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Peng Y, Chen X, Zhang Q, Liu S, Wu W, Li K, Lin H, Qing X, Xiao Y, Wang B, Quan D, Feng S, Rao Z, Bai Y, Shao Z. Enzymatically Bioactive Nucleus Pulposus Matrix Hydrogel Microspheres for Exogenous Stem Cells Therapy and Endogenous Repair Strategy to Achieve Disc Regeneration. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2304761. [PMID: 38145353 PMCID: PMC10933624 DOI: 10.1002/advs.202304761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Indexed: 12/26/2023]
Abstract
Exogenous stem cell therapy and endogenous repair has shown great potential in intervertebral disc regeneration. However, limited nutrients and accumulation of lactate largely impair the survival and regenerative capacity of implanted stem cells and endogenous nucleus pulposus cells (NPCs). Herein, an injectable hydrogel microsphere (LMGDNPs) have been developed by immersing lactate oxidase (LOX)-manganese dioxide (MnO2 ) nanozyme (LM) into glucose-enriched decellularized nucleus pulposus hydrogel microspheres (GDNPs) through a microfluidic system. LMGDNPs showed a delayed release profile of LOX and satisfactory enzymatic capacity in consuming lactate. Mesenchymal stem cells (MSCs) plated on LMGDNPs exhibited better cell viability than cells on GelMA and decellularized nucleus pulposus microspheres (DNP) and showed a obviously increased NPCs phenotype. LMGDNPs prevented MSCs and NPCs death and promoted extracellular matrix synthesis by exhausting lactate. It is determined that LMGDNPs promoted NPCs autophagy by activating transforming growth factor β2 overlapping transcript 1 (TGFB2-OT1), relying on the nanozyme. MSCs-loaded LMGDNPs largely preserved disc hydration and alleviated matrix degradation in vivo. Summarily, LMGDNPs promoted cell survival and matrix regeneration by providing a nutrient supply, exhausting lactate, and activating autophagy via TGFB2-OT1 and its downstream pathway and may serve as an ideal delivery system for exogenous stem cell therapy and endogenous repair.
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Affiliation(s)
- Yizhong Peng
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Xuanzuo Chen
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Qimin Zhang
- Department of RadiologyWuhan Third HospitalTongren Hospital of Wuhan University241 Pengliuyang RoadWuhanHubei430063China
| | - Sheng Liu
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Wei Wu
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Kanglu Li
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Hui Lin
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Xiangcheng Qing
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Yan Xiao
- Department of RadiologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - BaiChuan Wang
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Daping Quan
- School of Materials Science and EngineeringSun Yat‐sen UniversityGuangzhou510127China
| | - Shiqing Feng
- The Second Hospital of Shandong UniversityCheeloo College of MedicineShandong UniversityJinanShandong250033P. R. China
- Department of Orthopaedics Tianjin Medical University General HospitalTianjin Medica UniversityInternational Science and Technology Cooperation Base of Spinal Cord InjuryTianjin Key Laboratory of Spine and Spinal CordTianjin300052P. R. China
- Department of Orthopaedics Qilu Hospital of Shandong UniversityShandong University Centre for OrthopaedicsAdvanced Medical Research InstituteCheeloo College of MedicineShandong UniversityJinanShandong250012P. R. China
| | - Zilong Rao
- School of Materials Science and EngineeringSun Yat‐sen UniversityGuangzhou510127China
| | - Ying Bai
- School of Materials Science and EngineeringSun Yat‐sen UniversityGuangzhou510127China
| | - Zengwu Shao
- Department of OrthopedicsUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
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Goldberg JL, Garton A, Singh S, Kirnaz S, Sommer F, Carnevale JA, Atalay B, Medary B, McGrath LB, Härtl R. Challenges in the Development of Biological Approaches for the Treatment of Degenerative Disc Disease. World Neurosurg 2021; 157:274-281. [PMID: 34929785 DOI: 10.1016/j.wneu.2021.09.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
There are numerous innovative and promising approaches aimed at slowing, reversing, or healing degenerative disc disease. However, multiple treatment-specific impediments slow progress toward realizing the benefits of these therapies. First, the exact pathophysiology underlying degenerative disc disease remains complicated and challenging to study. In addition, the study of the spine and intervertebral disc in animal models is difficult to translate to humans, hindering the utility of preclinical research. Biological treatments are subject to the complex biomechanical environment in which native discs degenerate. The regulatory approval environment for these therapeutics will likely involve a high degree of scrutiny. Finally, patient selection and assessment of outcomes are a particular challenge in this clinical setting.
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Affiliation(s)
- Jacob L Goldberg
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Andrew Garton
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Sunidhi Singh
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Basar Atalay
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Lynn B McGrath
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
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3
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Wiersema T, Tellegen AR, Beukers M, van Stralen M, Wouters E, van de Vooren M, Woike N, Mihov G, Thies JC, Creemers LB, Tryfonidou MA, Meij BP. Prospective Evaluation of Local Sustained Release of Celecoxib in Dogs with Low Back Pain. Pharmaceutics 2021; 13:pharmaceutics13081178. [PMID: 34452138 PMCID: PMC8398998 DOI: 10.3390/pharmaceutics13081178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
Back pain affects millions globally and in 40% of the cases is attributed to intervertebral disc degeneration. Oral analgesics are associated with adverse systemic side-effects and insufficient pain relief. Local drug delivery mitigates systemic effects and accomplishes higher local dosing. Clinical efficacy of intradiscally injected celecoxib (CXB)-loaded polyesteramide microspheres (PEAMs) was studied in a randomized prospective double-blinded placebo controlled veterinary study. Client-owned dog patients suffering from back pain were treated with CXB-loaded (n = 20) or unloaded PEAMs ("placebo") (n = 10) and evaluated by clinical examination, gait analysis, owners' questionnaires, and MRI at 6 and 12 weeks follow-up. At 6 and 12 weeks, CXB-treated dogs experienced significantly less pain interference with their daily life activities compared to placebo. The risk ratio for treatment success was 1.90 (95% C.I. 1.24-2.91, p = 0.023) at week 6 and 1.95 (95% C.I. 1.10-3.45, p = 0.036) at week 12. The beneficial effects of CXB-PEAMs were more pronounced for the subpopulation of male dogs and those with no Modic changes in MRI at inclusion in the study; disc protrusion did not affect the outcome. It remains to be determined whether intradiscal injection of CXB-PEAMs, in addition to analgesic properties, has the ability to halt the degenerative process in the long term or restore the disc.
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Affiliation(s)
- Tijn Wiersema
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Anna R. Tellegen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Martijn Beukers
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Marijn van Stralen
- Image Sciences Institute, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Erik Wouters
- Anicura Dierenziekenhuis Dordrecht, Jan Valsterweg 26, 3315 LG Dordrecht, The Netherlands;
| | - Mandy van de Vooren
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
| | - Nina Woike
- DSM Biomedical, Koestraat 1, 6167 RA Geleen, The Netherlands; (N.W.); (G.M.); (J.C.T.)
| | - George Mihov
- DSM Biomedical, Koestraat 1, 6167 RA Geleen, The Netherlands; (N.W.); (G.M.); (J.C.T.)
| | - Jens C. Thies
- DSM Biomedical, Koestraat 1, 6167 RA Geleen, The Netherlands; (N.W.); (G.M.); (J.C.T.)
| | - Laura B. Creemers
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
- Correspondence: (M.A.T.); (B.P.M.)
| | - Björn P. Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands; (T.W.); (A.R.T.); (M.B.); (M.v.d.V.)
- Correspondence: (M.A.T.); (B.P.M.)
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Yin X, Motorwala A, Vesvoranan O, Levene HB, Gu W, Huang CY. Effects of Glucose Deprivation on ATP and Proteoglycan Production of Intervertebral Disc Cells under Hypoxia. Sci Rep 2020; 10:8899. [PMID: 32483367 PMCID: PMC7264337 DOI: 10.1038/s41598-020-65691-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/05/2020] [Indexed: 12/25/2022] Open
Abstract
As the most common cause of low back pain, the cascade of intervertebral disc (IVD) degeneration is initiated by the disappearance of notochordal cells and progressive loss of proteoglycan (PG). Limited nutrient supply in the avascular disc environment restricts the production of ATP which is an essential energy source for cell survival and function such as PG biosynthesis. The objective of this study was to examine ATP level and PG production of porcine IVD cells under prolonged exposure to hypoxia with physiological glucose concentrations. The results showed notochordal NP and AF cells responded differently to changes of oxygen and glucose. Metabolic activities (including PG production) of IVD cells are restricted under the in-vivo nutrient conditions while NP notochordal cells are likely to be more vulnerable to reduced nutrition supply. Moreover, provision of energy, together or not with genetic regulation, may govern PG production in the IVD under restricted nutrient supply. Therefore, maintaining essential levels of nutrients may reduce the loss of notochordal cells and PG in the IVD. This study provides a new insight into the metabolism of IVD cells under nutrient deprivation and the information for developing treatment strategies for disc degeneration.
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Affiliation(s)
- Xue Yin
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Aarif Motorwala
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Oraya Vesvoranan
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Howard B Levene
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Weiyong Gu
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA.,Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, USA
| | - Chun-Yuh Huang
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA.
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5
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Bashkuev M, Reitmaier S, Schmidt H. Is the sheep a suitable model to study the mechanical alterations of disc degeneration in humans? A probabilistic finite element model study. J Biomech 2019; 84:172-182. [PMID: 30660378 DOI: 10.1016/j.jbiomech.2018.12.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 01/08/2023]
Abstract
Intervertebral disc degeneration is one major source of low back pain, which because of its complex multifactorial nature renders the treatment challenging and thus necessitates extensive research. Experimental animal models have proven valuable in improving our understanding of degenerative processes and potentially promising therapies. Currently, the sheep is the most frequently used large animal in vivo model in intervertebral disc research. However, despite its undoubted value for investigations of the complex biological and cellular aspects, to date, it is unclear whether the sheep is also suited to study the mechanical aspects of disc degeneration in humans. A parametric finite element (FE) model of the L4-5 spinal motion segment was developed. Using this model, the geometry and the material properties of both the human and the ovine spinal segment as well as different appearances of disc degeneration can be depicted. Under pure and combined loads, it was investigated whether degenerative changes to both the human and the ovine model equivalent caused the same mechanical response. Different patterns of degeneration resulted in large variations in the ranges of motion, intradiscal pressure, ligament and facet loads. In the human, but not in the ovine model, all these results differed significantly between different degrees of degeneration. This FE model study highlighted possible differences in the mechanical response to disc degeneration between human and ovine intervertebral discs and indicates the necessity of further, more detailed, investigations.
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Affiliation(s)
- Maxim Bashkuev
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Julius Wolff Institute, Germany
| | - Sandra Reitmaier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Julius Wolff Institute, Germany
| | - Hendrik Schmidt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Julius Wolff Institute, Germany.
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6
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Intradiscal delivery of celecoxib-loaded microspheres restores intervertebral disc integrity in a preclinical canine model. J Control Release 2018; 286:439-450. [PMID: 30110616 DOI: 10.1016/j.jconrel.2018.08.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023]
Abstract
Low back pain, related to degeneration of the intervertebral disc (IVD), affects millions of people worldwide. Clinical studies using oral cyclooxygenase-2 (COX-2) inhibitors have shown beneficial effects, although side-effects were reported. Therefore, intradiscal delivery of nonsteroidal anti-inflammatory drugs can be an alternative treatment strategy to halt degeneration and address IVD-related pain. In the present study, the controlled release and biologic potency of celecoxib, a selective COX-2 inhibitor, from polyesteramide microspheres was investigated in vitro. In addition, safety and efficacy of injection of celecoxib-loaded microspheres were evaluated in vivo in a canine IVD degeneration model. In vitro, a sustained release of celecoxib was noted for over 28 days resulting in sustained inhibition of inflammation, as indicated by decreased prostaglandin E2 (PGE2) production, and anti-catabolic effects in nucleus pulposus (NP) cells from degenerated IVDs on qPCR. In vivo, there was no evidence of adverse effects on computed tomography and magnetic resonance imaging or macroscopic evaluation of IVDs. Local and sustained delivery of celecoxib prevented progression of IVD degeneration corroborated by MRI, histology, and measurement of NP proteoglycan content. Furthermore, it seemed to harness inflammation as indicated by decreased PGE2 tissue levels and decreased neuronal growth factor immunopositivity, providing indirect evidence that local delivery of a COX-2 inhibitor could also address pain related to IVD degeneration. In conclusion, intradiscal controlled release of celecoxib from polyesteramide microspheres prevented progression of IVD degeneration both in vitro and in vivo. Follow-up studies are warranted to determine the clinical efficacy of celecoxib-loaded PEAMs in chronic back pain.
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7
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Tellegen AR, Willems N, Beukers M, Grinwis GCM, Plomp SGM, Bos C, van Dijk M, de Leeuw M, Creemers LB, Tryfonidou MA, Meij BP. Intradiscal application of a PCLA-PEG-PCLA hydrogel loaded with celecoxib for the treatment of back pain in canines: What's in it for humans? J Tissue Eng Regen Med 2018; 12:642-652. [PMID: 28544701 DOI: 10.1002/term.2483] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/02/2017] [Accepted: 05/13/2017] [Indexed: 12/19/2022]
Abstract
Chronic low back pain is a common clinical problem in both the human and canine population. Current pharmaceutical treatment often consists of oral anti-inflammatory drugs to alleviate pain. Novel treatments for degenerative disc disease focus on local application of sustained released drug formulations. The aim of this study was to determine safety and feasibility of intradiscal application of a poly(ε-caprolactone-co-lactide)-b-poly(ethylene glycol)-bpoly(ε-caprolactone-co-lactide) PCLA-PEG-PCLA hydrogel releasing celecoxib, a COX-2 inhibitor. Biocompatibility was evaluated after subcutaneous injection in mice, and safety of intradiscal injection of the hydrogel was evaluated in experimental dogs with early spontaneous intervertebral disc (IVD) degeneration. COX-2 expression was increased in IVD samples surgically obtained from canine patients, indicating a role of COX-2 in clinical IVD disease. Ten client-owned dogs with chronic low back pain related to IVD degeneration received an intradiscal injection with the celecoxib-loaded hydrogel. None of the dogs showed adverse reactions after intradiscal injection. The hydrogel did not influence magnetic resonance imaging signal at long-term follow-up. Clinical improvement was achieved by reduction of back pain in 9 of 10 dogs, as was shown by clinical examination and owner questionnaires. In 3 of 10 dogs, back pain recurred after 3 months. This study showed the safety and effectiveness of intradiscal injections in vivo with a thermoresponsive PCLA-PEG-PCLA hydrogel loaded with celecoxib. In this set-up, the dog can be used as a model for the development of novel treatment modalities in both canine and human patients with chronic low back pain.
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Affiliation(s)
- Anna R Tellegen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nicole Willems
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Martijn Beukers
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Guy C M Grinwis
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Saskia G M Plomp
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Laura B Creemers
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marianna A Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Björn P Meij
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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8
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Reitmaier S, Graichen F, Shirazi-Adl A, Schmidt H. Separate the Sheep from the Goats: Use and Limitations of Large Animal Models in Intervertebral Disc Research. J Bone Joint Surg Am 2017; 99:e102. [PMID: 28976436 DOI: 10.2106/jbjs.17.00172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Approximately 5,168 large animals (pigs, sheep, goats, and cattle) were used for intervertebral disc research in identified studies published between 1985 and 2016. Most of the reviewed studies revealed a low scientific impact, a lack of sound justifications for the animal models, and a number of deficiencies in the documentation of the animal experimentation. The scientific community should take suitable measures to investigate the presumption that animal models have translational value in intervertebral disc research. Recommendations for future investigations are provided to improve the quality, validity, and usefulness of animal studies for intervertebral disc research. More in vivo studies are warranted to comprehensively evaluate the suitability of animal models in various applications and help place animal models as an integral, complementary part of intervertebral disc research.
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Affiliation(s)
- Sandra Reitmaier
- 1Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany 2École Polytechnique, Montréal, Canada
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9
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DeLucca JF, Peloquin JM, Smith LJ, Wright AC, Vresilovic EJ, Elliott DM. MRI quantification of human spine cartilage endplate geometry: Comparison with age, degeneration, level, and disc geometry. J Orthop Res 2016; 34:1410-7. [PMID: 27232974 PMCID: PMC5244473 DOI: 10.1002/jor.23315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/06/2016] [Indexed: 02/04/2023]
Abstract
Geometry is an important indicator of disc mechanical function and degeneration. While the geometry and associated degenerative changes in the nucleus pulposus and the annulus fibrosus are well-defined, the geometry of the cartilage endplate (CEP) and its relationship to disc degeneration are unknown. The objectives of this study were to quantify CEP geometry in three dimensions using an MRI FLASH imaging sequence and evaluate relationships between CEP geometry and age, degeneration, spinal level, and overall disc geometry. To do so, we assessed the MRI-based measurements for accuracy and repeatability. Next, we measured CEP geometry across a larger sample set and correlated CEP geometric parameters to age, disc degeneration, level, and disc geometry. The MRI-based measures resulted in thicknesses (0.3-1 mm) that are comparable to prior measurements of CEP thickness. CEP thickness was greatest at the anterior/posterior (A/P) margins and smallest in the center. The CEP A/P thickness, axial area, and lateral width decreased with age but were not related to disc degeneration. Age-related, but not degeneration-related, changes in geometry suggest that the CEP may not follow the progression of disc degeneration. Ultimately, if the CEP undergoes significant geometric changes with aging and if these can be related to low back pain, a clinically feasible translation of the FLASH MRI-based measurement of CEP geometry presented in this study may prove a useful diagnostic tool. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1410-1417, 2016.
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Affiliation(s)
- John F. DeLucca
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
| | - John M. Peloquin
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Lachlan J. Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Alexander C. Wright
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Edward J. Vresilovic
- Department of Orthopedic Surgery, Pennsylvania State University Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Dawn M. Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
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10
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Malandrino A, Pozo JM, Castro-Mateos I, Frangi AF, van Rijsbergen MM, Ito K, Wilke HJ, Dao TT, Ho Ba Tho MC, Noailly J. On the relative relevance of subject-specific geometries and degeneration-specific mechanical properties for the study of cell death in human intervertebral disk models. Front Bioeng Biotechnol 2015; 3:5. [PMID: 25717471 PMCID: PMC4324300 DOI: 10.3389/fbioe.2015.00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 01/07/2015] [Indexed: 12/30/2022] Open
Abstract
Capturing patient- or condition-specific intervertebral disk (IVD) properties in finite element models is outmost important in order to explore how biomechanical and biophysical processes may interact in spine diseases. However, disk degenerative changes are often modeled through equations similar to those employed for healthy organs, which might not be valid. As for the simulated effects of degenerative changes, they likely depend on specific disk geometries. Accordingly, we explored the ability of continuum tissue models to simulate disk degenerative changes. We further used the results in order to assess the interplay between these simulated changes and particular IVD morphologies, in relation to disk cell nutrition, a potentially important factor in disk tissue regulation. A protocol to derive patient-specific computational models from clinical images was applied to different spine specimens. In vitro, IVD creep tests were used to optimize poro-hyperelastic input material parameters in these models, in function of the IVD degeneration grade. The use of condition-specific tissue model parameters in the specimen-specific geometrical models was validated against independent kinematic measurements in vitro. Then, models were coupled to a transport-cell viability model in order to assess the respective effects of tissue degeneration and disk geometry on cell viability. While classic disk poro-mechanical models failed in representing known degenerative changes, additional simulation of tissue damage allowed model validation and gave degeneration-dependent material properties related to osmotic pressure and water loss, and to increased fibrosis. Surprisingly, nutrition-induced cell death was independent of the grade-dependent material properties, but was favored by increased diffusion distances in large IVDs. Our results suggest that in situ geometrical screening of IVD morphology might help to anticipate particular mechanisms of disk degeneration.
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Affiliation(s)
- Andrea Malandrino
- Biomechanics and Mechanobiology, Institute for Bioengineering of Catalonia, Barcelona, Spain
| | - José M. Pozo
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Isaac Castro-Mateos
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Alejandro F. Frangi
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Marc M. van Rijsbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Hans-Joachim Wilke
- Center of Musculoskeletal Research Ulm, Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - Tien Tuan Dao
- UTC CNRS UMR 7338, Biomécanique et Biongénierie (BMBI), Université de Technologie de Compiègne, Compiègne, France
| | - Marie-Christine Ho Ba Tho
- UTC CNRS UMR 7338, Biomécanique et Biongénierie (BMBI), Université de Technologie de Compiègne, Compiègne, France
| | - Jérôme Noailly
- Biomechanics and Mechanobiology, Institute for Bioengineering of Catalonia, Barcelona, Spain
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