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Mazy D, Jafari A, Savoji H, Nault ML. Advances in bioadhesives for meniscal repair: A comprehensive review and criteria for the ideal candidate. J Orthop 2024; 56:82-86. [PMID: 38800588 PMCID: PMC11127183 DOI: 10.1016/j.jor.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
The latest studies agree that meniscal tears that require surgery should be repaired whenever possible to avoid early-onset osteoarthritis secondary to meniscectomy. Unfortunately, there are several limitations associated with meniscal sutures, making it difficult to put into practice the theory behind the concept of saving the meniscus. Meanwhile, there is an exponential growth in the use of tissue adhesives for surgery, but finding one suited to meniscal repair remains a struggle. This review has two main goals (1) to compile the various bioadhesives used in this field and (2) to list the criteria for an ideal meniscal bioadhesive. The review was conducted in PubMed, Google Scholar, and Web of Science in November 2023 without date restrictions. The inclusion criteria were: Studies published in English and focusing on meniscal repair using bioadhesives. The exclusion criteria were: Studies published in languages other than English. Adhesives used in combination with sutures, as the aim was to determine the adhesive's capabilities for meniscal repair alone. Synthetic adhesives such as polycyanoacrylates, polyethylene glycol, polyurethanes, and polyesters. Among the 11 bioadhesives found, fibrin is the only one that has been studied in humans. There are advantages and disadvantages to all the bioadhesives identified but none that fully meet the requirements for meniscal repair. The anatomy of meniscal tissue is complex and poses unique challenges that are compounded by arthroscopic stresses. The future of meniscal repair probably lies in combining the advantages of several bioadhesives, and this area should be the focus of future research.
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Affiliation(s)
- David Mazy
- University of Montreal, 2900 Boul. Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- CHU Sainte-Justine, 3175 Chemin de La Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada
| | - Arman Jafari
- Institute of Biomedical Engineering, Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
- Azrieli Research Center CHU Sainte-Justine, Sainte-Justine University Hospital, Montreal, QC, H3T 1C5, Canada
- Montreal TransMedTech Institute, 2900 Boul. Édouard-Montpetit Montreal, QC, H3T 1J4, Canada
| | - Houman Savoji
- Institute of Biomedical Engineering, Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, QC, H3T 1J4, Canada
- Azrieli Research Center CHU Sainte-Justine, Sainte-Justine University Hospital, Montreal, QC, H3T 1C5, Canada
- Montreal TransMedTech Institute, 2900 Boul. Édouard-Montpetit Montreal, QC, H3T 1J4, Canada
| | - Marie-Lyne Nault
- University of Montreal, 2900 Boul. Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- CHU Sainte-Justine, 3175 Chemin de La Côte-Sainte-Catherine, Montréal, QC H3T 1C5, Canada
- CIUSSS Hôpital Du Sacré-Coeur de Montréal (HSCM), Department of Orthopedic Surgery, 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada
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Mazy D, Wang J, Dodin P, Lu D, Moldovan F, Nault ML. Emerging biologic augmentation strategies for meniscal repair: a systematic review. BMC Musculoskelet Disord 2024; 25:541. [PMID: 39003467 PMCID: PMC11245777 DOI: 10.1186/s12891-024-07644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Meniscal repair should be the gold standard. However, the meniscus is poorly vascularized and even an excellent meniscus repair may not heal. Therefore, numerous studies and systematic reviews have been carried out on platelet-rich plasma (PRP), mesenchymal stem cells (MSCs) and fibrin clots for meniscal augmentation, but the results remain controversial. This systematic review aimed to identify other emerging strategies for meniscal repair augmentation and to assess whether there are different avenues to explore in this field. METHODS A systematic literature review was conducted in August 2022. PubMed, Ovid MEDLINE(R) all, Ovid All EBM Reviews, Ovid Embase and ISI Web of Science databases were searched. In Vivo animal and human studies concerning the biological augmentation of meniscal lesions by factors other than PRP, MSCs or fibrin clots were included. Cartilage-only studies, previous systematic reviews and expert opinions were excluded. All data were analyzed by two independent reviewers. RESULTS Of 8965 studies only nineteen studies covering 12 different factors met the inclusion criteria. Eight studies investigated the use of growth factors for meniscal biologic augmentation, such as vascular endothelial growth factor or bone morphogenic protein 7. Five studies reported on cell therapy and six studies focused on other factors such as hyaluronic acid, simvastatin or atelocollagen. Most studies (n = 18) were performed on animal models with gross observation and histological evaluation as outcomes. Polymerase chain reaction and immunohistochemistry were also common. Biomechanical testing was the object of only two studies. CONCLUSIONS Although several augmentation strategies have been attempted, none has yielded conclusive results, testifying to a lack of understanding with regard to meniscal healing. More research is needed to better understand the pathways that regulate meniscus repair and how to act positively on them. LEVEL OF EVIDENCE Systematic review of case-control and animal laboratory studies.
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Affiliation(s)
- David Mazy
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada
| | - Jessica Wang
- Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Philippe Dodin
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada
| | - Daisy Lu
- Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Florina Moldovan
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada.
- Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
- CHU Sainte-Justine Azrieli Research Center, Montréal, 7905-3175 Côte Ste-Catherine, H3T 1J4, QC, Canada.
- Department of Orthopedic Surgery, CIUSSS Hôpital du Sacré-Cœur de Montréal (HSCM), 5400, Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
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Bandyopadhyay A, Ghibhela B, Mandal BB. Current advances in engineering meniscal tissues: insights into 3D printing, injectable hydrogels and physical stimulation based strategies. Biofabrication 2024; 16:022006. [PMID: 38277686 DOI: 10.1088/1758-5090/ad22f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
The knee meniscus is the cushioning fibro-cartilage tissue present in between the femoral condyles and tibial plateau of the knee joint. It is largely avascular in nature and suffers from a wide range of tears and injuries caused by accidents, trauma, active lifestyle of the populace and old age of individuals. Healing of the meniscus is especially difficult due to its avascularity and hence requires invasive arthroscopic approaches such as surgical resection, suturing or implantation. Though various tissue engineering approaches are proposed for the treatment of meniscus tears, three-dimensional (3D) printing/bioprinting, injectable hydrogels and physical stimulation involving modalities are gaining forefront in the past decade. A plethora of new printing approaches such as direct light photopolymerization and volumetric printing, injectable biomaterials loaded with growth factors and physical stimulation such as low-intensity ultrasound approaches are being added to the treatment portfolio along with the contemporary tear mitigation measures. This review discusses on the necessary design considerations, approaches for 3D modeling and design practices for meniscal tear treatments within the scope of tissue engineering and regeneration. Also, the suitable materials, cell sources, growth factors, fixation and lubrication strategies, mechanical stimulation approaches, 3D printing strategies and injectable hydrogels for meniscal tear management have been elaborated. We have also summarized potential technologies and the potential framework that could be the herald of the future of meniscus tissue engineering and repair approaches.
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Affiliation(s)
- Ashutosh Bandyopadhyay
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Baishali Ghibhela
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
| | - Biman B Mandal
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati, Assam, 781039, India
- Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
- Jyoti and Bhupat Mehta School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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Bai MY, Vy VPT, Tang SL, Hung TNK, Wang CW, Liang JY, Wong CC, Chan WP. Current Progress of Platelet-Rich Derivatives in Cartilage and Joint Repairs. Int J Mol Sci 2023; 24:12608. [PMID: 37628786 PMCID: PMC10454586 DOI: 10.3390/ijms241612608] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, several types of platelet concentrates have been investigated and applied in many fields, particularly in the musculoskeletal system. Platelet-rich fibrin (PRF) is an autologous biomaterial, a second-generation platelet concentrate containing platelets and growth factors in the form of fibrin membranes prepared from the blood of patients without additives. During tissue regeneration, platelet concentrates contain a higher percentage of leukocytes and a flexible fibrin net as a scaffold to improve cell migration in angiogenic, osteogenic, and antibacterial capacities during tissue regeneration. PRF enables the release of molecules over a longer period, which promotes tissue healing and regeneration. The potential of PRF to simulate the physiology and immunology of wound healing is also due to the high concentrations of released growth factors and anti-inflammatory cytokines that stimulate vessel formation, cell proliferation, and differentiation. These products have been used safely in clinical applications because of their autologous origin and minimally invasive nature. We focused on a narrative review of PRF therapy and its effects on musculoskeletal, oral, and maxillofacial surgeries and dermatology. We explored the components leading to the biological activity and the published preclinical and clinical research that supports its application in musculoskeletal therapy. The research generally supports the use of PRF as an adjuvant for various chronic muscle, cartilage, and tendon injuries. Further clinical trials are needed to prove the benefits of utilizing the potential of PRF.
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Affiliation(s)
- Meng-Yi Bai
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
- Adjunct Appointment to the Department of Biomedical Engineering, National Defense Medical Center, Taipei 11490, Taiwan
| | - Vu Pham Thao Vy
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Radiology, Thai Nguyen National Hospital, Thai Nguyen 24000, Vietnam
| | - Sung-Ling Tang
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 11490, Taiwan
| | | | - Ching-Wei Wang
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
| | - Jui-Yuan Liang
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chin-Chean Wong
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11011, Taiwan
- International Ph.D. Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 11011, Taiwan
| | - Wing P. Chan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116081, Taiwan
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Xue A, Mao Z, Zhu X, Yang Q, Wang P, Mao Z, Du M, Ma X, Jiang D, Fan Y, Zhao F. Biomechanical effects of the medial meniscus horizontal tear and the resection strategy on the rabbit knee joint under resting state: finite element analysis. Front Bioeng Biotechnol 2023; 11:1164922. [PMID: 37425368 PMCID: PMC10324406 DOI: 10.3389/fbioe.2023.1164922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
The biomechanical changes following meniscal tears and surgery could lead to or accelerate the occurrence of osteoarthritis. The aim of this study was to investigate the biomechanical effects of horizontal meniscal tears and different resection strategies on a rabbit knee joint by finite element analysis and to provide reference for animal experiments and clinical research. Magnetic resonance images of a male rabbit knee joint were used to establish a finite element model with intact menisci under resting state. A medial meniscal horizontal tear was set involving 2/3 width of a meniscus. Seven models were finally established, including intact medial meniscus (IMM), horizontal tear of the medial meniscus (HTMM), superior leaf partial meniscectomy (SLPM), inferior leaf partial meniscectomy (ILPM), double-leaf partial meniscectomy (DLPM), subtotal meniscectomy (STM), and total meniscectomy (TTM). The axial load transmitted from femoral cartilage to menisci and tibial cartilage, the maximum von Mises stress and the maximum contact pressure on the menisci and cartilages, the contact area between cartilage to menisci and cartilage to cartilage, and absolute value of the meniscal displacement were analyzed and evaluated. The results showed that the HTMM had little effect on the medial tibial cartilage. After the HTMM, the axial load, maximum von Mises stress and maximum contact pressure on the medial tibial cartilage increased 1.6%, 1.2%, and 1.4%, compared with the IMM. Among different meniscectomy strategies, the axial load and the maximum von Mises stress on the medial menisci varied greatly. After the HTMM, SLPM, ILPM, DLPM, and STM, the axial load on medial menisci decreased 11.4%, 42.2%, 35.4% 48.7%, and 97.0%, respectively; the maximum von Mises stress on medial menisci increased 53.9%, 62.6%, 156.5%, and 65.5%, respectively, and the STM decreased 57.8%, compared to IMM. The radial displacement of the middle body of the medial meniscal was larger than any other part in all the models. The HTMM led to few biomechanical changes in the rabbit knee joint. The SLPM showed minimal effect on joint stress among all resection strategies. It is recommended to preserve the posterior root and the remaining peripheral edge of the meniscus during surgery for an HTMM.
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Affiliation(s)
- Anqi Xue
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Beijing Institute of Medical Device Testing, Beijing, China
| | - Zuming Mao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaoyu Zhu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Qiang Yang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Peichen Wang
- Beijing Institute of Medical Device Testing, Beijing, China
| | - Zimu Mao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Mingze Du
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xu Ma
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Feng Zhao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Jin P, Liu L, Chen X, Cheng L, Zhang W, Zhong G. Applications and prospects of different functional hydrogels in meniscus repair. Front Bioeng Biotechnol 2022; 10:1082499. [PMID: 36568293 PMCID: PMC9773848 DOI: 10.3389/fbioe.2022.1082499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
The meniscus is a kind of fibrous cartilage structure that serves as a cushion in the knee joint to alleviate the mechanical load. It is commonly injured, but it cannot heal spontaneously. Traditional meniscectomy is not currently recommended as this treatment tends to cause osteoarthritis. Due to their good biocompatibility and versatile regulation, hydrogels are emerging biomaterials in tissue engineering. Hydrogels are excellent candidates in meniscus rehabilitation and regeneration because they are fine-tunable, easily modified, and capable of delivering exogenous drugs, cells, proteins, and cytokines. Various hydrogels have been reported to work well in meniscus-damaged animals, but few hydrogels are effective in the clinic, indicating that hydrogels possess many overlooked problems. In this review, we summarize the applications and problems of hydrogels in extrinsic substance delivery, meniscus rehabilitation, and meniscus regeneration. This study will provide theoretical guidance for new therapeutic strategies for meniscus repair.
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Affiliation(s)
- Pan Jin
- Health Science Center, Yangtze University, Jingzhou, China,Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, China,*Correspondence: Pan Jin, ; Gang Zhong,
| | - Lei Liu
- Articular Surgery, The Second Nanning People’s Hospital (Third Affiliated Hospital of Guangxi Medical University), Nanning, China
| | - Xichi Chen
- Health Science Center, Yangtze University, Jingzhou, China
| | - Lin Cheng
- Health Science Center, Yangtze University, Jingzhou, China
| | - Weining Zhang
- Health Science Center, Yangtze University, Jingzhou, China
| | - Gang Zhong
- Center for Materials Synthetic Biology, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China,*Correspondence: Pan Jin, ; Gang Zhong,
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Mahmoud EE, Mawas AS, Mohamed AA, Noby MA, Abdel-Hady ANA, Zayed M. Treatment strategies for meniscal lesions: from past to prospective therapeutics. Regen Med 2022; 17:547-560. [PMID: 35638397 DOI: 10.2217/rme-2021-0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Menisci play an important role in the biomechanics of knee joint function, including loading transmission, joint lubrication, prevention of soft tissue impingement during motion and joint stability. Meniscal repair presents a challenge due to a lack of vascularization that limits the healing capacity of meniscal tissue. In this review, the authors aimed to untangle the available treatment options for repairing meniscal tears. Various surgical procedures have been developed to treat meniscal tears; however, clinical outcomes are limited. Consequently, numerous researchers have focused on different treatments such as the application of exogenous and/or autologous growth factors, scaffolds including tissue-derived matrix, cell-based therapy and miRNA-210. The authors present current and prospective treatment strategies for meniscal lesions.
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Affiliation(s)
- Elhussein E Mahmoud
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Amany S Mawas
- Department of Pathology & Clinical Pathology, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Alsayed A Mohamed
- Department of Anatomy & Embryology, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | - Mohammed A Noby
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | | | - Mohammed Zayed
- Department of Surgery, College of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
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Hutchinson ID, Rodeo SA. The Current Role of Biologics for Meniscus Injury and Treatment. Curr Rev Musculoskelet Med 2022; 15:456-464. [PMID: 35881326 PMCID: PMC9789233 DOI: 10.1007/s12178-022-09778-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW There is little doubt that the consensus has changed to favor preservation of meniscal function where possible. Accordingly, the indications for meniscal repair strategies have been refocused on the long-term interest of knee joint health. The development and refinements in surgical technique have been complemented by biological augmentation strategies to address intrinsic challenges in healing capacity of meniscal tissue, with variable effects. RECENT FINDINGS A contemporary approach to meniscal healing includes adequate surgical fixation, meniscal and synovial tissue stimulation, and management of the intraarticular milieu. Overall, evidence supporting the use of autogenous or allogeneic cell sources remains limited. The use of FDA-approved medications to effect biologically favorable mechanisms during meniscal healing holds promise. Development and characterization of biologics continue to advance with translational research focused on specific growth factors, cell and tissue behaviors in meniscal healing, and joint homeostasis. Although significant strides have been made in laboratory and pre-clinical studies, translation to clinical application remains challenging. Finally, expert consensus and standardization of nomenclature related to orthobiologics for meniscal preservation will be important for the advancement of this field.
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Affiliation(s)
- Ian D. Hutchinson
- grid.239915.50000 0001 2285 8823Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,grid.239915.50000 0001 2285 8823Laboratory for Tissue Engineering, Regeneration & Repair, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Scott A. Rodeo
- grid.239915.50000 0001 2285 8823Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,grid.239915.50000 0001 2285 8823Laboratory for Tissue Engineering, Regeneration & Repair, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Deng Y, Tong ZM, Dai Z, Chen ZW. Regeneration of meniscal avascular zone using autogenous meniscal fragments in a rabbit model. BMC Surg 2022; 22:209. [PMID: 35643544 PMCID: PMC9148493 DOI: 10.1186/s12893-022-01663-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the effects of autologous meniscus fragment (AMF) implantation on injury in the meniscal avascular zone in mature rabbits. Methods Adult New Zealand white rabbits were randomly divided into two groups. Massive one-piece meniscus tissue was implanted in situ as control. In the experimental group, AMF was used to repair the meniscal injury in the avascular zone. Meniscal damage was assessed by gross observation of the degree of healing and histological semi-quantitative evaluation within 12 weeks postoperatively. The healing of meniscus interface was assessed by gross observation semiquantitative scoring and microscopic examination hematoxylin and eosin (H&E) staining at 2, 4, 8, and 12 weeks after surgery. The expressions of proliferating cell nuclear antigen (PCNA), collagen type I (COL1A1), and collagen type II (COL2) were detected by immunohistochemical staining. Results The degree of healing in the AMF group showed a significant increase over time (P < 0.05); the AMF group showed higher gross scores than the control group at 4, 8, and 12 weeks after surgery (P < 0.05). The histological scores in the AMF group were significantly higher than those in the control group at 4, 8, and 12 weeks after surgery (P < 0.05). The protein expression of PCNA in the AMF group was greater than that in the control group at 2, 4, and 8 weeks after surgery (P < 0.05). In addition, compared with the control group, the protein levels of COL1A1 and COL2 were significantly upregulated at each time-point. At 2 and 4 weeks after surgery, the expression level of COL1A1 increased in both groups followed by a gradual decrease after 8 weeks (P < 0.05). At 2, 4, 8, and 12 weeks after surgery, the expression levels of COL2 showed a gradual decrease in both groups (P < 0.05). Conclusions Our study demonstrated that the AMF method can promote the repair of rabbit meniscal injury in the avascular zone, and this method may potentially be used for clinical application. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01663-3.
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Hashimoto Y, Nishino K, Orita K, Yamasaki S, Nishida Y, Kinoshita T, Nakamura H. Biochemical Characteristics and Clinical Result of Bone Marrow-Derived Fibrin Clot for Repair of Isolated Meniscal Injury in the Avascular Zone. Arthroscopy 2022; 38:441-449. [PMID: 34052371 DOI: 10.1016/j.arthro.2021.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize bone marrow aspirate-derived fibrin clot (BMA clot) and evaluate the clinical result of meniscal repair with a BMA clot for isolated meniscal injury in the avascular zone. METHODS Blood counts of total leukocytes, platelets, and concentrations of basic fibroblast growth factor (bFGF), transforming growth factor β (TGF-β), and stromal cell-derived factor 1 (SDF-1) were analyzed with BMA, peripheral blood (PB), BMA clot, and PB clot from 5 patients treated for meniscal repair. In addition, a retrospective analysis of 30 patients with isolated avascular meniscal injuries who underwent repair with a BMA clot was performed to assess rate failure. Avascular meniscal injury was identified as horizontal tear, radial tear, and flap tear. Clinical failure was defined as the presence of 1 or more of Barrett's criteria. Anatomic failure was defined as the existence of equivalent signal intensity to intra-articular fluid along the repair area on follow-up magnetic resonance imaging (MRI). Patients' demographic and clinical data were compared between the overall failure group and the success group. RESULTS The bFGF, TGF-β, and SDF-1 levels of BMA clots were more highly concentrated compared with PB clots. The Lysholm scores and meniscal status evaluated by MRI were significantly improved from preoperatively to postoperatively (both P < .001). The Kellgren-Lawrence grading of knee radiographs did not significantly differ pre- and postoperatively (P = .140). Rates of clinical failure, anatomic failure, and retear were 10%, 6.7%, and 3.3%, respectively. The demographic characteristics and surgical and postoperative status did not significantly differ between the overall failure group and the success group. CONCLUSIONS BMA clots had increased levels of cytokines compared to PB clots. The retrospective analysis revealed that the rates of clinical failure and anatomic failure after meniscal repair with a BMA clot for isolated avascular meniscal injury were 10% and 6.7%, respectively. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kumi Orita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
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11
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Xu S, Qiu Y, Tao J. The challenges and optimization of cell-based therapy for cardiovascular disease. J Transl Int Med 2021; 9:234-238. [PMID: 35136722 PMCID: PMC8802397 DOI: 10.2478/jtim-2021-0017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
With the hope of achieving real cardiovascular repair, cell-based therapy raised as a promising strategy for the treatment of cardiovascular disease (CVD) in the past two decades. Various types of cells have been studied for their reparative potential for CVD in the ensuing years. Despite the exciting results from animal experiments, the outcome of clinical trials is unsatisfactory and the development of cell-based therapy for CVD has hit a plateau nowadays. Thus, it is important to summarize the obstacles we are facing in this field in order to explore possible solutions for optimizing cell-based therapy and achieving real clinical application.
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Affiliation(s)
- Shiyue Xu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou510080, Guangdong Province, China
- Department of Biomedical Engineering, Molecular Cardiology Program, School of Medicine and School of Engineering, University of Alabama at BirminghamBirminghamUnited States
| | - Yumin Qiu
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou510080, Guangdong Province, China
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou510080, Guangdong Province, China
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12
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Nakagawa K, Otsuki S, Murakami T, Okamoto Y, Okuno N, Wakama H, Sezaki S, Ikeda K, Okayoshi T, Neo M. Histological Analysis of the Wrapping Treatment for Meniscal Horizontal Tears in Rabbits. Cartilage 2021; 13:1551S-1561S. [PMID: 31466462 PMCID: PMC8804842 DOI: 10.1177/1947603519870838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate meniscal regeneration and prevent cartilage degeneration using wrapping treatment for meniscal horizontal tears that have been difficult to repair in rabbits. DESIGN Thirty knees from 15 Japanese white rabbits were divided into the horizontal (horizontal tears) or wrapping (horizontal tears with wrapping treatment) groups. Horizontal tears were created and wrapped with a sheet scaffold containing polyglycolic acid, polylactic acid, and polycaprolactone. The meniscus was stained with Safranin-O/Fast Green and evaluated with modified Pauli scores at 8, 12, and 16 weeks after implantation (n = 5). Cell morphology was determined with hematoxylin and eosin staining. Mature collagen was confirmed with Picrosirius Red staining. Furthermore, immunohistochemical analysis of inducible nitric oxide synthase (iNOS) for inflammation, Ki-67 for proliferation, and type II collagen for regeneration was performed. Medial femoral cartilage was stained with Safranin-O/Fast Green and evaluated with the Osteoarthritis Research Society International score at 8 and 16 weeks. RESULTS The wrapping group had significantly better regeneration than the horizontal group, especially at 16 weeks (P < 0.05). Wrapping treatment induced fibrochondrocyte-like cells at 16 weeks. After wrapping treatment, iNOS was overexpressed at 8 weeks, Ki-67 at 8 and 12 weeks, and type II collagen at 16 weeks. Cartilage degeneration in the wrapping group did not progress significantly compared with that in the horizontal group at 16 weeks (P < 0.05). CONCLUSIONS Wrapping treatment for meniscal horizontal tears induced meniscal regeneration as the sheet scaffold might induce intrinsic and extrinsic repair. Regaining the meniscal function by the wrapping treatment prevented cartilage degeneration.
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Affiliation(s)
- Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan,Shuhei Otsuki, Department of Orthopedic
Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki-city, Osaka
569-8686, Japan.
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Shunsuke Sezaki
- Department of QOL Research Center
Laboratory, Gunze Limited, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka
Medical College, Takatsuki, Osaka, Japan
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13
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Cell-Based Transplantation versus Cell Homing Approaches for Pulp-Dentin Complex Regeneration. Stem Cells Int 2021; 2021:8483668. [PMID: 34646323 PMCID: PMC8505125 DOI: 10.1155/2021/8483668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/01/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022] Open
Abstract
Regenerative dentistry has paved the way for a new era for the replacement of damaged dental tissues. Whether the causative factor is dental caries, trauma, or chemical insult, the loss of the pulp vitality constitutes one of the major health problems worldwide. Two regenerative therapies were introduced for a fully functional pulp-dentin complex regeneration, namely, cell-based (cell transplantation) and cell homing (through revascularization or homing by injection of stem cells in situ or intravenously) therapies, with each demonstrating advantages as well as drawbacks, especially in clinical application. The present review is aimed at elaborating on these two techniques in the treatment of irreversibly inflamed or necrotic pulp, which is aimed at regenerating a fully functional pulp-dentin complex.
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14
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Li H, Li P, Yang Z, Gao C, Fu L, Liao Z, Zhao T, Cao F, Chen W, Peng Y, Yuan Z, Sui X, Liu S, Guo Q. Meniscal Regenerative Scaffolds Based on Biopolymers and Polymers: Recent Status and Applications. Front Cell Dev Biol 2021; 9:661802. [PMID: 34327197 PMCID: PMC8313827 DOI: 10.3389/fcell.2021.661802] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
Knee menisci are structurally complex components that preserve appropriate biomechanics of the knee. Meniscal tissue is susceptible to injury and cannot heal spontaneously from most pathologies, especially considering the limited regenerative capacity of the inner avascular region. Conventional clinical treatments span from conservative therapy to meniscus implantation, all with limitations. There have been advances in meniscal tissue engineering and regenerative medicine in terms of potential combinations of polymeric biomaterials, endogenous cells and stimuli, resulting in innovative strategies. Recently, polymeric scaffolds have provided researchers with a powerful instrument to rationally support the requirements for meniscal tissue regeneration, ranging from an ideal architecture to biocompatibility and bioactivity. However, multiple challenges involving the anisotropic structure, sophisticated regenerative process, and challenging healing environment of the meniscus still create barriers to clinical application. Advances in scaffold manufacturing technology, temporal regulation of molecular signaling and investigation of host immunoresponses to scaffolds in tissue engineering provide alternative strategies, and studies have shed light on this field. Accordingly, this review aims to summarize the current polymers used to fabricate meniscal scaffolds and their applications in vivo and in vitro to evaluate their potential utility in meniscal tissue engineering. Recent progress on combinations of two or more types of polymers is described, with a focus on advanced strategies associated with technologies and immune compatibility and tunability. Finally, we discuss the current challenges and future prospects for regenerating injured meniscal tissues.
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Affiliation(s)
- Hao Li
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Pinxue Li
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yang
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Cangjian Gao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Liwei Fu
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Zhiyao Liao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Tianyuan Zhao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Fuyang Cao
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Wei Chen
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Yu Peng
- School of Medicine, Nankai University, Tianjin, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Sui
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Shuyun Liu
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Quanyi Guo
- The First Medical Center, Chinese PLA General Hospital, Institute of Orthopedics, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Beijing, China.,Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
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15
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Fardous J, Yamamoto E, Omoso Y, Nagao S, Inoue Y, Yoshida K, Ikegami Y, Zhang Y, Shirakigawa N, Ono F, Ijima H. Development of a gel-in-oil emulsion as a transdermal drug delivery system for successful delivery of growth factors. J Biosci Bioeng 2021; 132:95-101. [PMID: 33883072 DOI: 10.1016/j.jbiosc.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
Growth factors (GFs) are indispensable in regenerative medicine because of their high effectiveness. However, as GFs degenerate easily, the development of a suitable carrier with improved stability for GFs is necessary. In this study, we developed a gel-in-oil (G/O) emulsion technology for the transdermal delivery of growth factors. Nanogel particles prepared with heparin-immobilized gelatin that can bind growth factors were dispersed in isopropyl myristate. The particle size of the G/O emulsion could be controlled by changing the surfactant concentration, volume ratio of the water phase to the oil phase, and gelatin concentration. In vitro skin penetration studies showed better penetration through the stratum corneum of fluorescent proteins containing G/O emulsions than of the aqueous solution of GF. Similarly, an in vivo study showed an angiogenesis-inducing effect after transdermal application of GF-immobilized G/O emulsion. Angiogenesis in mice was confirmed owing to both an increased blood vessel network and higher hemoglobin content in the blood. Therefore, the G/O emulsion could be a promising carrier for GFs with better stability and can effectively deliver GFs at the target site.
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Affiliation(s)
- Jannatul Fardous
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Emiko Yamamoto
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Yuji Omoso
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Seiya Nagao
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Yuuta Inoue
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Kozue Yoshida
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Yasuhiro Ikegami
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Yi Zhang
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Nana Shirakigawa
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
| | - Fumiyasu Ono
- Global Innovation Center, Kyushu University, Fukuoka Industry-Academia Symphonicity, 4-1 Kyudai-Shinmachi, Nishi-ku, Fukuoka-city, Fukuoka 819-0388, Japan.
| | - Hiroyuki Ijima
- Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 819-0395, Japan.
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16
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Li H, Yang Z, Fu L, Yuan Z, Gao C, Sui X, Liu S, Peng J, Dai Y, Guo Q. Advanced Polymer-Based Drug Delivery Strategies for Meniscal Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:266-293. [PMID: 32988289 DOI: 10.1089/ten.teb.2020.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The meniscus plays a critical role in maintaining knee joint homeostasis. Injuries to the meniscus, especially considering the limited self-healing capacity of the avascular region, continue to be a challenge and are often treated by (partial) meniscectomy, which has been identified to cause osteoarthritis. Currently, meniscus tissue engineering focuses on providing extracellular matrix (ECM)-mimicking scaffolds to direct the inherent meniscal regeneration process, and it has been found that various stimuli are essential. Numerous bioactive factors present benefits in regulating cell fate, tissue development, and healing, but lack an optimal delivery system. More recently, bioengineers have developed various polymer-based drug delivery systems (PDDSs), which are beneficial in terms of the favorable properties of polymers as well as novel delivery strategies. Engineered PDDSs aim to provide not only an ECM-mimicking microenvironment but also the controlled release of bioactive factors with release profiles tailored according to the biological concerns and properties of the factors. In this review, both different polymers and bioactive factors involved in meniscal regeneration are discussed, as well as potential candidate systems, with examples of recent progress. This article aims to summarize drug delivery strategies in meniscal regeneration, with a focus on novel delivery strategies rather than on specific delivery carriers. The current challenges and future prospects for the structural and functional regeneration of the meniscus are also discussed. Impact statement Meniscal injury remains a clinical Gordian knot owing to the limited healing potential of the region, restricted surgical approaches, and risk of inducing osteoarthritis. Existing tissue engineering scaffolds that provide mechanical support and a favorable microenvironment also lack biological cues. Advanced polymer-based delivery strategies consisting of polymers incorporating bioactive factors have emerged as a promising direction. This article primarily reviews the types and applications of biopolymers and bioactive factors in meniscal regeneration. Importantly, various carrier systems and drug delivery strategies are discussed with the hope of inspiring further advancements in this field.
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Affiliation(s)
- Hao Li
- School of Medicine, Nankai University, Tianjin, China.,Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
| | - Zhen Yang
- School of Medicine, Nankai University, Tianjin, China.,Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
| | - Liwei Fu
- School of Medicine, Nankai University, Tianjin, China.,Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
| | - Zhiguo Yuan
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China.,Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Cangjian Gao
- School of Medicine, Nankai University, Tianjin, China.,Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
| | - Xiang Sui
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
| | - Shuyun Liu
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
| | - Jiang Peng
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
| | - Yongjing Dai
- Department of Orthopedic, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Quanyi Guo
- School of Medicine, Nankai University, Tianjin, China.,Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Laboratory of Musculoskeletal Trauma & War Injuries PLA; Beijing, China
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17
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Van Genechten W, Verdonk P, Krych AJ, Saris DB. Biologic Adjuvants in Meniscus Repair: A Review of Current Translational and Clinical Evidence. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Abbadessa A, Crecente-Campo J, Alonso MJ. Engineering Anisotropic Meniscus: Zonal Functionality and Spatiotemporal Drug Delivery. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:133-154. [PMID: 32723019 DOI: 10.1089/ten.teb.2020.0096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Human meniscus is a fibrocartilaginous structure that is crucial for an adequate performance of the human knee joint. Degeneration of the meniscus is often followed by partial or total meniscectomy, which enhances the risk of developing knee osteoarthritis. The lack of a satisfactory treatment for this condition has triggered a major interest in drug delivery (DD) and tissue engineering (TE) strategies intended to restore a bioactive and fully functional meniscal tissue. The aim of this review is to critically discuss the most relevant studies on spatiotemporal DD and TE, aiming for a multizonal meniscal reconstruction. Indeed, the development of meniscal tissue implants should involve a provision for adequate active molecules and scaffold features that take into account the anisotropic ultrastructure of human meniscus. This zonal differentiation is reflected in the meniscus biochemical composition, collagen fiber arrangement, and cell distribution. In this sense, it is expected that a proper combination of advanced DD and zonal TE strategies will play a key role in the future trends in meniscus regeneration. Impact statement Meniscus degeneration is one of the main causes of knee pain, inflammation, and reduced mobility. Currently used suturing procedures and meniscectomy are far from being ideal solutions to the loss of meniscal function. Therefore, drug delivery (DD) and tissue engineering (TE) strategies are currently under investigation. DD systems aim at an in situ controlled release of growth factors, whereas TE strategies aim at mimicking the anisotropy of native meniscus. The goal of this review is to discuss these two main approaches, as well as synergies between them that are expected to lead to a real breakthrough in the field.
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Affiliation(s)
- Anna Abbadessa
- Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), IDIS Research Institute, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Department of Pharmacology, Pharmacy and Pharmaceutical Technology, School of Pharmacy, Campus Vida, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Crecente-Campo
- Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), IDIS Research Institute, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Department of Pharmacology, Pharmacy and Pharmaceutical Technology, School of Pharmacy, Campus Vida, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - María José Alonso
- Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), IDIS Research Institute, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Department of Pharmacology, Pharmacy and Pharmaceutical Technology, School of Pharmacy, Campus Vida, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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19
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Liesveld JL, Sharma N, Aljitawi OS. Stem cell homing: From physiology to therapeutics. Stem Cells 2020; 38:1241-1253. [PMID: 32526037 DOI: 10.1002/stem.3242] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
Stem cell homing is a multistep endogenous physiologic process that is also used by exogenously administered hematopoietic stem and progenitor cells (HSPCs). This multistep process involves cell migration and is essential for hematopoietic stem cell transplantation. The process can be manipulated to enhance ultimate engraftment potential, and understanding stem cell homing is also important to the understanding of stem cell mobilization. Homing is also of potential importance in the recruitment of marrow mesenchymal stem and stromal cells (MSCs) to sites of injury and regeneration. This process is less understood but assumes importance when these cells are used for repair purposes. In this review, the process of HSPC and MSC homing is examined, as are methods to enhance this process.
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Affiliation(s)
- Jane L Liesveld
- James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Naman Sharma
- James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Omar S Aljitawi
- James P. Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, New York, USA
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20
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Carlson Strother CR, Saris DBF, Verdonk P, Nakamura N, Krych AJ. Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Kurnaz R, Balta O. Effect of platelet-rich plasma and platelet-rich fibrin matrix on healing of vertical meniscal tears in a rabbit model. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:186-195. [PMID: 32254035 DOI: 10.5152/j.aott.2020.02.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) on the healing of vertical medial meniscal tears in a rabbit model. METHODS The study was conducted on 72 New Zealand mature rabbits aged more than 6 months. Rabbits were randomly assigned to six groups: control (C) group, meniscal repair (MR) group, PRP group, PRFM group, MR+PRP group, and MR+PRFM group, with 12 rabbits in each group. A 5-mm full-thickness vertical tear was created in the avascular zone of the medial meniscus corpus in the right knee of all rabbits. The respective treatment for each group was given to the meniscal tear in each rabbit. Histological evaluation of healing was performed 6 and 12 weeks after surgery. RESULTS Defect filling and collagen formation remained low in the C group. However, in all other groups, there was no significant difference in the 6th week. In the 12th week, similar results as those obtained in the 6th week were obtained. In the C group, there was a difference in defect filling and cell type. This difference was that the defect filling and collagen formation remained low in the 12th week. No significant difference was observed between MR, MR + PRP and MR + PRFM groups. The MR group significantly differed from the other groups in the defect-filling rate and cell type; however, the use of PRP and PRFM did not provide an obvious benefit. CONCLUSION The contradictory results obtained in previous studies emphasize the need for further research on the use of PRP in meniscal recovery and repair. We believe that if surgery is indicated, repair is absolutely necessary to improve the healing of the tissue in meniscal tears. Studies using human meniscal tissue for meniscal injury and those that evaluate clinical applications of PRP are warranted.
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Affiliation(s)
- Recep Kurnaz
- Department of Orthopaedics and Traumatology, Eskişehir Acıbadem Hospital, Eskişehir, Turkey
| | - Orhan Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa University, School of Medicine, Tokat, Turkey
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22
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Guenoun D, Magalon J, de Torquemada I, Vandeville C, Sabatier F, Champsaur P, Jacquet C, Ollivier M. Treatment of degenerative meniscal tear with intrameniscal injection of platelets rich plasma. Diagn Interv Imaging 2019; 101:169-176. [PMID: 31727602 DOI: 10.1016/j.diii.2019.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/19/2019] [Accepted: 10/03/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this retrospective study was to describe our preliminary results of intra-meniscal administration of platelet rich plasma (PRP) in patients with degenerative meniscal tears of the knee. MATERIAL AND METHOD Ten patients with degenerative meniscal tears according to the Stoller classification and without knee osteoarthritis were included. There were 7 men and 3 women with a mean age of 40.4±13.6 [SD] years (range: 18-59 years). Patients were prospectively assessed at baseline and 3- and 6-months after intra meniscal PRP administration. Evaluation included the knee injury and osteoarthritis outcome score (KOOS), pain visual analog scale, and return to competition and training. MRI follow-up was performed 6 months after PRP administration. Adverse events were recorded. RESULTS Volume of injected PRP was standardized to 4.0mL. Adverse events during PRP administration was moderate pain in 8 patients (8/10; 80%). Mean KOOS total score significantly improved from 56.6±15.7 (SD) to 72.7±18.5 (SD) (P=0.0007). All six patients practicing sports regularly were able to recover competition or training. In seven patients who underwent MRI follow-up at 6 months, MRI showed stability of the meniscal tears and similar Stoller grades. CONCLUSION Intra-meniscal administration of PRP under ultrasound guidance directly into meniscal degenerative lesions is feasible and safe. Further randomized controlled studies are needed to definitely confirm the effectiveness of this procedure.
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Affiliation(s)
- D Guenoun
- Department of Radiology, Sainte-Marguerite Hospital, Institute of Movement and Locomotion, AP-HM, 13009 Marseille, France; CNRS, ISM, Inst Movement Sci, Aix Marseille Université, 13009 Marseille, France.
| | - J Magalon
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France; INSERM, INRA, C2VN, Aix Marseille Université, 13000 Marseille, France
| | - I de Torquemada
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France
| | - C Vandeville
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France
| | - F Sabatier
- Inserm CIC BT 1409, Cell Therapy Department, Conception Hospital, AP-HM, 13000 Marseille, France; INSERM, INRA, C2VN, Aix Marseille Université, 13000 Marseille, France
| | - P Champsaur
- Department of Radiology, Sainte-Marguerite Hospital, Institute of Movement and Locomotion, AP-HM, 13009 Marseille, France; CNRS, ISM, Inst Movement Sci, Aix Marseille Université, 13009 Marseille, France
| | - C Jacquet
- CNRS, ISM UMR 7287, Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Aix Marseille Université, 13288 Marseille, France
| | - M Ollivier
- CNRS, ISM UMR 7287, Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Aix Marseille Université, 13288 Marseille, France
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Feng Z, Fan Y, Guo J, Fu W. [Research progress of scaffold materials for tissue engineered meniscus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1019-1028. [PMID: 31407563 PMCID: PMC8337896 DOI: 10.7507/1002-1892.201810046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 06/26/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To summarize and analyze the research progress of scaffold materials used in tissue engineered meniscus. METHODS The classification and bionics design of scaffold materials were summarized by consulting domestic and foreign literature related to the research of tissue engineered meniscus in recent years. RESULTS Tissue engineered meniscus scaffolds can be roughly classified into synthetic polymers, hydrogels, extracellular matrix components, and tissue derived materials. These different materials have different characteristics, so the use of a single material has its unique disadvantages, and the use of a variety of materials composite scaffolds can learn from each other, which is a hot research area at present. In addition to material selection, material processing methods are also the focus of research. At the same time, according to the morphological structure and mechanical characteristics of the meniscus, the bionic design of tissue engineered meniscus scaffolds has great potential. CONCLUSION At present, there are many kinds of scaffold materials for tissue engineered meniscus. However, there is no material that can completely simulate the natural meniscus, and further research of scaffold materials is still needed.
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Affiliation(s)
- Ziyan Feng
- West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yifei Fan
- West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jiusi Guo
- West China School of Stomatology, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Weili Fu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Cell-Free Strategies for Repair and Regeneration of Meniscus Injuries through the Recruitment of Endogenous Stem/Progenitor Cells. Stem Cells Int 2018; 2018:5310471. [PMID: 30123286 PMCID: PMC6079391 DOI: 10.1155/2018/5310471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022] Open
Abstract
The meniscus plays a vital role in protecting the articular cartilage of the knee joint. The inner two-thirds of the meniscus are avascular, and injuries to this region often fail to heal without intervention. The use of tissue engineering and regenerative medicine techniques may offer novel and effective approaches to repairing meniscal injuries. Meniscal tissue engineering and regenerative medicine typically use one of two techniques, cell-based or cell-free. While numerous cell-based strategies have been applied to repair and regenerate meniscal defects, these techniques possess certain limitations including cellular contamination and an increased risk of disease transmission. Cell-free strategies attempt to repair and regenerate the injured tissues by recruiting endogenous stem/progenitor cells. Cell-free strategies avoid several of the disadvantages of cell-based techniques and, therefore, may have a wider clinical application. This review first compares cell-based to cell-free techniques. Next, it summarizes potential sources for endogenous stem/progenitor cells. Finally, it discusses important recruitment factors for meniscal repair and regeneration. In conclusion, cell-free techniques, which focus on the recruitment of endogenous stem and progenitor cells, are growing in efficacy and may play a critical role in the future of meniscal repair and regeneration.
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Rey-Rico A, Cucchiarini M, Madry H. Hydrogels for precision meniscus tissue engineering: a comprehensive review. Connect Tissue Res 2017; 58:317-328. [PMID: 28051883 DOI: 10.1080/03008207.2016.1276576] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The meniscus plays a pivotal role to preserve the knee joint homeostasis. Lesions to the meniscus are frequent, have a reduced ability to heal, and may induce tibiofemoral osteoarthritis. Current reconstructive therapeutic options mainly focus on the treatment of lesions in the peripheral vascularized region. In contrast, few approaches are capable of stimulating repair of damaged meniscal tissue in the central, avascular portion. Tissue engineering approaches are of high interest to repair or replace damaged meniscus tissue in this area. Hydrogel-based biomaterials are of special interest for meniscus repair as its inner part contains relatively high proportions of proteoglycans which are responsible for the viscoelastic compressive properties and hydration grade. Hydrogels exhibiting high water content and providing a specific three-dimensional (3D) microenvironment may be engineered to precisely resemble this topographical composition of the meniscal tissue. Different polymers of both natural and synthetic origins have been manipulated to produce hydrogels hosting relevant cell populations for meniscus regeneration and provide platforms for meniscus tissue replacement. So far, these compounds have been employed to design controlled delivery systems of bioactive molecules involved in meniscal reparative processes or to host genetically modified cells as a means to enhance meniscus repair. This review describes the most recent advances on the use of hydrogels as platforms for precision meniscus tissue engineering.
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Affiliation(s)
- Ana Rey-Rico
- a Center of Experimental Orthopaedics , Saarland University Medical Center , Homburg/Saar , Germany
| | - Magali Cucchiarini
- a Center of Experimental Orthopaedics , Saarland University Medical Center , Homburg/Saar , Germany
| | - Henning Madry
- a Center of Experimental Orthopaedics , Saarland University Medical Center , Homburg/Saar , Germany.,b Department of Orthopaedic Surgery , Saarland University Medical Center , Homburg/Saar , Germany
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Costa JB, Oliveira JM, Reis RL. Biomaterials in Meniscus Tissue Engineering. REGENERATIVE STRATEGIES FOR THE TREATMENT OF KNEE JOINT DISABILITIES 2017. [DOI: 10.1007/978-3-319-44785-8_13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Tiftikçi U, Serbest S. Repair of isolated horizontal meniscal tears with all-inside suture materials using the overlock method: outcome study with a minimum 2-year follow-up. J Orthop Surg Res 2016; 11:131. [PMID: 27793159 PMCID: PMC5084447 DOI: 10.1186/s13018-016-0466-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to consider the use of a meniscal repair in patients in order to close the horizontal cleavage extending up to the avascular zone. The hypothesis was to examine the clinical and arthroscopic outcomes following meniscal repair of degenerative horizontal cleavage tears with new-generation all-inside suture materials using the overlock method. Methods We retrospectively reviewed a consecutive series of 55 patients which had a horizontal pattern, and finally, 27 patients with a horizontal tear only which required no additional intra-articular surgical intervention were included in the study. Arthroscopic meniscal repair was performed using the overlock method. Functional outcomes were evaluated using Lysholm knee scoring scale, Cincinnati scores, subjective International Knee Documentation Committee (IKDC) criteria and Tegner activity scale. Assessment of meniscal healing was evaluated clinically by the presence of meniscal signs. The preoperative and postoperative MRIs were examined. Results The mean follow-up period was 29 months (range, 24–38). The mean Lysholm score improved significantly from 59.5 ± 12.4 points preoperatively to 90.0 ± 4.7 points postoperatively (P < 0.0001). The Cincinnati score increased from 14.8 ± 5.3 to 26.9 ± 1.6 (P < 0.0001). The Tegner activity score increased from 3.7 ± 1.4 to 6.4 ± 1.6 (P < 0.0001). The mean IKDC subjective score also improved significantly from 48.5 ± 9.8 preoperatively to 90.4 ± 5.0 postoperatively (P < 0.0001). Conclusion Meniscal repair of degenerative horizontal tears using the overlock method resulted in improved Lysholm and IKDC subjective scores. With careful selection of the patients and the horizontal meniscus tears, the success of the meniscus repairs increases. Repair can be recommended for all horizontal meniscus tears which can be repaired arthroscopically.
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Affiliation(s)
- Uğur Tiftikçi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
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Fujita M, Otani H, Iwasaki M, Yoshioka K, Shimazu T, Shiojima I, Tabata Y. Antagomir-92a impregnated gelatin hydrogel microsphere sheet enhances cardiac regeneration after myocardial infarction in rats. Regen Ther 2016; 5:9-16. [PMID: 31245495 PMCID: PMC6581790 DOI: 10.1016/j.reth.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/04/2016] [Accepted: 04/23/2016] [Indexed: 01/07/2023] Open
Abstract
Introduction We investigated whether attachment of gelatin hydrogel microsphere (GHM) sheet impregnated with antagomir-92a on the infarcted heart promotes angiogenesis and cardiomyogenesis, and improves cardiac function after myocardial infarction (MI) in rats. Methods GHM sheet impregnated with antagomir-92a, its scramble sequence antagomir-control sheet or the sheet alone was attached on the area at risk of MI after the left anterior descending coronary artery ligation. Bromodeoxyuridine (BrdU) was included in the sheet to trace proliferating cells. Results The antagomir-92a sheet significantly increased capillary density in the infarct border zone 14 days after MI compared to the antagomir-control sheet or the sheet alone, associated with an increase in endothelial cells incorporated with BrdU. The antagomir-92a sheet significantly increased cardiac stem cells incorporated with BrdU 3 days after MI in the infarct border zone. This was associated with an increase in cardiomyocytes incorporated with BrdU 14 days after MI. Scar area was significantly reduced by the antagomir-92a sheet compared to the antagomir-control sheet or the sheet alone (12.8 ± 1.3 vs 25.2 ± 2.2, 24.0 ± 1.7% LV area, respectively) 14 days after MI. LV dilatation was inhibited, and LV wall motion was improved 14 days after MI in rats with the antagomir-92a sheet compared to the antagomir-control sheet or the sheet alone. Conclusions These results suggest that attachment of the GHM sheet impregnated with antagomir-92a on the area at risk of MI enhances angiogenesis, promotes cardiomyogenesis, and ameliorates LV function.
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Key Words
- Angiogenesis
- BrdU, bromodeoxyuridine
- DAPI, 4′,6-diamidino-2-phenylindole
- DDA, double-distilled water
- FGF, fibroblast growth factor
- FS, fractional shortening
- GA, glutaraldehyde
- GHM, gelatin hydrogel microsphere
- Gelatin hydrogel microsphere
- Heart regeneration
- LAD, left anterior descending
- LV, left ventricular
- LVDd, left ventricular end-diastolic diameter
- LVDs, left ventricular end-systolic diameter
- MI, myocardial infarction
- MSCs, mesenchymal stem cells
- MicroRNA-92a
- VEGF, vascular endothelial growth factor
- miRs, microRNAs
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Affiliation(s)
- Masanori Fujita
- Department of Medicine II, Kansai Medical University, Moriguchi City, Japan
| | - Hajime Otani
- Department of Medicine II, Kansai Medical University, Moriguchi City, Japan
| | - Masayoshi Iwasaki
- Department of Medicine II, Kansai Medical University, Moriguchi City, Japan
| | - Kei Yoshioka
- Department of Medicine II, Kansai Medical University, Moriguchi City, Japan
| | - Takayuki Shimazu
- Department of Medicine II, Kansai Medical University, Moriguchi City, Japan
| | - Ichiro Shiojima
- Department of Medicine II, Kansai Medical University, Moriguchi City, Japan
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Kyoto City, Japan
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Lee HR, Shon OJ, Park SI, Kim HJ, Kim S, Ahn MW, Do SH. Platelet-Rich Plasma Increases the Levels of Catabolic Molecules and Cellular Dedifferentiation in the Meniscus of a Rabbit Model. Int J Mol Sci 2016; 17:ijms17010120. [PMID: 26784189 PMCID: PMC4730361 DOI: 10.3390/ijms17010120] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/24/2015] [Accepted: 01/11/2016] [Indexed: 01/10/2023] Open
Abstract
Despite the susceptibility to frequent intrinsic and extrinsic injuries, especially in the inner zone, the meniscus does not heal spontaneously owing to its poor vascularity. In this study, the effect of platelet-rich plasma (PRP), containing various growth factors, on meniscal mechanisms was examined under normal and post-traumatic inflammatory conditions. Isolated primary meniscal cells of New Zealand white (NZW) rabbits were incubated for 3, 10, 14 and 21 days with PRP(−), 10% PRP (PRP(+)), IL(+) or IL(+)PRP(+). The meniscal cells were collected and examined using reverse-transcription polymerase chain reaction (RT-PCR). Culture media were examined by immunoblot analyses for matrix metalloproteinases (MMP) catabolic molecules. PRP containing growth factors improved the cellular viability of meniscal cells in a concentration-dependent manner at Days 1, 4 and 7. However, based on RT-PCR, meniscal cells demonstrated dedifferentiation, along with an increase in type I collagen in the PRP(+) and in IL(+)PRP(+). In PRP(+), the aggrecan expression levels were lower than in the PRP(−) until Day 21. The protein levels of MMP-1 and MMP-3 were higher in each PRP group, i.e., PRP(+) and IL(+)PRP(+), at each culture time. A reproducible 2-mm circular defect on the meniscus of NZW rabbit was used to implant fibrin glue (control) or PRP in vivo. After eight weeks, the lesions in the control and PRP groups were occupied with fibrous tissue, but not with meniscal cells. This study shows that PRP treatment of the meniscus results in an increase of catabolic molecules, especially those related to IL-1α-induced inflammation, and that PRP treatment for an in vivo meniscus injury accelerates fibrosis, instead of meniscal cartilage.
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Affiliation(s)
- Hye-Rim Lee
- Department of Veterinary Clinical Pathology, College of Veterinary Medicine, Konkuk University, Seoul 143-701, Korea.
| | - Oog-Jin Shon
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu 705-717, Korea.
| | - Se-Il Park
- Cardiovascular Product Evaluation Center, College of Medicine, Yonsei University, Seoul 120-752, Korea.
| | - Han-Jun Kim
- Department of Veterinary Clinical Pathology, College of Veterinary Medicine, Konkuk University, Seoul 143-701, Korea.
| | - Sukyoung Kim
- School of Materials Science and Engineering, Yeungnam University, Gyeongsan 712-749, Korea.
| | - Myun-Whan Ahn
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu 705-717, Korea.
| | - Sun Hee Do
- Department of Veterinary Clinical Pathology, College of Veterinary Medicine, Konkuk University, Seoul 143-701, Korea.
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Shin KH, Lee H, Kang S, Ko YJ, Lee SY, Park JH, Bae JH. Effect of Leukocyte-Rich and Platelet-Rich Plasma on Healing of a Horizontal Medial Meniscus Tear in a Rabbit Model. BIOMED RESEARCH INTERNATIONAL 2015; 2015:179756. [PMID: 26180783 PMCID: PMC4477051 DOI: 10.1155/2015/179756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 05/24/2015] [Accepted: 05/25/2015] [Indexed: 12/23/2022]
Abstract
There are limited reports on the effect of platelet-rich plasma (PRP) on meniscus healing. The purpose of this study was to investigate the effect of leukocyte-rich PRP (L-PRP) on potential healing of the horizontal medial meniscus tears in a rabbit model. A horizontal medial meniscus tear was created in both knees of nine skeletally mature adult rabbits. Left or right knees were randomly assigned to a L-PRP group, or a control group. 0.5 mL of L-PRP from 10 mL of each rabbit's whole blood was prepared and injected into the horizontal tears in a L-PRP group. None was applied to the horizontal tears in a control group. The histological assessment of meniscus healing was performed at two, four, and six weeks after surgery. We found that there were no significant differences of quantitative histologic scoring between two groups at 2, 4, and 6 weeks after surgery (p > 0.05). This study failed to show the positive effect of single injection of L-PRP on enhancing healing of the horizontal medial meniscus tears in a rabbit model. Single injection of L-PRP into horizontal meniscus tears may not effectively enhance healing of horizontal medial meniscus tears.
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Affiliation(s)
- Kyun Ho Shin
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine & Medical School, Seoul 136-705, Republic of Korea
| | - Haseok Lee
- Korea University College of Medicine & Medical School, Seoul 136-705, Republic of Korea
| | - Seonghyun Kang
- Korea University College of Medicine & Medical School, Seoul 136-705, Republic of Korea
| | - You-Jin Ko
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine & Medical School, Ansan 425-707, Republic of Korea
| | - Seung-Yup Lee
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine & Medical School, Seoul 152-703, Republic of Korea
| | - Jung-Ho Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine & Medical School, Ansan 425-707, Republic of Korea
| | - Ji-Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine & Medical School, Seoul 152-703, Republic of Korea
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Ahn JH, Kwon OJ, Nam TS. Arthroscopic repair of horizontal meniscal cleavage tears with marrow-stimulating technique. Arthroscopy 2015; 31:92-8. [PMID: 25242513 DOI: 10.1016/j.arthro.2014.07.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate patients after arthroscopic repair of meniscal horizontal tears with a marrow-stimulating technique through clinical signs and second-look arthroscopy. METHODS We retrospectively reviewed a consecutive series of 32 meniscal repairs with horizontal cleavage tears and evaluated them through clinical assessment and second-look arthroscopic examinations. Arthroscopic meniscal repair and a marrow-stimulating technique were performed. Functional outcomes were evaluated using the visual analog scale (VAS) pain score, Lysholm knee scoring scale, and Tegner activity scale. Assessment of meniscal healing was evaluated clinically by the presence of meniscal signs; second-look arthroscopy was performed in 11 patients. Correlation between chronicity of a meniscal lesion (time from initial symptom [TFIS]) and meniscal healing was evaluated. RESULTS The mean follow-up period was 45.6 ± 13.9 months. Improvements in mean VAS scores from 6.7 to 1.9 (P < .001) were observed. The Lysholm score increased from 48.0 ± 14.4 to 92.0 ± 6.3 (P < .001). The Tegner activity score increased from 3.3 ± 1.1 to 6.8 ± 0.8 (P < .001). At the last follow-up, 29 of 32 patients (91%) were evaluated as healing in the clinical assessment. Of the 11 patients who underwent second-look arthroscopy, 8 (73%) showed complete healing, 2 (18%) had incomplete healing, and 1 (9%) failed to heal. Correlation between TFIS and meniscal healing was clinically significant (P = .001) but arthroscopically insignificant (P = .085) on second-look arthroscopy. CONCLUSIONS The meniscal repair procedure for horizontal cleavage tears in the present study suggests an alternative treatment option to approach the treatment of meniscal tears extending into the avascular zone and degenerative tissue. The marrow-stimulating technique using a cannulated reamer can be considered as an alternative method for the augmentation of meniscal healing. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ji-Hyun Ahn
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggi-do
| | - Oh-Jin Kwon
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggi-do
| | - Tae-Seok Nam
- Department of Orthopedic Surgery, Hyun-Myoung Medical Center, Seoul, Korea.
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Kamimura T, Kimura M. Meniscal Repair of Degenerative Horizontal Cleavage Tears Using Fibrin Clots: Clinical and Arthroscopic Outcomes in 10 Cases. Orthop J Sports Med 2014; 2:2325967114555678. [PMID: 26535282 PMCID: PMC4555553 DOI: 10.1177/2325967114555678] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Presently, the treatment options available for patients with horizontal degenerative cleavage tears of the meniscus are limited. These tears are considered an indication for partial or subtotal meniscectomy because when the tear is located within an avascular area, it is difficult to induce healing. However, meniscectomy is not ideal because it disrupts the normal anatomical structure and function of the meniscus. PURPOSE To examine the clinical and arthroscopic outcomes following meniscal repair of degenerative horizontal cleavage tears using fibrin clots. STUDY DESIGN Case series; Level of evidence, 4. METHODS Vertical sutures were placed in the meniscal tear, and the cleft was filled with fibrin clots before the sutures were tightened. We repaired 18 menisci in 18 consecutive eligible patients using a previously described technique. Three patients with anterior cruciate ligament (ACL) injury who underwent simultaneous ACL reconstruction and 5 patients who did not undergo follow-up arthroscopy within 12 months were excluded. The remaining 10 menisci in 10 patients were evaluated in this study. The mean age of the patients was 35.8 ± 16.5 years, and the mean postoperative follow-up time was 40.8 ± 5.4 months. Pre- and postoperative Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, and Tegner activity levels were compared. The arthroscopy findings were evaluated at a mean postoperative time of 6.7 ± 2.9 months. RESULTS The mean Lysholm score improved significantly from 69.3 ± 16.3 points preoperatively to 95.4 ± 3.6 points postoperatively (P < .005). The mean IKDC subjective score also improved significantly from 26.5% ± 19.0% preoperatively to 87.8% ± 7.5% postoperatively (P < .001). The Tegner activity level recovered to the preinjury level in 6 patients and to 1 level below the preinjury level in 4 patients. The follow-up arthroscopies showed complete healing in 7 patients (70%) and incomplete healing in 3 patients (30%). CONCLUSION Meniscal repair of degenerative horizontal cleavage tears using fibrin clots resulted in improved Lysholm and IKDC subjective scores, but the complete healing rate on follow-up arthroscopy was only 70%. CLINICAL RELEVANCE If we are to prevent osteoarthritis, we should minimize resection and restore the contact area of the meniscus to preserve the original shape.
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Affiliation(s)
- Tamiko Kamimura
- Department of Orthopaedic Surgery, Tokorozawa Chuo Hospital, Tokorozawa, Saitama, Japan
- Tamiko Kamimura, MD, PhD, Department of Orthopaedic Surgery, Tokorozawa Chuo Hospital, 753-2 Kita-akitsu, Tokorozawa, Saitama, 359-0038, Japan (e-mail: )
| | - Masashi Kimura
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Gunma, Japan
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Nonviral gene transfer to human meniscal cells. Part I: transfection analyses and cell transplantation to meniscus explants. INTERNATIONAL ORTHOPAEDICS 2014; 38:1923-30. [PMID: 24962292 DOI: 10.1007/s00264-014-2410-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE Our aim was to evaluate whether nonviral vectors can genetically modify primary human juvenile and adult meniscal fibrochondrocytes at low toxicity in vitro and to test the hypothesis that transfected human meniscal fibrochondrocytes transplanted into longitudinal defects and onto human medial meniscus explant cultures are capable of expressing transgene products in vitro. METHODS Eighteen nonviral gene transfer systems were examined to identify the best suited method for an efficient transfection of primary cultures of juvenile and adult human meniscal fibrochondrocytes using luciferase and lacZ reporter gene constructs and then transplanted to meniscus explant cultures. RESULTS Gene transfer systems FuGENE 6, GeneJammer, TurboFectin 8, calcium phosphate co-precipitates and GeneJuice led to minimal toxicity in both cell types. Nanofectin 2 and JetPEI resulted in maximal luciferase activity in both cell types. Maximal transfection efficiency based on X-gal staining following lacZ gene transfer was achieved using Lipofectamine 2000, revealing a mean transfection efficiency of 8.6 % in human juvenile and of 8.4 % in adult meniscal fibrochondrocytes. Transfected, transplanted meniscal fibrochondrocytes adhered to the meniscal tissue and continued to express the transgene for at least five days following transfection. CONCLUSIONS Nonviral gene transfer systems are safe and capable of transfecting both juvenile and adult human meniscal fibrochondrocytes, which, when transplanted to meniscal tissue in vitro, permit the expression of selected transgenes to be maintained. These results are of value for combining gene therapy and cell transplantation approaches as a means to enhance meniscal repair.
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Nonviral gene transfer into human meniscal cells. Part II: effect of three-dimensional environment and overexpression of human fibroblast growth factor 2. INTERNATIONAL ORTHOPAEDICS 2014; 38:1931-6. [PMID: 24957484 DOI: 10.1007/s00264-014-2405-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Our aim was to study the effect of three-dimensional (3D) environment and overexpression of human fibroblast growth factor 2 (FGF-2) on meniscal fibrochondrocytes in vitro. METHODS Human meniscal fibrochondrocytes were transfected with expression plasmid vectors carrying the Photinus pyralis luciferase gene, the Escherichia coli β-galactosidase gene or a human FGF-2 cDNA. Modified fibrochondrocytes were cultivated in 3D alginate hydrogel or cell pellets or in 2D monolayer culture. RESULTS The levels of luciferase activity showed a peak at day two and returned to baseline levels by day 11, regardless of the type of cultivation. Both 3D environments supported the secretion of human FGF-2 protein upon FGF-2 transfection. Overexpression of human FGF-2 by genetically modified human meniscal fibrochondrocytes stimulated proliferation but not glycosaminoglycan synthesis only in 3D culture. Culture in alginate spheres resulted in a larger difference in cell numbers compared with pellet cultures. CONCLUSIONS Three-dimensional alginate spheres are well suited for the culture of genetically modified human meniscal fibrochondrocytes. These data are of value for cell-based approaches to meniscal repair using genetically modified human meniscal fibrochondrocytes overexpressing human FGF-2.
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Abstract
Over the past 2 decades there has been a profound shift in our perception of the role of the meniscus in the knee joint. Orthopaedic opinion now favors salvaging and restoring the damaged meniscus where possible. Basic science is characterizing its form (anatomy) and functionality (biological and biomechanical) in an attempt to understand the effect of meniscal injury and repair on the knee joint as a whole. The meniscus is a complex tissue and has warranted extensive basic science, translational, and clinical research to identify techniques to augment healing and even replace the meniscus. The application of quantitative magnetic resonance image sequencing to the meniscus and articular cartilage of the affected compartment promises to add a quantifiable outcome measure to the body of clinical evidence that supports restoration of the meniscus. This article discusses the recent advances and outcomes in the pursuit of meniscal restoration with particular focus on the use of augmentation strategies in meniscal repair, meniscal imaging, and translational strategies.
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Affiliation(s)
- Ian D Hutchinson
- Ian Hutchinson, Laboratory for Tissue Engineering Regeneration & Repair, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. (
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Deponti D, Di Giancamillo A, Scotti C, Peretti GM, Martin I. Animal models for meniscus repair and regeneration. J Tissue Eng Regen Med 2013; 9:512-27. [PMID: 23712959 DOI: 10.1002/term.1760] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 02/24/2013] [Accepted: 04/02/2013] [Indexed: 12/21/2022]
Abstract
The meniscus plays an important role in knee function and mechanics. Meniscal lesions, however, are common phenomena and this tissue is not able to achieve spontaneous successful repair, particularly in the inner avascular zone. Several animal models have been studied and proposed for testing different reparative approaches, as well as for studying regenerative methods aiming to restore the original shape and function of this structure. This review summarizes the gross anatomy, function, ultrastructure and biochemical composition of the knee meniscus in several animal models in comparison with the human meniscus. The relevance of the models is discussed from the point of view of basic research as well as of clinical translation for meniscal repair, substitution and regeneration. Finally, the advantages and disadvantages of each model for various research directions are critically discussed.
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Abstract
Meniscal tears are relatively common injuries sustained by athletes and non-athletes alike and have far reaching functional and financial implications. Studies have clearly demonstrated the important biomechanical role played by the meniscus. Long-term follow-up studies of post-menisectomy patients show a predisposition toward the development of degenerative arthritic changes. As such, substantial efforts have been made by researchers and clinicians to understand the cellular and molecular basis of meniscal healing. Proinflammatory cytokines have been shown to have a catabolic effect on meniscal healing. In vitro and some limited in vivo studies have shown a proliferative and anabolic response to various growth factors. Surgical techniques that have been developed to stimulate a healing response include mechanical abrasion, fibrin clot application, growth factor application, and attempts at meniscal neovascularization. This article discusses various augmentation techniques for meniscal repair and reviews the current literature with regard to fibrin clot, platelet rich plasma, proinflammatory cytokines, and application of growth factors.
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