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Zhang M, Wan L, Li R, Li X, Zhu T, Lu H. Engineered exosomes for tissue regeneration: from biouptake, functionalization and biosafety to applications. Biomater Sci 2023; 11:7247-7267. [PMID: 37794789 DOI: 10.1039/d3bm01169k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Exosomes are increasingly recognized as important effector molecules that regulate intercellular signaling pathways. Notably, certain types of exosomes can induce therapeutic responses, including cell proliferation, angiogenesis, and tissue repair. The use of exosomes in therapy is a hot spot in current research, especially in regenerative medicine. Despite the therapeutic potential, problems have hindered their success in clinical applications. These shortcomings include low concentration, poor targeting and limited loading capability. To fully realize their therapeutic potential, certain modifications are needed in native exosomes. In the present review, we summarize the exosome modification and functionalization strategies. In addition, we provide an overview of potential clinical applications and highlight the issues associated with the biosafety and biocompatibility of engineered exosomes in applications.
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Affiliation(s)
- Mu Zhang
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China.
| | - Lei Wan
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China.
| | - Ruiqi Li
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China.
| | - Xiaoling Li
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China.
| | - Taifu Zhu
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China.
| | - Haibin Lu
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China.
- The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, 510900, China
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Nakagawa Y, Mukai S, Satomi K, Shinya Y, Nakamura R, Takahashi M. Autologous Osteochondral Grafts for Knee Osteochondral Diseases Result in Good Patient-Reported Outcomes in Patients Older Than 60 Years. Arthrosc Sports Med Rehabil 2023; 5:100774. [PMID: 37564902 PMCID: PMC10410132 DOI: 10.1016/j.asmr.2023.100774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/15/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose This study aims to examine the clinical autologous osteochondral grafts (AOG) outcomes for knee osteochondral diseases at operative ages >60 years, and to determine whether patients are able to sit straight in Japanese style after AOG. Methods All patients who underwent AOG for knee osteochondral diseases between November 2001 and April 2018 were retrospectively identified. The inclusion criteria were AOG only without osteotomy, operative ages between 60 and 79 years, >2 years of follow-up, and involved femorotibial angle between 169° and 179° (normal alignment). Patients who underwent osteotomy to improve knee alignment and patients with inflammatory diseases such as rheumatoid arthritis were excluded. The patients' knee symptoms and their clinical outcome were evaluated according to the criteria of the knee scoring system of the Japanese Orthopedic Association (JOA), International Knee Documentation Committee (IKDC) subjective score, and the ability of straight sitting in Japanese style. Results This study enrolled 57 cases and 60 knee joints during the study period. The follow-up ratio was 85.1%. Moreover, 14 men and 43 women and 29 right and 31 left knee joints were included in this study. The mean operative age and mean follow-up period were 67.8 years (range 60-76 years) and 81.1 months (range 24-167 months), respectively. In addition, the study involved 30 cases and 32 knee joints (60s group), and 27 cases and 28 knee joints (70s group). Moreover, 34 cases and 36 knee joints had osteonecrosis (ON group), and 23 cases and 24 knee joints had cartilage injury (CI group). The IKDC subjective and JOA scores in both the 60s and 70s groups showed significant differences: 2 years after AOG >at the follow-up period, >at the preoperative period. The scores in both the CI and ON groups showed similar significant differences. Furthermore, 8.3% and 53.5% of the patients could sit straight in Japanese style at the preoperative period and 2 years after AOG, respectively. Conclusion Even if the patient's operative age was >60 years, the AOG only for their knee osteochondral diseases had good clinical outcomes, including the ability to sit straight in Japanese style. Level of Evidence IV, Therapeutic case series Key words: autologous osteochondral grafts, aged patients, clinical outcome, knee joint, straight sitting in Japanese style.
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Affiliation(s)
- Yasuaki Nakagawa
- Clinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Department of Orthopaedic Surgery, Japan Baptist Medical Foundation, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Kentaro Satomi
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Yuki Shinya
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Ryota Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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Pagani S, Salerno M, Filardo G, Locs J, van Osch GJ, Vecstaudza J, Dolcini L, Borsari V, Fini M, Giavaresi G, Columbaro M. Human Osteoblasts' Response to Biomaterials for Subchondral Bone Regeneration in Standard and Aggressive Environments. Int J Mol Sci 2023; 24:14764. [PMID: 37834212 PMCID: PMC10573262 DOI: 10.3390/ijms241914764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Osteochondral lesions, when not properly treated, may evolve into osteoarthritis (OA), especially in the elderly population, where altered joint function and quality are usual. To date, a collagen/collagen-magnesium-hydroxyapatite (Col/Col-Mg-HAp) scaffold (OC) has demonstrated good clinical results, although suboptimal subchondral bone regeneration still limits its efficacy. This study was aimed at evaluating the in vitro osteogenic potential of this scaffold, functionalized with two different strategies: the addition of Bone Morphogenetic Protein-2 (BMP-2) and the incorporation of strontium (Sr)-ion-enriched amorphous calcium phosphate (Sr-ACP) granules. Human osteoblasts were seeded on the functionalized scaffolds (OC+BMP-2 and OC+Sr-ACP, compared to OC) under stress conditions reproduced with the addition of H2O2 to the culture system, as well as in normal conditions, and evaluated in terms of morphology, metabolic activity, gene expression, and matrix synthesis. The OC+BMP-2 scaffold supported a better osteoblast morphology and stimulated scaffold colonization, cell activity, and extracellular matrix secretion, especially in the stressed culture environment but also in normal culture conditions, with increased expression of genes related to osteoblast differentiation. In conclusion, the incorporation of BMP-2 into the Col/Col-Mg-HAp scaffold also represents an improvement of the osteochondral scaffold in more challenging conditions, supporting further preclinical studies to optimize it for use in clinical practice.
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Affiliation(s)
- Stefania Pagani
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.P.); (V.B.); (G.G.)
| | - Manuela Salerno
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Janis Locs
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre of RTU, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (J.L.); (J.V.)
| | - Gerjo J.V.M. van Osch
- Department of Orthopedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands;
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Jana Vecstaudza
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre of RTU, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV-1007 Riga, Latvia; (J.L.); (J.V.)
| | | | - Veronica Borsari
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.P.); (V.B.); (G.G.)
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Gianluca Giavaresi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.P.); (V.B.); (G.G.)
| | - Marta Columbaro
- Electron Microscopy Platform, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
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Philippe V, Jeannerat A, Peneveyre C, Jaccoud S, Scaletta C, Hirt-Burri N, Abdel-Sayed P, Raffoul W, Darwiche S, Applegate LA, Martin R, Laurent A. Autologous and Allogeneic Cytotherapies for Large Knee (Osteo)Chondral Defects: Manufacturing Process Benchmarking and Parallel Functional Qualification. Pharmaceutics 2023; 15:2333. [PMID: 37765301 PMCID: PMC10536774 DOI: 10.3390/pharmaceutics15092333] [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: 08/16/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Cytotherapies are often necessary for the management of symptomatic large knee (osteo)-chondral defects. While autologous chondrocyte implantation (ACI) has been clinically used for 30 years, allogeneic cells (clinical-grade FE002 primary chondroprogenitors) have been investigated in translational settings (Swiss progenitor cell transplantation program). The aim of this study was to comparatively assess autologous and allogeneic approaches (quality, safety, functional attributes) to cell-based knee chondrotherapies developed for clinical use. Protocol benchmarking from a manufacturing process and control viewpoint enabled us to highlight the respective advantages and risks. Safety data (telomerase and soft agarose colony formation assays, high passage cell senescence) and risk analyses were reported for the allogeneic FE002 cellular active substance in preparation for an autologous to allogeneic clinical protocol transposition. Validation results on autologous bioengineered grafts (autologous chondrocyte-bearing Chondro-Gide scaffolds) confirmed significant chondrogenic induction (COL2 and ACAN upregulation, extracellular matrix synthesis) after 2 weeks of co-culture. Allogeneic grafts (bearing FE002 primary chondroprogenitors) displayed comparable endpoint quality and functionality attributes. Parameters of translational relevance (transport medium, finished product suturability) were validated for the allogeneic protocol. Notably, the process-based benchmarking of both approaches highlighted the key advantages of allogeneic FE002 cell-bearing grafts (reduced cellular variability, enhanced process standardization, rationalized logistical and clinical pathways). Overall, this study built on our robust knowledge and local experience with ACI (long-term safety and efficacy), setting an appropriate standard for further clinical investigations into allogeneic progenitor cell-based orthopedic protocols.
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Affiliation(s)
- Virginie Philippe
- Orthopedics and Traumatology Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
| | - Annick Jeannerat
- Preclinical Research Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland; (A.J.); (C.P.)
| | - Cédric Peneveyre
- Preclinical Research Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland; (A.J.); (C.P.)
| | - Sandra Jaccoud
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
- Laboratory of Biomechanical Orthopedics, Federal Polytechnic School of Lausanne, CH-1015 Lausanne, Switzerland
| | - Corinne Scaletta
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
| | - Nathalie Hirt-Burri
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
| | - Philippe Abdel-Sayed
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
- STI School of Engineering, Federal Polytechnic School of Lausanne, CH-1015 Lausanne, Switzerland
| | - Wassim Raffoul
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
| | - Salim Darwiche
- Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland;
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
| | - Lee Ann Applegate
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
- Oxford OSCAR Suzhou Center, Oxford University, Suzhou 215123, China
| | - Robin Martin
- Orthopedics and Traumatology Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Alexis Laurent
- Regenerative Therapy Unit, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland; (S.J.); (C.S.); (N.H.-B.); (P.A.-S.); (W.R.); (L.A.A.)
- Preclinical Research Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland; (A.J.); (C.P.)
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Toom DAD, Rieke M, Elbadawi A, Kösters C. 2-year results of middle-aged patients with two-compartment cartilage lesions in one knee treated with two patient specific metal implants. J Exp Orthop 2023; 10:92. [PMID: 37707660 PMCID: PMC10501106 DOI: 10.1186/s40634-023-00648-2] [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: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE Focal chondral lesions of the femur are currently treated with biological repair or arthroplasty. However, some patients are not suitable for either one due to lesion size, age, or prior biological treatment attempts. While singular patient-specific focal mini metal implants already showed good results, the outcomes of bicompartmental implantation of these implants have not been discussed in the literature yet. This study aims to evaluate clinical outcomes of patients who underwent bicompartmental implantation of two patient-specific implants. METHODS This prospective, non-randomized, non-comparative pilot study evaluates results up to two years after bicompartmental implantation of two implants (Episealer Implant, Episurf, Stockholm, Sweden). A damage report is compiled using a special MRI program and patient specific implants are manufactured, including 3D-printed surgical instruments to provide exact placement of the implant. The patients were assessed repeatedly using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) for pain during the follow-up. RESULTS The scores were evaluated three, 12, and 24 months after surgery and showed good results. The median in both scores improved from 37.7 for the KOOS5 preoperatively to 69.1 after 24 months and from 69 for the VAS for pain preoperatively to 9 after 24 months. CONCLUSION Overall, for the small study group presented, the early results are promising. With noticeable improvement in KOOS and VAS for pain after two years, patient specific implants appear to become relevant in future standardized treatment of femoral chondral lesions. Especially with bicompartmental implantation, full arthroplasty can be delayed even further. LEVEL OF EVIDENCE IV.
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Becher C, Megaloikonomos PD, Lind M, Eriksson K, Brittberg M, Beckmann J, Verdonk P, Högström M, Konradsen L, Holz J, Franz A, Feucht MJ, Kösters C, van Buul G, Sköldenberg O, Emans PJ, Boutefnouchet T, Nathwani D, McNicholas MJ, O'Donnell T, Spalding T, Stålman A, Ostermeier S, Imhoff AB, Shearman AD, Hirschmann M. High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants. Knee Surg Sports Traumatol Arthrosc 2023; 31:4027-4034. [PMID: 37173573 DOI: 10.1007/s00167-023-07450-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The rationale for the use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions is still under debate. The evidence supporting best practise guidelines is based on studies with low-level evidence. A consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence. The purpose of this article is to report the resulting consensus statements. METHODS Twenty-five experts participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted via an online survey of two rounds, for initial agreement and comments on the proposed statements. An in-person meeting between the panellists was organised during the 2022 ESSKA congress to further discuss and debate each of the statements. A final agreement was made via a final online survey a few days later. The strength of consensus was characterised as: consensus, 51-74% agreement; strong consensus, 75-99% agreement; unanimous, 100% agreement. RESULTS Statements were developed in the fields of patient assessment and indications, surgical considerations and postoperative care. Between the 25 statements that were discussed by this working group, 18 achieved unanimous, whilst 7 strong consensus. CONCLUSION The consensus statements, derived from experts in the field, represent guidelines to assist clinicians in decision-making for the appropriate use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christoph Becher
- International Centre for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
| | | | - Martin Lind
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Karl Eriksson
- Department of Orthopaedic Surgery, Stockholm South Hospital, Department of Clinical Science and Education Karolinska Institutet, Stockholm, Sweden
| | - Mats Brittberg
- Cartilage Research Unit, Region Halland Orthopaedics, Varberg Hospital, University of Gothenburg, Varberg, Sweden
| | - Johannes Beckmann
- Department of Orthopaedics and Traumatology, Barmherzige Brüder Hospital, Munich, Germany
| | | | - Magnus Högström
- Department of Surgical and Perioperative Sciences, Sports Medicine Umeå and Orthopedics, Umeå University, Umeå, Sweden
| | - Lars Konradsen
- Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Alois Franz
- Hospital for Orthopedic Surgery and Sports Medicine, Siegen, Germany
| | - Matthias J Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany
| | - Clemens Kösters
- Department of Traumatology and Orthopedics, Maria-Josef-Hospital Greven, Greven, Germany
| | - Gerben van Buul
- Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden
| | - Pieter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tarek Boutefnouchet
- University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | | | | | | | - Tim Spalding
- Cleveland Clinic London, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | | | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander D Shearman
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
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Ni KN, Ye L, Zhang YJ, Fang JW, Yang T, Pan WZ, Hu XY, Lai HH, Pan B, Lou C, He DW. Formononetin improves the inflammatory response and bone destruction in knee joint lesions by regulating the NF-kB and MAPK signaling pathways. Phytother Res 2023; 37:3363-3379. [PMID: 37002905 DOI: 10.1002/ptr.7810] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 08/12/2023]
Abstract
Formononetin (FMN) is a phytoestrogen that belongs to the isoflavone family. It has antioxidant and anti-inflammatory effects, as well as, many other biological activities. Existing evidence has aroused interest in its ability to protect against osteoarthritis (OA) and promote bone remodeling. To date, research on this topic has not been thorough and many issues remain controversial. Therefore, the purpose of our study was to explore the protective effect of FMN against knee injury and clarify the possible molecular mechanisms. We found that FMN inhibited osteoclast formation induced by receptor activator of NF-κB ligand (RANKL). Inhibition of the phosphorylation and nuclear translocation of p65 in the NF-κB signaling pathway plays a role in this effect. Similarly, during the inflammatory response of primary knee cartilage cells activated by IL-1β, FMN inhibited the NF-κB signaling pathway and the phosphorylation of the ERK and JNK proteins in the MAPK signaling pathway to suppress the inflammatory response. In addition, in vivo experiments showed that both low- and high-dose FMN had a clear protective effect against knee injury in the DMM (destabilization of the medial meniscus) model, and the therapeutic effect of high-dose FMN was stronger. In conclusion, these studies provide evidence of the protective effect of FMN against knee injury.
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Affiliation(s)
- Kai-Nan Ni
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Lin Ye
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Ye-Jin Zhang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Jia-Wei Fang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Tao Yang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Wen-Zheng Pan
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Xing-Yu Hu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - He-Huan Lai
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Bin Pan
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Chao Lou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Deng-Wei He
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
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Menezes R, Sherman L, Rameshwar P, Arinzeh TL. Scaffolds containing GAG-mimetic cellulose sulfate promote TGF-β interaction and MSC Chondrogenesis over native GAGs. J Biomed Mater Res A 2023; 111:1135-1150. [PMID: 36708060 PMCID: PMC10277227 DOI: 10.1002/jbm.a.37496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/29/2023]
Abstract
Cartilage tissue engineering strategies seek to repair damaged tissue using approaches that include scaffolds containing components of the native extracellular matrix (ECM). Articular cartilage consists of glycosaminoglycans (GAGs) which are known to sequester growth factors. In order to more closely mimic the native ECM, this study evaluated the chondrogenic differentiation of mesenchymal stem cells (MSCs), a promising cell source for cartilage regeneration, on fibrous scaffolds that contained the GAG-mimetic cellulose sulfate. The degree of sulfation was evaluated, examining partially sulfated cellulose (pSC) and fully sulfated cellulose (NaCS). Comparisons were made with scaffolds containing native GAGs (chondroitin sulfate A, chondroitin sulfate C and heparin). Transforming growth factor-beta3 (TGF-β3) sequestration, as measured by rate of association, was higher for sulfated cellulose-containing scaffolds as compared to native GAGs. In addition, TGF-β3 sequestration and retention over time was highest for NaCS-containing scaffolds. Sulfated cellulose-containing scaffolds loaded with TGF-β3 showed enhanced chondrogenesis as indicated by a higher Collagen Type II:I ratio over native GAGs. NaCS-containing scaffolds loaded with TGF-β3 had the highest expression of chondrogenic markers and a reduction of hypertrophic markers in dynamic loading conditions, which more closely mimic in vivo conditions. Studies also demonstrated that TGF-β3 mediated its effect through the Smad2/3 signaling pathway where the specificity of TGF-β receptor (TGF- βRI)-phosphorylated SMAD2/3 was verified with a receptor inhibitor. Therefore, studies demonstrate that scaffolds containing cellulose sulfate enhance TGF-β3-induced MSC chondrogenic differentiation and show promise for promoting cartilage tissue regeneration.
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Affiliation(s)
- Roseline Menezes
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Lauren Sherman
- Department of Medicine, Rutgers University School of Medicine, Newark, New Jersey, USA
| | - Pranela Rameshwar
- Department of Medicine, Rutgers University School of Medicine, Newark, New Jersey, USA
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Ozturk T, Erpala F, Bozduman O, Gedikbas M, Eren MB, Zengin EC. Arthroscopic Treatment of Femoral Condyle Chondral Lesions: Microfracture Versus Liquid Bioscaffold. Indian J Orthop 2023; 57:975-982. [PMID: 37214380 PMCID: PMC10192492 DOI: 10.1007/s43465-023-00878-7] [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: 05/16/2022] [Accepted: 03/17/2023] [Indexed: 05/24/2023]
Abstract
Purpose This study aims to compare the microfracture (MF) technique with the bioscaffold solution application (BST-CarGel) in treating femoral chondral lesions. Methods Thirty-eight patients ages 18-45 with isolated single femoral condyle full-thickness (ICRS grade 3-4) chondral lesions were included in the study. Patients were divided into two groups as MF applied (Group I = 21) and bioscaffold combined with MF (Group II = 17). The visual analog scale (VAS), Western-Ontario, and McMaster Osteoarthritis Index (WOMAC) were used in clinical evaluation. The location, size, and depth of lesions were evaluated with preoperative magnetic resonance imaging (MRI). Magnetic resonance observation of cartilage repair tissue (MOCART) score was used for postoperative evaluation. Results The mean age was 32.5 (range 19-44) years. Mean follow-up was 14.9 months (range 12-24). Lesion size was 3 cm2 in group I and 2.9 cm2 in group II. There were no differences between groups regarding demographic characteristics but BMI (Body Mass Index) was lower in group II which was significant. The duration of surgery was longer in group II (p < 0.001). Postoperative statistical significant improvements were found in WOMAC and VAS scores in groups, but there was no statistical difference. Although there was no significant radiological difference in the group II according to the MOCART score, higher scores were obtained compared to group I. Conclusion No difference was found, clinical and radiological, in terms of short-term outcomes. MF is a method to be applied as a primary treatment with its cost-effective, simple and short surgery technique, and effective clinical results up to 4 cm2. Level of Evidence Level III: retrospective comparative study.
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Affiliation(s)
- Tahir Ozturk
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
| | - Firat Erpala
- Department of Orthopaedics and Traumatology, Cesme Alpercizgenakat State Hospital, 35930 Cesme, Izmir Turkey
| | - Omer Bozduman
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
| | - Mete Gedikbas
- Department of Orthopaedics and Traumatology, Turhal State Hospital, Tokat, Turkey
| | - Mehmet Burtac Eren
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
| | - Eyup Cagatay Zengin
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
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10
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Rahmati S, Khazaei M, Nadi A, Alizadeh M, Rezakhani L. Exosome-loaded scaffolds for regenerative medicine in hard tissues. Tissue Cell 2023; 82:102102. [PMID: 37178527 DOI: 10.1016/j.tice.2023.102102] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Tissue engineering can be used to repair tissue by employing bioscaffolds that provide better spatial control, porosity, and a three-dimensional (3D) environment like the human body. Optimization of injectability, biocompatibility, bioactivity, and controlled drug release are also features of such scaffolds. The 3D shape of the scaffold can control cell interaction and improve cell migration, proliferation, and differentiation. Exosomes (EXOs) are nanovesicles that can regulate osteoblast activity and proliferation using a complex composition of lipids, proteins, and nucleic acids in their vesicles. Due to their excellent biocompatibility and efficient cellular internalization, EXOs have enormous potential as desirable drug/gene delivery vectors in the field of regenerative medicine. They can cross the biological barrier with minimal immunogenicity and side effects. Scaffolds that contain EXOs have been studied extensively in both basic and preclinical settings for the regeneration and repair of both hard (bone, cartilage) and soft (skin, heart, liver, kidney) tissue. Cell motility, proliferation, phenotype, and maturation can all be controlled by EXOs. The angiogenic and anti-inflammatory properties of EXOs significantly influence tissue healing. The current study focused on the use of EXO-loaded scaffolds in hard tissue regeneration.
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Affiliation(s)
- Shima Rahmati
- Cancer Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mozafar Khazaei
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Tissue Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akram Nadi
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Morteza Alizadeh
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Leila Rezakhani
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Tissue Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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11
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Aktuelle Therapieempfehlungen zur operativen Knorpeltherapie am Kniegelenk. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Kaewkong P, Kosorn W, Sonthithai P, Lertwimol T, Thavornyutikarn B, Chantaweroad S, Janvikul W. Chondrogenic Differentiation of Human Mesenchymal Stem Cells and Macrophage Polarization on 3D-Printed Poly(ε-caprolactone)/Poly(3-hydroxybutyrate- co-3-hydroxyvalerate) Blended Scaffolds with Different Secondary Porous Structures. ACS APPLIED BIO MATERIALS 2022; 5:2689-2702. [PMID: 35594556 DOI: 10.1021/acsabm.2c00161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study was aimed to evaluate the chondrogenic differentiation of human mesenchymal stem cells (hMSCs) and polarization of THP-1-derived macrophages cultured on poly(ε-caprolactone) (PC)/poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PH) blended scaffolds with dual primary (PP) and secondary (SP) pores, which were fabricated via a 3D printing technique, i.e., fused deposition modeling, followed by a salt-leaching process at 50 °C for varied times, i.e., 15, 30, and 60 min. Sodium chloride (SC), a porogen, was initially incorporated in the blend at varied weight percentages, i.e., 0, 25, and 50%, whereas 1 M NaOH solution and deionized water were used as salt-leaching agents. To elucidate the surface properties of the developed scaffolds, directly governed by the amount of the salt originally mixed and the salt-leaching efficiency, several characterization techniques, e.g., scanning electron microscopy, X-ray microcomputed tomography, mercury intrusion porosimetry, atomic force microscopy, and contact angle measurement, were used. Meanwhile, the salt-leaching efficiency was determined by means of weight loss measurement and thermogravimetric analysis. It was found that the alkaline solution could satisfactorily leach out the salt particles in 60 min with a mild etching of the polymer framework. The most immensely and homogeneously pitted filament surface was observed in the NaOH-treated scaffold initially integrated with 50% salt, i.e., 60B_PC/PH/50SC; the SP structure was mostly open and interconnected. The size of most of micropores was about 0.14 μm. With its suitable microsurface roughness and hydrophilicity, 60B_PC/PH/50SC could properly support the initial attachment and lamellipodia formation of hMSCs, which was favorable for chondrogenesis. Consequently, a significantly increased ratio of glycosaminoglycans/deoxyribonucleic acid and a superior expression of the COL2A1 gene were detected when cells were grown on this material. Although 60B_PC/PH/50SC induced the macrophages to secrete a slightly high level of IL-1β during the first few days of culture, the polarized M1 cells could return to a nearly normal stage at Day7, suggesting no unfavorable chronic inflammation caused by the material.
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Affiliation(s)
- Pakkanun Kaewkong
- Biofunctional Materials and Devices Research Group, National Metal and Materials Technology Center, 114 Thailand Science Park, Phahonyothin Road, Klong Luang, Pathum Thani 12120, Thailand
| | - Wasana Kosorn
- Biofunctional Materials and Devices Research Group, National Metal and Materials Technology Center, 114 Thailand Science Park, Phahonyothin Road, Klong Luang, Pathum Thani 12120, Thailand
| | - Pacharapan Sonthithai
- Biofunctional Materials and Devices Research Group, National Metal and Materials Technology Center, 114 Thailand Science Park, Phahonyothin Road, Klong Luang, Pathum Thani 12120, Thailand
| | - Tareerat Lertwimol
- Biofunctional Materials and Devices Research Group, National Metal and Materials Technology Center, 114 Thailand Science Park, Phahonyothin Road, Klong Luang, Pathum Thani 12120, Thailand
| | - Boonlom Thavornyutikarn
- Biofunctional Materials and Devices Research Group, National Metal and Materials Technology Center, 114 Thailand Science Park, Phahonyothin Road, Klong Luang, Pathum Thani 12120, Thailand
| | - Surapol Chantaweroad
- Assistive Technology and Medical Devices Research Center, Central Office, 111 Thailand Science Park, Phahonyothin Road, Klong Luang, Pathum Thani 12120, Thailand
| | - Wanida Janvikul
- Biofunctional Materials and Devices Research Group, National Metal and Materials Technology Center, 114 Thailand Science Park, Phahonyothin Road, Klong Luang, Pathum Thani 12120, Thailand
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13
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Catapano M, Ahmed M, Breslow RG, Borg-Stein J. The aging athlete. PM R 2022; 14:643-651. [PMID: 35441493 DOI: 10.1002/pmrj.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
Aging athletes, those 60 years and older, are a growing population of mature, active individuals who value sports and exercise participation throughout their lifespan. Although recommendations for younger and masters athletes have been extrapolated to this population, there remains a paucity of specific guidelines, treatment algorithms, and considerations for aging athletes. The benefits of living an active lifestyle must be weighed against the risks for unique cardiovascular, metabolic, and musculoskeletal injuries requiring diagnostic and therapeutic interventions. In this article, we review the unique cardiovascular and muscular physiology of aging athletes and how it influences the risk of specific medical conditions. We also discuss general prevention and treatment strategies. Finally, we identify areas of future research priorities and emerging treatments.
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Affiliation(s)
- Michael Catapano
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwa Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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14
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Schagemann JC, Galle L, Gille J, Frydrychowicz A, Welsch G, Salzmann G, Paech A, Mittelstaedt H. Correlation of the Histological ICRS II Score and the 3D MOCART Score for the Analysis of Aged Osteochondral Regenerates in a Large Animal Model. Cartilage 2022; 13:19476035211072254. [PMID: 35176894 PMCID: PMC9137325 DOI: 10.1177/19476035211072254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Reliable outcome measures are essential to predict the success of cartilage repair techniques. Histology is probably the gold standard, but magnetic resonance imaging (MRI) has the potential to decrease the need for invasive histological biopsies. The 3D magnetic resonance observation of cartilage repair tissue (MOCART) score is a reliable yet elaborate tool. Moreover, literature is controversial concerning the correlation of histology and MRI. DESIGN To test the applicability of the International Cartilage Regeneration and Joint Preservation Society (ICRS) II and MOCART 3D score for the evaluation of aged osteochondral regenerates in a large animal model, and to identify correlating histological and MRI parameters. Osteochondral defects in medial femoral condyles of n = 12 adult sheep were reconstructed with biodegradable bilayer implants. About 19.5 months postoperation, n = 10 joints were analyzed with MRI (3D MOCART score). Histological samples were analyzed using the ICRS II score; both pre- and post-training. The intraclass correlation coefficient, the inter-rater reliability, and the 95% confidence interval were calculated. Matching histological and MRI parameters were tested for correlation. RESULTS We found a statistically significant correlation of all histological parameters. MRI parameters reflecting "overall" assessments had very strong inter-rater correlations. Statistically significant strong correlations were found for the MRI parameters defect filling, cartilage interface, bone interface, and surface. For defect overall (MRI) and overall assessment (ICRS II), we found a significant yet mild correlation. CONCLUSIONS The ICRS II and the 3D MOCART score are applicable to aged osteochondral regenerates. Prior training on the scoring systems is essential. Select MRI and histological parameters correlate; however, the only statistically significant correlation was found for overall assessment.
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Affiliation(s)
- J C Schagemann
- Medicine Section, University of Lübeck, Lübeck, Germany.,Christophorus-Kliniken, Coesfeld, Germany
| | - L Galle
- Medicine Section, University of Lübeck, Lübeck, Germany
| | - J Gille
- Medicine Section, University of Lübeck, Lübeck, Germany
| | - A Frydrychowicz
- Department of Radiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - G Welsch
- UKE Athleticum-Center for Athletic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Salzmann
- Gelenkzentrum Rhein-Main, Frankfurt, Germany
| | - A Paech
- Department for Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - H Mittelstaedt
- Department for Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Lübeck, Germany
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15
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Nakagawa Y, Mukai S, Nishitani K, Murata S, Satomi K, Shinya Y, Nakamura R. Autologous Osteochondral Grafts Result in Improved Clinical Outcomes in Patients With Early Knee Osteoarthritis. Arthrosc Sports Med Rehabil 2022; 4:e713-e719. [PMID: 35494285 PMCID: PMC9042906 DOI: 10.1016/j.asmr.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine whether autologous osteochondral grafts improve clinical outcomes in early knee osteoarthritis (EKOA) and whether the grafts prevent progression of radiographic joint degeneration. Methods In this study, we identified patients older than 40 years with EKOA having no traumatic events, with grade 0, 1, or 2 on the Kellgren-Lawrence (KL) classification and more than grade 3 of cartilage degeneration according to the International Cartilage Repair Society scale. Recipient sites were as follows: 14 patellofemoral (PF3) joint, 18 medial femoral condyle (M1), and 6 lateral femoral condyle (L2). Japanese Orthopedic Association (JOA) score and International Knee Documentation (IKDC) subjective score (SUB) were examined as clinical outcomes. Results The study included 31 knees in 31 patients who underwent autologous osteochondral grafts for EKOA and more than two years follow-up. The sample included 15 men and 16 women. The mean operative age was 56.0 years, and the mean follow-up period was 76 months (range, 24-170 months). In the preoperative period, JOA and SUB were 73.9 and 49.5, respectively. At follow-up, the JOA and SUB scores were 93.7 and 84.5, respectively. The differences were statistically significant. Progression of KL classification occurred in 0% of the PF3 group, 17% of the L2 group, and 33% of the M1 group. The outcomes of the M1 group significantly became worse (P = .0381) than those of the L2 and the PF3 groups, and the PF3 group significantly maintained good clinical outcomes (P = .0334). Conclusion Autologous osteochondral grafts for degenerated cartilage improved clinical outcomes of EKOA even if the recipient had cartilage degeneration, and not trauma. The PF3 group maintained significantly good clinical outcomes, and the M1 group became significantly worse.
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Affiliation(s)
- Yasuaki Nakagawa
- Department of Orthopedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
- Address correspondence to Yasuaki Nakagawa, M.D., Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho Fushimi-ku, Kyoto 612-8555, Japan.
| | - Shogo Mukai
- Department of Orthopedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Kentaro Satomi
- Department of Orthopedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Yuki Shinya
- Department of Orthopedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Ryota Nakamura
- Department of Orthopedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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16
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A review of composition‐structure‐function properties and tissue engineering strategies of articular cartilage: compare condyle process and knee‐joint. ADVANCED ENGINEERING MATERIALS 2022. [DOI: 10.1002/adem.202200304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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17
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Merkely G, Ackermann J, Gomoll AH. The Role of Hypertension in Cartilage Restoration: Increased Failure Rate After Autologous Chondrocyte Implantation but Not After Osteochondral Allograft Transplantation. Cartilage 2021; 13:1306S-1314S. [PMID: 31965812 PMCID: PMC8808780 DOI: 10.1177/1947603519900792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives. The purpose of this study was to examine whether patients with diagnosed hypertension have an increased risk of graft failure following cartilage repair with either autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA). We hypothesized that hypertension is related to higher ACI and OCA graft failure. Design. Patients who underwent ACI or OCA transplantation between February 2009 and December 2016 were included in this study. Inclusion criteria were (1) at least 2 years' follow-up, (2) available information related to the living habits (smoking and medication status), and (3) available information related to the presence of hypertension, diabetes mellitus, or hyperlipidemia. To identify potential independent risk factors of graft failure, univariate screening was performed and factors with significance at a level of P < 0.1 were entered in multivariate logistic regression models. Results. A total of 368 patients (209 ACI and 159 OCA) were included into our study. In the ACI group, 61 patients' (29.1%) graft failed. Univariate screening identified older age, female gender, defect size, higher prevalence of hypertension, and smoking as a predictor of graft failure. Following, multivariate logistic regression revealed female gender (odds ratio [OR] 1.02, P = 0.048), defect size (OR 1.07, P = 0.035), and hypertension (OR 3.73, P = 0.023) as significant independent risk factors predicting graft failure after ACI. In the OCA group, 29 patients' (18.2%) graft failed and none of the included factors demonstrated to be a potential risk factor for graft failure. Conclusion. Hypertension, defect size, and female gender seem to predict ACI graft failure but not OCA failure.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Traumatology, Semmelweis
University, Budapest, Hungary,Gergo Merkely, Cartilage Repair Center,
Brigham and Women’s Hospital, Harvard Medical School, 850 Boylston Steet # 112,
Chestnut Hill, Boston, MA 02467, USA.
| | - Jakob Ackermann
- Sports Medicine Center, Department of
Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA,Balgrist University Hospital, Zurich,
Switzerland
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18
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Styczynska-Soczka K, Amin AK, Simpson AHW, Hall AC. Optimization and Validation of a Human Ex Vivo Femoral Head Model for Preclinical Cartilage Research and Regenerative Therapies. Cartilage 2021; 13:386S-397S. [PMID: 32567330 PMCID: PMC8721618 DOI: 10.1177/1947603520934534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Articular cartilage is incapable of effective repair following injury or during osteoarthritis. While there have been developments in cartilage repair technologies, there is a need to advance biologically relevant models for preclinical testing of biomaterial and regenerative therapies. This study describes conditions for the effective ex vivo culture of the whole human femoral head. DESIGN Fresh, viable femoral heads were obtained from femoral neck fractures and cultured for up to 10 weeks in (a) Dulbecco's modified Eagle's medium (DMEM); (b) DMEM + mixing; (c) DMEM + 10% human serum (HS); (d) DMEM + 10% HS + mixing. The viability, morphology, volume, and density of fluorescently labelled in situ chondrocytes and cartilage surface roughness were assessed by confocal microscopy. Cartilage histology was studied for glycosaminoglycan content using Alcian blue and collagen content using picrosirius red. RESULTS Chondrocyte viability remained at >95% in DMEM + 10% HS. In DMEM alone, viability remained high for ~4 weeks and then declined. For the other conditions, superficial zone chondrocyte viability fell to <35% at 10 weeks with deeper zones being relatively unaffected. In DMEM + 10% HS at 10 weeks, the number of chondrocytes possessing cytoplasmic processes increased compared with DMEM (P = 0.017). Alcian blue labeling decreased (P = 0.02) and cartilage thinned (P ≤ 0.05); however, there was no change to surface roughness, chondrocyte density, chondrocyte volume, or picrosirius red labeling (P > 0.05). CONCLUSIONS In this ex vivo model, chondrocyte viability was maintained in human femoral heads for up to 10 weeks in culture, a novel finding not previously reported. This human model could prove invaluable for the exploration, development, and assessment of preclinical cartilage repair and regenerative therapies.
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Affiliation(s)
| | - Anish K. Amin
- Department of Trauma and Orthopaedic
Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - A. Hamish W. Simpson
- Department of Trauma and Orthopaedic
Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Andrew C. Hall
- Biomedical Sciences, Edinburgh Medical
School, University of Edinburgh, Edinburgh, Scotland, UK,Andrew C. Hall, Biomedical Sciences,
Edinburgh Medical School, University of Edinburgh, Hugh Robson Building, George
Square, Edinburgh, EH8 9XD, Scotland, UK.
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Lu KH, Lu PWA, Lu EWH, Tang CH, Su SC, Lin CW, Yang SF. The potential remedy of melatonin on osteoarthritis. J Pineal Res 2021; 71:e12762. [PMID: 34435392 DOI: 10.1111/jpi.12762] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 01/15/2023]
Abstract
Osteoarthritis (OA), the most common arthritis worldwide, is a degenerative joint disease characterized by progressive cartilage breakdown, subchondral remodeling, and synovial inflammation. Although conventional pharmaceutical therapies aimed to prevent further cartilage loss and joint dysfunction, there are no ideal strategies that target the pathogenesis of OA. Melatonin exhibits a variety of regulatory properties by binding to specific receptors and downstream molecules and exerts a myriad of receptor-independent actions via intracellular targets as a chondrocyte protector, an anti-inflammation modulator, and a free radical scavenger. Melatonin also modulates cartilage regeneration and degradation by directly/indirectly regulating the expression of main circadian clock genes, such as transcriptional activators [brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein (Bmal) and circadian locomotor output cycles kaput (Clock)], transcriptional repressors [period circadian regulator (Per)1/2, cryptochrome (Cry)1/2, and Dec2], and nuclear hormone receptors [Rev-Erbs and retinoid acid-related orphan receptors (Rors)]. Owing to its effects on cartilage homeostasis, we propose a potential role for melatonin in the prevention and therapy of OA via the modulation of circadian clock genes, mitigation of chondrocyte apoptosis, anti-inflammatory activity, and scavenging of free radicals.
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Affiliation(s)
- Ko-Hsiu Lu
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | | | | | - Chih-Hsin Tang
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Shih-Chi Su
- Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei, Linkou and Keelung, Taiwan
| | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan
- Department of Dentistry, Chung Shan Medical University Hospital 402, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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20
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Identifying Consensus and Open Questions around Assessing or Predicting the Quality and Success of Cartilage Repair: A Delphi Study. SURGERIES 2021. [DOI: 10.3390/surgeries2030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A range of surgical techniques have been developed for the repair or regeneration of lesioned cartilage in the human knee and a corresponding array of scoring systems have been created to assess their outcomes. The published literature displays a wide range of opinions regarding the factors that influence the success of surgical cartilage repair and which parameters are the most useful for measuring the quality of the repair at follow-up. Our objective was to provide some clarity to the field by collating items that were agreed upon by a panel of experts to be important in these areas. A modified, three-round Delphi consensus study was carried out consisting of one idea-generating focus-group and two subsequent, self-completed questionnaire rounds. In each round, items were assessed for their importance and level of consensus against pre-determined threshold levels. In total, 31 items reached consensus, including a hierarchy of tissues in the joint based on their importance in cartilage repair, markers of repair cartilage quality and the implications of environmental and patient-related factors. Items were stratified into those that can be employed for predicting the success of cartilage repair and those that could be used for assessing the structural quality of the resulting repair cartilage. Items that did not reach consensus represent areas where dissent remains and could, therefore, be used to guide future clinical and fundamental scientific research.
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21
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El-Senduny FF, Hegazi NM, Abd Elghani GE, Farag MA. Manuka honey, a unique mono-floral honey. A comprehensive review of its bioactives, metabolism, action mechanisms, and therapeutic merits. FOOD BIOSCI 2021. [DOI: 10.1016/j.fbio.2021.101038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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22
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Shafiei M, Ansari MNM, Razak SIA, Khan MUA. A Comprehensive Review on the Applications of Exosomes and Liposomes in Regenerative Medicine and Tissue Engineering. Polymers (Basel) 2021; 13:2529. [PMID: 34372132 PMCID: PMC8347192 DOI: 10.3390/polym13152529] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Tissue engineering and regenerative medicine are generally concerned with reconstructing cells, tissues, or organs to restore typical biological characteristics. Liposomes are round vesicles with a hydrophilic center and bilayers of amphiphiles which are the most influential family of nanomedicine. Liposomes have extensive research, engineering, and medicine uses, particularly in a drug delivery system, genes, and vaccines for treatments. Exosomes are extracellular vesicles (EVs) that carry various biomolecular cargos such as miRNA, mRNA, DNA, and proteins. As exosomal cargo changes with adjustments in parent cells and position, research of exosomal cargo constituents provides a rare chance for sicknesses prognosis and care. Exosomes have a more substantial degree of bioactivity and immunogenicity than liposomes as they are distinctly chiefly formed by cells, which improves their steadiness in the bloodstream, and enhances their absorption potential and medicinal effectiveness in vitro and in vivo. In this review, the crucial challenges of exosome and liposome science and their functions in disease improvement and therapeutic applications in tissue engineering and regenerative medicine strategies are prominently highlighted.
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Affiliation(s)
- Mojtaba Shafiei
- Bioinspired Device and Tissue Engineering Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81300, Johor, Malaysia; (M.S.); (M.U.A.K.)
| | | | - Saiful Izwan Abd Razak
- Bioinspired Device and Tissue Engineering Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81300, Johor, Malaysia; (M.S.); (M.U.A.K.)
| | - Muhammad Umar Aslam Khan
- Bioinspired Device and Tissue Engineering Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81300, Johor, Malaysia; (M.S.); (M.U.A.K.)
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Hopkins T, Wright KT, Kuiper NJ, Roberts S, Jermin P, Gallacher P, Kuiper JH. An In Vitro System to Study the Effect of Subchondral Bone Health on Articular Cartilage Repair in Humans. Cells 2021; 10:cells10081903. [PMID: 34440671 PMCID: PMC8392168 DOI: 10.3390/cells10081903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022] Open
Abstract
Chondrocyte-based cartilage repair strategies, such as articular chondrocyte implantation, are widely used, but few studies addressed the communication between native subchondral bone cells and the transplanted chondrocytes. An indirect co-culture model was developed, representing a chondrocyte/scaffold-construct repair of a cartilage defect adjoining bone, where the bone could have varying degrees of degeneration. Human BM-MSCs were isolated from two areas of subchondral bone in each of five osteochondral tissue specimens from five patients undergoing knee arthroplasty. These two areas underlaid the macroscopically and histologically best and worst cartilage, representing early and late-stage OA, respectively. BM-MSCs were co-cultured with normal chondrocytes suspended in agarose, with the two cell types separated by a porous membrane. After 0, 7, 14 and 21 days, chondrocyte-agarose scaffolds were assessed by gene expression and biochemical analyses, and the abundance of selected proteins in conditioned media was assessed by ELISA. Co-culture with late-OA BM-MSCs resulted in a reduction in GAG deposition and a decreased expression of genes encoding matrix-specific proteins (COL2A1 and ACAN), compared to culturing with early OA BM-MSCs. The concentration of TGF-β1 was significantly higher in the early OA conditioned media. The results of this study have clinical implications for cartilage repair, suggesting that the health of the subchondral bone may influence the outcomes of chondrocyte-based repair strategies.
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Affiliation(s)
- Timothy Hopkins
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, UK; (K.T.W.); (N.J.K.); (S.R.); (P.J.); (P.G.); (J.H.K.)
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire SY10 7AG, UK
- Correspondence: ; Tel.: +44-(0)-1691-404699
| | - Karina T. Wright
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, UK; (K.T.W.); (N.J.K.); (S.R.); (P.J.); (P.G.); (J.H.K.)
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire SY10 7AG, UK
| | - Nicola J. Kuiper
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, UK; (K.T.W.); (N.J.K.); (S.R.); (P.J.); (P.G.); (J.H.K.)
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire SY10 7AG, UK
| | - Sally Roberts
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, UK; (K.T.W.); (N.J.K.); (S.R.); (P.J.); (P.G.); (J.H.K.)
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire SY10 7AG, UK
| | - Paul Jermin
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, UK; (K.T.W.); (N.J.K.); (S.R.); (P.J.); (P.G.); (J.H.K.)
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire SY10 7AG, UK
| | - Peter Gallacher
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, UK; (K.T.W.); (N.J.K.); (S.R.); (P.J.); (P.G.); (J.H.K.)
| | - Jan Herman Kuiper
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, UK; (K.T.W.); (N.J.K.); (S.R.); (P.J.); (P.G.); (J.H.K.)
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire SY10 7AG, UK
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24
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Cardamonin Attenuates Inflammation and Oxidative Stress in Interleukin-1β-Stimulated Osteoarthritis Chondrocyte through the Nrf2 Pathway. Antioxidants (Basel) 2021; 10:antiox10060862. [PMID: 34072123 PMCID: PMC8227809 DOI: 10.3390/antiox10060862] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022] Open
Abstract
Osteoarthritis (OA) is a chronic degenerative joint disease characterized by the deterioration of articular cartilage. The progression of OA leads to an increase in inflammatory mediators in the joints, thereby promoting the destruction of the cartilage matrix. Recent studies have reported on the anti-inflammatory and antioxidant properties of cardamonin, which also appears to interact with cellular targets, such as nuclear erythroid 2-related factor 2 (Nrf2), extracellular signal-regulated kinase (ERK), and mammalian target of rapamycin (mTOR) during the progression of tumors. To date, few studies have investigated the effects of cardamonin on chondrocyte inflammation. In the current study, we determined that treating interleukin-1 beta (IL-1β-stimulated chondrocyte cells) with cardamonin significantly reduced the release of nitric oxide (NO) and prostaglandin E2 (PGE2) and significantly inhibited the expression of pro-inflammatory proteins, including inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX2). Cardamonin was also shown to: (1) inhibit the activation and production of matrix metalloproteinases (MMPs), (2) suppress the nuclear factor-κB (NF-κB) signaling pathway, (3) suppress the expression of toll-like receptor proteins, (4) activate the Nrf2 signaling pathway, and (5) increase the levels of antioxidant proteins heme oxygenase-1 (HO-1) and NAD(P)H:quinone oxidoreductase 1 (NQO1). The increase in antioxidant proteins led to corresponding antioxidant effects (which were abolished by Nrf2 siRNA). Our findings identify cardamonin as a candidate Nrf2 activator for the treatment and prevention of OA related to inflammation and oxidative stress.
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25
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[Cartilage repair procedures for early osteoarthritis]. DER ORTHOPADE 2021; 50:356-365. [PMID: 33844031 DOI: 10.1007/s00132-021-04099-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Commonly used cartilage repair procedures have been established for focal cartilage lesions; however, degenerative lesions with accompanying changes of other intraarticular structures are much more common in clinical practice. This stage, in which classic radiological signs of osteoarthritis are absent, is called early osteoarthritis and is characterized by impaired joint homeostasis with biomechanical and biochemical changes that can have a negative effect on regenerative cartilage therapy procedures. INDICATION Cartilage repair procedures are indicated for symptomatic focal early osteoarthritis, defined as cartilage degeneration ICRS grades I or II around a focal cartilage defect ICRS grades III or IV. In more advanced osteoarthritis with significant narrowing of the joint space, cartilage repair procedures are generally contraindicated. THERAPY The most studied cartilage repair procedure for early osteoarthritis is autologous chondrocyte implantation, which has shown acceptable results in case series, although higher failure rates are to be expected compared to focal, traumatic cartilage lesions. The use of bone marrow-stimulating techniques seems to be limited in early osteoarthritis and should only be used in cases of lesion < 2 cm2 and very little surrounding cartilage degeneration. Concomitant surgical procedures, especially unloading osteotomies, are very important.
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26
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Sundararajan SR, Ramakanth R, Rajasekaran S. Meniscal Root Repair Along with Auxiliary Procedures for Joint Preservation: Current Concepts. Indian J Orthop 2021; 55:237-251. [PMID: 33927803 PMCID: PMC8046868 DOI: 10.1007/s43465-021-00352-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/02/2021] [Indexed: 02/04/2023]
Abstract
Meniscal root repair and joint preservation surgeries have gained increased interest in the last decade, from a better interpretation of the role of meniscal functions, from the biomechanical studies. Several published results from both biomechanical and clinical studies has proven the effectiveness of meniscal root repairs and has led to a unanimous international consensus for the need for root repair surgery. Meniscal repair by suture pull-out technique is widely followed around the world and leads to adequate healing and good clinical outcome. There are auxiliary procedures like centralization sutures (to reduce the meniscal extrusion), high tibial osteotomy, cartilage repair procedures, meniscal root reconstruction and ligament reconstructions are performed along with meniscal root repair, especially in the younger patients and recently sub-chondroplasty for the bone marrow lesions (BMLs) are also executed. This review article discusses the anatomy, types of root tears, evaluation, treatment, outcomes of root repair, and the need for additional procedures, which are imperative for joint preservation and restoration of the biomechanics of the knee.
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27
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Merkely G, Ogura T, Ackermann J, Barbieri Mestriner A, Gomoll AH. Clinical Outcomes after Revision of Autologous Chondrocyte Implantation to Osteochondral Allograft Transplantation for Large Chondral Defects: A Comparative Matched-Group Analysis. Cartilage 2021; 12:155-161. [PMID: 30897940 PMCID: PMC7970380 DOI: 10.1177/1947603519833136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Osteochondral allograft transplantation (OCA) is a well-established procedure for patients with symptomatic cartilage defects in the knee. Revision to OCA after prior failed cartilage repair has shown similar clinical outcomes as primary OCA; however, most of the failed procedures were arthroscopic procedures for smaller defects. There is no literature investigating the clinical outcomes after OCA for prior failed autologous chondrocyte implantation (ACI) for the treatment of large chondral defects of the knee. The purpose of this study was therefore to determine clinical outcomes of patients undergoing revision to OCA after prior failed ACI as compared with a matched cohort of patients undergoing OCA as a primary cartilage repair procedure (primary OCA). DESIGN In this review of prospectively collected data, we analyzed data from 26 patients with at least 2 years follow-up. Thirteen patients who underwent revision to OCA after prior failed ACI by a single surgeon were compared with a matched group of patients who underwent primary OCA. The patients were matched per age, gender, body mass index, and defect size. Patient-reported outcomes, reoperations, and survival rates were compared between groups. RESULTS There were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. Moreover, there was no significant difference in reoperation rates and survival rates between the groups. CONCLUSION The present study demonstrates that revision to OCA is a viable treatment option with favorable functional outcomes and similar reoperation and survival rate as primary OCA even for revision of large chondral defects previously treated with ACI.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Traumatology, Semmelweis
University, Budapest, Hungary,Gergo Merkely, Cartilage Repair Center,
Brigham and Women’s Hospital, Harvard Medical Center, 850 Boylston St # 112,
Chestnut Hill, MA 02467, USA.
| | - Takahiro Ogura
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA,Sports Medicine Center, Funabashi
Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Jakob Ackermann
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandre Barbieri Mestriner
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA,Universidade Federal de São Paulo, São
Paulo, Brazil
| | - Andreas H. Gomoll
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA,Hospital for Special Surgery, New York,
New York, USA
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28
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张 梦, 杨 玉, 刘 敏, 梁 利, 罗 瑞, 尹 丹, 郭 风. [Estradiol activates ERK phosphorylation by binding to ERβ to inhibit proliferation and promote apoptosis of human chondrocytes]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:336-343. [PMID: 33849823 PMCID: PMC8075796 DOI: 10.12122/j.issn.1673-4254.2021.03.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore the effect of estradiol (E2) binding to its receptor ERβ on the proliferation and apoptosis of C28I2 cells. OBJECTIVE We cloned the sequence of ESR2 into a recombinant adenovirus plasmid (pAd-ESR2) and packaged the plasmid in HEK293 cells. Normal human chondrocyte C28I2 cells were transfected with Ad-ESR2 or small interfering RNA targeting ESR2-siRNA (ESR2-siRNA), and the effects of treatment with DMSO or E2 on the expression of the proteins associated with endoplasmic reticulum (ER) stress and cell apoptosis were determined using Western blotting. qRT-PCR was used to detect the expressions of proliferation-related marker genes, and an EdU kit and flow cytometry were used to assess cell proliferation and apoptosis. We also tested the effects of U0126 (an ERK pathway inhibitor) and E2, alone or in combination, on ER stress, apoptosis and the ERK signaling pathway in C28I2 cells infected with Ad-ESR2 using Western blotting. OBJECTIVE Overexpression of Ad-ESR2 in C28I2 cells significantly promoted the expressions of IRE1α, PERK, XBP1s, and cleaved caspase-12, inhibited proliferation related marker genes PCNA, cyclin B1, cyclin D1, and decreased the level of ERK phosphorylation following E2 treatment (all P < 0.05). Interference of ESR2 caused significant reduction in the expressions of ER stress-related proteins and apoptosis-related proteins, up-regulated the genes related to cell proliferation, and increased intracellular pERK/ERK ratio in C28I2 cells. The effect of E2 binding to ERβ, which promoted the expressions of ER stress associated proteins and apoptosis related proteins, was obviously antagonized by treatment of the cells with U0126. OBJECTIVE The binding of E2 to ERβ promotes ER stress and apoptosis in human chondrocytes by activating ERK pathway phosphorylation inhibit cell proliferation.
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Affiliation(s)
- 梦颖 张
- />重庆医科大学基础医学院细胞生物学与遗传学教研室,重庆 400016Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing 400016, China
| | - 玉有 杨
- />重庆医科大学基础医学院细胞生物学与遗传学教研室,重庆 400016Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing 400016, China
| | - 敏 刘
- />重庆医科大学基础医学院细胞生物学与遗传学教研室,重庆 400016Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing 400016, China
| | - 利 梁
- />重庆医科大学基础医学院细胞生物学与遗传学教研室,重庆 400016Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing 400016, China
| | - 瑞 罗
- />重庆医科大学基础医学院细胞生物学与遗传学教研室,重庆 400016Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing 400016, China
| | - 丹旸 尹
- />重庆医科大学基础医学院细胞生物学与遗传学教研室,重庆 400016Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing 400016, China
| | - 风劲 郭
- />重庆医科大学基础医学院细胞生物学与遗传学教研室,重庆 400016Department of Cell Biology and Genetics, Chongqing Medical University, Chongqing 400016, China
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29
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Gille J, Reiss E, Freitag M, Schagemann J, Steinwachs M, Piontek T, Reiss E. Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study. Orthop J Sports Med 2021; 9:2325967120981872. [PMID: 33738308 PMCID: PMC7934047 DOI: 10.1177/2325967120981872] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. Purpose: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. Results: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement (P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. Conclusion: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.
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Affiliation(s)
- Justus Gille
- Department of Orthopaedic and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Moritz Freitag
- Department of Orthopaedic and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Jan Schagemann
- Department of Orthopaedic and Trauma Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Tomasz Piontek
- Sport Medicine Lab, Department of Spine Disorders and Pediatric Orthopaedics, University of Medical Sciences Poznań, Poznán, Poland
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30
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Becher C, Imhoff A. [Guidelines for the treatment of unicompartmental cartilage defects of the knee-Cartilage repair, osteotomy, mini-implant or arthroplasty?]. DER ORTHOPADE 2021; 50:88-95. [PMID: 33337504 DOI: 10.1007/s00132-020-04051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The treatment of unicompartmental cartilage defects offers a large variety of therapeutic options. With help of an algorithm, decision-making for the most suitable treatment approach is supported. Correction of malalignment is key for successful treatment. Defect size, influencing factors such as "age" and prior treatments play an important role in choosing the most appropriate operative treatment option.
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Affiliation(s)
- Christoph Becher
- IZO - Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Deutschland.
| | - Andreas Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München (TUM), München, Deutschland
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31
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Jiang S, Tian G, Yang Z, Gao X, Wang F, Li J, Tian Z, Huang B, Wei F, Sang X, Shao L, Zhou J, Wang Z, Liu S, Sui X, Guo Q, Guo W, Li X. Enhancement of acellular cartilage matrix scaffold by Wharton's jelly mesenchymal stem cell-derived exosomes to promote osteochondral regeneration. Bioact Mater 2021; 6:2711-2728. [PMID: 33665503 PMCID: PMC7895679 DOI: 10.1016/j.bioactmat.2021.01.031] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/14/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
Articular cartilage defect repair is a problem that has long plagued clinicians. Although mesenchymal stem cells (MSCs) have the potential to regenerate articular cartilage, they also have many limitations. Recent studies have found that MSC-derived exosomes (MSC-Exos) play an important role in tissue regeneration. The purpose of this study was to verify whether MSC-Exos can enhance the reparative effect of the acellular cartilage extracellular matrix (ACECM) scaffold and to explore the underlying mechanism. The results of in vitro experiments show that human umbilical cord Wharton's jelly MSC-Exos (hWJMSC-Exos) can promote the migration and proliferation of bone marrow-derived MSCs (BMSCs) and the proliferation of chondrocytes. We also found that hWJMSC-Exos can promote the polarization of macrophages toward the M2 phenotype. The results of a rabbit knee osteochondral defect repair model confirmed that hWJMSC-Exos can enhance the effect of the ACECM scaffold and promote osteochondral regeneration. We demonstrated that hWJMSC-Exos can regulate the microenvironment of the articular cavity using a rat knee joint osteochondral defect model. This effect was mainly manifested in promoting the polarization of macrophages toward the M2 phenotype and inhibiting the inflammatory response, which may be a promoting factor for osteochondral regeneration. In addition, microRNA (miRNA) sequencing confirmed that hWJMSC-Exos contain many miRNAs that can promote the regeneration of hyaline cartilage. We further clarified the role of hWJMSC-Exos in osteochondral regeneration through target gene prediction and pathway enrichment analysis. In summary, this study confirms that hWJMSC-Exos can enhance the effect of the ACECM scaffold and promote osteochondral regeneration. hWJMSC-Exos can promote cell proliferation, migration and polarization in vitro. hWJMSC-Exos can enhance the repair effect of ACECM scaffold in vivo. hWJMSC-Exos can inhibit inflammation in the joint cavity. hWJMSC-Exos contain a variety of miRNAs that promote osteochondral regeneration.
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Affiliation(s)
- Shuangpeng Jiang
- Department of Orthopedics, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.,Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Guangzhao Tian
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,School of Medicine, Nankai University, Tianjin, 300071, China
| | - Zhen Yang
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xiang Gao
- Department of Orthopedics, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Fuxin Wang
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Juntan Li
- Department of Orthopedics, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
| | - Zhuang Tian
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bo Huang
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Fu Wei
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xinyu Sang
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Liuqi Shao
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jian Zhou
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhenyong Wang
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shuyun Liu
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xiang Sui
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Quanyi Guo
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Weimin Guo
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xu Li
- Department of Orthopedics, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China
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Xie WQ, Chen SF, Tao XH, Zhang LY, Hu PW, Pan WL, Fan YB, Li YS. Melatonin: Effects on Cartilage Homeostasis and Therapeutic Prospects in Cartilage-related Diseases. Aging Dis 2021; 12:297-307. [PMID: 33532142 PMCID: PMC7801270 DOI: 10.14336/ad.2020.0519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
Cartilage is a relatively simple connective tissue that plays a variety of roles in the human body, including joint support and protection, load bearing of the intervertebral discs, joint lubrication, formation of the external structure of the ears and nose and support of the trachea. The maintenance of cartilage homeostasis is therefore crucial. Cartilage-related diseases are difficult to diagnose and treat because their molecular and pathological mechanisms are not fully understood. Melatonin, which has a wide range of physiological effects, is an endocrine hormone mainly secreted by the pineal gland. Its biological effects include its antioxidant, antiaging, analgesic, and hypnotic effects and its ability to stabilize the circadian rhythm. In recent years, research on cartilage homeostasis and melatonin has been increasing, and melatonin has gradually been used in the treatment of cartilage-related diseases. Therefore, this article will briefly review the role of melatonin in cartilage homeostasis, including its anti-inflammatory effects and effects in protecting cartilage from damage by other factors and promoting chondrocyte growth and the expression of cartilage-related genes. Based on the above, the current status and future developmental direction of melatonin in the treatment of cartilage-related diseases are also discussed, demonstrating the broad prospects of melatonin in maintaining cartilage homeostasis and treating cartilage injury-related diseases.
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Affiliation(s)
- Wen-Qing Xie
- 1Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China.,6National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Song-Feng Chen
- 2Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Xiao-Hua Tao
- 3Department of Dermatology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310000, China
| | - Li-Yang Zhang
- 4Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Pei-Wu Hu
- 5Department of Scientific Research, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
| | - Wei-Li Pan
- 3Department of Dermatology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310000, China
| | - Yi-Bin Fan
- 3Department of Dermatology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310000, China
| | - Yu-Sheng Li
- 1Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China.,6National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
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Marcarelli M, Zappia M, Rissolio L, Baroni C, Astarita C, Trovato L, Graziano A. Cartilage Micrografts as a Novel Non-Invasive and Non-Arthroscopic Autograft Procedure for Knee Chondropathy: Three-Year Follow-Up Study. J Clin Med 2021; 10:jcm10020322. [PMID: 33477260 PMCID: PMC7830188 DOI: 10.3390/jcm10020322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Focal chondral defects of the knee can significantly impair patient quality of life. Although different options are available, they are still not conclusive and have several limitations. The aim of this study was to evaluate the role of autologous cartilage micrografts in the treatment of knee chondropathy. (2) Methods: Eight patients affected by knee chondropathy were evaluated before and after 6 months and 3 years following autologous cartilage micrografts by magnetic resonance imaging (MRI) for cartilage measurement and clinical assessment. (3) Results: All patients recovered daily activities, reporting pain reduction without the need for analgesic therapy; Oxford Knee Score (OKS) was 28.4 ± 6 and 40.8 ± 6.2 and visual analogue scale (VAS) was 5.5 ± 1.6 and 1.8 ± 0.7 before and after 6 months following treatment, respectively. Both scores remained stable after 3 years. Lastly, a significant improvement of the cartilage thickness was observed using MRI after 3 years. (4) Conclusions: Autologous cartilage micrografts can promote the formation of new cartilage, and could be a valid approach for the treatment of knee chondropathy.
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Affiliation(s)
- Marco Marcarelli
- Unit of Orthopedics and Traumatology of Chieri and Moncalieri, Santa Croce Hospital, 10024 Turin, Italy; (M.M.); (L.R.); (C.B.)
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Lorenzo Rissolio
- Unit of Orthopedics and Traumatology of Chieri and Moncalieri, Santa Croce Hospital, 10024 Turin, Italy; (M.M.); (L.R.); (C.B.)
| | - Chiara Baroni
- Unit of Orthopedics and Traumatology of Chieri and Moncalieri, Santa Croce Hospital, 10024 Turin, Italy; (M.M.); (L.R.); (C.B.)
| | - Carlo Astarita
- Human Brain Wave, Corso Galileo Ferraris, 63, 10128 Turin, Italy;
- Sbarro Institute for Cancer Research and Molecular Medicine, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19126, USA;
- Correspondence:
| | - Letizia Trovato
- Sbarro Institute for Cancer Research and Molecular Medicine, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19126, USA;
| | - Antonio Graziano
- Human Brain Wave, Corso Galileo Ferraris, 63, 10128 Turin, Italy;
- Sbarro Institute for Cancer Research and Molecular Medicine, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19126, USA;
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Taghiyar L, Jahangir S, Khozaei Ravari M, Shamekhi MA, Eslaminejad MB. Cartilage Repair by Mesenchymal Stem Cell-Derived Exosomes: Preclinical and Clinical Trial Update and Perspectives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1326:73-93. [PMID: 33629260 DOI: 10.1007/5584_2021_625] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Osteoarthritis (OA) and other degenerative joint diseases are characterized by articular cartilage destruction, synovial inflammation, sclerosis of subchondral bone, and loss of extracellular matrix (ECM). Worldwide, these diseases are major causes of disability. Cell therapies have been considered to be the best therapeutic strategies for long-term treatment of articular cartilage diseases. It has been suggested that the mechanism of stem cell-based therapy is related to paracrine secretion of extracellular vesicles (EVs), which are recognized as the main secretion factors of stem cells. EVs, and in particular the subclass exosomes (Exos), are novel therapeutic approaches for treatment of cartilage lesions and OA. The results of recent studies have shown that EVs isolated from mesenchymal stem cells (MSCs) could inhibit OA progression. EVs isolated from various stem cell sources, such as MSCs, may contribute to tissue regeneration of the limbs, skin, heart, and other tissues. Here, we summarize recent findings of preclinical and clinical studies on different MSC-derived EVs and their effectiveness as a treatment for damaged cartilage. The Exos isolation techniques in OA treatment are also highlighted.
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Affiliation(s)
- Leila Taghiyar
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Shahrbano Jahangir
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mojtaba Khozaei Ravari
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | | | - Mohamadreza Baghaban Eslaminejad
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
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35
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Chen Y, Ouyang X, Wu Y, Guo S, Xie Y, Wang G. Co-culture and Mechanical Stimulation on Mesenchymal Stem Cells and Chondrocytes for Cartilage Tissue Engineering. Curr Stem Cell Res Ther 2020; 15:54-60. [PMID: 31660820 DOI: 10.2174/1574888x14666191029104249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 02/08/2023]
Abstract
Defects in articular cartilage injury and chronic osteoarthritis are very widespread and common, and the ability of injured cartilage to repair itself is limited. Stem cell-based cartilage tissue engineering provides a promising therapeutic option for articular cartilage damage. However, the application of the technique is limited by the number, source, proliferation, and differentiation of stem cells. The co-culture of mesenchymal stem cells and chondrocytes is available for cartilage tissue engineering, and mechanical stimulation is an important factor that should not be ignored. A combination of these two approaches, i.e., co-culture of mesenchymal stem cells and chondrocytes under mechanical stimulation, can provide sufficient quantity and quality of cells for cartilage tissue engineering, and when combined with scaffold materials and cytokines, this approach ultimately achieves the purpose of cartilage repair and reconstruction. In this review, we focus on the effects of co-culture and mechanical stimulation on mesenchymal stem cells and chondrocytes for articular cartilage tissue engineering. An in-depth understanding of the impact of co-culture and mechanical stimulation of mesenchymal stem cells and chondrocytes can facilitate the development of additional strategies for articular cartilage tissue engineering.
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Affiliation(s)
- Yawen Chen
- Key Laboratory of Biological Medicines in Universities of Shandong Province, Weifang Medical University, Weifang, 261053, China
| | - Xinli Ouyang
- Key Laboratory of Biological Medicines in Universities of Shandong Province, Weifang Medical University, Weifang, 261053, China
| | - Yide Wu
- Key Laboratory of Biological Medicines in Universities of Shandong Province, Weifang Medical University, Weifang, 261053, China
| | - Shaojia Guo
- Key Laboratory of Biological Medicines in Universities of Shandong Province, Weifang Medical University, Weifang, 261053, China
| | - Yongfang Xie
- Key Laboratory of Biological Medicines in Universities of Shandong Province, Weifang Medical University, Weifang, 261053, China
| | - Guohui Wang
- Key Laboratory of Biological Medicines in Universities of Shandong Province, Weifang Medical University, Weifang, 261053, China
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36
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Schreiner AJ, Stoker AM, Bozynski CC, Kuroki K, Stannard JP, Cook JL. Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment. J Knee Surg 2020; 33:1056-1068. [PMID: 32583400 DOI: 10.1055/s-0040-1712944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
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Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Abstract
The menisci and articular cartilage of the knee have a close embryological, anatomical and functional relationship, which explains why often a pathology of one also affects the other. Traumatic meniscus tears should be repaired, when possible, to protect the articular cartilage. Traumatic articular cartilage lesions can be treated with success using biological treatment options such as microfracture or microdrilling, autologous chondrocyte transplantation (ACT), or osteochondral transplantation (OCT) depending on the depth and area of the lesion. Degenerative cartilage and meniscus lesions often occur together, and osteoarthritis is already present or impending. Most degenerative meniscus lesions should be treated first conservatively and, after failed conservative treatment, should undergo arthroscopic partial meniscus resection. Degenerative cartilage lesions should also be treated conservatively initially and then surgically; thereby treating the cartilage defect itself and also maintaining the axis of the leg if necessary. Tears of the meniscus roots are devastating injuries to the knee and should be repaired e.g. by transtibial re-fixation. The clinical role of ‘ramp’ lesions of the meniscus is still under investigation.
Cite this article: EFORT Open Rev 2020;5:652-662. DOI: 10.1302/2058-5241.5.200016
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Affiliation(s)
- Sebastian Kopf
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Germany
| | - Manuel-Paul Sava
- Orthopedics and Traumatology 2nd Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Christian Stärke
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Germany
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38
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Takizawa D, Sato M, Okada E, Takahashi T, Maehara M, Tominaga A, Sogo Y, Toyoda E, Watanabe M. Regenerative effects of human chondrocyte sheets in a xenogeneic transplantation model using immune-deficient rats. J Tissue Eng Regen Med 2020; 14:1296-1306. [PMID: 32652894 PMCID: PMC7540669 DOI: 10.1002/term.3101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023]
Abstract
Although cell transplantation has attracted much attention in regenerative medicine, animal models continue to be used in translational research to evaluate safety and efficacy because cell sources and transplantation modalities are so diverse. In the present study, we investigated the regenerative effects of human chondrocyte sheets on articular cartilage in a xenogeneic transplantation model using immune‐deficient rats. Osteochondral defects were created in the knee joints of immune‐deficient rats that were treated as Group A, untreated (without transplantation); Group B, transplantation of a layered chondrocyte sheet containing 5.0 × 105 cells (layered chondrocyte sheet transplantation); Group C, transplantation of a synoviocyte sheet containing 5.0 × 105 cells (synoviocyte sheet transplantation); or Group D, transplantation of both a synoviocyte sheet plus a layered chondrocyte sheet, each containing 5.0 × 105 cells (synoviocyte sheet plus layered chondrocyte sheet transplantation). Histological evaluation demonstrated that Group B showed cartilage regeneration with hyaline cartilage and fibrocartilage. In Groups C and D, the defect was filled with fibrous tissue but no hyaline cartilage. Transplanted cells were detected at 4 and 12 weeks after transplantation, but the number of cells had decreased at 12 weeks. Our results indicate that layered chondrocyte sheet transplantation contributes to articular cartilage regeneration; this model proved useful for evaluating these regenerative effects.
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Affiliation(s)
- Daichi Takizawa
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Eri Okada
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Takumi Takahashi
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Miki Maehara
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Ayako Tominaga
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Yasuyuki Sogo
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Eriko Toyoda
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
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39
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Merkely G, Farr J, Saris D, Lattermann C. Cartilage Surface Treatment: Factors Affecting Success and Failure Mechanisms. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2019.150711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Advances in cartilage repair: The influence of inorganic clays to improve mechanical and healing properties of antibacterial Gellan gum-Manuka honey hydrogels. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 108:110444. [DOI: 10.1016/j.msec.2019.110444] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/31/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
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41
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Boyer C, Réthoré G, Weiss P, d’Arros C, Lesoeur J, Vinatier C, Halgand B, Geffroy O, Fusellier M, Vaillant G, Roy P, Gauthier O, Guicheux J. A Self-Setting Hydrogel of Silylated Chitosan and Cellulose for the Repair of Osteochondral Defects: From in vitro Characterization to Preclinical Evaluation in Dogs. Front Bioeng Biotechnol 2020; 8:23. [PMID: 32117912 PMCID: PMC7025592 DOI: 10.3389/fbioe.2020.00023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
Articular cartilage (AC) may be affected by many injuries including traumatic lesions that predispose to osteoarthritis. Currently there is no efficient cure for cartilage lesions. In that respect, new strategies for regenerating AC are contemplated with interest. In this context, we aim to develop and characterize an injectable, self-hardening, mechanically reinforced hydrogel (Si-HPCH) composed of silanised hydroxypropymethyl cellulose (Si-HPMC) mixed with silanised chitosan. The in vitro cytocompatibility of Si-HPCH was tested using human adipose stromal cells (hASC). In vivo, we first mixed Si-HPCH with hASC to observe cell viability after implantation in nude mice subcutis. Si-HPCH associated or not with canine ASC (cASC), was then tested for the repair of osteochondral defects in canine femoral condyles. Our data demonstrated that Si-HPCH supports hASC viability in culture. Moreover, Si-HPCH allows the transplantation of hASC in the subcutis of nude mice while maintaining their viability and secretory activity. In the canine osteochondral defect model, while the empty defects were only partially filled with a fibrous tissue, defects filled with Si-HPCH with or without cASC, revealed a significant osteochondral regeneration. To conclude, Si-HPCH is an injectable, self-setting and cytocompatible hydrogel able to support the in vitro and in vivo viability and activity of hASC as well as the regeneration of osteochondral defects in dogs when implanted alone or with ASC.
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Affiliation(s)
- Cécile Boyer
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
| | - Gildas Réthoré
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- CHU Nantes, Service d’Odontologie Restauratrice et Chirurgicale, PHU4 OTONN, Nantes, France
| | - Pierre Weiss
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- CHU Nantes, Service d’Odontologie Restauratrice et Chirurgicale, PHU4 OTONN, Nantes, France
| | - Cyril d’Arros
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
| | - Julie Lesoeur
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- SC3M – “Electron Microscopy, Microcharacterization and Functional Morphohistology Imaging” Core Facility, Structure Fédérative de Recherche Franc̨ois Bonamy, INSERM – UMS016, CNRS 3556, CHU Nantes, Université de Nantes, Nantes, France
| | - Claire Vinatier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- SC3M – “Electron Microscopy, Microcharacterization and Functional Morphohistology Imaging” Core Facility, Structure Fédérative de Recherche Franc̨ois Bonamy, INSERM – UMS016, CNRS 3556, CHU Nantes, Université de Nantes, Nantes, France
| | - Boris Halgand
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- CHU Nantes, PHU4 OTONN, Nantes, France
| | - Olivier Geffroy
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- Centre of Research and Preclinical Investigation (C.R.I.P.), ONIRIS, Nantes, France
| | - Marion Fusellier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- Centre of Research and Preclinical Investigation (C.R.I.P.), ONIRIS, Nantes, France
| | - Gildas Vaillant
- CHU Nantes, PHU4 OTONN, Nantes, France
- Centre of Research and Preclinical Investigation (C.R.I.P.), ONIRIS, Nantes, France
| | - Patrice Roy
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- Centre of Research and Preclinical Investigation (C.R.I.P.), ONIRIS, Nantes, France
| | - Olivier Gauthier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- Centre of Research and Preclinical Investigation (C.R.I.P.), ONIRIS, Nantes, France
| | - Jérôme Guicheux
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France
- Université de Nantes, UFR Odontologie, Nantes, France
- SC3M – “Electron Microscopy, Microcharacterization and Functional Morphohistology Imaging” Core Facility, Structure Fédérative de Recherche Franc̨ois Bonamy, INSERM – UMS016, CNRS 3556, CHU Nantes, Université de Nantes, Nantes, France
- CHU Nantes, PHU4 OTONN, Nantes, France
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42
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Doyle EC, Wragg NM, Wilson SL. Intraarticular injection of bone marrow-derived mesenchymal stem cells enhances regeneration in knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2020; 28:3827-3842. [PMID: 32006075 PMCID: PMC7669782 DOI: 10.1007/s00167-020-05859-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/16/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE This review aimed to evaluate the efficacy of intra-articular injections of bone marrow derived mesenchymal stem cells (BM-MSCs) for the treatment of knee osteoarthritis (KOA). METHODS This narrative review evaluates recent English language clinical data and published research articles between 2014 and 2019. Key word search strings of ((("bone marrow-derived mesenchymal stem cell" OR "bone marrow mesenchymal stromal cell" OR "bone marrow stromal cell")) AND ("osteoarthritis" OR "knee osteoarthritis")) AND ("human" OR "clinical"))) AND "intra-articular injection" were used to identify relevant articles using PMC, Cochrane Library, Web Of Science and Scopus databases. RESULTS Pre-clinical studies have demonstrated successful, safe and encouraging results for articular cartilage repair and regeneration. This is concluded to be due to the multilineage differential potential, immunosuppressive and self-renewal capabilities of BM-MSCs, which have shown to augment pain and improve functional outcomes. Subsequently, clinical applications of intra-articular injections of BM-MSCs are steadily increasing, with most studies demonstrating a decrease in poor cartilage index, improvements in pain, function and Quality of Life (QoL); with moderate-to-high level evidence regarding safety for therapeutic administration. However, low confidence in clinical efficacy remains due to a plethora of heterogenous methodologies utilised, resulting in challenging study comparisons. A moderate number of cells (40 × 106) were identified as most likely to achieve optimal responses in individuals with grade ≥ 2 KOA. Likewise, significant improvements were reported when using lower (24 × 106) and higher (100 × 106) cell numbers, although adverse effects including persistent pain and swelling were a consequence. CONCLUSION Overall, the benefits of intra-articular injections of BM-MSCs were deemed to outweigh the adverse effects; thus, this treatment be considered as a future therapy strategy. To realise this, long-term large-scale randomised clinical trials are required to enable improved interpretations, to determine the validity of efficacy in future studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Emily Claire Doyle
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU Leicestershire UK
| | - Nicholas Martin Wragg
- Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough, LE11 3TU Leicestershire UK
| | - Samantha Louise Wilson
- Centre for Biological Engineering, Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough, LE11 3TU, Leicestershire, UK.
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Aoki K, Ogihara N, Tanaka M, Haniu H, Saito N. Carbon nanotube-based biomaterials for orthopaedic applications. J Mater Chem B 2020; 8:9227-9238. [DOI: 10.1039/d0tb01440k] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Carbon nanotubes can enhance the functionality of orthopedic applications.
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Affiliation(s)
- Kaoru Aoki
- Physical Therapy Division
- School of Health Sciences
- Shinshu University
- Nagano 390-8621
- Japan
| | - Nobuhide Ogihara
- Department of Orthopaedic Surgery
- Ina Central Hospital
- Nagano 396-8555
- Japan
| | - Manabu Tanaka
- Department of Orthopaedic Surgery
- Okaya City Hospital
- Nagano 394-8512
- Japan
| | - Hisao Haniu
- Department of Biomedical Engineering
- Graduate School of Medicine
- Science and Technology
- Shinshu University
- Nagano 390-8621
| | - Naoto Saito
- Institute for Biomedical Sciences
- Interdisciplinary Cluster for Cutting Edge Research
- Shinshu University
- Matsumoto
- Nagano 390-8621
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Niemeyer P, Schubert T, Grebe M, Hoburg A. Treatment Costs of Matrix-Associated Autologous Chondrocyte Implantation Compared With Microfracture: Results of a Matched-Pair Claims Data Analysis on the Treatment of Cartilage Knee Defects in Germany. Orthop J Sports Med 2019; 7:2325967119886583. [PMID: 31840030 PMCID: PMC6896134 DOI: 10.1177/2325967119886583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Articular cartilage damage is caused by traumatic sport accidents or age-related degeneration and might lead to osteoarthritis, which represents a socioeconomic burden to society. Cartilage damage in the knee is commonly treated surgically with microfracture (MFX) or matrix-associated autologous chondrocyte implantation (MACI). PURPOSE To quantify the initial and follow-up costs associated with MFX and MACI treatments from the viewpoint of statutory health insurance in Germany. STUDY DESIGN Economic decision analysis; Level of evidence, 2. METHODS This comparative study was based on an anonymized representative claims data set of 4 million patients covered by statutory health insurance in Germany. Patients undergoing outpatient or inpatient treatment with MACI or MFX for cartilage damage in the knee between January 1, 2012, and December 31, 2013, were included and evaluated over 5 years. Groups (MACI and MFX) were adjusted via propensity score matching before initial treatment. The matched groups were compared regarding their outpatient, inpatient, pharmaceutical, and other costs during the 5-year period. RESULTS In total, 127 patients per group were analyzed (59.1% male, 40.9% female; mean age, 37 years). In the year of the initial surgical procedure, costs were €14,804.13 in the MACI group and €5458.59 in the MFX group. In years 2 and 3 after initial surgery, treatment costs were comparable between patients treated with MACI (€2897.97 and €2114.87, respectively) and MFX (€2842.66 and €1967.42, respectively), with slightly higher treatment costs for those treated with MACI. In years 4 and 5 after surgery, costs were less in patients treated with MACI (€2154.79 and €1478.08, respectively) than in those treated with MFX (€2232.57 and €2061.63, respectively). Costs related to revision surgery were, on average, €3732 for MACI and €3765 for MFX. Thus, additional costs in years with revision surgery were €1672 for MACI and €1915 for MFX. CONCLUSION This was the first study to analyze a large representative population claims database with propensity score matching, and results indicated that follow-up costs of patients treated with MACI and MFX began to converge over time. We found that total costs for MACI were higher than for MFX but that additional costs for MACI were lower than previously reported. Perceived morbidity may have little to do with cost.
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Affiliation(s)
- Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, University Medical Center, Albert Ludwig University of Freiburg, Freiburg, Germany
- OCM Orthopädische Chirurgie München, Munich, Germany
| | | | | | - Arnd Hoburg
- Gelenk- und Wirbelsäulen-Zentrum Steglitz, Berlin, Germany
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Niemeyer P, Schubert T, Grebe M, Hoburg A. Matrix-Associated Chondrocyte Implantation Is Associated With Fewer Reoperations Than Microfracture: Results of a Population-Representative, Matched-Pair Claims Data Analysis for Cartilage Defects of the Knee. Orthop J Sports Med 2019; 7:2325967119877847. [PMID: 31673564 PMCID: PMC6804358 DOI: 10.1177/2325967119877847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Symptomatic cartilage defects of the knee are commonly surgically treated by microfracture (MFX) or matrix-associated chondrocyte implantation (M-ACI). Several randomized controlled trials have compared MFX and M-ACI, showing a tendency to lower reoperation rates for M-ACI, but results vary widely between studies. Purpose: To compare reoperation rates after MFX and M-ACI in cartilage defects of the knee outside clinical trials in a representative sample of the population. Study Design: Cohort study; Level of evidence, 3. Methods: This study was based on anonymized, population-representative claims data of 4 million insured persons in Germany. Patients who underwent MFX or M-ACI for cartilage defects of the knee with a follow-up of 2 years were compared. The primary endpoint was the need for a reoperation, defined as a claim for a second surgical procedure from the same patient at the knee joint (27 procedure codes), meniscus and cartilage (35 procedure codes), or patella (102 procedure codes) or the need for knee replacement (11 procedure codes). Group comparisons were performed using log-rank tests, with a 2-sided P value of <.05 to indicate significance. For adjusted analysis, propensity score matching was applied. Age, sex, comedications, and comorbidities were used as matching parameters. Results: A total of 6425 patients fulfilled the inclusion criteria: 6273 treated with MFX and 152 treated with M-ACI (mean age, 53 and 36 years, respectively). In the 2 years after treatment, 1271 patients in the MFX group needed a reoperation compared with 19 in the M-ACI group (20.3% vs 12.5%, respectively; P = .0199). For adjusted analysis after propensity score matching, 127 patients per group were analyzed. Their mean age was 37 years. At the end of the second follow-up year, 28 and 16 patients needed reoperations in the MFX and M-ACI groups, respectively (22.0% vs 12.6%, respectively; P = .0498). Conclusion: This study used a representative sample of the population and a broad definition of a reoperation, thus expanding evidence from clinical trials. We found a significant advantage of M-ACI in reoperation rates 2 years after treatment. After adjusting for age, sex, comedications, and comorbidities, M-ACI still showed significantly lower reoperation rates after 2 years.
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Affiliation(s)
- Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Albert Ludwig University of Freiburg, Freiburg, Germany.,OCM Orthopädische Chirurgie München, Munich, Germany
| | | | | | - Arnd Hoburg
- Gelenk- und Wirbelsäulen-Zentrum Steglitz, Berlin, Germany
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Merkely G, Ogura T, Bryant T, Minas T. Severe Bone Marrow Edema Among Patients Who Underwent Prior Marrow Stimulation Technique Is a Significant Predictor of Graft Failure After Autologous Chondrocyte Implantation. Am J Sports Med 2019; 47:1874-1884. [PMID: 31251661 DOI: 10.1177/0363546519853584] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is a well-established cartilage repair procedure; however, numerous studies have shown higher ACI graft failure rates after prior marrow stimulation techniques (MSTs). PURPOSE To identify which factors may predict decreased graft survival after ACI among patients who underwent a prior MST. A secondary aim was to investigate the specificity of these predictors. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS In this review of prospectively collected data, the authors analyzed 38 patients who had failed prior MST surgery and subsequently underwent collagen-covered ACI (case group). The case group was divided into graft failure ACI (n = 8, 21%) and successful ACI (n = 30, 79%). Fourteen clinical variables were categorized and analyzed to determine predictors for failure of the ACI graft: age, body mass index, sex, defect characteristics (number, size, location, etiology, type), presence of kissing lesion, intraoperative presence of intralesional osteophyte, time between an MST and ACI, previous surgery, duration of the symptoms, and concomitant surgical procedure. Preoperative magnetic resonance imaging (MRI) was used to evaluate the severity of subchondral bone marrow edema (BME), graded I (absent) to IV (severe), and the presence of subchondral cyst, hypertrophic sclerosis, and intralesional osteophyte. The effects of these MRI findings on the graft survivor were also investigated. Concurrently, a control group without a prior MST was matched to investigate the specificity of the previously determined predictors. These patients were matched individually according to age, sex, body mass index, and outcome of the procedure (failure [n = 8] or successful [n = 30] per the case group). RESULTS In the case group, the presence of preoperative severe BME was significantly higher among patients with failed ACI as compared with patients with successful ACI (P < .001). In the control group, the presence of severe BME was not significantly different between the failure and successful groups (P = .747). The ACI graft failure rate among patients with a prior MST and preoperative grade IV BME was 83.7% at 5 years postoperatively, resulting in a significantly lower survival rate as compared with patients with a prior MST and without severe BME (5-year graft failure rate, 6.5%; P < .001). All the other parameters did not differ significantly. CONCLUSION After a prior MST, the presence of grade IV BME by MRI was a predictive factor for graft failure among patients who then underwent second-generation ACI.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Traumatology, Semmelweis University, Budapest, Hungary
| | - Takahiro Ogura
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Sports Medicine Center Funabashi Orthopedic Hospital, Funabashi, Japan
| | - Tim Bryant
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Minas
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Paley Orthopedic and Spine Institute, West Palm Beach, Florida, USA
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MaioRegen Osteochondral Substitute for the Treatment of Knee Defects: A Systematic Review of the Literature. J Clin Med 2019; 8:jcm8060783. [PMID: 31159439 PMCID: PMC6617307 DOI: 10.3390/jcm8060783] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aims to investigate the clinical and radiological efficacy of three-dimensional acellular scaffolds (MaioRegen) in restoring osteochondral knee defects. METHODS MEDLINE, Scopus, CINAHL, Embase, and Cochrane Databases were searched for articles in which patients were treated with MaioRegen for osteochondral knee defects. RESULTS A total of 471 patients were included in the study (mean age 34.07 ± 5.28 years). The treatment involved 500 lesions divided as follows: 202 (40.4%) medial femoral condyles, 107 (21.4%) lateral femoral condyles, 28 (5.6%) tibial plateaus, 46 (9.2%) trochleas, 74 (14.8%) patellas, and 43 (8.6%) unspecified femoral condyles. Mean lesion size was 3.6 ± 0.85 cm2. Only four studies reported a follow-up longer than 24 months. Significant clinical improvement has been reported in almost all studies with further improvement up to 5 years after surgery. A total of 59 complications were reported of which 52 (11.1%) experienced minor complications and 7 (1.48%) major complications. A total of 16 (3.39%) failures were reported. CONCLUSION This systematic review describes the current available evidence for the treatment of osteochondral knee defects with MaioRegen Osteochondral substitute reporting promising satisfactory and reliable results at mid-term follow-up. A low rate of complications and failure was reported, confirming the safety of this scaffold. Considering the low level of evidence of the study included in the review, this data does not support the superiority of the Maioregen in terms of clinical improvement at follow-up compared to conservative treatment or other cartilage techniques.
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Osteoarthritis, Exercise, and Tissue Engineering: A Stimulating Triad for Health Professionals. J Aging Res 2019; 2019:1935806. [PMID: 31192012 PMCID: PMC6525949 DOI: 10.1155/2019/1935806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/13/2019] [Accepted: 03/27/2019] [Indexed: 12/12/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative disease, promoted by abnormal chronic mechanical loading over the joint, for instance, due to excessive body mass. Patients frequently report pain, fatigue, and limitations in specific functional daily activities. Regarding the treatment of OA, two nonpharmacological options are available. However, it is not clear which type and intensity of exercise have better outcomes in treatment and how tissue engineering can be a promising field due to the mechanical load implants will suffer. The aims of this work were to investigate (1) the main characteristics, prevalence, and consequences of OA; (2) the exercise prescription guidelines and whether exercise interventions have a positive effect on OA treatment; and (3) the novel improvements on tissue engineering for OA treatment. Both patients and practitioners should be aware that benefits may come from prescribed and supervised exercise. Recent studies have highlighted that an optimal balance between exercise and nutritional income should be widely recommended. Regarding tissue engineering, significant steps towards the development of implants that mimic the native tissue have been taken. Thus, further studies should focus on the impact that exercise (repetitive loading) might have on cartilage regeneration. Finally, suggestions for future research were proposed.
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Blanke F, Vogt S. Regeneration artikulärer Knorpeldefekte am Kniegelenk. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-0277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen K, Lv ZT, Zhou CH, Liang S, Huang W, Wang ZG, Zhu WT, Wang YT, Jing XZ, Lin H, Guo FJ, Cheng P, Chen AM. Peimine suppresses interleukin‑1β‑induced inflammation via MAPK downregulation in chondrocytes. Int J Mol Med 2019; 43:2241-2251. [PMID: 30896805 DOI: 10.3892/ijmm.2019.4141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/13/2019] [Indexed: 11/06/2022] Open
Abstract
Osteoarthritis (OA) is the most common type of degenerative joint disease and secreted inflammatory molecules serve a pivotal role in it. Peimine has been reported to have anti‑inflammatory activity. In order to investigate the potential therapeutic role of Peimine in OA, mouse articular chondrocytes were treated with IL‑1β and different doses of Peimine in vitro. The data revealed that Peimine not only suppressed IL‑1β‑induced production of nitric oxide (NO) and prostaglandin E2, but also reduced the protein levels of inducible NO synthase (iNOS) and cyclooxygenase‑2 (COX‑2). In addition, Peimine inhibited the IL‑1β‑induced mRNA expression of matrix metalloproteinase (MMP)‑1, MMP‑3, MMP‑9, MMP‑13, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)‑4 and ADAMTS‑5. Furthermore, Peimine inhibited IL‑1β‑induced activation of the mitogen‑activated protein kinase (MAPK) pathway. The protective effect of Peimine on IL‑1β‑treated chondrocytes was attenuated following activation of the MAPK pathway, as demonstrated by the increased expression levels of MMP‑3, MMP‑13, ADAMTS‑5, iNOS and COX‑2 compared with the Peimine group. The in vivo data suggested that Peimine limited the development of OA in the mouse model. In general, the data indicate that Peimine suppresses IL‑1β‑induced inflammation in mouse chondrocytes by inhibiting the MAPK pathway, suggesting a promising therapeutic role for Peimine in the treatment of OA.
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Affiliation(s)
- Kun Chen
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zheng-Tao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Chen-He Zhou
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Shuang Liang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Wen Huang
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China
| | - Zheng-Gang Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Wen-Tao Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yu-Ting Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xing-Zhi Jing
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Hui Lin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Feng-Jing Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Peng Cheng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - An-Min Chen
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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