1
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Peng Y, Liu G, Li S, Li Z, Song J. A machine learning system for artificial ligaments with desired mechanical properties in ACL reconstruction applications. J Mech Behav Biomed Mater 2024; 159:106691. [PMID: 39182251 DOI: 10.1016/j.jmbbm.2024.106691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/08/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
The anterior cruciate ligament is one of the important tissues to maintain the stability of the human knee joint, but it is difficult for this ligament to self-heal after injury. Consequently, transplantation of artificial ligaments (ALs) has gained widespread attention as an important alternative treatment method in recent years. However, accurately predicting the intricate mechanical properties of ALs remains a formidable challenge, particularly when employing theoretical frameworks such as braiding theory. This obstacle presents a significant impediment to achieving optimal AL design. Therefore, in this study, a high-precision machine learning model based on an artificial neural network was developed to rapidly and accurately predict the mechanical properties of ALs. The results showed that the proposed model achieved a reduction of 45.22% and 50.17% in the normalized root mean square error on the testing set when compared to traditional machine learning models (Random Forest and Support Vector Machine), demonstrating its higher accuracy. In addition, the design of ALs with desired mechanical properties was achieved by optimizing the braiding parameters, and its effectiveness was verified through experiments. The mechanical properties of the prepared ALs were able to fully meet the desired targets and were at least 2% higher. Finally, the influence weights of different braiding parameters on the mechanical properties of ALs were analyzed by feature importance.
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Affiliation(s)
- Yeping Peng
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen 518060, China
| | - Guiyang Liu
- Guangdong Key Laboratory of Electromagnetic Control and Intelligent Robots, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen 518060, China; School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China
| | - Shenglin Li
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China
| | - Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080, China
| | - Jian Song
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China.
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Roldán E, Reeves ND, Cooper G, Andrews K. Machine learning to mechanically assess 2D and 3D biomimetic electrospun scaffolds for tissue engineering applications: Between the predictability and the interpretability. J Mech Behav Biomed Mater 2024; 157:106630. [PMID: 38896922 DOI: 10.1016/j.jmbbm.2024.106630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/21/2024]
Abstract
Currently, the use of autografts is the gold standard for the replacement of many damaged biological tissues. However, this practice presents disadvantages that can be mitigated through tissue-engineered implants. The aim of this study is to explore how machine learning can mechanically evaluate 2D and 3D polyvinyl alcohol (PVA) electrospun scaffolds (one twisted filament, 3 twisted filament and 3 twisted/braided filament scaffolds) for their use in different tissue engineering applications. Crosslinked and non-crosslinked scaffolds were fabricated and mechanically characterised, in dry/wet conditions and under longitudinal/transverse loading, using tensile testing. 28 machine learning models (ML) were used to predict the mechanical properties of the scaffolds. 4 exogenous variables (structure, environmental condition, crosslinking and direction of the load) were used to predict 2 endogenous variables (Young's modulus and ultimate tensile strength). ML models were able to identify 6 structures and testing conditions with comparable Young's modulus and ultimate tensile strength to ligamentous tissue, skin tissue, oral and nasal tissue, and renal tissue. This novel study proved that Classification and Regression Trees (CART) models were an innovative and easy to interpret tool to identify biomimetic electrospun structures; however, Cubist and Support Vector Machine (SVM) models were the most accurate, with R2 of 0.93 and 0.8, to predict the ultimate tensile strength and Young's modulus, respectively. This approach can be implemented to optimise the manufacturing process in different applications.
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Affiliation(s)
- Elisa Roldán
- Department of Engineering, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, M1 5GD, UK.
| | - Neil D Reeves
- Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, M1 5GD, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YW, UK
| | - Glen Cooper
- School of Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Kirstie Andrews
- Department of Engineering, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, M1 5GD, UK
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3
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Wang X, Li K, Yuan Y, Zhang N, Zou Z, Wang Y, Yan S, Li X, Zhao P, Li Q. Nonlinear Elasticity of Blood Vessels and Vascular Grafts. ACS Biomater Sci Eng 2024; 10:3631-3654. [PMID: 38815169 DOI: 10.1021/acsbiomaterials.4c00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The transplantation of vascular grafts has emerged as a prevailing approach to address vascular disorders. However, the development of small-diameter vascular grafts is still in progress, as they serve in a more complicated mechanical environment than their counterparts with larger diameters. The biocompatibility and functional characteristics of small-diameter vascular grafts have been well developed; however, mismatch in mechanical properties between the vascular grafts and native arteries has not been accomplished, which might facilitate the long-term patency of small-diameter vascular grafts. From a point of view in mechanics, mimicking the nonlinear elastic mechanical behavior exhibited by natural blood vessels might be the state-of-the-art in designing vascular grafts. This review centers on elucidating the nonlinear elastic behavior of natural blood vessels and vascular grafts. The biological functionality and limitations associated with as-reported vascular grafts are meticulously reviewed and the future trajectory for fabricating biomimetic small-diameter grafts is discussed. This review might provide a different insight from the traditional design and fabrication of artificial vascular grafts.
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Affiliation(s)
- Xiaofeng Wang
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
- The State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou 310027, China
| | - Kecheng Li
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Yuan Yuan
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Ning Zhang
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Zifan Zou
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Yun Wang
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Shujie Yan
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Xiaomeng Li
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
| | - Peng Zhao
- The State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou 310027, China
| | - Qian Li
- School of Mechanics and Safety Engineering, National Center for International Research of Micro-nano Molding Technology, Zhengzhou University, Zhengzhou 450001, China
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Garg A, Alfatease A, Hani U, Haider N, Akbar MJ, Talath S, Angolkar M, Paramshetti S, Osmani RAM, Gundawar R. Drug eluting protein and polysaccharides-based biofunctionalized fabric textiles- pioneering a new frontier in tissue engineering: An extensive review. Int J Biol Macromol 2024; 268:131605. [PMID: 38641284 DOI: 10.1016/j.ijbiomac.2024.131605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/20/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
In the ever-evolving landscape of tissue engineering, medicated biotextiles have emerged as a game-changer. These remarkable textiles have garnered significant attention for their ability to craft tissue scaffolds that closely mimic the properties of natural tissues. This comprehensive review delves into the realm of medicated protein and polysaccharide-based biotextiles, exploring a diverse array of fabric materials. We unravel the intricate web of fabrication methods, ranging from weft/warp knitting to plain/stain weaving and braiding, each lending its unique touch to the world of biotextiles creation. Fibre production techniques, such as melt spinning, wet/gel spinning, and multicomponent spinning, are demystified to shed light on the magic behind these ground-breaking textiles. The biotextiles thus crafted exhibit exceptional physical and chemical properties that hold immense promise in the field of tissue engineering (TE). Our review underscores the myriad applications of drug-eluting protein and polysaccharide-based textiles, including TE, tissue repair, regeneration, and wound healing. Additionally, we delve into commercially available products that harness the potential of medicated biotextiles, paving the way for a brighter future in healthcare and regenerative medicine. Step into the world of innovation with medicated biotextiles-where science meets the art of healing.
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Affiliation(s)
- Ankitha Garg
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India
| | - Adel Alfatease
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia.
| | - Umme Hani
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia.
| | - Nazima Haider
- Department of Pathology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Mohammad J Akbar
- Department of Pharmaceutics, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia.
| | - Sirajunisa Talath
- Department of Pharmaceutical Chemistry, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates.
| | - Mohit Angolkar
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India
| | - Sharanya Paramshetti
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India
| | - Riyaz Ali M Osmani
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India.
| | - Ravi Gundawar
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India.
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Abhari RE, Snelling SJ, Augustynak E, Davis S, Fischer R, Carr AJ, Mouthuy PA. A Hybrid Electrospun-Extruded Polydioxanone Suture for Tendon Tissue Regeneration. Tissue Eng Part A 2024; 30:214-224. [PMID: 38126344 PMCID: PMC10954604 DOI: 10.1089/ten.tea.2023.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Many surgical tendon repairs fail despite advances in surgical materials and techniques. Tendon repair failure can be partially attributed to the tendon's poor intrinsic healing capacity and the repurposing of sutures from other clinical applications. Electrospun materials show promise as a biological scaffold to support endogenous tendon repair, but their relatively low tensile strength has limited their clinical translation. It is hypothesized that combining electrospun fibers with a material with increased tensile strength may improve the suture's mechanical properties while retaining biophysical cues necessary to encourage cell-mediated repair. This article describes the production of a hybrid electrospun-extruded suture with a sheath of submicron electrospun fibers and a core of melt-extruded fibers. The porosity and tensile strength of this hybrid suture is compared with an electrospun-only braided suture and clinically used sutures Vicryl and polydioxanone (PDS). Bioactivity is assessed by measuring the adsorbed serum proteins on electrospun and melt-extruded filaments using mass spectrometry. Human hamstring tendon fibroblast attachment and proliferation were quantified and compared between the hybrid and control sutures. Combining an electrospun sheath with melt-extruded cores created a hybrid braid with increased tensile strength (70.1 ± 0.3N) compared with an electrospun only suture (12.9 ± 1 N, p < 0.0001). The hybrid suture had a similar force at break to clinical sutures, but lower stiffness and stress. The Young's modulus was 772.6 ± 32 MPa for the hybrid suture, 1693.0 ± 69 MPa for PDS, and 3838.0 ± 132 MPa for Vicryl, p < 0.0001. Hybrid sutures had lower overall porosity than electrospun-only sutures (40 ± 4% and 60 ± 7%, respectively, p = 0.0018) but had a significantly larger overall porosity and average pore diameter compared with surgical sutures. There were similar clusters of adsorbed proteins on electrospun and melt-extruded filaments, which were distinct from PDS. Tendon fibroblast attachment and cell proliferation on hybrid and electrospun sutures were significantly higher than on clinical sutures. This study demonstrated that a bioactive suture with increased tensile strength and lower stiffness could be produced by adding a core of 10 μm melt-extruded fibers to a sheath of electrospun fibers. In contrast to currently used sutures, the hybrid sutures promoted a bioactive response: serum proteins adsorbed, and fibroblasts attached, survived, grew along the sutures, and adopted appropriate morphologies.
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Affiliation(s)
- Roxanna E. Abhari
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah J.B. Snelling
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Edyta Augustynak
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon Davis
- Nuffield Department of Medicine, Target Discovery Institute, Centre for Medicines Discovery, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, Chinese Academy for Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Roman Fischer
- Nuffield Department of Medicine, Target Discovery Institute, Centre for Medicines Discovery, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, Chinese Academy for Medical Sciences Oxford Institute, University of Oxford, Oxford, United Kingdom
| | - Andrew J. Carr
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Pierre-Alexis Mouthuy
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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6
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Sriram M, Priya S, Mahajan A, Katti DS. Directing ligament-mimetic bi-directional cell organization in scaffolds through zone-specific microarchitecture for ligament tissue engineering. Biofabrication 2024; 16:025015. [PMID: 38277689 DOI: 10.1088/1758-5090/ad22f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 01/28/2024]
Abstract
Ligament tissues exhibit zone-specific anisotropic cell organization. The cells in ligament-proper are longitudinally oriented, whereas, the cells in epiligament are circumferentially oriented. Therefore, scaffolds developed to regenerate ligament tissues should possess adequate architectural features to govern ligament-mimetic bi-directional cell organization. The scaffold architectural features along with ligament-mimetic cell organization may ultimately yield neo-tissues with ligament-like extracellular matrix (ECM) structure and biomechanical properties. Towards this goal, we fabricated a silk/gelatin-based core-shell scaffold (csSG) with zone-specific anisotropic architectural features, wherein, the core of the scaffold possessed longitudinally aligned pores while the shell of the scaffold possessed parallel microgrooves that are aligned circumferentially around the surface of the scaffold. The ligament-mimetic architectural features significantly improved the mechanical properties of the scaffold. Moreover, architectural features of the csSG scaffold governed zone-specific anisotropic organization of cells. The cells in the core were longitudinally oriented as observed in the ligament-proper and the cells on the shell were circumferentially oriented as observed in epiligament. This bi-directional cell orientation partially mimicked the complex cellular network in native ligament tissue. Additionally, both the core and the shell individually supported fibrogenic differentiation of stem cells which further improved their potential for ligament tissue engineering. Further, the aligned pores of the core could govern unidirectional organization of ECM deposited by cells which is crucial for regenerating anisotropic tissues like ligaments. Finally, when implanted subcutaneously in mice, the scaffolds retained their anisotropic architecture for at least 2 weeks, were biocompatible, supported cell infiltration and governed anisotropic organization of cells and ECM. Taken together, the fabricated biomimetic csSG scaffold, through its zone-specific architectural features, could govern ligament-mimetic cellular and ECM organization which is ultimately expected to achieve regeneration of ligament tissues with native-like hierarchical structure and biomechanical properties. Consequently, this study introduces bi-directional structural parameters as design criteria for developing scaffolds for ligament tissue engineering.
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Affiliation(s)
- M Sriram
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
- Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
| | - Smriti Priya
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
| | - Aman Mahajan
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
- Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
| | - Dhirendra S Katti
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
- Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, Uttar Pradesh, India
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Bauer B, Emonts C, Pitts J, Buhl EM, Eschweiler J, Hänsch R, Betsch M, Gries T, Menzel H. Topographically and Chemically Enhanced Textile Polycaprolactone Scaffolds for Tendon and Ligament Tissue Engineering. Polymers (Basel) 2024; 16:488. [PMID: 38399866 PMCID: PMC10893359 DOI: 10.3390/polym16040488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The use of tissue engineering to address the shortcomings of current procedures for tendons and ligaments is promising, but it requires a suitable scaffold that meets various mechanical, degradation-related, scalability-related, and biological requirements. Macroporous textile scaffolds made from appropriate fiber material have the potential to fulfill the first three requirements. This study aimed to investigate the biocompatibility, sterilizability, and functionalizability of a multilayer braided scaffold. These macroporous scaffolds with dimensions similar to those of the human anterior cruciate ligament consist of fibers with appropriate tensile strength and degradation behavior melt-spun from Polycaprolactone (PCL). Two different cross-sectional geometries resulting in significantly different specific surface areas and morphologies were used at the fiber level, and a Chitosan-graft-PCL (CS-g-PCL) surface modification was applied to the melt-spun substrates for the first time. All scaffolds elicited a positive cell response, and the CS-g-PCL modification provided a platform for incorporating functionalization agents such as drug delivery systems for growth factors, which were successfully released in therapeutically effective quantities. The fiber geometry was found to be a variable that could be manipulated to control the amount released. Therefore, scaled, surface-modified textile scaffolds are a versatile technology that can successfully address the complex requirements of tissue engineering for ligaments and tendons, as well as other structures.
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Affiliation(s)
- Benedict Bauer
- Institut für Textiltechnik, RWTH Aachen University, Otto-Blumenthal-Straße 1, 52074 Aachen, Germany; (C.E.)
| | - Caroline Emonts
- Institut für Textiltechnik, RWTH Aachen University, Otto-Blumenthal-Straße 1, 52074 Aachen, Germany; (C.E.)
| | - Johannes Pitts
- Institute for Technical Chemistry, Braunschweig University of Technology, Hagenring 30, 38106 Braunschweig, Germany
| | - Eva Miriam Buhl
- Institute of Pathology, Electron Microscopy Facility, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Jörg Eschweiler
- Department of Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost, Merseburgerstr. 165, 06112 Halle (Saale), Germany;
- Department of Trauma and Reconstructive Surgery, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Robert Hänsch
- Institute of Plant Biology, Braunschweig University of Technology, Humboldtstraße 1, 38106 Braunschweig, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Thomas Gries
- Institut für Textiltechnik, RWTH Aachen University, Otto-Blumenthal-Straße 1, 52074 Aachen, Germany; (C.E.)
| | - Henning Menzel
- Institute for Technical Chemistry, Braunschweig University of Technology, Hagenring 30, 38106 Braunschweig, Germany
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Pugliese E, Rossoni A, Zeugolis DI. Enthesis repair - State of play. BIOMATERIALS ADVANCES 2024; 157:213740. [PMID: 38183690 DOI: 10.1016/j.bioadv.2023.213740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
The fibrocartilaginous enthesis is a highly specialised tissue interface that ensures a smooth mechanical transfer between tendon or ligament and bone through a fibrocartilage area. This tissue is prone to injury and often does not heal, even after surgical intervention. Enthesis augmentation approaches are challenging due to the complexity of the tissue that is characterised by the coexistence of a range of cellular and extracellular components, architectural features and mechanical properties within only hundreds of micrometres. Herein, we discuss enthesis repair and regeneration strategies, with particular focus on elegant interfacial and functionalised scaffold-based designs.
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Affiliation(s)
- Eugenia Pugliese
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), University of Galway, Galway, Ireland
| | - Andrea Rossoni
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland
| | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), University of Galway, Galway, Ireland; Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular & Biomedical Research and School of Mechanical & Materials Engineering, University College Dublin (UCD), Dublin, Ireland.
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9
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Hahn J, Gögele C, Schulze-Tanzil G. Could an Anterior Cruciate Ligament Be Tissue-Engineered from Silk? Cells 2023; 12:2350. [PMID: 37830564 PMCID: PMC10571837 DOI: 10.3390/cells12192350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
Silk has a long history as an exclusive textile, but also as a suture thread in medicine; nowadays, diverse cell carriers are manufactured from silk. Its advantages are manifold, including high biocompatibility, biomechanical strength and processability (approved for nearly all manufacturing techniques). Silk's limitations, such as scarcity and batch to batch variations, are overcome by gene technology, which allows for the upscaled production of recombinant "designed" silk proteins. For processing thin fibroin filaments, the sericin component is generally removed (degumming). In contrast to many synthetic biomaterials, fibroin allows for superior cell adherence and growth. In addition, silk grafts demonstrate superior mechanical performance and long-term stability, making them attractive for anterior cruciate ligament (ACL) tissue engineering. Looking at these promising properties, this review focusses on the responses of cell types to silk variants, as well as their biomechanical properties, which are relevant for ACL tissue engineering. Meanwhile, sericin has also attracted increasing interest and has been proposed as a bioactive biomaterial with antimicrobial properties. But so far, fibroin was exclusively used for experimental ACL tissue engineering approaches, and fibroin from spider silk also seems not to have been applied. To improve the bone integration of ACL grafts, silk scaffolds with osteogenic functionalization, silk-based tunnel fillers and interference screws have been developed. Nevertheless, signaling pathways stimulated by silk components remain barely elucidated, but need to be considered during the development of optimized silk cell carriers for ACL tissue engineering.
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Affiliation(s)
- Judith Hahn
- Workgroup BioEngineering, Institute of Polymer Materials, Leibniz-Institut für Polymerforschung Dresden e.V. (IPF), Hohe Straße 6, 01069 Dresden, Germany;
| | - Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany;
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany;
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10
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Legnani C, Ventura A. Synthetic grafts for anterior cruciate ligament reconstructive surgery. Med Eng Phys 2023; 117:103992. [PMID: 37331747 DOI: 10.1016/j.medengphy.2023.103992] [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: 05/17/2022] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023]
Abstract
The quest for a good and durable substitute to anterior cruciate ligament (ACL) is driving scientists to explore new promising areas of research. Autologous and allogenic ligament reconstruction bring satisfactory results in managing ACL surgery although their use is associated with significant drawbacks. To overcome the limitations of biologic grafts, many artificial devices have been developed and implanted as a substitute to the native ACL over the past decades. Although many synthetic grafts used in the past have been withdrawn from the market due to early mechanical failures ultimately leading to synovitis and osteoarthritis, there is recently a resurgence of interest in the use of synthetic ligaments for ACL reconstruction. However, this new generation of artificial ligaments, despite promising initial results, have shown to produce serious side effects such as high rupture rates, insufficient tendon-bone healing and loosening. For these reasons, recent advancements in biomedical engineering are focusing on improving technical features of artificial ligaments combining mechanical properties to biocompatibility. Bioactive coatings and surface modification methods have been proposed to enhance synthetic ligament biocompatibility and promote osseointegration. The path to the development of a safe and effective artificial ligament is still full of challenges, however recent advancements are leading the way towards a tissue-engineered substitute to the native ACL.
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Affiliation(s)
- Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sports Traumatology and Minimally Invasive Articular Surgery Center, Milan, Italy.
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sports Traumatology and Minimally Invasive Articular Surgery Center, Milan, Italy
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11
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Govindaraju DT, Chen CH, Shalumon KT, Kao HH, Chen JP. Bioactive Nanostructured Scaffold-Based Approach for Tendon and Ligament Tissue Engineering. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:1847. [PMID: 37368277 DOI: 10.3390/nano13121847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
An effective therapeutic strategy to treat tendon or ligament injury continues to be a clinical challenge due to the limited natural healing capacity of these tissues. Furthermore, the repaired tendons or ligaments usually possess inferior mechanical properties and impaired functions. Tissue engineering can restore the physiological functions of tissues using biomaterials, cells, and suitable biochemical signals. It has produced encouraging clinical outcomes, forming tendon or ligament-like tissues with similar compositional, structural, and functional attributes to the native tissues. This paper starts by reviewing tendon/ligament structure and healing mechanisms, followed by describing the bioactive nanostructured scaffolds used in tendon and ligament tissue engineering, with emphasis on electrospun fibrous scaffolds. The natural and synthetic polymers for scaffold preparation, as well as the biological and physical cues offered by incorporating growth factors in the scaffolds or by dynamic cyclic stretching of the scaffolds, are also covered. It is expected to present a comprehensive clinical, biological, and biomaterial insight into advanced tissue engineering-based therapeutics for tendon and ligament repair.
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Affiliation(s)
- Darshan Tagadur Govindaraju
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan City 33302, Taiwan
| | - Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Anle, Keelung 20401, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Kwei-San, Taoyuan City 33305, Taiwan
| | - K T Shalumon
- Department of Chemistry, Sacred Heart College, Mahatma Gandhi University, Kochi 682013, India
| | - Hao-Hsi Kao
- Division of Nephrology, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Anle, Keelung 20401, Taiwan
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan City 33302, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Kwei-San, Taoyuan City 33305, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Kwei-San, Taoyuan City 33305, Taiwan
- Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Kwei-San, Taoyuan City 33305, Taiwan
- Department of Materials Engineering, Ming Chi University of Technology, Tai-Shan, New Taipei City 24301, Taiwan
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12
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Hanum S. F, Izak R. D, Hadi S, Amrillah T, Che Abdullah CA. Fabrication and compatibility evaluation of polycaprolactone/hydroxyapatite/collagen-based fiber scaffold for anterior cruciate ligament injury. RSC Adv 2023; 13:10459-10467. [PMID: 37021102 PMCID: PMC10068953 DOI: 10.1039/d2ra07756f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Knee injuries are musculoskeletal system injuries, including the Anterior Cruciate Ligament (ACL). ACL injuries are most common in athletes. This ACL injury necessitates biomaterial replacement. It is sometimes taken from the patient's tendon and a biomaterial scaffold is used. The use of biomaterial scaffolds as artificial ACLs remains to be investigated. The purpose of this study is to determine the properties of an ACL scaffold made of polycaprolactone (PCL)–hydroxyapatite (HA) and collagen with various composition variations of (50 : 45 : 5), (50 : 40 : 10), (50 : 35 : 15), (50 : 30 : 20), and (50 : 25 : 25) wt%. The scaffold was created using the electrospinning method with a voltage of 23 kV, a needle–collector distance of 15 cm, and a solution flow rate of 2 mL h−1. The average fiber diameter in all samples was less than 1000 nm. The model with the best characterization was PCL : HA : collagen with a weight-to-weight (wt%) ratio of 50 : 45 : 5 and an average fiber diameter of 488 ± 271 nm. The UTS and modulus of elasticity for braided samples were 2.796 MPa and 3.224 MPa, respectively, while the non-braided samples were 2.864 MPa and 12.942 MPa. The estimated time of degradation was 9.44 months. It was also revealed to be non-toxic, with an 87.95% viable cell percentage. An ACL scaffold made of polycaprolactone (PCL)–hydroxyapatite (HA) and collagen is fabricated using an electrospinning method.![]()
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Affiliation(s)
- Faika Hanum S.
- Study Program of Biomedical Engineering, Department of Physics, Faculty of Science and Technology, Universitas AirlanggaSurabayaIndonesia
| | - Djoni Izak R.
- Study Program of Physics, Department of Physics, Faculty of Science and Technology, Universitas AirlanggaSurabayaIndonesia
| | - Sofijan Hadi
- Study Program of Chemistry, Department of Physics, Faculty of Science and Technology, Universitas AirlanggaSurabayaIndonesia
| | - Tahta Amrillah
- Study Program of Nanotechnology Engineering, Faculty of Advanced Technology and Multidiscipline, Universitas AirlanggaSurabayaIndonesia
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13
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Amini M, Venkatesan JK, Liu W, Leroux A, Nguyen TN, Madry H, Migonney V, Cucchiarini M. Advanced Gene Therapy Strategies for the Repair of ACL Injuries. Int J Mol Sci 2022; 23:ijms232214467. [PMID: 36430947 PMCID: PMC9695211 DOI: 10.3390/ijms232214467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
Abstract
The anterior cruciate ligament (ACL), the principal ligament for stabilization of the knee, is highly predisposed to injury in the human population. As a result of its poor intrinsic healing capacities, surgical intervention is generally necessary to repair ACL lesions, yet the outcomes are never fully satisfactory in terms of long-lasting, complete, and safe repair. Gene therapy, based on the transfer of therapeutic genetic sequences via a gene vector, is a potent tool to durably and adeptly enhance the processes of ACL repair and has been reported for its workability in various experimental models relevant to ACL injuries in vitro, in situ, and in vivo. As critical hurdles to the effective and safe translation of gene therapy for clinical applications still remain, including physiological barriers and host immune responses, biomaterial-guided gene therapy inspired by drug delivery systems has been further developed to protect and improve the classical procedures of gene transfer in the future treatment of ACL injuries in patients, as critically presented here.
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Affiliation(s)
- Mahnaz Amini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, D-66421 Homburg, Germany
| | - Jagadeesh K. Venkatesan
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, D-66421 Homburg, Germany
| | - Wei Liu
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, D-66421 Homburg, Germany
| | - Amélie Leroux
- Laboratoire CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, Avenue JB Clément, 93430 Villetaneuse, France
| | - Tuan Ngoc Nguyen
- Laboratoire CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, Avenue JB Clément, 93430 Villetaneuse, France
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, D-66421 Homburg, Germany
| | - Véronique Migonney
- Laboratoire CSPBAT UMR CNRS 7244, Université Sorbonne Paris Nord, Avenue JB Clément, 93430 Villetaneuse, France
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr. Bldg 37, D-66421 Homburg, Germany
- Correspondence: or
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14
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Emonts C, Wienen D, Bauer B, Idrissi A, Gries T. 3D-Braided Poly-ε-Caprolactone-Based Scaffolds for Ligament Tissue Engineering. J Funct Biomater 2022; 13:jfb13040230. [PMID: 36412872 PMCID: PMC9680250 DOI: 10.3390/jfb13040230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
The anterior cruciate ligament (ACL) is the most commonly injured intra-articular ligament of the knee. Due to its limited intrinsical healing potential and vascularization, injuries of the ACL do not heal satisfactorily, and surgical intervention is usually required. The limitations of existing reconstructive grafts and autologous transplants have prompted interest in tissue-engineered solutions. A tissue engineering scaffold for ACL reconstruction must be able to mimic the mechanical properties of the native ligament, provide sufficient porosity to promote cell growth of the neoligament tissue, and be biodegradable. This study investigates long-term biodegradable poly-ε-caprolactone (PCL)-based scaffolds for ACL replacement using the 3D hexagonal braiding technique. The scaffolds were characterized mechanically as well as morphologically. All scaffolds, regardless of their braid geometry, achieved the maximum tensile load of the native ACL. The diameter of all scaffolds was lower than that of the native ligament, making the scaffolds implantable with established surgical methods. The 3D hexagonal braiding technique offers a high degree of geometrical freedom and, thus, the possibility to develop novel scaffold architectures. Based on the findings of this study, the 3D-braided PCL-based scaffolds studied were found to be a promising construct for tissue engineering of the anterior cruciate ligament.
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Mehta SM, De Santos DR, Sridhar S, Aguayo VC, Meraz CA, Mikos M, Grande-Allen KJ. Fabricating a Low-Cost, Microscopy-Compatible Mechanical Testing Device. EXPERIMENTAL TECHNIQUES 2022; 46:731-743. [PMID: 39119455 PMCID: PMC11308025 DOI: 10.1007/s40799-021-00513-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 09/16/2021] [Indexed: 08/10/2024]
Abstract
Most commercially-available mechanical testing devices are bulky, expensive, and unable to evaluate changes in sample microstructure under load. This leaves a crucial gap in understanding between material structure and bulk mechanical properties. Our objective was to fabricate a mechanical testing device small enough to fit in most upright or inverted microscopy stages and able to position samples to allow for simultaneous mechanical and microstructural characterization. Parts were 3D printed using the hobbyist-friendly Fused Filament Fabrication technique, then assembled with commercial fasteners and translation components to create a mechanical testing device that utilized the deflection of plastic posts to determine sample reaction forces under applied strain. Video of sample deformation was analyzed using a custom processing script to calculate stress and strain behavior in an automated and high-throughput manner. This device was able to perform mechanical characterization with an accuracy comparable to commercial mechanical testing devices for a wide range of nonlinear and viscoelastic samples under dry and hydrated conditions. Additionally, the device showed compatibility with different upright and inverted microscopes and was able to demonstrate accurate mechanical testing results when used with these instruments. We successfully developed a device capable of accurately testing a majority of soft materials in the field of Biomedical Engineering with the ability to perform additional microstructural characterization using microscopy at a price point of $600.
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Affiliation(s)
- S M Mehta
- Department of Bioengineering, Rice University, Houston, TX, 77005
| | - D R De Santos
- Department of Mechanical Engineering, University of Texas at El Paso, El Paso, TX 79968
| | - S Sridhar
- Department of Bioengineering, Rice University, Houston, TX, 77005
| | - V C Aguayo
- Department of Biomedical Engineering, Texas A&M, College Station, TX 77843
| | - C A Meraz
- Department of Mechanical Engineering, University of Texas at El Paso, El Paso, TX 79968
| | - M Mikos
- Department of Bioengineering, Rice University, Houston, TX, 77005
| | - K J Grande-Allen
- Department of Bioengineering, Rice University, Houston, TX, 77005
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16
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Aminatun, Huriah R, Hikmawati D, Hadi S, Amrillah T, Abdullah CAC. Nanofiber Scaffold Based on Polylactic Acid-Polycaprolactone for Anterior Cruciate Ligament Injury. Polymers (Basel) 2022; 14:2983. [PMID: 35893947 PMCID: PMC9331771 DOI: 10.3390/polym14152983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Anterior Cruciate Ligament (ACL) injuries are becoming more prevalent in athletes. Anterior Cruciatum Ligament Reconstruction (ACLR) surgery was used to treat ACL injuries and resulted in a recurrence rate of 94% due to the biomechanically repaired tissue being weaker than the original tissue. As a result, biodegradable artificial ligaments must be developed that can withstand mechanical stress during neoligament formation and stabilize the ACL. The purpose of this study is to determine the effect of composition variations in polylactic acid (PLA) and polycaprolactone (PCL) used as ACL nanofiber scaffolds on ultimate tensile strength (UTS) and modulus of elasticity, fiber diameter, cytotoxicity level, and degradation level, as well as the PLA-PCL concentration that provides the best value as an ACL scaffold. Electrospinning was used to fabricate the nanofiber scaffold with the following PLA-PCL compositions: A (100:0), B (85:15), C (80:20), D (70:30), and E (0:100) (wt%). The functional group test revealed no new peaks in any of the samples, and the ester group could be identified in the C-O bond at wave numbers 1300-1100 cm-1 and in the C=O bond at wave numbers 1750-1730 cm-1. The average fiber diameter, as determined by SEM morphology, is between 1000 and 2000 nm. The unbraided sample had a UTS range of 1.578-4.387 MPa and an elastic modulus range of 8.351-141.901 MPa, respectively, whereas the braided sample had a range of 0.879-1.863 MPa and 2.739-4.746 MPa. The higher the PCL composition, the lower the percentage of viable cells and the faster the sample degrades. All samples had a cell viability percentage greater than 60%, and samples C, D, and E had a complete degradation period greater than six months. The ideal scaffold, Sample C, was composed of PLA-PCL 80:20 (wt%), had an average fiber diameter of 827 ± 271 nm, a living cell percentage of 97.416 ± 5.079, and a degradation time of approximately 219 days.
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Affiliation(s)
- Aminatun
- Study Program of Physics, Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Rifqha Huriah
- Study Program of Biomedical Engineering, Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Dyah Hikmawati
- Study Program of Physics, Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Sofijan Hadi
- Study Program of Chemistry, Department of Chemistry, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Tahta Amrillah
- Study Program of Nanotechnology, Faculty of Advance Technology and Multidiscipline-Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Che Azurahanim Che Abdullah
- Nanomaterial Synthesis and Characterization Lab, Institute of Nanoscience and Nanotechnology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
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17
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Melt-Spun, Cross-Section Modified Polycaprolactone Fibers for Use in Tendon and Ligament Tissue Engineering. FIBERS 2022. [DOI: 10.3390/fib10030023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tissue Engineering is considered a promising route to address existing deficits of autografts and permanent synthetic prostheses for tendons and ligaments. However, the requirements placed on the scaffold material are manifold and include mechanical, biological and degradation-related aspects. In addition, scalable processes and FDA-approved materials should be applied to ensure the transfer into clinical practice. To accommodate these aspects, this work focuses on the high-scale fabrication of high-strength and highly oriented polycaprolactone (PCL) fibers with adjustable cross-sectional geometry and degradation kinetics applying melt spinning technology. Four different fiber cross-sections were investigated to account for potential functionalization and cell growth guidance. Mechanical properties and crystallinity were studied for a 24-week exposure to phosphate-buffered saline (PBS) at 37 °C. PCL fibers were further processed into scaffolds using multistage circular braiding with three different hierarchical structures. One structure was selected based on its morphology and scaled up in thickness to match the requirements for a human anterior cruciate ligament (ACL) replacement. Applying a broad range of draw ratios (up to DR9.25), high-strength PCL fibers with excellent tensile strength (up to 69 cN/tex) could be readily fabricated. The strength retention after 24 weeks in PBS at 37 °C was 83–93%. The following braiding procedure did not affect the scaffolds’ mechanical properties as long as the number of filaments and the braiding angle remained constant. Up-scaled PCL scaffolds resisted loads of up to 4353.88 ± 37.30 N, whilst matching the stiffness of the human ACL (111–396 N/mm). In conclusion, this work demonstrates the fabrication of highly oriented PCL fibers with excellent mechanical properties. The created fibers represent a promising building block that can be further processed into versatile textile implants for tissue engineering and regenerative medicine.
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Smolle MA, Fischerauer SF, Zötsch S, Kiegerl AV, Sadoghi P, Gruber G, Leithner A, Bernhardt GA. Long-term outcomes of surgery using the Ligament Advanced Reinforcement System as treatment for anterior cruciate ligament tears. Bone Joint J 2022; 104-B:242-248. [PMID: 35094581 DOI: 10.1302/0301-620x.104b2.bjj-2021-0798.r2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS The aim of this prospective study was to assess the long-term clinical, radiological, functional, and quality of life (QoL)-related outcome of patients treated with the synthetic Ligament Advanced Reinforcement System (LARS) device for anterior cruciate ligament (ACL) rupture. METHODS A total of 41 patients who underwent ACL reconstruction with the LARS device (mean age 39.8 years (SD 12.1 ); 32% females (n = 13)) were prospectively included between August 2001 and March 2005. MRI scans and radiographs were performed at a median follow-up of 2.0 years (interquartile range (IQR) 1.3 to 3.0; n = 40) and 12.8 years (IQR 12.1 to 13.8; n = 22). Functional and QoL-related outcome was assessed in 29 patients at a median follow-up of 12.8 years (IQR 12.0 to 14.0) and clinically reconfirmed at latest median follow-up of 16.5 years (IQR 15.5 to 17.9). International Knee Documentation Committee (IKDC) and Tegner scores were obtained pre- and postoperatively, and Lysholm score postoperatively only. At latest follow-up, range of motion, knee stability tests, 36-Item Short Form Health Survey (SF-36), and IKDC scores were ascertained. Complications and reoperations during follow-up were documented. RESULTS Cumulative complication rate was 66% (n = 27), with 11 developing within one year from surgery and 16 after one year (including five patients with both early and late complications). Ten graft failures (24%) and eight cases of reactive synovitis were observed (20%). All 11 patients with early complications and ten with late complications underwent reoperation (including five with another surgical procedure for early complications), amounting to a cumulative reoperation rate of 51% (n = 21). Revision ACL reconstruction was performed in one patient (2.4%). Median IKDC at latest follow-up was 89.7 (IQR 78.2 to 93.1), being significantly worse in the event of previous complications. Lachman test was positive in 56% (n = 15) of reconstructed knees. All norm-based SF-36 items were at or above median at latest follow-up, and did not differ depending on development of complications. CONCLUSION Despite good functional and QoL-related results in the long term, the cumulative complication rate of 66%, including graft failures and reactive synovitis, has to be viewed with great concern. Cite this article: Bone Joint J 2022;104-B(2):242-248.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Stefan F Fischerauer
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Silvia Zötsch
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Anna V Kiegerl
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Gerald Gruber
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopaedics and Trauma, Medizinische Universitat Graz, Graz, Austria
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Balasubramaniyan K, Bhoobalan K, Jayaraman D, Sounderraj S, Muthuukumar KR, Santhini E. Development and assessment of biologically compatible anterior cruciate ligament using braided ultra-high molecular weight polyethylene. J Biomed Mater Res B Appl Biomater 2021; 110:1306-1318. [PMID: 34931730 DOI: 10.1002/jbm.b.35001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 11/11/2022]
Abstract
In this study, a ultra-high molecular weight polyethylene (UHMWPE) braided structure was surface modified with low temperature plasma and was coated with cationized gelatin and hyaluronic acid to improve its biocompatibility for the reconstruction of an anterior cruciate ligament (ACL). The ligament was studied for its various mechanical properties. Surface modifications were studied through FESEM. Biological compatibility of the ligament was assessed in accordance to ISO 10993 standard. Tensile strength of the UHMWPE reconstructed ligament ranges between 2628 and 5937 N; maximum tensile strength was attained in 1600 denier 2/2 pattern of triple braided structure along with higher strain at failure of 36.1%. In 1600 denier 2/2 pattern of triple braid structure, the linear stiffness was found to be high at 375 N/mm. Among the developed materials, four braided structures namely as 800 denier 2/2 pattern of double braids and triple braids, 1600 denier 1/1 pattern of double braid and 2/2 pattern of triple braid were found to be mechanically suitable. Specifically, the 1600 denier 2/2 pattern of triple braid having higher mechanical properties was selected for coating. The results of in-vitro cytotoxicity and genotoxicity confirmed the extract of ACL to non-toxic and non-mutant. Furthermore, in-vivo analysis of the extract and the coated ACL graft proved the ligament to be non-irritant, non-sensitizer and also found to promote new tissue formation around the graft. Based on the results, the CG and HA coated ACL graft were concluded to be biocompatible and having considerable potential as an alternate for autograft/allograft.
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Affiliation(s)
| | | | - Dhasarathi Jayaraman
- Spinning, Weaving and Knitting, The South India Textile Research Association (SITRA), Coimbatore, India
| | - Shanmugam Sounderraj
- Weaving and Knitting, The South India Textile Research Association (SITRA), Coimbatore, India
| | - K Rajendran Muthuukumar
- Centre of Excellence for Medical Textiles, The South India Textile Research Association (SITRA), Coimbatore, India
| | - Elango Santhini
- Centre of Excellence for Medical Textiles, The South India Textile Research Association (SITRA), Coimbatore, India
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20
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Maintenance of Ligament Homeostasis of Spheroid-Colonized Embroidered and Functionalized Scaffolds after 3D Stretch. Int J Mol Sci 2021; 22:ijms22158204. [PMID: 34360970 PMCID: PMC8348491 DOI: 10.3390/ijms22158204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 01/12/2023] Open
Abstract
Anterior cruciate ligament (ACL) ruptures are usually treated with autograft implantation to prevent knee instability. Tissue engineered ACL reconstruction is becoming promising to circumvent autograft limitations. The aim was to evaluate the influence of cyclic stretch on lapine (L) ACL fibroblasts on embroidered scaffolds with respect to adhesion, DNA and sulphated glycosaminoglycan (sGAG) contents, gene expression of ligament-associated extracellular matrix genes, such as type I collagen, decorin, tenascin C, tenomodulin, gap junctional connexin 43 and the transcription factor Mohawk. Control scaffolds and those functionalized by gas phase fluorination and cross-linked collagen foam were either pre-cultured with a suspension or with spheroids of LACL cells before being subjected to cyclic stretch (4%, 0.11 Hz, 3 days). Stretch increased significantly the scaffold area colonized with cells but impaired sGAGs and decorin gene expression (functionalized scaffolds seeded with cell suspension). Stretching increased tenascin C, connexin 43 and Mohawk but decreased decorin gene expression (control scaffolds seeded with cell suspension). Pre-cultivation of functionalized scaffolds with spheroids might be the more suitable method for maintaining ligamentogenesis in 3D scaffolds compared to using a cell suspension due to a significantly higher sGAG content in response to stretching and type I collagen gene expression in functionalized scaffolds.
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Jiang C, Wang K, Liu Y, Zhang C, Wang B. Application of textile technology in tissue engineering: A review. Acta Biomater 2021; 128:60-76. [PMID: 33962070 DOI: 10.1016/j.actbio.2021.04.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/26/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
One of the key elements in tissue engineering is to design and fabricate scaffolds with tissue-like properties. Among various scaffold fabrication methods, textile technology has shown its unique advantages in mimicking human tissues' properties such as hierarchical, anisotropic, and strain-stiffening properties. As essential components in textile technology, textile patterns affect the porosity, architecture, and mechanical properties of textile-based scaffolds. However, the potential of various textile patterns has not been fully explored when fabricating textile-based scaffolds, and the effect of different textile patterns on scaffold properties has not been thoroughly investigated. This review summarizes textile technology development and highlights its application in tissue engineering to facilitate the broader application of textile technology, especially various textile patterns in tissue engineering. The potential of using different textile methods such as weaving, knitting, and braiding to mimic properties of human tissues is discussed, and the effect of process parameters in these methods on fabric properties is summarized. Finally, perspectives on future directions for explorations are presented. STATEMENT OF SIGNIFICANCE: Recently, biomedical engineers have applied textile technology to fabricate scaffolds for tissue engineering applications. Various textile methods, especially weaving, knitting, and braiding, enables engineers to customize the physical, mechanical, and biological properties of scaffolds. However, most textile-based scaffolds only use simple textile patterns, and the effect of different textile patterns on scaffold properties has not been thoroughly investigated. In this review, we cover for the first time the effect of process parameters in different textile methods on fabric properties, exploring the potential of using different textile methods to mimic properties of human tissues. Previous advances in textile technology are presented, and future directions for explorations are presented, hoping to facilitate new breakthroughs of textile-based tissue engineering.
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Affiliation(s)
- Chen Jiang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States; Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, GA 30332, United States
| | - Kan Wang
- Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, GA 30332, United States.
| | - Yi Liu
- Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, GA 30332, United States; School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30318, United States
| | - Chuck Zhang
- Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, GA 30332, United States; H. Milton Stewart School of Industrial and System Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States
| | - Ben Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States; Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, GA 30332, United States; H. Milton Stewart School of Industrial and System Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States
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Zahn I, Stöbener DD, Weinhart M, Gögele C, Breier A, Hahn J, Schröpfer M, Meyer M, Schulze-Tanzil G. Cruciate Ligament Cell Sheets Can Be Rapidly Produced on Thermoresponsive poly(glycidyl ether) Coating and Successfully Used for Colonization of Embroidered Scaffolds. Cells 2021; 10:cells10040877. [PMID: 33921450 PMCID: PMC8069541 DOI: 10.3390/cells10040877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 01/14/2023] Open
Abstract
Anterior cruciate ligament (ACL) cell sheets combined with biomechanically competent scaffolds might facilitate ACL tissue engineering. Since thermoresponsive polymers allow a rapid enzyme-free detachment of cell sheets, we evaluated the applicability of a thermoresponsive poly(glycidyl ether) (PGE) coating for cruciate ligamentocyte sheet formation and its influence on ligamentocyte phenotype during sheet-mediated colonization of embroidered scaffolds. Ligamentocytes were seeded on surfaces either coated with PGE or without coating. Detached ligamentocyte sheets were cultured separately or wrapped around an embroidered scaffold made of polylactide acid (PLA) and poly(lactic-co-ε-caprolactone) (P(LA-CL)) threads functionalized by gas-phase fluorination and with collagen foam. Ligamentocyte viability, protein and gene expression were determined in sheets detached from surfaces with or without PGE coating, scaffolds seeded with sheets from PGE-coated plates and the respective monolayers. Stable and vital ligamentocyte sheets could be produced within 24 h with both surfaces, but more rapidly with PGE coating. PGE did not affect ligamentocyte phenotype. Scaffolds could be colonized with sheets associated with high cell survival, stable gene expression of ligament-related type I collagen, decorin, tenascin C and Mohawk after 14 d and extracellular matrix (ECM) deposition. PGE coating facilitates ligamentocyte sheet formation, and sheets colonizing the scaffolds displayed a ligament-related phenotype.
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Affiliation(s)
- Ingrid Zahn
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany; (I.Z.); (C.G.)
- Department of Applied Chemistry, Nuremberg Institute of Technology Georg Simon Ohm, Keßlerplatz 12, 90489 Nuremberg, Germany
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University, Erlangen-Nuremberg, Universitätsstr. 19, 91054 Erlangen, Germany
| | - Daniel David Stöbener
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 3, 14195 Berlin, Germany; (D.D.S.); (M.W.)
- Institute of Physical Chemistry and Electrochemistry, Leibniz Universität Hannover, Callinstr. 3A, 30167 Hannover, Germany
| | - Marie Weinhart
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 3, 14195 Berlin, Germany; (D.D.S.); (M.W.)
- Institute of Physical Chemistry and Electrochemistry, Leibniz Universität Hannover, Callinstr. 3A, 30167 Hannover, Germany
| | - Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany; (I.Z.); (C.G.)
- Department of Biosciences, Paris Lodron University Salzburg, Hellbrunnerstraße 34, 5020 Salzburg, Austria
| | - Annette Breier
- Leibniz-Institut für Polymerforschung Dresden e. V. (IPF), Hohe Straße 6, 01069 Dresden, Germany; (A.B.); (J.H.)
| | - Judith Hahn
- Leibniz-Institut für Polymerforschung Dresden e. V. (IPF), Hohe Straße 6, 01069 Dresden, Germany; (A.B.); (J.H.)
| | - Michaela Schröpfer
- FILK Freiberg Institute (FILK), Meißner Ring 1-5, 09599 Freiberg, Germany; (M.S.); (M.M.)
| | - Michael Meyer
- FILK Freiberg Institute (FILK), Meißner Ring 1-5, 09599 Freiberg, Germany; (M.S.); (M.M.)
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany; (I.Z.); (C.G.)
- Correspondence: ; Tel.: +49-911-398-(11)-6772
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23
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Textile-based sandwich scaffold using wet electrospun yarns for skin tissue engineering. J Mech Behav Biomed Mater 2021; 119:104499. [PMID: 33857876 DOI: 10.1016/j.jmbbm.2021.104499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/27/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023]
Abstract
One of the key elements in tissue engineering is to design and fabricate scaffolds with tissue-like properties. However, mimicking the strain-stiffening property of human tissues by using synthetic materials is still a challenge in scaffold fabrication since most synthetic materials exhibit strain-softening behavior. To address this challenge, we propose a textile-based sandwich scaffold to mimic strain-stiffening behavior observed in human tissues. For this purpose, we first fabricate polycaprolactone (PCL) yarns by wet electrospinning. Then, we crochet PCL yarns into a textile fabric. Finally, we fabricate the sandwich scaffold by embedding the textile fabric inside two electrospun mats. The wet electrospun PCL yarns induce cellular alignment and elongation. The textile-based sandwich scaffold exhibits strain-stiffening behavior. By changing process parameters during the yarn fabrication and textile process, we can adjust the maximum stress of the scaffold from 3.74 to 11.82 MPa, the maximum strain from 0.16 to 2.37, and the elastic modulus from 2.10 to 18.05 MPa, all within the ranges of that of human skin. The scaffold is also able to support cell proliferation and infiltration after optimizing the thickness of the outer layers of the sandwich scaffold. This study validates the potential of the textile-based sandwich scaffold to mimic the physical, mechanical, and biological properties of human skin and other tissues.
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24
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Jiang C, Wang K, Liu Y, Zhang C, Wang B. Using Wet Electrospun PCL/Gelatin/CNT Yarns to Fabricate Textile-Based Scaffolds for Vascular Tissue Engineering. ACS Biomater Sci Eng 2021; 7:2627-2637. [PMID: 33821604 DOI: 10.1021/acsbiomaterials.1c00097] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Incorporating conductive materials in scaffolds has shown advantages in regulating adhesion, mitigation, and proliferation of electroactive cells for tissue engineering applications. Among various conductive materials, carbon nanotubes (CNTs) have shown great promises in tissue engineering because of their good mechanical properties. However, the broad application of CNTs in tissue engineering is limited by current methods to incorporate CNTs in polymers that require miscible solvents to dissolve CNTs and polymers or CNT surface modification. These methods either limit polymer selections or adversely affect the properties of polymer/CNT composites. Here, we report a novel method to fabricate polymer/CNT composite yarns by electrospinning polycaprolactone/gelatin into a bath of CNT dispersion and extracting electrospun fibers out of the bath. The concentration of CNTs in the bath affects the thermal and mechanical properties and the yarns' degradation behavior. In vitro biological test results show that within a limited range of CNT concentrations in the bath, the yarns exhibit good biocompatibility and the ability to guide cell elongation and alignment. We also report the design and fabrication of a vascular scaffold by knitting the yarns into a textile fabric and combining the textile fabric with gelatin. The scaffold has similar mechanical properties to native vessels and supports cell proliferation. This work demonstrates that the wet electrospun polymer/CNT yarns are good candidates for constructing vascular scaffolds and provides a novel method to incorporate CNTs or other functional materials into biopolymers for tissue engineering applications.
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Affiliation(s)
- Chen Jiang
- School of Materials Science and Engineering, Georgia Institute of Technology, 771 Ferst Dr NW, Atlanta 30332, Georgia, United States.,Georgia Tech Manufacturing Institute, Callaway Manufacturing Research Center Building, 813 Ferst Dr NW, Atlanta 30332, Georgia, United States
| | - Kan Wang
- Georgia Tech Manufacturing Institute, Callaway Manufacturing Research Center Building, 813 Ferst Dr NW, Atlanta 30332, Georgia, United States
| | - Yi Liu
- Georgia Tech Manufacturing Institute, Callaway Manufacturing Research Center Building, 813 Ferst Dr NW, Atlanta 30332, Georgia, United States.,School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, North Ave NW, Atlanta 30332, Georgia, United States
| | - Chuck Zhang
- Georgia Tech Manufacturing Institute, Callaway Manufacturing Research Center Building, 813 Ferst Dr NW, Atlanta 30332, Georgia, United States.,H. Milton Stewart School of Industrial and System Engineering, Georgia Institute of Technology, 755 Ferst Dr NW, Atlanta 30332, Georgia, United States
| | - Ben Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, 771 Ferst Dr NW, Atlanta 30332, Georgia, United States.,Georgia Tech Manufacturing Institute, Callaway Manufacturing Research Center Building, 813 Ferst Dr NW, Atlanta 30332, Georgia, United States.,H. Milton Stewart School of Industrial and System Engineering, Georgia Institute of Technology, 755 Ferst Dr NW, Atlanta 30332, Georgia, United States
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25
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Rinoldi C, Kijeńska-Gawrońska E, Khademhosseini A, Tamayol A, Swieszkowski W. Fibrous Systems as Potential Solutions for Tendon and Ligament Repair, Healing, and Regeneration. Adv Healthc Mater 2021; 10:e2001305. [PMID: 33576158 PMCID: PMC8048718 DOI: 10.1002/adhm.202001305] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Tendon and ligament injuries caused by trauma and degenerative diseases are frequent and affect diverse groups of the population. Such injuries reduce musculoskeletal performance, limit joint mobility, and lower people's comfort. Currently, various treatment strategies and surgical procedures are used to heal, repair, and restore the native tissue function. However, these strategies are inadequate and, in some cases, fail to re-establish the lost functionality. Tissue engineering and regenerative medicine approaches aim to overcome these disadvantages by stimulating the regeneration and formation of neotissues. Design and fabrication of artificial scaffolds with tailored mechanical properties are crucial for restoring the mechanical function of tendons. In this review, the tendon and ligament structure, their physiology, and performance are presented. On the other hand, the requirements are focused for the development of an effective reconstruction device. The most common fiber-based scaffolding systems are also described for tendon and ligament tissue regeneration like strand fibers, woven, knitted, braided, and braid-twisted fibrous structures, as well as electrospun and wet-spun constructs, discussing critically the advantages and limitations of their utilization. Finally, the potential of multilayered systems as the most effective candidates for tendon and ligaments tissue engineering is pointed out.
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Affiliation(s)
- Chiara Rinoldi
- Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, 02-507, Poland
| | - Ewa Kijeńska-Gawrońska
- Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, 02-507, Poland
- Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, Warsaw, 02-822, Poland
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Department of Radiology, California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
- Terasaki Institute for Biomedical Innovation (TIBI), Los Angeles, CA, 90024, USA
| | - Ali Tamayol
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, 06030, USA
| | - Wojciech Swieszkowski
- Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, 02-507, Poland
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26
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Shiroud Heidari B, Ruan R, De-Juan-Pardo EM, Zheng M, Doyle B. Biofabrication and Signaling Strategies for Tendon/Ligament Interfacial Tissue Engineering. ACS Biomater Sci Eng 2021; 7:383-399. [PMID: 33492125 DOI: 10.1021/acsbiomaterials.0c00731] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tendons and ligaments (TL) have poor healing capability, and for serious injuries like tears or ruptures, surgical intervention employing autografts or allografts is usually required. Current tissue replacements are nonideal and can lead to future problems such as high retear rates, poor tissue integration, or heterotopic ossification. Alternatively, tissue engineering strategies are being pursued using biodegradable scaffolds. As tendons connect muscle and bone and ligaments attach bones, the interface of TL with other tissues represent complex structures, and this intricacy must be considered in tissue engineered approaches. In this paper, we review recent biofabrication and signaling strategies for biodegradable polymeric scaffolds for TL interfacial tissue engineering. First, we discuss biodegradable polymeric scaffolds based on the fabrication techniques as well as the target tissue application. Next, we consider the effect of signaling factors, including cell culture, growth factors, and biophysical stimulation. Then, we discuss human clinical studies on TL tissue healing using commercial synthetic scaffolds that have occurred over the past decade. Finally, we highlight the challenges and future directions for biodegradable scaffolds in the field of TL and interface tissue engineering.
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Affiliation(s)
- Behzad Shiroud Heidari
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia 6009, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia 6009, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
| | - Rui Ruan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia
| | - Elena M De-Juan-Pardo
- School of Engineering, The University of Western Australia, Perth, Western Australia 6009, Australia.,T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia 6009, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, 4000, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia 6009, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia 6009, Australia
| | - Barry Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, Nedlands, Western Australia 6009, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia 6009, Australia.,Australian Research Council Centre for Personalised Therapeutics Technologies, Australia.,BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
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27
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Mengsteab PY, Otsuka T, McClinton A, Shemshaki NS, Shah S, Kan HM, Obopilwe E, Vella AT, Nair LS, Laurencin CT. Mechanically superior matrices promote osteointegration and regeneration of anterior cruciate ligament tissue in rabbits. Proc Natl Acad Sci U S A 2020; 117:28655-28666. [PMID: 33144508 PMCID: PMC7682397 DOI: 10.1073/pnas.2012347117] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The gold standard treatment for anterior cruciate ligament (ACL) reconstruction is the use of tendon autografts and allografts. Limiting factors for this treatment include donor site morbidity, potential disease transmission, and variable graft quality. To address these limitations, we previously developed an off-the-shelf alternative, a poly(l-lactic) acid (PLLA) bioengineered ACL matrix, and demonstrated its feasibility to regenerate ACL tissue. This study aims to 1) accelerate the rate of regeneration using the bioengineered ACL matrix by supplementation with bone marrow aspirate concentrate (BMAC) and growth factors (BMP-2, FGF-2, and FGF-8) and 2) increase matrix strength retention. Histological evaluation showed robust tissue regeneration in all groups. The presence of cuboidal cells reminiscent of ACL fibroblasts and chondrocytes surrounded by an extracellular matrix rich in anionic macromolecules was up-regulated in the BMAC group. This was not observed in previous studies and is indicative of enhanced regeneration. Additionally, intraarticular treatment with FGF-2 and FGF-8 was found to suppress joint inflammation. To increase matrix strength retention, we incorporated nondegradable fibers, polyethylene terephthalate (PET), into the PLLA bioengineered ACL matrix to fabricate a "tiger graft." The tiger graft demonstrated the greatest peak loads among the experimental groups and the highest to date in a rabbit model. Moreover, the tiger graft showed superior osteointegration, making it an ideal bioengineered ACL matrix. The results of this study illustrate the beneficial effect bioactive factors and PET incorporation have on ACL regeneration and signal a promising step toward the clinical translation of a functional bioengineered ACL matrix.
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Affiliation(s)
- Paulos Y Mengsteab
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
| | - Takayoshi Otsuka
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
| | - Aneesah McClinton
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, 06030
| | - Nikoo Saveh Shemshaki
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
| | - Shiv Shah
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269
| | - Ho-Man Kan
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
| | - Elifho Obopilwe
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030
| | - Anthony T Vella
- Department of Immunology, University of Connecticut School of Medicine, Farmington, CT 06030
| | - Lakshmi S Nair
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030;
- Raymond and Beverly Sackler Center for Biological, Physical and Engineering Sciences, University of Connecticut Health, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT 06030
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT 06030
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28
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Araque-Monrós MC, Gil-Santos L, Pradas MM, Más-Estellés J. New bioreactor for mechanical stimulation of cultured tendon-like constructs: design and validation. Expert Rev Med Devices 2020; 17:1115-1121. [PMID: 32938254 DOI: 10.1080/17434440.2020.1825072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although several different types of bioreactors are currently available with mechanical stimulation of constructs or prostheses for tendon regeneration, they are in many cases expensive and difficult to operate. This paper proposes a simple bioreactor to mechanically stimulate up to three constructs for tendon and ligament repair, composed of a stainless-steel frame and an electric motor. METHODS The deformation is produced by a cam wheel, whose eccentricity defines the maximum deformation. The test samples, braids of PLA seeded in surface with mouse fibroblasts, are immersed in the culture medium during mechanical stimulation. RESULTS Its advantages over existing similar bioreactor designs include: easy renewal of the culture medium and an external electric motor to avoid heating and contamination issues. After 14 days of stretching, the culture samples showed enhanced cellular proliferation and cell fiber alignment in addition to higher production of type I collagen. The cells initially seeded on the braid surface migrated to the inside of the braid. CONCLUSION Although the results obtained have a poor statistical basis, they do suggest that the bioreactor could be usefully applied to stimulate constructs for tendon and ligament repair. Anyway, further experiments should be conducted in the future.
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Affiliation(s)
- María Carmen Araque-Monrós
- CIBER en Bioingeniería, Biomateriales Y Nanomedicina , Valencia, Spain.,Centro de Biomateriales e Ingeniería Tisular, Universitat Politécnica de València , Valencia, Spain
| | - Luis Gil-Santos
- Centro de Biomateriales e Ingeniería Tisular, Universitat Politécnica de València , Valencia, Spain.,Departamento de Cirugía, Instituto Universitario de Investigación en Enfermedades Músculo-esqueléticas Universidad Católica de Valencia, Camino de Vera s/n, 46022 , Valencia, Spain
| | - Manuel Monleón Pradas
- CIBER en Bioingeniería, Biomateriales Y Nanomedicina , Valencia, Spain.,Centro de Biomateriales e Ingeniería Tisular, Universitat Politécnica de València , Valencia, Spain
| | - Jorge Más-Estellés
- Centro de Biomateriales e Ingeniería Tisular, Universitat Politécnica de València , Valencia, Spain
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29
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Samitier G, Vinagre G. Author Reply to "Regarding 'Hamstring Braid Graft Technique for Anterior Cruciate Ligament Reconstruction'". Arthroscopy 2020; 36:1800-1802. [PMID: 32474049 DOI: 10.1016/j.arthro.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023]
Affiliation(s)
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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30
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Silva M, Ferreira FN, Alves NM, Paiva MC. Biodegradable polymer nanocomposites for ligament/tendon tissue engineering. J Nanobiotechnology 2020; 18:23. [PMID: 32000800 PMCID: PMC6993465 DOI: 10.1186/s12951-019-0556-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023] Open
Abstract
Ligaments and tendons are fibrous tissues with poor vascularity and limited regeneration capacity. Currently, a ligament/tendon injury often require a surgical procedure using auto- or allografts that present some limitations. These inadequacies combined with the significant economic and health impact have prompted the development of tissue engineering approaches. Several natural and synthetic biodegradable polymers as well as composites, blends and hybrids based on such materials have been used to produce tendon and ligament scaffolds. Given the complex structure of native tissues, the production of fiber-based scaffolds has been the preferred option for tendon/ligament tissue engineering. Electrospinning and several textile methods such as twisting, braiding and knitting have been used to produce these scaffolds. This review focuses on the developments achieved in the preparation of tendon/ligament scaffolds based on different biodegradable polymers. Several examples are overviewed and their processing methodologies, as well as their biological and mechanical performances, are discussed.
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Affiliation(s)
- Magda Silva
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's, Associate PT Government Laboratory, Braga/Guimarães, Portugal
- Department of Polymer Engineering, Institute for Polymers and Composites/i3N, University of Minho, 4800-058, Guimarães, Portugal
- 2C2T-Centre of Textile Science and Technology, University of Minho, 4800-058, Guimarães, Portugal
| | - Fernando N Ferreira
- 2C2T-Centre of Textile Science and Technology, University of Minho, 4800-058, Guimarães, Portugal
| | - Natália M Alves
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, 4805-017, Guimarães, Portugal.
- ICVS/3B's, Associate PT Government Laboratory, Braga/Guimarães, Portugal.
| | - Maria C Paiva
- Department of Polymer Engineering, Institute for Polymers and Composites/i3N, University of Minho, 4800-058, Guimarães, Portugal.
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31
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Gwiazda M, Kumar S, Świeszkowski W, Ivanovski S, Vaquette C. The effect of melt electrospun writing fiber orientation onto cellular organization and mechanical properties for application in Anterior Cruciate Ligament tissue engineering. J Mech Behav Biomed Mater 2020; 104:103631. [PMID: 32174392 DOI: 10.1016/j.jmbbm.2020.103631] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/23/2019] [Accepted: 01/08/2020] [Indexed: 01/13/2023]
Abstract
The effect of melt electrospun writing fiber arrangement on cellular behavior has not yet been thoroughly investigated. Cellular orientation is particularly important in the context of ligament tissue engineering for orthopedic applications whereby a high degree of cell alignment is present in the native tissue. The aim of this study was to investigate the response of human mesenchymal stem cells (hMSC) to three different patterned porous polycaprolactone scaffolds (aligned, crimped and random) fabricated by melt electrospinning writing, resulting in 20 μm diameter electrospun fibers. Cell orientation was investigated over 4 weeks in vitro and it was demonstrated that the aligned pattern was capable of orientating the hMSCs towards the main direction of the fibers and this feature was maintained over the entire culture period whereas the orientation was rapidly lost in the crimped pattern. In order to fabricate a functional scaffold for ligament tissue engineering, the scaffolds were rolled in three bundles, subsequently braided and combined with a bone compartment (consisting of a melt electrospun scaffold seeded with osteogenically induced hMSCs) for the development of a Bone-Ligament-Bone (BLB) construct. The mechanical properties of non-cellularized and cellularized BLB constructs were assessed under both quasi-static and cyclic conditions. This revealed that the in vitro maturation significantly softened the BLB constructs and that the mechanical properties were several fold lower than those of native tissue. The cyclic testing demonstrated that the presence of cell sheets resulted in increased resilience and elasticity, even though the global mechanical properties were decreased for the in vitro matured constructs (regardless of the pattern). In conclusion, we demonstrated that melt electrospinning writing fiber organization can induce spontaneous cell alignment and that large cellularized BLB constructs with complex geometry can achieve mechanical resilience under cyclic stretching.
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Affiliation(s)
- Marcin Gwiazda
- Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland; Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Sudheesh Kumar
- Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Wojciech Świeszkowski
- Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Saso Ivanovski
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia
| | - Cedryck Vaquette
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia.
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32
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Chang CW, Lee JH, Chao PHG. Chemical Optimization for Functional Ligament Tissue Engineering. Tissue Eng Part A 2020; 26:102-110. [DOI: 10.1089/ten.tea.2019.0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Chun-Wei Chang
- Department of Biomedical Engineering, School of Engineering and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jian-Hong Lee
- Department of Biomedical Engineering, School of Engineering and School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pen-hsiu Grace Chao
- Department of Biomedical Engineering, School of Engineering and School of Medicine, National Taiwan University, Taipei, Taiwan
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Ryan CNM, Zeugolis DI. Engineering the Tenogenic Niche In Vitro with Microenvironmental Tools. ADVANCED THERAPEUTICS 2019. [DOI: 10.1002/adtp.201900072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Christina N. M. Ryan
- Regenerative, Modular and Developmental Engineering LaboratoryBiomedical Sciences BuildingNational University of Ireland Galway Galway H91 W2TY Ireland
- Science Foundation Ireland, Centre for Research in Medical DevicesBiomedical Sciences BuildingNational University of Ireland Galway Galway H91 W2TY Ireland
| | - Dimitrios I. Zeugolis
- Regenerative, Modular and Developmental Engineering LaboratoryBiomedical Sciences BuildingNational University of Ireland Galway Galway H91 W2TY Ireland
- Science Foundation Ireland, Centre for Research in Medical DevicesBiomedical Sciences BuildingNational University of Ireland Galway Galway H91 W2TY Ireland
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Araque-Monrós MC, García-Cruz DM, Escobar-Ivirico JL, Gil-Santos L, Monleón-Pradas M, Más-Estellés J. Regenerative and Resorbable PLA/HA Hybrid Construct for Tendon/Ligament Tissue Engineering. Ann Biomed Eng 2019; 48:757-767. [DOI: 10.1007/s10439-019-02403-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/04/2019] [Indexed: 12/21/2022]
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Hahn J, Schulze-Tanzil G, Schröpfer M, Meyer M, Gögele C, Hoyer M, Spickenheuer A, Heinrich G, Breier A. Viscoelastic Behavior of Embroidered Scaffolds for ACL Tissue Engineering Made of PLA and P(LA-CL) After In Vitro Degradation. Int J Mol Sci 2019; 20:E4655. [PMID: 31546928 PMCID: PMC6770114 DOI: 10.3390/ijms20184655] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 01/31/2023] Open
Abstract
A rupture of the anterior cruciate ligament (ACL) is the most common knee ligament injury. Current applied reconstruction methods have limitations in terms of graft availability and mechanical properties. A new approach could be the use of a tissue engineering construct that temporarily reflects the mechanical properties of native ligament tissues and acts as a carrier structure for cell seeding. In this study, embroidered scaffolds composed of polylactic acid (PLA) and poly(lactic-co-ε-caprolactone) (P(LA-CL)) threads were tested mechanically for their viscoelastic behavior under in vitro degradation. The relaxation behavior of both scaffold types (moco: mono-component scaffold made of PLA threads, bico: bi-component scaffold made of PLA and P(LA-CL) threads) was comparable to native lapine ACL. Most of the lapine ACL cells survived 32 days of cell culture and grew along the fibers. Cell vitality was comparable for moco and bico scaffolds. Lapine ACL cells were able to adhere to the polymer surfaces and spread along the threads throughout the scaffold. The mechanical behavior of degrading matrices with and without cells showed no significant differences. These results demonstrate the potential of embroidered scaffolds as an ACL tissue engineering approach.
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Affiliation(s)
- Judith Hahn
- Leibniz-Institut für Polymerforschung Dresden e. V., 01069 Dresden, Germany.
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical Private University, Salzburg and Nuremberg, 90419 Nuremberg, Germany.
| | - Michaela Schröpfer
- Forschungsinstitut für Leder und Kunststoffbahnen (FILK) gGmbH, 09599 Freiberg, Germany.
| | - Michael Meyer
- Forschungsinstitut für Leder und Kunststoffbahnen (FILK) gGmbH, 09599 Freiberg, Germany.
| | - Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical Private University, Salzburg and Nuremberg, 90419 Nuremberg, Germany.
- Department of Biosciences, Paris Lodron University Salzburg, 5020 Salzburg, Austria.
| | - Mariann Hoyer
- Amedes MVZ für Laboratoriumsdiagnostik und Mikrobiologie Halle/Leipzig GmbH, 06112 Halle, Germany.
| | - Axel Spickenheuer
- Leibniz-Institut für Polymerforschung Dresden e. V., 01069 Dresden, Germany.
| | - Gert Heinrich
- Leibniz-Institut für Polymerforschung Dresden e. V., 01069 Dresden, Germany.
- Technische Universität Dresden, Faculty of Mechanical Science and Engineering, Institute of Textile Machinery and High Performance Material Technology, 01069 Dresden, Germany.
| | - Annette Breier
- Leibniz-Institut für Polymerforschung Dresden e. V., 01069 Dresden, Germany.
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Analysis of early cellular responses of anterior cruciate ligament fibroblasts seeded on different molecular weight polycaprolactone films functionalized by a bioactive poly(sodium styrene sulfonate) polymer. Biointerphases 2019; 14:041004. [PMID: 31405286 DOI: 10.1116/1.5102150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With the growing number of anterior cruciate ligament (ACL) ruptures and the increased interest for regenerative medicine procedures, many studies are now concentrated on developing bioactive and biodegradable synthetic ligaments. For this application, the choice of raw materials with appropriate physicochemical characteristics and long-term degradation features is essential. Polycaprolactone (PCL) has the advantage of slow degradation that depends on its molecular weight. This study evaluates two PCL materials: a technical grade (PC60: 60 kDa) versus a medical grade (PC12: 80 kDa), both before and after functionalization with poly(sodium styrene sulfonate) (pNaSS). After determining the grafting process had little to no effect on the PCL physicochemical properties, sheep ACL fibroblast responses were investigated. The PC12 films induced a significantly lower expression of the tumor necrosis factor alpha inflammatory gene compared to the PC60 films. Both film types induced an overproduction of fibroblast growth factor-2 and transforming growth factor beta compared to the controls on day 5 and demonstrated collagen gene expression profiles similar to the controls on day 7. Upon protein adsorption, pNaSS grafting caused a rapid cell adhesion in the first 30 min and an increased adhesion strength (1.5-fold higher). Moreover, after 7 days, an increase in cell density and actin network development were noted on the grafted films.
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Ramakrishna H, Li T, He T, Temple J, King MW, Spagnoli A. Tissue engineering a tendon-bone junction with biodegradable braided scaffolds. Biomater Res 2019; 23:11. [PMID: 31131112 PMCID: PMC6521458 DOI: 10.1186/s40824-019-0160-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Tendons play an important role in transferring stress between muscles and bones and in maintaining the stability of joints. Tendon tears are difficult to heal and are associated with high recurrence rates. So, the objective of this study was to develop a biodegradable scaffold for tendon-bone junction regeneration. Methods Two types of polylactic acid (PLA) yarns, having fibers with round and four deep grooved cross-sections, were braided into tubular scaffolds and cultured with murine Transforming growth factor beta type II receptor (Tgfbr2)-expressing joint progenitor cells. The scaffolds were designed to mimic the mechanical, immuno-chemical and biological properties of natural mouse tendon-bone junctions. Three different tubular scaffolds measuring 2 mm in diameter were braided on a Steeger 16-spindle braiding machine and biological and mechanical performance of the three scaffolds were evaluated. Results The mechanical test results indicated that three different braided scaffold structures provided a wide range of mechanical properties that mimic the components of tendon bone junction and results of the biological tests confirmed cell viability, active cell attachment and proliferation throughout all three scaffolds. Conclusions This study has identified that the three proposed types of braided scaffolds with some improvement in their structures have the potential to be used as scaffolds for the regeneration of a tendon bone tissue junction.
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Affiliation(s)
- Harshini Ramakrishna
- 1Wilson College of Textiles, North Carolina State University, 1020 Main Campus Drive, Raleigh, NC 27606 USA
| | - Tieshi Li
- 5Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, NE 68198-5945 USA
| | - Ting He
- 1Wilson College of Textiles, North Carolina State University, 1020 Main Campus Drive, Raleigh, NC 27606 USA
| | - Joseph Temple
- 2Department of Pediatrics, Rush University Medical Center, 1735 W. Harrison Street, 502A Cohn Research Building, 5th floor, Chicago, IL 60612 USA
| | - Martin W King
- 1Wilson College of Textiles, North Carolina State University, 1020 Main Campus Drive, Raleigh, NC 27606 USA.,3College of Textiles, Donghua University, 2999 Renmin Road North, Songjiang District, Shanghai, 201620 China.,4Department of Biosystems Engineering, University of Manitoba, Engineering, Information and Technology Complex, 75A Chancellor's Circle, Winnipeg, MB R3T 5V6 Canada
| | - Anna Spagnoli
- 5Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, NE 68198-5945 USA
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Leroux A, Maurice E, Viateau V, Migonney V. Feasibility Study of the Elaboration of a Biodegradable and Bioactive Ligament Made of Poly(ε-caprolactone)-pNaSS Grafted Fibers for the Reconstruction of Anterior Cruciate Ligament: In Vivo Experiment. Ing Rech Biomed 2019. [DOI: 10.1016/j.irbm.2018.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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39
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Marchiori G, Parrilli A, Sancisi N, Berni M, Conconi M, Luzi L, Cassiolas G, Zaffagnini S, Lopomo N. Integration of micro-CT and uniaxial loading to analyse the evolution of 3D microstructure under increasing strain: application to the Anterior Cruciate Ligament. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.matpr.2018.11.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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40
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Rotational Shortening of Collateral Ligament in TKR With Severe Deformity. Tech Orthop 2018; 33:274-278. [PMID: 30542231 PMCID: PMC6250263 DOI: 10.1097/bto.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Instability of the knee joint after total knee replacement (TKR) is one of the most important reasons for revision TKR. Inadequate release or tightening of the collateral ligaments in the knee joint may cause instability and early failure. This study presents a case series study of a new technique for ligament balancing wherein the collateral ligament is detached from its origin and rotated (twisted) around its longitudinal axis to tighten the ligament before the origin is reattached to its original position. The surgical technique for collateral ligament tightening during TKR was performed on 6 patients with a deformed knee caused by osteoarthritis and rheumatoid arthritis. The range of motion, knee society score, and laxity of the patients' knee joint, after 7 months to 13 years of follow-up, were evaluated. The technique was successful, achieving good range of motion and satisfactory stability of the joint. Further evaluation in a larger number of cases and a comparative analysis with different techniques would further support the usefulness of this rotational ligamentoplasty technique.
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Molecular dynamics study of the influence of solvents on the structure and mechanical properties of poly(vinyl alcohol) gels. J Mol Model 2018; 24:325. [DOI: 10.1007/s00894-018-3850-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
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Leroux A, Egles C, Migonney V. Impact of chemical and physical treatments on the mechanical properties of poly(ε-caprolactone) fibers bundles for the anterior cruciate ligament reconstruction. PLoS One 2018; 13:e0205722. [PMID: 30308052 PMCID: PMC6181421 DOI: 10.1371/journal.pone.0205722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/01/2018] [Indexed: 12/16/2022] Open
Abstract
The anterior cruciate ligament rupture is one of the most common sport injuries. Due to ligaments’ poor healing capacity, surgical intervention is often required. Nowadays, these injuries are managed using replacement autografts or to a lesser extent using artificial ligaments. With the expansion of tissue engineering, more recent researches focus on the development of biodegradable structures that could allow graft functioning while enhancing host integration. The main challenge is to develop a structure that gradually loses its mechanical properties when at the same time the neo-ligament gains in solidity. Mechanical behavior and reconstruction of natural tissue are the two key points for such a successful device. This article evaluates the mechanical consistency of poly(ε-caprolactone) fibers bundles grafted with sodium polystyrene sulfonate, as a candidate for ligament prosthesis. In order to be medically used, PCL fibers need to cope with multiple steps before implantation including extensive washings, knitting, grafting and sterilization processes. The evolution of mechanical properties at each step of the elaboration process has been investigated. The results show that PCL bundles have the same visco-elastic behavior than the native ACL. Nevertheless, when undergoing physical treatments such as ionizing radiations, like UV or β-rays, the material endures a hardening, increasing its stiffness but also its fragility. At this opposite, the thermal radical grafting acts like an annealing step, increasing significantly the elasticity of the PCL fibers. With this chemical treatment, the stiffness is decreasing, leading to higher energy dissipation. Added to the observation of the structure of the material, this demonstrates the possibility of the PCL to modulate it microstructure. In case of orthopedic prosthesis, the need of such a construct is strongly required to avoid distension of the future prosthesis and to restore good knee stabilization, showing the promising future of PCL ligament prosthesis.
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Affiliation(s)
- Amélie Leroux
- Laboratory of Biomaterials and Polymers of Specialty, UMR CNRS 7244, Institut Galilée, Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France
| | - Christophe Egles
- Laboratory of Biomechanics and Bioengineering, UMR CNRS 7338, Sorbonne Universités, Université de Technologie de Compiègne, Compiègne, France
| | - Véronique Migonney
- Laboratory of Biomaterials and Polymers of Specialty, UMR CNRS 7244, Institut Galilée, Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France
- * E-mail:
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43
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Shi L, Han Q. Molecular dynamics study of deformation mechanisms of poly(vinyl alcohol) hydrogel. MOLECULAR SIMULATION 2018. [DOI: 10.1080/08927022.2018.1506120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lixin Shi
- School of Civil Engineering and Transportation, South China University of Technology, Guangzhou, People’s Republic of China
| | - Qiang Han
- School of Civil Engineering and Transportation, South China University of Technology, Guangzhou, People’s Republic of China
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A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction. Appl Bionics Biomech 2018; 2018:4657824. [PMID: 29861784 PMCID: PMC5971278 DOI: 10.1155/2018/4657824] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/10/2018] [Indexed: 01/25/2023] Open
Abstract
The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a) the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b) the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c) a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d) nearly all synthetic grafts have been recalled from the market; and (e) bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the published reviews on the ACL focus largely on animal ACL than human ACL. Further, this review article summarizes the issues with autografts and synthetic grafts used so far. Autografts (patellar tendon and hamstring tendon) remains the gold standard as nearly all synthetic grafts introduced for clinical use have been withdrawn from the market. The mechanical strength during the ligamentization of autografts is also highlighted in this work.
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45
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Scaglione S, Zerega B, Badano R, Benatti U, Fato M, Quarto R. A Three-Dimensional Traction/Torsion Bioreactor System for Tissue Engineering. Int J Artif Organs 2018. [DOI: 10.1177/039139881003300604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose The aim of this study was to design, develop and validate a simple, compact bioreactor system for tissue engineering. The resulting bioreactor was designed to achieve ease-of-use and low costs for automated cell-culturing procedures onto three-dimensional scaffolds under controlled torsion/traction regimes. Methods Highly porous poly-caprolactone-based scaffolds were used as substrates colonized by fibroblast cells (3T3 cell line). Constructs were placed within the cylindrical culture chamber, clumped at the ends and exposed to controlled sequences of torsional stimuli (forward/back-forward sequential cycles of 100° from neutral position at a rate of 600°/min) through a stepper-motor; working settings were defined via PC by an easy user-interface. Cell adhesion, morphology, cytoskeletal fiber orientation and gene expression of extracellular matrix proteins (collagen type I, tenascin C, collagen type III) were evaluated after three days of torsional stimulation in the bioreactor system. Results and Conclusions The 3D bioreactor system was validated in terms of sterility, experimental reproducibility and flexibility. Cells adhered well onto the polymeric scaffolds. Collagen type I, tenascin C and collagen type III gene expression were significantly up-regulated when cells were cultured under torsion in the bioreactor for three days. In conclusion, we have developed a simple, efficient and versatile 3D cell-culture system to engineer ligament grafts. This system can be used either as a model to investigate mechanisms of tissue development or as a graft manufacturing system for possible clinical use in the field of regenerative medicine.
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Affiliation(s)
- Silvia Scaglione
- Advanced Biotechnology Center (CBA), Genoa - Italy
- Department of Computer Science, Systems and Telematics (DIST), University of Genoa, Genoa - Italy
| | | | - Roberto Badano
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa - Italy
| | - Umberto Benatti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa - Italy
| | - Marco Fato
- Department of Computer Science, Systems and Telematics (DIST), University of Genoa, Genoa - Italy
| | - Rodolfo Quarto
- Advanced Biotechnology Center (CBA), Genoa - Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa - Italy
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Narayanan G, Nair LS, Laurencin CT. Regenerative Engineering of the Rotator Cuff of the Shoulder. ACS Biomater Sci Eng 2018; 4:751-786. [PMID: 33418763 DOI: 10.1021/acsbiomaterials.7b00631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rotator cuff tears often heal poorly, leading to re-tears after repair. This is in part attributed to the low proliferative ability of the resident cells (tendon fibroblasts and tendon-stem cells) upon injury to the rotator cuff tissue and the low vascularity of the tendon insertion. In addition, surgical outcomes of current techniques used in clinical settings are often suboptimal, leading to the formation of neo-tissue with poor biomechanics and structural characteristics, which results in re-tears. This has prompted interest in a new approach, which we term as "Regenerative Engineering", for regenerating rotator cuff tendons. In the Regenerative Engineering paradigm, roles played by stem cells, scaffolds, growth factors/small molecules, the use of local physical forces, and morphogenesis interplayed with clinical surgery techniques may synchronously act, leading to synergistic effects and resulting in successful tissue regeneration. In this regard, various cell sources such as tendon fibroblasts and adult tissue-derived stem cells have been isolated, characterized, and investigated for regenerating rotator cuff tendons. Likewise, numerous scaffolds with varying architecture, geometry, and mechanical characteristics of biologic and synthetic origin have been developed. Furthermore, these scaffolds have been also fabricated with biochemical cues (growth factors and small molecules), facilitating tissue regeneration. In this Review, various strategies to regenerate rotator cuff tendons using stem cells, advanced materials, and factors in the setting of physical forces under the Regenerative Engineering paradigm are described.
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Affiliation(s)
- Ganesh Narayanan
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
| | - Lakshmi S Nair
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Cato T Laurencin
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Connecticut Institute for Clinical and Translational Science, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
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Abstract
Collagen fibers exist in many parts of the body as parallel bundles with a wavy morphology, known as crimp. This crimp structure contributes to the nonlinear mechanical properties of the tissue, such as ligament, blood vessels, and intestine, which provide elasticity and prevent injury. To recapitulate the native collagen crimp structure, we report a robust method using electrospinning and post-processing to generate parallel polymeric fibers with crimp that simulate the structure-function relationship of native tissue mechanics. In addition to recreating the mechanical functionalities, these fibers are instructive for cell morphology and phenotype and can serve as a platform to study cell-material interactions in a biomimetic physical microenvironment.
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Affiliation(s)
- Pen-Hsiu Grace Chao
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
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48
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Sub-failure Stretch Injury Response in Rat Achilles Tendon. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2017. [DOI: 10.1007/s40883-017-0043-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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49
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Narayanan G, Bhattacharjee M, Nair LS, Laurencin CT. Musculoskeletal Tissue Regeneration: the Role of the Stem Cells. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2017. [DOI: 10.1007/s40883-017-0036-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Surface biofunctionalization of three-dimensional porous poly(lactic acid) scaffold using chitosan/OGP coating for bone tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:92-101. [DOI: 10.1016/j.msec.2017.03.220] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/09/2017] [Accepted: 03/24/2017] [Indexed: 11/24/2022]
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