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Milián L, Oliver-Ferrándiz M, Peregrín I, Sancho-Tello M, Martín-de-Llano JJ, Martínez-Ramos C, Carda C, Mata M. Alginate Improves the Chondrogenic Capacity of 3D PCL Scaffolds In Vitro: A Histological Approach. Curr Issues Mol Biol 2024; 46:3563-3578. [PMID: 38666953 PMCID: PMC11048942 DOI: 10.3390/cimb46040223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Polycaprolactone (PCL) scaffolds have demonstrated an effectiveness in articular cartilage regeneration due to their biomechanical properties. On the other hand, alginate hydrogels generate a 3D environment with great chondrogenic potential. Our aim is to generate a mixed PCL/alginate scaffold that combines the chondrogenic properties of the two biomaterials. Porous PCL scaffolds were manufactured using a modified salt-leaching method and embedded in a culture medium or alginate in the presence or absence of chondrocytes. The chondrogenic capacity was studied in vitro. Type II collagen and aggrecan were measured by immunofluorescence, cell morphology by F-actin fluorescence staining and gene expression of COL1A1, COL2A1, ACAN, COL10A1, VEGF, RUNX1 and SOX6 by reverse transcription polymerase chain reaction (RT-PCR). The biocompatibility of the scaffolds was determined in vivo using athymic nude mice and assessed by histopathological and morphometric analysis. Alginate improved the chondrogenic potential of PCL in vitro by increasing the expression of type II collagen and aggrecan, as well as other markers related to chondrogenesis. All scaffolds showed good biocompatibility in the in vivo model. The presence of cells in the scaffolds induced an increase in vascularization of the PCL/alginate scaffolds. The results presented here reinforce the benefits of the combined use of PCL and alginate for the regeneration of articular cartilage.
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Affiliation(s)
- Lara Milián
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, Blasco Ibáñez Avenue, 15, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, Menéndez y Pelayo Street, 4, 46010 Valencia, Spain
| | - María Oliver-Ferrándiz
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, Blasco Ibáñez Avenue, 15, 46010 Valencia, Spain
| | - Ignacio Peregrín
- INCLIVA Biomedical Research Institute, Menéndez y Pelayo Street, 4, 46010 Valencia, Spain
- IMED Hospital, 46100 Valencia, Spain
| | - María Sancho-Tello
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, Blasco Ibáñez Avenue, 15, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, Menéndez y Pelayo Street, 4, 46010 Valencia, Spain
| | - José Javier Martín-de-Llano
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, Blasco Ibáñez Avenue, 15, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, Menéndez y Pelayo Street, 4, 46010 Valencia, Spain
| | - Cristina Martínez-Ramos
- Centro de Biomateriales e Ingeniería Tisular (CBIT), Universitat Politècnica de València, Camino de Vera, s/n Ciudad Politécnica de la Innovación, Edificio 8E. Acceso F. Nivel 1, 46022 Valencia, Spain
- Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - Carmen Carda
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, Blasco Ibáñez Avenue, 15, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, Menéndez y Pelayo Street, 4, 46010 Valencia, Spain
- Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - Manuel Mata
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, Blasco Ibáñez Avenue, 15, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, Menéndez y Pelayo Street, 4, 46010 Valencia, Spain
- Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
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O'Shea DG, Hodgkinson T, Curtin CM, O'Brien FJ. An injectable and 3D printable pro-chondrogenic hyaluronic acid and collagen type II composite hydrogel for the repair of articular cartilage defects. Biofabrication 2023; 16:015007. [PMID: 37852239 DOI: 10.1088/1758-5090/ad047a] [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: 07/28/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Current treatments for repairing articular cartilage defects are limited. However, pro-chondrogenic hydrogels formulated using articular cartilage matrix components (such as hyaluronic acid (HA) and collagen type II (Col II)), offer a potential solution if they could be injected into the defect via minimally invasive arthroscopic procedures, or used as bioinks to 3D print patient-specific customised regenerative scaffolds-potentially combined with cells. However, HA and Col II are difficult to incorporate into injectable/3D printable hydrogels due to poor physicochemical properties. This study aimed to overcome this by developing an articular cartilage matrix-inspired pro-chondrogenic hydrogel with improved physicochemical properties for both injectable and 3D printing (3DP) applications. To achieve this, HA was methacrylated to improve mechanical properties and mixed in a 1:1 ratio with Col I, a Col I/Col II blend or Col II. Col I possesses superior mechanical properties to Col II and so was hypothesised to enhance hydrogel mechanical properties. Rheological analysis showed that the pre-gels had viscoelastic and shear thinning properties. Subsequent physicochemical analysis of the crosslinked hydrogels showed that Col II inclusion resulted in a more swollen and softer polymer network, without affecting degradation time. While all hydrogels exhibited exemplary injectability, only the Col I-containing hydrogels had sufficient mechanical stability for 3DP applications. To facilitate 3DP of multi-layered scaffolds using methacrylated HA (MeHA)-Col I and MeHA-Col I/Col II, additional mechanical support in the form of a gelatin slurry support bath freeform reversible embedding of suspended hydrogels was utilised. Biological analysis revealed that Col II inclusion enhanced hydrogel-embedded MSC chondrogenesis, thus MeHA-Col II was selected as the optimal injectable hydrogel, and MeHA-Col I/Col II as the preferred bioink. In summary, this study demonstrates how tailoring biomaterial composition and physicochemical properties enables development of pro-chondrogenic hydrogels with potential for minimally invasive delivery to injured articular joints or 3DP of customised regenerative implants for cartilage repair.
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Affiliation(s)
- Donagh G O'Shea
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Tom Hodgkinson
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Caroline M Curtin
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin (TCD), Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
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3
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Peng Y, Zhuang Y, Liu Y, Le H, Li D, Zhang M, Liu K, Zhang Y, Zuo J, Ding J. Bioinspired gradient scaffolds for osteochondral tissue engineering. EXPLORATION (BEIJING, CHINA) 2023; 3:20210043. [PMID: 37933242 PMCID: PMC10624381 DOI: 10.1002/exp.20210043] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/05/2023] [Indexed: 11/08/2023]
Abstract
Repairing articular osteochondral defects present considerable challenges in self-repair due to the complex tissue structure and low proliferation of chondrocytes. Conventional clinical therapies have not shown significant efficacy, including microfracture, autologous/allograft osteochondral transplantation, and cell-based techniques. Therefore, tissue engineering has been widely explored in repairing osteochondral defects by leveraging the natural regenerative potential of biomaterials to control cell functions. However, osteochondral tissue is a gradient structure with a smooth transition from the cartilage to subchondral bone, involving changes in chondrocyte morphologies and phenotypes, extracellular matrix components, collagen type and orientation, and cytokines. Bioinspired scaffolds have been developed by simulating gradient characteristics in heterogeneous tissues, such as the pores, components, and osteochondrogenesis-inducing factors, to satisfy the anisotropic features of osteochondral matrices. Bioinspired gradient scaffolds repair osteochondral defects by altering the microenvironments of cell growth to induce osteochondrogenesis and promote the formation of osteochondral interfaces compared with homogeneous scaffolds. This review outlines the meaningful strategies for repairing osteochondral defects by tissue engineering based on gradient scaffolds and predicts the pros and cons of prospective translation into clinical practice.
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Affiliation(s)
- Yachen Peng
- Department of OrthopedicsChina‐Japan Union Hospital of Jilin UniversityChangchunP. R. China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
| | - Yaling Zhuang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
| | - Yang Liu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
- Institute of BioengineeringÉcole Polytechnique Fédérale de Lausanne (EPFL)LausanneSwitzerland
| | - Hanxiang Le
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
| | - Di Li
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
| | - Mingran Zhang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
| | - Kai Liu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
| | - Yanbo Zhang
- Department of OrthopedicsChina‐Japan Union Hospital of Jilin UniversityChangchunP. R. China
| | - Jianlin Zuo
- Department of OrthopedicsChina‐Japan Union Hospital of Jilin UniversityChangchunP. R. China
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
- School of Applied Chemistry and EngineeringUniversity of Science and Technology of ChinaHefeiP. R. China
- Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied ChemistryChinese Academy of SciencesChangchunP. R. China
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4
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Shi R, Wang G, Chen Z, Yuan L, Zhou T, Tan H. Dual-tissue transplantation versus osteochondral autograft transplantation in the treatment of osteochondral defects: a porcine model study. J Orthop Surg Res 2023; 18:481. [PMID: 37403163 DOI: 10.1186/s13018-023-03964-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Osteochondral injury is a common sports injury, and hyaline cartilage does not regenerate spontaneously when injured. However, there is currently no gold standard for treating osteochondral defects. Osteochondral autograft transplantation (OAT) is widely used in clinical practice and is best used to treat small osteochondral lesions in the knee that are < 2 cm2 in size. Autologous dual-tissue transplantation (ADTT) is a promising method with wider indications for osteochondral injuries; however, ADTT has not been evaluated in many studies. This study aimed to compare the radiographic and histological results of ADTT and OAT for treating osteochondral defects in a porcine model. METHODS Osteochondral defects were made in the bilateral medial condyles of the knees of 12 Dian-nan small-ear pigs. The 24 knees were divided into the ADTT group (n = 8), OAT group (n = 8), and empty control group (n = 8). At 2 and 4 months postoperatively, the knees underwent gross evaluation based on the International Cartilage Repair Society (ICRS) score, radiographic assessment based on CT findings and the magnetic resonance observation of cartilage repair tissue (MOCART) score, and histological evaluation based on the O'Driscoll histological score of the repair tissue. RESULTS At 2 months postoperatively, the ICRS score, CT evaluation, MOCART score, and O'Driscoll histological score were significantly better in the OAT group than the ADTT group (all P < 0.05). At 4 months postoperatively, the ICRS score, CT evaluation, MOCART score, and O'Driscoll histological score tended to be better in the OAT group than the ADTT group, but these differences did not reach statistical significance (all P > 0.05). CONCLUSIONS In a porcine model, ADTT and OAT are both effective treatments for osteochondral defects in weight bearing areas. ADTT may be useful as an alternative procedure to OAT for treating osteochondral defects.
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Affiliation(s)
- Rongmao Shi
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Gang Wang
- Department of Orthopaedic Surgery, Xiangzhou Distract People's Hospital, Xiangyang City, Hubei Province, China
| | - Zhian Chen
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Libo Yuan
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Tianhua Zhou
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Hongbo Tan
- Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China.
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5
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Leite CBG, Tavares LP, Leite MS, Demange MK. Revisiting the role of hyperbaric oxygen therapy in knee injuries: Potential benefits and mechanisms. J Cell Physiol 2023; 238:498-512. [PMID: 36649313 DOI: 10.1002/jcp.30947] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
Knee injury negatively impacts routine activities and quality of life of millions of people every year. Disruption of tendons, ligaments, and articular cartilage are major causes of knee lesions, leading to social and economic losses. Besides the attempts for an optimal recovery of knee function after surgery, the joint healing process is not always adequate given the nature of intra-articular environment. Based on that, different therapeutic methods attempt to improve healing capacity. Hyperbaric oxygen therapy (HBOT) is an innovative biophysical approach that can be used as an adjuvant treatment post-knee surgery, to potentially prevent chronic disorders that commonly follows knee injuries. Given the well-recognized role of HBOT in improving wound healing, further research is necessary to clarify the benefits of HBOT in damaged musculoskeletal tissues, especially knee disorders. Here, we review important mechanisms of action for HBOT-induced healing including the induction of angiogenesis, modulation of inflammation and extracellular matrix components, and activation of parenchyma cells-key events to restore knee function after injury. This review discusses the basic science of the healing process in knee injuries, the role of oxygen during cicatrization, and shed light on the promising actions of HBOT in treating knee disorders, such as tendon, ligament, and cartilage injuries.
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Affiliation(s)
- Chilan B G Leite
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Orthopedic Surgery, Center for Cartilage Repair and Sports Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Luciana P Tavares
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Magno S Leite
- Laboratório de Poluição Atmosférica Experimental LIM05, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Marco K Demange
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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6
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Tolabi H, Davari N, Khajehmohammadi M, Malektaj H, Nazemi K, Vahedi S, Ghalandari B, Reis RL, Ghorbani F, Oliveira JM. Progress of Microfluidic Hydrogel-Based Scaffolds and Organ-on-Chips for the Cartilage Tissue Engineering. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023:e2208852. [PMID: 36633376 DOI: 10.1002/adma.202208852] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/09/2022] [Indexed: 05/09/2023]
Abstract
Cartilage degeneration is among the fundamental reasons behind disability and pain across the globe. Numerous approaches have been employed to treat cartilage diseases. Nevertheless, none have shown acceptable outcomes in the long run. In this regard, the convergence of tissue engineering and microfabrication principles can allow developing more advanced microfluidic technologies, thus offering attractive alternatives to current treatments and traditional constructs used in tissue engineering applications. Herein, the current developments involving microfluidic hydrogel-based scaffolds, promising structures for cartilage regeneration, ranging from hydrogels with microfluidic channels to hydrogels prepared by the microfluidic devices, that enable therapeutic delivery of cells, drugs, and growth factors, as well as cartilage-related organ-on-chips are reviewed. Thereafter, cartilage anatomy and types of damages, and present treatment options are briefly overviewed. Various hydrogels are introduced, and the advantages of microfluidic hydrogel-based scaffolds over traditional hydrogels are thoroughly discussed. Furthermore, available technologies for fabricating microfluidic hydrogel-based scaffolds and microfluidic chips are presented. The preclinical and clinical applications of microfluidic hydrogel-based scaffolds in cartilage regeneration and the development of cartilage-related microfluidic chips over time are further explained. The current developments, recent key challenges, and attractive prospects that should be considered so as to develop microfluidic systems in cartilage repair are highlighted.
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Affiliation(s)
- Hamidreza Tolabi
- New Technologies Research Center (NTRC), Amirkabir University of Technology, Tehran, 15875-4413, Iran
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, 15875-4413, Iran
| | - Niyousha Davari
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, 143951561, Iran
| | - Mehran Khajehmohammadi
- Department of Mechanical Engineering, Faculty of Engineering, Yazd University, Yazd, 89195-741, Iran
- Medical Nanotechnology and Tissue Engineering Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, 8916877391, Iran
| | - Haniyeh Malektaj
- Department of Materials and Production, Aalborg University, Fibigerstraede 16, Aalborg, 9220, Denmark
| | - Katayoun Nazemi
- Drug Delivery, Disposition and Dynamics Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, 3052, Australia
| | - Samaneh Vahedi
- Department of Material Science and Engineering, Faculty of Engineering, Imam Khomeini International University, Qazvin, 34149-16818, Iran
| | - Behafarid Ghalandari
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Rui L Reis
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, 4805-017, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, 4805-017, Portugal
| | - Farnaz Ghorbani
- Institute of Biomaterials, University of Erlangen-Nuremberg, Cauerstrasse 6, 91058, Erlangen, Germany
| | - Joaquim Miguel Oliveira
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, 4805-017, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, 4805-017, Portugal
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Alcaide-Ruggiero L, Molina-Hernández V, Morgaz J, Fernández-Sarmiento JA, Granados MM, Navarrete-Calvo R, Pérez J, Quirós-Carmona S, Carrillo JM, Cugat R, Domínguez JM. Particulate cartilage and platelet-rich plasma treatment for knee chondral defects in sheep. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-022-07295-7. [PMID: 36598512 DOI: 10.1007/s00167-022-07295-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Articular cartilage is vulnerable to multiple types of damage and it has limited reparative and regenerative capacities due to its absence of vascularity. Although a large number of therapeutic strategies exist to treat chondral defects, they have some limitations, such as fibrocartilage formation. Therefore, the goal of the present study was to evaluate the chondrogenic regenerative properties of an autologous-made matrix of particulated cartilage and platelet-rich plasma (PACI + PRP) implantation for the treatment of full-thickness chondral defects in sheep. METHODS A full-thickness 8 mm diameter cartilage defect was created in the weight-bearing area of the medial femoral condyle in both knees of 16 sheep. The right knees of all animals were treated with particulated autograft cartilage implantation and platelet-rich plasma, while the left knees were injected with Ringer's lactate solution or hyaluronic acid. The sheep were killed 9 or 18 months after surgery. Macroscopic evaluations were performed using three different scoring systems, and histopathological evaluations were performed using a modified scoring system based on different scoring systems. RESULTS The PACI + PRP groups showed statistically significant differences in the percentage of defect repair and chondrocytes in the newly formed cartilage tissue at 18 months compared to 9 months. CONCLUSIONS The results suggest that macroscopic appearance, histological structure and chondrocyte repair were improved when using PACI + PRP treatment for chondral defects, producing an outcome similar to the surrounding healthy cartilage. PACI + PRP is a totally autologous, easy, and unexpensive treatment that can be performed in one-step procedure and is useful as a therapeutic option for knee chondral defects.
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Affiliation(s)
- Lourdes Alcaide-Ruggiero
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain.,Fundación García Cugat para Investigación Biomédica, Barcelona, Spain
| | - Verónica Molina-Hernández
- Departamento de Anatomía y Anatomía Patológica Comparadas y Toxicología. UIC Zoonosis y Enfermedades Emergentes ENZOEM, Universidad de Córdoba, Córdoba, Spain.
| | - Juan Morgaz
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | | | - María M Granados
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - Rocío Navarrete-Calvo
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - José Pérez
- Departamento de Anatomía y Anatomía Patológica Comparadas y Toxicología. UIC Zoonosis y Enfermedades Emergentes ENZOEM, Universidad de Córdoba, Córdoba, Spain
| | - Setefilla Quirós-Carmona
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - José M Carrillo
- Fundación García Cugat para Investigación Biomédica, Barcelona, Spain.,Departamento de Medicina y Cirugía Animal, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Ramón Cugat
- Fundación García Cugat para Investigación Biomédica, Barcelona, Spain.,Instituto Cugat y Mutualidad de Futbolistas Españoles, Delegación Catalana, Barcelona, Spain
| | - Juan M Domínguez
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain.,Fundación García Cugat para Investigación Biomédica, Barcelona, Spain
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8
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Han S, Yim HW, Jeong H, Choi S, Han S. Establishing Rationale for the Clinical Development of Cell Therapy Products: Consensus between Risk and Benefit. Int J Stem Cells 2022; 16:16-26. [PMID: 36581365 PMCID: PMC9978837 DOI: 10.15283/ijsc21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 12/31/2022] Open
Abstract
Despite long-term research achievements, the development of cell therapy (CT) products remains challenging. This is because the risks experienced by the subject and therapeutic effects in the clinical trial stage are unclear due to the various uncertainties of CT when administered to humans. Nevertheless, as autologous cell products for systemic administration have recently been approved for marketing, CT product development is accelerating, particularly in the field of unmet medical needs. The human experience of CT remains insufficient compared with other classes of pharmaceuticals, while there are countless products for clinical development. Therefore, for many sponsors, understanding the rationale of human application of an investigational product based on the consensus and improving the ability to apply it appropriately for CT are necessary. Thus, defining the level of evidence for safety and efficacy fundamentally required for initiating the clinical development and preparing it using a reliable method for CT. Furthermore, the expertise should be strengthened in the design of the first-in-human trial, such as the starting dose and dose-escalation plan, based on a sufficiently acceptable rationale. Cultivating development professionals with these skills will increase the opportunity for more candidates to enter the clinical development phase.
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Affiliation(s)
- Seunghoon Han
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea,Department of Clinical Pharmacology and Therapeutics, The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea,Correspondence to Seunghoon Han, Department of Pharmacology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea, Tel: +82-2-2258-7326, Fax: +82-2-2258-7330, E-mail:
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suein Choi
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea,Department of Clinical Pharmacology and Therapeutics, The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea
| | - Sungpil Han
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, Korea,Department of Clinical Pharmacology and Therapeutics, The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea
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9
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Three-dimensional scaffolds for tissue bioengineering cartilages. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Filardo G, Andriolo L, Angele P, Berruto M, Brittberg M, Condello V, Chubinskaya S, de Girolamo L, Di Martino A, Di Matteo B, Gille J, Gobbi A, Lattermann C, Nakamura N, Nehrer S, Peretti GM, Shabshin N, Verdonk P, Zaslav K, Kon E. Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. A Consensus Statement. Cartilage 2021; 13:1036S-1046S. [PMID: 31941355 PMCID: PMC8808892 DOI: 10.1177/1947603519894729] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To develop patient-focused consensus guidelines on the indications for the use of scaffolds to address chondral and osteochondral femoral condyle lesions. DESIGN The RAND/UCLA Appropriateness Method (RAM) was used to develop patient-specific recommendations by combining the best available scientific evidence with the collective judgement of a panel of experts guided by a core panel and multidisciplinary discussers. A list of specific clinical scenarios was produced regarding adult patients with symptomatic lesions without instability, malalignment, or meniscal deficiency. Each scenario underwent discussion and a 2-round vote on a 9-point Likert-type scale (range 1-3 "inappropriate," 4-6 "uncertain," 7-9 "appropriate"). Scores were pooled to generate expert recommendations. RESULTS Scaffold (chondral vs. osteochondral), patient characteristics (age and sport activity level), and lesion characteristics (etiology, size, and the presence of osteoarthritis [OA]) were considered to define 144 scenarios. The use of scaffold-based procedures was considered appropriate in all cases of chondral or osteochondral lesions when joints are not affected by OA, while OA joints presented more controversial results. The analysis of the evaluated factors showed a different weight in influencing treatment appropriateness: the presence of OA influenced 58.3% of the indications, while etiology, size, and age were discriminating factors in 54.2%, 29.2%, and 16.7% of recommendations, respectively. CONCLUSIONS The consensus identified indications still requiring investigation, but also the convergence of the experts in several scenarios defined appropriate or inappropriate, which could support decision making in the daily clinical practice, guiding the use of scaffold-based procedures for the treatment of chondral and osteochondral knee defects.
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Affiliation(s)
- Giuseppe Filardo
- Applied and Translational Research (ATR)
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Luca Andriolo, Clinica Ortopedica e
Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10,
Bologna 40136, Italy.
| | - Peter Angele
- Clinic for Trauma and Reconstructive
Surgery, University Hospital Regensburg, Regensburg, Bayern, Germany,Sporthopaedicum Regensburg, Regensburg,
Germany
| | - Massimo Berruto
- UOS Knee SURGERY-1st University Clinic
of Orthopaedics, ASST Pini-CTO, Milan, Italy
| | - Mats Brittberg
- Cartilage Research Unit, University of
Gothenburg, Gothenburg, Sweden,Region Halland Orthopaedics, Kungsbacka
Hospital, Kungsbacka, Sweden
| | - Vincenzo Condello
- Joint Preservation and Reconstructive
Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Lombardy,
Italy
| | - Susan Chubinskaya
- Department of Pediatrics, Orthopedic
Surgery & Medicine (Section of Rheumatology), Rush University Medical Center,
Chicago, IL, USA
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory,
IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Berardo Di Matteo
- Department of Biomedical Sciences,
Humanitas University, Rozzano, Milan, Italy,Humanitas Clinical and Research
Center- IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Justus Gille
- Department of Trauma and Orthopaedic
Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck,
Germany
| | - Alberto Gobbi
- Orthopaedic Arthroscopic Surgery
International (OASI) Bioresearch Foundation, Milan, Italy
| | - Christian Lattermann
- Department of Orthopaedic Surgery,
Division of Sports Medicine, Center for Cartilage Repair, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, USA
| | - Norimasa Nakamura
- Institute for Medical Science in
Sports, Osaka Health Science University, Osaka, Japan
| | - Stefan Nehrer
- Center for Regenerative Medicine,
Danube University, Krems an der Donau, Austria
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi,
Milan, Italy,Department of Biomedical Sciences for
Health, University of Milan, Milan, Italy
| | - Nogah Shabshin
- Department of Radiology, Emek Medical
Center, Clalit Healthcare Services, Afula, Israel,Department of Radiology, PennMedicine,
Philadelphia, PA, USA
| | - Peter Verdonk
- ORTHOCA, AZ Monica Hospitals, Antwerp,
Belgium,Aspetar Hospital, Doha, Qatar
| | - Kenneth Zaslav
- Ortho Virginia, Virginia Commonwealth
University, Richmond, VA, USA
| | - Elizaveta Kon
- Department of Biomedical Sciences,
Humanitas University, Rozzano, Milan, Italy,Humanitas Clinical and Research
Center- IRCCS, Via Manzoni 56, 20089, Rozzano - Milan, Italy,Department of Traumatology,
Orthopedics and Disaster Surgery, First Moscow State Medical University of the
Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian
Federation
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11
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Vaish A, Shanmugasundaram S, Kim SA, Lee DH, Shetty AA, Kim SJ. Biological reconstruction of the joint: Concepts of articular cartilage regeneration and their scientific basis. J Clin Orthop Trauma 2021; 24:101718. [PMID: 34926150 PMCID: PMC8645445 DOI: 10.1016/j.jcot.2021.101718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
Articular cartilage injuries are common. The diagnosis of these injuries is often delayed and may lead to early osteoarthritis. Treatment depends on many factors but mainly on the stage and size of the lesion. The anatomy of articular cartilage is complex, and it is an avascular, aneural, and alymphatic structure. Recently, more emphasis is laid on its anatomy and biomechanics to understand the regeneration process of articular cartilage.
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Affiliation(s)
- Abhishek Vaish
- Department of Orthopedics, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Seon Ae Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Hwan Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Asode Ananthram Shetty
- Canterbury Christ Church University, Faculty of Health and Social Sciences, Chatham Maritime, Kent, United Kingdom
| | - Seok Jung Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,Corresponding author.
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12
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Donahue RP, Nordberg RC, Bielajew BJ, Hu JC, Athanasiou KA. The effect of neonatal, juvenile, and adult donors on rejuvenated neocartilage functional properties. Tissue Eng Part A 2021; 28:383-393. [PMID: 34605665 PMCID: PMC9131355 DOI: 10.1089/ten.tea.2021.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Cartilage does not naturally heal, and cartilage lesions from trauma and wear-and-tear can lead to eventual osteoarthritis. To address long-term repair, tissue engineering of functional biologic implants to treat cartilage lesions is desirable, but the development of such implants is hindered by several limitations including 1) donor tissue scarcity due to the presence of diseased tissues in joints, 2) dedifferentiation of chondrocytes during expansion, and 3) differences in functional output of cells dependent on donor age. Toward overcoming these challenges, 1) costal cartilage has been explored as a donor tissue, and 2) methods have been developed to rejuvenate the chondrogenic phenotype of passaged chondrocytes for generating self-assembled neocartilage. However, it remains unclear how the rejuvenation processes are influenced by donor age, and, thus, how to develop strategies that specifically target age-related differences. Using histological, biochemical, proteomic, and mechanical assays, this study sought to determine the differences among neocartilage generated from neonatal, juvenile, and adult donors using the Yucatan minipig, a clinically relevant large animal model. Based on the literature, a relatively young adult population of animals was chosen due to a reduction in functional output of human articular chondrocytes after 40 years of age. After isolation, costal chondrocytes were expanded, rejuvenated, and self-assembled, and the neocartilages were assessed. The aggregate modulus values of neonatal constructs were at least 1.65-fold of those from the juvenile or adult constructs. Poisson's ratio also significantly differed among all groups, with neonatal constructs exhibiting values 49% higher than adult constructs. Surprisingly, other functional properties such as tensile modulus and GAG content did not significantly differ among groups. Total collagen content was slightly elevated in the adult constructs when compared to neonatal and juvenile constructs. A more nuanced view via bottom-up mass spectrometry showed that Col2a1 protein was not significantly different among groups, but content of several other collagen subtypes (i.e., Col1a1, Col9a1, Col11a2, and Col12a1) was modulated by donor age. For example, Col12a1 in adult constructs was found to be 102.9% higher than neonatal-derived constructs. Despite these differences, this study shows that different aged donors can be used to generate neocartilages of similar functional properties.
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Affiliation(s)
- Ryan P Donahue
- University of California, Irvine, Biomedical Engineering, Irvine, California, United States;
| | - Rachel C Nordberg
- University of California, Irvine, Biomedical Engineering, Irvine, California, United States;
| | - Benjamin J Bielajew
- University of California, Irvine, Biomedical Engineering, Irvine, California, United States;
| | - Jerry C Hu
- University of California, Irvine, Biomedical Engineering, Irvine, California, United States;
| | - Kyriacos A Athanasiou
- University of California, Irvine, Biomedical Engineering, Irvine, California, United States;
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13
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Kwon H, Brown WE, O'Leary SA, Hu JC, Athanasiou KA. Rejuvenation of extensively passaged human chondrocytes to engineer functional articular cartilage. Biofabrication 2021; 13. [PMID: 33418542 DOI: 10.1088/1758-5090/abd9d9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/08/2021] [Indexed: 11/11/2022]
Abstract
Human articular chondrocytes (hACs) are scarce and lose their chondrogenic potential during monolayer passaging, impeding their therapeutic use. This study investigated i) the translatability of conservative chondrogenic passaging and aggregate rejuvenation on restoring chondrogenic properties of hACs passaged up to P9; and ii) the efficacy of a combined treatment of TGF-β1 (T), chondroitinase-ABC (C), and lysyl oxidase-like 2 (L), collectively termed TCL, on engineering functional human neocartilage via the self-assembling process, as a function of passage number up to P11. Here, we show that aggregate rejuvenation enhanced glycosaminoglycan (GAG) content and type II collagen staining at all passages and yielded human neocartilage with chondrogenic phenotype present up to P7. Addition of TCL extended the chondrogenic phenotype to P11 and significantly enhanced GAG content and type II collagen staining at all passages. Human neocartilage derived from high passages, treated with TCL, displayed mechanical properties that were on par with or greater than those derived from low passages. Conservative chondrogenic passaging and aggregate rejuvenation may be a viable new strategy 1) to address the perennial problem of chondrocyte scarcity and 2) to successfully rejuvenate the chondrogenic phenotype of extensively passaged cells (up to P11). Furthermore, tissue engineering human neocartilage via self-assembly in conjunction with TCL treatment advances the clinical use of extensively passaged human chondrocytes for cartilage repair.
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Affiliation(s)
- Heenam Kwon
- Biomedical Engineering, University of California Irvine, University of California Irvine, Irvine, California, 92697, UNITED STATES
| | - Wendy E Brown
- Biomedical Engineering, University of California Irvine, University of California Irvine, Irvine, California, 92697, UNITED STATES
| | - Siobhan A O'Leary
- Align Technology Inc, 2820 Orchard Pkwy, San Jose, California, 95134, UNITED STATES
| | - Jerry C Hu
- University of California Irvine, University of California Irvine, Irvine, California, 92697, UNITED STATES
| | - Kyriacos A Athanasiou
- Biomedical Engineering, University of California Irvine, University of California Irvine, Irvine, California, 92697, UNITED STATES
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14
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Wasyłeczko M, Sikorska W, Chwojnowski A. Review of Synthetic and Hybrid Scaffolds in Cartilage Tissue Engineering. MEMBRANES 2020; 10:E348. [PMID: 33212901 PMCID: PMC7698415 DOI: 10.3390/membranes10110348] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
Cartilage tissue is under extensive investigation in tissue engineering and regenerative medicine studies because of its limited regenerative potential. Currently, many scaffolds are undergoing scientific and clinical research. A key for appropriate scaffolding is the assurance of a temporary cellular environment that allows the cells to function as in native tissue. These scaffolds should meet the relevant requirements, including appropriate architecture and physicochemical and biological properties. This is necessary for proper cell growth, which is associated with the adequate regeneration of cartilage. This paper presents a review of the development of scaffolds from synthetic polymers and hybrid materials employed for the engineering of cartilage tissue and regenerative medicine. Initially, general information on articular cartilage and an overview of the clinical strategies for the treatment of cartilage defects are presented. Then, the requirements for scaffolds in regenerative medicine, materials intended for membranes, and methods for obtaining them are briefly described. We also describe the hybrid materials that combine the advantages of both synthetic and natural polymers, which provide better properties for the scaffold. The last part of the article is focused on scaffolds in cartilage tissue engineering that have been confirmed by undergoing preclinical and clinical tests.
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Affiliation(s)
- Monika Wasyłeczko
- Nałęcz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 str., 02-109 Warsaw, Poland; (W.S.); (A.C.)
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15
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Abstract
The pace of advances in the world of science have created new opportunities and insights that give us new and more understanding of our nature and environment. Among the different fields of science, new medical sciences have drawn a great deal of attention among medical science researchers and the society. The hope for finding treatments for incurable diseases and further improvement of man's health is growing thanks to new medical technologies. Among the novel medical fields that have been extensively covered by medical and academic societies are cell therapy and gene therapy that are categorized under regenerative medicine. The present paper is an attempt to introduce the prospect of a curative cell-based therapy and new cellular and gene therapy drugs that have been recently approved by FDA (food and drug administration). Cellular and gene therapy are two very close fields of regenerative medicine and sciences which their targets and applications can be discussed together. What adds to the importance of this new field of science is the possibility to translate the hope for treatment of incurable diseases into actual treatments. What follows delves deeper into this new field of science and the drugs.
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Affiliation(s)
- Ali Golchin
- Student Research Committee, Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Tahereh Zarnoosheh Farahany
- Department of Biology, School of Advanced Technologies in Medicine, Islamic Azad University Medical Branch of Tehran, Tehran, Iran
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16
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Scognamiglio F, Travan A, Borgogna M, Donati I, Marsich E. Development of biodegradable membranes for the delivery of a bioactive chitosan‐derivative on cartilage defects: A preliminary investigation. J Biomed Mater Res A 2020; 108:1534-1545. [DOI: 10.1002/jbm.a.36924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Francesca Scognamiglio
- Department of Life SciencesUniversity of Trieste Trieste Italy
- Department of Medical, Surgical and Health SciencesUniversity of Trieste Trieste Italy
| | | | | | - Ivan Donati
- Department of Life SciencesUniversity of Trieste Trieste Italy
| | - Eleonora Marsich
- Department of Medical, Surgical and Health SciencesUniversity of Trieste Trieste Italy
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17
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Casanova MR, Reis RL, Martins A, Neves NM. Fibronectin Bound to a Fibrous Substrate Has Chondrogenic Induction Properties. Biomacromolecules 2020; 21:1368-1378. [DOI: 10.1021/acs.biomac.9b01546] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Marta R. Casanova
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark—Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Rui L. Reis
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark—Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, 4805-017 Guimarães, Portugal
| | - Albino Martins
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark—Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Nuno M. Neves
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark—Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, 4805-017 Guimarães, Portugal
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18
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Bozkurt M, Aşık MD, Gürsoy S, Türk M, Karahan S, Gümüşkaya B, Akkaya M, Şimşek ME, Cay N, Doğan M. Autologous stem cell-derived chondrocyte implantation with bio-targeted microspheres for the treatment of osteochondral defects. J Orthop Surg Res 2019; 14:394. [PMID: 31779662 PMCID: PMC6883666 DOI: 10.1186/s13018-019-1434-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Chondral injury is a common problem around the world. Currently, there are several treatment strategies for these types of injuries. The possible complications and problems associated with conventional techniques lead us to investigate a minimally invasive and biotechnological alternative treatment. Combining tissue-engineering and microencapsulation technologies provide new direction for the development of biotechnological solutions. The aim of this study is to develop a minimal invasive tissue-engineering approach, using bio-targeted microspheres including autologous cells, for the treatment of the cartilage lesions. METHOD In this study, a total of 28 sheeps of Akkaraman breed were randomly assigned to one of the following groups: control (group 1), microfracture (group 2), scaffold (group 3), and microsphere (group 4). Microspheres and scaffold group animals underwent adipose tissue collection prior to the treatment surgery. Mesenchymal cells collected from adipose tissue were differentiated into chondrocytes and encapsulated with scaffolds and microspheres. Osteochondral damage was conducted in the right knee joint of the sheep to create an animal model and all animals treated according to study groups. RESULTS Both macroscopic and radiologic examination showed that groups 3 and 4 have resulted better compared to the control and microfracture groups. Moreover, histologic assessments indicate hyaline-like cartilage formations in groups 3 and 4. CONCLUSION In conclusion, we believe that the bio-targeted microspheres can be a more effective, easier, and safer approach for cartilage tissue engineering compared to previous alternatives.
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Affiliation(s)
- Murat Bozkurt
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey.
| | - Mehmet Doğan Aşık
- Department of Medical Biology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Safa Gürsoy
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Mustafa Türk
- Deparment Of Bioengineering, Faculty of Engineering, Kırıkkale University, 72450, Kırıkkale, Turkey
| | - Siyami Karahan
- Deparment of Histology and Embryology, Faculty of Vetarinary Medicine, Kırıkkale University, 72450, Kırıkkale, Turkey
| | - Berrak Gümüşkaya
- Department of Pathology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Mehmet Emin Şimşek
- Department of Orthopedics and Traumatology, Ankara Yenimahalle Research and Training Hospital, 06800, Ankara, Turkey
| | - Nurdan Cay
- Deparment of Radiology, School of Medicine, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Metin Doğan
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
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19
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Kwon H, Brown WE, Lee CA, Wang D, Paschos N, Hu JC, Athanasiou KA. Surgical and tissue engineering strategies for articular cartilage and meniscus repair. Nat Rev Rheumatol 2019; 15:550-570. [PMID: 31296933 PMCID: PMC7192556 DOI: 10.1038/s41584-019-0255-1] [Citation(s) in RCA: 361] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/30/2022]
Abstract
Injuries to articular cartilage and menisci can lead to cartilage degeneration that ultimately results in arthritis. Different forms of arthritis affect ~50 million people in the USA alone, and it is therefore crucial to identify methods that will halt or slow the progression to arthritis, starting with the initiating events of cartilage and meniscus defects. The surgical approaches in current use have a limited capacity for tissue regeneration and yield only short-term relief of symptoms. Tissue engineering approaches are emerging as alternatives to current surgical methods for cartilage and meniscus repair. Several cell-based and tissue-engineered products are currently in clinical trials for cartilage lesions and meniscal tears, opening new avenues for cartilage and meniscus regeneration. This Review provides a summary of surgical techniques, including tissue-engineered products, that are currently in clinical use, as well as a discussion of state-of-the-art tissue engineering strategies and technologies that are being developed for use in articular cartilage and meniscus repair and regeneration. The obstacles to clinical translation of these strategies are also included to inform the development of innovative tissue engineering approaches.
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Affiliation(s)
- Heenam Kwon
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Cassandra A Lee
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Nikolaos Paschos
- Division of Sports Medicine, Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
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20
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Editorial Commentary: Can We Really See the Calcified Cartilage Layer When Debriding Focal Cartilage Defects? Arthroscopy 2018; 34:2189-2190. [PMID: 29976435 DOI: 10.1016/j.arthro.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 02/02/2023]
Abstract
Cell-based cartilage restoration techniques have made huge leaps in recent years; however, many hurdles still lay ahead, one of which is the fundamental task of preparing the cartilage lesion site. Although it is one of the first skills an arthroscopist learns during training, it seems that current techniques and instrumentation still yield inconsistent results, which can hinder patient outcomes.
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21
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Pereira DR, Reis RL, Oliveira JM. Layered Scaffolds for Osteochondral Tissue Engineering. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1058:193-218. [DOI: 10.1007/978-3-319-76711-6_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Vascular Endothelial Growth Factor Sequestration Enhances In Vivo Cartilage Formation. Int J Mol Sci 2017; 18:ijms18112478. [PMID: 29160845 PMCID: PMC5713444 DOI: 10.3390/ijms18112478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/01/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022] Open
Abstract
Autologous chondrocyte transplantation for cartilage repair still has unsatisfactory clinical outcomes because of inter-donor variability and poor cartilage quality formation. Re-differentiation of monolayer-expanded human chondrocytes is not easy in the absence of potent morphogens. The Vascular Endothelial Growth Factor (VEGF) plays a master role in angiogenesis and in negatively regulating cartilage growth by stimulating vascular invasion and ossification. Therefore, we hypothesized that its sole microenvironmental blockade by either VEGF sequestration by soluble VEGF receptor-2 (Flk-1) or by antiangiogenic hyperbranched peptides could improve chondrogenesis of expanded human nasal chondrocytes (NC) freshly seeded on collagen scaffolds. Chondrogenesis of several NC donors was assessed either in vitro or ectopically in nude mice. VEGF blockade appeared not to affect NC in vitro differentiation, whereas it efficiently inhibited blood vessel ingrowth in vivo. After 8 weeks, in vivo glycosaminoglycan deposition was approximately two-fold higher when antiangiogenic approaches were used, as compared to the control group. Our data indicates that the inhibition of VEGF signaling, independently of the specific implementation mode, has profound effects on in vivo NC chondrogenesis, even in the absence of chondroinductive signals during prior culture or at the implantation site.
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23
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Bauer C, Jeyakumar V, Niculescu-Morzsa E, Kern D, Nehrer S. Hyaluronan thiomer gel/matrix mediated healing of articular cartilage defects in New Zealand White rabbits-a pilot study. J Exp Orthop 2017; 4:14. [PMID: 28470629 PMCID: PMC5415448 DOI: 10.1186/s40634-017-0089-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Articular cartilage defects are limited to their regenerative potential in human adults. Our current study evaluates tissue regeneration in a surgically induced empty defect site with hyaluronan thiomer as a provisional scaffold in a gel/matrix combination without cells on rabbit models to restore tissue formation. Methods An osteochondral defect of 4 mm in diameter and 5 mm in depth was induced by mechanical drilling in the femoral center of the trochlea in 18 New Zealand White rabbits. Previously evaluated from an in vitro study hyaluronan thiomer matrix, and a hyaluronan thiomer gel was used to treat the defect. As a control, the defect was left untreated. During the whole study, rabbits were clinically examined and after 4 (n = 3) or 12 (n = 3) weeks, the rabbits were sacrificed. Joints were evaluated macroscopically (Brittberg score) and by histology (O’Driscoll score). Synovial cells from the synovial fluid smear were histopathologically evaluated. Results The healing of the defects varied intra-group wise at the first observation period. After 12 weeks the results concerning the cartilage repair score were inhomogeneous within each group, while the macroscopic analysis was more homogenous. In the synovial fluid smear, the mean score of infiltrated synovial and non-synovial cells was slightly increased after 4 weeks and slightly decreased after 12 weeks in both the treatment groups in comparison to the untreated control. Conclusions Taken together with results from the in vivo study indicated that implantation of hyaluronan thiomer as a combination of gel and matrix might enhance articular cartilage regeneration in an empty defect. Despite their benefits, the intrinsic healing capacity of New Zealand rabbits is a limitation for comparative test subject in pre-clinical models of cartilage defects.
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Affiliation(s)
- Christoph Bauer
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube-University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, Austria.
| | - Vivek Jeyakumar
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube-University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, Austria
| | - Eugenia Niculescu-Morzsa
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube-University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, Austria
| | - Daniela Kern
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube-University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube-University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, Austria
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Vaish A, Vaishya R, Vijay V, Agarwal AK. Practice guidelines for approaching articular cartilage defects of the knee. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bauer C, Berger M, Baumgartner RR, Höller S, Zwickl H, Niculescu-Morzsa E, Halbwirth F, Nehrer S. A Novel Cross-Linked Hyaluronic Acid Porous Scaffold for Cartilage Repair: An In Vitro Study With Osteoarthritic Chondrocytes. Cartilage 2016; 7:265-73. [PMID: 27375842 PMCID: PMC4918062 DOI: 10.1177/1947603515611949] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE An important feature of biomaterials used in cartilage regeneration is their influence on the establishment and stabilization of a chondrocytic phenotype of embedded cells. The purpose of this study was to examine the effects of a porous 3-dimensional scaffold made of cross-linked hyaluronic acid on the expression and synthesis performance of human articular chondrocytes. MATERIALS AND METHODS Osteoarthritic chondrocytes from 5 patients with a mean age of 74 years were passaged twice and cultured within the cross-linked hyaluronic acid scaffolds for 2 weeks. Analyses were performed at 3 different time points. For estimation of cell content within the scaffold, DNA-content (CyQuant cell proliferation assay) was determined. The expression of chondrocyte-specific genes by embedded cells as well as the total amount of sulfated glycosaminoglycans produced during the culture period was analyzed in order to characterize the synthesis performance and differentiation status of the cells. RESULTS Cells showed a homogenous distribution within the scaffold. DNA quantification revealed a reduction of the cell number. This might be attributed to loss of cells from the scaffold during media exchange connected with a stop in cell proliferation. Indeed, the expression of cartilage-specific genes and the production of sulfated glycosaminoglycans were increased and the differentiation index was clearly improved. CONCLUSIONS These results suggest that the attachment of osteoarthritic P2 chondrocytes to the investigated material enhanced the chondrogenic phenotype as well as promoted the retention.
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Affiliation(s)
- Christoph Bauer
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria,Christoph Bauer, Center for Regenerative Medicine and Orthopedics, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, Krems, 3500, Austria.
| | - Manuela Berger
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | | | | | - Hannes Zwickl
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | - Eugenia Niculescu-Morzsa
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | - Florian Halbwirth
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopedics, Department for Health Sciences and Biomedicine, Danube University, Krems, Austria
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Wylie JD, Hartley MK, Kapron AL, Aoki SK, Maak TG. Failures and Reoperations After Matrix-Assisted Cartilage Repair of the Knee: A Systematic Review. Arthroscopy 2016; 32:386-92. [PMID: 26422710 DOI: 10.1016/j.arthro.2015.07.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/25/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the reported failures and reoperations for the emerging technique of matrix-assisted cartilage repair at short-term and midterm follow-up. METHODS We conducted a systematic review of 3 databases from March 2004 to February 2014 using keywords important for articular cartilage repair. Two authors reviewed the articles, the study exclusion criteria were applied, and articles were determined to be relevant (or not) to the research question. All studies with a minimum of 2 years' clinical follow-up were reviewed for all reported reoperations. The reasons for reoperations were recorded. RESULTS We reviewed 66 articles from the 301 articles identified in the original systematic search. There were 60 articles on matrix-assisted cartilage transplantation and 6 articles on matrix-induced chondrogenesis. The matrix-assisted cartilage transplantation studies reported on a total of 1,380 patients at 2 to 5 years' follow-up. Among these, there were 72 reoperations (5%) including 46 treatment failures (3%). These numbers increased to an 11% reoperation rate and 9% treatment failure rate at minimum 5-year follow-up of 961 patients. The most common procedures performed other than revision cartilage surgery or arthroplasty were manipulation under anesthesia for arthrofibrosis (0.7%) and debridement for graft hypertrophy (1.2%). The matrix-induced chondrogenesis studies reported on 163 patients. Among these, there were 15 reoperations (9%) that included 4 treatment failures (2%), 9 manipulations under anesthesia (6%), and 2 debridements for graft hypertrophy (1%). CONCLUSIONS Treatment failure rates for matrix-assisted cartilage repair increase from short-term to midterm follow-up, with 11% of patients having undergone further surgery at a minimum of 5 years' follow-up. These data can be used to counsel patients on the potential need for further operative intervention after this emerging cartilage repair technique.
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Affiliation(s)
- James D Wylie
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Ashley L Kapron
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
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Gadjanski I, Vunjak-Novakovic G. Challenges in engineering osteochondral tissue grafts with hierarchical structures. Expert Opin Biol Ther 2015; 15:1583-99. [PMID: 26195329 PMCID: PMC4628577 DOI: 10.1517/14712598.2015.1070825] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION A major hurdle in treating osteochondral (OC) defects is the different healing abilities of two types of tissues involved - articular cartilage and subchondral bone. Biomimetic approaches to OC-construct engineering, based on recapitulation of biological principles of tissue development and regeneration, have potential for providing new treatments and advancing fundamental studies of OC tissue repair. AREAS COVERED This review on state of the art in hierarchical OC tissue graft engineering is focused on tissue engineering approaches designed to recapitulate the native milieu of cartilage and bone development. These biomimetic systems are discussed with relevance to bioreactor cultivation of clinically sized, anatomically shaped human cartilage/bone constructs with physiologic stratification and mechanical properties. The utility of engineered OC tissue constructs is evaluated for their use as grafts in regenerative medicine, and as high-fidelity models in biological research. EXPERT OPINION A major challenge in engineering OC tissues is to generate a functionally integrated stratified cartilage-bone structure starting from one single population of mesenchymal cells, while incorporating perfusable vasculature into the bone, and in bone-cartilage interface. To this end, new generations of advanced scaffolds and bioreactors, implementation of mechanical loading regimens and harnessing of inflammatory responses of the host will likely drive the further progress.
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Affiliation(s)
- Ivana Gadjanski
- Belgrade Metropolitan University, Center for Bioengineering – BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia, Tel: +381 64 083 58 62, Fax: +381 11 203 06 28,
| | - Gordana Vunjak-Novakovic
- Laboratory for Stem Cells and Tissue Engineering, Columbia University, 622 west 168th Street, VC12-234, New York NY 10032, USA, tel: +1-212-305-2304, fax: +1-212-305-4692,
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28
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Koushki N, Katbab AA, Tavassoli H, Jahanbakhsh A, Majidi M, Bonakdar S. A new injectable biphasic hydrogel based on partially hydrolyzed polyacrylamide and nanohydroxyapatite as scaffold for osteochondral regeneration. RSC Adv 2015. [DOI: 10.1039/c4ra10890f] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fabrication of an injectable biphasic hydrogel based on partially hydrolyzed polyacrylamide (HPAM), nanocrystalline hydroxyapatite (nHAp), and chromium acetate (Cr(iii)) as a novel scaffold for osteochondral repair has been attempted.
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Affiliation(s)
- Newsha Koushki
- Polymer Engineering and Color Technology Department
- Amirkabir University of Technology
- Tehran
- Iran
- National Cell Bank of Iran
| | - Ali Asghar Katbab
- Polymer Engineering and Color Technology Department
- Amirkabir University of Technology
- Tehran
- Iran
| | | | | | - Mohammad Majidi
- National Cell Bank of Iran
- Pasteur Institute of Iran
- Tehran
- Iran
| | - Shahin Bonakdar
- National Cell Bank of Iran
- Pasteur Institute of Iran
- Tehran
- Iran
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29
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Zhang Z, Zhong X, Ji H, Tang Z, Bai J, Yao M, Hou J, Zheng M, Wood DJ, Sun J, Zhou SF, Liu A. Matrix-induced autologous chondrocyte implantation for the treatment of chondral defects of the knees in Chinese patients. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2439-48. [PMID: 25525334 PMCID: PMC4266264 DOI: 10.2147/dddt.s71356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Articular cartilage injury is the most common type of damage seen in clinical orthopedic practice. The matrix-induced autologous chondrocyte implant (MACI) was developed to repair articular cartilage with an advance on the autologous chondrocyte implant procedure. This study aimed to evaluate whether MACI is a safe and efficacious cartilage repair treatment for patients with knee cartilage lesions. The primary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) domains and magnetic resonance imaging (MRI) results, compared between baseline and postoperative months 3, 6, 12, and 24. A total of 15 patients (20 knees), with an average age of 33.9 years, had a mean defect size of 4.01 cm(2). By 6-month follow-up, KOOS results demonstrated significant improvements in symptoms and knee-related quality of life. MRI showed significant improvements in four individual graft scoring parameters at 24 months postoperatively. At 24 months, 90% of MACI grafts had filled completely and 10% had good-to-excellent filling of the chondral defect. Most (95%) of the MACI grafts were isointense and 5% were slightly hyperintense. Histologic evaluation at 15 and 24 months showed predominantly hyaline cartilage in newly generated tissue. There were no postoperative complications in any patients and no adverse events related to the MACI operation. This 2-year study has confirmed that MACI is safe and effective with the advantages of a simple technique and significant clinical improvements. Further functional and mechanistic studies with longer follow-up are needed to validate the efficacy and safety of MACI in patients with articular cartilage injuries.
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Affiliation(s)
- Zhongwen Zhang
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Xin Zhong
- Department of MRI Center, General Hospital of CAPF, Beijing, People's Republic of China
| | - Huiru Ji
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Zibin Tang
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Jianpeng Bai
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Minmin Yao
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Jianlei Hou
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Minghao Zheng
- Center for Orthopedic Research, School of Surgery and Pathology, University of Western Australia, Perth, Western Australia, Australia
| | - David J Wood
- Center for Orthopedic Research, School of Surgery and Pathology, University of Western Australia, Perth, Western Australia, Australia
| | - Jiazhi Sun
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Shu-Feng Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA ; Guizhou Provincial Key Laboratory for Regenerative Medicine, Stem Cell and Tissue Engineering Research Center and Sino-US Joint Laboratory for Medical Sciences, Guiyang Medical University, Guiyang, Guizhou
| | - Aibing Liu
- Medical Research Center, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing, People's Republic of China
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