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Gong L, He L, Lu N, Petchakup C, Li KHH, Tay CY, Hou HW. Label-Free Single Microparticles and Cell Aggregates Sorting in Continuous Cell-Based Manufacturing. Adv Healthc Mater 2024; 13:e2304529. [PMID: 38465888 DOI: 10.1002/adhm.202304529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Indexed: 03/12/2024]
Abstract
There is a paradigm shift in biomanufacturing toward continuous bioprocessing but cell-based manufacturing using adherent and suspension cultures, including microcarriers, hydrogel microparticles, and 3D cell aggregates, remains challenging due to the lack of efficient in-line bioprocess monitoring and cell harvesting tools. Herein, a novel label-free microfluidic platform for high throughput (≈50 particles/sec) impedance bioanalysis of biomass, cell viability, and stem cell differentiation at single particle resolution is reported. The device is integrated with a real-time piezo-actuated particle sorter based on user-defined multi-frequency impedance signatures. Biomass profiling of Cytodex-3 microcarriers seeded with adipose-derived mesenchymal stem cells (ADSCs) is first performed to sort well-seeded or confluent microcarriers for downstream culture or harvesting, respectively. Next, impedance-based isolation of microcarriers with osteogenic differentiated ADSCs is demonstrated, which is validated with a twofold increase of calcium content in sorted ADSCs. Impedance profiling of heterogenous ADSCs-encapsulated hydrogel (alginate) microparticles and 3D ADSC aggregate mixtures is also performed to sort particles with high biomass and cell viability to improve cell quality. Overall, the scalable microfluidic platform technology enables in-line sample processing from bioreactors directly and automated analysis of cell quality attributes to maximize cell yield and improve the control of cell quality in continuous cell-based manufacturing.
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Affiliation(s)
- Lingyan Gong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Linwei He
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Nan Lu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Chayakorn Petchakup
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - King Ho Holden Li
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Chor Yong Tay
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, 639798, Singapore
- Environmental Chemistry and Materials Centre, Nanyang Environment & Water Research Institute, Singapore, 637141, Singapore
| | - Han Wei Hou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, 639798, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
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Li X, Li D, Li J, Wang G, Yan L, Liu H, Jiu J, Li JJ, Wang B. Preclinical Studies and Clinical Trials on Cell-Based Treatments for Meniscus Regeneration. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:634-670. [PMID: 37212339 DOI: 10.1089/ten.teb.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study aims at performing a thorough review of cell-based treatment strategies for meniscus regeneration in preclinical and clinical studies. The PubMed, Embase, and Web of Science databases were searched for relevant studies (both preclinical and clinical) published from the time of database construction to December 2022. Data related to cell-based therapies for in situ regeneration of the meniscus were extracted independently by two researchers. Assessment of risk of bias was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Statistical analyses based on the classification of different treatment strategies were performed. A total of 5730 articles were retrieved, of which 72 preclinical studies and 6 clinical studies were included in this review. Mesenchymal stem cells (MSCs), especially bone marrow MSCs (BMSCs), were the most commonly used cell type. Among preclinical studies, rabbit was the most commonly used animal species, partial meniscectomy was the most commonly adopted injury pattern, and 12 weeks was the most frequently chosen final time point for assessing repair outcomes. A range of natural and synthetic materials were used to aid cell delivery as scaffolds, hydrogels, or other morphologies. In clinical trials, there was large variation in the dose of cells, ranging from 16 × 106 to 150 × 106 cells with an average of 41.52 × 106 cells. The selection of treatment strategy for meniscus repair should be based on the nature of the injury. Cell-based therapies incorporating various "combination" strategies such as co-culture, composite materials, and extra stimulation may offer greater promise than single strategies for effective meniscal tissue regeneration, restoring natural meniscal anisotropy, and eventually achieving clinical translation. Impact Statement This review provides an up-to-date and comprehensive overview of preclinical and clinical studies that tested cell-based treatments for meniscus regeneration. It presents novel perspectives on studies published in the past 30 years, giving consideration to the cell sources and dose selection, delivery methods, extra stimulation, animal models and injury patterns, timing of outcome assessment, and histological and biomechanical outcomes, as well as a summary of findings for individual studies. These unique insights will help to shape future research on the repair of meniscus lesions and inform the clinical translation of new cell-based tissue engineering strategies.
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Affiliation(s)
- Xiaoke Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Dijun Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Jiarong Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Guishan Wang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, China
| | - Lei Yan
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Haifeng Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Jingwei Jiu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Bin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Bone Marrow-Derived Fibrin Clots Stimulate Healing of a Meniscal Defect in a Rabbit Model. Arthroscopy 2022:S0749-8063(22)00838-6. [PMID: 36574822 DOI: 10.1016/j.arthro.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the in vivo effectiveness of bone marrow aspirate-derived (BMA) fibrin clots for avascular meniscal defect healing in a rabbit model. METHODS In 42 Japanese white rabbits, a 2.0-mm cylindrical defect was introduced into the avascular zone of the anterior part of the medial meniscus in the bilateral knees. The rabbits were grouped according to implantation of a BMA fibrin clot (BMA group) or a peripheral blood (PB)-derived clot (PB group) into the defect and nonimplantation (control group). Macroscopic and histological assessments were performed using a scoring system at 4 and 12 weeks after surgery. At 12 weeks after surgery, compressive stress was analyzed biomechanically. RESULTS The meniscal score in the BMA group (12.1) was greater than that in the PB group (5.5; P = .031) and control group (4.4; P = .013) at 4 weeks. The meniscal score in the BMA group (13.1) was greater than that in the control group (6.4; BMA = 13.1; P = .0046) at 12 weeks. In the biomechanical analysis, the BMA group demonstrated significantly higher compressive strength than the PB group (6.6 MPa) (BMA = 15.4 MPa; P = .0201) and control group (3.6 MPa; BMA = 15.4 MPa; P = .007). CONCLUSIONS Implantation of BMA fibrin clots into the meniscal defect of the avascular zone in a rabbit model improved the meniscal score at 4 weeks and strengthened the reparative meniscal tissue at 12 weeks compared with the implantation of PB fibrin clots. CLINICAL RELEVANCE Healing in the avascular zone of the meniscus can be problematic. Approaches to improving this healing response have had variable results. This study provides additional information that may help improve the outcomes in patients with these injuries.
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Adipose-Derived Stem Cell Sheets Promote Meniscus Regeneration Regardless of Whether the Defect Involves the Inner Half or the Whole Width of the Anterior Half of the Medial Meniscus in a Rabbit Model. Arthroscopy 2022; 38:2672-2683. [PMID: 35248702 DOI: 10.1016/j.arthro.2022.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the regenerative effect of adipose-derived stem cell (ADSC) sheets in two different rabbit models of meniscal defects. METHODS Forty-two rabbits were randomly divided into two groups: the whole (Group 1) or the inner half (Group 2) of anterior half of the medial meniscus was removed from both knees. The ADSC sheets were transplanted into one knee, whereas in the other knee the meniscal defect was left untreated (self-control). The histological score and expression of genes encoding collagen type I and II (COL1/2), SRY-box transcription factor 9 (SOX9), and aggrecan (ACAN) were compared between the ADSC sheet-treated and untreated menisci at 4 and 12 weeks. The ADSC sheet-treated menisci at 12 weeks were also analyzed immunohistochemically to assess the collagen component. RESULTS The histological score was significantly higher in the treated side than in the control side at 4 and 12 weeks in both groups (Group 1; P = .016 and .032; Group 2; P = .030 and .016, respectively). All genes evaluated showed significantly higher expression in the treated side than in the control side in both groups, except COL2 and SOX9 at 4 weeks and COL2 at 12 weeks in Group 1, and COL1 in Group 2 at 4 weeks. The ADSC sheet-treated meniscus in Group 1 contained mostly COL1, whereas the Group 2 had less COL1, but was rich in COL2. CONCLUSIONS ADSC sheets can promote meniscal regeneration regardless of whether the defect involves the inner half or whole width of the anterior half of the medial meniscus. However, the collagen component of the ADSC sheet-treated tissue differs depending on the defect site. CLINICAL RELEVANCE ADSCs may help meniscal regeneration due to meniscal defects after meniscectomy. This study suggests longer-term follow-up and mechanical analysis as next steps.
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Progress in Osteochondral Regeneration with Engineering Strategies. Ann Biomed Eng 2022; 50:1232-1242. [PMID: 35994165 DOI: 10.1007/s10439-022-03060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
Abstract
Osteoarthritis, the main cause of disability worldwide, involves not only cartilage injury but also subchondral bone injury, which brings challenges to clinical repair. Tissue engineering strategies provide a promising solution to this degenerative disease. Articular cartilage connects to subchondral bone through the osteochondral interfacial tissue, which has a complex anatomical architecture, distinct cell distribution and unique biomechanical properties. Forming a continuous and stable osteochondral interface between cartilage tissue and subchondral bone is challenging. Thus, successful osteochondral regeneration with engineering strategies requires intricately coordinated interplay between cells, materials, biological factors, and physical/chemical factors. This review provides an overview of the anatomical composition, microstructure, and biomechanical properties of the osteochondral interface. Additionally, the latest research on the progress related to osteochondral regeneration is reviewed, especially discussing the fabrication of biomimetic scaffolds and the regulation of biological factors for osteochondral defects.
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Abpeikar Z, Javdani M, Alizadeh A, Khosravian P, Tayebi L, Asadpour S. Development of meniscus cartilage using polycaprolactone and decellularized meniscus surface modified by gelatin, hyaluronic acid biomacromolecules: A rabbit model. Int J Biol Macromol 2022; 213:498-515. [PMID: 35623463 PMCID: PMC9297736 DOI: 10.1016/j.ijbiomac.2022.05.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/15/2022]
Abstract
The lack of vascularization in the white-red and white zone of the meniscus causes these zones of tissue to have low self-healing capacity in case of injury and accelerate osteoarthritis (OA). In this study, we have developed hybrid constructs using polycaprolactone (PCL) and decellularized meniscus extracellular matrix (DMECM) surface modified by gelatin (G), hyaluronic acid (HU) and selenium (Se) nanoparticles (PCL/DMECM/G/HU/Se), following by the cross-linking of the bio-polymeric surface. Material characterization has been performed on the fabricated scaffold using scanning electron microscopy (SEM), Fourier transforms infrared (FTIR) spectroscopy, swelling and degradation analyses, and mechanical tests. In Vitro, investigations have been conducted by C28/I2 human chondrocyte culture into the scaffold and evaluated the cytotoxicity and cell/scaffold interaction. For the in vivo study, the scaffolds were transplanted into the defect sites of female New Zealand white rabbits. Good regeneration was observed after two months. We have concluded that the designed PCL/DMECM/G/HU construct can be a promising candidate as a meniscus tissue engineering scaffold to facilitate healing.
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Affiliation(s)
- Zahra Abpeikar
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Moosa Javdani
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Akram Alizadeh
- Department of Tissue Engineering and Applied Cell Sciences, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Pegah Khosravian
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Lobat Tayebi
- Marquett University School of Dentistry, Milwaukee, WI 53233, USA
| | - Shiva Asadpour
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of Medical Sciences, Shahrekord, Iran; Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Bai B, Hou M, Hao J, Liu Y, Ji G, Zhou G. Research progress in seed cells for cartilage tissue engineering. Regen Med 2022; 17:659-675. [PMID: 35703020 DOI: 10.2217/rme-2022-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cartilage defects trouble millions of patients worldwide and their repair via conventional treatment is difficult. Excitingly, tissue engineering technology provides a promising strategy for efficient cartilage regeneration with structural regeneration and functional reconstruction. Seed cells, as biological prerequisites for cartilage regeneration, determine the quality of regenerated cartilage. The proliferation, differentiation and chondrogenesis of seed cells are greatly affected by their type, origin and generation. Thus, a systematic description of the characteristics of seed cells is necessary. This article reviews in detail the cellular characteristics, research progress, clinical translation challenges and future research directions of seed cells while providing guidelines for selecting appropriate seed cells for cartilage regeneration.
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Affiliation(s)
- Baoshuai Bai
- Research Institute of Plastic Surgery, Wei Fang Medical University, Wei Fang, Shandong, 261053, China.,Shanghai Key Laboratory of Tissue Engineering, Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.,National Tissue Engineering Center of China, Shanghai, 200240, China
| | - Mengjie Hou
- Shanghai Key Laboratory of Tissue Engineering, Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.,National Tissue Engineering Center of China, Shanghai, 200240, China
| | - Junxiang Hao
- Research Institute of Plastic Surgery, Wei Fang Medical University, Wei Fang, Shandong, 261053, China.,Shanghai Key Laboratory of Tissue Engineering, Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.,National Tissue Engineering Center of China, Shanghai, 200240, China
| | - Yanhan Liu
- Shanghai JiaoTong University School of Medicine, Shanghai, 200240, China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200240, China
| | - Guangdong Zhou
- Research Institute of Plastic Surgery, Wei Fang Medical University, Wei Fang, Shandong, 261053, China.,Shanghai Key Laboratory of Tissue Engineering, Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200240, China.,National Tissue Engineering Center of China, Shanghai, 200240, China
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Hayashi K, Fang X, Ueda H, Miwa A, Naka T, Tsuchiya H. Bone Regeneration Using Autologous Adipose-Derived Stem Cell Spheroid Complex. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.3014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bone defects require reconstruction using various biomaterials or non-biological materials. Stem cell spheroids can be used for scaffold-free approaches for osteogenesis. We set up a culture method for creating an optimal osteogenic adipose-derived stem cell (ADSC) spheroid complex
by measuring the expression of protein in a sequential series of culture media. After culturing ADSC spheroids for 24 hours in DMEM, the spheroids were cultured in ascorbic acid-containing medium for five days followed by osteoblast differentiation medium. One day after exchanging to osteoblast
differentiation medium, spheroids were collected and cultured for four days to obtain a spheroid complex. Each culture period was determined by analyzing the expression of collagen type I, alkaline phosphatase and integrin α5 to maximize the activity of ADSC spheroids. The expression
of collagen type I increased significantly in ascorbic acid-containing medium (p < 0.05) compared with control medium on day five, suggesting that culturing spheroids in ascorbic acid increases collagen synthesis. RNA was extracted from ADSC spheroids after 1, 3, 5, and 7 days in
each medium and RT-PCR was performed to measure integrin α5 expression. The expression was transiently high on the first day of osteoblast differentiation culture and then gradually decreased. Osteoblast differentiation medium enhanced cell adhesion in spheroids. An in vivo
study confirmed the osteogenic potential of the ADSC spheroid complex created by the established protocol. The ADSC spheroid complex stimulated bone regeneration and will be applied to the treatment of large bone defects.
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Affiliation(s)
- Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, 920-8641, Japan
| | - Xang Fang
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, 920-8641, Japan
| | - Hiroshi Ueda
- Shibuya Corporation, Ko-58 Mameda-Honmachi, Kanazawa, Ishikawa, 920-8681, Japan
| | - Akihiro Miwa
- Shibuya Corporation, Ko-58 Mameda-Honmachi, Kanazawa, Ishikawa, 920-8681, Japan
| | - Toshiaki Naka
- Shibuya Corporation, Ko-58 Mameda-Honmachi, Kanazawa, Ishikawa, 920-8681, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, 920-8641, Japan
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Bian Y, Wang H, Zhao X, Weng X. Meniscus repair: up-to-date advances in stem cell-based therapy. Stem Cell Res Ther 2022; 13:207. [PMID: 35578310 PMCID: PMC9109379 DOI: 10.1186/s13287-022-02863-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/26/2022] [Indexed: 12/24/2022] Open
Abstract
The meniscus is a semilunar fibrocartilage between the tibia and femur that is essential for the structural and functional integrity of the keen joint. In addition to pain and knee joint dysfunction, meniscus injuries can also lead to degenerative changes of the knee joint such as osteoarthritis, which further affect patient productivity and quality of life. However, with intrinsic avascular property, the tearing meniscus tends to be nonunion and the augmentation of post-injury meniscus repair has long time been a challenge. Stem cell-based therapy with potent regenerative properties has recently attracted much attention in repairing meniscus injuries, among which mesenchymal stem cells were most explored for their easy availability, trilineage differentiation potential, and immunomodulatory properties. Here, we summarize the advances and achievements in stem cell-based therapy for meniscus repair in the last 5 years. We also highlight the obstacles before their successful clinical translation and propose some perspectives for stem cell-based therapy in meniscus repair.
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Affiliation(s)
- Yixin Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Han Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiuli Zhao
- Department of Medical Genetics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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Tan Q, Wu C, Li L, Liang Y, Bai X, Shao W. Stem Cells as a Novel Biomedicine for the Repair of Articular Meniscus: Pharmacology and Applications. Front Pharmacol 2022; 13:897635. [PMID: 35559234 PMCID: PMC9086353 DOI: 10.3389/fphar.2022.897635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Qiaoyin Tan
- College of Teacher Education, Zhejiang Normal University, Jinhua, China
| | - Cuicui Wu
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Lei Li
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Yijie Liang
- Nova Doctors Group, Hunan Carnation Biotechnology Co., Ltd., Carnation Hospital, Changsha, China
| | - Xiaoyong Bai
- Nova Doctors Group, Hunan Carnation Biotechnology Co., Ltd., Carnation Hospital, Changsha, China
| | - Weide Shao
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
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11
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Ding G, Du J, Hu X, Ao Y. Mesenchymal Stem Cells From Different Sources in Meniscus Repair and Regeneration. Front Bioeng Biotechnol 2022; 10:796367. [PMID: 35573249 PMCID: PMC9091333 DOI: 10.3389/fbioe.2022.796367] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/11/2022] [Indexed: 01/22/2023] Open
Abstract
Meniscus damage is a common trauma that often arises from sports injuries or menisci tissue degeneration. Current treatment methods focus on the repair, replacement, and regeneration of the meniscus to restore its original function. The advance of tissue engineering provides a novel approach to restore the unique structure of the meniscus. Recently, mesenchymal stem cells found in tissues including bone marrow, peripheral blood, fat, and articular cavity synovium have shown specific advantages in meniscus repair. Although various studies explore the use of stem cells in repairing meniscal injuries from different sources and demonstrate their potential for chondrogenic differentiation, their meniscal cartilage-forming properties are yet to be systematically compared. Therefore, this review aims to summarize and compare different sources of mesenchymal stem cells for meniscal repair and regeneration.
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Affiliation(s)
- Guocheng Ding
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Jianing Du
- School of Basic Medical Sciences, Peking University, Beijing, China
| | - Xiaoqing Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
- *Correspondence: Yingfang Ao,
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Kluyskens L, Debieux P, Wong KL, Krych AJ, Saris DBF. Biomaterials for meniscus and cartilage in knee surgery: state of the art. J ISAKOS 2022; 7:67-77. [PMID: 35543667 DOI: 10.1136/jisakos-2020-000600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/24/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022]
Abstract
Meniscus and cartilage injuries of the knee joint lead to cartilage degeneration and osteoarthritis (OA). The research on biomaterials and artificial implants as substitutes in reconstruction and regeneration has become a main international focus in order to solve clinical problems such as irreparable meniscus injury, postmeniscectomy syndrome, osteochondral lesions and generalised chronic OA. In this review, we provide a summary of biomaterials currently used in clinical practice as well as state-of-the-art tissue engineering strategies and technologies that are developed for articular cartilage and meniscus repair and regeneration. The literature was reviewed over the last 5 years on clinically used meniscus and cartilage repair biomaterials, such as Collagen Meniscal Implant, Actifit, NUsurface, TruFit, Agili-C and MaioRegen. There are clinical advantages for these biomaterials and the application of these treatment options should be considered individually. Standardised evaluation protocols are needed for biological and mechanical assessment and comparison between different scaffolds, and long-term randomised independent clinical trials with large study numbers are needed to provide more insight into the use of these biomaterials. Surgeons should become familiar and stay up to date with evolving repair options to improve their armamentarium for meniscal and cartilage defects.
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Affiliation(s)
- Louis Kluyskens
- Orthopedics, AZ Monica Antwerpen, Antwerpen, Belgium; Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
| | - Pedro Debieux
- Department of Orthopedics and Traumatology, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil; Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
| | - Keng Lin Wong
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore; Department of Orthopaedic Surgery, National University of Singapore, Singapore
| | - Aaron J Krych
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA; Department of Orthopedic Surgery, University Medical Centre, Utrecht, Netherlands.
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13
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Zhou YF, Zhang D, Yan WT, Lian K, Zhang ZZ. Meniscus Regeneration With Multipotent Stromal Cell Therapies. Front Bioeng Biotechnol 2022; 10:796408. [PMID: 35237572 PMCID: PMC8883323 DOI: 10.3389/fbioe.2022.796408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Meniscus is a semilunar wedge-shaped structure with fibrocartilaginous tissue, which plays an essential role in preventing the deterioration and degeneration of articular cartilage. Lesions or degenerations of it can lead to the change of biomechanical properties in the joints, which ultimately accelerate the degeneration of articular cartilage. Even with the manual intervention, lesions in the avascular region are difficult to be healed. Recent development in regenerative medicine of multipotent stromal cells (MSCs) has been investigated for the significant therapeutic potential in the repair of meniscal injuries. In this review, we provide a summary of the sources of MSCs involved in repairing and regenerative techniques, as well as the discussion of the avenues to utilizing these cells in MSC therapies. Finally, current progress on biomaterial implants was reviewed.
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Affiliation(s)
- Yun-Feng Zhou
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Zhang
- Department of Obstetrics-Gynecology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Wan-Ting Yan
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Kai Lian
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- *Correspondence: Zheng-Zheng Zhang, ; Kai Lian,
| | - Zheng-Zheng Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zheng-Zheng Zhang, ; Kai Lian,
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14
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Editorial Commentary: Biologic Augmentation of Meniscus Repair Is Complex. Arthroscopy 2022; 38:450-451. [PMID: 35123718 DOI: 10.1016/j.arthro.2021.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 02/02/2023]
Abstract
In the setting of biological augmentation for meniscus repair, it is extremely important to evaluate all aspects, including effectiveness, costs, potential risks, benefits, and limitations. It seems that everything matters in healing: the aspirate source of the bioactive agents, cell content, presence of stem cells and their type, growth factors, cytokines, biomechanical scaffold, and the quality of the tissue. There are several differences among mesenchymal, adipose, and peripheral blood stem cells, with the cell origin affecting the differentiation potential towards bone, cartilage and ligament. Moreover, different aspirate sources and fibrin clots have different content in cells, growth factors, and cytokines. In this equation, it is not as simple as the more the better. Different doses of growth factors may have different effects in the different cell types. And as this was not complicated enough, synergistic phenomena between cells and between growth factors can play a huge role. Add to that the role of the biomechanical environment, the proper timing of the healing phases and the inherent patient characteristics. There is very, very much to learn, and finally, we acknowledge that not all menisci repairs can always heal.
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15
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Abpeikar Z, Moradi L, Javdani M, Kargozar S, Soleimannejad M, Hasanzadeh E, Mirzaei SA, Asadpour S. Characterization of Macroporous Polycaprolactone/Silk Fibroin/Gelatin/Ascorbic Acid Composite Scaffolds and In Vivo Results in a Rabbit Model for Meniscus Cartilage Repair. Cartilage 2021; 13:1583S-1601S. [PMID: 34340598 PMCID: PMC8804732 DOI: 10.1177/19476035211035418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Meniscus injuries in the inner avascular zone have weak intrinsic self-healing capacity and often progress to osteoarthritis. This study focused on evaluating the effects of polycaprolactone/silk fibroin/gelatin/ascorbic acid (PCL/SF/Gel/AA) composite scaffolds seeded with adipose-derived mesenchymal stem cells (ASCs), in the meniscus repair. DESIGN To this end, composite scaffolds were cross-linked using N-hydroxysuccinimide and 1-ethyl-3-(3-dimethyl-aminopropyl)-1-carbodiimide hydrochloride. Scaffolds were then characterized by scanning electron microscope, mechanical tests, total antioxidant capacity, swelling, and toxicity tests. RESULTS The PCL/SF/Gel/AA scaffolds exhibited suitable mechanical properties. Furthermore, vitamin C rendered them the highest antioxidant capacity. The PCL/SF/Gel/AA scaffolds also showed good biocompatibility and proliferation for chondrocytes. Moreover, the PCL/SF/Gel/AA scaffold seeded with allogeneic ASCs was engrafted in New Zealand rabbits who underwent unilateral punch defect in the medial meniscus of the right knee. After 2 months postimplantation, macroscopic and histologic studies for new meniscus cartilage were performed. CONCLUSIONS Our results indicated that the PCL/SF/Gel/AA composite scaffolds seeded with allogeneic ASCs could successfully improve meniscus healing in damaged rabbits.
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Affiliation(s)
- Zahra Abpeikar
- Department of Tissue Engineering and
Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of
Medical Sciences, Shahrekord, Iran
| | - Lida Moradi
- Department of Orthopedic Surgery,
Department of Cell Biology, Medical School, New York University, New York, NY,
USA
| | - Moosa Javdani
- Department of Clinical Sciences,
Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Saeid Kargozar
- Tissue Engineering Research Group
(TERG), Department of Anatomy and Cell Biology, School of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran
| | - Mostafa Soleimannejad
- Department of Tissue Engineering and
Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of
Medical Sciences, Shahrekord, Iran
| | | | - Seyed Abbas Mirzaei
- Department of Medical Biotechnology,
School of Advanced Technologies, Shahrekord University of Medical Sciences,
Shahrekord, Iran,Cellular and Molecular Research Center,
Basic Health Sciences Institute, Shahrekord University of Medical Sciences,
Shahrekord, Iran
| | - Shiva Asadpour
- Department of Tissue Engineering and
Applied Cell Sciences, School of Advanced Technologies, Shahrekord University of
Medical Sciences, Shahrekord, Iran,Cellular and Molecular Research Center,
Basic Health Sciences Institute, Shahrekord University of Medical Sciences,
Shahrekord, Iran,Shiva Asadpour, Cellular and Molecular
Research Center, Basic Health Sciences Institute, Shahrekord University of
Medical Sciences, Shahrekord, 8815713471, Iran. Emails:
;
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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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Dai TY, Pan ZY, Yin F. In Vivo Studies of Mesenchymal Stem Cells in the Treatment of Meniscus Injury. Orthop Surg 2021; 13:2185-2195. [PMID: 34747566 PMCID: PMC8654668 DOI: 10.1111/os.13002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/27/2022] Open
Abstract
This review summarizes the literature of preclinical studies and clinical trials on the use of mesenchymal stem cells (MSCs) to treat meniscus injury and promote its repair and regeneration and provide guidance for future clinical research. Due to the special anatomical features of the meniscus, conservative or surgical treatment can hardly achieve complete physiological and histological repair. As a new method, stem cells promote meniscus regeneration in preclinical research and human preliminary research. We expect that, in the near future, in vivo injection of stem cells to promote meniscus repair can be used as a new treatment model in clinical treatment. The treatment of animal meniscus injury, and the clinical trial of human meniscus injury has begun preliminary exploration. As for the animal experiments, most models of meniscus injury are too simple, which can hardly simulate the complexity of actual meniscal tears, and since the follow-up often lasts for only 4-12 weeks, long-term results could not be observed. Lastly, animal models failed to simulate the actual stress environment faced by the meniscus, so it needs to be further studied if regenerated meniscus has similar anti-stress or anti-twist features. Despite these limitations, repair of the meniscus by MSCs has great potential in clinics. MSCs can differentiate into fibrous chondrocytes, which can possibly repair the meniscus and provide a new strategy for repairing meniscus injury.
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Affiliation(s)
- Tian-Yu Dai
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhang-Yi Pan
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Feng Yin
- Department of Joint Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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18
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Rhim HC, Jeon OH, Han SB, Bae JH, Suh DW, Jang KM. Mesenchymal stem cells for enhancing biological healing after meniscal injuries. World J Stem Cells 2021; 13:1005-1029. [PMID: 34567422 PMCID: PMC8422933 DOI: 10.4252/wjsc.v13.i8.1005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/02/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
The meniscus is a semilunar fibrocartilage structure that plays important roles in maintaining normal knee biomechanics and function. The roles of the meniscus, including load distribution, force transmission, shock absorption, joint stability, lubrication, and proprioception, have been well established. Injury to the meniscus can disrupt overall joint stability and cause various symptoms including pain, swelling, giving-way, and locking. Unless treated properly, it can lead to early degeneration of the knee joint. Because meniscal injuries remain a significant challenge due to its low intrinsic healing potential, most notably in avascular and aneural inner two-thirds of the area, more efficient repair methods are needed. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential in vitro and in vivo. Thus far, the application of MSCs, including bone marrow-derived, synovium-derived, and adipose-derived MSCs, has shown promising results in preclinical studies in different animal models. These preclinical studies could be categorized into intra-articular injection and tissue-engineered construct application according to delivery method. Despite promising results in preclinical studies, there is still a lack of clinical evidence. This review describes the basic knowledge, current treatment, and recent studies regarding the application of MSCs in treating meniscal injuries. Future directions for MSC-based approaches to enhance meniscal healing are suggested.
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Affiliation(s)
- Hye Chang Rhim
- T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, United States
| | - Ok Hee Jeon
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul 08308, Seoul, South Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam 13497, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
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Macroporous scaffold surface modified with biological macromolecules and piroxicam-loaded gelatin nanofibers toward meniscus cartilage repair. Int J Biol Macromol 2021; 183:1327-1345. [PMID: 33932422 DOI: 10.1016/j.ijbiomac.2021.04.151] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 12/15/2022]
Abstract
Meniscus cartilage has poor self-healing capacity in the inner zone and its damage leads to articular cartilage degeneration. Here we have developed hybrid constructs using polycaprolactone (PCL) and polyurethane (PU) surface modified by gelatin (G), chitosan (C), and hyaluronic acid (H) biomacromolecules and piroxicam-loaded gelatin nanofibers (PCL/PU/GCH/P). The surface of constructs was crosslinked using EDC and NHS. The scaffolds were investigated by SEM, FTIR spectroscopy, swelling test, degradation rate, mechanical tests, and in vitro piroxicam release assay. Furthermore, the cell-seeded scaffolds were evaluated by SEM, viability assay, dapi staining, cell migration, proliferation, and gene expression of chondrocytes within these scaffolds. Finally, the animal study was performed in a rabbit model. Chondrocyte and rabbit adipose-derived mesenchymal stem cells (ASCs) from the infrapatellar fat pad (Hoffa's fat pad) were used. Swelling and degradation rate were increased in the modified scaffolds. Tensile and compressive Young's modulus also were near to human native meniscus tissue. The highest expression level of chondrocyte marker genes was observed for the PCL/PU/GCH scaffold. A significant regeneration was obtained in rabbits treated with ASCs-loaded PCL/PU/GCH/P scaffold after 3 months. The surface-modified scaffolds with or without ASCs could successfully accelerate meniscus regeneration and exhibit potential application in meniscus tissue engineering.
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20
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Okuno N, Otsuki S, Aoyama J, Nakagawa K, Murakami T, Ikeda K, Hirose Y, Wakama H, Okayoshi T, Okamoto Y, Hirano Y, Neo M. Feasibility of a self-assembling peptide hydrogel scaffold for meniscal defect: An in vivo study in a rabbit model. J Orthop Res 2021; 39:165-176. [PMID: 32852842 DOI: 10.1002/jor.24841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 06/19/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
The inner avascular zone of the meniscus has limited healing capacity as the area is poorly vascularized. Although peptide hydrogels have been reported to regenerate bone and cartilage, their effect on meniscus regeneration remains unknown. We tested whether the self-assembling peptide hydrogel scaffold KI24RGDS stays in the meniscal lesion and facilitates meniscal repair and regeneration in an induced rabbit meniscal defect model. Full-thickness (2.0 mm diameter) cylindrical defects were introduced into the inner avascular zones of the anterior portions of the medial menisci of rabbit knees (n = 40). Right knee defects were left empty (control group) while the left knee defects were transplanted with peptide hydrogel (KI24RGDS group). Macroscopic meniscus scores were significantly higher in the KI24RGDS group than in the control group at 2, 4, and 8 weeks after surgery. Histological examinations including quantitative and qualitative scores indicated that compared with the control group, the reparative tissue in the meniscus was significantly enhanced in the KI24RGDS group at 2, 4, 8, and 12 weeks after surgery. Immunohistochemical staining showed that the reparative tissue induced by KI24RGDS at 12 weeks postimplantation was positive for Type I and II collagen. KI24RGDS is highly biocompatible and biodegradable, with strong stiffness, and a three dimensional structure mimicking native extracellular matrix and RGDS sequences that enhance cell adhesion and proliferation. This in vivo study demonstrated that KI24RGDS remained in the meniscal lesion and facilitated the repair and regeneration in a rabbit meniscal defect model.
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Affiliation(s)
- Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Jo Aoyama
- Department of Chemistry and Materials Engineering, Faculty of Chemistry, Materials, and Bioengineering, Kansai University, Osaka, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | | | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Tomohiro Okayoshi
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshiaki Hirano
- Department of Chemistry and Materials Engineering, Faculty of Chemistry, Materials, and Bioengineering, Kansai University, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
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21
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Takagi T, Kabata T, Hayashi K, Fang X, Kajino Y, Inoue D, Ohmori T, Ueno T, Yoshitani J, Ueoka K, Yamamuro Y, Tsuchiya H. Periodic injections of adipose-derived stem cell sheets attenuate osteoarthritis progression in an experimental rabbit model. BMC Musculoskelet Disord 2020; 21:691. [PMID: 33076883 PMCID: PMC7574575 DOI: 10.1186/s12891-020-03718-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/13/2020] [Indexed: 12/05/2022] Open
Abstract
Background Subcutaneous adipose tissue represents an abundant source of multipotent adult stem cells named as Adipose-derived stem cells (ADSCs). With a cell sheet approach, ADSCs survive longer, and can be delivered in large quantities. We investigated whether intra-articular ADSC sheets attenuated osteoarthritis (OA) progression in a rabbit anterior cruciate ligament transection (ACLT) model. Methods Fabricating medium containing ascorbate-2-phosphate was used to enhance collagen protein secretion by the ADSCs to make ADSC sheets. At 4 weeks after ACLT, autologous ADSC sheets were injected intra-articularly into the right knee (ADSC sheets group), and autologous cell death sheets treated by liquid nitrogen were injected into the left knee (control group). Subsequent injections were administered once weekly. Femoral condyles were compared macroscopically and histologically. Results Macroscopically, OA progression was significantly milder in the ADSC sheets than in the control groups. Histologically, control knees showed obvious erosions in the medial and lateral condyles, while cartilage was retained predominantly in the ADSC sheets group. Immunohistochemically, MMP-1, MMP-13, ADAMTS-4 were less expressive in the ADSC sheets than in the control groups. Conclusions Periodic ADSC sheets injections inhibited articular cartilage degeneration without inducing any adverse effects. A large quantity of autologous ADSCs delivered by cell sheets homed to the synovium and protected chondrocytes.
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Affiliation(s)
- Tomoharu Takagi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Xiang Fang
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Takaaki Ohmori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Junya Yoshitani
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Yuki Yamamuro
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa university, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Takata Y, Nakase J, Shimozaki K, Asai K, Tsuchiya H. Autologous Adipose-Derived Stem Cell Sheet Has Meniscus Regeneration-Promoting Effects in a Rabbit Model. Arthroscopy 2020; 36:2698-2707. [PMID: 32554078 DOI: 10.1016/j.arthro.2020.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study investigated meniscal regeneration-promoting effects of adipose-derived stem cell (ADSC) sheets in a rabbit meniscal defect models. METHODS ADSCs were extracted from the interscapular fat pad adipose tissue of 42 mature female Japanese white rabbits. Once cells reached confluence at the third passage, the culture medium was supplemented with ascorbic acid. Within a week, the cells in culture formed removable sheets, which were used as ADSC sheets. Cell death (CD) sheets were created by killing ADSCs by freezing to investigate the need for viable ADSCs in ADSC sheets. The anterior half of the medial meniscus from the anterior root to the posterior edge of the medial collateral ligament was removed from both limbs. An autologous ADSC or CD sheet was transplanted to one knee (ADSC sheet or CD sheet group). The contralateral limb was closed without transplantation following meniscal removal (control group). Rabbits were euthanized 4 and 12 weeks after transplantation to harvest the entire medial menisci. The meniscal tissue area, transverse diameter on the inside of the medial collateral ligament, and histologic score were compared between the 3 groups. RESULTS The area and transverse diameter of regenerated tissues were larger in the ADSC sheet group than in the control group at 4 and 12 weeks. Further, the histologic score in the ADSC sheet group (8) was significantly greater than that in the control group (4.5) at 4 weeks (P = .02) and greater than that in the CD sheet group (9) (ADSC = 12.5, P = .009) and control group (6) (ADSC = 12.5, P = .0003) at 12 weeks. CONCLUSIONS Transplantation of the ADSC sheet into the meniscal defect increased the volume and improved the histologic score of the regenerated meniscal tissue. ADSC sheets may have meniscal regeneration-promoting effects in a rabbit model with meniscal defects. CLINICAL RELEVANCE ADSC sheets do not require a scaffold for implantation in the rabbit model, and this evidence suggests that some tissue regeneration occurs at the site of a surgically created meniscal defect.
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Affiliation(s)
- Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan.
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
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Editorial Commentary: Tissue Engineering of the Meniscus: Are We at the Point That if Something Looks Like a Meniscus, We Can Call It a Meniscus? Arthroscopy 2020; 36:2708-2709. [PMID: 33039042 DOI: 10.1016/j.arthro.2020.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
It was thought that the meniscus together with articular cartilage would be among the first tissues to successfully engineer. However, despite extensive research in the field, this path was proven not to be easy. Tissue engineering of musculoskeletal tissues remains promising, and several advancements have further identified the role of biological treatments in meniscus repair and regeneration. To move forward, and advance from being promising to being forthcoming, an important step would be to improve the quality of presented studies. This editorial commentary proposes a checklist of necessary reported data for tissue engineering studies: macroscopic and histologic appearance, tissue composition, mechanical properties, and translational data.
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Murata D, Arai K, Nakayama K. Scaffold-Free Bio-3D Printing Using Spheroids as "Bio-Inks" for Tissue (Re-)Construction and Drug Response Tests. Adv Healthc Mater 2020; 9:e1901831. [PMID: 32378363 DOI: 10.1002/adhm.201901831] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
In recent years, scaffold-free bio-3D printing using cell aggregates (spheroids) as "bio-inks" has attracted increasing attention as a method for 3D cell construction. Bio-3D printing uses a technique called the Kenzan method, wherein spheroids are placed one-by-one in a microneedle array (the "Kenzan") using a bio-3D printer. The bio-3D printer is a machine that was developed to perform bio-3D printing automatically. Recently, it has been reported that cell constructs can be produced by a bio-3D printer using spheroids composed of many types of cells and that this can contribute to tissue (re-)construction. This progress report summarizes the production and effectiveness of various cell constructs prepared using bio-3D printers. It also considers the future issues and prospects of various cell constructs obtained by using this method for further development of scaffold-free 3D cell constructions.
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Affiliation(s)
- Daiki Murata
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Kenichi Arai
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Koichi Nakayama
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
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Twomey-Kozak J, Jayasuriya CT. Meniscus Repair and Regeneration: A Systematic Review from a Basic and Translational Science Perspective. Clin Sports Med 2020; 39:125-163. [PMID: 31767102 DOI: 10.1016/j.csm.2019.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Meniscus injuries are among the most common athletic injuries and result in functional impairment in the knee. Repair is crucial for pain relief and prevention of degenerative joint diseases like osteoarthritis. Current treatments, however, do not produce long-term improvements. Thus, recent research has been investigating new therapeutic options for regenerating injured meniscal tissue. This review comprehensively details the current methodologies being explored in the basic sciences to stimulate better meniscus injury repair. Furthermore, it describes how these preclinical strategies may improve current paradigms of how meniscal injuries are clinically treated through a unique and alternative perspective to traditional clinical methodology.
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Affiliation(s)
- John Twomey-Kozak
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA
| | - Chathuraka T Jayasuriya
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA.
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26
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Sego TJ, Prideaux M, Sterner J, McCarthy BP, Li P, Bonewald LF, Ekser B, Tovar A, Jeshua Smith L. Computational fluid dynamic analysis of bioprinted self-supporting perfused tissue models. Biotechnol Bioeng 2019; 117:798-815. [PMID: 31788785 PMCID: PMC7015804 DOI: 10.1002/bit.27238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 01/11/2023]
Abstract
Natural tissues are incorporated with vasculature, which is further integrated with a cardiovascular system responsible for driving perfusion of nutrient‐rich oxygenated blood through the vasculature to support cell metabolism within most cell‐dense tissues. Since scaffold‐free biofabricated tissues being developed into clinical implants, research models, and pharmaceutical testing platforms should similarly exhibit perfused tissue‐like structures, we generated a generalizable biofabrication method resulting in self‐supporting perfused (SSuPer) tissue constructs incorporated with perfusible microchannels and integrated with the modular FABRICA perfusion bioreactor. As proof of concept, we perfused an MLO‐A5 osteoblast‐based SSuPer tissue in the FABRICA. Although our resulting SSuPer tissue replicated vascularization and perfusion observed in situ, supported its own weight, and stained positively for mineral using Von Kossa staining, our in vitro results indicated that computational fluid dynamics (CFD) should be used to drive future construct design and flow application before further tissue biofabrication and perfusion. We built a CFD model of the SSuPer tissue integrated in the FABRICA and analyzed flow characteristics (net force, pressure distribution, shear stress, and oxygen distribution) through five SSuPer tissue microchannel patterns in two flow directions and at increasing flow rates. Important flow parameters include flow direction, fully developed flow, and tissue microchannel diameters matched and aligned with bioreactor flow channels. We observed that the SSuPer tissue platform is capable of providing direct perfusion to tissue constructs and proper culture conditions (oxygenation, with controllable shear and flow rates), indicating that our approach can be used to biofabricate tissue representing primary tissues and that we can model the system in silico.
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Affiliation(s)
- T J Sego
- Department of Intelligent Systems Engineering, Indiana University, Bloomington, Indiana
| | - Matthew Prideaux
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, Indiana.,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jane Sterner
- Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.,3D Bioprinting Core, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian Paul McCarthy
- Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ping Li
- Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lynda F Bonewald
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, Indiana.,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana.,Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Burcin Ekser
- Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andres Tovar
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Lester Jeshua Smith
- Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.,3D Bioprinting Core, Indiana University School of Medicine, Indianapolis, Indiana
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Effectiveness of Adhering Adipose-Derived Stem Cells to Defective Cartilage in Promoting Cartilage Regeneration in a Rabbit Model. Arthroscopy 2019; 35:2619-2626. [PMID: 31307837 DOI: 10.1016/j.arthro.2019.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the therapeutic effect of using a local adherent technique to transplant adipose-derived stem cells (ADSCs) for cartilage regeneration in a rabbit model for patients with traumatic damage or osteochondritis dissecans. METHODS Cartilage defects were created in the trochlear groove of 60 adult white rabbit knees. The rabbits were either left untreated (control group), treated with intra-articularly injected ADSCs (injected group), or treated by adhering ADSCs (adherent group). The 3 groups were compared at 4, 12, and 24 weeks postoperatively using the International Cartilage Repair Society macroscopic scoring system and a modified Wakitani histologic grading system to quantitatively evaluate the regenerated cartilage. The degree of defect repair, integration to the border zone, macroscopic appearance, cell morphology, matrix staining, surface regularity, cartilage thickness, and integration of the donor with the host were evaluated. RESULTS The mean International Cartilage Repair Society scores in the control, injected, and adherent groups were 6.4 ± 2.9, 7.6 ± 0.8, and 7.6 ± 1.4, respectively, at 4 weeks; 6.2 ± 2.4, 8.2 ± 1.5, and 9.6 ± 1.0, respectively, at 8 weeks; and 7.6 ± 1.0, 8.4 ± 1.4, and 10.2 ± 1.7, respectively, at 24 weeks. Although the scores were higher in the adherent group, no significant difference was noted. The mean modified Wakitani scores in the control, injected, and adherent groups were 3.8 ± 2.0, 5.1 ± 1.8, and 7.8 ± 1.3, respectively, at 4 weeks (P = .041); 5.1 ± 1.0, 5.4 ± 2.7, and 9.6 ± 1.4, respectively, at 12 weeks (P = .016); and 5.4 ± 1.0, 5.9 ± 1.5, and 9.8 ± 1.8, respectively, at 24 weeks (P = .007). CONCLUSIONS The histologic modified Wakitani scores showed that adhering ADSCs to osteochondral cartilage defects was more effective than intra-articular injection for promoting cartilage regeneration. CLINICAL RELEVANCE Local adhesion of ADSCs can promote cartilage regeneration and may be a treatment option for cartilage repair.
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Han Y, Li X, Zhang Y, Han Y, Chang F, Ding J. Mesenchymal Stem Cells for Regenerative Medicine. Cells 2019; 8:E886. [PMID: 31412678 PMCID: PMC6721852 DOI: 10.3390/cells8080886] [Citation(s) in RCA: 618] [Impact Index Per Article: 123.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023] Open
Abstract
In recent decades, the biomedical applications of mesenchymal stem cells (MSCs) have attracted increasing attention. MSCs are easily extracted from the bone marrow, fat, and synovium, and differentiate into various cell lineages according to the requirements of specific biomedical applications. As MSCs do not express significant histocompatibility complexes and immune stimulating molecules, they are not detected by immune surveillance and do not lead to graft rejection after transplantation. These properties make them competent biomedical candidates, especially in tissue engineering. We present a brief overview of MSC extraction methods and subsequent potential for differentiation, and a comprehensive overview of their preclinical and clinical applications in regenerative medicine, and discuss future challenges.
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Affiliation(s)
- Yu Han
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, China
| | - Xuezhou Li
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, China
| | - Yanbo Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, China.
| | - Yuping Han
- Department of Urology, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, China.
| | - Fei Chang
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, China.
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, China
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29
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Progress in biological reconstruction and enhanced bone revitalization for bone defects. J Orthop Sci 2019; 24:387-392. [PMID: 30797666 DOI: 10.1016/j.jos.2019.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 11/22/2022]
Abstract
Bone defect reconstruction with artificial materials may produce good functional recovery in the short term. Over time, the durability of artificial materials becomes an issue, and therefore, artificial materials cannot be considered a permanent solution to reconstruction. For long-term outcomes, the goal is to regain function, permanence, and form that are as close to normal as possible. Thus, physiological materials are desirable for use in reconstruction. Biological reconstruction involves the use of materials that are modified in vivo following reconstruction of bone defects. The goal is to achieve bone union, bone revival and remodeling, with biointegration of soft tissue and bone. Allograft use has been the mainstay of bone defect reconstruction in most parts of the world, although in some countries like Japan, allogeneic bone is difficult to obtain due to socio-religious concerns. Therefore, we developed new biological reconstruction techniques to overcome this problem. Bone derived from distraction osteogenesis is autologous bone, which must be an ideal reconstruction material for its biological affinity, strength, resilience, and immunity to infection. When applying this method to patients with malignant disease however, it is important to preserve as much of the local soft tissue as possible, and the clinician must be especially careful of infection and callus formation. Liquid nitrogen treatment of tumor-bearing bone produces equal, if not better, bone revitalization compared to other forms of treatment to date. Reconstruction with liquid nitrogen-treated bone involves resecting the diseased bone and returning it to the body following liquid nitrogen treatment (free-freezing method). Another method involves dislocating the joint proximal to the tumor, or cutting the bone while the distal side remains attached to the body and the limb inverted and treated with liquid nitrogen (pedicle freezing method). When both methods are possible, the pedicle freezing method is preferable since it is performed with minimal osteotomy. Our recent research has looked into the possible role of adipose-derived stem cells in promoting bone fusion and revitalization. This method has produced promising results for the future of biological reconstruction.
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30
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Chansoria P, Narayanan LK, Schuchard K, Shirwaiker R. Ultrasound-assisted biofabrication and bioprinting of preferentially aligned three-dimensional cellular constructs. Biofabrication 2019; 11:035015. [DOI: 10.1088/1758-5090/ab15cf] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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31
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Aguilar IN, Olivos DJ, Brinker A, Alvarez MB, Smith LJ, Chu TMG, Kacena MA, Wagner DR. Scaffold-free bioprinting of mesenchymal stem cells using the Regenova printer: Spheroid characterization and osteogenic differentiation. ACTA ACUST UNITED AC 2019; 15. [PMID: 31457109 DOI: 10.1016/j.bprint.2019.e00050] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Limitations in scaffold material properties, such as sub-optimal degradation time, highlight the need for alternative approaches to engineer de novo tissues. One emerging solution for fabricating tissue constructs is scaffold-free tissue engineering. To facilitate this approach, three-dimensional (3D) bioprinting technology (Regenova Bio 3D Printer) has been developed to construct complex geometric shapes from discrete cellular spheroids without exogenous scaffolds. Optimizing spheroid fabrication and characterizing cellular behavior in the spheroid environment are important first steps prior to printing larger constructs. Here, we characterized spheroids of immortalized mouse bone marrow stromal cells (BMSCs) that were differentiated to the osteogenic lineage. Immortalized BMSCs were seeded in low attachment 96-well plates in various numbers to generate self-aggregated spheroids either under the force of gravity or centrifugation. Cells were cultured in control or osteogenic media for up to 28 days. Spheroid diameter, roundness and smoothness were measured. Cell viability, DNA content and alkaline phosphatase activity were assessed at multiple time points. Additionally, expression of osteogenic markers was determined using real time qPCR. Spheroids formed under gravity with 20 K, 30 K and 40 K cells had average diameters of 498.5 ± 8.3 μm, 580.0 ± 32.9 μm and 639.2 ± 54.0 μm, respectively, while those formed under 300G centrifugation with the same numbers of cells had average diameters of 362.3 ± 3.5 μm, 433.1 ± 6.4 μm and 491.2 ± 8.0 μm. Spheroids formed via centrifugation were superior to those formed by gravity, as evidenced by better roundness and smoothness and double the retention of DNA (cellular) content. Cells in spheroids exhibited a robust osteogenic response to the differentiation medium, including higher mRNA expression of alkaline phosphatase, collagen type I, and osteocalcin than those cultured in control medium, as well as greater alkaline phosphatase activity. The optimal spheroid fabrication technique from this study was to aggregate 40K cells under 150-300G centrifugation. In future investigations, these spheroids will be 3D printed into larger tissue constructs.
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Affiliation(s)
- Izath Nizeet Aguilar
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - David J Olivos
- Department of Biochemistry and Molecular Biology, Indiana University of School of Medicine, Indianapolis, IN, USA
| | - Alexander Brinker
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Marta B Alvarez
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lester J Smith
- Department of Radiology and Imaging Sciences, Indiana University of School of Medicine, Indianapolis, IN, USA.,3D Bioprinting Core, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tien-Min Gabriel Chu
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47908, USA.,Department of Biomedical and Applied Sciences, Indiana University School of Dentistry, Indianapolis, IN, 46202, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Diane R Wagner
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Mechanical and Energy Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
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Oshima T, Nakase J, Toratani T, Numata H, Takata Y, Nakayama K, Tsuchiya H. A Scaffold-Free Allogeneic Construct From Adipose-Derived Stem Cells Regenerates an Osteochondral Defect in a Rabbit Model. Arthroscopy 2019; 35:583-593. [PMID: 30612760 DOI: 10.1016/j.arthro.2018.08.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine whether an osteochondral defect could be healed histologically by implanting allogeneic 3-dimensionally formed adipose-derived stem cells (ADSCs) in a rabbit model. METHODS Thirty Japanese white rabbits (aged 15-17 weeks) were assigned to 1 of 2 groups. An osteochondral defect (diameter, 4.8 mm; depth, 3 mm) was created in the trochlear groove of the knee using a drill. The defects were left empty in the control group and were filled with cylindrical plugs of allogeneic ADSCs extracted from adipose tissue in the experimental group. Macroscopic scoring, histologic scoring, and immunohistologic stainability of type II collagen were evaluated at 4, 8, and 12 weeks postoperatively. RESULTS The macroscopic scores of the healing tissue in the experimental group were significantly greater than those in the control group at 12 weeks (P = .031). Histologically, safranin O staining was noted at 4 weeks and increased gradually over time in the experimental group. The modified International Cartilage Repair Society histologic score in the experimental group was significantly higher than that in the controls at 8 and 12 weeks (14 vs 9 at 8 weeks [P = .008], 18 vs 10 at 12 weeks [P = .007]). The implanted tissue was positive for type II collagen, and stainability increased gradually over time. CONCLUSIONS The 3-dimensional scaffold-free allogeneic ADSCs implanted into the osteochondral defect survived, adhered to the defect, increased the stainability of type II collagen gradually over time, and promoted histologic healing in a rabbit model. CLINICAL RELEVANCE ADSC implantation designed to promote osteochondral healing may play an important role in osteochondral healing.
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Affiliation(s)
- Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
| | - Tatsuhiro Toratani
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hitoaki Numata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Comparative efficacy of stem cells and secretome in articular cartilage regeneration: a systematic review and meta-analysis. Cell Tissue Res 2018; 375:329-344. [PMID: 30084022 DOI: 10.1007/s00441-018-2884-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/04/2018] [Indexed: 12/17/2022]
Abstract
Articular cartilage defect remains the most challenging joint disease due to limited intrinsic healing capacity of the cartilage that most often progresses to osteoarthritis. In recent years, stem cell therapy has evolved as therapeutic strategies for articular cartilage regeneration. However, a number of studies have shown that therapeutic efficacy of stem cell transplantation is attributed to multiple secreted factors that modulate the surrounding milieu to evoke reparative processes. This systematic review and meta-analysis aim to evaluate and compare the therapeutic efficacy of stem cell and secretome in articular cartilage regeneration in animal models. We systematically searched the PubMed, CINAHL, Cochrane Library, Ovid Medline and Scopus databases until August 2017 using search terms related to stem cells, cartilage regeneration and animals. A random effect meta-analysis of the included studies was performed to assess the treatment effects on new cartilage formation on an absolute score of 0-100% scale. Subgroup analyses were also performed by sorting studies independently based on similar characteristics. The pooled analysis of 59 studies that utilized stem cells significantly improved new cartilage formation by 25.99% as compared with control. Similarly, the secretome also significantly increased cartilage regeneration by 26.08% in comparison to the control. Subgroup analyses revealed no significant difference in the effect of stem cells in new cartilage formation. However, there was a significant decline in the effect of stem cells in articular cartilage regeneration during long-term follow-up, suggesting that the duration of follow-up is a predictor of new cartilage formation. Secretome has shown a similar effect to stem cells in new cartilage formation. The risk of bias assessment showed poor reporting for most studies thereby limiting the actual risk of bias assessment. The present study suggests that both stem cells and secretome interventions improve cartilage regeneration in animal trials. Graphical abstract ᅟ.
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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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Loghmani MT, Roche JA. Conference Report: 6th Annual International Symposium on Regenerative Rehabilitation. Regen Med 2018; 13:371-374. [PMID: 29611460 DOI: 10.2217/rme-2018-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The 6th International Symposium on Regenerative Rehabilitation, hosted by the Alliance for Regenerative Rehabilitation Research and Training (AR3T), included a preconference meeting of institutional representatives of the International Consortium of Regenerative Rehabilitation, keynote talks from distinguished scientists, platform and poster presentations from experts and trainees, panel discussions and postconference workshops. The following priorities were identified: increasing rigor in basic, preclinical and clinical studies, especially the use of better controls; developing better outcome measures for preclinical and clinical trials; focusing on developing more tissue-based interventions versus cell-based interventions; including regenerative rehabilitation in curricula of professional programs like occupational and physical therapy; and developing better instruments to quantify rehabilitative interventions.
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Affiliation(s)
- M Terry Loghmani
- Applied Regenerative Medicine Lab, Department of Physical Therapy, Indiana University, School of Health & Rehabilitation Sciences, Indianapolis, IN 46202, USA
| | - Joseph A Roche
- Physical Therapy Program, Department of Health Care Sciences, College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA
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Barber FA. Editorial Commentary: Polyurethane Meniscal Scaffold: A Perfect Fit or Flop? Arthroscopy 2018; 34:1628-1630. [PMID: 29729765 DOI: 10.1016/j.arthro.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 02/02/2023]
Abstract
The goal of using a synthetic scaffold to establish a biomechanically functioning meniscus or provide an equivalent meniscus substitute is not achieved by the polycaprolactone-polyurethane Actifit scaffold. Recent research, that did not include a control group, shows that the revision rate is significant, and any improvements in patient outcomes could reflect the associated reconstructive surgery. Based on these data and similar published reports, it is premature to conclude that this implant is clinically indicated. The technique is currently more flop than fit.
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Nie X, Wang DA. Decellularized orthopaedic tissue-engineered grafts: biomaterial scaffolds synthesised by therapeutic cells. Biomater Sci 2018; 6:2798-2811. [DOI: 10.1039/c8bm00772a] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In orthopaedic surgery, the reconstruction of musculoskeletal defects is a constant challenge.
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Affiliation(s)
- Xiaolei Nie
- Division of Bioengineering
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore 637457
- Singapore
| | - Dong-An Wang
- Division of Bioengineering
- School of Chemical and Biomedical Engineering
- Nanyang Technological University
- Singapore 637457
- Singapore
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Terai S, Hashimoto Y, Orita K, Yamasaki S, Takigami J, Shinkuma T, Teraoka T, Nishida Y, Takahashi M, Nakamura H. The origin and distribution of CD68, CD163, and αSMA + cells in the early phase after meniscal resection in a parabiotic rat model. Connect Tissue Res 2017; 58:562-572. [PMID: 28165810 DOI: 10.1080/03008207.2017.1284825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We previously reported that circulating peripheral blood-borne cells (PBCs) contribute to early-phase meniscal reparative change. Because macrophages and myofibroblasts are important contributors of tissue regeneration, we examined their origin and distribution in the reparative meniscus. Reparative menisci were evaluated at 1, 2, and 4 weeks post-meniscectomy by immunohistochemistry to locate monocytes and macrophages (stained positive for CD68 and CD163), and myofibroblasts (stained positive for αSMA). Of the total number of cells, 13% were CD68+ at 1 week post-meniscectomy, which decreased to 1% by 4 weeks post-meniscectomy; of these, almost half of CD68+ cells (49.4%: 98.8% as PBCs) were green fluorescent protein (GFP)-positive post-meniscectomy (1, 2, and 4 weeks), indicating that the majority of CD68+ cells were derived from PBCs. Of the total cells, 6% were CD163+ at 1 week post-meniscectomy, which decreased to 1% by week 4. Of the CD163+ cells, the majority were GFP-positive (42.5%: 85.0% as PBCs) after 1 week; however, this decreased significantly over time, which indicates that the majority of CD163+ cells are derived from PBCs during the early phase of meniscal reparative change, but are derived from resident cells at later time points. Of the total cells, 38% were αSMA+ at 1 week post-meniscectomy, which decreased to 3% by 4 weeks. The proportion of GFP-positive αSMA+ cells was 2.8% after 1 week, with no significant change over time, which indicates that the majority of αSMA+ cells originated from resident cells. Here, we describe the origin and distribution of macrophages and myofibroblasts during meniscal reparative change.
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Affiliation(s)
- Shozaburo Terai
- a Department of Orthopaedic Surgery , Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Yusuke Hashimoto
- a Department of Orthopaedic Surgery , Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Kumi Orita
- a Department of Orthopaedic Surgery , Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Shinya Yamasaki
- b Department of Orthopaedic Surgery , Osaka City General Hospital , Osaka , Japan
| | - Junsei Takigami
- c Department of Orthopaedic Surgery , Shimada Hospital , Habikino , Japan
| | - Takafumi Shinkuma
- a Department of Orthopaedic Surgery , Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Takanori Teraoka
- a Department of Orthopaedic Surgery , Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Yohei Nishida
- a Department of Orthopaedic Surgery , Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Masafumi Takahashi
- d Division of Inflammation Research, Centre for Molecular Medicine , Jichi Medical University , Shimotsuke , Japan
| | - Hiroaki Nakamura
- a Department of Orthopaedic Surgery , Osaka City University Graduate School of Medicine , Osaka , Japan
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Platelet-Rich Fibrin Facilitates Rabbit Meniscal Repair by Promoting Meniscocytes Proliferation, Migration, and Extracellular Matrix Synthesis. Int J Mol Sci 2017; 18:ijms18081722. [PMID: 28783120 PMCID: PMC5578112 DOI: 10.3390/ijms18081722] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 12/18/2022] Open
Abstract
Although platelet-rich fibrin (PRF) has been used in clinical practice for some time, to date, few studies reveal its role as a bioactive scaffold in facilitating meniscal repair. Here, the positive anabolic effects of PRF on meniscocytes harvested from the primary culture of a rabbit meniscus were revealed. The rabbit meniscocytes were cultured with different concentrations of PRF-conditioned medium, and were evaluated for their ability to stimulate cell migration, proliferation, and extracellular matrix formation. In vivo, meniscal defects were created via an established rabbit animal model and were evaluated by a histology-based four-stage scoring system to validate the treatment outcome three months postoperatively. The in vitro results showed that PRF could induce cellular migration and promote proliferation and meniscocyte extracellular matrix (ECM) synthesis of cultured meniscocytes. In addition, PRF increased the formation and deposition of cartilaginous matrix produced by cultured meniscocytes. Morphological and histological evaluations demonstrated that PRF could facilitate rabbit meniscal repair. The data highlight the potential utility of using PRF in augmenting the healing of meniscal injuries. These advantages would benefit clinical translation, and are a potential new treatment strategy for meniscal repair.
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Koh RH, Jin Y, Kang BJ, Hwang NS. Chondrogenically primed tonsil-derived mesenchymal stem cells encapsulated in riboflavin-induced photocrosslinking collagen-hyaluronic acid hydrogel for meniscus tissue repairs. Acta Biomater 2017; 53:318-328. [PMID: 28161573 DOI: 10.1016/j.actbio.2017.01.081] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
Current meniscus tissue repairing strategies involve partial or total meniscectomy, followed by allograft transplantation or synthetic material implantation. However, allografts and synthetic implants have major drawbacks such as the limited supply of grafts and lack of integration into host tissue, respectively. In this study, we investigated the effects of conditioned medium (CM) from meniscal fibrochondrocytes and TGF-β3 on tonsil-derived mesenchymal stem cells (T-MSCs) for meniscus tissue engineering. CM-expanded T-MSCs were encapsulated in riboflavin-induced photocrosslinked collagen-hyaluronic acid (COL-RF-HA) hydrogels and cultured in chondrogenic medium containing TGF-β3. In vitro results indicate that CM-expanded cells followed by TGF-β3 exposure stimulated the expression of fibrocartilage-related genes (COL2, SOX9, ACAN, COL1) and production of extracellular matrix components. Histological assessment of in vitro and subcutaneously implanted in vivo constructs demonstrated that CM-expanded cells followed by TGF-β3 exposure resulted in highest cell proliferation, GAG accumulation, and collagen deposition. Furthermore, when implanted into meniscus defect model, CM treatment amplified the potential of TGF-β3 and induced complete regeneration. STATEMENT OF SIGNIFICANCE Conditioned medium derived from chondrocytes have been reported to effectively prime mesenchymal stem cells toward chondrogenic lineage. Type I collagen is the main component of meniscus extracellular matrix and hyaluronic acid is known to promote meniscus regeneration. In this manuscript, we investigated the effects of conditioned medium (CM) and transforming growth factor-β3 (TGF-β3) on tonsil-derived mesenchymal stem cells (T-MSCs) encapsulated in riboflavin-induced photocrosslinked collagen-hyaluronic acid (COL-RF-HA) hydrogel. We employed a novel source of conditioned medium, derived from meniscal fibrochondrocytes. Our in vitro and in vivo results collectively illustrate that CM-expanded cells followed by TGF-β3 exposure have the best potential for meniscus regeneration. This manuscript highlights a novel stem cell commitment strategy combined with biomaterials designs for meniscus regeneration.
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