Novel repair technique for articular cartilage defect using a fibrin and hyaluronic acid mixture

Platelet-Rich Plasma Power-Mix Gel (ppm)-An Orthobiologic Optimization Protocol Rich in Growth Factors and Fibrin

Platelet- and fibrin-rich orthobiologic products, such as autologous platelet concentrates, have been extensively studied and appreciated for their beneficial effects on multiple conditions. Platelet-rich plasma (PRP) and its derivatives, including platelet-rich fibrin (PRF), have demonstrated encouraging outcomes in clinical and laboratory settings, particularly in the treatment of musculoskeletal disorders such as osteoarthritis (OA). Although PRP and PRF have distinct characteristics, they share similar properties. The relative abundance of platelets, peripheral blood cells, and molecular components in these orthobiologic products stimulates numerous biological pathways. These include inflammatory modulation, augmented neovascularization, and the delivery of pro-anabolic stimuli that regulate cell recruitment, proliferation, and differentiation. Furthermore, the fibrinolytic system, which is sometimes overlooked, plays a crucial role in musculoskeletal regenerative medicine by regulating proteolytic activity and promoting the recruitment of inflammatory cells and mesenchymal stem cells (MSCs) in areas of tissue regeneration, such as bone, cartilage, and muscle. PRP acts as a potent signaling agent; however, it diffuses easily, while the fibrin from PRF offers a durable scaffolding effect that promotes cell activity. The combination of fibrin with hyaluronic acid (HA), another well-studied orthobiologic product, has been shown to improve its scaffolding properties, leading to more robust fibrin polymerization. This supports cell survival, attachment, migration, and proliferation. Therefore, the administration of the "power mix" containing HA and autologous PRP + PRF may prove to be a safe and cost-effective approach in regenerative medicine.

Bone Marrow Aspirate Matrix: A Convenient Ally in Regenerative Medicine

The rise in musculoskeletal disorders has prompted medical experts to devise novel effective alternatives to treat complicated orthopedic conditions. The ever-expanding field of regenerative medicine has allowed researchers to appreciate the therapeutic value of bone marrow-derived biological products, such as the bone marrow aspirate (BMA) clot, a potent orthobiologic which has often been dismissed and regarded as a technical complication. Numerous in vitro and in vivo studies have contributed to the expansion of medical knowledge, revealing optimistic results concerning the application of autologous bone marrow towards various impactful disorders. The bone marrow accommodates a diverse family of cell populations and a rich secretome; therefore, autologous BMA-derived products such as the “BMA Matrix”, may represent a safe and viable approach, able to reduce the costs and some drawbacks linked to the expansion of bone marrow. BMA provides —it eliminates many hurdles associated with its preparation, especially in regards to regulatory compliance. The BMA Matrix represents a suitable alternative, indicated for the enhancement of tissue repair mechanisms by modulating inflammation and acting as a natural biological scaffold as well as a reservoir of cytokines and growth factors that support cell activity. Although promising, more clinical studies are warranted in order to further clarify the efficacy of this strategy.

Age-Related Regeneration of Osteochondral and Tibial Defects by a Fibrin-Based Construct in vivo

Tissue-biomaterial interactions in different microenvironments influence significantly the repair and regeneration outcomes when a scaffold or construct is implanted. In order to elucidate this issue, a fibrin gel filled macroporous fibrin scaffold (fibrin-based scaffold) was fabricated by loading fibrinogen via a negative pressure method, following with thrombin crosslinking. The macroporous fibrin scaffold exhibited a porous structure with porosity of (88.1 ± 1.3)%, and achieved a modulus of 19.8 ± 0.4 kPa at a wet state after fibrin gel filling, providing a suitable microenvironment for bone marrow-derived mesenchymal stem cells (BMSCs). The in vitro cellular culture revealed that the fibrin-based scaffold could support the adhesion, spreading, and proliferation of BMSCs in appropriate cell encapsulation concentrations. The fibrin-based scaffolds were then combined with BMSCs and lipofectamine/plasmid deoxyribonucleic acid (DNA) encoding mouse-transforming growth factor β1 (pDNA-TGF-β1) complexes to obtain the fibrin-based constructs, which were implanted into osteochondral and tibial defects at young adult rabbits (3 months old) and aged adult rabbits (12 months old) to evaluate their respective repair effects. Partial repair of osteochondral defects and perfect restoration of tibial defects were realized at 18 weeks post-surgery for the young adult rabbits, whereas only partial repair of subchondral bone and tibial bone defects were found at the same time for the aged adult rabbits, confirming the adaptability of the fibrin-based constructs to the different tissue microenvironments by tissue-biomaterial interplays.

In vitro and in vivo evaluation of the duck's feet collagen sponge for hemostatic applications

Recently different hemostatic agents have been developed, but most of them are ineffective in severe bleeding and expensive or cause safety concerns. In this study, we fabricated duck's feet collagen-based porous sponges and investigated its use as a hemostatic agent. We determined the sponge's physical and biological characteristics and compared with Avitene via scanning electron microscope analysis, water-uptake abilities and porosity test, and cytotoxicity assay. The duck's feet collagen/silk sponge showed a larger interconnected porous structure compared to others sponges. The duck's feet collagen/silk sponge also exhibited significantly higher porosity than Avitene. Hemostatic properties of the sponges were evaluated by whole blood clotting and rat femoral artery hemorrhage experiment. The addition of silk to duck's feet collagen showed better blood clotting ability than Avitene in vitro. However, rat femoral artery hemorrhage test showed a similar hemostatic property between the duck's feet collagen-based sponges and Avitene. We suggest that duck's feet collagen-based sponge can be effectively used for hemostatic applications.

Topical Application of a Silicone Gel Sheet with Verapamil Microparticles in a Rabbit Model of Hypertrophic Scar

BACKGROUND

The authors developed a novel treatment based on the topical application of a silicone gel sheet containing verapamil microparticles. The ability of these silicone gel sheets to inhibit hypertrophic scar in a rabbit ear wound model was examined.

METHODS

Ten New Zealand White rabbits with a total of 80 wounds in both ears were used in this study. The rabbits were divided into five groups (control; silicone gel sheet; and silicone gel sheet plus 0.25, 2.5, and 25 mg of verapamil per gram). Histopathologic findings were quantified.

RESULTS

The mean scar elevation index, fibroblast counts, and capillary counts differed significantly among the five groups (p < 0.05). The median scar elevation index was significantly lower in the silicone gel sheet plus 2.5 mg of verapamil per gram group than in the silicone gel sheet group (1.2 versus 2.2). The median number of fibroblasts was significantly lower in the silicone gel sheet plus 0.25 mg of verapamil per gram group than in the silicone gel sheet group (172.5 versus 243). In the median number of capillary lumina, there was no significant difference between the silicone gel sheet group and the silicone gel sheet plus 0.25, 2.5, and 25 mg of verapamil per gram groups (28.5, 18, 20, and 18, respectively).

CONCLUSION

Topical application of a silicone gel sheet with verapamil microparticles may be a novel, effective treatment method for hypertrophic scar, but its safety and efficacy in humans must be tested in clinical trials.

Autologous bone marrow mesenchymal cell induced chondrogenesis for the treatment of osteoarthritis of knee

Healthy and high quality of life has become the main issue with increasing human life span. Many biological treatments for osteoarthritis of the knee have been tried with limited success. We compared data from 7 patients who underwent total knee arthroplasty and 46 patients who underwent autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC) for osteoarthritis of grade IV of the Kellgren-Lawrence classification and grade IV of modified Outerbridge classification from 50 to 65 years of age. Clinical evaluation of the 2 groups showed significant improvement in the mean telephone Knee Society Scoring system (tKSS)-A (pain) and tKSS-B (function) scores throughout the postoperative follow-up period. There was no difference in the patients' satisfaction between the 2 groups. MCIC is a treatment option at least for delaying disease progression of osteoarthritis of the knee.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available for this article at 10.1007/s13770-016-9125-y and is accessible for authorized users.

Autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC)

Degenerative and traumatic articular cartilage defects are common, difficult to treat, and progressive lesions that cause significant morbidity in the general population. There have been multiple approaches to treat such lesions, including arthroscopic debridement, microfracture, multiple drilling, osteochondral transplantation and autologous chondrocyte implantation (ACI) that are currently being used in clinical practice. Autologous bone-marrow mesenchymal cell induced chondrogenesis (MCIC) is a single-staged arthroscopic procedure. This method combines a modified microfracture technique with the application of a bone marrow aspirate concentrate (BMAC), hyaluronic acid and fibrin gel to treat articular cartilage defects. We reviewed the current literatures and surgical techniques for mesenchymal cell induced chondrogenesis.