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Zhang H, Xu M, Zhang L, Zhang H, Yang L, Liu J, Zhang J, Hu Y. Effects of Chemical Sterilization and Gamma Irradiation on the Biochemical and Biomechanical Properties of Human Tendon Allografts In Vitro Study. Orthop Surg 2022; 14:2657-2668. [PMID: 36054510 PMCID: PMC9531057 DOI: 10.1111/os.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Pre‐implantation sterilization procedures for tendons are important measures to reduce the risk of disease transmission, however these procedures may compromise tendon microarchitecture and biomechanical properties to varying degrees. We explore the effects of different sterilization procedures on the micro‐histology, biomechanical strength and biochemical properties of human tendon allografts in vitro study. Methods The tendon allografts were harvested from cadaveric donors after the donors were serologically screened by antibody or nucleic acid testing of infectious agents. All samples were divided into five groups, which were fresh‐frozen group (control group), 15 kGy gamma irradiation group, 25 kGy gamma irradiation group, 70% ethanol group, and peracetic acid‐ethanol group. Each group included 10 tendons for testing. Histological staining and transmission electron microscopy were applied to observe the internal structure and arrangement of tendon collagen fibers, while the machine learning classifier was trained to distinguish the darker cross‐sections of collagen fibers and brighter backgrounds of the electron micrograph to detect the distribution of diameters of tendon collagen fibers. The viscoelasticity, mechanical properties and material properties of tendon allografts were examined to detect the influence of different intervention factors on the biomechanical properties of tendons. Results Histological staining and transmission electron microscopy showed that the structure of fresh‐frozen tendons was similar to the structures of other experimental groups, and no obvious fiber disorder or delamination was observed. In the uniaxial cyclic test, the cyclic creep of 25 kGy irradiation group (1.5%) and peracetic acid‐ethanol group (1.5%) were significantly lower than that of the control group (3.6%, F = 1.52, P = 0.039) while in the load‐to‐failure test, the maximum elongation and maximum strain of the peracetic acid‐ethanol group were significantly higher than those of the control group (F = 4.60, P = 0.010), and there was no significant difference in other biomechanical indicators. According to the experimental results of denatured collagen, it could be seen that no matter which disinfection procedure was used, the denaturation of the tendon sample would be promoted (F = 1.97, P = 0.186), and high‐dose irradiation seemed to cause more damage to collagen fibers than the other two disinfection procedures (296.2 vs 171.1 vs 212.9 μg/g). Conclusion Biomechanical experiments and collagen denaturation tests showed that 15 kGy gamma irradiation and 70% ethanol can preserve the biomechanical strength and biochemical properties of tendons to the greatest extent, and these two sterilization methods are worthy of further promotion.
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Affiliation(s)
- Hao‐ran Zhang
- Department of Bone Tumor Tianjin Hospital Tianjin China
| | - Ming‐you Xu
- Graduate School Tianjin Medical University Tianjin China
| | - Lei Zhang
- Beijing Wonderful Medical Biomaterial Co. Ltd. Beijing China
| | - Hao Zhang
- Graduate School Tianjin Medical University Tianjin China
| | - Li Yang
- Graduate School Tianjin Medical University Tianjin China
| | - Jie Liu
- Graduate School Tianjin Medical University Tianjin China
| | - Jing‐yu Zhang
- Department of Bone Tumor Tianjin Hospital Tianjin China
| | - Yong‐cheng Hu
- Department of Bone Tumor Tianjin Hospital Tianjin China
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Xu MY, Zhang HR, Zhang L, Zhang H, Yang L, Liu J, Li J, Qiao RQ, Zhang JY, Hu YC. Peracetic Acid-Ethanol Processed Human Tendon Allograft: A Morphological, Biochemical, and Biomechanical Study In Vitro. Orthop Surg 2021:os.13030. [PMID: 34477308 DOI: 10.1111/os.13030] [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: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To clarify the morphological, biochemical, and biomechanical effects of peracetic acid-ethanol sterilization processing to human hamstring tendon allografts for different time periods. METHODS Thirty-two fresh-frozen human hamstring tendon allografts obtained from an allograft supplier were prepared and incubated in peracetic acid-ethanol solution (PES) containing 1% v/v peracetic acid and 24% v/v ethanol. Specimens were randomly classified into four groups according to the PES processing time (untreated as the control group, 30 min as the PES30 group, 120 min as the PES120 group, and 240 min as the PES240group). Light microscopy with hematoxylin-eosin and toluidine blue were performed, along with transmission electron microscopy (TEM) to measure the collagen fibril diameters and their distributions, from which the collagen fibril index (CFI) and mass average diameter (MAD) were calculated. The thermal stability and collagen denaturation were analyzed by differential scanning calorimetry (DSC) and collagen denaturation test by α-chymotrypsin. Cyclic loading and failure testing were applied on five tendons from each group, from which the cyclic creep strain, elastic modulus, maximum stress, maximum strain, and strain energy density were calculated. RESULTS Tendons in the control, PES30, PES120 groups showed similar regularly aligned collagen fibers in light microscopy images, while the images from the PES240 group revealed relatively disordered and heterogeneous collagen bundles with larger interfiber spaces. TEM analysis showed that the mean diameter (F = 3.09, P = 0.04) was lower in the PES120 group (87.15 ± 4.76 nm) than it was in the control group (99.39 ± 9.19 nm) but not statistically (P = 0.05). Moreover, the CFI value in the PES30 group (65.37 ± 4.14%) was the lowest among groups (all P ≤ 0.01), while no variance existed in density and MAD among groups (F = 2.09, P = 0.13, and F = 0.27, P = 0.85, respectively). The onset temperature (H = 8.74, P = 0.03) and peak temperature (H = 9.97, P = 0.02) were decreased in the PES30 group compared to the control group (P = 0.02 and P = 0.01, respectively), but there were no differences in enthalpy of denaturation among groups (F = 2.20, P = 0.17). The collagen denaturation test revealed lower hydroxyproline concentrations in PES-treated specimens with no statistical differences among groups (H = 8.86, P = 0.07). The maximum stress showed variance (F = 10.52, P < 0.01) that it was higher in PES30 group (68.29 ± 10.86 MPa) compared to the PES120 and the PES240 group, while it was lower in the PES120 group (19.40 ± 4.94 MPa) compared to the control and the PES30 group (all P < 0.05). The strain energy density (F = 7.34, P < 0.01) was over 4 times higher in the PES30 group (7.39 ± 2.51 MPa) than it was in the PES120 group (1.56 ± 0.64 MPa, P < 0.01). CONCLUSION PES treatment for 30 min has no adverse effect on the properties of human hamstring tendon allografts, longer processing time could not promise better properties preservation.
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Affiliation(s)
- Ming-You Xu
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao-Ran Zhang
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Lei Zhang
- Beijing Wonderful Medical Biomaterial Co. Ltd., Beijing, China
| | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Li Yang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Jie Liu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Jikai Li
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Rui-Qi Qiao
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Jing-Yu Zhang
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, Tianjin, China
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Chen P, Jiang C, Shen L, Zhang W, Zhu L. Optimal number of chemical extraction treatments for maintaining the biological properties of an allogeneic tendon. Cell Tissue Bank 2018; 19:629-636. [PMID: 30062596 DOI: 10.1007/s10561-018-9713-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 07/18/2018] [Indexed: 12/14/2022]
Abstract
The aim of this study was to explore the biological effects of the amount of chemical extraction treatments performed on an allogeneic tendon through histomorphology, biological mechanics testing, and an immunogenicity assay. Sixteen New Zealand rabbits (body weight 2.5-3.0 kg) were randomly divided into four groups: group A (chemical extraction once), group B (chemical extraction twice), group C (chemical extraction three times), and group D (blank control group), with four rabbits in each group. The Achilles tendons of each rabbit were separated and subjected to a chemical extraction process with Triton X-100 and sodium deoxycholate, followed by hematoxylin and eosin staining, electron microscopy observation, biomechanical testing, and mixed lymphocyte culture. There were no significant differences in the surface color and fiber bundles between groups A and B and the blank control group, whereas group C showed clear differences from the blank control group with a rough surface, loose fibers, and poor tension. There were no significant differences in the biomechanics among the four groups. The four groups showed significant differences in the lymphocyte conversion ratio, with reduced rates of lymphocyte conversion along with increasing treatment numbers. Two chemical extractions of the tendon allowed for retaining most of the integrity of the original tendon fiber while removing immunogenicity with good biological properties. These findings lay a foundation for application of this method to human tendons so as to provide a good tissue source for tendon transplantation.
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Affiliation(s)
- Peng Chen
- ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China.,Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Changqing Jiang
- Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Li Shen
- Pingshan Women and Children's Hospital, Shenzhen, Guangdong Province, China
| | - Wentao Zhang
- Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Lixin Zhu
- ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China.
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Effects of supercritical fluid CO2 and 25 kGy gamma irradiation on the initial mechanical properties and histological appearance of tendon allograft. Cell Tissue Bank 2018; 19:603-612. [DOI: 10.1007/s10561-018-9709-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/03/2018] [Indexed: 01/02/2023]
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A sterilization method for decellularized xenogeneic cardiovascular scaffolds. Acta Biomater 2018; 67:282-294. [PMID: 29183849 DOI: 10.1016/j.actbio.2017.11.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 01/09/2023]
Abstract
Decellularized xenogeneic scaffolds have shown promise to be employed as compatible and functional cardiovascular biomaterials. However, one of the main barriers to their clinical exploitation is the lack of appropriate sterilization procedures. This study investigated the efficiency of a two-step sterilization method, antibiotics/antimycotic (AA) cocktail and peracetic acid (PAA), on porcine and bovine decellularized pericardium. In order to assess the efficiency of the method, a sterilization assessment protocol was specifically designed, comprising: i) controlled contamination with a known amount of bacteria; ii) sterility test; iii) identification of contaminants through MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight) mass spectrometry and iv) quantification by the Most Probable Number (MPN) method. This sterilization assessment protocol proved to be a successful tool to monitor and optimize the proposed sterilization method. The treatment with AA + PAA method provided sterile scaffolds while preserving the structural integrity and biocompatibility of the decellularized porcine and bovine tissues. However, surface properties and cellular adhesion resulted slightly impaired on porcine pericardium. This work developed a sterilization method suitable for decellularized pericardial scaffolds that could be adopted for in vivo tissue engineering. Together with the proposed sterilization assessment protocol, this decontamination method will foster the clinical translation of decellularized xenogeneic substitutes. STATEMENT OF SIGNIFICANCE Clinical application of functional and compatible xenogeneic decellularized scaffolds has been delayed due to the lack of appropriate sterilization methodologies. In this study, it was investigated an effective sterilization method optimized for porcine and bovine decellularized pericardia, based on the use of antibiotics/antimycotics followed by peracetic acid treatment. This treatment effectively sterilizes both species scaffolds, proves to maintain tissue overall structure and components, preserves biocompatibility and biomechanical properties. Furthermore, it was also developed a sterilization assessment protocol used to monitor and validate the previous method, consisting in three main parts: i) controlled contamination; ii) sterility test, and iii) identification and quantification of contaminants. Both methodologies were optimized for the tissues in study but can be applied to other scaffolds and accelerate their clinical translation.
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Baldini T, Caperton K, Hawkins M, McCarty E. Effect of a novel sterilization method on biomechanical properties of soft tissue allografts. Knee Surg Sports Traumatol Arthrosc 2016; 24:3971-3975. [PMID: 25100489 DOI: 10.1007/s00167-014-3221-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/28/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE Evaluate allograft tissue commonly used in soft tissue reconstruction to determine whether stiffness and strength were significantly altered after grafts were treated with different sterilization methods. Unprocessed, irradiated, and grafts treated with supercritical CO2 were compared. METHODS Thirty-eight anterior or posterior tibialis tendons were obtained from a tissue bank (Allograft Innovations, Gainesville, FL). Group I was unprocessed, group II was sterilized with gamma irradiation (20-28 kGy), and group III was sterilized with supercritical CO2. The grafts were pretensioned to 89 N for 300 s. Specimens were then loaded from 50 to 300 N at 0.5 Hz for 250 cycles before being loaded to failure at 50 mm/min. Dependent variables were compared between sterilization groups with one-way ANOVA (P < 0.05) and equivalence trial. RESULTS There was no significant difference in load to failure or failure stress among groups I, II, and III. Group III resulted in 27-36 % lower stiffness than group I and II. This difference was significant at 1, 10, 50, 100, and 250 cycles. There was no significant difference in stiffness between group I and group II. CONCLUSION The two sterilization methods tested in this study do not affect allograft strength. The supercritical CO2 sterilization method resulted in significantly lower stiffness than unprocessed and irradiated allografts. However, the stiffness and strength of all groups tested were greater than that of published values of the native intact anterior cruciate ligament (ACL). This study provides previously unpublished mechanical test data on a new sterilization technique that will assist surgeons to decide which allograft to use in ACL reconstruction surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T Baldini
- University of Colorado, Denver, 13001 E. 17th Place, MSF432, Aurora, CO, 80045, USA.
| | - K Caperton
- University of Colorado, Denver, 13001 E. 17th Place, MSF432, Aurora, CO, 80045, USA
| | - M Hawkins
- Stryker Joint Preservation, Mahwah, NJ, USA
| | - E McCarty
- University of Colorado, Denver, 13001 E. 17th Place, MSF432, Aurora, CO, 80045, USA
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Gaspar D, Spanoudes K, Holladay C, Pandit A, Zeugolis D. Progress in cell-based therapies for tendon repair. Adv Drug Deliv Rev 2015; 84:240-56. [PMID: 25543005 DOI: 10.1016/j.addr.2014.11.023] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 02/07/2023]
Abstract
The last decade has seen significant developments in cell therapies, based on permanently differentiated, reprogrammed or engineered stem cells, for tendon injuries and degenerative conditions. In vitro studies assess the influence of biophysical, biochemical and biological signals on tenogenic phenotype maintenance and/or differentiation towards tenogenic lineage. However, the ideal culture environment has yet to be identified due to the lack of standardised experimental setup and readout system. Bone marrow mesenchymal stem cells and tenocytes/dermal fibroblasts appear to be the cell populations of choice for clinical translation in equine and human patients respectively based on circumstantial, rather than on hard evidence. Collaborative, inter- and multi-disciplinary efforts are expected to provide clinically relevant and commercially viable cell-based therapies for tendon repair and regeneration in the years to come.
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Affiliation(s)
- Diana Gaspar
- Network of Excellence for Functional Biomaterials (NFB), National University of Ireland, Galway (NUI Galway), Galway, Ireland
| | - Kyriakos Spanoudes
- Network of Excellence for Functional Biomaterials (NFB), National University of Ireland, Galway (NUI Galway), Galway, Ireland
| | - Carolyn Holladay
- Network of Excellence for Functional Biomaterials (NFB), National University of Ireland, Galway (NUI Galway), Galway, Ireland
| | - Abhay Pandit
- Network of Excellence for Functional Biomaterials (NFB), National University of Ireland, Galway (NUI Galway), Galway, Ireland
| | - Dimitrios Zeugolis
- Network of Excellence for Functional Biomaterials (NFB), National University of Ireland, Galway (NUI Galway), Galway, Ireland.
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Lebled C, Grover LM, Paxton JZ. Combined decellularisation and dehydration improves the mechanical properties of tissue-engineered sinews. J Tissue Eng 2014; 5:2041731414536720. [PMID: 24904729 PMCID: PMC4046806 DOI: 10.1177/2041731414536720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/07/2014] [Indexed: 12/30/2022] Open
Abstract
Novel sources of replacement sinews are needed to repair damaged tissue after injury. The current methods of repair ultilise autografts, allografts or xenografts, although each method has distinct disadvantages that limit their success. Decellularisation of harvested tissues has been previously investigated for sinew repair with the long-term aim of repopulating the structure with autologous cells. Although this procedure shows promise, the demand for donor scaffolds will always outweigh supply. Here, we report the fabrication of fibrin-based tissue-engineered sinews, which can be decellularised, dehydrated and stored. The sinews may then be rehydrated and repopulated with an autologous cell population. In addition to enabling production of patient-specific implants, interestingly, the process of combined decellularisation, dehydration and rehydration enhanced the mechanical properties of the sinew. The treated sinews exhibited a 2.6-fold increase in maximum load and 8-fold increase in ultimate tensile strength when compared with the control group (p < 0.05 in both cases).
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Affiliation(s)
- Claire Lebled
- School of Chemical Engineering, University of Birmingham, Birmingham, UK ; Superior Institute for Biomedical Engineering (ISIFC), Franche-Comté University, Besançon, France
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, UK
| | - Jennifer Z Paxton
- School of Chemical Engineering, University of Birmingham, Birmingham, UK ; School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
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Farnebo S, Woon CY, Kim M, Pham H, Chang J. Reconstruction of the tendon-bone insertion with decellularized tendon-bone composite grafts: comparison with conventional repair. J Hand Surg Am 2014; 39:65-74. [PMID: 24246756 DOI: 10.1016/j.jhsa.2013.09.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE Injuries involving the tendon-bone interface (TBI) are difficult to address. Standard techniques typically lead to diminished strength of the healed insertion site. We hypothesized that these injuries would benefit from being reconstructed with decellularized composite grafts replacing both tendon and bone. To test this hypothesis, decellularized grafts were compared with conventional pullout repairs in an in vivo animal model. METHODS We harvested 48 Achilles TBI grafts from rats and decellularized them. Tendon-bone interface graft reconstruction and pullout repairs were compared using a pair-matched design. Biomechanical properties were evaluated at 2, 4, 8, and 12 weeks. We evaluated histological analysis of insertion morphology and collagen type I/III content. RESULTS There was a significant increase in ultimate failure load (35 ± 11 vs 24 ± 7 N) and ultimate tensile stress (1.5 ± 0.3 vs 1.0 ± 0.4 N/mm(2)) of the TBI grafts compared with pullout repairs at 2 weeks. These differences remained at 4 weeks. At 12 weeks, both TBI grafts and pullout repairs were as strong as native tissue and not significantly different from each other. Histology showed a more organized extracellular matrix in the TBI graft group at the early time points. Repopulation of the decellularized grafts increased over time. At 12 weeks, the insertion points of both groups were richly populated with cells that possessed morphologies similar to those found in native TBI. CONCLUSIONS This study showed that decellularized TBI grafts were stronger compared with conventional pullout repairs at 2 and 4 weeks but were comparable at 12 weeks. A more organized extracellular matrix and different collagen composition in the early time points may explain the observed differences in strength. CLINICAL RELEVANCE In the future, decellularized TBI grafts may be used to reconstruct tendon-bone insertion tears in multiple areas including the flexor tendon system.
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Affiliation(s)
- Simon Farnebo
- Division of Plastic Surgery, VA Palo Alto Health Care System; and the Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA.
| | - Colin Y Woon
- Division of Plastic Surgery, VA Palo Alto Health Care System; and the Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA
| | - Maxwell Kim
- Division of Plastic Surgery, VA Palo Alto Health Care System; and the Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA
| | - Hung Pham
- Division of Plastic Surgery, VA Palo Alto Health Care System; and the Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA
| | - James Chang
- Division of Plastic Surgery, VA Palo Alto Health Care System; and the Division of Plastic Surgery, Stanford University Medical Center, Stanford, CA
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