy, 12 post-treatment) underwent creep-recovery protocols simulating Sitting, Walking or Running, followed by 12 h of recovery. A rheological model decoupled the fluid-independent (elastic, fast) and fluid-dependent (slow) recovery phases. In post-nuclectomy and post-treatment groups, nuclectomy efficiency (ratio of NP removed to remaining NP) was quantified following post-test sectioning. Relative to intact, post-nuclectomy recovery significantly decreased in Sitting (-0.3 ± 0.4 mm, p < 0.05) and Walking (-0.6 ± 0.3 mm, p < 0.001) coupled with significant decreases to the slow response (p < 0.05). Post-nuclectomy, the fast and slow responses negatively correlated with nuclectomy efficiency (p < 0.05). In all protocols, the post-treatment group performed significantly worse in recovery (-0.5 ± 0.3 mm, p < 0.01) and the slow response (p < 0.05). Results suggest the NP mainly facilitates slow-phase recovery, linearly dependent on the amount of NP present. Failure of this NRD to recover is attributed to poor fluid imbibition. Additionally, unconfined NRD performance cannot be extrapolated to the in vitro response. This knowledge informs NRD design criteria to provide high osmotic pressure, and encourages testing standards to incorporate long-term recovery protocols.
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Affiliation(s)
- K Raftery
- Department of Bioengineering, Imperial College London, London, UK
| | - T Rahman
- Department of Bioengineering, Imperial College London, London, UK; Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - N Smith
- Division of Surgery and Interventional Science, University College London, Stanmore, UK
| | - T Schaer
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, USA
| | - N Newell
- Department of Bioengineering, Imperial College London, London, UK.
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Xiao F, van Dieën JH, Han J, Maas H. Stab lesion of the L4/L5 intervertebral disc in the rat causes acute changes in disc bending mechanics. J Biomech 2023; 161:111830. [PMID: 37821333 DOI: 10.1016/j.jbiomech.2023.111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
Low-back pain often coincides with altered neuromuscular control, possibly due to changes in spine stability resulting from injury or degeneration, or due to effects of nociception. The relative importance of these mechanisms, and their possible interaction, are unknown. In spine bending, the bulk of the load is borne by the IVD, yet the acute effects of intervertebral disc (IVD) injury on bending mechanics have not been investigated. In the present study, we aimed to quantify the acute effects of a stab lesion of the disc on its mechanical properties, because such changes can be expected to elicit compensatory changes in neuromuscular control. L4/L5 spinal segments were collected from 27 Wistar rats within two hours after sacrifice and stored at -20℃. Following thawing, bending tests were performed to assess the intersegmental angle-moment characteristics. Specimens were loaded in right bending, left bending and flexion, before and after a stab lesion of the IVD fully penetrating the nucleus pulposus. In the angle-moment curves, we found reduced moments at equal bending angles after IVD lesion in left bending, right bending and flexion. Peak stiffness, peak moment, and hysteresis were significantly decreased (by 7.8-27.7 %) after IVD lesion in all directions. In conclusion, L4/L5 IVD lesion in the rat caused small to moderate acute changes in IVD mechanical properties. Our next steps will be to evaluate the longer term effects of IVD lesion on spine mechanics and the neural control of trunk muscles.
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Affiliation(s)
- Fangxin Xiao
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China; Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
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Zhao W, Li Y, Cheng X, Wei H, Li P, Fan L, Liu K, Zhang S, Wang H. The antioxidant Glycitin protects against intervertebral disc degeneration through antagonizing inflammation and oxidative stress in nucleus pulposus cells. Aging (Albany NY) 2023; 15:13693-13709. [PMID: 38019477 PMCID: PMC10756108 DOI: 10.18632/aging.205251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023]
Abstract
Intervertebral disc degeneration (IVDD) is a kind of typical degenerative disorder of the skeletal muscle system caused by many factors including aging, abnormal mechanical stress and inflammatory responses. Glycitin is a natural isoflavone extracted from legumes. Previous studies have found that it is anti-inflammatory and promotes wound repair. However, the role of Glycitin in IVDD has not been elucidated. In the present research, we were surprised that Glycitin antagonized the NF-κB pathway activity. In addition, we also found that Glycitin alleviated TNF-α-induced metabolic disorders, extracellular matrix degradation, oxidative stress, inflammation responses, and mitochondrial damage. Furthermore, in in vivo experimental study, we discovered Glycitin attenuated IVDD. The results revealed that Glycitin alleviated the degenerative phenotype of IVDD. According to this research, Glycitin has anti-inflammatory properties that might exert a protective function in IVDD, suggesting a prospective therapeutic approach for IVDD.
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Affiliation(s)
- Wei Zhao
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Yanpei Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Xiang Cheng
- Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Hui Wei
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Peng Li
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Lixia Fan
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Kaiwen Liu
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Shuai Zhang
- Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| | - Hao Wang
- Department of Trauma Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
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Samanta A, Lufkin T, Kraus P. Intervertebral disc degeneration-Current therapeutic options and challenges. Front Public Health 2023; 11:1156749. [PMID: 37483952 PMCID: PMC10359191 DOI: 10.3389/fpubh.2023.1156749] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Degeneration of the intervertebral disc (IVD) is a normal part of aging. Due to the spine's declining function and the development of pain, it may affect one's physical health, mental health, and socioeconomic status. Most of the intervertebral disc degeneration (IVDD) therapies today focus on the symptoms of low back pain rather than the underlying etiology or mechanical function of the disc. The deteriorated disc is typically not restored by conservative or surgical therapies that largely focus on correcting symptoms and structural abnormalities. To enhance the clinical outcome and the quality of life of a patient, several therapeutic modalities have been created. In this review, we discuss genetic and environmental causes of IVDD and describe promising modern endogenous and exogenous therapeutic approaches including their applicability and relevance to the degeneration process.
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Ex vivo biomechanical evaluation of Acute lumbar endplate injury and comparison to annulus fibrosus injury in a rat model. J Mech Behav Biomed Mater 2022; 131:105234. [DOI: 10.1016/j.jmbbm.2022.105234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022]
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Tang SN, Walter BA, Heimann MK, Gantt CC, Khan SN, Kokiko-Cochran ON, Askwith CC, Purmessur D. In vivo Mouse Intervertebral Disc Degeneration Models and Their Utility as Translational Models of Clinical Discogenic Back Pain: A Comparative Review. FRONTIERS IN PAIN RESEARCH 2022; 3:894651. [PMID: 35812017 PMCID: PMC9261914 DOI: 10.3389/fpain.2022.894651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Low back pain is a leading cause of disability worldwide and studies have demonstrated intervertebral disc (IVD) degeneration as a major risk factor. While many in vitro models have been developed and used to study IVD pathophysiology and therapeutic strategies, the etiology of IVD degeneration is a complex multifactorial process involving crosstalk of nearby tissues and systemic effects. Thus, the use of appropriate in vivo models is necessary to fully understand the associated molecular, structural, and functional changes and how they relate to pain. Mouse models have been widely adopted due to accessibility and ease of genetic manipulation compared to other animal models. Despite their small size, mice lumbar discs demonstrate significant similarities to the human IVD in terms of geometry, structure, and mechanical properties. While several different mouse models of IVD degeneration exist, greater standardization of the methods for inducing degeneration and the development of a consistent set of output measurements could allow mouse models to become a stronger tool for clinical translation. This article reviews current mouse models of IVD degeneration in the context of clinical translation and highlights a critical set of output measurements for studying disease pathology or screening regenerative therapies with an emphasis on pain phenotyping. First, we summarized and categorized these models into genetic, age-related, and mechanically induced. Then, the outcome parameters assessed in these models are compared including, molecular, cellular, functional/structural, and pain assessments for both evoked and spontaneous pain. These comparisons highlight a set of potential key parameters that can be used to validate the model and inform its utility to screen potential therapies for IVD degeneration and their translation to the human condition. As treatment of symptomatic pain is important, this review provides an emphasis on critical pain-like behavior assessments in mice and explores current behavioral assessments relevant to discogenic back pain. Overall, the specific research question was determined to be essential to identify the relevant model with histological staining, imaging, extracellular matrix composition, mechanics, and pain as critical parameters for assessing degeneration and regenerative strategies.
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Affiliation(s)
- Shirley N. Tang
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Benjamin A. Walter
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Mary K. Heimann
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Connor C. Gantt
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Safdar N. Khan
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Olga N. Kokiko-Cochran
- Department of Neuroscience, The Ohio State University, Columbus, OH, United States
- Institute for Behavioral Medicine Research, Neurological Institute, The Ohio State University, Columbus, OH, United States
| | - Candice C. Askwith
- Department of Neuroscience, The Ohio State University, Columbus, OH, United States
| | - Devina Purmessur
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
- *Correspondence: Devina Purmessur ;
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Varden LJ, Turner EJ, Coon AT, Michalek AJ. Establishing a through-puncture model for assessing post-injection leakage in the intervertebral disc. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:865-873. [PMID: 35179651 DOI: 10.1007/s00586-022-07140-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/12/2022] [Accepted: 01/31/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Needle injection through the outer annulus fibrosus of the intervertebral disc (IVD) is the most practical approach for delivery of therapeutic agents, which have been shown to potentially leak following needle retraction. The goal of this work was to establish a protocol for quantifying post-injection leakage and test its sensitivity to factors believed to affect needle track geometry. METHODS A through-puncture defect procedure, followed by controlled injection, was performed on bovine caudal IVDs. Sensitivity to needle size was tested by injection of saline into unconstrained discs with either a 30G, 26G, or 21G hypodermic needle. Sensitivity to axial load was tested by repeated injection via a 26G needle with either no constraint, fixed height, or 10% axial compressive strain. Sensitivity to flexion was tested by applying combined 0.2 MPa compression and 15° of flexion following injection of 5% of disc volume. RESULTS Needle diameter significantly affected maximum volume prior to leakage, ranging from 34.6 ± 31.9 µL when using 21G to 115.6 ± 23.6 µL when using 30G. While all unloaded discs leaked, axial compression decreased the incidence of leakage events by 50-100% depending on load history. Forward flexion resulted in a 22% incidence of leakage. CONCLUSION Fluid injected into IVDs is at significant risk of leakage following needle retraction. This risk depends on factors which alter the geometry of the needle track, including needle size, pinching due to axial compression, and stretching as a result of forward flexion.
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Affiliation(s)
- Lara J Varden
- Department of Biology, Clarkson University, Potsdam, NY, USA
| | - Evan J Turner
- Department of Mechanical and Aerospace Engineering, Clarkson University, 8 Clarkson Ave, Box 5725, Potsdam, NY, USA
| | - Allison T Coon
- Department of Mechanical and Aerospace Engineering, Clarkson University, 8 Clarkson Ave, Box 5725, Potsdam, NY, USA
| | - Arthur J Michalek
- Department of Mechanical and Aerospace Engineering, Clarkson University, 8 Clarkson Ave, Box 5725, Potsdam, NY, USA.
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Hickman TT, Rathan-Kumar S, Peck SH. Development, Pathogenesis, and Regeneration of the Intervertebral Disc: Current and Future Insights Spanning Traditional to Omics Methods. Front Cell Dev Biol 2022; 10:841831. [PMID: 35359439 PMCID: PMC8963184 DOI: 10.3389/fcell.2022.841831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
The intervertebral disc (IVD) is the fibrocartilaginous joint located between each vertebral body that confers flexibility and weight bearing capabilities to the spine. The IVD plays an important role in absorbing shock and stress applied to the spine, which helps to protect not only the vertebral bones, but also the brain and the rest of the central nervous system. Degeneration of the IVD is correlated with back pain, which can be debilitating and severely affects quality of life. Indeed, back pain results in substantial socioeconomic losses and healthcare costs globally each year, with about 85% of the world population experiencing back pain at some point in their lifetimes. Currently, therapeutic strategies for treating IVD degeneration are limited, and as such, there is great interest in advancing treatments for back pain. Ideally, treatments for back pain would restore native structure and thereby function to the degenerated IVD. However, the complex developmental origin and tissue composition of the IVD along with the avascular nature of the mature disc makes regeneration of the IVD a uniquely challenging task. Investigators across the field of IVD research have been working to elucidate the mechanisms behind the formation of this multifaceted structure, which may identify new therapeutic targets and inform development of novel regenerative strategies. This review summarizes current knowledge base on IVD development, degeneration, and regenerative strategies taken from traditional genetic approaches and omics studies and discusses the future landscape of investigations in IVD research and advancement of clinical therapies.
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Affiliation(s)
- Tara T. Hickman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sudiksha Rathan-Kumar
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sun H. Peck
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
- *Correspondence: Sun H. Peck,
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Wang Y, Kang J, Guo X, Zhu D, Liu M, Yang L, Zhang G, Kang X. Intervertebral Disc Degeneration Models for Pathophysiology and Regenerative Therapy -Benefits and Limitations. J INVEST SURG 2021; 35:935-952. [PMID: 34309468 DOI: 10.1080/08941939.2021.1953640] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aim:This review summarized the recent intervertebral disc degeneration (IDD) models and described their advantages and potential disadvantages, aiming to provide an overview for the current condition of IDD model establishment and new ideas for new strategies development of the treatment and prevention of IDD.Methods:The database of PubMed was searched up to May 2021 with the following search terms: nucleus pulposus, annulus fibrosus, cartilage endplate, intervertebral disc(IVD), intervertebral disc degeneration, animal model, organ culture, bioreactor, inflammatory reaction, mechanical stress, pathophysiology, epidemiology. Any IDD model-related articles were collected and summarized.Results:The best IDD model should have the features of repeatability, measurability and controllability. There are a lot of aspects to be considered in the selection of animals. Mice, rats and rabbits are low-cost and easy to access. However, their IVD size and shape are more different from human anatomy than pigs, cattle, sheep and goats. Organ culture models and animal models are two options in model establishment for IDD. The IVD organ culture model can put the studying variables into the controllable system for transitional research. Unlike the animal model, the organ culture model can only be used to evaluate the short-term effects and it is not applicable in simulating the complex process of IDD. Similarly, the animal models induced by different methods also have their advantages and disadvantages. For studying the mechanism of IDD and the corresponding treatment and prevention strategies, the selection of model should be individualized based on the purpose of each study.Conclusions:Various models have different characteristics and scope of application due to their different rationales and methods of construction. Currently, there is no experimental model that can perfectly mimic the degenerative process of human IVD. Personalized selection of appropriate model based on study purpose and experimental designing can enhance the possibility to obtain reliable and real results.
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Affiliation(s)
- Yidian Wang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Jihe Kang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Xudong Guo
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Daxue Zhu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Mingqiang Liu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Liang Yang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Guangzhi Zhang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China
| | - Xuewen Kang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, P.R. China.,Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, P.R. China.,The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Gansu, P.R. China
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Peng Y, Qing X, Shu H, Tian S, Yang W, Chen S, Lin H, Lv X, Zhao L, Chen X, Pu F, Huang D, Cao X, Shao Z, Yp, Zs, Xc, Yp, Yp, Xq, Hs, St, Wy, Yp, Xq, Hs, St, Hl, Xl, Lz, Xc, Fp, Sc, Yp, Xq, Hs, St, Yp, Xq, Wy, Hl, Xl, Lz, Xc, Fp, Sc, Hdh, Wy, Hl, Xl, Lz, Xc, Fp, Sc, Hdh, Zs, Xc. Proper animal experimental designs for preclinical research of biomaterials for intervertebral disc regeneration. BIOMATERIALS TRANSLATIONAL 2021; 2:91-142. [PMID: 35836965 PMCID: PMC9255780 DOI: 10.12336/biomatertransl.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Abstract
Low back pain is a vital musculoskeletal disease that impairs life quality, leads to disability and imposes heavy economic burden on the society, while it is greatly attributed to intervertebral disc degeneration (IDD). However, the existing treatments, such as medicines, chiropractic adjustments and surgery, cannot achieve ideal disc regeneration. Therefore, advanced bioactive therapies are implemented, including stem cells delivery, bioreagents administration, and implantation of biomaterials etc. Among these researches, few reported unsatisfying regenerative outcomes. However, these advanced therapies have barely achieved successful clinical translation. The main reason for the inconsistency between satisfying preclinical results and poor clinical translation may largely rely on the animal models that cannot actually simulate the human disc degeneration. The inappropriate animal model also leads to difficulties in comparing the efficacies among biomaterials in different reaches. Therefore, animal models that better simulate the clinical charateristics of human IDD should be acknowledged. In addition, in vivo regenerative outcomes should be carefully evaluated to obtain robust results. Nevertheless, many researches neglect certain critical characteristics, such as adhesive properties for biomaterials blocking annulus fibrosus defects and hyperalgesia that is closely related to the clinical manifestations, e.g., low back pain. Herein, in this review, we summarized the animal models established for IDD, and highlighted the proper models and parameters that may result in acknowledged IDD models. Then, we discussed the existing biomaterials for disc regeneration and the characteristics that should be considered for regenerating different parts of discs. Finally, well-established assays and parameters for in vivo disc regeneration are explored.
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Affiliation(s)
- Yizhong Peng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiangcheng Qing
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hongyang Shu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shuo Tian
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wenbo Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Songfeng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hui Lin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Lv
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Lei Zhao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xi Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Feifei Pu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Donghua Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xu Cao
- Department of Orthopaedic Surgery, Institute for Cell Engineering, Johns Hopkins University, Baltimore, MD, USA,Corresponding authors: Zengwu Shao, ; Xu Cao,
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China,Corresponding authors: Zengwu Shao, ; Xu Cao,
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Yang B, Klineberg E, O'Connell GD. Intervertebral Disc Mechanics With Nucleotomy: Differences Between Simple and Dual Loading. J Biomech Eng 2021; 143:1104432. [PMID: 33729477 DOI: 10.1115/1.4050538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Indexed: 11/08/2022]
Abstract
Painful herniated discs are treated surgically by removing extruded nucleus pulposus (NP) material (nucleotomy). NP removal through enzymatic digestion is also commonly performed to initiate degenerative changes to study potential biological repair strategies. Experimental and computational studies have shown a decrease in disc stiffness with nucleotomy under single loading modalities, such as compression-only or bending-only loading. However, studies that apply more physiologically relevant loading conditions, such as compression in combination with bending or torsion, have shown contradicting results. We used a previously validated bone-disc-bone finite element model (Control) to create a Nucleotomy model to evaluate the effect of dual loading conditions (compression with torsion or bending) on intradiscal deformations. While disc joint stiffness decreased with nucleotomy under single loading conditions, as commonly reported in the literature, dual loading resulted in an increase in bending stiffness. More specifically, dual loading resulted in a 40% increase in bending stiffness under flexion and extension and a 25% increase in stiffness under lateral bending. The increase in bending stiffness was due to an increase and shift in compressive stress, where peak stresses migrated from the NP-annulus interface to the outer annulus. In contrast, the decrease in torsional stiffness was due to greater fiber reorientation during compression. In general, large radial strains were observed with nucleotomy, suggesting an increased risk for delamination or degenerative remodeling. In conclusion, the effect of nucleotomy on disc mechanics depends on the type and complexity of applied loads.
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Affiliation(s)
- Bo Yang
- Department of Mechanical Engineering, University of California Berkeley, Etcheverry Hall, Berkeley, CA 94720
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis Medical Center, Sacramento, CA 95817
| | - Grace D O'Connell
- Department of Mechanical Engineering, University of California Berkeley, 5122 Etcheverry Hall, #1740, Berkeley, CA 94720; Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA 94142
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13
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Wang JY, Mansfield JC, Brasselet S, Vergari C, Meakin JR, Winlove CP. Micro-mechanical damage of needle puncture on bovine annulus fibrosus fibrils studied using polarization-resolved Second Harmonic Generation(P-SHG) microscopy. J Mech Behav Biomed Mater 2021; 118:104458. [PMID: 33761373 DOI: 10.1016/j.jmbbm.2021.104458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022]
Abstract
Needle injection has been widely used in spinal therapeutic or diagnostic processes, such as discography. The use of needles has been suspected in causing mild disc degeneration which can lead to long-term back pain. However, the localised microscopic damage caused by needles has not been well studied. The local progressive damage on a microscopic level caused by needle punctures on the surface of bovine annulus fibrosus was investigated. Four different sizes of needle were used for the puncture and twenty-nine bovine intervertebral discs were studied. Polarization-resolved second harmonic generation and fluorescent microscopy were used to study the local microscopic structural changes in collagen and cell nuclei due to needle damage. Repeated 70 cyclic loadings at ±5% of axial strain were applied after the needle puncture in order to assess progressive damage caused by the needle. Puncture damage on annulus fibrosus were observed either collagen fibre bundles being pushed aside, being cut through or combination of both with part being lift or pushed in. The progressive damage was found less relevant to the needle size and more progressive damage was only observed using the larger needle. Two distinct populations of collagen, in which one was relatively more organised than the other population, were observed especially after the puncture from skewed distribution of polarization-SHG analysis. Cell shape was found rounder near the puncture site where collagen fibres were damaged.
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Affiliation(s)
- J-Y Wang
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK.
| | - J C Mansfield
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| | - S Brasselet
- Aix Marseille Univ, CNRS, Centrale Marseille, Institut Fresnel, F-13013, Marseille, France
| | - C Vergari
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris
| | - J R Meakin
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
| | - C P Winlove
- College of Engineering, Mathematics & Physical Sciences, Physics Building, Stocker Road, Exeter, EX4 4QL, UK
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14
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Alexeev D, Cui S, Grad S, Li Z, Ferguson SJ. Mechanical and biological characterization of a composite annulus fibrosus repair strategy in an endplate delamination model. JOR Spine 2020; 3:e1107. [PMID: 33392447 PMCID: PMC7770194 DOI: 10.1002/jsp2.1107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/08/2020] [Accepted: 06/21/2020] [Indexed: 12/23/2022] Open
Abstract
This study compares the mechanical response of the commonly used annulus fibrosus (AF) puncture injury model of the intervertebral disc (IVD) and a newly proposed AF failure at the endplate junction (delamination) on ex vivo bovine IVDs. Biocompatibility and mechanics of a newly developed repair strategy comprising of electrospun polycaprolactone (PCL) scaffold and fibrin-genipin (FibGen) adhesive was tested on the delamination model. The study found no significant difference in the mechanical response to compressive loading between the two models. Primary goals of the repair strategy to create a tight seal on the damage area and restore mechanical properties, while showing minimal cytotoxicity, were broadly achieved. Postrepair, the IVDs showed a significant restoration of mechanical properties compared to the injured samples for the delamination model. The FibGen glue showed a limited toxicity in the AF and produced a resilient and mechanically stable seal on the damaged area.
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Affiliation(s)
| | - Shangbin Cui
- AO Research Institute DavosDavosSwitzerland
- The First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Sibylle Grad
- ETH Zürich, Institute for BiomechanicsZürichSwitzerland
- AO Research Institute DavosDavosSwitzerland
| | - Zhen Li
- AO Research Institute DavosDavosSwitzerland
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15
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Collateral effects of targeting the nucleus pulposus via a transpedicular or transannular surgical route: a combined X-ray, MRI, and histological long-term descriptive study in sheep. 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 2020; 30:585-595. [PMID: 32945962 DOI: 10.1007/s00586-020-06602-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE In the context of regenerative medicine strategies, based in particular on the injection of regenerative cells, biological factors, or biomaterials into the nucleus pulposus (NP), two main routes are used: the transpedicular approach (TPA) and the transannular approach (TAA). The purpose of our study was to compare the long-term consequences of the TPA and the TAA on intervertebral disc (IVD) health through a longitudinal follow-up in an ovine model. METHODS The TPA and the TAA were performed on 12 IVDs from 3 sheep. Six discs were left untreated and used as controls. The route and injection feasibility, as well as the IVD environment integrity, were assessed by MRI (T2-weighted signal intensity), micro-CT scan, and histological analyses (Boos' scoring). The sheep were assessed at 1, 3, and 7 months. RESULTS Both the TPA and the TAA allowed access to the NP. They both induced NP degeneration, as evidenced by a decrease in the T2wsi and an increase in the Boos' scores. The TPA led to persistent end-plate defects and herniation of NP tissue (Schmorl's node-like) after 7 months as well as the presence of osseous fragments in the NP. CONCLUSIONS The TPA induced more severe lesions in IVDs and vertebrae compared to the TAA. The lesions induced by the TPA are reason to consider whether or not this route is optimal for studying IVD regenerative medicine approaches.
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16
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Glaeser JD, Salehi K, Kanim LE, NaPier Z, Kropf MA, Cuéllar JM, Perry TG, Bae HW, Sheyn D. NF-κB inhibitor, NEMO-binding domain peptide attenuates intervertebral disc degeneration. Spine J 2020; 20:1480-1491. [PMID: 32413485 PMCID: PMC7494571 DOI: 10.1016/j.spinee.2020.04.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/16/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Nonphysiological mechanical loading and inflammation are both critically involved in intervertebral disc (IVD) degeneration, which is characterized by an increase in cytokines and matrix metalloproteases (MMPs) in the nucleus pulposus (NP). This process is known to be mediated by the NF-κB pathway. CLINICAL SIGNIFICANCE Current clinical treatments for IVD degeneration focus on the alleviation of symptoms rather than targeting the underlying mechanism. Injection of an NF-κB inhibitor may attenuate the progression of IVD degeneration. PURPOSE To investigate the ability of the NF-κB inhibitor, NEMO binding domain peptide (NBD), to alter IVD degeneration processes by reducing IL-1β- and mechanically-induced cytokine and MMP levels in human nucleus pulposus cells in vitro, and by attenuating IVD degeneration in an in vivo rat model for disc degeneration. STUDY DESIGN Experimental in vitro and animal model. PATIENT SAMPLE Discarded specimens of lumbar disc from 21 patients, and 12 Sprague Dawley rats. OUTCOME MEASURES Gene and protein expression, cell viability, µMRI and histology. METHODS IL-1β-prestimulated human nucleus pulposus cells embedded into fibrin constructs were loaded in the Flexcell FX-5000 compression system at 5 kPa and 1 Hz for 48 hours in the presence and absence of NBD. Unloaded hNPC/fibrin constructs served as controls. Cell viability in loaded and unloaded constructs was quantified, and gene and protein expression levels determined. For in vivo testing, a rat needle disc puncture model was employed. Experimental groups included injured discs with and without NBD injection and uninjured controls. Levels of disc degeneration were determined via µMRI, qPCR and histology. Funding sources include $48,874 NASS Young Investigator Research Grant and $119,174 NIH 5K01AR071512-02. There were no applicable financial relationships or conflicts of interest. RESULTS Mechanical compression of hNPC/fibrin constructs resulted in upregulation of MMP-3 and IL-8. Supplementation of media with 10 μM NBD during loading increased cell viability, and decreased MMP-3 gene and protein levels. IVD injury in rat resulted in an increase in MMP-3, IL-1β and IL-6 gene expression. Injections of 250 µg of NBD during disc injury resulted in decreased IL-6 gene expression. µMRI analysis demonstrated a reduction of disc hydration in response to disc needle injury, which was attenuated in NBD-treated IVDs. Histological evaluation showed NP and AF lesion in injured discs, which was attenuated by NBD injection. CONCLUSIONS The results of this study show NBD peptide's capacity to reduce IL-1β- and loading-induced MMP-3 levels in hNPC/fibrin constructs while increasing the cells' viability, and to attenuate IVD degeneration in rat, involving downregulation of IL-6. Therefore, NBD may be a potential therapeutic agent to treat IVD degeneration.
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Affiliation(s)
- Juliane D. Glaeser
- Orthopedic Stem Cell Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA,Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Khosrowdad Salehi
- Orthopedic Stem Cell Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA,Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Linda E.A. Kanim
- Orthopedic Stem Cell Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zachary NaPier
- Orthopedic Stem Cell Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA,Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael A. Kropf
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jason M. Cuéllar
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tiffany G. Perry
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hyun W. Bae
- Orthopedic Stem Cell Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA,Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Dmitriy Sheyn
- Orthopedic Stem Cell Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Orthopedics, 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.
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17
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Su QH, Zhang Y, Shen B, Li YC, Tan J. Application of molybdenum target X-ray photography in imaging analysis of caudal intervertebral disc degeneration in rats. World J Clin Cases 2020; 8:3431-3439. [PMID: 32913849 PMCID: PMC7457105 DOI: 10.12998/wjcc.v8.i16.3431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Conventional plain X-ray images of rats, the most common animals used as degeneration models, exhibit unclear vertebral structure and blurry intervertebral disc spaces due to their small size, slender vertebral bodies.
AIM To apply molybdenum target X-ray photography in the evaluation of caudal intervertebral disc (IVD) degeneration in rat models.
METHODS Two types of rat caudal IVD degeneration models (needle-punctured model and endplate-destructed model) were established, and their effectiveness was verified using nuclear magnetic resonance imaging. Molybdenum target inspection and routine plain X-ray were then performed on these models. Additionally, four observers were assigned to measure the intervertebral height of degenerated segments on molybdenum target plain X-ray images and routine plain X-ray images, respectively. The degeneration was evaluated and statistical analysis was subsequently conducted.
RESULTS Nine rats in the needle-punctured model and 10 rats in the endplate-destructed model were effective. Compared with routine plain X-ray images, molybdenum target plain X-ray images showed higher clarity, stronger contrast, as well as clearer and more accurate structural development. The McNemar test confirmed that the difference was statistically significant (P = 0.031). In the two models, the reliability of the intervertebral height measured by the four observers on routine plain X-ray images was poor (ICC < 0.4), while the data obtained from the molybdenum target plain X-ray images were more reliable.
CONCLUSION Molybdenum target inspection can obtain clearer images and display fine calcification in the imaging evaluation of caudal IVD degeneration in rats, thus ensuring a more accurate evaluation of degeneration.
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Affiliation(s)
- Qi-Hang Su
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yan Zhang
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Bin Shen
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Yong-Chao Li
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jun Tan
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
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18
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Glaeser JD, Tawackoli W, Ju DG, Yang JH, Kanim LEA, Salehi K, Yu V, Saidara E, Vit J, Khnkoyan Z, NaPier Z, Stone LS, Bae HW, Sheyn D. Optimization of a rat lumbar IVD degeneration model for low back pain. JOR Spine 2020; 3:e1092. [PMID: 32613167 PMCID: PMC7323460 DOI: 10.1002/jsp2.1092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Intervertebral disc (IVD) degeneration is often associated with low back pain and radiating leg pain. The purpose of this study is to develop a reproducible and standardized preclinical model of painful lumbar IVD degeneration by evaluation of structural and behavioral changes in response to IVD injury with increasing needle sizes. This model can be used to develop new therapies for IVD degeneration. METHODS Forty-five female Sprague Dawley rats underwent anterior lumbar disc needle puncture at levels L4-5 and L5-6 under fluoroscopic guidance. Animals were randomly assigned to four different experimental groups: needle sizes of 18 Gauge (G), 21G, 23G, and sham control. To monitor the progression of IVD degeneration and pain, the following methods were employed: μMRI, qRT-PCR, histology, and biobehavioral analysis. RESULTS T1- and T2-weighted μMRI analysis showed a correlation between the degree of IVD degeneration and needle diameter, with the most severe degeneration in the 18G group. mRNA expression of markers for IVD degeneration markers were dysregulated in the 18G and 21G groups, while pro-nociceptive markers were increased in the 18G group only. Hematoxylin and Eosin (H&E) and Alcian Blue/Picrosirius Red staining confirmed the most pronounced IVD degeneration in the 18G group. Randall-Selitto and von Frey tests showed increased hindpaw sensitivity in the 18G group. CONCLUSION Our findings demonstrate that anterior disc injury with an 18G needle creates severe IVD degeneration and mechanical hypersensitivity, while the 21G needle results in moderate degeneration with no increased pain sensitivity. Therefore, needle sizes should be selected depending on the desired phenotype for the pre-clinical model.
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Affiliation(s)
- Juliane D. Glaeser
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Wafa Tawackoli
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of SurgeryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Biomedical Imaging Research InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Derek G. Ju
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jae H. Yang
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of Orthopedic SurgeryKorea University Guro HospitalSeoulSouth Korea
| | - Linda EA Kanim
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Khosrowdad Salehi
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Victoria Yu
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Evan Saidara
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jean‐Phillipe Vit
- Department of Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Zhanna Khnkoyan
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Zachary NaPier
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Laura S. Stone
- McGill University, Faculty of DentistryAlan Edwards Centre for Research on PainMontrealCanada
| | - Hyun W. Bae
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Dmitriy Sheyn
- Orthopaedic Stem Cell Research LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Board of Governors Regenerative Medicine InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of OrthopedicsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of SurgeryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Department of Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
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19
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Zwambag DP, Molladavoodi S, Guerreiro MJ, DeWitte-Orr SJ, Gregory DE. Immuno-stimulatory capacity of decorin in the rat tail intervertebral disc and the mechanical consequence of resultant inflammation. 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 2020; 29:1641-1648. [PMID: 32451779 DOI: 10.1007/s00586-020-06469-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Determine whether decorin is immuno-stimulatory to rat tail IVD cells and to characterize the mechanical consequence of inflammation at the whole rat tail IVD level. METHODS Cultured rat tail annulus fibrosus (AF) cells were exposed to decorin, a resident IVD small leucine-rich proteoglycan (SLRP), with and without the presence of a toll-like receptor (TLR) 4 inhibitor, TAK-242. Resultant expression of pro-inflammatory cytokine and chemokines (MCP-1; MIP-2; RANTES; IL-6; TNFα) were quantified over 24 h. Whole rat tail IVD cultures (n = 50) were also treated with decorin (two concentrations: 0.5 and 5.0 μg/mL) with and without TAK-242 (via nucleus pulpous injection with a 33-gauge needle), and resultant mechanical properties were measured. RESULTS AF cells exposed to decorin showed significant increases in pro-inflammatory cytokine and chemokine production; this was significantly blunted with the presence of TAK-242. Whole IVDs injected with decorin showed a dose-dependent decrease in neutral zone and tensile stiffness and an increase in neutral zone size. When TAK-242 was injected into the IVD with the decorin, mechanical stiffness was preserved and not different from sham controls (injected with PBS). CONCLUSION AF cells are capable of detecting decorin and inducing inflammation. Decorin further resulted in a functional deterioration in IVD mechanical integrity. TAK- 242, a TLR4 inhibitor, blunted chemokine production at the cellular level and preserved mechanical stiffness in the whole IVD.
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Affiliation(s)
- Derek P Zwambag
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L 3C5, Canada
| | - Sara Molladavoodi
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L 3C5, Canada
| | - Matthew J Guerreiro
- Department of Integrative Biology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Stephanie J DeWitte-Orr
- Department of Integrative Biology, Wilfrid Laurier University, Waterloo, ON, Canada.,Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Diane E Gregory
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave W, Waterloo, ON, N2L 3C5, Canada. .,Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada.
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20
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Barakat AH, Elwell VA, Lam KS. Stem cell therapy in discogenic back pain. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:561-583. [PMID: 32043007 PMCID: PMC6989932 DOI: 10.21037/jss.2019.09.22] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Chronic low back pain has both substantial social and economic impacts on patients and healthcare budgets. Adding to the magnitude of the problem is the difficulty in identifying the exact causes of disc degeneration with modern day diagnostic and imaging techniques. With that said, current non-operative and surgical treatment modalities for discogenic low back pain fails to meet the expectations in many patients and hence the challenge. The objective for newly emerging stem cell regenerative therapy is to treat degenerative disc disease (DDD) by restoring the disc's cellularity and modulating the inflammatory response. Appropriate patient selection is crucial for the success of stem cell therapy. Regenerative modalities for discogenic pain currently focus on the use of either primary cells harvested from the intervertebral discs or stem cells from other sources whether autogenic or allogenic. The microenvironment in which stem cells are being cultured has been recognized to play a crucial role in directing or maintaining the production of the desired phenotypes and may enhance their regenerative potential. This has led to a more specific focus on innovating more effective culturing techniques, delivery vehicles and scaffolds for stem cell application. Although stem cell therapy might offer an attractive alternative treatment option, more clinical studies are still needed to establish on the safety and feasibility of such therapy. In this literature review, we aim to present the most recent in vivo and in vitro studies related to the use of stem cell therapy in the treatment of discogenic low back pain.
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Affiliation(s)
- Ahmed H. Barakat
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Vivian A. Elwell
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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21
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Lai A, Ho L, Evashwick-Rogler TW, Watanabe H, Salandra J, Winkelstein BA, Laudier D, Hecht AC, Pasinetti GM, Iatridis JC. Dietary polyphenols as a safe and novel intervention for modulating pain associated with intervertebral disc degeneration in an in-vivo rat model. PLoS One 2019; 14:e0223435. [PMID: 31577822 PMCID: PMC6774529 DOI: 10.1371/journal.pone.0223435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/21/2019] [Indexed: 01/08/2023] Open
Abstract
Developing effective therapies for back pain associated with intervertebral disc (IVD) degeneration is a research priority since it is a major socioeconomic burden and current conservative and surgical treatments have limited success. Polyphenols are naturally occurring compounds in plant-derived foods and beverages, and evidence suggests dietary supplementation with select polyphenol preparations can modulate diverse neurological and painful disorders. This study tested whether supplementation with a select standardized Bioactive-Dietary-Polyphenol-Preparation (BDPP) may alleviate pain symptoms associated with IVD degeneration. Painful IVD degeneration was surgically induced in skeletally-mature rats by intradiscal saline injection into three consecutive lumbar IVDs. Injured rats were given normal or BDPP-supplemented drinking water. In-vivo hindpaw mechanical allodynia and IVD height were assessed weekly for 6 weeks following injury. Spinal column, dorsal-root-ganglion (DRG) and serum were collected at 1 and 6 weeks post-operative (post-op) for analyses of IVD-related mechanical and biological pathogenic processes. Dietary BDPP significantly alleviated the typical behavioral sensitivity associated with surgical procedures and IVD degeneration, but did not modulate IVD degeneration nor changes of pro-inflammatory cytokine levels in IVD. Gene expression analyses suggested BDPP might have an immunomodulatory effect in attenuating the expression of pro-inflammatory cytokines in DRGs. This study supports the idea that dietary supplementation with BDPP has potential to alleviate IVD degeneration-related pain, and further investigations are warranted to identify the mechanisms of action of dietary BDPP.
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Affiliation(s)
- Alon Lai
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lap Ho
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States of America
| | - Thomas W. Evashwick-Rogler
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | | | - Jonathan Salandra
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, United States of America
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Damien Laudier
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Andrew C. Hecht
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Giulio M. Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, United States of America
| | - James C. Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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22
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Mosley GE, Hoy RC, Nasser P, Kaseta T, Lai A, Evashwick-Rogler TW, Lee M, Iatridis JC. Sex Differences in Rat Intervertebral Disc Structure and Function Following Annular Puncture Injury. Spine (Phila Pa 1976) 2019; 44:1257-1269. [PMID: 30973506 PMCID: PMC6722021 DOI: 10.1097/brs.0000000000003055] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A rat puncture injury intervertebral disc (IVD) degeneration model with structural, biomechanical, and histological analyses. OBJECTIVE To determine if males and females have distinct responses in the IVD after injury. SUMMARY OF BACKGROUND DATA Low back pain (LBP) and spinal impairments are more common in women than men. However, sex differences in IVD response to injury have been underexplored, particularly in animal models where sex differences can be measured without gender confounds. METHODS Forty-eight male and female Sprague Dawley rats underwent sham, single annular puncture with tumor necrosis factor α (TNFα) injection (1×), or triple annular puncture with TNFα injection (3×) surgery. Six weeks after surgery, lumbar IVDs were assessed by radiologic IVD height, spinal motion segment biomechanical testing, histological degeneration grading, second harmonic generation (SHG) imaging, and immunofluorescence for fibronectin and α-smooth muscle actin. RESULTS Annular puncture injuries significantly increased degenerative grade and IVD height loss for males and females, but females had increased degeneration grade particularly in the annulus fibrosus (AF). Despite IVD height loss, biomechanical properties were largely unaffected by injury at 6 weeks. However, biomechanical measures sensitive to outer AF differed by sex after 3× injury-male IVDs had greater torsional stiffness, torque range, and viscoelastic creep responses. SHG intensity of outer AF was reduced after injury only in female IVDs, suggesting sex differences in collagen remodeling. Both males and females exhibited decreased cellularity and increased fibronectin expression at injury sites. CONCLUSION IVD injury results in distinct degeneration and functional healing responses between males and females. The subtle sex differences identified in this animal model suggest differences in response to IVD injury that might explain some of the variance observed in human LBP, and demonstrate the need to better understand differences in male and female IVD degeneration patterns and pain pathogenesis. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Grace E. Mosley
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert C. Hoy
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Philip Nasser
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Timothy Kaseta
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alon Lai
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Michael Lee
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James C. Iatridis
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
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23
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Varden LJ, Nguyen DT, Michalek AJ. Slow depressurization following intradiscal injection leads to injectate leakage in a large animal model. JOR Spine 2019; 2:e1061. [PMID: 31572978 PMCID: PMC6764785 DOI: 10.1002/jsp2.1061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022] Open
Abstract
Needle injection has been indicated as the most practical method of delivering therapeutic agents to the intervertebral disc due to the disc's largely avascular nature. As the disc is characterized by both high stiffness and low permeability, injection requires substantial pressure, which may not relax on practical time scales. Additionally, needle puncture results in a localized disruption to the annulus fibrosus that can provide a leakage pathway for pressurized injectate. We hypothesized that intradiscal injection would result in slow relaxation of injectate pressure, followed by leakage upon needle retraction. This hypothesis was tested via controlled injection of fluorescently labeled saline into bovine caudal discs via a 21 gauge needle. Injections were performed with 10% of total disc volume injected at 3%/s followed by a 4-minute dwell. An analytical poroelastic model was calibrated to the experimental data and used to estimate injectate delivery with time. Experimental results confirmed both pressurization (with a peak of 199 ± 45 kPa) and slow recovery (final pressure of 81 ± 23 kPa). Injectate leakage through the needle puncture was verified following needle retraction in all samples. Histological sections of the discs displayed a clear defect at each disc's injection site with strong fluorescent labeling indicating a leakage pathway. The modeling results suggest that less than one-fourth of the injected volume was absorbed by the tissue in 4 minutes. Taken together these results suggest that needle injection is a feasible, albeit inefficient method for delivery of therapeutic agents into the intervertebral disc. Particular care should be taken to aspirate un-absorbed injectate prior to needle retraction to prevent leakage and exposure of surrounding tissues.
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Affiliation(s)
- Lara J. Varden
- Interdisciplinary Bioscience and Biotechnology ProgramClarkson UniversityPotsdamNew York
| | - Duc T. Nguyen
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
| | - Arthur J. Michalek
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
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24
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Hom WW, Tschopp M, Lin HA, Nasser P, Laudier DM, Hecht AC, Nicoll SB, Iatridis JC. Composite biomaterial repair strategy to restore biomechanical function and reduce herniation risk in an ex vivo large animal model of intervertebral disc herniation with varying injury severity. PLoS One 2019; 14:e0217357. [PMID: 31136604 PMCID: PMC6538241 DOI: 10.1371/journal.pone.0217357] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022] Open
Abstract
Back pain commonly arises from intervertebral disc (IVD) damage including annulus fibrosus (AF) defects and nucleus pulposus (NP) loss. Poor IVD healing motivates developing tissue engineering repair strategies. This study evaluated a composite injectable IVD biomaterial repair strategy using carboxymethylcellulose-methylcellulose (CMC-MC) and genipin-crosslinked fibrin (FibGen) that mimic NP and AF properties, respectively. Bovine ex vivo caudal IVDs were evaluated in cyclic compression-tension, torsion, and compression-to-failure tests to determine IVD biomechanical properties, height loss, and herniation risk following experimentally-induced severe herniation injury and discectomy (4 mm biopsy defect with 20% NP removed). FibGen with and without CMC-MC had failure strength similar to discectomy injury suggesting no increased risk compared to surgical procedures, yet no biomaterials improved axial or torsional biomechanical properties suggesting they were incapable of adequately restoring AF tension. FibGen had the largest failure strength and was further evaluated in additional discectomy injury models with varying AF defect types (2 mm biopsy, 4 mm cruciate, 4 mm biopsy) and NP removal volume (0%, 20%). All simulated discectomy defects significantly compromised failure strength and biomechanical properties. The 0% NP removal group had mean values of axial biomechanical properties closer to intact levels than defects with 20% NP removed but they were not statistically different and 0% NP removal also decreased failure strength. FibGen with and without CMC-MC failed at super-physiological stress levels above simulated discectomy suggesting repair with these tissue engineered biomaterials may perform better than discectomy alone, although restored biomechanical function may require additional healing with the potential application of these biomaterials as sealants and cell/drug delivery carriers.
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Affiliation(s)
- Warren W. Hom
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Melanie Tschopp
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Huizi A. Lin
- Department of Biomedical Engineering, The City College of New York, New York, New York, United States of America
| | - Philip Nasser
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Damien M. Laudier
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Andrew C. Hecht
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Steven B. Nicoll
- Department of Biomedical Engineering, The City College of New York, New York, New York, United States of America
| | - James C. Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
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25
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Biomechanical test protocols to detect minor injury effects in intervertebral discs. J Mech Behav Biomed Mater 2019; 95:13-20. [PMID: 30947120 DOI: 10.1016/j.jmbbm.2019.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/26/2019] [Accepted: 03/22/2019] [Indexed: 01/21/2023]
Abstract
Intervertebral discs (IVDs) maintain flexibility of the spine and bear mechanical load. Annulus fibrosus (AF) defects are associated with IVD degeneration and herniation which disrupt biomechanical function and can cause pain. AF puncture injuries can induce IVD degeneration but are needed to inject therapies. Identifying small AF defects with biomechanical testing can be difficult because IVDs have a complex, composite structure and nonlinear biomechanical properties that are dependent on AF fiber tension. It remains unclear how choice of biomechanical testing protocols affect the sensitivity of biomechanical properties to AF injuries. This study determined whether axial preload or magnitude of cyclic axial or torsional testing affected the ability to detect minor AF defects in rat caudal motion segments using ex vivo biomechanical testing. Intact and injured motion segments were subjected to a repeated measures study design with multiple biomechanical testing protocols that varied axial tension-compression force amplitude (±1.6 N, ±8.0 N, ±16.0 N), axial preload (-1.6 N, -8.0 N, -16.0 N, corresponding to -0.1 MPa, -0.5 MPa, and -1.0 MPa, respectively), and torsional rotation angle (±10°, ±15°, and ±20°). Biomechanical properties obtained from the lowest force testing conditions for axial tension-compression (±1.6 N), axial preload (-1.6 N), and angular rotation (±10°) exhibited the largest differences in biomechanical properties between intact and injured conditions. Biomechanical properties determined under low axial force or torsion amplitudes involve less AF fiber tension and were most sensitive to injury. Low force testing protocols are recommended for detecting minor structural AF defects and may enable more precise assessments of IVD injuries, healing or repair.
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26
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Krishnamoorthy D, Hoy RC, Natelson DM, Torre OM, Laudier DM, Iatridis JC, Illien-Jünger S. Dietary advanced glycation end-product consumption leads to mechanical stiffening of murine intervertebral discs. Dis Model Mech 2018; 11:dmm.036012. [PMID: 30498097 PMCID: PMC6307905 DOI: 10.1242/dmm.036012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022] Open
Abstract
Back pain is a leading cause of disability and is strongly associated with intervertebral disc (IVD) degeneration. Reducing structural disruption and catabolism in IVD degeneration remains an important clinical challenge. Pro-oxidant and structure-modifying advanced glycation end-products (AGEs) contribute to obesity and diabetes, which are associated with increased back pain, and accumulate in tissues due to hyperglycemia or ingestion of foods processed at high heat. Collagen-rich IVDs are particularly susceptible to AGE accumulation due to their slow metabolic rates, yet it is unclear whether dietary AGEs can cross the endplates to accumulate in IVDs. A dietary mouse model was used to test the hypothesis that chronic consumption of high AGE diets results in sex-specific IVD structural disruption and functional changes. High AGE diet resulted in AGE accumulation in IVDs and increased IVD compressive stiffness, torque range and failure torque, particularly for females. These biomechanical changes were likely caused by significantly increased AGE crosslinking in the annulus fibrosus, measured by multiphoton imaging. Increased collagen damage measured with collagen hybridizing peptide did not appear to influence biomechanical properties and may be a risk factor as these animals age. The greater influence of high AGE diet on females is an important area of future investigation that may involve AGE receptors known to interact with estrogen. We conclude that high AGE diets can be a source for IVD crosslinking and collagen damage known to be important in IVD degeneration. Dietary modifications and interventions that reduce AGEs warrant further investigation and may be particularly important for diabetics, in whom AGEs accumulate more rapidly. Summary: Dietary AGEs lead to sex-specific intervertebral disc structural and functional changes and may be targeted for promoting spinal health, especially in diabetes, in which AGEs form rapidly.
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Affiliation(s)
- Divya Krishnamoorthy
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Robert C Hoy
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Devorah M Natelson
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Olivia M Torre
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Damien M Laudier
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Svenja Illien-Jünger
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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27
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Smith LJ, Silverman L, Sakai D, Le Maitre CL, Mauck RL, Malhotra NR, Lotz JC, Buckley CT. Advancing cell therapies for intervertebral disc regeneration from the lab to the clinic: Recommendations of the ORS spine section. JOR Spine 2018; 1:e1036. [PMID: 30895277 PMCID: PMC6419951 DOI: 10.1002/jsp2.1036] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
Intervertebral disc degeneration is strongly associated with chronic low back pain, a leading cause of disability worldwide. Current back pain treatment approaches (both surgical and conservative) are limited to addressing symptoms, not necessarily the root cause. Not surprisingly therefore, long-term efficacy of most approaches is poor. Cell-based disc regeneration strategies have shown promise in preclinical studies, and represent a relatively low-risk, low-cost, and durable therapeutic approach suitable for a potentially large patient population, thus making them attractive from both clinical and commercial standpoints. Despite such promise, no such therapies have been broadly adopted clinically. In this perspective we highlight primary obstacles and provide recommendations to help accelerate successful clinical translation of cell-based disc regeneration therapies. The key areas addressed include: (a) Optimizing cell sources and delivery techniques; (b) Minimizing potential risks to patients; (c) Selecting physiologically and clinically relevant efficacy metrics; (d) Maximizing commercial potential; and (e) Recognizing the importance of multidisciplinary collaborations and engaging with clinicians from inception through to clinical trials.
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Affiliation(s)
- Lachlan J. Smith
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
| | - Lara Silverman
- DiscGenics Inc.Salt Lake CityUtah
- Department of NeurosurgeryUniversity of Tennessee Health Science CenterMemphisTennessee
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical ScienceTokai University School of MedicineIseharaJapan
| | | | - Robert L. Mauck
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Neil R. Malhotra
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Conor T. Buckley
- Trinity Centre for BioengineeringTrinity Biomedical Sciences Institute, Trinity College Dublin, The University of DublinDublinIreland
- School of EngineeringTrinity College Dublin, The University of DublinDublinIreland
- Advanced Materials and Bioengineering Research (AMBER) CentreRoyal College of Surgeons in Ireland & Trinity College Dublin, The University of DublinDublinIreland
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28
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Chen T, Cheng X, Wang J, Feng X, Zhang L. Time-Course Investigation of Intervertebral Disc Degeneration Induced by Different Sizes of Needle Punctures in Rat Tail Disc. Med Sci Monit 2018; 24:6456-6465. [PMID: 30216335 PMCID: PMC6151108 DOI: 10.12659/msm.910636] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to determine the best size needle to use in inducing IVDD and to find the proper time point of disc degeneration suitable for further biologic treatment study. Material/Methods First, rat tail level 5/6, 7/8, and 9/10 discs were punctured by 18G, 21G, or 25G needles. Then, degeneration was assessed by radiography, MRI, and histological evaluation at 2, 4, and 6 weeks after puncture. Later, real-time reverse transcriptase (RT-PCR) was used to examine mRNA expressions of aggrecan, collagen type II, hypoxia-inducible factor-1α (HIF-1α), glucose transporter1 (GLUT-1), and vascular endothelial growth factor (VEGF). Results Significant differences were identified in almost all parameters compared with the control group in the 18G and 21G group at almost all time points. To assess the effect of different needle sizes on DHI, we used magnetic resonance imaging (MRI), grade, and mRNA expression. We found significant differences between different groups, except for DHI between the 21G group and 25G group and MRI grade between the 18G and 21G group at the 2-week time point. In assessing the effect of different needle sizes on HE staining score and toluidine blue staining grade, statistical differences were observed at some time points. The effects of time on all parameters were significant at almost all time points in all groups. Conclusions The middle-size needle (21G) performed better in inducing disc degeneration. The 2-week time point may be better for use in further experimental studies.
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Affiliation(s)
- Tao Chen
- Xiangya School of Medicine Central South University, Changsha, Hunan, China (mainland).,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Xiaofei Cheng
- Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland)
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
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29
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Torre OM, Mroz V, Bartelstein MK, Huang AH, Iatridis JC. Annulus fibrosus cell phenotypes in homeostasis and injury: implications for regenerative strategies. Ann N Y Acad Sci 2018; 1442:61-78. [PMID: 30604562 DOI: 10.1111/nyas.13964] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/05/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022]
Abstract
Despite considerable efforts to develop cellular, molecular, and structural repair strategies and restore intervertebral disk function after injury, the basic biology underlying intervertebral disk healing remains poorly understood. Remarkably, little is known about the origins of cell populations residing within the annulus fibrosus, or their phenotypes, heterogeneity, and roles during healing. This review focuses on recent literature highlighting the intrinsic and extrinsic cell types of the annulus fibrosus in the context of the injury and healing environment. Spatial, morphological, functional, and transcriptional signatures of annulus fibrosus cells are reviewed, including inner and outer annulus fibrosus cells, which we propose to be referred to as annulocytes. The annulus also contains peripheral cells, interlamellar cells, and potential resident stem/progenitor cells, as well as macrophages, T lymphocytes, and mast cells following injury. Phases of annulus fibrosus healing include inflammation and recruitment of immune cells, cell proliferation, granulation tissue formation, and matrix remodeling. However, annulus fibrosus healing commonly involves limited remodeling, with granulation tissues remaining, and the development of chronic inflammatory states. Identifying annulus fibrosus cell phenotypes during health, injury, and degeneration will inform reparative regeneration strategies aimed at improving annulus fibrosus healing.
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Affiliation(s)
- Olivia M Torre
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Victoria Mroz
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meredith K Bartelstein
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alice H Huang
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
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30
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Yang JJ, Li F, Hung KC, Hsu SH, Wang JL. Intervertebral disc needle puncture injury can be repaired using a gelatin–poly (γ-glutamic acid) hydrogel: an in vitro bovine biomechanical validation. 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 2018; 27:2631-2638. [DOI: 10.1007/s00586-018-5727-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/08/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022]
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31
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Newton MD, Hartner SE, Gawronski K, Davenport EJ, Timmons SC, Baker KC, Maerz T. Nondestructive, indirect assessment of the biomechanical properties of the rat intervertebral disc using contrast-enhanced μCT. J Orthop Res 2018; 36:2030-2038. [PMID: 29314237 DOI: 10.1002/jor.23850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/24/2017] [Indexed: 02/04/2023]
Abstract
Mechanical characterization of the intervertebral disc involves labor-intensive and destructive experimental methodology. Contrast-enhanced micro-computed tomography is a nondestructive imaging modality for high-resolution visualization and glycosaminoglycan quantification of cartilaginous tissues. The purpose of this study was to determine whether anionic and cationic contrast-enhanced micro-computed tomography of the intervertebral disc can be used to indirectly assess disc mechanical properties in an ex vivo model of disc degeneration. L3/L4 motion segments were dissected from female Lewis rats. To deplete glycosaminoglycan, samples were treated with 0 U/ml (Control) or 5 U/ml papain. Contrast-enhanced micro-computed tomography was performed following incubation in 40% Hexabrix (anionic) or 30 mg I/ml CA4+ (cationic) for 24 h (n = 10/contrast agent/digestion group). Motion segments underwent cyclic mechanical testing to determine compressive and tensile modulus, stiffness, and hysteresis. Glycosaminoglycan content was determined using the dimethylmethylene blue assay. Correlations between glycosaminoglycan content, contrast-enhanced micro-computed tomography attenuation, and mechanical properties were assessed via the Pearson correlation. The predictive accuracy of attenuation on compressive properties was assessed via repeated random sub-sampling cross validation. Papain digestion produced significant decreases in glycosaminoglycan content and corresponding differences in attenuation and mechanical properties. Attenuation correlated significantly to glycosaminoglycan content and to all compressive mechanical properties using both Hexabrix and CA4+ . Predictive linear regression models demonstrated a predictive accuracy of attenuation on compressive modulus and stiffness of 79.8-86.0%. Contrast-enhanced micro-computed tomography was highly predictive of compressive mechanical properties in an ex vivo simulation of disc degeneration and may represent an effective modality for indirectly assessing disc compressive properties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2030-2038, 2018.
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Affiliation(s)
- Michael D Newton
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
| | | | - Karissa Gawronski
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
| | - Erik J Davenport
- Department of Natural Sciences, Lawrence Technological University, Southfield, Michigan
| | - Shannon C Timmons
- Department of Natural Sciences, Lawrence Technological University, Southfield, Michigan
| | - Kevin C Baker
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan.,Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, Michigan
| | - Tristan Maerz
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan.,Department of Orthopaedic Surgery, Oakland University - William Beaumont School of Medicine, Rochester, Michigan.,Department of Orthopaedic Surgery, University of Michigan, 109 Zina Pitcher Place, 48109, Ann Arbor, Michigan
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32
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Gansau J, Kelly L, Buckley CT. Influence of key processing parameters and seeding density effects of microencapsulated chondrocytes fabricated using electrohydrodynamic spraying. Biofabrication 2018; 10:035011. [PMID: 29888707 DOI: 10.1088/1758-5090/aacb95] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cell delivery and leakage during injection remains a challenge for cell-based intervertebral disc regeneration strategies. Cellular microencapsulation may offer a promising approach to overcome these limitations by providing a protective niche during intradiscal injection. Electrohydrodynamic spraying (EHDS) is a versatile one-step approach for microencapsulation of cells using a high voltage electric field. The primary objective of this work was to characterise key processing parameters such as applied voltage (0, 5, 10 or 15 kV), emitter needle gauge (21, 26 or 30 G), alginate concentration (1%, 2% or 3%) and flow rate (50, 100, 250 or 500 μl min-1) to regulate the size and morphology of alginate microcapsules as well as subsequent cell viability when altering these parameters. The effect of initial cell seeding density (5, 10 and 20 × 106 cells ml-1) on subsequent matrix accumulation of microencapsulated articular chondrocytes was also evaluated. Results showed that increasing alginate concentration and thus viscosity increased overall microcapsule size but also affected the geometry towards ellipsoidal-shaped gels. Altering the electric field strength and needle diameter regulated microcapsule size towards a smaller diameter with increasing voltage and smaller needle diameter. Needle size did not appear to affect cell viability when operating with lower alginate concentrations (1% and 2%), although higher concentrations (3%) and thus higher viscosity hydrogels resulted in diminished viability with decreasing needle diameter. Increasing cell density resulted in decreased cell viability and a concomitant decrease in DNA content, perhaps due to competing nutrient demands as a result of more closely packed cells. However, higher cell densities resulted in increased levels of extracellular matrix accumulated. Overall, this work highlights the potential of EHDS as a controllable and versatile approach to fabricate microcapsules for injectable delivery which can be used in a variety of applications such as drug development or cell therapies.
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Affiliation(s)
- Jennifer Gansau
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland. School of Engineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Long RG, Zderic I, Gueorguiev B, Ferguson SJ, Alini M, Grad S, Iatridis JC. Effects of Level, Loading Rate, Injury and Repair on Biomechanical Response of Ovine Cervical Intervertebral Discs. Ann Biomed Eng 2018; 46:1911-1920. [PMID: 29926304 DOI: 10.1007/s10439-018-2077-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/13/2018] [Indexed: 12/15/2022]
Abstract
A need exists for pre-clinical large animal models of the spine to translate biomaterials capable of repairing intervertebral disc (IVD) defects. This study characterized the effects of cervical spinal level, loading rate, injury and repair with genipin-crosslinked fibrin (FibGen) on axial and torsional mechanics in an ovine cervical spine model. Cervical IVDs C2-C7 from nine animals were tested with cyclic tension-compression (- 240 to 100 N) and cyclic torsion (± 2° and ± 4°) tests at three rates (0.1, 1 and 2 Hz) in intact, injured and repaired conditions. Intact IVDs from upper cervical levels (C2-C4) had significantly higher torque range and torsional stiffness and significantly lower axial range of motion (ROM) and tensile compliance than IVDs from lower cervical levels (C5-C7). A tenfold increase in loading rate significantly increased torque range and torsional stiffness 4-8% (depending on amplitude) (p < 0.001). When normalized to intact, FibGen significantly restored torque range (FibGen: 0.96 ± 0.14, Injury: 0.88 ± 0.14, p = 0.03) and axial ROM (FibGen: 1.00 ± 0.05, Injury: 1.04 ± 0.15, p = 0.02) compared to Injury, with a values of 1 indicating full repair. Cervical spinal level must be considered for controlling biomechanical evaluations, and FibGen restored some torsional and axial biomechanical properties to intact levels.
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Affiliation(s)
- Rose G Long
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland.,Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, New York, NY, 10029-6574, USA
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | | | - Mauro Alini
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, New York, NY, 10029-6574, USA.
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Frauchiger DA, Chan SCW, Benneker LM, Gantenbein B. Intervertebral disc damage models in organ culture: a comparison of annulus fibrosus cross-incision versus punch model under complex loading. 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 2018; 27:1785-1797. [PMID: 29789921 DOI: 10.1007/s00586-018-5638-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Comparison of two annulus fibrosus injury models that mimic intervertebral disc (IVD) herniation, enabling the study of IVD behaviour under three loading regimes in a bovine organ culture model. METHODS An injury was induced by custom-designed cross-incision tool or a 2-mm biopsy punch in IVDs. Discs were cultured for 14 days under (1) complex (compression and torsion), (2) static, and (3) no load. Disc height, mitochondrial activity, DNA and glycosaminoglycan (GAG) contents, and disc stiffness under complex load were determined. Further, gene expression and histology analysis were performed. RESULTS While both injury models did not change the compressional stiffness of IVDs, cross-incision decreased disc height under complex load. Moreover, under complex load, the biopsy punch injury induced down-regulation of several anabolic, catabol ic, and inflammatory genes, whereas cross-incision did not significantly differ from control discs. However, DNA and GAG contents were in the range of the healthy control discs for both injury models but did show lower contents under no load and static load. Injury side and contralateral side of the IVD showed a similar behaviour on the biochemical assays tested. CONCLUSION Compressional stiffness, GAG and DNA contents, did not differ between injury models under complex load. This behaviour was partially attributed to the positive influence of complex loading on matrix regeneration and cell viability. However, disc height was reduced for the cross-incision. Relative gene expression changes of the inflammatory and anabolic genes for the biopsy punch approach might indicate that induced damage was too intense to trigger any inflammatory or repair response. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Daniela A Frauchiger
- Tissue and Organ Mechanobiology, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland
| | - Samantha C W Chan
- Tissue and Organ Mechanobiology, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland
| | - Lorin M Benneker
- Department of Orthopedic Surgery and Traumatology, Insel University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Benjamin Gantenbein
- Tissue and Organ Mechanobiology, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland.
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Torre OM, Das R, Berenblum RE, Huang AH, Iatridis JC. Neonatal mouse intervertebral discs heal with restored function following herniation injury. FASEB J 2018; 32:4753-4762. [PMID: 29570392 DOI: 10.1096/fj.201701492r] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Adult intervertebral discs (IVDs) have poor endogenous healing capacity, because of their challenging microenvironment and complex mechanical demands, which can result in painful IVD herniation. There are no regenerative strategies available to improve IVD healing and restore its function. Neonatal mice are excellent models of mammalian regeneration, but there are no studies of the regenerative capacity of neonatal IVDs. In this study, we developed a neonatal model of improved IVD healing to inform repair strategies after herniation. In vivo puncture injuries were performed to simulate herniation with complete annulus fibrosus (AF) tears in caudal IVDs of neonatal (postnatal d 5) and adult (4-6 mo) Scleraxis green fluorescent protein ( ScxGFP) mice. Acute and long-term healing responses were assessed with histologic, radiologic, and biomechanical measurements. Neonates underwent accelerated IVD healing compared to adults with functional restoration and enhanced structural repair after herniation. A population of ScxGFP- cells identified in the neonatal repair site may be associated with this improved healing and warrants future investigation. In summary, function of neonatal IVDs was restored after herniation injury, whereas that of adult discs was not. This improved healing response is likely driven by multiple mechanisms that may include differences in mechanical loading and available repair cells during growth.-Torre, O. M., Das, R., Berenblum, R. E., Huang, A. H., Iatridis, J. C. Neonatal mouse intervertebral discs heal with restored function following herniation injury.
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Affiliation(s)
- Olivia M Torre
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rohit Das
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ramy E Berenblum
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alice H Huang
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Newman HR, Bowles RD, Buckley MR. Viscoelastic heating of insulated bovine intervertebral disc. JOR Spine 2018; 1:e1002. [PMID: 31463434 PMCID: PMC6686830 DOI: 10.1002/jsp2.1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/09/2022] Open
Abstract
Back pain is the leading cause of disability globally and the second most common cause of doctors' visits. Despite extensive research efforts, the underlying mechanism of back pain has not been fully elucidated. The intervertebral disc (IVD) is a viscoelastic tissue that provides flexibility to the spinal column and acts as a shock absorber in the spine. When viscoelastic materials like the IVD are cyclically loaded, they dissipate energy as heat. Thus, diurnal, regular movements of the vertebral column that deform the IVD could increase disc temperature through viscoelastic heating. This temperature rise has the potential to influence cell function, drive cell death and induce nociception in innervating nociceptive neurons within the IVD. The present study was conducted to investigate the capacity of IVD to increase in temperature due to viscoelastic heating. Insulated caudal bovine IVD were subjected to physiological cyclic uniaxial compression over a range of frequencies (0.1-15 Hz) and loading durations (1-10 min) ex vivo, and the temperature rise in the tissue was recorded. According to our findings, the IVD can experience a temperature rise of up to 2.5°C under cyclic loading. Furthermore, under similar conditions, the inner nucleus pulposus exhibits more viscoelastic heating than the outer annulus fibrosis, likely due to its more viscous composition. The measured temperature rise of the disc has physiological relevance as degenerative IVD tissue has been shown to produce a sensitization of nociceptive neurons that spontaneously fire at 37°C, with a T50 response at 37.3°C and a maximum response at 38°C. Our results suggest that viscoelastic heating of IVD could interact with sensitized nociceptive neurons in the degenerative IVD to play a role in back pain.
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Affiliation(s)
- Harrah R. Newman
- Department of Biomedical EngineeringUniversity of RochesterRochesterNew York
| | - Robert D. Bowles
- Department of BioengineeringUniversity of UtahSalt Lake CityUtah
| | - Mark R. Buckley
- Department of Biomedical EngineeringUniversity of RochesterRochesterNew York
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Abstract
STUDY DESIGN Ovine in vivo study. OBJECTIVE To perform lateral approach lumbar surgery in an ovine model to administer an injectable riboflavin cross-linked high-density collagen (HDC) gel and to assess its ability to mitigate intervertebral disc (IVD) degeneration after induced annulus fibrosus (AF) injury. SUMMARY OF BACKGROUND DATA Biological-based injectable gels have shown efficacy in restoring biomechanical, radiographic, and histological parameters in IVD-injured animal models. Riboflavin cross-linked HDC gel has previously demonstrated retention of nucleus pulposus (NP) tissue, reduced loss of disc height, and prevention of terminal cellular degenerative changes in rat-tail spines. However, this biological therapy has never been tested in large animal models. METHODS Forty lumbar IVDs were accessed from eight sheep via lateral approach surgery. IVDs were randomly assigned to healthy control, injury and HDC treatment, or negative control with injury and no treatment. IVD injury was carried out using a drill-bit through the AF followed by needle puncture of the NP. Sheep were followed for 16 weeks and underwent qualitative/quantitative magnetic resonance imaging, x-ray, and histological analyses of collagen and proteoglycan content. RESULTS The lateral approach to the ovine lumbar spine to deliver HDC gel proved to be safe and reproducible. IVDs treated with the HDC gel revealed less degenerative changes at the microscopic level based on AF and NP histology. However, mean Pfirrmann grade, T2 relaxation time, NP voxel size, and disc height index were not significantly different between the two injury groups. CONCLUSION Injectable HDC gel can be administered safely via lateral approach surgery in an ovine AF injury model. IVDs treated with HDC gel demonstrated less degeneration at the microscopic level though radiographic changes were slight when comparing treated to untreated IVDs. Future studies will need to elucidate the role of injury technique and time frame for follow-up in correlating histological and radiographical outcomes. LEVEL OF EVIDENCE N /A.
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Hu MH, Yang KC, Chen YJ, Sun YH, Lin FH, Yang SH. Optimization of puncture injury to rat caudal disc for mimicking early degeneration of intervertebral disc. J Orthop Res 2018; 36:202-211. [PMID: 28594131 DOI: 10.1002/jor.23628] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/05/2017] [Indexed: 02/04/2023]
Abstract
The caudal discs of rats have been proposed as a puncture model in which intervertebral disc (IVD) degeneration can be induced and novel therapies can be tested. For biological repair, treatments for ongoing IVD degeneration are ideally administered during the earlier stages. The purpose of this study was to elucidate the optimal puncture needle size for creating a model that mimicked the earlier stages of IVD degeneration. According to the disc height index, histologic score, and MRI grading, a puncture needle sized 21G or larger induced rapid degenerative processes in rat caudal discs during the initial 2-4 weeks. The degenerative changes were severe and continued deteriorating after 4 weeks. Conversely, puncture injury induced by needles sized 25G or smaller also produced degenerative changes in rat caudal discs during initial 2-4 weeks; however, the changes were less severe. Furthermore, the degenerative process became stabilized and showed no further deterioration or spontaneous recovery after 4 weeks. In the discs punctured by 25G needles, the expression of collagen I was increased at 2-4 weeks with a gradually fibrotic transformation thereafter. The expressions of collagen II and SOX9 were enhanced initially but returned to pre-injury levels at 4-8 weeks. The above-mentioned findings were more compatible with earlier degeneration in discs punctured by needles sized 25G or smaller than by needles sized 21G or larger, and the appropriate timing for intradiscal administration of proposed therapeutic agents would be 4 weeks or longer after puncture. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:202-211, 2018.
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Affiliation(s)
- Ming-Hsiao Hu
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Chiang Yang
- Department of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yeong-Jang Chen
- Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Hui Sun
- Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Institute of Biomedical Engineering & Nanomedicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shu-Hua Yang
- Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
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Effects of axial compression and rotation angle on torsional mechanical properties of bovine caudal discs. J Mech Behav Biomed Mater 2018; 77:353-359. [DOI: 10.1016/j.jmbbm.2017.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 12/30/2022]
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Vergari C, Mansfield JC, Chan D, Clarke A, Meakin JR, Winlove PC. The effects of needle damage on annulus fibrosus micromechanics. Acta Biomater 2017; 63:274-282. [PMID: 28917706 DOI: 10.1016/j.actbio.2017.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/23/2017] [Accepted: 09/13/2017] [Indexed: 01/07/2023]
Abstract
Needle puncture of the intervertebral disc can initiate a mechanical and biochemical cascade leading to disc degeneration. Puncture's mechanical effects have been shown near the puncture site, mechanical effects should be observed far, relative to needle size, from the puncture site, given the disc-wide damage induced by the stab. The aim of this work was to quantify these far-field effects, and to observe the local structural damage provoked by the needle. Strips of cow tail annulus fibrosus underwent two consecutive mechanical loadings to 5% tensile strain; fifteen samples were punctured in a radial direction with a randomly assigned needle between the two loadings (needle gauges between 19 and 23). Ten samples (control group) were not punctured. During loading, the tissue strains were imaged using second harmonic generation microscopy in a <600×800µm region about 4.4mm from the puncture site. After mechanical testing, the puncture site was imaged in 3D. Puncture had no significant effect on annulus elastic modulus. Imaging showed a modest change in the shearing between fibre bundles however, the linear strain between bundles, intra-bundle shear and linear strain were not significantly affected. At the puncture site, detached lumps of tissue were present. These results suggest that the mechanical effects observed in intact discs are due to the depressurization of the disc, rather than the local damage to the annulus. Needle profiles could be designed, aiming at separating fibre bundles rather than cutting through them, to avoid leaving dying tissue behind. STATEMENT OF SIGNIFICANCE Needle puncture of the intervertebral disc can initiate a mechanical and biochemical cascade leading to disc degeneration, but the link between the local damage of the puncture and the disc-wide effects is not well understood. This work aimed at determining the micro-mechanical effects of the puncture far from its site, and to observe the damage induced by the puncture with high resolution imaging. Results show that the puncture had modest effect far from the puncture, but lumps of tissue were left by the needle, detached from the disc; these could cause further damage through friction and inflammation of the surrounding tissues. This suggests that the cascade leading to degeneration is probably driven by a biochemical response rather than disc-wide mechanical effects.
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Henry N, Clouet J, Fragale A, Griveau L, Chédeville C, Véziers J, Weiss P, Le Bideau J, Guicheux J, Le Visage C. Pullulan microbeads/Si-HPMC hydrogel injectable system for the sustained delivery of GDF-5 and TGF-β1: new insight into intervertebral disc regenerative medicine. Drug Deliv 2017; 24:999-1010. [PMID: 28645219 PMCID: PMC8241148 DOI: 10.1080/10717544.2017.1340362] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/31/2017] [Accepted: 06/06/2017] [Indexed: 12/16/2022] Open
Abstract
Discogenic low back pain is considered a major health concern and no etiological treatments are today available to tackle this disease. To clinically address this issue at early stages, there is a rising interest in the stimulation of local cells by in situ injection of growth factors targeting intervertebral disc (IVD) degenerative process. Despite encouraging safety and tolerability results in clinic, growth factors efficacy may be further improved. To this end, the use of a delivery system allowing a sustained release, while protecting growth factors from degradation appears of particular interest. We propose herein the design of a new injectable biphasic system, based on the association of pullulan microbeads (PMBs) into a cellulose-based hydrogel (Si-HPMC), for the TGF-β1 and GDF-5 growth factors sustained delivery. We present for the first time the design and mechanical characterization of both the PMBs and the called biphasic system (PMBs/Si-HPMC). Their loading and release capacities were also studied and we were able to demonstrate a sustained release of both growth factors, for up to 28 days. Noteworthy, the growth factors biological activity on human cells was maintained. Altogether, these data suggest that this PMBs/Si-HPMC biphasic system may be a promising candidate for the development of an innovative bioactive delivery system for IVD regenerative medicine.
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Affiliation(s)
- Nina Henry
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
- Institut des Matériaux Jean Rouxel (IMN), Université de Nantes, CNRS, Nantes, France
- UFR Odontologie, Université de Nantes, Nantes, France
| | - Johann Clouet
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
- UFR Odontologie, Université de Nantes, Nantes, France
- CHU Nantes, PHU 11 Pharmacie, Pharmacie Centrale, Nantes, France
- UFR Sciences Biologiques et Pharmaceutiques, Université de Nantes, Nantes, France
| | - Audrey Fragale
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
- UFR Odontologie, Université de Nantes, Nantes, France
| | - Louise Griveau
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
| | - Claire Chédeville
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
| | - Joëlle Véziers
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
- UFR Odontologie, Université de Nantes, Nantes, France
- SC3M platform, UMS INSERM 016/CNRS 3556, SFR François Bonamy, Nantes, France
- CHU Nantes, PHU 4 OTONN, Nantes, France
| | - Pierre Weiss
- UFR Odontologie, Université de Nantes, Nantes, France
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team REGOS “Regenerative Medicine of Bone Tissues”, Nantes, France
| | - Jean Le Bideau
- Institut des Matériaux Jean Rouxel (IMN), Université de Nantes, CNRS, Nantes, France
| | - Jérôme Guicheux
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
- UFR Odontologie, Université de Nantes, Nantes, France
- CHU Nantes, PHU 4 OTONN, Nantes, France
| | - Catherine Le Visage
- INSERM, UMRS 1229, RMeS “Regenerative Medicine and Skeleton”, Team STEP “Skeletal Physiopathology and Joint Regenerative Medicine”, Nantes, France
- UFR Odontologie, Université de Nantes, Nantes, France
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Long RG, Torre OM, Hom WW, Assael DJ, Iatridis JC. Design Requirements for Annulus Fibrosus Repair: Review of Forces, Displacements, and Material Properties of the Intervertebral Disk and a Summary of Candidate Hydrogels for Repair. J Biomech Eng 2016; 138:021007. [PMID: 26720265 DOI: 10.1115/1.4032353] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Indexed: 02/02/2023]
Abstract
There is currently a lack of clinically available solutions to restore functionality to the intervertebral disk (IVD) following herniation injury to the annulus fibrosus (AF). Microdiscectomy is a commonly performed surgical procedure to alleviate pain caused by herniation; however, AF defects remain and can lead to accelerated degeneration and painful conditions. Currently available AF closure techniques do not restore mechanical functionality or promote tissue regeneration, and have risk of reherniation. This review determined quantitative design requirements for AF repair materials and summarized currently available hydrogels capable of meeting these design requirements by using a series of systematic PubMed database searches to yield 1500+ papers that were screened and analyzed for relevance to human lumbar in vivo measurements, motion segment behaviors, and tissue level properties. We propose a testing paradigm involving screening tests as well as more involved in situ and in vivo validation tests to efficiently identify promising biomaterials for AF repair. We suggest that successful materials must have high adhesion strength (∼0.2 MPa), match as many AF material properties as possible (e.g., approximately 1 MPa, 0. 3 MPa, and 30 MPa for compressive, shear, and tensile moduli, respectively), and have high tensile failure strain (∼65%) to advance to in situ and in vivo validation tests. While many biomaterials exist for AF repair, few undergo extensive mechanical characterization. A few hydrogels show promise for AF repair since they can match at least one material property of the AF while also adhering to AF tissue and are capable of easy implantation during surgical procedures to warrant additional optimization and validation.
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Lai A, Moon A, Purmessur D, Skovrlj B, Laudier DM, Winkelstein BA, Cho SK, Hecht AC, Iatridis JC. Annular puncture with tumor necrosis factor-alpha injection enhances painful behavior with disc degeneration in vivo. Spine J 2016; 16:420-31. [PMID: 26610672 PMCID: PMC4913353 DOI: 10.1016/j.spinee.2015.11.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 10/01/2015] [Accepted: 11/10/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Painfulintervertebral disc degeneration is extremely common and costly. Effective treatments are lacking because the nature of discogenic pain is complex with limited capacity to distinguish painful conditions from age-related changes in the spine. Hypothesized sources of discogenic pain include chronic inflammation, neurovascular ingrowth, and structural disruption. PURPOSE This study aimed to investigate inflammation, pro-neurovascular growth factors, and structural disruption as sources of painful disc degeneration STUDY DESIGN/SETTING This study used an in vivo study to address these hypothesized mechanisms with anterior intradiscal injections of tumor necrosis factor-alpha (TNFα), pro-neurovascular growth factors: nerve growth factor and vascular endothelial growth factor (NGF and VEGF), and saline with additional sham surgery and naïve controls. Depth of annular puncture was also evaluated for its effects on structural and painful degeneration. METHODS Rat lumbar discs were punctured (shallow or deeper puncture) and intradiscally injected with saline, TNFα, or NGF and VEGF. Structural disc degeneration was assessed using X-ray, magnetic resonance imaging (MRI), and histology. The rat painful condition was evaluated using Von Frey hyperalgesia measurements, and substance P immunostaining in dorsal root ganglion (DRG) was performed to determine the source of pain. RESULTS Saline injection increased painful responses with degenerative changes in disc height, MRI intensity, and morphologies of disc structure and cell. TNFα and NGF/VEGF accelerated painful behavior, and TNFα-injected animals had increased substance P in DRGs. Deeper punctures led to more severe disc degeneration. Multiple regression analysis showed that the painful behavior was correlated with disc height loss. CONCLUSIONS We concluded that rate and severity of structural disc degeneration was associated with the amount of annular disruption and puncture depth. The painful behavior was associated with disc height loss and discal inflammatory state, whereas pro-inflammatory cytokines might play a more important role in the level of pain, which might have resulted from enhanced DRG sensitization. These in vivo painful disc degeneration models with different severities of structural changes may be useful for investigating discogenic pain mechanisms and for screening therapies, although interpretations must note the differences between all surgically induced animal models and the human condition.
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Affiliation(s)
- Alon Lai
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574
| | - Andrew Moon
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574
| | - Devina Purmessur
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574,The Ohio State University, Dorothy Davis Heart and Lung Research Institute, 473 W 12th Avenue, Room 012L, Columbus OH 43210
| | | | - Damien M. Laudier
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574
| | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574
| | - Andrew C. Hecht
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574
| | - James C. Iatridis
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574,Corresponding author. Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, Orthopaedics, New York, NY 10029-6574, USA. Tel.: 212 241 1517; fax: 212 876 3168. (J.C. Iatridis)
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Cuellar JM, Stauff MP, Herzog RJ, Carrino JA, Baker GA, Carragee EJ. Does provocative discography cause clinically important injury to the lumbar intervertebral disc? A 10-year matched cohort study. Spine J 2016; 16:273-80. [PMID: 26133255 DOI: 10.1016/j.spinee.2015.06.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 05/16/2015] [Accepted: 06/16/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Provocative discography, an invasive diagnostic procedure involving disc puncture with pressurization, is a test for presumptive discogenic pain in the lumbar spine. The clinical validity of this test is unproven. Data from multiple animal studies confirm that disc puncture causes early disc degeneration. A recent study identified radiographic disc degeneration on magnetic resonance imaging (MRI) performed 10 years later in human subjects exposed to provocative discography. The clinical effect of this disc degeneration after provocative discography is unknown. PURPOSE The aim of this study was to investigate the clinical effects of lumbar provocative discography on patients subjected to this evaluation method. STUDY DESIGN/SETTING A prospective, 10-year matched cohort study. PATIENT SAMPLE Subjects (n=75) without current low back pain (LBP) problems were recruited to participate in a study of provocative discography at the L3-S1 discs. A closely matched control cohort was simultaneously recruited to undergo a similar evaluation except for discography injections. OUTCOME MEASURES The primary outcome variables were diagnostic imaging events and lumbar disc surgery events. The secondary outcome variables were serious LBP events, disability events, and medical visits. METHODS The discography subjects and control subjects were followed by serial protocol evaluations at 1, 2, 5, and 10 years after enrollment. The lumbar disc surgery events and diagnostic imaging (computed tomography (CT) or MRI) events were recorded. In addition, the interval and cumulative lumbar spine events were recorded. RESULTS Of the 150 subjects enrolled, 71 discography subjects and 72 control subjects completed the baseline evaluation. At 10-year follow-up, 57 discography and 53 control subjects completed all interval surveillance evaluations. There were 16 lumbar surgeries in the discography group, compared with four in the control group. Medical visits, CT/MRI examinations, work loss, and prolonged back pain episodes were all more frequent in the discography group compared with control subjects. CONCLUSION The disc puncture and pressurized injection performed during provocative discography can increase the risk of clinical disc problems in exposed patients.
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Affiliation(s)
- Jason M Cuellar
- Cedars-Sinai Medical Center, Spinal Surgery Fellowship, 444 S. San Vicente Blvd, Los Angeles, CA 90048, USA
| | - Michael P Stauff
- Department of Orthopaedics and Physical Rehabilitation, University of Massachusetts Medical School, Spine Center, 119 Belmont St, Worcester, MA 01605, USA.
| | - Richard J Herzog
- Department of Radiology, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - John A Carrino
- Department of Radiology, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Geoffrey A Baker
- Pacific Northwest University of Health Sciences, 111 University Parkway, Yakima, WA 98901, USA
| | - Eugene J Carragee
- Department of Orthopedic Surgery, Stanford Medicine Outpatient Center, Stanford University School of Medicine, 450 Broadway St, Redwood City, CA 94063, USA
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Likhitpanichkul M, Torre OM, Gruen J, Walter BA, Hecht AC, Iatridis JC. Do mechanical strain and TNF-α interact to amplify pro-inflammatory cytokine production in human annulus fibrosus cells? J Biomech 2016; 49:1214-1220. [PMID: 26924657 DOI: 10.1016/j.jbiomech.2016.02.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 12/20/2022]
Abstract
During intervertebral disc (IVD) injury and degeneration, annulus fibrosus (AF) cells experience large mechanical strains in a pro-inflammatory milieu. We hypothesized that TNF-α, an initiator of IVD inflammation, modifies AF cell mechanobiology via cytoskeletal changes, and interacts with mechanical strain to enhance pro-inflammatory cytokine production. Human AF cells (N=5, Thompson grades 2-4) were stretched uniaxially on collagen-I coated chambers to 0%, 5% (physiological) or 15% (pathologic) strains at 0.5Hz for 24h under hypoxic conditions with or without TNF-α (10ng/mL). AF cells were treated with anti-TNF-α and anti-IL-6. ELISA assessed IL-1β, IL-6, and IL-8 production and immunocytochemistry measured F-actin, vinculin and α-tubulin in AF cells. TNF-α significantly increased AF cell pro-inflammatory cytokine production compared to basal conditions (IL-1β:2.0±1.4-84.0±77.3, IL-6:10.6±9.9-280.9±214.1, IL-8:23.9±26.0-5125.1±4170.8pg/ml for basal and TNF-α treatment, respectively) as expected, but mechanical strain did not. Pathologic strain in combination with TNF-α increased IL-1β, and IL-8 but not IL-6 production of AF cells. TNF-α treatment altered F-actin and α-tubulin in AF cells, suggestive of altered cytoskeletal stiffness. Anti-TNF-α (infliximab) significantly inhibited pro-inflammatory cytokine production while anti-IL-6 (atlizumab) did not. In conclusion, TNF-α altered AF cell mechanobiology with cytoskeletal remodeling that potentially sensitized AF cells to mechanical strain and increased TNF-α-induced pro-inflammatory cytokine production. Results suggest an interaction between TNF-α and mechanical strain and future mechanistic studies are required to validate these observations.
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Affiliation(s)
- Morakot Likhitpanichkul
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Box 1188, New York, NY 10029, United States.
| | - Olivia M Torre
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Box 1188, New York, NY 10029, United States.
| | - Jadry Gruen
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Box 1188, New York, NY 10029, United States.
| | - Benjamin A Walter
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Box 1188, New York, NY 10029, United States; Department of Biomedical Engineering, The City College of New York, New York, NY, United States.
| | - Andrew C Hecht
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Box 1188, New York, NY 10029, United States.
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, Box 1188, New York, NY 10029, United States.
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Gantenbein B, Illien-Jünger S, Chan SCW, Walser J, Haglund L, Ferguson SJ, Iatridis JC, Grad S. Organ culture bioreactors--platforms to study human intervertebral disc degeneration and regenerative therapy. Curr Stem Cell Res Ther 2016; 10:339-52. [PMID: 25764196 DOI: 10.2174/1574888x10666150312102948] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 12/31/2022]
Abstract
In recent decades the application of bioreactors has revolutionized the concept of culturing tissues and organs that require mechanical loading. In intervertebral disc (IVD) research, collaborative efforts of biomedical engineering, biology and mechatronics have led to the innovation of new loading devices that can maintain viable IVD organ explants from large animals and human cadavers in precisely defined nutritional and mechanical environments over extended culture periods. Particularly in spine and IVD research, these organ culture models offer appealing alternatives, as large bipedal animal models with naturally occurring IVD degeneration and a genetic background similar to the human condition do not exist. Latest research has demonstrated important concepts including the potential of homing of mesenchymal stem cells to nutritionally or mechanically stressed IVDs, and the regenerative potential of "smart" biomaterials for nucleus pulposus or annulus fibrosus repair. In this review, we summarize the current knowledge about cell therapy, injection of cytokines and short peptides to rescue the degenerating IVD. We further stress that most bioreactor systems simplify the real in vivo conditions providing a useful proof of concept. Limitations are that certain aspects of the immune host response and pain assessments cannot be addressed with ex vivo systems. Coccygeal animal disc models are commonly used because of their availability and similarity to human IVDs. Although in vitro loading environments are not identical to the human in vivo situation, 3D ex vivo organ culture models of large animal coccygeal and human lumbar IVDs should be seen as valid alternatives for screening and feasibility testing to augment existing small animal, large animal, and human clinical trial experiments.
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Affiliation(s)
- Benjamin Gantenbein
- Institute for Surgical Technology & Biomechanics, Medical Faculty, University, Stauffacherstrasse 78, CH-3014 Bern, Switzerland.
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Liao JC. Cell Therapy Using Bone Marrow-Derived Stem Cell Overexpressing BMP-7 for Degenerative Discs in a Rat Tail Disc Model. Int J Mol Sci 2016; 17:ijms17020147. [PMID: 26805824 PMCID: PMC4783881 DOI: 10.3390/ijms17020147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 01/08/2023] Open
Abstract
Degenerative discs can cause low back pain. Cell-based transplantation or growth factors therapy have been suggested as a strategy to stimulate disc regeneration. Bone marrow-derived mesenchymal stem cells (BMDMSC) containing bone morphogenetic protein-7 (BMP-7) gene were constructed. We evaluated the effectiveness of these BMP-7 overexpressing cells on degenerative discs in rat tails. In vitro and in vivo studies were designed. In the first stage, the rats were divided into two group according to discs punctured by different needle gauges (18 gauge and 22 gauge). In the second stage, the ideal size of needle was used to induce rat tail disc degeneration. These animals are divided into three groups according to timing of treatment (zero-week, two-week, four-week). Each group was divided into three treating subgroups: control group, BMDMSC group, and Baculo-BMP-7-BMDMSC group. Each rat undergoes radiography examination every two weeks. After eight weeks, the discs were histologically examined with hematoxylin and eosin stain and Alcian blue stain. The 18-gauge group exhibited significant decrease in disc height index (%) than 22-gauge group at eight weeks at both Co6-7 (58.1% ± 2.8% vs. 63.7% ± 1.0%, p = 0.020) and Co8-9 discs (62.7% ± 2.8% vs. 62.8% ± 1.5%, p = 0.010). Baculo-BMP-7-BMDMSCs group showed significant difference in disc height index compared to the BMDMSCs group at both Co6-7 (93.7% ± 1.5% vs. 84.8% ± 1.0%, p = 0.011) and Co8-9 (86.0% ± 2.1% vs. 81.8% ± 1.7%, p = 0.012). In Baculo-BMP-7-BMDMSCs group, the zero-week treatment subgroup showed significant better in disc height index compared to two-week treatment group (p = 0.044), and four-week treatment group (p = 0.011). The zero-week treatment subgroup in Baculo-BMP-7-BMDMSCs group also had significant lower histology score than two-week treatment (4.3 vs. 5.7, p = 0.045) and four-week treatment (4.3 vs. 6.0, p = 0.031). In conclusion, Baculo-BMP-7-BMDMSC can slow down the progression of disc degeneration, but could not provide evidence of regeneration. Early treatment might obtain more distinct results.
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Affiliation(s)
- Jen-Chung Liao
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No._5, Fu-Shin Street; Kweishian, Taoyuan 333, Taiwan.
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Long RG, Bürki A, Zysset P, Eglin D, Grijpma DW, Blanquer SBG, Hecht AC, Iatridis JC. Mechanical restoration and failure analyses of a hydrogel and scaffold composite strategy for annulus fibrosus repair. Acta Biomater 2016; 30:116-125. [PMID: 26577987 DOI: 10.1016/j.actbio.2015.11.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 11/04/2015] [Accepted: 11/10/2015] [Indexed: 01/07/2023]
Abstract
Unrepaired defects in the annulus fibrosus of intervertebral disks are associated with degeneration and persistent back pain. A clinical need exists for a disk repair strategy that can seal annular defects, be easily delivered during surgical procedures, and restore biomechanics with low risk of herniation. Multiple annulus repair strategies were developed using poly(trimethylene carbonate) scaffolds optimized for cell delivery, polyurethane membranes designed to prevent herniation, and fibrin-genipin adhesive tuned to annulus fibrosus shear properties. This three-part study evaluated repair strategies for biomechanical restoration, herniation risk and failure mode in torsion, bending and compression at physiological and hyper-physiological loads using a bovine injury model. Fibrin-genipin hydrogel restored some torsional stiffness, bending ROM and disk height loss, with negligible herniation risk and failure was observed histologically at the fibrin-genipin mid-substance following rigorous loading. Scaffold-based repairs partially restored biomechanics, but had high herniation risk even when stabilized with sutured membranes and failure was observed histologically at the interface between scaffold and fibrin-genipin adhesive. Fibrin-genipin was the simplest annulus fibrosus repair solution evaluated that involved an easily deliverable adhesive that filled irregularly-shaped annular defects and partially restored disk biomechanics with low herniation risk, suggesting further evaluation for disk repair may be warranted. STATEMENT OF SIGNIFICANCE Lower back pain is the leading cause of global disability and commonly caused by defects and failure of intervertebral disk tissues resulting in herniation and compression of adjacent nerves. Annulus fibrosus repair materials and techniques have not been successful due to the challenging mechanical and chemical microenvironment and the needs to restore biomechanical behaviors and promote healing with negligible herniation risk while being delivered during surgical procedures. This work addressed this challenging biomaterial and clinical problem using novel materials including an adhesive hydrogel, a scaffold capable of cell delivery, and a membrane to prevent herniation. Composite repair strategies were evaluated and optimized in quantitative three-part study that rigorously evaluated disk repair and provided a framework for evaluating alternate repair techniques.
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Affiliation(s)
- Rose G Long
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Alexander Bürki
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
| | - Philippe Zysset
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
| | - David Eglin
- AO Research Institute Davos, Davos, Switzerland; Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Dirk W Grijpma
- Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland; University of Twente, Department of Biomaterials Science and Technology, PO Box 217, 7500 AE Enschede, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Biomedical Engineering, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Sebastien B G Blanquer
- Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland; University of Twente, Department of Biomaterials Science and Technology, PO Box 217, 7500 AE Enschede, The Netherlands
| | - Andrew C Hecht
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland.
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Oxland TR. Fundamental biomechanics of the spine--What we have learned in the past 25 years and future directions. J Biomech 2015; 49:817-832. [PMID: 26706717 DOI: 10.1016/j.jbiomech.2015.10.035] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/10/2015] [Accepted: 10/23/2015] [Indexed: 12/20/2022]
Abstract
Since the publication of the 2nd edition of White and Panjabi׳s textbook, Clinical Biomechanics of the Spine in 1990, there has been considerable research on the biomechanics of the spine. The focus of this manuscript will be to review what we have learned in regards to the fundamentals of spine biomechanics. Topics addressed include the whole spine, the functional spinal unit, and the individual components of the spine (e.g. vertebra, intervertebral disc, spinal ligaments). In these broad categories, our understanding in 1990 is reviewed and the important knowledge or understanding gained through the subsequent 25 years of research is highlighted. Areas where our knowledge is lacking helps to identify promising topics for future research. In this manuscript, as in the White and Panjabi textbook, the emphasis is on experimental research using human material, either in vivo or in vitro. The insights gained from mathematical models and animal experimentation are included where other data are not available. This review is intended to celebrate the substantial gains that have been made in the field over these past 25 years and also to identify future research directions.
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Affiliation(s)
- Thomas R Oxland
- Departments of Orthopaedics and Mechanical Engineering, University of British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada.
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50
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Needle puncture in rabbit functional spinal units alters rotational biomechanics. ACTA ACUST UNITED AC 2015; 28:E146-53. [PMID: 25370985 DOI: 10.1097/bsd.0000000000000196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
STUDY DESIGN An in vitro biomechanical study for rabbit lumbar functional spinal units (FSUs) using a robot-based spine testing system. OBJECTIVE To elucidate the effect of annular puncture with a 16 G needle on mechanical properties in flexion/extension, axial rotation, and lateral bending. SUMMARY OF BACKGROUND DATA Needle puncture of the intervertebral disk has been shown to alter mechanical properties of the disk in compression, torsion, and bending. The effect of needle puncture in FSUs, where intact spinal ligaments and facet joints may mitigate or amplify these changes in the disk, on spinal motion segment stability subject to physiological rotations remains unknown. METHODS Rabbit FSUs were tested using a robot testing system whose force/moment and position precision were assessed to demonstrate system capability. Flexibility testing methods were developed by load-to-failure testing in flexion/extension, axial rotation, and lateral bending. Subsequent testing methods were used to examine a 16 G needle disk puncture and No. 11 blade disk stab (positive control for mechanical disruption). Flexibility testing was used to assess segmental range-of-motion (degrees), neutral zone stiffness (N m/degrees) and width (degrees and N m), and elastic zone stiffness before and after annular injury. RESULTS The robot-based system was capable of performing flexibility testing on FSUs-mean precision of force/moment measurements and robot system movements were <3% and 1%, respectively, of moment-rotation target values. Flexibility moment targets were 0.3 N m for flexion and axial rotation and 0.15 N m for extension and lateral bending. Needle puncture caused significant (P<0.05) changes only in flexion/extension range-of-motion and neutral zone stiffness and width (N m) compared with preintervention. No. 11 blade-stab significantly increased range-of-motion in all motions, decreased neutral zone stiffness and width (N m) in flexion/extension, and increased elastic zone stiffness in flexion and lateral bending. CONCLUSIONS These findings suggest that disk puncture and stab can destabilize FSUs in primary rotations.
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