Tissue engineering and autologous transplant formation: practical approaches with resorbable biomaterials and new cell culture techniques

Sustainable Vegetable Oil-Based Biomaterials: Synthesis and Biomedical Applications

One of the main criteria for ecological sustainability is that the materials produced for common use are green. This can include the use of biomaterials and materials that are environmentally friendly, biodegradable and produced at low cost. The exploration of natural resources as sustainable precursors leads to the production of biopolymers that are useful for 3D printing technology. Recently, waste vegetable oils have been found to be a good alternative source for the production of biopolymers in various applications from the engineering to the biomedicine. In this review, the processes for the synthesis of vegetable oil-based biomaterials are described in detail. Moreover, the functionalization strategies to improve the mechanical properties of these materials and the cell-material interaction for their potential use as micro-structured scaffolds in regenerative medicine are discussed.

Highlights on Advancing Frontiers in Tissue Engineering

The field of tissue engineering continues to advance, sometimes in exponential leaps forward, but also sometimes at a rate that does not fulfill the promise that the field imagined a few decades ago. This review is in part a catalog of success in an effort to inform the process of innovation. Tissue engineering has recruited new technologies and developed new methods for engineering tissue constructs that can be used to mitigate or model disease states for study. Key to this antecedent statement is that the scientific effort must be anchored in the needs of a disease state and be working toward a functional product in regenerative medicine. It is this focus on the wildly important ideas coupled with partnered research efforts within both academia and industry that have shown most translational potential. The field continues to thrive and among the most important recent developments are the use of three-dimensional bioprinting, organ-on-a-chip, and induced pluripotent stem cell technologies that warrant special attention. Developments in the aforementioned areas as well as future directions are highlighted in this article. Although several early efforts have not come to fruition, there are good examples of commercial profitability that merit continued investment in tissue engineering. Impact statement Tissue engineering led to the development of new methods for regenerative medicine and disease models. Among the most important recent developments in tissue engineering are the use of three-dimensional bioprinting, organ-on-a-chip, and induced pluripotent stem cell technologies. These technologies and an understanding of them will have impact on the success of tissue engineering and its translation to regenerative medicine. Continued investment in tissue engineering will yield products and therapeutics, with both commercial importance and simultaneous disease mitigation.

3D Bone Biomimetic Scaffolds for Basic and Translational Studies with Mesenchymal Stem Cells

Mesenchymal stem cells (MSCs) are recognized as an attractive tool owing to their self-renewal and differentiation capacity, and their ability to secrete bioactive molecules and to regulate the behavior of neighboring cells within different tissues. Accumulating evidence demonstrates that cells prefer three-dimensional (3D) to 2D culture conditions, at least because the former are closer to their natural environment. Thus, for in vitro studies and in vivo utilization, great effort is being dedicated to the optimization of MSC 3D culture systems in view of achieving the intended performance. This implies understanding cell–biomaterial interactions and manipulating the physicochemical characteristics of biomimetic scaffolds to elicit a specific cell behavior. In the bone field, biomimetic scaffolds can be used as 3D structures, where MSCs can be seeded, expanded, and then implanted in vivo for bone repair or bioactive molecules release. Actually, the union of MSCs and biomaterial has been greatly improving the field of tissue regeneration. Here, we will provide some examples of recent advances in basic as well as translational research about MSC-seeded scaffold systems. Overall, the proliferation of tools for a range of applications witnesses a fruitful collaboration among different branches of the scientific community.

Bio-Based Polymers for 3D Printing of Bioscaffolds

Three-dimensional (3D) printing technologies enable not only faster bioconstructs development but also on-demand and customized manufacturing, offering patients a personalized biomedical solution. This emerging technique has a great potential for fabricating bioscaffolds with complex architectures and geometries and specifically tailored for use in regenerative medicine. The next major innovation in this area will be the development of biocompatible and histiogenic 3D printing materials with bio-based printable polymers. This review will briefly discuss 3D printing techniques and their current limitations, with a focus on novel bio-based polymers as 3D printing feedstock for clinical medicine and tissue regeneration.

Induction of Ectopic Bone Formation by Using Human Periosteal Cells in Combination with a Novel Scaffold Technology

Due to their osteogenic germination potential, periosteum-derived osteoprogenitor cells are a potential source for tissue engineering a bone graft that could be used to regenerate skeletal defects. In this study we evaluated if ectopic bone formation could be induced by a construct made of human periosteal cells and a novel scaffold architecture whose mechanical properties are in the range of cancellous bone. Biopsies from human calvarial periosteum were harvested and cells were isolated from the inner cambial layer. Fifty thousand periosteal cells were seeded into the scaffolds measuring 6 × 6 × 2 mm. The cell–scaffold constructs were cultured for a period of 3 weeks prior to implantation into balb C nude mice. Mice were sacrificed and implants were analyzed 6 and 17 weeks postoperatively. Immunohistochemical analysis confirmed the osteoblastic phenotype of the seeded cells. Formation of focal adhesions and stress fibers could be observed in both scaffold architectures. Three-dimensional cell proliferation was observed after 2 weeks of culturing with centripetal growth pattern inside the pore network. The deposition of calcified extracellular matrix was observed after 3 weeks of culturing. In vivo, endochondral bone formation with osteoid production was detectable via von Kossa and Osteocalcin staining after 6 and 17 weeks. Histology and SEM revealed that the entire scaffold/bone grafts were penetrated by a vascular network. This study showed the potential of bone tissue engineering by using human periosteal cells in combination with a novel scaffold technology.

Biocompatibility of Subcutaneously Implanted Plant-Derived Cellulose Biomaterials

There is intense interest in developing novel biomaterials which support the invasion and proliferation of living cells for potential applications in tissue engineering and regenerative medicine. Decellularization of existing tissues have formed the basis of one major approach to producing 3D scaffolds for such purposes. In this study, we utilize the native hypanthium tissue of apples and a simple preparation methodology to create implantable cellulose scaffolds. To examine biocompatibility, scaffolds were subcutaneously implanted in wild-type, immunocompetent mice (males and females; 6-9 weeks old). Following the implantation, the scaffolds were resected at 1, 4 and 8 weeks and processed for histological analysis (H&E, Masson's Trichrome, anti-CD31 and anti-CD45 antibodies). Histological analysis revealed a characteristic foreign body response to the scaffold 1 week post-implantation. However, the immune response was observed to gradually disappear by 8 weeks post-implantation. By 8 weeks, there was no immune response in the surrounding dermis tissue and active fibroblast migration within the cellulose scaffold was observed. This was concomitant with the deposition of a new collagen extracellular matrix. Furthermore, active blood vessel formation within the scaffold was observed throughout the period of study indicating the pro-angiogenic properties of the native scaffolds. Finally, while the scaffolds retain much of their original shape they do undergo a slow deformation over the 8-week length of the study. Taken together, our results demonstrate that native cellulose scaffolds are biocompatible and exhibit promising potential as a surgical biomaterial.

Toward a skin-material interface with vacuum-integrated capped macroporous scaffolds

Avulsion, epidermal marsupialization, and infection cause failure at the skin-material interface. A robust interface would permit implantable robotics, prosthetics, and other medical devices; reconstruction of surgical defects, and long-term access to blood vessels and body cavities. Torus-shaped cap-scaffold structures were designed to work in conjunction with negative pressure to address the three causes of failure. Six wounds were made on the backs of each of four 3-month old pigs. Four unmodified (no caps) scaffolds were implanted along with 20 cap-scaffolds. Collagen type 4 was attached to 21 implants. Negative pressure then was applied. Structures were explanted and assessed histologically at day 7 and day 28. At day 28, there was close tissue apposition to scaffolds, without detectable reactions from defensive or interfering cells. Three cap-scaffolds explanted at day 28 showed likely attachment of epidermis to the cap or cap-scaffold junction, without deeper marsupialization. The combination of toric-shaped cap-scaffolds with negative pressure appears to be an intrinsically biocompatible system, enabling a robust skin-material interface. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1307-1318, 2017.

Bridging the gap between traditional cell cultures and bioreactors applied in regenerative medicine: practical experiences with the MINUSHEET perfusion culture system

To meet specific requirements of developing tissues urgently needed in tissue engineering, biomaterial research and drug toxicity testing, a versatile perfusion culture system was developed. First an individual biomaterial is selected and then mounted in a MINUSHEET(®) tissue carrier. After sterilization the assembly is transferred by fine forceps to a 24 well culture plate for seeding cells or mounting tissue on it. To support spatial (3D) development a carrier can be placed in various types of perfusion culture containers. In the basic version a constant flow of culture medium provides contained tissue with always fresh nutrition and respiratory gas. For example, epithelia can be transferred to a gradient container, where they are exposed to different fluids at the luminal and basal side. To observe development of tissue under the microscope, in a different type of container a transparent lid and base are integrated. Finally, stem/progenitor cells are incubated in a container filled by an artificial interstitium to support spatial development. In the past years the described system was applied in numerous own and external investigations. To present an actual overview of resulting experimental data, the present paper was written.

Arrested Phase Separation of Elastin-like Polypeptide Solutions Yields Stiff, Thermoresponsive Gels

The preparation of new responsive hydrogels is crucial for the development of soft materials for various applications, including additive manufacturing and biomedical implants. Here, we report the discovery of a new mechanism for forming physical hydrogels by the arrested phase separation of a subclass of responsively hydrophobic elastin-like polypeptides (ELPs). When moderately concentrated solutions of ELPs with the pentapeptide repeat (XPAVG)n (where X is either 20% or 60% valine with the remainder isoleucine) are warmed above their inverse transition temperature, phase separation becomes arrested, and hydrogels can be formed with shear moduli on the order of 0.1-1 MPa at 20 wt % in water. The longest stress relaxation times are well beyond 10(3) s. This result is surprising because ELPs are classically known for thermoresponsive coacervation that leads to macrophase separation, and solids are typically formed in the bulk or by supplemental cross-linking strategies. This new mechanism can form gels with remarkable mechanical behavior based on simple macromolecules that can be easily engineered. Small angle scattering experiments indicate that phase separation arrests to form a network of nanoscale domains, exhibiting rheological and structural features consistent with an arrested spinodal decomposition mechanism. Gel nanostructure can be modeled as a disordered bicontinuous network with interdomain, intradomain, and curvature length scales that can be controlled by sequence design and assembly conditions. These studies introduce a new class of reversible, responsive materials based on a classic artificial biopolymer that is a versatile platform to address critical challenges in industrial and medical applications.

Microstructure and in vitro cellular response to novel soy protein-based porous structures for tissue regeneration applications

Interest in the development of new bioresorbable structures for various tissue engineering applications is on the rise. In the current study, we developed and studied novel soy protein-based porous blends as potential new scaffolds for such applications. Soy protein has several advantages over the various types of natural proteins employed for biomedical applications due to its low price, non-animal origin and relatively long storage time and stability. In the present study, blends of soy protein with other polymers (gelatin, pectin and alginate) were added and chemically cross-linked using the cross-linking agents carbodiimide or glyoxal, and the porous structure was obtained through lyophilization. The resulting blend porous structures were characterized using environmental scanning microscopy, and the cytotoxicity of these scaffolds was examined in vitro. The biocompatibility of the scaffolds was also evaluated in vitro by seeding and culturing human fibroblasts on these scaffolds. Cell growth morphology and adhesion were examined histologically. The results show that these blends can be assembled into porous three-dimensional structures by combining chemical cross-linking with freeze-drying. The achieved blend structures combine suitable porosity with a large pore size (100–300 µm). The pore structure in the soy-alginate scaffolds possesses adequate interconnectivity compared to that of the soy-gelatin scaffolds. However, porous structure was not observed for the soy-pectin blend, which presented a different structure with significantly lower porosities than all other groups. The in vitro evaluation of these porous soy blends demonstrated that soy-alginate blends are advantageous over soy-gelatin blends and exhibited adequate cytocompatibility along with better cell infiltration and stability. These soy protein scaffolds may be potentially useful as a cellular/acellular platform for skin regeneration applications.

Are surface antigens suited to verify the redifferentiation potential and culture purity of human chondrocytes in cell-based implants

Cell expansion in vitro is a prequisite to obtain a sufficient quantity of cells for cell-based cartilage repair of articular cartilage lesions. During this process verification of redifferentiation potential of highly expanded chondrocytes is required. Furthermore, cellular impurities of chondrocyte cultures have to be excluded. For this purpose, redifferentiation of expanded human chondrocytes in passage 3 or 5 was initiated in bioresorbable polyglycolic acid-fibrin (PGA-fibrin) scaffolds and selected potential markers were analysed during the process of cell expansion and redifferentiation. Chondrocyte expansion was accompanied by a decrease of collagen type II and COMP and an increase of collagen type I expression indicating cell dedifferentiation. Redifferentiation of chondrocytes in PGA-fibrin scaffolds was accompanied by an increase of collagen II/I ratio. Flow cytometric analyses revealed that in contrast to CD44 and CD49e, CD63 and CD166 showed significant changes in the number of positive cells during redifferentiation. CD14 and CD45 are not expressed by chondrocytes and are therefore possible candidates to detect specifically monocytes or haematopoetic cells in chondrocyte cultures. Characterization of surface antigen expression revealed two promising candidates (CD63 and CD166) to describe the process of redifferentiation, while CD14 and CD45 are suitable markers to exclude impurities by monocytes or haematopoetic cells.

Alternative methods for assessing biocompatibility and function of implant materials

Biocompatibility testing is used to evaluate the host response to implantable materials and to assess their ability to perform in applications in which they are intended to interact with biological systems. In compliance with international and/or national standards, such assessment is based mainly on the results of experimental implantation into animal tissues. However, the development of in vitro experimental techniques creates new opportunities to observe and to understand the interaction of biomaterials with host tissue. The state-of-the-art application of alternative methods in biocompatibility testing is presented in this review article. It is discussed with respect to the Three Rs concept (reduction, refinement, replacement) of Russell & Burch. Perspectives on alternative methods in biocompatibility studies are discussed with regard to the possible role of biomaterials in tissue engineering.

Improved Chondrogenic Capacity of Collagen Hydrogel-Expanded Chondrocytes: In Vitro and in Vivo Analyses

BACKGROUND

The use of autologous chondrocytes in cartilage repair is limited because of loss of the cartilage phenotype during expansion. The mechanosensing capacity of chondrocytes suggests evaluating the use of soft substrates for in vitro expansion. Our aim was to test the expansion of chondrocytes on collagen hydrogels to improve their capacity for chondrogenesis after a number of passages.

METHODS

Rat cartilage cells were expanded on collagen hydrogels and on plastic, and the preservation of their chondrogenic capacity was tested both in vitro and in vivo. The expression of relevant markers during expansion on each surface was measured by real-time PCR (polymerase chain reaction). Expanded cells were then implanted in focal lesions in the medial femoral condyle of healthy sheep, and the newly formed tissue was analyzed by histomorphometry.

RESULTS

Compared with cells cultured on plastic, cells cultured on hydrogels had better maintenance of the expression of the Sox9, Col2 (type-II collagen), FGFR3, and Alk-5 genes and decreased expression of Alk-1 and BMP-2. Pellets also showed increased expression of the cartilage marker genes aggrecan, Sox9, and Col2, and decreased expression of Col1 and Col10 (type-I and type-X collagen). ELISA (enzyme-linked immunosorbent assay) also showed a higher ratio of type-II to type-I collagen in pellets formed from cells expanded on hydrogels. When sheep chondrocytes were expanded and implanted in cartilage lesions in the femoral condyle of healthy sheep, hydrogel-expanded cells produced histologically better tissue compared with plastic-expanded cells.

CONCLUSIONS

The expansion of chondrocytes on collagen hydrogels yielded cells with an improved chondrogenic capacity compared with cells expanded on plastic.

CLINICAL RELEVANCE

The study results favor the use of hydrogel-expanded cells over the traditional plastic-expanded cells for autologous chondrocyte implantation.

Implanted cell-dense prevascularized tissues develop functional vasculature that supports reoxygenation after thrombosis

Achieving adequate vascularization within implanted engineered tissues is a significant obstacle to maintaining viability and functionality. In vitro prevascularization of engineered tissues has been explored as a potential solution to this challenge. The traditional paradigm of in vitro prevascularization is to implant an engineered tissue with a preformed vascular network that is perfused after anastomosis with the host circulation. We investigated the efficacy of this strategy by implanting cell-dense prevascularized tissues created via cell-mediated contraction and composed of collagen and a collagen-fibrin mixture into dorsal window chambers surgically prepared on immunocompromised mice. We found that host-implant anastomosis takes place in 2-6 days and that perfusion of vessels within the implants is subsequently restricted by thrombosis. However, by day 7, a functional vascular network composed of host and implant vessels developed. Prevascularization enhanced intra-implant pO2 significantly as early as 2 days postimplantation, reaching a maximum of 55 mmHg by day 8, which was significantly greater than the maximum within cellularized control tissues (18 mmHg). By day 14, collagen tissues supported ∼ 0.51 × 10(9) implanted and host-derived cells per mL. Our findings elucidate key features of in vitro prevascularization that can be used toward the design of larger and more functionally complex engineered tissues.

Morphology and functions of astrocytes cultured on water-repellent fractal tripalmitin surfaces

In the brain, astrocytes play an essential role with their multiple functions and sophisticated structure, as surrounded by a fractal environment which has not been available in our traditional cell culture. Water-repellent fractal tripalmitin (PPP) surfaces can imitate the fractal environment in vivo, so the morphology and biochemical characterization of astrocytes on these surfaces are examined. Water-repellent fractal PPP surface can induce astrocytes to display sophisticated morphology with smaller size of cell area, longer and finer filopodium-like processes, and higher morphological complexity. The super water-repellent fractal PPP surface with water contact angle of 150°∼160° produces the maximal effects compared with other surfaces at lower water contact angles. The trends of characteristic protein expression, including that of nestin, vimentin, GFAP and glutamine synthetase, for astrocytes cultured on super water-repellent fractal PPP surfaces approximate more to in vivo pattern. The super water-repellent PPP surface also render astrocytes to perform more pronounced promotion of neurogenesis by increasing the release of nerve growth factor in a co-culture system. Altogether, our results suggest that the super water-repellent fractal PPP surface facilitates the astrocytes to mimic their in vivo performance, thus provides a closer-to-natural culture environment for experimental assessment of glial structure and functions.

Isolation, characterization, differentiation, and application of adipose-derived stem cells

While bone marrow-derived mesenchymal stem cells are known and have been investigated for a long time, mesenchymal stem cells derived from the adipose tissue were identified as such by Zuk et al. in 2001. However, as subcutaneous fat tissue is a rich source which is much more easily accessible than bone marrow and thus can be reached by less invasive procedures, adipose-derived stem cells have moved into the research spotlight over the last 8 years.Isolation of stromal cell fractions involves centrifugation, digestion, and filtration, resulting in an adherent cell population containing mesenchymal stem cells; these can be subdivided by cell sorting and cultured under common conditions.They seem to have comparable properties to bone marrow-derived mesenchymal stem cells in their differentiation abilities as well as a favorable angiogenic and anti-inflammatory cytokine secretion profile and therefore have become widely used in tissue engineering and clinical regenerative medicine.

Maxillary sinus floor elevation with a tissue-engineered bone composite of deciduous tooth stem cells and calcium phosphate cement in goats

The study aimed to assess the effect of maxillary sinus floor elevation with tissue-engineered bone constructed from deciduous tooth stem cells (DTSCs) and calcium phosphate cement (CPC). The stem cells from goat deciduous teeth (SGDs) were isolated and transfected by means of the adenovirus with an enhanced green fluorescent protein gene (AdEGFP). As many as 18 bilateral maxillary sinuses of nine goats were randomly allocated into three groups (n = 6/group): group A (SGDs-CPC compound), group B (CPC alone) and group C (autogenous bone obtained from an iliac crest). All the samples were evaluated by computed tomography (CT), histology and histomorphometric analysis. Furthermore, the fate of implanted SGDs was traced using an immunohistochemical staining method in the decalcified samples. SGDs might be differentiated into osteoblasts in an osteogenic medium. In the present study, three-dimensional CT analysis showed that the volume of newly formed bone in group A was greater than that in the other two groups. After a healing period of 3 months, sequential analyses of triad-colour fluorescence labelling, histology and histomorphology indicated that the SGDs-CPC compound primarily promoted bone formation and mineralization at 2 and 3 months after the operation. Moreover, the areas of new bone formation in elevated sinuses were 41.82 ± 6.24% in the SGDs-CPC group, which was significantly higher than the 30.11 ± 8.05% in the CPC-alone group or the 23.07 ± 10.21% in the autogenous bone group. Immunohistochemical staining revealed that GFP and OCN were both expressed in the new bone tissue for the samples with eGFP, which suggested that the implanted SGDs might have contributed to new bone formation on the elevated sinus floor. SGDs can promote new bone formation and maturation in the goat maxillary sinus, and the tissue-engineered bone composite of SGDs and CPC might be a potential substitute for existing maxillary sinus floor elevation methods. Copyright © 2014 John Wiley & Sons, Ltd.

Methylcellulose based thermally reversible hydrogel system for tissue engineering applications

The thermoresponsive behavior of a Methylcellulose (MC) polymer was systematically investigated to determine its usability in constructing MC based hydrogel systems in cell sheet engineering applications. Solution-gel analyses were made to study the effects of polymer concentration, molecular weight and dissolved salts on the gelation of three commercially available MCs using differential scanning calorimeter and rheology. For investigation of the hydrogel stability and fluid uptake capacity, swelling and degradation experiments were performed with the hydrogel system exposed to cell culture solutions at incubation temperature for several days. From these experiments, the optimal composition of MC-water-salt that was able to produce stable hydrogels at or above 32 °C, was found to be 12% to 16% of MC (Mol. wt. of 15,000) in water with 0.5× PBS (~150mOsm). This stable hydrogel system was then evaluated for a week for its efficacy to support the adhesion and growth of specific cells in culture; in our case the stromal/stem cells derived from human adipose tissue derived stem cells (ASCs). The results indicated that the addition (evenly spread) of ~200 µL of 2 mg/mL bovine collagen type -I (pH adjusted to 7.5) over the MC hydrogel surface at 37 °C is required to improve the ASC adhesion and proliferation. Upon confluence, a continuous monolayer ASC sheet was formed on the surface of the hydrogel system and an intact cell sheet with preserved cell–cell and cell–extracellular matrix was spontaneously and gradually detached when the grown cell sheet was removed from the incubator and exposed to room temperature (~30 °C) within minutes.

Response of sheep chondrocytes to changes in substrate stiffness from 2 to 20 Pa: effect of cell passaging

AIM

The influence of culture substrate stiffness (in the kPa range) on chondrocyte behavior has been described. Here we describe the response to variations in substrate stiffness in a soft range (2-20 Pa), as it may play a role in understanding cartilage physiopathology.

METHODS

We developed a system for cell culture in substrates with different elastic moduli using collagen hydrogels and evaluated chondrocytes after 2, 4, and 7 days in monolayer and three-dimensional (3D) cultures. Experiments were performed in normoxia and hypoxia in order to describe the effect of a low oxygen environment on chondrocytes. Finally, we also evaluated if dedifferentiated cells preserve the capacity for mechanosensing.

RESULTS

Chondrocytes showed less proliferating activity when cultured in monolayer in the more compliant substrates. Expression of the cartilage markers Aggrecan (Acan), type II collagen (Col2a1), and Sox9 was upregulated in the less stiff gels (both in monolayer and in 3D culture). Stiffer gels induced an organization of the actin cytoskeleton that correlated with the loss of a chondrocyte phenotype. When cells were cultured in hypoxia, we observed changes in the cellular response that were mediated by HIF-1α. Results in 3D hypoxia cultures were opposite to those found in normoxia, but remained unchanged in monolayer hypoxic experiments. Similar results were found for dedifferentiated cells.

CONCLUSIONS

Chondrocytes respond differently according to the stiffness of the substrate. This response depends greatly on the oxygen environment and on whether the chondrocyte is embedded or grown onto the hydrogel, since mechanosensing capacity was not lost with cell expansion.

Strategic design and fabrication of engineered scaffolds for articular cartilage repair

Damage to articular cartilage can eventually lead to osteoarthritis (OA), a debilitating, degenerative joint disease that affects millions of people around the world. The limited natural healing ability of cartilage and the limitations of currently available therapies make treatment of cartilage defects a challenging clinical issue. Hopes have been raised for the repair of articular cartilage with the help of supportive structures, called scaffolds, created through tissue engineering (TE). Over the past two decades, different designs and fabrication techniques have been investigated for developing TE scaffolds suitable for the construction of transplantable artificial cartilage tissue substitutes. Advances in fabrication technologies now enable the strategic design of scaffolds with complex, biomimetic structures and properties. In particular, scaffolds with hybrid and/or biomimetic zonal designs have recently been developed for cartilage tissue engineering applications. This paper reviews critical aspects of the design of engineered scaffolds for articular cartilage repair as well as the available advanced fabrication techniques. In addition, recent studies on the design of hybrid and zonal scaffolds for use in cartilage tissue repair are highlighted.

Supportive development of functional tissues for biomedical research using the MINUSHEET® perfusion system

Functional tissues generated under in vitro conditions are urgently needed in biomedical research. However, the engineering of tissues is rather difficult, since their development is influenced by numerous parameters. In consequence, a versatile culture system was developed to respond the unmet needs.

Optimal adhesion for cells in this system is reached by the selection of individual biomaterials. To protect cells during handling and culture, the biomaterial is mounted onto a MINUSHEET® tissue carrier. While adherence of cells takes place in the static environment of a 24 well culture plate, generation of tissues is accomplished in one of several available perfusion culture containers. In the basic version a continuous flow of always fresh culture medium is provided to the developing tissue. In a gradient perfusion culture container epithelia are exposed to different fluids at the luminal and basal sides. Another special container with a transparent lid and base enables microscopic visualization of ongoing tissue development. A further container exhibits a flexible silicone lid to apply force onto the developing tissue thereby mimicking mechanical load that is required for developing connective and muscular tissue. Finally, stem/progenitor cells are kept at the interface of an artificial polyester interstitium within a perfusion culture container offering for example an optimal environment for the spatial development of renal tubules.

The system presented here was evaluated by various research groups. As a result a variety of publications including most interesting applications were published. In the present paper these data were reviewed and analyzed. All of the results point out that the cell biological profile of engineered tissues can be strongly improved, when the introduced perfusion culture technique is applied in combination with specific biomaterials supporting primary adhesion of cells.

Cartilage tissue engineering of nasal septal chondrocyte-macroaggregates in human demineralized bone matrix

Tissue Engineering is an important method for generating cartilage tissue with isolated autologous cells and the support of biomaterials. In contrast to various gel-like biomaterials, human demineralized bone matrix (DBM) guarantees some biomechanical stability for an application in biomechanically loaded regions. The present study combined for the first time the method of seeding chondrocyte-macroaggregates in DBM for the purpose of cartilage tissue engineering. After isolating human nasal chondrocytes and creating a three-dimensional macroaggregate arrangement, the DBM was cultivated in vitro with the macroaggregates. The interaction of the cells within the DBM was analyzed with respect to cell differentiation and the inhibitory effects of chondrocyte proliferation. In contrast to chondrocyte-macroaggregates in the cell-DBM constructs, morphologically modified cells expressing type I collagen dominated. The redifferentiation of chondrocytes, characterized by the expression of type II collagen, was only found in low amounts in the cell-DBM constructs. Furthermore, caspase 3, a marker for apoptosis, was detected in the chondrocyte-DBM constructs. In another experimental setting, the vitality of chondrocytes as related to culture time and the amount of DBM was analyzed with the BrdU assay. Higher amounts of DBM tended to result in significantly higher proliferation rates of the cells within the first 48 h. After 96 h, the vitality decreased in a dose-dependent fashion. In conclusion, this study provides the proof of concept of chondrocyte-macroaggregates with DBM as an interesting method for the tissue engineering of cartilage. The as-yet insufficient redifferentiation of the chondrocytes and the sporadic initiation of apoptosis will require further investigations.

Prefabricated tracheal prosthesis with partial biodegradable materials: a surgical and tissue engineering evaluation in vivo

Large and circumferential tracheal defects remain at this time an unsolved problem for reconstructive surgery. Many types of prosthetic and tissue grafts have been used but with limited comfortable results. Major complications are anastomotic dehiscence, graft ischemia and stenosis due to the poor vascularization of the prosthetic complex. We studied the in vivo behaviour of a prefabricated flap composed of a partially bioresorbable tracheal prosthesis and an arterio-venous vascular carrier. The prosthesis was made of a tubular skeleton of knitted Dacron (20 microm porosity) embedded within a bioresorbable poly-lactic-co-glycolic acid polymer (PLA(75)GA(25)) covering both sides. Fifteen New Zealand White rabbits were divided in three groups, depending on the time of examination (30, 90 and 180 days post-implantation). The prosthesis was implanted in the visceral space of the neck using the common carotid trunk and the internal jugular vein as vascular pedicle. The histological, immunohistochemical, and ESEM analyses of collected samples, showed a time-dependent process of tissue neoformation and neovascularization on the prosthetic material with a significant increase from 30 to 90 days post-implantation. In contrast, there was no statistically significant difference in the fibrovascular connective deposition from 90 to 180 days. This finding indicated the three months time as the best period for the tissue deposition and consequent hypothetical orthotopic transplantation of the prosthesis. Further in vivo studies are intended to confirm the results.

Advancing nasal reconstructive surgery: the application of tissue engineering technology

Cartilage tissue engineering is a rapidly progressing area of regenerative medicine with advances in cell biology and scaffold engineering constantly being investigated. Many groups are now capable of making neocartilage constructs with some level of morphological, biochemical, and histological likeness to native human cartilage tissues. The application of this useful technology in articular cartilage repair is well described in the literature; however, few studies have evaluated its application in head and neck reconstruction. Although there are many studies on auricular cartilage tissue engineering, there are few studies regarding cartilage tissue engineering for complex nasal reconstruction. This study therefore highlighted the challenges involved with nasal reconstruction, with special focus on nasal cartilage tissue, and examined how advancements made in cartilage tissue engineering research could be applied to improve the clinical outcomes of total nasal reconstructive surgery.

In Vitro Degradation of Electrospun Fiber Membranes of PCL/PVP Blends

The ultrafine fibers of poly(ε-caprolactone) (PCL) composited with different Polyvinyl Pyrrolidone (PVP) content were successfully prepared by electrospinning method. The morphology, hydrophilicity and in vitro degradation behavior of samples were characterized by Scanning Electron Microscopy (SEM), water contact angle and weight loss rate. Pore size and distribution on the fibers changed with the increase of PVP content. The hydrophilicity of PCL membrane was improved by addition of PVP. When the content of PVP was 25% and 50%, the water contact angle approached zero. The degradation was essentially a dissolution process of PVP on the first 7days. Since large specific surface, high porosity and different crystallinity, percent degradation loss of electrospun fiber membranes were about 1 to 12 times higher than that of cast films.

Bioresorbable Microspheres as Injectable Cell Carrier: FRom Preparation to in Vitro Evaluation

A new approach to the vesico-ureteral reflux could be a local regeneration of the defective vesicoureteral junction by transplanting living cells to the target site. The aim of this work is to provide a long-term effective treatment by producing bioresorbable microspheres which can act as support matrix for those cells, with the goal of an in vivo transfer of the in vitro cultured cells with a minimal surgical procedure. After microsphere degradation, the cells should be integrated into the muscular structure of the junction. Most innovative is that these are cultured muscle and urothelial cells from the bladder of the same patient.

Thin films of functionalized multiwalled carbon nanotubes as suitable scaffold materials for stem cells proliferation and bone formation

In the field of regenerative medicine, human mesenchymal stem cells envisage extremely promising applications, due to their ability to differentiate into a wide range of connective tissue species on the basis of the substrate on which they grow. For the first time ever reported, we investigated the effects of a thin film of pegylated multiwalled carbon nanotubes spray dried onto preheated coverslips in terms of their ability to influence human mesenchymal stem cells' proliferation, morphology, and final differentiation into osteoblasts. Results clearly indicated that the homogeneous layer of functionalized nanotubes did not show any cytotoxicity and accelerated cell differentiation to a higher extent than carboxylated nanotubes or uncoated coverslips, by creating a more viable microenvironment for stem cells. Interestingly, cell differentiation occurred even in the absence of additional biochemical inducing agents, as evidenced by multiple independent criteria at the transcriptional, protein expression, and functional levels. Taken together, these findings suggest that functionalized carbon nanotubes represent a suitable scaffold toward a very selective differentiation into bone.

Human mesenchymal stem cells: Influence of oxygen pressure on proliferation and chondrogenic differentiation in fibrin glue in vitro

Tissue engineering using biomaterials is a promising solution for cartilage replacement. The purpose of this study was to investigate whether the fibrin sealant Tissucol(R) provides a suitable scaffold for re-implanting stem cells during chondrogenic replacement therapy. Pluripotent stem cells were isolated from adult human bone marrow (hMSCs), cultured and characterized by FACS (CD105+/CD106+, CD45-/CD14-/CD34-). A large-holed porous hMSC-containing fibrin matrix was built that allowed hMSCs to survive throughout the period of culture (42 days) in either proliferation or chondrogenic differentiation medium under normoxic (21% O2) or hypoxic (3% O2) conditions. Morphology (as determined by electron microscopy) and proliferation (Ki67 staining) of the embedded hMSCs did not markedly vary under normoxic and hypoxic culture even after 42 days in culture. The stem cell marker Oct-4 was expressed during the whole culture period. Under chondrogenic differentiation conditions, especially under hypoxic conditions, we observed rounded chondrocyte-like cell types and a chondral phenotype assessed by mRNA expression of collagen II and Alcian blue staining. hMSCs seeded into large-holed porous preparations of Tissucol survive, proliferate and keep their stem cell character. Furthermore, culturing the cells in a corresponding medium induces chondrogenic differentiation, which could be remarkably and significantly enhanced under hypoxic conditions.

Delivery systems for bone growth factors — the new players in skeletal regeneration

Given the challenge of an increasing elderly population, the ability to repair and regenerate traumatised or lost tissue is a major clinical and socio-economic need. Pivotal in this process will be the ability to deliver appropriate growth factors in the repair cascade in a temporal and tightly regulated sequence using appropriately designed matrices and release technologies within a tissue engineering strategy. This review outlines the current concepts and challenges in growth factor delivery for skeletal regeneration and the potential of novel delivery matrices and biotechnologies to influence the healthcare of an increasing ageing population.

Bone engineering-vitalisation of alloplastic and allogenic bone grafts by human osteoblast-like cells

Human osteoblasts on non-sintered hydroxyapatite and demineralised bone matrix (DBX) were analysed in vitro to find out whether they would be suitable for reconstruction of bones in oral surgery. Human osteoblasts were isolated from the jaw during routine dental operations and seeded onto the two biomaterials. Cells were characterised by assay of alkaline phosphatase, detection of type 1 collagen, and production of osteocalcin. After 21 days of cultivation, the cell/biomaterial constructs were examined by scanning electron microscopy, thin sections, and propidium iodide/fluorescein diacetate staining. The osteoblasts formed a vital multiple cell layer on DBX within 3 weeks of cultivation. On hydroxyapatite, the cells showed no tendency to proliferate or migrate onto the synthetic biomaterial, or to form well-spread and viable cell constructs. These findings suggest that surface morphology or the presence of osteoinductive factors may have an important role in the adhesion and proliferation of osteoblasts. Human DBX can be colonised by human osteoblast-like cells in vitro, indicating the potential of allogeneic carriers for future procedures in bone engineering.

Bone regeneration in sinus lifts: comparing tissue-engineered bone and iliac bone

Lifting of the sinus floor is a standard procedure for bony augmentation that enables dental implantation. Although cultivated skin and mucosal grafts are often used in plastic and maxillofacial surgery, tissue-engineered bone has not achieved the same success. We present the clinical results of dental implants placed after the insertion of periosteum-derived, tissue-engineered bone grafts in sinus lifts. Periosteal cells were isolated from biopsy specimens of periosteum, resuspended and cultured. The cell suspension was soaked in polymer fleeces. The cell-polymer constructs were transplanted by sinus lift 8 weeks after harvesting. The patients (n=35) had either one or both sides operated on. Seventeen had a one-stage sinus lift with simultaneous implantation (54 implants). In 18 patients the implants were inserted 3 months after augmentation (64 implants). Selected cases were biopsied. A control group (41 patients: one stage=48 implants, two stage=135 implants) had augmentation with autologous bone only. They were followed up clinically and radiologically for at least 24 months. Both implants and augmentation were significantly more successful in the control group. Failure of augmentation of the tissue-engineered bone was more common after large areas had been augmented. Eleven implants were lost in the study group and only one in the control group. Lifting the sinus floor with autologous bone is more reliable than with tissue-engineered transplants. Although lamellar bone can be found in periosteum-derived, tissue-engineered transplants, the range of indications must be limited.

Tissue engineering in plastic surgery: an up-to-date review of the current literature

Tissue engineering is an interdisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function. This field has enjoyed tremendous growth in the past 10 years fuelled by its potential role in regenerating new tissues and naturally healing injured or diseased organs. Stem cells due to their pluripotentiality and unlimited capacity for self-renewal, may allow significant advances for distinct reconstructive and cosmetic procedures. This review aims at outlining the principles of tissue engineering, focusing on the use of adult-derived stem cells as applied to the research and practice of plastic surgery. Review categories have been divided into tissue engineering of the skin and connective tissue, bone marrow, cartilage, adipose tissue, and breast tissue. An analytical review of the current literature on stem cell technology on the above mentioned areas is presented. There have been reports of side effects and unsuccessful treatments. The key to the progress of tissue engineering is an understanding between basic scientists, biochemical engineers, clinicians, and industry. Although there has been an ongoing research pointing to the enormous potential of using stem cells in cosmetic and reconstructive surgery, at this stage, stem cell therapy is still a hope that has not been fully studied and approved. More long-term studies are needed and many questions remain to be answered.

[New strategies for tissue replacement in the head and neck region]

In recent years there has been an increase in the need for tissue replacement in the head and neck region. The disadvantages of classical reconstructive procedures are donor site morbidity for autologous transplants and the immunogenity of allogenous transplants. Tissue engineering is a promising method for the generation of autologous cartilagenous transplants for plastic and reconstructive surgery for closure of large defects by the use of minimal amounts of material for reconstruction. For this purpose harvested material must be cultivated in suitable culture/carrier systems. One obstacle is the loss of phenotype and function once the cells are detached from their environment (dedifferentiation). Adult mesenchymal stem cells are a valuable cell source for tissue engineering. The underlying strategy of using stem cells is the replacement of functionally compromised cells either by in vitro expanded stem cells or activation of stem cells in the tissue. However, there are still problems regarding valuable markers for cellular differentiation and the controlled differentiation towards a specific phenotype.

Histological and biomechanical properties of regenerated articular cartilage using chondrogenic bone marrow stromal cells with a PLGA scaffold in vivo

The properties of regenerated cartilage using bone marrow-derived mesenchymal stem cells (MSCs) and poly lactic-co-glycolic acid (PLGA) scaffold composites pretreated with TGF-beta3 were investigated and compared to the non-TGF-beta3 treated MSCs/PLGA composites in a rabbit model. We prepared MSCs/PLGA scaffold composites and pretreated it with TGF-beta3 for 3 weeks prior to transplantation. Then, composites were transplanted to the osteochondral defect in the rabbit knee. After 12 weeks of transplantation, 10 of the 12 rabbits in which TGF-beta3 pretreated MSCs/PLGA scaffold composites were transplanted showed cartilaginous regeneration. In gross morphology, regenerated cartilage showed smooth, flush, and transparent features. In indentation test, this had about 80% of Young's modulus of normal articular cartilage. Histological examination demonstrated hyaline like cartilage structures with glycosaminoglycan and type II collagen expression. Histological scores were not statistically different to the normal articular cartilage. These results showed improvement of cartilage regeneration compared to the non-TGF-beta3 pretreated MSCs/PLGA scaffold composite transplanted group. Thus, we have successfully regenerated improved hyaline-like cartilage and determined the feasibility of treating damaged articular cartilage using MSCs/PLGA scaffold composite pretreated with TGF-beta3. Also, we suggest this treatment modality as another concept of cartilage tissue engineering.

Maxillary sinus floor elevation using a tissue-engineered bone complex with OsteoBone and bMSCs in rabbits

OBJECTIVES

To evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex with OsteoBone(trade mark) and bone marrow stromal cells (bMSCs) in rabbits.

MATERIAL AND METHODS

Autologous bMSCs from adult New Zealand rabbits were cultured and combined with OsteoBone(trade mark) at a concentration of 20 x 10(6) cells/ml in vitro. Twenty-four animals were used and randomly allocated into groups. For each time point, 16 maxillary sinus floor elevation surgeries were made bilaterally in eight animals and randomly repaired by bMSCs/material (i.e. OsteoBone), material, autogenous bone and blood clot (n=4 per group). A polychrome sequential fluorescent labeling was also performed post-operatively. The animals were sacrificed 2, 4 and 8 weeks after the procedure and evaluated histologically as well as histomorphometrically.

RESULTS

New bone area significantly decreased from weeks 2 to 8 in the blood clot group, while bone area in the autologous bone reduced from weeks 4 to 8. In both groups, a significant amount of fatty tissue appeared at week 8. Accordingly, augmented height in both groups was also significantly decreased from weeks 2 to 8. The bone area in the material-alone group as well as in the bMSCs/material group, on the other hand, increased over time. Significantly more newly formed bone area and mineralization was observed in the center of the raised space in the bMSCs/material group than in the material-alone group. The augmented height was maintained in these two groups throughout the course of this study.

CONCLUSION

These results suggest that OsteoBone can successfully be used as a bone graft substitute and that the combination of this material with bMSCs can effectively promote new bone formation in sinus elevation.

Solvent-Free Protein Encapsulation within Biodegradable Polymer Foams

Microporous poly(D,L-lactide-co-glycolide) matrices containing encapsulated proteins were fabricated in a solvent-free manner. Microporous foam was generated by saturating a mixture of polymer and protein particles in supercritical carbon dioxide (SC-CO2), dispersing the protein particles in the polymer melt followed by a rapid evaporation of the CO2 phase. The release rates of protein encapsulated within porous poly(lactide-co-glycolide)(PLGA) constructs produced in SC-CO2 were measured in vitro. Although a substantial amount of protein was released within the first 48 h, results indicated that protein may be dispersed throughout the polymer phase and released over 3 weeks using this solvent-free technique. Basic fibroblast growth factor (bFGF), known to promote angiogenesis in vivo, was encapsulated within the polymer matrix. In addition, retention of biological activity was measured for bFGF encapsulated within PLGA foams. Encapsulated bFGF was released from the porous constructs for up to 10 days in vitro with little loss of biological activity.

Seeding Osteoblastic Cells into a Macroporous Biodegradable CaP/PLGA Scaffold by a Centrifugal Force

This study aims to construct a hybrid biomaterial by seeding osteoblastic cells into a CaP/PLGA scaffold by a centrifugal force. Constructs are evaluated with respect to potential application in bone tissue engineering. Cells adher, spread, and form a layer of tissue lining the scaffold and are capable of migrating, proliferating, and producing mineralized matrix. We have demonstrated that the centrifugal force is highly efficient for constructing a hybrid biomaterial, which acts similarly to bone explants in a cell culture environment. In this way, these constructs could mimic an autogenous bone graft in clinical circumstances. Such a strategy may be useful for bone tissue engineering.