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The Effect of Blood-Derived Products on the Chondrogenic and Osteogenic Differentiation Potential of Adipose-Derived Mesenchymal Stem Cells Originated from Three Different Locations. Stem Cells Int 2019; 2019:1358267. [PMID: 32082382 PMCID: PMC7012275 DOI: 10.1155/2019/1358267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background Adipose-derived mesenchymal stem cells (AD-MSCs) from fat tissue considered “surgical waste” during joint surgery may provide a potent source for regenerative medicine. Intra-articular, homologous fat tissue (Hoffa's fat pad, pouch fat) might possess a superior chondrogenic and osteogenic differentiation potential in comparison to extra-articular, nonhomologous fat. Blood products might further enhance this potential. Methods AD-MSCs were isolated from fat tissue of 3 donors from 3 locations each, during total knee replacement. Isolated cells were analyzed via flow cytometry. Cells were supplemented with blood products: two types of platelet-rich plasma (EPRP—PRP prepared in the presence of EDTA; CPRP—PRP prepared in the presence of citrate), hyperacute serum (hypACT), and standard fetal calf serum (FCS) as a positive control. The viability of the cells was determined by XTT assay, and the progress of differentiation was tested via histological staining and monitoring of specific gene expression. Results Blood products enhance ex vivo cell metabolism. Chondrogenesis is enhanced by EDTA-PRP and osteogenesis by citrate PRP, whereas hyperacute serum enhances both differentiations comparably. This finding was consistent in histological analysis as well as in gene expression. Lower blood product concentrations and shorter differentiation periods lead to superior histological results for chondrogenesis. Both PRP types had a different biological effect depending upon concentration, whereas hyperacute serum seemed to have a more consistent effect, independent of the used concentration. Conclusion (i) Blood product preparation method, (ii) type of anticoagulant, (iii) differentiation time, and (iv) blood product concentration have a significant influence on stem cell viability and the differentiation potential, favouring no use of anticoagulation, shorter differentiation time, and lower blood product concentrations. Cell-free blood products like hyperacute serum may be considered as an alternative supplementation in regenerative medicine, especially for stem cell therapies.
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Golab KG, Kashani IR, Azami-Tameh A, Zaminy A, Nik IN, Nik SN. Evaluation of the effect of adipose tissue-derived stem cells on the quality of bone healing around implants. Connect Tissue Res 2015; 57:10-9. [PMID: 26691556 DOI: 10.3109/03008207.2015.1079180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE/AIM This study evaluates the efficacy of grafted adipose-derived stem cells (ADSCs) on blade-type implants in improving osseointegration in rat femurs using a low-density bone model. MATERIALS AND METHODS After isolating and expanding ADSCs, twice-passaged cells were seeded on blade-type implants on culture plates. Osteogenic induction of grafted cells began after attaching cells to the prepared titanium surfaces and it continued for 4 days. The scaffolds were then implanted in the femurs of Wistar rats. Osteogenic differentiation of these cells was confirmed using polymerase chain reaction (PCR) and alizarin red staining of the mineralized extracellular matrix. After 8 weeks, histological and histomorphometric evaluations of undecalcified resin sections (bone-implant contact [BIC] % and bone mineral index [BMI]) were performed using light microscopy and scanning electron microscopy. RESULTS Alizarin red staining in conjunction with gene expression results confirmed osteogenic differentiation. Histomorphometric assessment using scanning electron microscopy demonstrated improved BIC% and BMI near the treated surface compared with the untreated surface. CONCLUSIONS The complex of differentiated grafted ADSCs and extracellular matrix and the macrodesign and microdesign of the implant can improve osseointegration in low-density bone.
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Affiliation(s)
| | - Iraj Ragerdi Kashani
- b Department of Anatomy , School of Medicine, Medical Sciences, University of Tehran , Tehran , Iran
| | - Abolfazl Azami-Tameh
- c Anatomical Sciences Research Center , Kashan University of Medical Sciences , Kashan , Iran
| | - Arash Zaminy
- d Department of Anatomy , School of Medicine, Guilan University of Medical Sciences , Rasht , Iran
| | - Iman Namjoy Nik
- e Faculty of Life Sciences , University of Manchester , Manchester , United Kingdom
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Fukuda K, Kamoshida Y, Kurokawa T, Yoshida M, Fujita-Yamaguchi Y, Nakata M. Migration of breast cancer cells into reconstituted type I collagen gels assessed via a combination of frozen sectioning and azan staining. Biosci Trends 2015; 8:212-6. [PMID: 25224627 DOI: 10.5582/bst.2014.01090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study sought to devise a way to assess the infiltration of cancer cells in model stromal tissues. Human breast carcinoma MDA-MB-231 cells were loaded on the surface of a type I collagen gel in the well of 8-well chamber slide and allowed to migrate into the gel. The gel was then subjected to frozen sectioning and staining. Azan staining facilitated satisfactory microscopic observation of cancer cells migrating into the collagen gel. Cell migration was promoted by the presence of fetal calf serum in the gel. In contrast, the proportion of cells remaining on the gel surface increased in the presence of galardin, a matrix metalloproteinase inhibitor. Moreover, the distance of cell migration from the gel surface was significantly shorter depending on the concentration of galardin. Observation of cancer cell migration into reconstituted type I collagen gel with a combination of frozen sectioning and azan staining is a useful way to assess the ability of individual cancer cells to migrate and to evaluate how effectively pharmaceuticals inhibit the first step of invasion.
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Affiliation(s)
- Kyohei Fukuda
- Department of Applied Biochemistry, Tokai University
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Gassling V, Hedderich J, Açil Y, Purcz N, Wiltfang J, Douglas T. Comparison of platelet rich fibrin and collagen as osteoblast-seeded scaffolds for bone tissue engineering applications. Clin Oral Implants Res 2011; 24:320-8. [PMID: 22092514 DOI: 10.1111/j.1600-0501.2011.02333.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The loss of jaw bone caused by different kinds of pathologies leads to dysfunction and reduced quality of life in affected patients. Thus, the pivotal goal in bone tissue engineering is to reconstruct these defects. The essential precondition for new tissue generation is an extracellular matrix which acts as a scaffold so that cells can migrate, differentiate, and proliferate. Fibrin, a biopolymer responsible for blood clot formation, has been shown to be suitable for tissue engineering applications. The aim of the present study is a comparison of platelet rich fibrin (PRF) with the commonly used collagen membrane BioGide(®) as a scaffold for human osteoblast cell seeding for bone tissue engineering. MATERIAL AND METHODS Human osteoblasts were cultured with eluates from PRF (n = 7) and BioGide(®) (n = 8) membranes incubated in serum-free cell culture medium. Vitality of these cells was assessed by fluorescein diacetate and propidium iodide staining, biocompatibility with the lactate dehydrogenase test and proliferation levels with the MTT ([3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium-bromide]), and BrdU (5-bromo-2-deoxyuridine) tests. In addition, human osteoblasts were seeded on both membrane systems and cell growth was compared by the water soluble tetrazolium (WST-1) (4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate) test and scanning electron microscopy (SEM). Osteoblastic differentiation was assessed by alkaline phosphatase activity measured by ELISA in the supernatant of osteoblasts cultivated on PRF membranes (n = 10), PRF clots (n = 10), and BioGide(®) membranes (n = 10). RESULTS Lactate dehydrogenase test values were higher for PRF compared to BioGide(®) . The BrdU test showed superior cell growth after cultivation in eluate from PRF than in eluate from BioGide(®) . The WST-1 assay demonstrated superior cell proliferation on PRF than on BioGide(®) . SEM revealed osteoblast colonization of both membranes. Cultivation of osteoblasts on PRF membranes and PRF clots showed significantly higher alkaline phosphatase activity than on BioGide(®) membranes. CONCLUSION Metabolic activity and proliferation of human osteoblast cells in vitro were supported to a significant higher extent by eluates from PRF membranes. Both membranes are suitable as scaffolds for cultivation of human osteoblast cells in vitro; proliferation was significant higher on PRF membranes and on PRF clot than on BioGide(®) membranes.
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Affiliation(s)
- Volker Gassling
- Department of Oral and Maxillofacial Surgery, University of Schleswig-Holstein, 24105 Kiel, Germany.
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Sese N, Cole M, Tawil B. Proliferation of Human Keratinocytes and Cocultured Human Keratinocytes and Fibroblasts in Three-Dimensional Fibrin Constructs. Tissue Eng Part A 2011; 17:429-37. [DOI: 10.1089/ten.tea.2010.0113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nadjah Sese
- Baxter Healthcare Corporation, BioSurgery Division, Westlake Village, California
| | - Marietta Cole
- Baxter Healthcare Corporation, BioSurgery Division, Westlake Village, California
| | - Bill Tawil
- Baxter Healthcare Corporation, BioSurgery Division, Westlake Village, California
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Petter-Puchner AH, Simunek M, Redl H, Puchner KU, Griensven MV. A Comparison of a Cyanaocrylate Glue (Glubran) vs. Fibrin Sealant (Tisseel) in Experimental Models of Partial Pulmonary Resection and Lung Incison in Rabbits. J INVEST SURG 2010; 23:40-7. [DOI: 10.3109/08941930903469383] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hankemeier S, Hurschler C, Zeichen J, van Griensven M, Miller B, Meller R, Ezechieli M, Krettek C, Jagodzinski M. Bone marrow stromal cells in a liquid fibrin matrix improve the healing process of patellar tendon window defects. Tissue Eng Part A 2009; 15:1019-30. [PMID: 18783321 DOI: 10.1089/ten.tea.2008.0046] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Following injury, ligaments and tendons do not regain their normal biological and biomechanical status. This study analyzed whether an injection of human bone marrow stromal cells (BMSC) or human fibroblast in a liquid fibrin matrix influences the histological results, ultrastructural morphology, mRNA expression of essential extracellular matrix proteins, and material properties of the healing tissue. Standardized full-thickness, full-length defects of the central portion of patellar tendons were created in 96 immunodeficient rats, and filled with human BMSC in a fibrin matrix (BMSC group), human fibroblasts in a fibrin matrix (fibroblast group), or fibrin matrix only (matrix group), or left untreated (defect group). Histological sections revealed more mature tissue formation with more regular patterns of cell distribution in the BMSC group, without signs of ectopic tissue formation into bone or cartilage. Mean collagen fibril diameter and relative area covered by collagen fibrils were significantly higher at 10 and 20 days postoperatively in the BMSC group compared to the defect and matrix groups, and comparable to normal tendon tissue. Further, collagen I mRNA expression, collagen I/collagen III mRNA ratio, and Young's modulus were significantly increased at 20 days postoperatively in comparison to the defect and matrix groups. In the fibroblast group, only mean collagen fibril diameter was significantly higher compared to the defect group, whereas the other biological and biomechanical parameters were not significantly improved. This study reveals that an injection of BMSC in a liquid fibrin matrix stimulates histological, ultrastructural, molecular biologic, and biomechanical parameters of patellar tendon healing, whereas injection of fibroblasts in fibrin matrix had only minor effects on the stimulation of tendon healing.
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Affiliation(s)
- Stefan Hankemeier
- Department of Trauma, Hanover Medical School (MHH), Hanover, Germany.
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Hankemeier S, van Griensven M, Ezechieli M, Barkhausen T, Austin M, Jagodzinski M, Meller R, Bosch U, Krettek C, Zeichen J. Tissue engineering of tendons and ligaments by human bone marrow stromal cells in a liquid fibrin matrix in immunodeficient rats: results of a histologic study. Arch Orthop Trauma Surg 2007; 127:815-21. [PMID: 17569067 DOI: 10.1007/s00402-007-0366-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The original complex structure and mechanical properties are not fully restored after ligament and tendon injuries. Due to their high proliferation rate and differentiation potential, Bone Marrow Stromal Cells (BMSC) are considered to be an ideal cell source for tissue engineering to optimize the healing process. Ideal matrices for tissue engineering of ligaments and tendons should allow for homogenous cell seeding and offer sufficient stability. MATERIAL AND METHODS A mixture of human BMSC and liquid fibrin glue was injected into a standardized full-thickness window defect of the patellar tendon of immunodeficient rats (BMSC group). The histology of the tissue was analysed 10 and 20 days postoperatively and compared to four control groups. These groups consisted of a cohort with a mixture of human fibroblasts and fibrin glue, fibrin glue without cells, a defect group without treatment, and a group with uninjured patellar tendon tissue. RESULTS Tendon defects in the BMSC group revealed dense collagen fibres and spindle-shaped cells, which were mainly orientated along the loading axis. Histologic sections of the control groups, especially of untreated defects and of defects filled with fibrin glue only, showed irregular patterns of cell distribution, irregular formed cell nucleoli and less tissue maturation. Compared to healthy tendon tissue, higher numbers of cells and less intense matrix staining was observed in the BMSC group. No ectopic bone or cartilage formation was observed in any specimen. CONCLUSIONS Injection of human BMSC in a fibrin glue matrix appears to lead to more mature tissue formation with more regular patterns of cell distribution. Advantages of this "in-vivo" tissue engineering approach are a homogenous cell-matrix mixture in a well-known and approved biological matrix, and simple, minimally-invasive application by injection.
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Affiliation(s)
- Stefan Hankemeier
- Trauma Department, Hanover Medical School (MHH), Carl-Neuberg-Str 1, 30625, Hanover, Germany.
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Cornwell KG, Pins GD. Discrete crosslinked fibrin microthread scaffolds for tissue regeneration. J Biomed Mater Res A 2007; 82:104-12. [PMID: 17269139 DOI: 10.1002/jbm.a.31057] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we report on the development of discrete fibrin microthreads as well as novel scaffolds composed of arrays of fibrin threads. These scaffolds exhibit mechanical properties that are significantly greater than fibrin gels and cellular responses suggesting that the materials are conducive to the development of organized, aligned tissues. Fibrin microthreads were produced by coextruding solutions of 70 mg/mL fibrinogen and 6 U/mL thrombin through small diameter polyethylene tubing. Uncrosslinked fibrin microthreads averaged 55-65 microm in hydrated diameter and achieved ultimate tensile strengths approaching 4.5 MPa. The strengths and stiffnesses of the microthreads were approximately twofold greater when the materials were treated with exposure to ultraviolet (UV) light. Although UV crosslinking attenuated fibroblast proliferation, uncrosslinked fibrin microthreads supported fibroblast attachment, proliferation, and alignment, suggesting that they represent a viable biomaterial for the aligned regeneration of tissues. Because of the physiologic roles of fibrin matrices in the early phase of wound healing, we anticipate that these fibrin-based microthreads will direct the spatially and temporally complex processes of cell-mediated tissue ingrowth and regeneration.
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Affiliation(s)
- Kevin G Cornwell
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts 01609, USA
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Osteopontin and bone metabolism in healing cranial defects in rabbits. Int J Oral Maxillofac Surg 2006; 35:1127-32. [PMID: 17014992 DOI: 10.1016/j.ijom.2006.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 04/27/2006] [Accepted: 07/03/2006] [Indexed: 10/24/2022]
Abstract
Non-collagen proteins such as bone sialoprotein and osteopontin (OPN) form 10% of the extracellular bone matrix. In this study, the influence of OPN on bone repair was investigated. Human OPN (Innogenetics) was produced by a recombinant technique and bonded onto the surface of hydroxyapatite (Interpore 200). Thirty rabbits were divided into six equal groups. A circular defect (10mm) was prepared in each parietal bone. In four rabbits of each group the left and right defects were filled with either OPN-coated hydroxyapatite (OPN-HA) or non-coated hydroxyapatite (HA). One sham animal of each group received no implants. The animals were killed after 1, 2, 6, 12, 18 and 30 weeks. The histological sections were scanned and analysed digitally. There were no statistically significant differences in total bone formation between defects filled with OPN-HA and HA. Bone formation at the borders of the healing area was significantly higher in defects filled with OPN-HA than in those filled with HA. Less bone formation was noted in the OPN-HA and HA groups at the centre of the healing area than at the borders of the healing area and the dural area. Although some animals in the sham group showed a high level of bone formation in the dural area, this was not significantly different to that in the dural area of the other groups. There was no sign of infection or tissue rejection of the graft.
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Willers C, Chen J, Wood D, Xu J, Zheng MH. Autologous chondrocyte implantation with collagen bioscaffold for the treatment of osteochondral defects in rabbits. ACTA ACUST UNITED AC 2005; 11:1065-76. [PMID: 16144442 DOI: 10.1089/ten.2005.11.1065] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Osteochondral injury is therapeutically irreversible within current treatment parameters. Autologous chondrocyte implantation (ACI) promises to regenerate hyaline articular cartilage, but conventional ACI is plagued by complications determined by periosteal grafting. Here we propose the utilization of collagen membrane in ACI as an effective bioscaffold for the regeneration of osteochondral lesions. Using a rabbit model of osteochondral injury, we have inoculated autologous chondrocytes onto a type I/III collagen scaffold [so-called matrix-induced ACI (MACI)] and implanted into 3-mm osteochondral knee defects. All untreated defect histology showed inferior fibrocartilage and/or fibrous tissue repair. In our time-course study, ACI with type I/III collagen membrane regenerated cartilage with healthy osteochondral architecture in osteochondral defects at 6 weeks. At 12 weeks, articular cartilage regeneration was maintained, with reduced thickness and proteoglycan compared with the adjacent cartilage. Both 6-week (p < 0.01) and 12-week (p < 0.05) ACI with collagen membrane showed significant improvement as compared with untreated controls. To further examine the efficacy of cartilage regeneration by ACI, we conducted a dose-response study, using chondrocytes at various cell densities between 10(4) and 10(6) cells/cm(2). The results showed that cell density had no effect on outcome histology, but all cell densities were significantly better than untreated controls (p < 0.01) and cell-free collagen membrane treatment (p < 0.05). In short, our data suggest that autologous chondrocyte-seeded type I/III collagen membrane is an effective method for the treatment of focal osteochondral knee injury in rabbits.
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Affiliation(s)
- C Willers
- Unit of Orthopaedics, School of Pathology and Surgery, University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands
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Campbell PG, Miller ED, Fisher GW, Walker LM, Weiss LE. Engineered spatial patterns of FGF-2 immobilized on fibrin direct cell organization. Biomaterials 2005; 26:6762-70. [PMID: 15941581 DOI: 10.1016/j.biomaterials.2005.04.032] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 04/12/2005] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to initiate the exploration of cell behavioral responses to inkjet printed spatial patterns of hormones biologically immobilized on biomimetic substrates. This approach was investigated using the example of preosteoblastic cell response in vitro to fibroblast growth factor-2 (FGF-2) printed on fibrin films. Concentration modulated patterns of FGF-2, including continuous concentration gradients, were created by overprinting dilute FGF-2 bioinks with a custom inkjet printer. The immobilized FGF-2 was biologically active and the printed patterns persisted up to 10 days under cell culture conditions. Cell numbers increased in register to printed patterns from an initial random uniform cell distribution across the patterned and non-patterned fibrin substrate. Patterned immobilized FGF-2, not cell attachment directed cell organization because the fibrin substrate was homogeneous. The capability to engineer arbitrary and persistent hormone patterns is relevant to basic studies across various fields including developmental biology and tissue regeneration. Furthermore, since this hormone inkjet printing methodology is extensible to create complex three-dimensional structures, this methodology has potential to create therapies for tissue engineering using spatial patterned delivery of exogenous hormones.
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Affiliation(s)
- Phil G Campbell
- Institute for Complex Engineered Systems, Carnegie Mellon University, 1213 Hamburg Hall, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA.
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Sorkin AM, Dee KC, Knothe Tate ML. “Culture shock” from the bone cell's perspective: emulating physiological conditions for mechanobiological investigations. Am J Physiol Cell Physiol 2004; 287:C1527-36. [PMID: 15317661 DOI: 10.1152/ajpcell.00059.2004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bone physiology can be examined on multiple length scales. Results of cell-level studies, typically carried out in vitro, are often extrapolated to attempt to understand tissue and organ physiology. Results of organ- or organism-level studies are often analyzed to deduce the state(s) of the cells within the larger system(s). Although phenomena on all of these scales—cell, tissue, organ, system, organism—are interlinked and contribute to the overall health and function of bone tissue, it is difficult to relate research among these scales. For example, groups of cells in an exogenous, in vitro environment that is well defined by the researcher would not be expected to function similarly to those in a dynamic, endogenous environment, dictated by systemic as well as organismal physiology. This review of the literature on bone cell culture describes potential causes and components of cell “culture shock,” i.e., behavioral variations associated with the transition from in vivo to in vitro environment, focusing on investigations of mechanotransduction and experimental approaches to mimic aspects of bone tissue on a macroscopic scale. The state of the art is reviewed, and new paradigms are suggested to begin bridging the gap between two-dimensional cell cultures in petri dishes and the three-dimensional environment of living bone tissue.
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Affiliation(s)
- Adam M Sorkin
- Department of Biomedical Engineering, Case Western Reserve Univ., 10900 Euclid Ave., Olin 219, Cleveland, OH 44106, USA
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