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Confalonieri D, Schwab A, Walles H, Ehlicke F. Advanced Therapy Medicinal Products: A Guide for Bone Marrow-derived MSC Application in Bone and Cartilage Tissue Engineering. TISSUE ENGINEERING PART B-REVIEWS 2017; 24:155-169. [PMID: 28990462 DOI: 10.1089/ten.teb.2017.0305] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Millions of people worldwide suffer from trauma- or age-related orthopedic diseases such as osteoarthritis, osteoporosis, or cancer. Tissue Engineering (TE) and Regenerative Medicine are multidisciplinary fields focusing on the development of artificial organs, biomimetic engineered tissues, and cells to restore or maintain tissue and organ function. While allogenic and future autologous transplantations are nowadays the gold standards for both cartilage and bone defect repair, they are both subject to important limitations such as availability of healthy tissue, donor site morbidity, and graft rejection. Tissue engineered bone and cartilage products represent a promising and alternative approach with the potential to overcome these limitations. Since the development of Advanced Therapy Medicinal Products (ATMPs) such as TE products requires the knowledge of diverse regulation and an extensive communication with the national/international authorities, the aim of this review is therefore to summarize the state of the art on the clinical applications of human bone marrow-derived stromal cells for cartilage and bone TE. In addition, this review provides an overview of the European legislation to facilitate the development and commercialization of new ATMPs.
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Affiliation(s)
- Davide Confalonieri
- 1 Department Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg , Wuerzburg, Germany
| | - Andrea Schwab
- 1 Department Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg , Wuerzburg, Germany
| | - Heike Walles
- 1 Department Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg , Wuerzburg, Germany .,2 Translational Center Wuerzburg "Regenerative Therapies in Oncology and Musculoskeletal Disease," Wuerzburg, Germany
| | - Franziska Ehlicke
- 1 Department Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg , Wuerzburg, Germany
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Kawa MP, Stecewicz I, Piecyk K, Paczkowska E, Rogińska D, Sobuś A, Łuczkowska K, Pius-Sadowska E, Gawrych E, Petriczko E, Walczak M, Machaliński B. The Impact of Growth Hormone Therapy on the Apoptosis Assessment in CD34+ Hematopoietic Cells from Children with Growth Hormone Deficiency. Int J Mol Sci 2017; 18:ijms18010111. [PMID: 28067847 PMCID: PMC5297745 DOI: 10.3390/ijms18010111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/10/2016] [Accepted: 12/21/2016] [Indexed: 01/07/2023] Open
Abstract
Growth hormone (GH) modulates hematopoietic cell homeostasis and is associated with apoptosis control, but with limited mechanistic insights. Aim of the study was to determine whether GH therapeutic supplementation (GH-TS) could affect apoptosis of CD34+ cells enriched in hematopoietic progenitor cells of GH deficient (GHD) children. CD34+ cells from peripheral blood of 40 GHD children were collected before and in 3rd and 6th month of GH-TS and compared to 60 controls adjusted for bone age, sex, and pubertal development. Next, apoptosis assessment via different molecular techniques was performed. Finally, to comprehensively characterize apoptosis process, global gene expression profile was determined using genome-wide RNA microarray technology. Results showed that GH-TS significantly reduced spontaneous apoptosis in CD34+ cells (p < 0.01) and results obtained using different methods to detect early and late apoptosis in analyzed cells population were consistent. GH-TS was also associated with significant downregulation of several members of TNF-alpha superfamily and other genes associated with apoptosis and stress response. Moreover, the significant overexpression of cyto-protective and cell cycle-associated genes was detected. These findings suggest that recombinant human GH has a direct anti-apoptotic activity in hematopoietic CD34+ cells derived from GHD subjects in course of GH-TS.
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Affiliation(s)
- Miłosz Piotr Kawa
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
| | - Iwona Stecewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland.
| | - Katarzyna Piecyk
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
| | - Edyta Paczkowska
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
| | - Dorota Rogińska
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
| | - Anna Sobuś
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
| | - Karolina Łuczkowska
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
| | - Ewa Pius-Sadowska
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
| | - Elżbieta Gawrych
- Department of Pediatric and Oncological Surgery, Pomeranian Medical University in Szczecin, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland.
| | - Elżbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland.
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland.
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University in Szczecin, 72 Powstancow Wlkp. Street, 70-111 Szczecin, Poland.
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Olarescu NC, Berryman DE, Householder LA, Lubbers ER, List EO, Benencia F, Kopchick JJ, Bollerslev J. GH action influences adipogenesis of mouse adipose tissue-derived mesenchymal stem cells. J Endocrinol 2015; 226:13-23. [PMID: 25943560 PMCID: PMC4560118 DOI: 10.1530/joe-15-0012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 12/15/2022]
Abstract
GH influences adipocyte differentiation, but both stimulatory and inhibitory effects have been described. Adipose tissue-derived mesenchymal stem cells (AT-MSCs) are multipotent and are able to differentiate into adipocytes, among other cells. Canonical Wnt/β-catenin signaling activation impairs adipogenesis. The aim of the present study was to elucidate the role of GH on AT-MSC adipogenesis using cells isolated from male GH receptor knockout (GHRKO), bovine GH transgenic (bGH) mice, and wild-type littermate control (WT) mice. AT-MSCs from subcutaneous (sc), epididiymal (epi), and mesenteric (mes) AT depots were identified and isolated by flow cytometry (Pdgfrα+ Sca1+ Cd45- Ter119- cells). Their in vitro adipogenic differentiation capacity was determined by cell morphology and real-time RT-PCR. Using identical in vitro conditions, adipogenic differentiation of AT-MSCs was only achieved in the sc depot, and not in epi and mes depots. Notably, we observed an increased differentiation in cells isolated from sc-GHRKO and an impaired differentiation of sc-bGH cells as compared to sc-WT cells. Axin2, a marker of Wnt/β-catenin activation, was increased in mature sc-bGH adipocytes, which suggests that activation of this pathway may be responsible for the decreased adipogenesis. Thus, the present study demonstrates that (i) adipose tissue in mice has a well-defined population of Pdgfrα+ Sca1+ MSCs; (ii) the differentiation capacity of AT-MSCs varies from depot to depot regardless of GH genotype; (iii) the lack of GH action increases adipogenesis in the sc depot; and iv) activation of the Wnt/β-catenin pathway might mediate the GH effect on AT-MSCs. Taken together, the present results suggest that GH diminishes fat mass in part by altering adipogenesis of MSCs.
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Affiliation(s)
- Nicoleta C Olarescu
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - Darlene E Berryman
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - Lara A Householder
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - Ellen R Lubbers
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - Edward O List
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - Fabian Benencia
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - John J Kopchick
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
| | - Jens Bollerslev
- Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA Section of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950, N-0424 Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayEdison Biotechnology InstituteOhio University, Athens, Ohio, USAHeritage College of Osteopathic MedicineOhio University, Athens, Ohio, USA
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Wang JR, Ahmed SF, Gadegaard N, Meek RMD, Dalby MJ, Yarwood SJ. Nanotopology potentiates growth hormone signalling and osteogenesis of mesenchymal stem cells. Growth Horm IGF Res 2014; 24:245-250. [PMID: 25466909 DOI: 10.1016/j.ghir.2014.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/03/2014] [Accepted: 10/20/2014] [Indexed: 11/16/2022]
Abstract
Custom engineered materials can influence the differentiation of human mesenchymal stem cells (MSCs) towards osteoblasts, chondrocytes and adipocytes, through the control of chemistry, stiffness and nanoscale topography. Here we demonstrate that polycaprolactone growth surfaces engineered with disordered (but controlled) 120 nm diameter dots (NSQ50), but not flat surfaces, promote osteogenic conversion of MSCs in the absence of other osteogenic stimuli. Differentiating MSCs on NSQ50 were found to express growth hormone receptors (GH) and stimulation with recombinant human GH (rhGH) further enhanced NSQ50-driven osteogenic conversion of MSCs. This increased osteogenesis coincided with an enhanced ability of GH to activate ERK MAP kinase on NSQ50, but not on flat topology. The importance of ERK for MSC differentiation was demonstrated by using the inhibitor of ERK activation, U0126, which completely suppressed osteogenesis of GH-stimulated MSCs on NSQ50. The ability of GH to activate ERK in MSCs may therefore be a central control mechanism underlying bone development and growth.
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Gruber HE, Riley FE, Hoelscher GL, Bayoumi EM, Ingram JA, Ramp WK, Bosse MJ, Kellam JF. Osteogenic and chondrogenic potential of biomembrane cells from the PMMA-segmental defect rat model. J Orthop Res 2012; 30:1198-212. [PMID: 22246998 DOI: 10.1002/jor.22047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 12/05/2011] [Indexed: 02/04/2023]
Abstract
A layer of cells (the "biomembrane") has been identified in large segmental defects between bone and surgically placed methacrylate spacers or antibiotic-impregnated cement beads. We hypothesize that this contains a pluripotent stem cell population with potential valuable applications in orthopedic tissue engineering. Objectives using biomembranes harvested from rat segmental defects were to: (1) Culture biomembrane cells in specialized media to direct progenitor cells along bone or cartilage cell differentiation lineages; (2) evaluate harvested biomembranes for mesenchymal stem cell markers, and (3) define relevant gene expression patterns in harvested biomembranes using microarray analysis. Culture in osteogenic media produced mineralized nodules; culture in chondrogenic media produced masses containing chondroitin sulfate/sulfated proteoglycans. Molecular analysis of biomembrane cells versus control periosteum showed significant upregulation of key genes functioning in mesenchymal stem cell differentiation, development, maintenance, and proliferation. Results identified significant upregulation of WNT receptor signaling pathway genes and significant upregulation of BMP signaling pathway genes. Findings confirm that the biomembrane has a pluripotent stem cell population. The ability to heal large bone defects is clinically challenging, and novel tissue engineering uses of the biomembrane hold great promise in treating non-unions, open fractures with large bone loss and/or infections, and defects associated with tumor resection.
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Affiliation(s)
- Helen E Gruber
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
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Hall SL, Chen ST, Wergedal JE, Gridley DS, Mohan S, Lau KHW. Stem cell antigen-1 positive cell-based systemic human growth hormone gene transfer strategy increases endosteal bone resorption and bone loss in mice. J Gene Med 2011; 13:77-88. [PMID: 21322098 DOI: 10.1002/jgm.1542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The present study assesses the effect of the stem cell antigen-1 positive (Sca-1(+) ) cell-based human growth hormone (hGH) ex vivo gene transfer strategy on endosteal bone mass in the mouse. METHODS Sublethally irradiated recipient mice were transplanted with Sca-1(+) cells transduced with lentiviral vectors expressing hGH or β-galactosidase control genes. Bone parameters were assessed by micro-computed tomography and histomorphometry. RESULTS This hGH strategy drastically increased hGH mRNA levels in bone marrow cells and serum insulin-like growth factor-I (IGF-I) (by nearly 50%, p < 0.002) in hGH recipient mice. Femoral trabecular bone volume of the hGH mice was significantly reduced by 35% (p < 0.002). The hGH mice also had decreased trabecular number (by 26%; p < 0.0001), increased trabecular separation (by 38%; p < 0.0002) and reduced trabecular connectivity density (by 64%; p < 0.001), as well as significantly more osteoclasts (2.5-fold; p < 0.05) and greater osteoclastic surface per bone surface (2.6-fold; p < 0.01). CONCLUSIONS Targeted expression of hGH in cells of marrow cavity through the Sca-1(+) cell-based gene transfer strategy increased circulating IGF-I and decreased endosteal bone mass through an increase in resorption in recipient mice. These results indicate that high local levels of hGH or IGF-I in the bone marrow microenvironment enhanced resorption, which is consistent with previous findings in transgenic mice with targeted bone IGF-I expression showing that high local IGF-I expression increased bone remodeling, favoring a net bone loss. Thus, GH and/or IGF-I would not be an appropriate transgene for use in this Sca-1(+) cell-based gene transfer strategy to promote endosteal bone formation. Published 2011 John Wiley & Sons, Ltd.
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Affiliation(s)
- Susan L Hall
- Musculoskeletal Disease Center, Jerry L. Pettis Memorial VA Medical Center, Loma Linda, CA, USA.
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Abstract
The 'cancer stem cell hypothesis' posits that cancers, including breast cancer, arise in tissue stem or progenitor cells. If this is the case, then it follows that the risk for developing breast cancer may be determined in part by the number of breast stem/progenitor cells that can serve as targets for transformation. Stem cell number may be set during critical windows of development, including in utero, adolescence, and pregnancy. The growth hormone/insulin-like growth factor-1 axis may play an important role in regulating breast stem cell number during these developmental windows, suggesting an important link between this signaling pathway and breast cancer risk.
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Affiliation(s)
- Christophe Ginestier
- Comprehensive Cancer Center, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USA
| | - Max S Wicha
- Comprehensive Cancer Center, Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USA
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Ebert R, Schütze N, Schilling T, Seefried L, Weber M, Nöth U, Eulert J, Jakob F. Influence of hormones on osteogenic differentiation processes of mesenchymal stem cells. Expert Rev Endocrinol Metab 2007; 2:59-78. [PMID: 30743749 DOI: 10.1586/17446651.2.1.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Bone development, regeneration and maintenance are governed by osteogenic differentiation processes from mesenchymal stem cells through to mature bone cells, which are directed by local growth and differentiation factors and modulated strongly by hormones. Mesenchymal stem cells develop from both mesoderm and neural crest and can give rise to development, regeneration and maintenance of mesenchymal tissues, such as bone, cartilage, muscle, tendons and discs. There are only limited data regarding the effects of hormones on early events, such as regulation of stemness and maintenance of the mesenchymal stem cell pool. Hormones, such as estrogens, vitamin D-hormone and parathyroid hormone, besides others, are important modulators of osteogenic differentiation processes and bone formation, starting off with fate decision and the development of osteogenic offspring from mesenchymal stem cells, which end up in osteoblasts and osteocytes. Hormones are involved in fetal bone development and regeneration and, in childhood, adolescence and adulthood, they control adaptive needs for growth and reproduction, nutrition, physical power and crisis adaptation. As in other tissues, aging in mesenchymal stem cells and their osteogenic offspring is accompanied by the accumulation of genomic and proteomic damage caused by oxidative burden and insufficient repair. Failsafe programs, such as apoptosis and cellular senescence avoid tumorigenesis. Hormones can influence the pace of such events, thus supporting the quality of tissue regeneration in aging organisms in vivo; for example, by delaying osteoporosis development. The potential for hormones in systemic therapeutic strategies is well appreciated and some concepts are approved for clinical use already. Their potential for cell-based therapeutic strategies for tissue regeneration is probably underestimated and could enhance the quality of tissue-engineering constructs for transplantation and the concept of in situ-guided tissue regeneration.
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Affiliation(s)
- Regina Ebert
- a University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
| | - Norbert Schütze
- b University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
| | - Tatjana Schilling
- c University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
| | - Lothar Seefried
- d University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
| | - Meike Weber
- e University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
| | - Ulrich Nöth
- f University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
| | - Jochen Eulert
- g University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
| | - Franz Jakob
- h University of Wuerzburg, Orthopedic Center for Musculoskeletal Research, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
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