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Dec P, Żyłka M, Burszewski P, Modrzejewski A, Pawlik A. Recent Advances in the Use of Stem Cells in Tissue Engineering and Adjunct Therapies for Tendon Reconstruction and Future Perspectives. Int J Mol Sci 2024; 25:4498. [PMID: 38674084 PMCID: PMC11050411 DOI: 10.3390/ijms25084498] [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: 02/28/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Due to their function, tendons are exposed to acute injuries. This type of damage to the musculoskeletal system represents a challenge for clinicians when natural regeneration and treatment methods do not produce the expected results. Currently, treatment is long and associated with long-term complications. In this review, we discuss the use of stem cells in the treatment of tendons, including how to induce appropriate cell differentiation based on gene therapy, growth factors, tissue engineering, proteins involved in regenerative process, drugs and three-dimensional (3D) structures. A multidirectional approach as well as the incorporation of novel components of the therapy will improve the techniques used and benefit patients with tendon injuries in the future.
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Affiliation(s)
- Paweł Dec
- Plastic and Reconstructive Surgery Department, 109 Military Hospital, 71-422 Szczecin, Poland; (P.D.); (M.Ż.); (P.B.)
| | - Małgorzata Żyłka
- Plastic and Reconstructive Surgery Department, 109 Military Hospital, 71-422 Szczecin, Poland; (P.D.); (M.Ż.); (P.B.)
| | - Piotr Burszewski
- Plastic and Reconstructive Surgery Department, 109 Military Hospital, 71-422 Szczecin, Poland; (P.D.); (M.Ż.); (P.B.)
| | | | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University, 70-111 Szczecin, Poland
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2
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Makuku R, Werthel JD, Zanjani LO, Nabian MH, Tantuoyir MM. New frontiers of tendon augmentation technology in tissue engineering and regenerative medicine: a concise literature review. J Int Med Res 2022; 50:3000605221117212. [PMID: 35983666 PMCID: PMC9393707 DOI: 10.1177/03000605221117212] [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] [Indexed: 11/23/2022] Open
Abstract
Tissue banking programs fail to meet the demand for human organs and tissues for
transplantation into patients with congenital defects, injuries, chronic
diseases, and end-stage organ failure. Tendons and ligaments are among the most
frequently ruptured and/or worn-out body tissues owing to their frequent use,
especially in athletes and the elderly population. Surgical repair has remained
the mainstay management approach, regardless of scarring and adhesion formation
during healing, which then compromises the gliding motion of the joint and
reduces the quality of life for patients. Tissue engineering and regenerative
medicine approaches, such as tendon augmentation, are promising as they may
provide superior outcomes by inducing host-tissue ingrowth and tendon
regeneration during degradation, thereby decreasing failure rates and morbidity.
However, to date, tendon tissue engineering and regeneration research has been
limited and lacks the much-needed human clinical evidence to translate most
laboratory augmentation approaches to therapeutics. This narrative review
summarizes the current treatment options for various tendon pathologies, future
of tendon augmentation, cell therapy, gene therapy, 3D/4D bioprinting,
scaffolding, and cell signals.
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Affiliation(s)
- Rangarirai Makuku
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-David Werthel
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Oryadi Zanjani
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France
| | - Marcarious M Tantuoyir
- Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), School of Medicine, 48439Tehran University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Hospital Ambroise Pare, Boulogne-Billancourt, France.,Biomedical Engineering Unit, University of Ghana Medical Centre, Accra, Ghana
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3
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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: 2] [Impact Index Per Article: 1.0] [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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4
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Washington KS, Shemshaki NS, Laurencin CT. The Role of Nanomaterials and Biological Agents on Rotator Cuff Regeneration. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2022; 7:440-449. [PMID: 35005215 DOI: 10.1007/s40883-020-00171-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The rotator cuff is a musculotendon unit responsible for movement in the shoulder. Rotator cuff tears represent a significant number of musculoskeletal injuries in the adult population. In addition, there is a high incidence of retear rates due to various complications within the complex anatomical structure and the lack of proper healing. Current clinical strategies for rotator cuff augmentation include surgical intervention with autograft tissue grafts and beneficial impacts have been shown, but challenges still exist because of limited supply. For decades, nanomaterials have been engineered for the repair of various tissue and organ systems. This review article provides a thorough summary of the role nanomaterials, stem cells and biological agents have played in rotator cuff repair to date and offers input on next generation approaches for regenerating this tissue.
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Affiliation(s)
- Kenyatta S Washington
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA
| | - Nikoo Saveh Shemshaki
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030, USA.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA.,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
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5
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Impact of Electrospun Piezoelectric Core-Shell PVDFhfp/PDMS Mesh on Tenogenic and Inflammatory Gene Expression in Human Adipose-Derived Stem Cells: Comparison of Static Cultivation with Uniaxial Cyclic Tensile Stretching. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9010021. [PMID: 35049730 PMCID: PMC8772741 DOI: 10.3390/bioengineering9010021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/29/2021] [Indexed: 02/06/2023]
Abstract
Specific microenvironments can trigger stem cell tenogenic differentiation, such as specific substrates or dynamic cell cultivation. Electrospun meshes composed by core–shell fibers (random or aligned; PDMS core; piezoelectric PVDFhfp shell) were fabricated by coaxial electrospinning. Elastic modulus and residual strain were assessed. Human ASCs were seeded on such scaffolds either under static conditions for 1 week or with subsequent 10% dynamic stretching for 10,800 cycles (1 Hz, 3 h), assessing load elongation curves in a Bose® bioreactor system. Gene expression for tenogenic expression, extracellular matrix, remodeling, pro-fibrotic and inflammatory marker genes were assessed (PCR). For cell-seeded meshes, the E modulus increased from 14 ± 3.8 MPa to 31 ± 17 MPa within 3 h, which was not observed for cell-free meshes. Random fibers resulted in higher tenogenic commitment than aligned fibers. Dynamic cultivation significantly enhanced pro-inflammatory markers. Compared to ASCs in culture flasks, ASCs on random meshes under static cultivation showed a significant upregulation of Mohawk, Tenascin-C and Tenomodulin. The tenogenic commitment expressed by human ASCs in contact with random PVDFhfp/PDMS paves the way for using this novel highly elastic material as an implant to be wrapped around a lacerated tendon, envisioned as a functional anti-adhesion membrane.
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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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7
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Lim TK, Dorthé E, Williams A, D'Lima DD. Nanofiber Scaffolds by Electrospinning for Rotator Cuff Tissue Engineering. Chonnam Med J 2021; 57:13-26. [PMID: 33537215 PMCID: PMC7840345 DOI: 10.4068/cmj.2021.57.1.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Rotator cuff tears continue to be at risk of retear or failure to heal after surgical repair, despite the use of various surgical techniques, which stimulate development of novel scaffolding strategies. They should be able to address the known causes of failure after the conventional rotator cuff repair: (1) failure to reproduce the normal tendon healing process, (2) resultant failure to reproduce four zones of the enthesis, and (3) failure to attain sufficient mechanical strength after repair. Nanofiber scaffolds are suited for this application because they can be engineered to mimic the ultrastructure and properties of the native rotator cuff tendon. Among various methods for tissue-engineered nanofibers, electrospinning has recently been highlighted in the rotator cuff field. Electrospinning can create fibrous and porous structures that resemble natural tendon's extracellular matrix. Other advantages include the ability to create relatively large surface-to-volume ratios, the ability to control fiber size from the micro to the nano scale, and the flexibility of material choices. In this review, we will discuss the anatomical and mechanical features of the rotator cuff tendon, their potential impacts on improper healing after repair, and the current knowledge of the use of electrospinning for rotator cuff tissue engineering.
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Affiliation(s)
- Tae Kang Lim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.,Shiley Center for Orthopedic Research & Education at Scripps Clinic, CA, USA.,Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
| | - Erik Dorthé
- Shiley Center for Orthopedic Research & Education at Scripps Clinic, CA, USA.,Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
| | - Austin Williams
- Shiley Center for Orthopedic Research & Education at Scripps Clinic, CA, USA.,Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
| | - Darryl D D'Lima
- Shiley Center for Orthopedic Research & Education at Scripps Clinic, CA, USA.,Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
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8
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Taylor BL, Kim DH, Huegel J, Raja HA, Burkholder SJ, Weiss SN, Nuss CA, Soslowsky LJ, Mauck RL, Kuntz AF, Bernstein J. Localized delivery of ibuprofen via a bilayer delivery system (BiLDS) for supraspinatus tendon healing in a rat model. J Orthop Res 2020; 38:2339-2349. [PMID: 32215953 PMCID: PMC7529744 DOI: 10.1002/jor.24670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/15/2020] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
The high prevalence of tendon retear following rotator cuff repair motivates the development of new therapeutics to promote improved tendon healing. Controlled delivery of non-steroidal anti-inflammatory drugs to the repair site via an implanted scaffold is a promising option for modulating inflammation in the healing environment. Furthermore, biodegradable nanofibrous delivery systems offer an optimized architecture and surface area for cellular attachment, proliferation, and infiltration while releasing soluble factors to promote tendon regeneration. To this end, we developed a bilayer delivery system (BiLDS) for localized and controlled release of ibuprofen (IBP) to temporally mitigate inflammation and enhance tendon remodeling following surgical repair by promoting organized tissue formation. In vitro evaluation confirmed the delayed and sustained release of IBP from Labrafil-modified poly(lactic-co-glycolic) acid microspheres within sintered poly(ε-caprolactone) electrospun scaffolds. Biocompatibility of the BiLDS was demonstrated with primary Achilles tendon cells in vitro. Implantation of the IBP-releasing BiLDS at the repair site in a rat rotator cuff injury and repair model led to decreased expression of proinflammatory cytokine, tumor necrotic factor-α, and increased anti-inflammatory cytokine, transforming growth factor-β1. The BiLDS remained intact for mechanical reinforcement and recovered the tendon structural properties by 8 weeks. These results suggest the therapeutic potential of a novel biocompatible nanofibrous BiLDS for localized and tailored delivery of IBP to mitigate tendon inflammation and improve repair outcomes. Future studies are required to define the mechanical implications of an optimized BiLDS in a rat model beyond 8 weeks or in a larger animal model.
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Affiliation(s)
- Brittany L. Taylor
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Dong Hwa Kim
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Julianne Huegel
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Harina A. Raja
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Sophie J. Burkholder
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Stephanie N. Weiss
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Courtney A. Nuss
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Louis J. Soslowsky
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Robert L. Mauck
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Andrew F. Kuntz
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Joseph Bernstein
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
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9
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Conte AA, Sun K, Hu X, Beachley VZ. Effects of Fiber Density and Strain Rate on the Mechanical Properties of Electrospun Polycaprolactone Nanofiber Mats. Front Chem 2020; 8:610. [PMID: 32793555 PMCID: PMC7385238 DOI: 10.3389/fchem.2020.00610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022] Open
Abstract
This study examines the effects of electrospun polycaprolactone (PCL) fiber density and strain rate on nanofiber mat mechanical properties. An automated track collection system was employed to control fiber number per mat and promote uniform individual fiber properties regardless of the duration of collection. Fiber density is correlated to the mechanical properties of the nanofiber mats. Young's modulus was reduced as fiber density increased, from 14,901 MPa for samples electrospun for 30 s (717 fibers +/- 345) to 3,615 MPa for samples electrospun for 40 min (8,310 fibers +/- 1,904). Ultimate tensile strength (UTS) increased with increasing fiber density, where samples electrospun for 30 s resulted in a UTS of 594 MPa while samples electrospun for 40 min demonstrated a UTS of 1,250 MPa. An average toughness of 0.239 GJ/m3 was seen in the 30 s group, whereas a toughness of 0.515 GJ/m3 was observed at 40 min. The ultimate tensile strain for samples electrospun for 30 s was observed to be 0.39 and 0.48 for samples electrospun for 40 min. The relationships between UTS, Young's modulus, toughness, and ultimate tensile strain with increasing fiber density are the result of fiber-fiber interactions which leads to network mesh interactions.
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Affiliation(s)
- Adriano A. Conte
- Department of Biomedical Engineering, Rowan University, Glassboro, NJ, United States
| | - Katie Sun
- Department of Materials Science and Engineering, Rutgers University, New Brunswick, NJ, United States
| | - Xiao Hu
- Department of Physics and Astronomy, Rowan University, Glassboro, NJ, United States
| | - Vince Z. Beachley
- Department of Biomedical Engineering, Rowan University, Glassboro, NJ, United States
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10
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Kim W, Kim GE, Attia Abdou M, Kim S, Kim D, Park S, Kim YK, Gwon Y, Jeong SE, Kim MS, Kim J. Tendon-Inspired Nanotopographic Scaffold for Tissue Regeneration in Rotator Cuff Injuries. ACS OMEGA 2020; 5:13913-13925. [PMID: 32566858 PMCID: PMC7301599 DOI: 10.1021/acsomega.0c01328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
Acute and chronic rotator cuff (RC) tears are common etiologies of shoulder disabilities. Despite the advanced surgical techniques and graft materials available for tendon repair, the high re-tear rate remains a critical challenge in RC healing. Inspired by the highly organized nanotopography of the extracellular matrix (ECM) in tendon tissue of the shoulder, nanotopographic scaffolds are developed using polycaprolactone for the repair and regeneration of RC tendons. The scaffolds show appropriate flexibility and mechanical properties for application in tendon tissue regeneration. It is found that the highly aligned nanotopographic cues of scaffolds could sensitively control and improve the morphology, attachment, proliferation, and differentiation of tendon-derived cells as well as promote their wound healing capacity in vitro. In particular, this study showed that the scaffolds could promote tendon regeneration along the direction of the nanotopography in the rabbit models of acute and chronic RC tears. Nanotopographic scaffold-augmented rotator cuff repair showed a more appropriate healing pattern compared to the control groups in a rabbit RC tear model. We demonstrated that the tendon ECM-like nanoscale structural cues of the tendon-inspired patch may induce the more aligned tissue regeneration of the underlying tissues including tendon-to-bone interface.
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Affiliation(s)
- Woochan Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Ga-Eon Kim
- Department
of Pathology, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Mohamed Attia Abdou
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Sujin Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Daun Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Sunho Park
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Yang-Kyung Kim
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Yonghyun Gwon
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
| | - Sung-Eun Jeong
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Myung-Sun Kim
- Department
of Orthopedics, Chonnam National University
Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61649, Republic of Korea
| | - Jangho Kim
- Department
of Rural and Biosystems Engineering, Chonnam
National University, 77, Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea
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11
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Gniesmer S, Brehm R, Hoffmann A, de Cassan D, Menzel H, Hoheisel AL, Glasmacher B, Willbold E, Reifenrath J, Ludwig N, Zimmerer R, Tavassol F, Gellrich NC, Kampmann A. Vascularization and biocompatibility of poly(ε-caprolactone) fiber mats for rotator cuff tear repair. PLoS One 2020; 15:e0227563. [PMID: 31929570 PMCID: PMC6957163 DOI: 10.1371/journal.pone.0227563] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/20/2019] [Indexed: 12/22/2022] Open
Abstract
Rotator cuff tear is the most frequent tendon injury in the adult population. Despite current improvements in surgical techniques and the development of grafts, failure rates following tendon reconstruction remain high. New therapies, which aim to restore the topology and functionality of the interface between muscle, tendon and bone, are essentially required. One of the key factors for a successful incorporation of tissue engineered constructs is a rapid ingrowth of cells and tissues, which is dependent on a fast vascularization. The dorsal skinfold chamber model in female BALB/cJZtm mice allows the observation of microhemodynamic parameters in repeated measurements in vivo and therefore the description of the vascularization of different implant materials. In order to promote vascularization of implant material, we compared a porous polymer patch (a commercially available porous polyurethane based scaffold from Biomerix™) with electrospun polycaprolactone (PCL) fiber mats and chitosan-graft-PCL coated electrospun PCL (CS-g-PCL) fiber mats in vivo. Using intravital fluorescence microscopy microcirculatory parameters were analyzed repetitively over 14 days. Vascularization was significantly increased in CS-g-PCL fiber mats at day 14 compared to the porous polymer patch and uncoated PCL fiber mats. Furthermore CS-g-PCL fiber mats showed also a reduced activation of immune cells. Clinically, these are important findings as they indicate that the CS-g-PCL improves the formation of vascularized tissue and the ingrowth of cells into electrospun PCL scaffolds. Especially the combination of enhanced vascularization and the reduction in immune cell activation at the later time points of our study points to an improved clinical outcome after rotator cuff tear repair.
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Affiliation(s)
- Sarah Gniesmer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
- NIFE—Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Ralph Brehm
- Institute for Anatomy, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Hoffmann
- NIFE—Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
- Department of Orthopedic Surgery, Laboratory for Biomechanics and Biomaterials, Graded Implants and Regenerative Strategies, Hannover Medical School, Hannover, Germany
| | - Dominik de Cassan
- Institute for Technical Chemistry, Braunschweig University of Technology, Braunschweig, Germany
| | - Henning Menzel
- Institute for Technical Chemistry, Braunschweig University of Technology, Braunschweig, Germany
| | - Anna Lena Hoheisel
- NIFE—Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
- Institute of Multiphase Processes, Leibniz University Hannover, Hannover, Germany
| | - Birgit Glasmacher
- NIFE—Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
- Institute of Multiphase Processes, Leibniz University Hannover, Hannover, Germany
| | - Elmar Willbold
- NIFE—Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Janin Reifenrath
- NIFE—Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Nils Ludwig
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Ruediger Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Kampmann
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
- NIFE—Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
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12
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Tarafder S, Brito JA, Minhas S, Effiong L, Thomopoulos S, Lee CH. In situ tissue engineering of the tendon-to-bone interface by endogenous stem/progenitor cells. Biofabrication 2019; 12:015008. [PMID: 31561236 PMCID: PMC6904927 DOI: 10.1088/1758-5090/ab48ca] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The long-term success of surgical repair of rotator cuff tears is largely dependent on restoration of a functional tendon-to-bone interface. We implemented micro-precise spatiotemporal delivery of growth factors in three-dimensional printed scaffolds for integrative regeneration of a fibrocartilaginous tendon-to-bone interface. Sustained and spatially controlled release of tenogenic, chondrogenic and osteogenic growth factors was achieved using microsphere-based delivery carriers embedded in thin membrane-like scaffolds. In vitro, the scaffolds embedded with spatiotemporal delivery of growth factors successfully guided regional differentiation of mesenchymal progenitor cells, forming multiphase tissues with tendon-like, cartilage-like and bone-like regions. In vivo, when implanted at the interface between the supraspinatus tendon and the humeral head in a rat rotator cuff repair model, these scaffolds promoted recruitment of endogenous tendon progenitor cells followed by integrative healing of tendon and bone via re-formation of strong fibrocartilaginous interfaces. Our findings demonstrate the potential of in situ tissue engineering of tendon-to-bone interfaces by endogenous progenitor cells. The in situ tissue engineering approach shows translational potential for improving outcomes after rotator cuff repair.
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Affiliation(s)
- Solaiman Tarafder
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
| | - John A Brito
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
| | - Sumeet Minhas
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
| | - Linda Effiong
- Department of Orthopedic Surgery, Columbia University Medical Center, 650 W. 168th Street, BB14-1408, NY 10032, New York
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University Medical Center, 650 W. 168th Street, BB14-1408, NY 10032, New York
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, NY 10027, New York
| | - Chang H Lee
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168th Street, VC12-230, NY 10032, New York
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13
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Willbold E, Wellmann M, Welke B, Angrisani N, Gniesmer S, Kampmann A, Hoffmann A, Cassan D, Menzel H, Hoheisel AL, Glasmacher B, Reifenrath J. Possibilities and limitations of electrospun chitosan‐coated polycaprolactone grafts for rotator cuff tear repair. J Tissue Eng Regen Med 2019; 14:186-197. [DOI: 10.1002/term.2985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/27/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Elmar Willbold
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Mathias Wellmann
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
| | - Bastian Welke
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
| | - Nina Angrisani
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Sarah Gniesmer
- Clinic for Cranio‐Maxillo‐Facial SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Andreas Kampmann
- Clinic for Cranio‐Maxillo‐Facial SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Andrea Hoffmann
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Dominik Cassan
- Institute for Technical ChemistryBraunschweig University of Technology Braunschweig Germany
| | - Henning Menzel
- Institute for Technical ChemistryBraunschweig University of Technology Braunschweig Germany
| | - Anna Lena Hoheisel
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
- Institute for Multiphase ProcessesLeibniz University Hannover Hannover Germany
| | - Birgit Glasmacher
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
- Institute for Multiphase ProcessesLeibniz University Hannover Hannover Germany
| | - Janin Reifenrath
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
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14
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Song W, Ma Z, Wang C, Li H, He Y. Pro-chondrogenic and immunomodulatory melatonin-loaded electrospun membranes for tendon-to-bone healing. J Mater Chem B 2019; 7:6564-6575. [PMID: 31588948 DOI: 10.1039/c9tb01516g] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Reconstructing the native structure of the tendon-to-bone insertion site (enthesis) in rotator cuff repair has always been a great challenge for orthopedic surgeons. Difficulty arises mainly due to the limited enthesis regenerative capability and severe inflammatory cell infiltration, which result in fibrovascular scar formation instead of native cartilage-like enthesis. Therefore, tissue engineering scaffolds with pro-chondrogenic and immunomodulatory capabilities may offer a new strategy for native enthesis regeneration. In this study, melatonin-loaded aligned polycaprolactone (PCL) electrospun fibrous membranes were fabricated. The sustained release of melatonin from this membrane significantly promoted the chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBMSCs) in a long-term chondroid pellet model. After the membranes were implanted in a rat acute rotator cuff tear model, melatonin-loaded PCL membranes inhibited macrophage infiltration in the tendon-to-bone interface at the early healing phase, increasing chondroid zone formation, promoting collagen maturation, decreasing fibrovascular tissue formation and eventually improving the biomechanical strength of the regenerated enthesis. Taken together, melatonin-loaded PCL membranes possess great clinical application potential for tendon-to-bone healing.
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Affiliation(s)
- Wei Song
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
| | - Zhijie Ma
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China.
| | - Chongyang Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
| | - Haiyan Li
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China.
| | - Yaohua He
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China. and Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, 147 Jiankang Road, Shanghai 201599, China
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15
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Baldwin M, Snelling S, Dakin S, Carr A. Augmenting endogenous repair of soft tissues with nanofibre scaffolds. J R Soc Interface 2019; 15:rsif.2018.0019. [PMID: 29695606 DOI: 10.1098/rsif.2018.0019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022] Open
Abstract
As our ability to engineer nanoscale materials has developed we can now influence endogenous cellular processes with increasing precision. Consequently, the use of biomaterials to induce and guide the repair and regeneration of tissues is a rapidly developing area. This review focuses on soft tissue engineering, it will discuss the types of biomaterial scaffolds available before exploring physical, chemical and biological modifications to synthetic scaffolds. We will consider how these properties, in combination, can provide a precise design process, with the potential to meet the requirements of the injured and diseased soft tissue niche. Finally, we frame our discussions within clinical trial design and the regulatory framework, the consideration of which is fundamental to the successful translation of new biomaterials.
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Affiliation(s)
- Mathew Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Snelling
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephanie Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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16
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Saveh-Shemshaki N, S.Nair L, Laurencin CT. Nanofiber-based matrices for rotator cuff regenerative engineering. Acta Biomater 2019; 94:64-81. [PMID: 31128319 DOI: 10.1016/j.actbio.2019.05.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/27/2019] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
The rotator cuff consists of a cuff of soft tissue responsible for rotating the shoulder. Rotator cuff tendon tears are responsible for a significant source of disability and pain in the adult population. Most rotator cuff tendon tears occur at the bone-tendon interface. Tear size, patient age, fatty infiltration of muscle, have a major influence on the rate of retear after surgical repair. The high incidence of retears (up to 94% in some studies) after surgery makes rotator cuff injuries a critical musculoskeletal problem to address. The limitations of current treatments motivate regenerative engineering approaches for rotator cuff regeneration. Various fiber-based matrices are currently being investigated due to their structural similarity with native tendons and their ability to promote regeneration. This review will discuss the current approaches for rotator cuff regeneration, recent advances in fabrication and enhancement of nanofiber-based matrices and the development and use of complex nano/microstructures for rotator cuff regeneration. STATEMENT OF SIGNIFICANCE: Regeneration paradigms for musculoskeletal tissues involving the rotator cuff of the shoulder have received great interest. Novel technologies based on nanomaterials have emerged as possible robust solutions for rotator cuff injury and treatment due to structure/property relationships. The aim of the review submitted is to comprehensively describe and evaluate the development and use of nano-based material technologies for applications to rotator cuff tendon healing and regeneration.
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17
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Tang X, Daneshmandi L, Awale G, Nair LS, Laurencin CT. Skeletal Muscle Regenerative Engineering. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019; 5:233-251. [PMID: 33778155 DOI: 10.1007/s40883-019-00102-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skeletal muscles have the intrinsic ability to regenerate after minor injury, but under certain circumstances such as severe trauma from accidents, chronic diseases or battlefield injuries the regeneration process is limited. Skeletal muscle regenerative engineering has emerged as a promising approach to address this clinical issue. The regenerative engineering approach involves the convergence of advanced materials science, stem cell science, physical forces, insights from developmental biology, and clinical translation. This article reviews recent studies showing the potential of the convergences of technologies involving biomaterials, stem cells and bioactive factors in concert with clinical translation, in promoting skeletal muscle regeneration. Several types of biomaterials such as electrospun nanofibers, hydrogels, patterned scaffolds, decellularized tissues, and conductive matrices are being investigated. Detailed discussions are given on how these biomaterials can interact with cells and modulate their behavior through physical, chemical and mechanical cues. In addition, the application of physical forces such as mechanical and electrical stimulation are reviewed as strategies that can further enhance muscle contractility and functionality. The review also discusses established animal models to evaluate regeneration in two clinically relevant muscle injuries; volumetric muscle loss (VML) and muscle atrophy upon rotator cuff injury. Regenerative engineering approaches using advanced biomaterials, cells, and physical forces, developmental cues along with insights from immunology, genetics and other aspects of clinical translation hold significant potential to develop promising strategies to support skeletal muscle regeneration.
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Affiliation(s)
- Xiaoyan Tang
- Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington, CT 06030, USA.,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Leila Daneshmandi
- Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington, CT 06030, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Guleid Awale
- Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington, CT 06030, USA.,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Lakshmi S Nair
- Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington, CT 06030, USA.,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT 06030, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, CT 06030, USA.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington, CT 06030, USA.,Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
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18
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Zhang H, Liu MF, Liu RC, Shen WL, Yin Z, Chen X. Physical Microenvironment-Based Inducible Scaffold for Stem Cell Differentiation and Tendon Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:443-453. [PMID: 29724151 DOI: 10.1089/ten.teb.2018.0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tendon injuries are common musculoskeletal system disorders, but the tendons have poor regeneration ability. To address this issue, tendon tissue engineering provides potential strategies for future therapeutic treatment. Elements of the physical microenvironment, such as the mechanical force and surface topography, play a vital role in regulating stem cell fate, enhancing the differentiation efficiency of seed cells in tendon tissue engineering. Various inducible scaffolds have been widely explored for tendon regeneration, and scaffold-enhancing modifications have been extensively studied. In this review, we systematically summarize the effects of the physical microenvironment on stem cell differentiation and tendon regeneration; we also provide an overview of the inducible scaffolds for stem cell tenogenic differentiation. Finally, we suggest some potential scaffold-based therapies for tendon injuries, presenting an interesting perspective on tendon regenerative medicine.
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Affiliation(s)
- Hong Zhang
- 1 School of Basic Medical Sciences, and Department of Orthopedic Surgery of The Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China .,2 Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, School of Medicine, Zhejiang University , Hangzhou, China .,3 Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University , Hangzhou, China
| | - Meng-Fei Liu
- 1 School of Basic Medical Sciences, and Department of Orthopedic Surgery of The Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China .,2 Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, School of Medicine, Zhejiang University , Hangzhou, China .,3 Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University , Hangzhou, China
| | - Ri-Chun Liu
- 4 Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University , Nanning, China
| | - Wei-Liang Shen
- 2 Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, School of Medicine, Zhejiang University , Hangzhou, China .,5 Department of Sports Medicine, School of Medicine, Zhejiang University , Hangzhou, China .,6 China Orthopedic Regenerative Medicine Group (CORMed) , Hangzhou, China .,7 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China
| | - Zi Yin
- 1 School of Basic Medical Sciences, and Department of Orthopedic Surgery of The Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China .,2 Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, School of Medicine, Zhejiang University , Hangzhou, China .,3 Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University , Hangzhou, China .,6 China Orthopedic Regenerative Medicine Group (CORMed) , Hangzhou, China
| | - Xiao Chen
- 1 School of Basic Medical Sciences, and Department of Orthopedic Surgery of The Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China .,2 Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, School of Medicine, Zhejiang University , Hangzhou, China .,3 Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University , Hangzhou, China .,4 Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University , Nanning, China .,5 Department of Sports Medicine, School of Medicine, Zhejiang University , Hangzhou, China .,6 China Orthopedic Regenerative Medicine Group (CORMed) , Hangzhou, China
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19
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Sensini A, Cristofolini L. Biofabrication of Electrospun Scaffolds for the Regeneration of Tendons and Ligaments. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E1963. [PMID: 30322082 PMCID: PMC6213815 DOI: 10.3390/ma11101963] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022]
Abstract
Tendon and ligament tissue regeneration and replacement are complex since scaffolds need to guarantee an adequate hierarchical structured morphology, and non-linear mechanical properties. Moreover, to guide the cells' proliferation and tissue re-growth, scaffolds must provide a fibrous texture mimicking the typical of the arrangement of the collagen in the extracellular matrix of these tissues. Among the different techniques to produce scaffolds, electrospinning is one of the most promising, thanks to its ability to produce fibers of nanometric size. This manuscript aims to provide an overview to researchers approaching the field of repair and regeneration of tendons and ligaments. To clarify the general requirements of electrospun scaffolds, the first part of this manuscript presents a general overview concerning tendons' and ligaments' structure and mechanical properties. The different types of polymers, blends and particles most frequently used for tendon and ligament tissue engineering are summarized. Furthermore, the focus of the review is on describing the different possible electrospinning setups and processes to obtain different nanofibrous structures, such as mats, bundles, yarns and more complex hierarchical assemblies. Finally, an overview concerning how these technologies are exploited to produce electrospun scaffolds for tendon and ligament tissue applications is reported together with the main findings and outcomes.
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Affiliation(s)
- Alberto Sensini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, 40131 Bologna, Italy.
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-Università di Bologna, 40131 Bologna, Italy.
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum-Università di Bologna, 40064 Ozzano dell'Emilia, Bologna, Italy.
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20
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Ker DFE, Wang D, Behn AW, Wang ETH, Zhang X, Zhou BY, Mercado-Pagán ÁE, Kim S, Kleimeyer J, Gharaibeh B, Shanjani Y, Nelson D, Safran M, Cheung E, Campbell P, Yang YP. Functionally Graded, Bone- and Tendon-Like Polyurethane for Rotator Cuff Repair. ADVANCED FUNCTIONAL MATERIALS 2018; 28:1707107. [PMID: 29785178 PMCID: PMC5959293 DOI: 10.1002/adfm.201707107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 05/25/2023]
Abstract
Critical considerations in engineering biomaterials for rotator cuff repair include bone-tendon-like mechanical properties to support physiological loading and biophysicochemical attributes that stabilize the repair site over the long-term. In this study, UV-crosslinkable polyurethane based on quadrol (Q), hexamethylene diisocyante (H), and methacrylic anhydride (M; QHM polymers), which are free of solvent, catalyst, and photoinitiator, is developed. Mechanical characterization studies demonstrate that QHM polymers possesses phototunable bone- and tendon-like tensile and compressive properties (12-74 MPa tensile strength, 0.6-2.7 GPa tensile modulus, 58-121 MPa compressive strength, and 1.5-3.0 GPa compressive modulus), including the capability to withstand 10 000 cycles of physiological tensile loading and reduce stress concentrations via stiffness gradients. Biophysicochemical studies demonstrate that QHM polymers have clinically favorable attributes vital to rotator cuff repair stability, including slow degradation profiles (5-30% mass loss after 8 weeks) with little-to-no cytotoxicity in vitro, exceptional suture retention ex vivo (2.79-3.56-fold less suture migration relative to a clinically available graft), and competent tensile properties (similar ultimate load but higher normalized tensile stiffness relative to a clinically available graft) as well as good biocompatibility for augmenting rat supraspinatus tendon repair in vivo. This work demonstrates functionally graded, bone-tendon-like biomaterials for interfacial tissue engineering.
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Affiliation(s)
- Dai Fei Elmer Ker
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Dan Wang
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Anthony William Behn
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Evelyna Tsi Hsin Wang
- Department of Material Science and Engineering Stanford University 496 Lomita Mall, Stanford, CA 94305, USA
| | - Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine The Chinese University of Hong Kong New Territories, Hong Kong SAR
| | - Benjamin Yamin Zhou
- Department of Mathematics Stanford University Building 380, Sloan Mathematical Center, Stanford, CA 94305, USA
| | | | - Sungwoo Kim
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - John Kleimeyer
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Burhan Gharaibeh
- Department of Biological Sciences University of Pittsburgh 4249 Fifth Avenue, Pittsburgh, PA 15260, USA
| | - Yaser Shanjani
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Drew Nelson
- Department of Mechanical Engineering Stanford University 440 Escondido Mall, Stanford, CA 94305, USA
| | - Marc Safran
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Emilie Cheung
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Phil Campbell
- Engineering Research Accelerator Carnegie Mellon University 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
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21
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Effects of pulsed electromagnetic field therapy at different frequencies and durations on rotator cuff tendon-to-bone healing in a rat model. J Shoulder Elbow Surg 2018; 27:553-560. [PMID: 29174271 PMCID: PMC5835831 DOI: 10.1016/j.jse.2017.09.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears affect millions of individuals each year, often requiring surgical intervention. However, repair failure remains common. We have previously shown that pulsed electromagnetic field (PEMF) therapy improved tendon-to-bone healing in a rat rotator cuff model. The purpose of this study was to determine the influence of both PEMF frequency and exposure time on rotator cuff healing. METHODS Two hundred ten Sprague-Dawley rats underwent acute bilateral supraspinatus injury and repair followed by either Physio-Stim PEMF or high-frequency PEMF therapy for 1, 3, or 6 hours daily. Control animals did not receive PEMF therapy. Mechanical and histologic properties were assessed at 4, 8, and 16 weeks. RESULTS Improvements in different mechanical properties at various endpoints were identified for all treatment modalities when compared with untreated animals, regardless of PEMF frequency or duration. Of note, 1 hour of Physio-Stim treatment showed significant improvements in tendon mechanical properties across all time points, including increases in both modulus and stiffness as early as 4 weeks. Collagen organization improved for several of the treatment groups compared with controls. In addition, improvements in type I collagen and fibronectin expression were identified with PEMF treatment. An important finding was that no adverse effects were identified in any mechanical or histologic property. CONCLUSIONS Overall, our results suggest that PEMF therapy has a positive effect on rat rotator cuff healing for each electromagnetic fundamental pulse frequency and treatment duration tested in this study.
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22
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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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23
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Rinoldi C, Kijeńska E, Chlanda A, Choinska E, Khenoussi N, Tamayol A, Khademhosseini A, Swieszkowski W. Nanobead-on-string composites for tendon tissue engineering. J Mater Chem B 2018; 6:3116-3127. [DOI: 10.1039/c8tb00246k] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The bead-on-string topography of electrospun nanocomposite scaffolds improves fibroblast response in terms of cell spreading and proliferation.
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Affiliation(s)
- Chiara Rinoldi
- Materials Design Division, Faculty of Material Science and Engineering
- Warsaw University of Technology
- 02-507 Warsaw
- Poland
| | - Ewa Kijeńska
- Materials Design Division, Faculty of Material Science and Engineering
- Warsaw University of Technology
- 02-507 Warsaw
- Poland
| | - Adrian Chlanda
- Materials Design Division, Faculty of Material Science and Engineering
- Warsaw University of Technology
- 02-507 Warsaw
- Poland
| | - Emilia Choinska
- Materials Design Division, Faculty of Material Science and Engineering
- Warsaw University of Technology
- 02-507 Warsaw
- Poland
| | - Nabyl Khenoussi
- Laboratoire de Physique et Mécanique Textiles (EA 4365)
- Université de Haute Alsace
- Mulhouse Cedex 68093
- France
| | - Ali Tamayol
- Biomaterials Innovation Research Center
- Department of Medicine
- Brigham and Women's Hospital
- Harvard Medical School
- Boston
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center
- Department of Medicine
- Brigham and Women's Hospital
- Harvard Medical School
- Boston
| | - Wojciech Swieszkowski
- Materials Design Division, Faculty of Material Science and Engineering
- Warsaw University of Technology
- 02-507 Warsaw
- Poland
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24
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Poly-N-Acetyl Glucosamine (sNAG) Enhances Early Rotator Cuff Tendon Healing in a Rat Model. Ann Biomed Eng 2017; 45:2826-2836. [PMID: 28905242 DOI: 10.1007/s10439-017-1923-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
Rotator cuff injuries frequently require surgical repairs which have a high failure rate. Biological augmentation has been utilized in an attempt to improve tendon repair. Poly-N-acetyl glucosamine (sNAG) polymer containing nanofibers has been shown to increase the rate for healing of venous leg ulcers. The purpose of this study was to investigate the healing and analgesic properties of sNAG in a rat rotator cuff injury and repair model. 144 adult male Sprague-Dawley rats underwent a transection and repair of their left supraspinatus tendons. Half of the animals received a sNAG membrane on the tendon-to-bone insertion site. Animals were further subdivided, receiving 1 or 3 days of analgesics. Animals were sacrificed 2, 4, or 8 weeks post-injury. Animals sacrificed at 4 and 8 weeks underwent longitudinal in vivo ambulatory assessment. Histological properties were assessed at 2, 4, and 8 weeks, and mechanical properties at 4 and 8 weeks. In the presence of analgesics, tendons receiving the sNAG polymer had significantly increased max load and max stress at 4 weeks, but not at 8 weeks. Ambulatory improvements were observed at 14 days in stride length and speed. Therefore, sNAG improves tendon-to-bone healing in a rat rotator cuff detachment and repair model.
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25
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Riggin CN, Qu F, Kim DH, Huegel J, Steinberg DR, Kuntz AF, Soslowsky LJ, Mauck RL, Bernstein J. Electrospun PLGA Nanofiber Scaffolds Release Ibuprofen Faster and Degrade Slower After In Vivo Implantation. Ann Biomed Eng 2017; 45:2348-2359. [PMID: 28653294 DOI: 10.1007/s10439-017-1876-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/15/2017] [Indexed: 01/04/2023]
Abstract
While delayed delivery of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with improved tendon healing, early delivery has been associated with impaired healing. Therefore, NSAID use is appropriate only if the dose, timing, and mode of delivery relieves pain but does not impede tissue repair. Because delivery parameters can be controlled using drug-eluting nanofibrous scaffolds, our objective was to develop a scaffold for local controlled release of ibuprofen (IBP), and characterize the release profile and degradation both in vitro and in vivo. We found that when incubated in vitro in saline, scaffolds containing IBP had a linear release profile. However, when implanted subcutaneously in vivo or when incubated in vitro in serum, scaffolds showed a rapid burst release. These data demonstrate that scaffold properties are dependent on the environment in which they are placed and the importance of using serum, rather than saline, for initial in vitro evaluation of biofactor release from biodegradable scaffolds.
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Affiliation(s)
- Corinne N Riggin
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA.,Department of Bioengineering, University of Pennsylvania, Suite 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Feini Qu
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA.,School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce Street, Philadelphia, PA, 19104, USA
| | - Dong Hwa Kim
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Julianne Huegel
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA
| | - David R Steinberg
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Andrew F Kuntz
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Louis J Soslowsky
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA.,Department of Bioengineering, University of Pennsylvania, Suite 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Robert L Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA.,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA.,Department of Bioengineering, University of Pennsylvania, Suite 240 Skirkanich Hall, 210 South 33rd Street, Philadelphia, PA, 19104, USA
| | - Joseph Bernstein
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Philadelphia VA Medical Center, 3900 University & Woodland Avenue, Philadelphia, PA, 19104, USA. .,McKay Orthopaedic Research Lab, University of Pennsylvania, 424 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA, 19104, USA.
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26
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Huegel J, Kim DH, Cirone JM, Pardes AM, Morris TR, Nuss CA, Mauck RL, Soslowsky LJ, Kuntz AF. Autologous tendon-derived cell-seeded nanofibrous scaffolds improve rotator cuff repair in an age-dependent fashion. J Orthop Res 2017; 35:1250-1257. [PMID: 27500782 PMCID: PMC5299067 DOI: 10.1002/jor.23381] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 08/05/2016] [Indexed: 02/04/2023]
Abstract
Rotator cuff tendon tears are one of the most common shoulder pathologies, especially in the aging population. Due to a poor healing response and degenerative changes associated with aging, rotator cuff repair failure remains common. Although cell-based therapies to augment rotator cuff repair appear promising, it is unknown whether the success of such a therapy is age-dependent. We hypothesized that autologous cell therapy would improve tendon-to-bone healing across age groups, with autologous juvenile cells realizing the greatest benefit. In this study, juvenile, adult, and aged rats underwent bilateral supraspinatus tendon repair with augmentation of one shoulder with autologous tendon-derived cell-seeded polycaprolactone scaffolds. At 8 weeks, shoulders treated with cells in both juvenile and aged animals exhibited increased cellularity, increased collagen organization, and improved mechanical properties. No changes between treated and control limbs were seen in adult rats. These findings suggest that cell delivery during supraspinatus repair initiates earlier matrix remodeling in juvenile and aged animals. This may be due to the relative "equilibrium" of adult tendon tissue with regards to catabolic and anabolic processes, contrasted with actively growing juvenile tendons and degenerative aged tendons. This study demonstrates the potential for autologous cell-seeded scaffolds to improve repairs in both the juvenile and aged population. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1250-1257, 2017.
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Affiliation(s)
- Julianne Huegel
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - Dong Hwa Kim
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - James M. Cirone
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - Adam M. Pardes
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - Tyler R. Morris
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - Courtney A. Nuss
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
| | - Andrew F. Kuntz
- McKay Orthopaedic Research Laboratory; Penn Musculoskeletal Center; University of Pennsylvania; 3737 Market Street, 6th Floor Philadelphia 19104 Pennsylvania
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27
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Tucker JJ, Cirone JM, Morris TR, Nuss CA, Huegel J, Waldorff EI, Zhang N, Ryaby JT, Soslowsky LJ. Pulsed electromagnetic field therapy improves tendon-to-bone healing in a rat rotator cuff repair model. J Orthop Res 2017; 35:902-909. [PMID: 27282093 PMCID: PMC5554861 DOI: 10.1002/jor.23333] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/05/2016] [Indexed: 02/04/2023]
Abstract
Rotator cuff tears are common musculoskeletal injuries often requiring surgical intervention with high failure rates. Currently, pulsed electromagnetic fields (PEMFs) are used for treatment of long-bone fracture and lumbar and cervical spine fusion surgery. Clinical studies examining the effects of PEMF on soft tissue healing show promising results. Therefore, we investigated the role of PEMF on rotator cuff healing using a rat rotator cuff repair model. We hypothesized that PEMF exposure following rotator cuff repair would improve tendon mechanical properties, tissue morphology, and alter in vivo joint function. Seventy adult male Sprague-Dawley rats were assigned to three groups: bilateral repair with PEMF (n = 30), bilateral repair followed by cage activity (n = 30), and uninjured control with cage activity (n = 10). Rats in the surgical groups were sacrificed at 4, 8, and 16 weeks. Control group was sacrificed at 8 weeks. Passive joint mechanics and gait analysis were assessed over time. Biomechanical analysis and μCT was performed on left shoulders; histological analysis on right shoulders. Results indicate no differences in passive joint mechanics and ambulation. At 4 weeks the PEMF group had decreased cross-sectional area and increased modulus and maximum stress. At 8 weeks the PEMF group had increased modulus and more rounded cells in the midsubstance. At 16 weeks the PEMF group had improved bone quality. Therefore, results indicate that PEMF improves early tendon healing and does not alter joint function in a rat rotator cuff repair model. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:902-909, 2017.
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Affiliation(s)
- Jennica J Tucker
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | - James M. Cirone
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | - Tyler R. Morris
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | - Courtney A. Nuss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | - Julianne Huegel
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
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28
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Zheng Z, Ran J, Chen W, Hu Y, Zhu T, Chen X, Yin Z, Heng BC, Feng G, Le H, Tang C, Huang J, Chen Y, Zhou Y, Dominique P, Shen W, Ouyang HW. Alignment of collagen fiber in knitted silk scaffold for functional massive rotator cuff repair. Acta Biomater 2017; 51:317-329. [PMID: 28093363 DOI: 10.1016/j.actbio.2017.01.041] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 12/31/2022]
Abstract
Rotator cuff tear is one of the most common types of shoulder injuries, often resulting in pain and physical debilitation. Allogeneic tendon-derived decellularized matrices do not have appropriate pore size and porosity to facilitate cell infiltration, while commercially-available synthetic scaffolds are often inadequate at inducing tenogenic differentiation. The aim of this study is to develop an advanced 3D aligned collagen/silk scaffold (ACS) and investigate its efficacy in a rabbit massive rotator cuff tear model. ACS has similar 3D alignment of collagen fibers as natural tendon with superior mechanical characteristics. Based on ectopic transplantation studies, the optimal collagen concentration (10mg/ml), pore diameter (108.43±7.25μm) and porosity (97.94±0.08%) required for sustaining a stable macro-structure conducive for cellular infiltration was determined. Within in vitro culture, tendon stem/progenitor cells (TSPCs) displayed spindle-shaped morphology, and were well-aligned on ACS as early as 24h. TSPCs formed intercellular contacts and deposited extracellular matrix after 7days. With the in vivo rotator cuff repair model, the regenerative tendon of the ACS group displayed more conspicuous native microstructures with larger diameter collagen fibrils (48.72±3.75 vs. 44.26±5.03nm) that had better alignment and mechanical properties (139.85±49.36vs. 99.09±33.98N) at 12weeks post-implantation. In conclusion, these findings demonstrate the positive efficacy of the macroporous 3D aligned scaffold in facilitating rotator cuff tendon regeneration, and its practical applications for rotator cuff tendon tissue engineering. STATEMENT OF SIGNIFICANCE Massive rotator cuff tear is one of the most common shoulder injuries, and poses a formidable clinical challenge to the orthopedic surgeon. Tissue engineering of tendon can potentially overcome the problem. However, more efficacious scaffolds with good biocompatibility, appropriate pore size, favorable inductivity and sufficient mechanical strength for repairing massive rotator cuff tendon injuries need to be developed. In this study, we developed a novel macroporous 3D aligned collagen/silk scaffold, and demonstrated that this novel scaffold enhanced the efficacy of rotator cuff tendon regeneration by inducing aligned supracellular structures similar to natural tendon, which in turn enhanced cellular infiltration and tenogenic differentiation of stem/progenitor cells from both the tendon itself and surrounding tissues. Hence, it can potentially be a clinically useful application for tendon tissue engineering.
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29
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Tucker JJ, Gordon JA, Zanes RC, Zuskov A, Vinciguerra JD, Bloebaum RD, Soslowsky LJ. P 2 porous titanium implants improve tendon healing in an acute rat supraspinatus repair model. J Shoulder Elbow Surg 2017; 26:529-535. [PMID: 27751717 DOI: 10.1016/j.jse.2016.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/01/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current techniques in rotator cuff repair often lack structural integrity. P2 porous titanium-coated constructs (DJO Surgical, Austin, TX, USA) promote osseointegration and soft tissue ingrowth. This study examined the ability of this material to improve the structural integrity of supraspinatus tendon repair in a rat model. We hypothesized that P2 implants placed at the tendon-to-bone interface would improve mechanical and histologic measures of supraspinatus healing. METHODS Forty rats underwent supraspinatus repairs with P2 implants in 1 shoulder and standard repair in the other. Rats were humanely killed at time 0 (n = 3), 2 weeks (n = 8), 4 weeks (n = 15), and 12 weeks (n = 14). Tendon-to-bone composite specimens were harvested and evaluated mechanically and histologically. RESULTS Tendon cross-sectional area was decreased in the P2 implant group at 4 weeks, percentage of relaxation was increased at 2 weeks, elastic modulus was increased at 4 weeks, and maximum load and maximum stress were both increased at 2 and 4 weeks. Histologic analysis revealed no foreign body reactions within or around the P2 implant, and healthy viable bone was visible within the P2 implant. CONCLUSION The results support our hypothesis, specifically in early healing, in this randomized controlled animal study. These data support the use of P2 porous titanium implants to improve tendon-to-bone healing.
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Affiliation(s)
- Jennica J Tucker
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua A Gordon
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert C Zanes
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrey Zuskov
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Roy D Bloebaum
- Departments of Bioengeering, Biology, and Orthopaedics, University of Utah, Salt Lake City, UT, USA; Bone and Joint Research Laboratory, Department of Veterans Affairs, Salt Lake City, UT, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA.
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30
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Mubyana K, Koppes RA, Lee KL, Cooper JA, Corr DT. The influence of specimen thickness and alignment on the material and failure properties of electrospun polycaprolactone nanofiber mats. J Biomed Mater Res A 2016; 104:2794-800. [PMID: 27355844 DOI: 10.1002/jbm.a.35821] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 12/24/2022]
Abstract
Electrospinning is a versatile fabrication technique that has been recently expanded to create nanofibrous structures that mimic ECM topography. Like many materials, electrospun constructs are typically characterized on a smaller scale, and scaled up for various applications. This established practice is based on the assumption that material properties, such as toughness, failure stress and strain, are intrinsic to the material, and thus will not be influenced by specimen geometry. However, we hypothesized that the material and failure properties of electrospun nanofiber mats vary with specimen thickness. To test this, we mechanically characterized polycaprolactone (PCL) nanofiber mats of three different thicknesses in response to constant rate elongation to failure. To identify if any observed thickness-dependence could be attributed to fiber alignment, such as the effects of fiber reorientation during elongation, these tests were performed in mats with either random or aligned nanofiber orientation. Contrary to our hypothesis, the failure strain was conserved across the different thicknesses, indicating similar maximal elongation for specimens of different thickness. However, in both the aligned and randomly oriented groups, the ultimate tensile stress, short-range modulus, yield modulus, and toughness all decreased with increasing mat thickness, thereby indicating that these are not intrinsic material properties. These findings have important implications in engineered scaffolds for fibrous and soft tissue applications (e.g., tendon, ligament, muscle, and skin), where such oversights could result in unwanted laxity or reduced resistance to failure. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2794-2800, 2016.
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Affiliation(s)
- Kuwabo Mubyana
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, New York, 12180
| | - Ryan A Koppes
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, New York, 12180
| | - Kristen L Lee
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, New York, 12180
| | - James A Cooper
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, New York, 12180.,Musculoskeletal and Translational Tissue Engineering Research Lab©, P.O. Box 153, 7715 Crittenden Street, Philadelphia, Pennsylvania 19118
| | - David T Corr
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, New York, 12180.
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Abstract
Rotator cuff tears continue to be at significant risk for re-tear or for failure to heal after surgical repair despite the use of a variety of surgical techniques and augmentation devices. Therefore, there is a need for functionalized scaffold strategies to provide sustained mechanical augmentation during the critical first 12-weeks following repair, and to enhance the healing potential of the repaired tendon and tendon-bone interface. Tissue engineered approaches that combine the use of scaffolds, cells, and bioactive molecules towards promising new solutions for rotator cuff repair are reviewed. The ideal scaffold should have adequate initial mechanical properties, be slowly degrading or non-degradable, have non-toxic degradation products, enhance cell growth, infiltration and differentiation, promote regeneration of the tendon-bone interface, be biocompatible and have excellent suture retention and handling properties. Scaffolds that closely match the inhomogeneity and non-linearity of the native rotator cuff may significantly advance the field. While substantial pre-clinical work remains to be done, continued progress in overcoming current tissue engineering challenges should allow for successful clinical translation.
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32
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Omi R, Gingery A, Steinmann SP, Amadio PC, An KN, Zhao C. Rotator cuff repair augmentation in a rat model that combines a multilayer xenograft tendon scaffold with bone marrow stromal cells. J Shoulder Elbow Surg 2016; 25:469-77. [PMID: 26387915 PMCID: PMC5175472 DOI: 10.1016/j.jse.2015.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS A composite of multilayer tendon slices (COMTS) seeded with bone marrow stromal cells (BMSCs) may impart mechanical and biologic augmentation effects on supraspinatus tendon repair under tension, thereby improving the healing process after surgery in rats. METHODS Adult female Lewis rats (n = 39) underwent transection of the supraspinatus tendon and a 2-mm tendon resection at the distal end, followed by immediate repair to its bony insertion site under tension. Animals received 1 of 3 treatments at the repair site: (1) no augmentation, (2) COMTS augmentation alone, or (3) BMSC-seeded COMTS augmentation. BMSCs were labeled with a fluorescent cell marker. Animals were euthanized 6 weeks after surgery, and the extent of healing of the repaired supraspinatus tendon was evaluated with biomechanical testing and histologic analysis. RESULTS Histologic analysis showed gap formation between the repaired tendon and bone in all specimens, regardless of treatment. Robust fibrous tissue was observed in rats with BMSC-seeded COMTS augmentation; however, fibrous tissue was scarce within the gap in rats with no augmentation or COMTS-only augmentation. Labeled transplanted BMSCs were observed throughout the repair site. Biomechanical analysis showed that the repairs augmented with BMSC-seeded COMTS had significantly greater ultimate load to failure and stiffness compared with other treatments. However, baseline (time 0) data showed that COMTS-only augmentation did not increase mechanical strength of the repair site. CONCLUSION Although the COMTS scaffold did not increase the initial repair strength, the BMSC-seeded scaffold increased healing strength and stiffness 6 weeks after rotator cuff repair in a rat model.
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Affiliation(s)
- Rei Omi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Anne Gingery
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | | | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Lowe CJ, Reucroft IM, Grota MC, Shreiber DI. Production of Highly Aligned Collagen Scaffolds by Freeze-drying of Self-assembled, Fibrillar Collagen Gels. ACS Biomater Sci Eng 2016; 2:643-651. [PMID: 27430016 DOI: 10.1021/acsbiomaterials.6b00036] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Matrix and cellular alignment are critical factors in the native function of many tissues, including muscle, nerve, and ligaments. Collagen is frequently a component of these aligned tissues, and collagen biomaterials are widely used in tissue engineering applications. However, the generation of aligned collagen scaffolds that maintain the native architecture of collagen fibrils has not been straightforward, with many methods requiring specialized equipment or technical procedures, extensive incubation times, or denaturing of the collagen. Herein, we present a simple, rapid method for fabrication of highly aligned collagen scaffolds. Collagen was assembled to form a fibrillar hydrogel in a cylindrical conduit with high aspect ratio and then frozen and lyophilized. The resulting collagen scaffolds demonstrated highly aligned topographical features along the scaffold surface. This presence of an initial fibrillar network and the high-aspect ratio vessel were both required to generate alignment. The diameter of fabricated scaffolds was found to vary significantly with both the collagen concentration of the hydrogel suspension and the diameter of conduits used for fabrication. Additionally, the size of individual aligned topographical features was significantly dependent on the conduit diameter and the freezing temperature. When cultured on aligned collagen scaffolds, both rat dermal fibroblasts and axons emerging from chick dorsal root ganglia explants demonstrated elongated, aligned morphology and growth on the aligned topographical features. Overall, this method presents a simple means for generating aligned collagen scaffolds that can be applied to a wide variety of tissue types, particularly those where such alignment is critical to native function.
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Affiliation(s)
- Christopher J Lowe
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, 599 Taylor Road, Piscataway, New Jersey 08854, United States
| | - Ian M Reucroft
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, 599 Taylor Road, Piscataway, New Jersey 08854, United States
| | - Matthew C Grota
- Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, Massachusetts 02747, United States
| | - David I Shreiber
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, 599 Taylor Road, Piscataway, New Jersey 08854, United States
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Tucker JJ, Riggin CN, Connizzo BK, Mauck RL, Steinberg DR, Kuntz AF, Soslowsky LJ, Bernstein J. Effect of overuse-induced tendinopathy on tendon healing in a rat supraspinatus repair model. J Orthop Res 2016. [PMID: 26218457 PMCID: PMC4710550 DOI: 10.1002/jor.22993] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Supraspinatus tears often result in the setting of chronic tendinopathy. However, the typical repair model utilizes an acute injury. In recognition of that distinction, our laboratory developed an overuse animal model; however it is unclear whether induced overuse is necessary in the repair model. We studied the repair properties of overuse-induced tendons compared to normal tendons. We hypothesized that histological and mechanical properties would not be altered between the overuse-induced and normal tendons 1 and 4 weeks after repair. Thirty-one adult male Sprague-Dawley rats were subjected to either overuse or cage activity for 4 weeks prior to bilateral supraspinatus tendon repair surgery. Rats were sacrificed at 1 and 4 weeks post-surgery and evaluated for histology and mechanics. Results at 1 week showed no clear histologic changes, but increased inflammatory protein expression in overuse tendons. At 4 weeks, percent relaxation was slightly increased in the overuse group. No other alterations in mechanics or histology were observed. Our results suggest that the effects of the surgical injury overshadow the changes evoked by overuse. Because clinically relevant mechanical parameters were not altered in the overuse group, we conclude that when examining tendons 4 weeks after repair in the classic rat supraspinatus model, inducing overuse prior to surgery is likely to be unnecessary.
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Affiliation(s)
| | | | | | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, Philadelphia, PA,Philadelphia VA Medical Center (PVAMC), Philadelphia, PA
| | - David R. Steinberg
- McKay Orthopaedic Research Laboratory, Philadelphia, PA,Philadelphia VA Medical Center (PVAMC), Philadelphia, PA
| | - Andrew F. Kuntz
- McKay Orthopaedic Research Laboratory, Philadelphia, PA,Philadelphia VA Medical Center (PVAMC), Philadelphia, PA
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Sun Y, Han F, Zhang P, Zhi Y, Yang J, Yao X, Wang H, Lin C, Wen X, Chen J, Zhao P. A synthetic bridging patch of modified co-electrospun dual nano-scaffolds for massive rotator cuff tear. J Mater Chem B 2016; 4:7259-7269. [PMID: 32263728 DOI: 10.1039/c6tb01674j] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An electrospun nano-scaffold with two different segments is fabricated to bridge a massive rotator cuff tear successfully.
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A radiopaque electrospun scaffold for engineering fibrous musculoskeletal tissues: Scaffold characterization and in vivo applications. Acta Biomater 2015; 26:97-104. [PMID: 26248165 DOI: 10.1016/j.actbio.2015.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/30/2015] [Accepted: 08/01/2015] [Indexed: 12/11/2022]
Abstract
Tissue engineering strategies have emerged in response to the growing prevalence of chronic musculoskeletal conditions, with many of these regenerative methods currently being evaluated in translational animal models. Engineered replacements for fibrous tissues such as the meniscus, annulus fibrosus, tendons, and ligaments are subjected to challenging physiologic loads, and are difficult to track in vivo using standard techniques. The diagnosis and treatment of musculoskeletal conditions depends heavily on radiographic assessment, and a number of currently available implants utilize radiopaque markers to facilitate in vivo imaging. In this study, we developed a nanofibrous scaffold in which individual fibers included radiopaque nanoparticles. Inclusion of radiopaque particles increased the tensile modulus of the scaffold and imparted radiation attenuation within the range of cortical bone. When scaffolds were seeded with bovine mesenchymal stem cells in vitro, there was no change in cell proliferation and no evidence of promiscuous conversion to an osteogenic phenotype. Scaffolds were implanted ex vivo in a model of a meniscal tear in a bovine joint and in vivo in a model of total disc replacement in the rat coccygeal spine (tail), and were visualized via fluoroscopy and microcomputed tomography. In the disc replacement model, histological analysis at 4 weeks showed that the scaffold was biocompatible and supported the deposition of fibrous tissue in vivo. Nanofibrous scaffolds that include radiopaque nanoparticles provide a biocompatible template with sufficient radiopacity for in vivo visualization in both small and large animal models. This radiopacity may facilitate image-guided implantation and non-invasive long-term evaluation of scaffold location and performance. STATEMENT OF SIGNIFICANCE The healing capacity of fibrous musculoskeletal tissues is limited, and injury or degeneration of these tissues compromises the standard of living of millions in the US. Tissue engineering repair strategies for the intervertebral disc, meniscus, tendon and ligament have progressed from in vitro to in vivo evaluation using a variety of animal models, and the clinical application of these technologies is imminent. The composition of most scaffold materials however does not allow for visualization by methods available to clinicians (e.g., radiography), and thus it is not possible to assess their performance in situ. In this work, we describe a radiopaque nanofibrous scaffold that can be visualized radiographically in both small and large animal models and serve as a framework for the development of an engineered fibrous tissue.
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Hakimi O, Mouthuy PA, Zargar N, Lostis E, Morrey M, Carr A. A layered electrospun and woven surgical scaffold to enhance endogenous tendon repair. Acta Biomater 2015; 26:124-35. [PMID: 26275911 DOI: 10.1016/j.actbio.2015.08.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 08/01/2015] [Accepted: 08/11/2015] [Indexed: 01/26/2023]
Abstract
Surgical reattachments of tendon to bone in the rotator cuff are reported to fail in around 40% of cases. There are no adequate solutions to improve tendon healing currently available. Electrospun, sub-micron materials, have been extensively studied as scaffolds for tendon repair with promising results, but are too weak to be surgically implanted or to mechanically support the healing tendon. To address this, we developed a bonding technique that enables the processing of electrospun sheets into multi-layered, robust, implantable fabrics. Here, we show a first prototype scaffold created with this method, where an electrospun sheet was reinforced with a woven layer. The resulting scaffold presents a maximum suture pull out strength of 167N, closely matched with human rotator cuff tendons, and the desired nanofibre-mediated bioactivity in vitro and in vivo. This type of scaffold has potential for broader application for augmenting other soft tissues.
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Affiliation(s)
- O Hakimi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
| | - P A Mouthuy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
| | - N Zargar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
| | - E Lostis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
| | - M Morrey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - A Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
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Orr SB, Chainani A, Hippensteel KJ, Kishan A, Gilchrist C, Garrigues NW, Ruch DS, Guilak F, Little D. Aligned multilayered electrospun scaffolds for rotator cuff tendon tissue engineering. Acta Biomater 2015; 24:117-26. [PMID: 26079676 PMCID: PMC4560626 DOI: 10.1016/j.actbio.2015.06.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/13/2015] [Accepted: 06/09/2015] [Indexed: 12/29/2022]
Abstract
The rotator cuff consists of several tendons and muscles that provide stability and force transmission in the shoulder joint. Whereas most rotator cuff tears are amenable to suture repair, the overall success rate of repair is low, and massive tears are prone to re-tear. Extracellular matrix (ECM) patches are used to augment suture repair, but they have limitations. Tissue-engineered approaches provide a promising solution for massive rotator cuff tears. Previous studies have shown that, compared to nonaligned scaffolds, aligned electrospun polymer scaffolds exhibit greater anisotropy and exert a greater tenogenic effect. Nevertheless, achieving rapid cell infiltration through the full thickness of the scaffold is challenging, and scaling to a translationally relevant size may be difficult. Our goal was to evaluate whether a novel method of alignment, combining a multilayered electrospinning technique with a hybrid of several electrospinning alignment techniques, would permit cell infiltration and collagen deposition through the thickness of poly(ε-caprolactone) scaffolds following seeding with human adipose-derived stem cells. Furthermore, we evaluated whether multilayered aligned scaffolds enhanced collagen alignment, tendon-related gene expression, and mechanical properties compared to multilayered nonaligned scaffolds. Both aligned and nonaligned multilayered scaffolds demonstrated cell infiltration and ECM deposition through the full thickness of the scaffold after only 28days of culture. Aligned scaffolds displayed significantly increased expression of tenomodulin compared to nonaligned scaffolds and exhibited aligned collagen fibrils throughout the full thickness, the presence of which may account for the increased yield stress and Young's modulus of cell-seeded aligned scaffolds along the axis of fiber alignment. STATEMENT OF SIGNIFICANCE Rotator cuff tears are an important clinical problem in the shoulder, with over 300,000 surgical repairs performed annually. Re-tear rates may be high, and current methods used to augment surgical repair have limited evidence to support their clinical use due to inadequate initial mechanical properties and slow cellular infiltration. Tissue engineering approaches such as electrospinning have shown similar challenges in previous studies. In this study, a novel technique to align electrospun fibers while using a multilayered approach demonstrated increased mechanical properties and development of aligned collagen through the full thickness of the scaffolds compared to nonaligned multilayered scaffolds, and both types of scaffolds demonstrated rapid cell infiltration through the full thickness of the scaffold.
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Affiliation(s)
- Steven B Orr
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Abby Chainani
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Kirk J Hippensteel
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Alysha Kishan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Christopher Gilchrist
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - N William Garrigues
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Dianne Little
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Effect of scapular dyskinesis on supraspinatus repair healing in a rat model. J Shoulder Elbow Surg 2015; 24:1235-42. [PMID: 25745826 PMCID: PMC4509794 DOI: 10.1016/j.jse.2014.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/09/2014] [Accepted: 12/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears are common conditions that often require surgical repair to improve function and to relieve pain. Unfortunately, repair failure remains a common problem after rotator cuff repair surgery. Several factors may contribute to repair failure, including age, tear size, and time from injury. However, the mechanical mechanisms resulting in repair failure are not well understood, making clinical management difficult. Specifically, altered scapular motion (termed scapular dyskinesis) may be one important and modifiable factor contributing to the risk of repair failure. Therefore, the objective of this study was to determine the effect of scapular dyskinesis on supraspinatus tendon healing after repair. METHODS A rat model of scapular dyskinesis was used. Seventy adult male Sprague-Dawley rats (400-450 g) were randomized into 2 groups: nerve transection of the accessory and long thoracic nerves (SD) or sham nerve transection (Sham control). After this procedure, all rats underwent unilateral detachment and repair of the supraspinatus tendon. All rats were sacrificed at 2, 4, and 8 weeks after surgery. Shoulder function, passive joint mechanics, and tendon properties (mechanical, histologic, organizational, and compositional) were evaluated. RESULTS Scapular dyskinesis alters joint function and may lead to compromised supraspinatus tendon properties. Specifically, diminished mechanical properties, altered histology, and decreased tendon organization were observed for some parameters. CONCLUSION This study identifies scapular dyskinesis as one underlying mechanism leading to compromise of supraspinatus healing after repair. Identifying modifiable factors that lead to compromised tendon healing will help improve clinical outcomes after repair.
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Viateau V, Decambron A, Manassero M. Animal Models for Orthopedic Applications of Tissue Engineering. Biomaterials 2014. [DOI: 10.1002/9781119043553.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Tidjarat S, Winotapun W, Opanasopit P, Ngawhirunpat T, Rojanarata T. Uniaxially aligned electrospun cellulose acetate nanofibers for thin layer chromatographic screening of hydroquinone and retinoic acid adulterated in cosmetics. J Chromatogr A 2014; 1367:141-7. [PMID: 25294296 DOI: 10.1016/j.chroma.2014.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
Uniaxially aligned cellulose acetate (CA) nanofibers were successfully fabricated by electrospinning and applied to use as stationary phase for thin layer chromatography. The control of alignment was achieved by using a drum collector rotating at a high speed of 6000 rpm. Spin time of 6h was used to produce the fiber thickness of about 10 μm which was adequate for good separation. Without any chemical modification after the electrospinning process, CA nanofibers could be readily devised for screening hydroquinone (HQ) and retinoic acid (RA) adulterated in cosmetics using the mobile phase consisting of 65:35:2.5 methanol/water/acetic acid. It was found that the separation run on the aligned nanofibers over a distance of 5 cm took less than 15 min which was two to three times faster than that on the non-aligned ones. On the aligned nanofibers, the masses of HQ and RA which could be visualized were 10 and 25 ng, respectively, which were two times lower than those on the non-aligned CA fibers and five times lower than those on conventional silica plates due to the appearance of darker and sharper of spots on the aligned nanofibers. Furthermore, the proposed method efficiently resolved HQ from RA and ingredients commonly found in cosmetic creams. Due to the satisfactory analytical performance, facile and inexpensive production process, uniaxially aligned electrospun CA nanofibers are promising alternative media for planar chromatography.
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Affiliation(s)
- Siripran Tidjarat
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Weerapath Winotapun
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Praneet Opanasopit
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Tanasait Ngawhirunpat
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand
| | - Theerasak Rojanarata
- Pharmaceutical Development of Green Innovations Group (PDGIG), Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand.
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Connizzo BK, Yannascoli SM, Tucker JJ, Caro AC, Riggin CN, Mauck RL, Soslowsky LJ, Steinberg DR, Bernstein J. The detrimental effects of systemic Ibuprofen delivery on tendon healing are time-dependent. Clin Orthop Relat Res 2014; 472:2433-9. [PMID: 23982408 PMCID: PMC4079885 DOI: 10.1007/s11999-013-3258-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current clinical treatment after tendon repairs often includes prescribing NSAIDs to limit pain and inflammation. The negative influence of NSAIDs on bone repair is well documented, but their effects on tendon healing are less clear. While NSAIDs may be detrimental to early tendon healing, some evidence suggests that they may improve healing if administered later in the repair process. QUESTIONS/PURPOSES We asked whether the biomechanical and histologic effects of systemic ibuprofen administration on tendon healing are influenced by either immediate or delayed drug administration. METHODS After bilateral supraspinatus detachment and repair surgeries, rats were divided into groups and given ibuprofen orally for either Days 0 to 7 (early) or Days 8 to 14 (delayed) after surgery; a control group did not receive ibuprofen. Healing was evaluated at 1, 2, and 4 weeks postsurgery through biomechanical testing and histologic assessment. RESULTS Biomechanical evaluation resulted in decreased stiffness and modulus at 4 weeks postsurgery for early ibuprofen delivery (mean ± SD [95% CI]: 10.8 ± 6.4 N/mm [6.7-14.8] and 8.9 ± 5.9 MPa [5.4-12.3]) when compared to control repair (20.4 ± 8.6 N/mm [16.3-24.5] and 15.7 ± 7.5 MPa [12.3-19.2]) (p = 0.003 and 0.013); however, there were no differences between the delayed ibuprofen group (18.1 ± 7.4 N/mm [14.2-22.1] and 11.5 ± 5.6 MPa [8.2-14.9]) and the control group. Histology confirmed mechanical results with reduced fiber reorganization over time in the early ibuprofen group. CONCLUSIONS Early administration of ibuprofen in the postoperative period was detrimental to tendon healing, while delayed administration did not affect tendon healing. CLINICAL RELEVANCE Historically, clinicians have often prescribed ibuprofen after tendon repair, but this study suggests that the timing of ibuprofen administration is critical to adequate tendon healing. This research necessitates future clinical studies investigating the use of ibuprofen for pain control after rotator cuff repair and other tendon injuries.
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Affiliation(s)
- Brianne K. Connizzo
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA 19104 USA
| | - Sarah M. Yannascoli
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA 19104 USA
| | - Jennica J. Tucker
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA 19104 USA
| | - Adam C. Caro
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA 19104 USA
| | - Corinne N. Riggin
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA 19104 USA
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA 19104 USA
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 34th and Hamilton Walk, Philadelphia, PA 19104 USA
| | | | - Joseph Bernstein
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA USA
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Abstract
Tendinopathy is a debilitating musculoskeletal
condition which can cause significant pain and lead to complete rupture
of the tendon, which often requires surgical repair. Due in part
to the large spectrum of tendon pathologies, these disorders continue
to be a clinical challenge. Animal models are often used in this
field of research as they offer an attractive framework to examine
the cascade of processes that occur throughout both tendon pathology and
repair. This review discusses the structural, mechanical, and biological
changes that occur throughout tendon pathology in animal models,
as well as strategies for the improvement of tendon healing. Cite this article: Bone Joint Res 2014;3:193–202.
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Affiliation(s)
- M W Hast
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - A Zuskov
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - L J Soslowsky
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
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Zhao S, Zhao J, Dong S, Huangfu X, Li B, Yang H, Zhao J, Cui W. Biological augmentation of rotator cuff repair using bFGF-loaded electrospun poly(lactide-co-glycolide) fibrous membranes. Int J Nanomedicine 2014; 9:2373-85. [PMID: 24868155 PMCID: PMC4027937 DOI: 10.2147/ijn.s59536] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clinically, rotator cuff tear (RCT) is among the most common shoulder pathologies. Despite significant advances in surgical techniques, the re-tear rate after rotator cuff (RC) repair remains high. Insufficient healing capacity is likely the main factor for reconstruction failure. This study reports on a basic fibroblast growth factor (bFGF)-loaded electrospun poly(lactide-co-glycolide) (PLGA) fibrous membrane for repairing RCT. Implantable biodegradable bFGF-PLGA fibrous membranes were successfully fabricated using emulsion electrospinning technology and then characterized and evaluated with in vitro and in vivo cell proliferation assays and repairs of rat chronic RCTs. Emulsion electrospinning fabricated ultrafine fibers with a core-sheath structure which secured the bioactivity of bFGF in a sustained manner for 3 weeks. Histological observations showed that electrospun fibrous membranes have excellent biocompatibility and biodegradability. At 2, 4, and 8 weeks after in vivo RCT repair surgery, electrospun fibrous membranes significantly increased the area of glycosaminoglycan staining at the tendon-bone interface compared with the control group, and bFGF-PLGA significantly improved collagen organization, as measured by birefringence under polarized light at the healing enthesis compared with the control and PLGA groups. Biomechanical testing showed that the electrospun fibrous membrane groups had a greater ultimate load-to-failure and stiffness than the control group at 4 and 8 weeks. The bFGF-PLGA membranes had the highest ultimate load-to-failure, stiffness, and stress of the healing enthesis, and their superiority compared to PLGA alone was significant. These results demonstrated that electrospun fibrous membranes aid in cell attachment and proliferation, as well as accelerating tendon-bone remodeling, and bFGF-loaded PLGA fibrous membranes have a more pronounced effect on tendon-bone healing. Therefore, augmentation using bFGF-PLGA electrospun fibrous membranes is a promising treatment for RCT.
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Affiliation(s)
- Song Zhao
- Department of Arthroscopic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jingwen Zhao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Shikui Dong
- Department of Arthroscopic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xiaoqiao Huangfu
- Department of Arthroscopic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Bin Li
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, People's Republic of China ; Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Huilin Yang
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, People's Republic of China ; Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Jinzhong Zhao
- Department of Arthroscopic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Wenguo Cui
- Orthopedic Institute, Soochow University, Suzhou, Jiangsu, People's Republic of China ; Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
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Ma B, Xie J, Jiang J, Shuler FD, Bartlett DE. Rational design of nanofiber scaffolds for orthopedic tissue repair and regeneration. Nanomedicine (Lond) 2014; 8:1459-81. [PMID: 23987110 DOI: 10.2217/nnm.13.132] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This article reviews recent significant advances in the design of nanofiber scaffolds for orthopedic tissue repair and regeneration. It begins with a brief introduction on the limitations of current approaches for orthopedic tissue repair and regeneration. It then illustrates that rationally designed scaffolds made up of electrospun nanofibers could be a promising solution to overcome the problems that current approaches encounter. The article also discusses the intriguing properties of electrospun nanofibers, including control of composition, structures, orders, alignments and mechanical properties, use as carriers for topical drug and/or gene sustained delivery, and serving as substrates for the regulation of cell behaviors, which could benefit musculoskeletal tissue repair and regeneration. It further highlights a few of the many recent applications of electrospun nanofiber scaffolds in repairing and regenerating various orthopedic tissues. Finally, the article concludes with perspectives on the challenges and future directions for better design, fabrication and utilization of nanofiber scaffolds for orthopedic tissue engineering.
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Affiliation(s)
- Bing Ma
- Marshall Institute for Interdisciplinary Research & Center for Diagnostic Nanosystems, Marshall University, Huntington, WV 25755, USA
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He X, Xiao Q, Lu C, Wang Y, Zhang X, Zhao J, Zhang W, Zhang X, Deng Y. Uniaxially aligned electrospun all-cellulose nanocomposite nanofibers reinforced with cellulose nanocrystals: scaffold for tissue engineering. Biomacromolecules 2014; 15:618-27. [PMID: 24405043 DOI: 10.1021/bm401656a] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Uniaxially aligned cellulose nanofibers with well oriented cellulose nanocrystals (CNCs) embedded were fabricated via electrospinning using a rotating drum as the collector. Scanning electron microscope (SEM) images indicated that most cellulose nanofibers were uniaxially aligned. The incorporation of CNCs into the spinning dope resulted in more uniform morphology of the electrospun cellulose/CNCs nanocomposite nanofibers (ECCNN). Polarized light microscope (PLM) and transmission electron microscope (TEM) showed that CNCs dispersed well in ECCNN nonwovens and achieved considerable orientation along the long axis direction. This unique hierarchical microstructure of ECCNN nonwovens gave rise to remarkable enhancement of their physical properties. By incorporating 20% loading (in weight) of CNCs, the tensile strength and elastic modulus of ECCNN along the fiber alignment direction were increased by 101.7 and 171.6%, respectively. Their thermal stability was significantly improved as well. In addition, the ECCNN nonwovens were assessed as potential scaffold materials for tissue engineering. It was elucidated from MTT tests that the ECCNN were essentially nontoxic to human cells. Cell culture experiments demonstrated that cells could proliferate rapidly not only on the surface but also deep inside the ECCNN. More importantly, the aligned nanofibers of ECCNN exhibited a strong effect on directing cellular organization. This feature made the scaffold particularly useful for various artificial tissues or organs, such as blood vessel, tendon, nerve, and so on, in which cell orientation was crucial for their performance.
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Affiliation(s)
- Xu He
- State Key Laboratory of Polymer Materials Engineering, Polymer Research Institute at Sichuan University , Chengdu 610065, China
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Hakimi O, Mouthuy PA, Carr A. Synthetic and degradable patches: an emerging solution for rotator cuff repair. Int J Exp Pathol 2013; 94:287-92. [PMID: 23837794 DOI: 10.1111/iep.12030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/16/2013] [Indexed: 12/16/2022] Open
Abstract
The use of rotator cuff augmentation has increased dramatically over the last 10 years in response to the high rate of failure observed after non-augmented surgery. However, although augmentations have been shown to reduce shoulder pain, there is no consensus or clear guideline as to what is the safest or most efficacious material. Current augmentations, either available commercially or in development, can be classified into three categories: non-degradable structures, extra cellular matrix (ECM)-based patches and degradable synthetic scaffolds. Non-degradable structures have excellent mechanical properties, but can cause problems of infection and loss of integrity in the long-term. ECM-based patches usually demonstrate excellent biological properties in vitro, but studies have highlighted complications in vivo due to poor mechanical support and to infection or inflammation. Degradable synthetic scaffolds represent the new generation of implants. It is proposed that a combination of good mechanical properties, active promotion of biological healing, low infection risk and bio-absorption are the ideal characteristics of an augmentation material. Among the materials with these features, those processed by electrospinning have shown great promis. However, their clinical effectiveness has yet to be proven and well conducted clinical trials are urgently required.
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Affiliation(s)
- Osnat Hakimi
- NIHR, Oxford, Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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Chainani A, Hippensteel KJ, Kishan A, Garrigues NW, Ruch DS, Guilak F, Little D. Multilayered electrospun scaffolds for tendon tissue engineering. Tissue Eng Part A 2013; 19:2594-604. [PMID: 23808760 DOI: 10.1089/ten.tea.2013.0165] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Full-thickness rotator cuff tears are one of the most common causes of shoulder pain in people over the age of 65. High retear rates and poor functional outcomes are common after surgical repair, and currently available extracellular matrix scaffold patches have limited abilities to enhance new tendon formation. In this regard, tissue-engineered scaffolds may provide a means to improve repair of rotator cuff tears. Electrospinning provides a versatile method for creating nanofibrous scaffolds with controlled architectures, but several challenges remain in its application to tissue engineering, such as cell infiltration through the full thickness of the scaffold as well as control of cell growth and differentiation. Previous studies have shown that ligament-derived extracellular matrix may enhance differentiation toward a tendon or ligament phenotype by human adipose stem cells (hASCs). In this study, we investigated the use of tendon-derived extracellular matrix (TDM)-coated electrospun multilayered scaffolds compared to fibronectin (FN) or phosphate-buffered saline (PBS) coating for use in rotator cuff tendon tissue engineering. Multilayered poly(ɛ-caprolactone) scaffolds were prepared by sequentially collecting electrospun layers onto the surface of a grounded saline solution into a single scaffold. Scaffolds were then coated with TDM, FN, or PBS and seeded with hASCs. Scaffolds were maintained without exogenous growth factors for 28 days in culture and evaluated for protein content (by immunofluorescence and biochemical assay), markers of tendon differentiation, and tensile mechanical properties. The collagen content was greatest by day 28 in TDM-scaffolds. Gene expression of type I collagen, decorin, and tenascin C increased over time, with no effect of scaffold coating. Sulfated glycosaminoglycan and dsDNA contents increased over time in culture, but there was no effect of scaffold coating. The Young's modulus did not change over time, but yield strain increased with time in culture. Histology demonstrated cell infiltration through the full thickness of all scaffolds and immunofluorescence demonstrated greater expression of type I, but not type III collagen through the full thickness of the scaffold in TDM-scaffolds compared to other treatment groups. Together, these data suggest that nonaligned multilayered electrospun scaffolds permit tenogenic differentiation by hASCs and that TDM may promote some aspects of this differentiation.
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Affiliation(s)
- Abby Chainani
- 1 Department of Orthopaedic Surgery, Duke University Medical Center , Durham, North Carolina
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Lomas AJ, Webb WR, Han J, Chen GQ, Sun X, Zhang Z, El Haj AJ, Forsyth NR. Poly (3-hydroxybutyrate-co-3-hydroxyhexanoate)/collagen hybrid scaffolds for tissue engineering applications. Tissue Eng Part C Methods 2013; 19:577-85. [PMID: 23281705 DOI: 10.1089/ten.tec.2012.0457] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The benefits associated with polyhydroxyalkanoates (PHA) in tissue engineering include high immunotolerance, low toxicity, and biodegradability. Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx), a molecule from the PHA family of biopolymers, shares these features. In this study, the applicability of human embryonic stem cells (hESCs), spontaneously differentiated hESCs (SDhESCs), and mesenchymal stem cells (hMSCs) in conjunction with PHBHHx and collagen as a biocompatible replacement strategy for damaged tissues was exploited. Collagen gel contraction was monitored by seeding cells at controlled densities (0, 10(3), 10(4), and 10(5) cells/mL) and measuring length and diameter at regular time intervals thereafter when cultured in a complete medium. Cell viability was measured by trypan blue exclusion assay. Porous PHBHHx tube scaffolds were prepared using a dipping method followed by salt leaching. PHBHHx/collagen composites were generated via syringe injection of collagen/cell mixtures into sterile PHBHHx porous tubes. Reverse transcription polymerase chain reaction was used to determine the fate of cells within PHBHHx/collagen scaffolds with tendon, bone, cartilage, and fat-linked transcript expression being explored at days 0, 5 10, and 20. The capacity of PHBHHx/collagen scaffolds to support differentiation was explored using a medium specific for osteogenic, chondrogenic, and adipogenic lineage generation. Collagen gel tube contraction required initial seeding densities of ≥10(5) hMSCs or SDhESCs in 1.5 mg/mL collagen gel tubes. Gels with a collagen concentration of 3 mg/mL did not display contraction across the examined cell seeding densities. Cell viability was ∼50% for SDhESC and 90% for hMSCs at all cell densities tested in porous PHBHHx tube/3 mg/mL collagen hybrid scaffolds after 20 days in vitro culture. Undifferentiated hESCs did not contract collagen gel tubes and were unviable after 20 days culture. In the absence of additional stimuli, SOX9 was sporadically found, while RUNX2 was not present in both hMSC and SDhESC. Hybrid scaffolds were shown to promote retention of osteogenic, chondrogenic, and adipogenic differentiation by expression of RUNX2, SOX9, and PPARγ genes, respectively, following exposure to the appropriate induction medium. PHBHHx/collagen scaffolds have been successfully used to culture hMSC and SDhESC over an extended period supporting the potential of this scaffold combination in future tissue engineering applications.
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Affiliation(s)
- Alex J Lomas
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom
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Connizzo BK, Yannascoli SM, Soslowsky LJ. Structure-function relationships of postnatal tendon development: a parallel to healing. Matrix Biol 2013; 32:106-16. [PMID: 23357642 DOI: 10.1016/j.matbio.2013.01.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 11/18/2022]
Abstract
This review highlights recent research on structure-function relationships in tendon and comments on the parallels between development and healing. The processes of tendon development and collagen fibrillogenesis are reviewed, but due to the abundance of information in this field, this work focuses primarily on characterizing the mechanical behavior of mature and developing tendon, and how the latter parallels healing tendon. The role that extracellular matrix components, mainly collagen, proteoglycans, and collagen cross-links, play in determining the mechanical behavior of tendon will be examined in this review. Specifically, collagen fiber re-alignment and collagen fibril uncrimping relate mechanical behavior to structural alterations during development and during healing. Finally, attention is paid to a number of recent efforts to augment injured tendon and how future efforts could focus on recreating the important structure-function relationships reviewed here.
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Affiliation(s)
- Brianne K Connizzo
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
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