Options for tissue engineering to address challenges of the aging skeleton

Vascular persistence following precision micropuncture

OBJECTIVE

The success of engineered tissues continues to be limited by time to vascularization and perfusion. Recently, we described a simple microsurgical approach, termed micropuncture (MP), which could be used to rapidly vascularize an adjacently placed scaffold from the recipient macrovasculature. Here we studied the long-term persistence of the MP-induced microvasculature.

METHODS

Segmental 60 μm diameter MPs were created in the recipient rat femoral artery and vein followed by coverage with a simple Type 1 collagen scaffold. The recipient vasculature and scaffold were then wrapped en bloc with a silicone sheet to isolate intrinsic vascularization. Scaffolds were harvested at 28 days post-implantation for detailed analysis, including using a novel artificial intelligence (AI) approach.

RESULTS

MP scaffolds demonstrated a sustained increase of vascular density compared to internal non-MP control scaffolds (p < 0.05) secondary to increases in both vessel diameters (p < 0.05) and branch counts (p < 0.05). MP scaffolds also demonstrated statistically significant increases in red blood cell (RBC) perfused lumens.

CONCLUSIONS

This study further highlights that the intrinsic MP-induced vasculature continues to persist long-term. Its combination of rapid and stable angiogenesis represents a novel surgical platform for engineered scaffold and graft perfusion.

Nicotinamide Mononucleotide Alleviates Osteoblast Senescence Induction and Promotes Bone Healing in Osteoporotic Mice

Combating the accumulated senescent cells and the healing of osteoporotic bone fractures in the older remains a significant challenge. Nicotinamide mononucleotide (NMN), a precursor of NAD+, is an excellent candidate for mitigating aging-related disorders. However, it is unknown if NMN can alleviate senescent cell induction and enhance osteoporotic bone fracture healing. Here we show that NMN treatment partially reverses the effects of tumor necrosis factor-alpha (TNF-α) on human primary osteoblasts (HOBs): senescent cell induction, diminished osteogenic differentiation ability, and intracellular NAD+ and NADH levels. Mechanistically, NMN restores the mitochondrial dysfunction in HOBs induced by TNF-α evidenced by increased mitochondrial membrane potential and reduced reactive oxidative species and mitochondrial mass. NMN also increases mitophagy activity by down-regulating P62 expression and up-regulating light chain 3B-II protein expression. In addition, the cell senescence protective effects of NMN on HOBs are mitigated by a mitophagy inhibitor (Bafilomycin A1). In vivo, NMN supplementation attenuates senescent cell induction in growth plates, partially prevents osteoporosis in an ovariectomized mouse model, and accelerates bone healing in osteoporotic mice. We conclude that NMN can be a novel and promising therapeutic candidate to enhance bone fracture healing capacity in the older.

A Spheroid Model of Early and Late-Stage Osteosarcoma Mimicking the Divergent Relationship between Tumor Elimination and Bone Regeneration

Osteosarcoma is the most diagnosed bone tumor in children. The use of tissue engineering strategies after malignant tumor resection remains a subject of scientific controversy. As a result, there is limited research that focuses on bone regeneration postresection, which is further compromised following chemotherapy. This study aims to develop the first co-culture spheroid model for osteosarcoma, to understand the divergent relationship between tumor elimination and bone regeneration. By manipulating the ratio of stromal to osteosarcoma cells the modelled cancer state (early/late) is modified, as is evident by the increased tumor growth rates and an upregulation of a panel of well-established osteosarcoma prognostic genes. Validation of the authors' model is conducted by analyzing its ability to mimic the cytotoxic effects of the FDA-approved chemotherapeutic Doxorubicin. Next, the model is used to investigate what effect osteogenic supplements have, if any, on tumor growth. When their model is treated with osteogenic supplements, there is a stimulatory effect on the surrounding stromal cells. However, when treated with chemotherapeutics this stimulatory effect is significantly diminished. Together, the results of this study present a novel multicellular model of osteosarcoma and provide a unique platform for screening potential therapeutic options for osteosarcoma before conducting in vivo experiments.

Tissue Engineering: What is New?

Soft and hard tissue engineering has expanded the frontiers of oral/maxillofacial augmentation. Soft tissue grafting enhancements include improving flap prevascularization and using stem cells and other cells to create not only the graft, but also the vascularization and soft tissue scaffolding for the graft. Hard tissue grafts have been enhanced by osteoinductive factors, such as bone morphogenic proteins, that have allowed the elimination of harvesting autogenous bone and thus decrease the need for other surgical sites. Advancements in bone graft scaffolds have developed via seeding with stem cells and improvement of the silica/calcium/phosphate composite to improve graft characteristics and healing.

Mathematical and computational models for bone tissue engineering in bioreactor systems

Research into cellular engineered bone grafts offers a promising solution to problems associated with the currently used auto- and allografts. Bioreactor systems can facilitate the development of functional cellular bone grafts by augmenting mass transport through media convection and shear flow-induced mechanical stimulation. Developing successful and reproducible protocols for growing bone tissue in vitro is dependent on tuning the bioreactor operating conditions to the specific cell type and graft design. This process, largely reliant on a trial-and-error approach, is challenging, time-consuming and expensive. Modelling can streamline the process by providing further insight into the effect of the bioreactor environment on the cell culture, and by identifying a beneficial range of operational settings to stimulate tissue production. Models can explore the impact of changing flow speeds, scaffold properties, and nutrient and growth factor concentrations. Aiming to act as an introductory reference for bone tissue engineers looking to direct their experimental work, this article presents a comprehensive framework of mathematical models on various aspects of bioreactor bone cultures and overviews modelling case studies from literature.

Electrical Stimulation of Human Mesenchymal Stem Cells on Conductive Nanofibers Enhances their Differentiation toward Osteogenic Outcomes

Tissue scaffolds allowing the behavior of the cells that reside within them to be controlled are of particular interest for tissue engineering. Herein, the preparation of conductive fiber-based bone tissue scaffolds (nonwoven mats of electrospun polycaprolactone with an interpenetrating network of polypyrrole and polystyrenesulfonate) is described that enable the electrical stimulation of human mesenchymal stem cells to enhance their differentiation toward osteogenic outcomes.

Electrical stimulation of human mesenchymal stem cells on biomineralized conducting polymers enhances their differentiation towards osteogenic outcomes

Tissue scaffolds allowing the behaviour of the cells that reside on them to be controlled are of particular interest for tissue engineering.

Bone tissue engineering: recent advances and challenges

The worldwide incidence of bone disorders and conditions has trended steeply upward and is expected to double by 2020, especially in populations where aging is coupled with increased obesity and poor physical activity. Engineered bone tissue has been viewed as a potential alternative to the conventional use of bone grafts, due to their limitless supply and no disease transmission. However, bone tissue engineering practices have not proceeded to clinical practice due to several limitations or challenges. Bone tissue engineering aims to induce new functional bone regeneration via the synergistic combination of biomaterials, cells, and factor therapy. In this review, we discuss the fundamentals of bone tissue engineering, highlighting the current state of this field. Further, we review the recent advances of biomaterial and cell-based research, as well as approaches used to enhance bone regeneration. Specifically, we discuss widely investigated biomaterial scaffolds, micro- and nano-structural properties of these scaffolds, and the incorporation of biomimetic properties and/or growth factors. In addition, we examine various cellular approaches, including the use of mesenchymal stem cells (MSCs), embryonic stem cells (ESCs), adult stem cells, induced pluripotent stem cells (iPSCs), and platelet-rich plasma (PRP), and their clinical application strengths and limitations. We conclude by overviewing the challenges that face the bone tissue engineering field, such as the lack of sufficient vascularization at the defect site, and the research aimed at functional bone tissue engineering. These challenges will drive future research in the field.

Bone regeneration by stem cell and tissue engineering in oral and maxillofacial region

Clinical imperatives for the reconstruction of jaw bone defects or resorbed alveolar ridge require new therapies or procedures instead of autologous/allogeneic bone grafts. Regenerative medicine, based on stem cell science and tissue engineering technology, is considered as an ideal alternative strategy for bone regeneration. In this paper, we review the current choices of cell source and strategies on directing the osteogenic differentiation of stem cells. The preclinical animal models for bone regeneration and the key translational points to clinical success in oral and maxillofacial region are also discussed. We propose comprehensive strategies based on stem cell and tissue engineering researches, allowing for clinical application in oral and maxillofacial region.

Evaluation of the ability of collagen-glycosaminoglycan scaffolds with or without mesenchymal stem cells to heal bone defects in Wistar rats

PURPOSE

The aim of this experiment was to examine the capacity of collagen-glycosaminoglycan scaffolds, with or without mesenchymal stem cells, to satisfactorily repair a 5-mm rat calvarial defect.

METHODS

Fifty-five Wistar rats were used in the study. The defects were either left empty to serve as controls (n = 7) or filled with cell-free scaffolds (n = 11), cell-seeded scaffolds that were pre-cultured in standard culture medium (n = 13), cell-seeded scaffolds that were pre-cultured in osteoinductive factor-supplemented medium (n = 12) or particulate autogenous bone (n = 12). The animals were sacrificed at 12 weeks after surgery, and specimens were prepared for histomorphometric analysis. The linear bone healing and the bone area within the defect were measured.

RESULTS

Comparable results were obtained using cell-free collagen-glycosaminoglycan scaffolds and autogenous bone both in terms of linear bone healing (P < 0.986) and area of new bone (P < 0.846). While the test groups showed significantly more bone formation compared to the empty defect control group, the linear bone healing and area of new bone within the defect were significantly lower in the cell-seeded scaffolds than in the cell-free scaffolds. The results have demonstrated that a cell-free collagen-glycosaminoglycan scaffold is capable of repairing a 5-mm rat calvarial defect as effectively as autogenous bone and that seeding the scaffold with pre-cultured mesenchymal stem cells prior to implantation offered no beneficial effect and resulted in incomplete healing of the defect.

CONCLUSIONS

The results thus suggest that the scaffold has immense potential for tissue repair showing favorable osteoconductive properties, biocompatibility and degradability.

Progress and outlook of inorganic nanoparticles for delivery of nucleic acid sequences related to orthopedic pathologies: a review

The anticipated growth in the aging population will drastically increase medical needs of society; of which, one of the largest components will undoubtedly be from orthopedic-related pathologies. There are several proposed solutions being investigated to cost-effectively prepare for the future--pharmaceuticals, implant devices, cell and gene therapies, or some combination thereof. Gene therapy is one of the more promising possibilities because it seeks to correct the root of the problem, thereby minimizing treatment duration and cost. Currently, viral vectors have shown the highest efficacies, but immunological concerns remain. Nonviral methods show reduced immune responses but are regarded as less efficient. The nonviral paradigms consist of mechanical and chemical approaches. While organic-based materials have been used more frequently in particle-based methods, inorganic materials capable of delivery have distinct advantages, especially advantageous in orthopedic applications. The inorganic gene therapy field is highly interdisciplinary in nature, and requires assimilation of knowledge across the broad fields of cell biology, biochemistry, molecular genetics, materials science, and clinical medicine. This review provides an overview of the role each area plays in orthopedic gene therapy as well as possible future directions for the field.

Initial cell pre-cultivation can maximize ECM mineralization by human mesenchymal stem cells on silk fibroin scaffolds

Fast remineralization of bone defects by means of tissue engineering is one of many targets in orthopedic regeneration. This study investigated the influence of a range of pre-culture durations for human bone marrow derived mesenchymal stem cells (hMSC) before inducing differentiation into osteoblast-like cells. The aim was to find the conditions that lead to maximal extracellular matrix (ECM) mineralization, in terms of both amount and best distribution. Additionally, the influence of silk fibroin scaffold pore size on mineralization was assessed. The formation of mineralized ECM by hMSCs cultured in osteogenic medium on silk fibroin scaffolds was monitored and quantified for up to 72 days in culture using non-invasive time-lapse micro-computed tomography (micro-CT). ECM mineralization increased linearly 3 weeks after the beginning of the experiment with addition of differentiation medium. Biochemical end-point assays measured the amount of DNA, calcium deposits, alkaline phosphatase activity and cell metabolic activity to corroborate the hypothesis that an initial pre-culture period of hMSCs on silk fibroin scaffolds can accelerate mineralized ECM formation. According to the micro-CT analysis mineralization on silk fibroin scaffolds with pores of 112-224 μm diameter was most efficient with an initial cell pre-culture period of 9 days, showing 6.87±0.81× higher mineralization values during the whole cultivation period than without an initial cell pre-culture period.

Bone grafting, orthopaedic biomaterials, and the clinical need for bone engineering

As the population ages, the number of operations performed on bone is expected to increase. Diseases such as arthritis, tumours, and trauma can lead to defects in the skeleton requiring an operation to replace or restore the lost bone. Surgeons can use autografts, allografts, and/or bone graft substitutes to restore areas of bone loss. Surgical implants are also used in addition or in isolation to replace the diseased bone. This review considers the application of available bone grafts in different clinical settings. It also discusses recently introduced bioactive biomaterials and highlights the clinical difficulties and technological deficiencies that exist in our current surgical practice.

Farnesol-modified biodegradable polyurethanes for cartilage tissue engineering

A bifunctionalized 3,7,11-trimethyl-2,6,10-dodecatrien-1-diaminobutane amide (isoprenoid) was obtained from 3,7,11-trimethyl-2,6,10-dodecatrien-1-ol (farnesol) in a three-step synthesis. The bifunctionalized isoprenoid was characterized using infrared spectroscopy and (1)H and (13)C nuclear magnetic resonance spectroscopy and was covalently incorporated (0.12 mmol x g(-1)) into the biodegradable aliphatic polyurethane formed on the polycondensation reaction of poly(epsilon-caprolactone) diol, 1,4,3,6-dianhydro-D-sorbitol and 1,6-hexamethylene diisocyanate. Although the covalent incorporation of the isoprenoid molecule into the polyurethane chain modified the surface chemistry of the polymer, it did not affect the viability of attached chondrocytes. Porous 3D scaffolds were produced from the modified and unmodified biodegradable segmented polyurethanes by a salt leaching-phase-inverse technique. The scaffolds were seeded with bovine chondrocytes encapsulated in fibrin gel and cultured in vitro for 14 days. The incorporation of bifunctional isoprenoid into the polyurethane affected the morphology of the scaffolds produced, when compared with the morphology of the scaffolds produced using the same technique from the unmodified polyurethane. As a consequence, there was more uniform cell seeding and more homogeneous distribution of the synthesized extracellular matrix throughout the scaffold resulting in a reduced cell/tissue layer at the edges of the constructs. However, glycosaminoglycan (GAG), DNA content, and chondrocytes phenotype in the scaffolds produced from these two polyurethane formulations did not vary significantly. The findings suggest that the change of surface characteristics and the more open pore structure of the scaffolds produced from the isoprenoid-modified polyurethane are beneficial for the seeding efficiency and the homogeneity of the tissue engineered constructs.

Design and validation of a novel bioreactor principle to combine online micro-computed tomography monitoring and mechanical loading in bone tissue engineering

Mechanical loading plays an important role in bone remodeling in vivo and, therefore, has been suggested as a key parameter in stem cell-based engineering of bone-like tissue in vitro. However, the optimization of loading protocols during stem cell differentiation and subsequent bone-like tissue formation is challenged by multiple input factors, which are difficult to control and validate. These include the variable cellular performance of cells harvested from different patients, nonstandardized culture media components, the choice of the biomaterial forming the scaffold, and its morphology, impacting a broader validity of mechanical stimulation regimens. To standardize the cell culture of bone-like tissue constructs, we suggest the involvement of time-lapsed feedback loops. For this purpose we present a prototype bioreactor that combines online, nondestructive monitoring using micro-computed tomography and direct mechanical loading of three-dimensional tissue engineering constructs. Validation of this system showed displacement steps down to 1 microm and cyclic sinusoidal loadings of up to 10 Hz. Load detection resolution was 0.01 N, and micro-computed tomography data were of high quality. For the first time, the developed bioreactor links time-lapsed, nondestructive, and dynamic imaging with mechanical stimulation, designed for cell culture under sterile conditions. This system is believed to substantially improve today's experimental options to study and optimize osteogenic stem cell culture and differentiation at the interface with mechanical stimulation.

Systematic evaluation of a tissue-engineered bone for maxillary sinus augmentation in large animal canine model

The objective of this study is to systematically evaluate the effects of a tissue-engineered bone complex for maxillary sinus augmentation in a canine model. Twelve sinus floor augmentation surgeries in 6 animals were performed bilaterally and randomly repaired with the following 3 groups of grafts: group A consisted of tissue-engineered osteoblasts/beta-TCP complex (n=4); group B consisted of beta-TCP alone (n=4); group C consisted of autogenous bone obtained from iliac crest as a positive control (n=4). All dogs had uneventful healings following the surgery. Sequential polychrome fluorescent labeling, maxillofacial CT, microhardness tests, as well as histological and histomorphometric analyses indicated that the tissue-engineered osteoblasts/beta-TCP complex dramatically promoted bone formation and mineralization and maximally maintained the height and volume of elevated maxillary sinus. By comparison, both control groups of beta-TCP or autologous iliac bone showed considerable resorption and replacement by fibrous or fatty tissue. We thus conclude that beta-TCP alone could barely maintain the height and volume of the elevated sinus floor, and that the transplantation of autogenous osteoblasts on beta-TCP could promote earlier bone formation and mineralization, maximally maintain height, volume and increase the compressive strength of augmented maxillary sinus. This tissue engineered bone complex might be a better alternative to autologous bone for the clinical edentulous maxillary sinus augmentation.

Platelet-derived growth factor BB treated osteoprogenitors inhibit bone regeneration

The study evaluates the ability of osteoprogenitors treated with platelet-derived growth factor BB (PDGF-BB) delivered on vinyl styrene microbeads (VSM) to regenerate rat calvarial critical-size defects (CSDs). Fetal rat calvarial cells were cultured and tested for their ability to attach to VSM using scanning electron microscopy. Twenty-five rats were equally divided into 5 groups; a negative control (GPI), vinyl styrene microbeads (GPII), PDGF-BB (GPIII), VSM plus osteoblastic progenitors (GPIV), and VSM plus PDGF-BB treated osteoblastic progenitors (GPV). CSDs were created and reconstructed according to the mentioned study design. After 16 weeks, animals were sacrificed and defect areas evaluated for bone regeneration. Cells attached to the microbeads; however, their morphology and topography were affected by the PDGF-BB. Transplanting the VSM/cells constructs to CSDs revealed significant reduction of bone regeneration upon pretreatment of the cells with PDGF-BB. However, short-term application of PDGF-BB to CSD stimulated bone regeneration. The ability of osteoprogenitor cells to regenerate bone was significantly reduced upon pretreatment with PDGF-BB in vitro. However, adding PDGF-BB at the time of surgery had stimulated bone regeneration.

Marrow-derived mesenchymal stem cells-directed bone regeneration in the dog mandible: a comparison between biphasic calcium phosphate and natural bone mineral

OBJECTIVE

This study was designed to compare mesenchymal stem cell (MSC)-based alveolar bone regeneration in biphasic bone substitutes and natural bone mineral in a canine full-thickness alveolar defect model.

MATERIALS AND METHODS

MSCs were isolated from bone marrow aspirates and culture expanded through 3 successive subcultures. The bone differentiation potential of third passage cells was evaluated and confirmed in vitro before cells were used in the transplantation experiment. Undifferentiated cells were then incubated with 3 x 3 x 3 mm(3) hydroxyapatite/beta-tricalcium phosphate (HA/TCP) matrices (Kasios, Lanauguet, France) and 1- to 2-mm Bio-Oss spongiosa (Geistlich Biomaterials, Osteohealth, Switzerland), which is a natural bovine bone mineral (NBM). Kasios/cell, Kasios alone, Bio-Oss/cell, and Bio-Oss alone were implanted in masseter muscle and 4 cylindrical (10-mm diameter) through-and-through bilateral mandibular body defects in 4 mongrel dogs. Histomorphometric analysis was performed 6 weeks after insertion of the scaffold loaded with MSCs.

RESULTS

H&E staining of the decalcified scaffold and scanning electron microscopy demonstrated large MSC coverage of the HA/TCP and Bio-Oss. Cell-loaded Kasios matrices showed the greatest amount of the bone regeneration among the groups in both the muscle (29.11%) and the bone specimens (65.78%). Cell-free biphasic scaffold revealed 44.9% bone fill in bone defects and 23.55% in muscle specimen, and Bio-Oss alone matrices had the least amount of new bone formation: 36.84% and 24.16% in bone and muscle specimens respectively. Kasios loaded with MSCs demonstrated more bone regeneration than Bio-Oss/cell but there was no significant statistical difference (P > .05).

CONCLUSIONS

New biphasic synthetic bone substitutes may offer better conditions for bone regeneration than traditional bone substitute in combination with MSCs. They remained in the defect and contributed to bone regeneration.

Bioluminescence imaging of calvarial bone repair using bone marrow and adipose tissue-derived mesenchymal stem cells

A combined strategy using bioluminescence imaging, bone densitometry and histology was used to analyze the bone regeneration capacity of human bone marrow (hBMSC) and adipose tissue (hAMSC) mesenchymal stem cells, seeded in an osteoconductive arginine-glycine-aspartate (RGD) crosslinked hydrogel scaffold, implanted in a mouse calvarial bone defect. We show that firefly luciferase labeled stem cells can be monitored in vivo through a prolonged 90 days period, during which hBMSCs survive better than hAMSCs and that the density of scaffold bearing defects increased significantly more than that of defects without scaffolds.

Tissue engineering of the synovial joint: the role of cell density

The ultimate goal in the tissue engineering of the synovial joint is to fabricate biologically derived analogues that can replace severely degenerated or traumatized synovial joint components. A number of challenges must be addressed before reaching this ultimate goal. In this report, the relevance of cell seeding density in the synthesis of chondrogenic and osteogenic matrices from human mesenchymal stem cells is explored. Human mesenchymal stem cells (hMSCs) were differentiated into chondrogenic cells and osteogenic cells ex vivo and encapsulated in poly(ethylene glycol) diacrylate (PEGDA) hydrogel at densities of 5 x 106 cells/ml, 40 x 10(6) cells/ml, and 80 x 10(6) cells/ml, in addition to a cell-free poly(ethylene glycol) (PEG) control group (0 x 10(6) cells/ml). Cell-seeded or cell-free PEG constructs were separately incubated in vitro for 4 weeks or implanted in vivo in the dorsum of immunodeficient rats for 4 weeks. In-vitro data demonstrated that hMSC-derived chondrocytes or hMSC-derived osteoblasts maintained their lineages per Safranin O and von Kossa staining after incubation for 4 weeks. The general pattern of initial cell seeding densities of 5 x 10(6) cells/ml, 40 x 10(6) cells/ml, and 80 x 10(6) cells/ml were preserved following in-vitro cultivation. Similarly, in-vivo data revealed that hMSC-derived chondrocytes and hMSC-derived osteoblasts maintained their respective lineages and the pattern of cell-seeding densities. An attempt was made to fabricate a composite construct with PEGDA hydrogel and polycaprolactone (PCL) with designed internal porosity for an osteochondral graft. Various cell-seeding densities as delineated in this report can be realized in the composite PEG-PCL graft. The findings demonstrate that cell-seeding density is likely a key parameter to consider in tissue-engineering design. The source of cells can either be transplanted cells or internally recruited cells.

Bespoke human hypertrophic chondrocytic cell lines provide the osteoinductive signals required for vascularized bone formation

Hypertrophic cartilage provides the morphological and biochemical template for orchestrating bone growth. To produce a bone-inductive material such as hypertrophic cartilage for clinical use, we have conditionally immortalized hypertrophic chondrocytic cells from human femur and expanded them in vitro through more than 145 divisions. The clonal cell lines generated by this process consistently express signals that induce both rat and human marrow cells to differentiate in vitro into osteoblastic cells. Further, implantation of the cell-free extracellular matrix from the immortalized chondrocytic cells causes vascularized bone to form in vivo in bony defects, but not in ectopic sites such as skeletal muscle. This study shows that molecular techniques can be used to generate bespoke human cell lines for bone tissue engineering. It also demonstrates that matrix material generated from human immortalized hypertrophic chondrocytic cells may provide an abundant, efficacious, and safer alternative to bone autograft--the currently preferred material for fracture repair.

Non-invasive time-lapsed monitoring and quantification of engineered bone-like tissue

The formation of bone-like tissue from human mesenchymal stem cells (hMSC) cultured in osteogenic medium on silk fibroin scaffolds was monitored and quantified over 44 days in culture using non-invasive time-lapsed micro-computed tomography (microCT). Each construct was imaged nine times in situ. From microCT imaging, detailed morphometrical data on bone volume density, surface-to-volume ratio, trabecular thickness, trabecular spacing, and the structure model index and tissue mineral density were obtained. microCT irradiation did not impact the osteogenic performance of hMSCs based on DNA content, alkaline phosphatase activity, and calcium deposition when compared to non-exposed control samples. Bone-like tissue formation initiated at day 10 of the culture with the deposition of small mineralized clusters. Tissue mineral density increased linearly over time. The surface-to-volume ratio of the bone-like tissues converged asymptotically to 26 mm(-1). Although in vitro formation of bone-like tissue started from clusters, the overall bone volume was not predictable from the time, number, and size of initially formed bone-like clusters. Based on microstructural analysis, the morphometry of the tissue-engineered constructs was found to be in the range of human trabecular bone. In future studies, non-invasive, time-lapsed monitoring may enable researchers to culture tissues in vitro, right until the development of a desired morphology is accomplished. Our data demonstrate the feasibility of qualitatively and quantitatively detailing the spatial and temporal mineralization of bone-like tissue formation in tissue engineering.

Osteoporosis of hematologic etiology

OBJECTIVE

Here we present evidence that overexertion of the hematopoietic system following chronic bleeding plays an important role in the etiology of osteoporosis.

MATERIALS AND METHODS

C57BL/6 mice were exposed to chronic bloodletting (0.2 mL twice per month for 10 months), total body irradiation (900 cGy), or aging (20-30 months old). Bone marrow from standard untreated donors was transplanted under the kidney capsules of all three categories of recipients to investigate the influence of each of these conditions on new bone marrow formation. Cellularity and histologic structure of developed osteohematopoietic sites and histomorphometry of lumbar vertebrae were studied, thus assessing the role of bleeding, irradiation, and old age on new bone formation and effects on existing bone.

RESULTS

Chronic blood loss led to augmented production of hematopoietic microenvironment, relative reduction in the amount of generated bone, and activation of the bone resorptive process in the newly forming osteohematopoietic complex. Similar results were seen in irradiated and senescent mice. Activity, stimulating expansion of hematopoietic microenvironment, was revealed in the plasma of all three categories of experimental mice. Likewise, quantification of the relative amount of bone and hematopoietic areas in skeletal sites showed a significant reduction in bone tissue of the first lumbar vertebrae of chronically bled mice.

CONCLUSIONS

Our experimental data, together with existing clinical observations documenting the role of hematopoietic insufficiency in the development of osteoporosis, confirm our working hypothesis that chronic blood loss may be the primary factor responsible for the rapid and consistent development of postmenopausal osteoporosis.

Efficacy of bone marrow-derived stem cells in strengthening osteoporotic bone in a rabbit model

Osteoporosis might be due to defects in mesenchymal stem cells (MSCs) that lead to reduced proliferation and osteoblast differentiation. We hypothesized that transplantation of MSCs into sites at risk for developing osteoporotic bone could improve bone structure and biomechanics. The aim of this study was to establish an osteoporosis rabbit model by ovariectomy (OVX), characterize the autologous MSCs from the OVX rabbits, and transplant the autologous MSCs into the OVX rabbits. MSCs harvested from bone marrow of normal and OVX rabbits were culture expanded and differentiated in osteogenic medium. Phenotypes were evaluated by collagen I immunostaining, von Kossa staining, and quantitative assays of bone-specific alkaline phosphatase (B-ALP) and osteocalcin (OCN). MSCs were transfected with green fluorescence protein (GFP) and implanted in the gluteus muscle to trace their fate in vivo. Cultured autologous MSCs from OVX rabbits were constructed in calcium alginate gels and then transplanted in the distal femurs. At 4 and 8 weeks after implantation, histomorphometrical and biomechanical analyses were performed on the samples. MSCs from OVX rabbits displayed higher B-ALP activity, but had similar OCN levels as compared to those from sham rabbits. After 8 weeks of implantation, more bone apposition was found in the MSC-alginate-treated group. Histomorphometry indicated increased trabecular thickness. Histology also illustrated improved microstructures with newly formed osteoids and enhanced trabecular thickness. In addition, biomechanical testing revealed stronger stiffness in the MSC-alginate treatment group. Therefore, this study implies that transplantation of MSCs can help to strengthen osteoporotic bone in rabbits.

Investigation of a thermoplastic polymeric carrier for bone tissue engineering using allogeneic mesenchymal stem cells in granular scaffolds

PURPOSE

The purpose of this project was to compare alveolar bone repair by allogeneic mesenchymal stem cells using bioglass or synthetic hydroxyapatite (HA)/tricalcium phosphate (TCP) granular scaffolds delivered in a thermoplastic polymeric carrier.

MATERIALS AND METHODS

Canine mesenchymal stem cells were obtained from iliac crest bone marrow of beagle dogs and expanded without differentiation. Cells were resuspended at a final concentration of 5 x 10(6) cells/ml in a thermoplastic polymeric carrier (30% w/v Pluronic F-127) and mixed with an equal volume of synthetic HA/TCP or bioglass scaffold and placed into surgically created 5 mm cylindrical defects in the edentulous premolar region of beagle dogs. After 4 weeks or 7 weeks, tissue healing was evaluated by standard histomorphometric methods (Bioquant Nova, Bioquant Image Analysis Corporation, Nashville, TN) by measurement of bone formation within five random sites from each biopsy.

RESULTS

After 4 weeks, sites treated with or without mesenchymal stem cells contained 58.25 +/-18.43% or 43.35 +/- 17.68% bone area (p= 0.049), respectively. After 7 weeks, sites treated with or without mesenchymal stem cells contained 62.73 +/- 19.10% or 60.39 +/- 21.32% bone area. Bone formation occurred without inflammation in defects treated using Pluronic F-127 carrier with and without mesenchymal stem cells. There was no difference in percent bone area when bioglass or HA/TCP scaffolds were compared at either time point.

CONCLUSIONS

The thermoplastic polymeric carrier did not limit alveolar bone repair in the canine mandible. The combination of a thermoplastic, viscous carrier with a granular scaffold allowed for the delivery of allogeneic mesenchymal stem cells in a clinically manageable form that enhanced bone formation at early stages of alveolar repair.

Stem-cell-driven regeneration of synovial joints

Mammalian skeletal motion is made possible by synovial joints. Widespread suffering from arthritis and joint injuries has motivated recent effort to regenerate a stem-cell-driven synovial joint condyle implantable in total joint replacement. A single adult stem cell lineage, mesenchymal stem cells, differentiate to form all components of a synovial joint. Whereas localized joint lesions may be repaired by either cell-based or cell-free approaches, regeneration of the entire articular condyle of the synovial joint is unattainable without tissue-forming cells. A series of experiments are presented here to describe our initial attempts to regenerate a synovial joint condyle in the shape and dimensions of a human mandibular condyle, with both cartilaginous and osseous components derived from a single population of rat mesenchymal stem cells. Upcoming challenges are along several intertwining fronts including structural integrity, tissue maturation, mechanical strength and host integration. The synovial joint condyle may turn out to be one of the first 'human body parts' or organs truly regeneratable by stem-cell-derived approaches. Current approaches to regenerate the synovial joint condyle from stem-cell-derived multiple cell lineages may also offer clues for engineering complex organs such as the kidney or liver.

Evolving concepts in bone tissue engineering

The field of tissue engineering integrates the latest advances in molecular biology, biochemistry, engineering, material science, and medical transplantation. Researchers in the developing field of regenerative medicine have identified bone tissue engineering as an attractive translational target. Clinical problems requiring bone regeneration are diverse, and no single regeneration approach will likely resolve all defects. Recent advances in the field of tissue engineering have included the use of sophisticated biocompatible scaffolds, new postnatal multipotent cell populations, and the appropriate cellular stimulation. In particular, synthetic polymer scaffolds allow for fast and reproducible construction, while still retaining biocompatible characteristics. These criteria relate to the immediate goal of determining the ideal implant. The search is becoming a reality with widespread availability of biocompatible scaffolds; however, the desired parameters have not been clearly defined. Currently, most research focuses on the use of bone morphogenetic proteins (BMPs), specifically BMP-2 and BMP-7. These proteins induce osteogenic differentiation in vitro, as well as bone defect healing in vivo. Protein-scaffold interactions that enhance BMP binding are of the utmost importance, since prolonged BMP release creates the most osteogenic microenvironment. Transition into clinical studies has had only mild success and relies on large doses of BMPs for bone formation. Advances within the field of bone tissue engineering will likely overcome these challenges and lead to more clinically relevant therapies.

Exogenous Runx2 Expression Enhances in Vitro Osteoblastic Differentiation and Mineralization in Primary Bone Marrow Stromal Cells

Bone marrow stromal cells represent a promising cell source for cell-based therapeutic and bone tissue-engineering applications, but are restricted by a low frequency in healthy marrow, an age-related decrease in osteogenic capacity, and a propensity for dedifferentiation during in vitro expansion. To address these limitations, retroviral gene delivery was used to examine the effects of sustained and elevated expression of the Runx2 osteoblastic transcription factor on osteoblastic gene and protein expression and mineralization in primary rat bone marrow stromal cells. Runx2 overexpression upregulated several osteoblast-specific genes, including collagen type I and osteocalcin, and enhanced alkaline phosphatase activity and biological mineral deposition. Forced Runx2 expression in combination with dexamethasone increased matrix mineralization compared with exogenous Runx2 expression or dexamethasone treatment alone, whereas dexamethasone-free control cultures displayed minimal mineralization. These additive effects suggest complementary interactions between Runx2 and dexamethasone-responsive regulatory factors. Finally, Runx2 overexpression in stromal cell cultures undergoing considerable in vitro expansion resulted in higher matrix mineralization capacity compared with controls, which completely lost the ability to produce mineralized matrix even in the presence of dexamethasone. These findings provide a novel strategy for cell-based therapeutic applications requiring significant numbers of osteogenic cells to synthesize mineralized constructs for the treatment of large bone defects.

Hydrodynamic Shear Stimulates Osteocalcin Expression But Not Proliferation of Bone Marrow Stromal Cells

Bone marrow stromal cells (BMSCs) are a promising component for engineered bone tissues, but in vitro formation of a bonelike tissue requires culture conditions that direct these multipotent cells toward osteoblastic maturation. Fluid flow has been postulated to stimulate bone tissue development in vivo, but the effect of shear stress on proliferation and differentiation of osteoprogenitor cell cultures in vitro has not been examined closely. In this study BMSCs were cultured on fibronectin-coated substrates and exposed intermittently (for 30 min 3, 5, 7, 9, 11, and 13 days after seeding) to a spatially dependent range of shear stresses (0.36 to 2.7 dyn/cm(2)) using a radial-flow chamber. After 7 days cell density did not vary between sheared and control cell layers. In contrast, after 21 days the accumulation of osteocalcin protein (OC) in cell layers was increased significantly relative to static controls, while the quantity of multilayer cell aggregates (i.e., bone nodules) was diminished. Neither of these effects varied systematically with shear magnitude. Finally, pretreatment of cultures with the cyclooxygenase (COX)-2-specific inhibitor NS-398 blocked prostaglandin secretion in response to shearing flow and significantly reduced OC accumulation in cell layers. These results provide evidence that flow stimulates osteoblastic maturation but not proliferation of bone marrow stromal cells and that prostaglandin signaling is involved in this effect.

New frontiers in bone tissue engineering

No single scientific field can generate the ideal method of engineering bone. However, through collaboration and expansion of programs in bone tissue engineering, the right combination of materials, cells, growth factors, and methodology will come together for each clinical situation such that harvesting bone grafts will become obsolete. This article reviews the need for engineered bone and provides a historical perspective of bone engineering research, current research efforts, and the future direction of this work.

Investigation of allogeneic mesenchymal stem cell-based alveolar bone formation: preliminary findings

This study was designed to evaluate mesenchymal stem cell (MSC)-based alveolar bone regeneration in a canine alveolar saddle defect model. MSCs were loaded onto hydroxyapatite/tricalcium phosphate (HA/TCP) matrices. Scanning electron microscopic (SEM) evaluation demonstrated greater than 75% MSC coverage of the HA/TCP porous surface prior to placement regardless of MSC donor. Matrices, 6 mm x 6 mm x 20 mm, with and without cells, were implanted for 4 and 9 weeks, then removed for histological evaluation of bone formation. Cell-free control matrices were compared with MSC-loaded matrices post implantation. Histomorphometrical analysis showed that equivalent amounts of new bone were formed within the pores of the matrices loaded with autologous MSCs or MSCs from an unrelated donor. Bone formation in the cell-free HA/TCP matrices was less extensive. There was no histologic evidence of an immunological response to autologous MSCs. Surprisingly, allogeneic MSC implantation also failed to provoke an immune response. Analysis of circulating antibody levels against MSCs supported the hypothesis that neither autologous nor allogeneic MSCs induced a systemic response by the host. Analysis of dye-labelled MSCs in histological sections confirmed that the MSCs persisted in the implants throughout the course of the experiment. At 9 weeks, labelled cells were present within the lacunae of newly formed bone. We conclude that autologous and allogeneic MSCs have the capacity to regenerate bone within craniofacial defects.

Bone tissue engineering: recent advances and promising therapeutic agents

Bone regeneration can be accomplished with growth factors, cells and delivery systems. This review is a summary of these components that may be used for tissue regeneration. Support for the potential therapeutic applications of transcription factors in bone tissue engineering will also be discussed.

Gene therapy and tissue engineering in repair of the musculoskeletal system

Historically, surgeons have sought and used different procedures in order to augment the repair of various skeletal tissues. Now, with the completion of the Human Genome Project, many researchers have turned to gene therapy as a means to aid various ailments. In the orthopedic field, many strides have been made toward using gene therapy and tissue engineering in a clinical setting. In this review, several studies are outlined in different areas that gene therapy has or will influence orthopedic surgery. Gene therapy and tissue engineering can aid in fracture healing and spinal fusions by inducing bone formation, ligamentous repairs by increasing the production of connective tissue fibers, intervertebral disc disease by creating potential replacements, and articular cartilage repairs by providing means to improve cartilage. As we continue to see great contributions, such as the few mentioned here, this field will continue to mature and develop.

Characterization of bone defect repair in young and aged rat femur induced by xenogenic demineralized bone matrix

BACKGROUND

The osteoinductive effect of some biomaterials could be affected by those systemic conditions typical of old age. The aim of the present paper was to assess the effects of age on the healing of bone defects treated with demineralized bone matrix (DBM).

METHODS

The study was conducted in young (3 month old) and aged (18 month old) rats to assess the efficacy of DBM in the treatment of osseous defects in bone with limited repair capacities. A standard bone defect was created in the distal femoral condyles of male Wistar rats: the left condyle was filled with rabbit DBM granules, while the right condyle was left empty (control). Histological and microhardness analyses were performed at 30 and 45 days after implant surgery.

RESULTS

After implantation of xenogenic DBM, bone healing areas of the aged and young groups showed a significant increase in the formation of newly mineralized bone relative to controls. Measurements of trabecular thickness on day 45 revealed no differences between newly formed and preexisting bone in the young group, while control values were lower. Microhardness measurements demonstrated that newly mineralized bone, either induced by DBM or not, and preexisting bone were comparable in terms of trabecular hardness after 45 days.

CONCLUSIONS

In conclusion, xenogenic DBM seems to be effective in bone defect healing, since it increases mineralized tissue volume. In both DBM-filled and empty sites, age seems to have a detrimental effect on the volume of new bone formation but no influence on bone maturation.

Osteointegration of bioactive glass-coated zirconia in healthy bone: an in vivo evaluation

Osteointegration of yttria stabilised tetragonal zirconia (YSTZ), either coated with bioactive glass named RKKP bioglaze (RKKP) or uncoated, was evaluated in an animal model. RKKP-coated and uncoated (controls) YSTZ cylinders were implanted in the distal femoral epiphyses of 14 Sprague Dawley rats under general anaesthesia. At the experimental times of 30 and 60 days after sacrifice, histomorphometry and SEM microanalysis were performed on methylmethacrylate-embedded undecalcified sections to determine the osteointegration rate. At 30 days, a significantly higher affinity index was demonstrated in vivo by histomorphometric evaluation in RKKP-coated versus uncoated YSTZ implants p < 0.05); at 60 days, the coated implants behaved better than controls (affinity index of + 32%), but the difference observed lay within the statistical uncertainty. SEM analysis demonstrated better bone adhesion to the material in RKKP-coated YSTZ at both 30 and 60 days. These findings suggest that YSTZ coated with the bioactive glass named RKKP enhances osteointegration of ceramics.

Bone morphogenetic protein delivery systems

STUDY DESIGN

A review was conducted.

OBJECTIVES

To review the rationale for the use of carrier systems to deliver bone morphogenetic proteins to sites of orthopedic repair, and to discuss commonly used carriers.

SUMMARY OF BACKGROUND DATA

Carriers for bone morphogenetic protein in spine fusion are used to increase the retention of these osteogenic factors at the treatment site, and to serve as an osteoconductive matrix for bone forming cells while maintaining a space or volume in which bone formation can occur.

METHODS

The literature is reviewed and discussed.

RESULTS

Although bone morphogenetic proteins can induce bone formation when delivered in formulation buffer in small animal models, carriers often are used in larger animal models and human clinical trials to maintain the concentration of osteogenic factors at the treatment site for a sufficient period to allow bone-forming cells to migrate to the area of injury and to proliferate and differentiate. For spine fusion, carriers also are required to serve as an osteoconductive matrix for bone-forming cells while maintaining a space or volume in which bone formation can occur. Four major categories of carrier materials are used for osteogenic factor delivery: inorganic materials, synthetic polymers, natural polymers, and composites of the first three materials. In addition, allograft bone has been used to deliver osteogenic factors to the site of orthopedic repairs. The efficacy of osteogenic carrier combinations often is site specific and species specific. The requirement for supraphysiologic concentrations of osteogenic factors may be related to the ability of the delivery system to increase the retention time at the treatment site and overcome tight regulation of these factors by their inhibitors. Dose escalation in large animal models also may be related to a decrease in the number of responding cells and a slower rate of bone formation. New delivery systems being evaluated include depot delivery systems, viral vector systems, conjugated osteogenic factor delivery systems, and oral small molecule targets.

CONCLUSIONS

Delivery systems play an important role in the use of osteogenic factors to augment spine fusions and other orthopedic repairs.

Improvement in zirconia osseointegration by means of a biological glass coating: An in vitro and in vivo investigation

The biocompatibility and osseointegration of zirconia (ZrO(2)), either coated with RKKP bioglazeor uncoated, were evaluated in vitro and in vivo. The in vitro test was performed in human osteoblasts, whereas maximal sensitization was performed in 23 Dunkin Hurtley guinea pigs. RKKP bioglaze-coated and uncoated (controls) ZrO(2) cylinders were implanted in the distal femoral epiphyses of 14 Sprague-Dawley rats under general anesthesia, and animals were sacrificed at 30 and 60 days. Lactate dehydrogenase, alkaline phosphatase, and Thiazolyl Blue (MTT) were tested in vitro. A graded score was used for evaluating the results of the sensitization test. Histomorphometry and microhardness testing were performed to quantify the osseointegration rate, as well as bone quality around the implants. Neither in vitro cytotoxicity nor sensitization were observed. Histomorphometry demonstrated that at 30 days, the affinity index was significantly higher in coated implants than in uncoated ones (p < 0.05); at 60 days, the behavior of coated implants was better than that of uncoated ones, but differences were not significant. Significant increases in bone microhardness were found at 1000 microm from the interface area for both uncoated (p < 0.0005) and RKKP bioglaze-coated (p < 0.0005) ZrO(2), and also within 200 microm from the interface (p = 0.014) but only for coated ZrO(2.) These results suggest that RKKP bioglaze-coated ZrO(2) permits biocompatible devices with improved osseointegration properties to be manufactured.

The potential of biomimesis in bone tissue engineering: lessons from the design and synthesis of invertebrate skeletons

Synthetic bone replacement materials are now widely used in orthopedics. However, to date, replication of trabecular bone structure and mechanical competence has proved elusive. Maximization of bone tissue attachment to replacement materials requires a highly organized porous structure for tissue integration and a template for assembly, combined with structural properties analogous to living bone. Natural structural biomaterials provide an abundant source of novel bone replacements. Animal skeletons have been designed through optimization by natural selection to physically support and physiologically maintain diverse tissue types encompassing a variety of functions. These skeletons possess structural properties that provide support for the complete reconstruction and regeneration of ectodermal, mesodermal, and bone tissues derived from animal and human and are thus suited to a diversity of tissue engineering applications. Increased understanding of biomineralization has initiated developments in biomimetic synthesis with the generation of synthetic biomimetic materials fabricated according to biological principles and processes of self-assembly and self-organization. The synthesis of complex inorganic forms, which mimic natural structures, offers exciting avenues for the chemical construction of macrostructures and a new generation of biologically and structurally related bone analogs for tissue engineering.

Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects

OBJECTIVE

To review the basic scientific status of repair in articular cartilage tissue and to assess the efficiency of current clinical therapies instigated for the treatment of structural lesions generated therein as a result of trauma or during the course of various diseases, notably osteoarthritis (OA). Current scientific trends and possible directions for the future will also be discussed.

DESIGN

A systematic and critical analysis is undertaken, beginning with a description of the spontaneous repair responses in different types of lesion. Surgical interventions aimed at inducing repair without the use of active biologics will then be considered, followed by those involving active biologics and those drawing on autogenic and allogeneic tissue transplantation principles. Cell transplantation approaches, in particular novel tissue engineering concepts, will be critically presented. These will include growth-factor-based biological treatments and gene transfection protocols. A number of technical problems associated with repair interventions, such as tissue integration, tissue retention and the role of mechanical factors, will also be analysed.

RESULTS

A critical analysis of the literature reveals the existence of many novel and very promising biologically-based approaches for the induction of articular cartilage repair, the vast majority of which are still at an experimental phase of development. But prospective, double-blinded clinical trials comparing currently practiced surgical treatments have, unfortunately, not been undertaken.

CONCLUSION

The existence of many new and encouraging biological approaches to cartilage repair justifies the future investment of time and money in this research area, particularly given the extremely high socio-economic importance of such therapeutic strategies in the prevention and treatment of these common joint diseases and traumas. Clinical epidemiological and prospective trials are, moreover, urgently needed for an objective, scientific appraisal of current therapies and future novel approaches.

Osteogenesis of large segmental radius defects enhanced by basic fibroblast growth factor activated bone marrow stromal cells grown on non-woven hyaluronic acid-based polymer scaffold

Osteogenesis of large segmental radius defects in a rat model was studied by implanting a biodegradable non-woven hyaluronic acid-based polymer scaffold (Hyaff 11) alone or in combination with bone marrow stromal cells (BMSCs). These cells had been previously grown in vitro in mineralising medium either supplemented with basic fibroblast growth factor (bFGF) or unsupplemented. The healing of bone defects was evaluated at 40, 80, 160 and 200 days and the repair process investigated by radiographic, histomorphometric (assessment of new bone growth and lamellar bone) and histological analyses (toluidine blue and von Kossa staining). Mineralisation of bone defects occurred in the presence of the Hyaff 11 scaffold alone or when combined with BMSCs grown with or without bFGF, but each process had a different timing. In particular, bFGF significantly induced mineralisation from day 40, whereas 160 days were necessary for direct evidence that a similar process was developing under the other two conditions tested (scaffold alone or with BMSCs). Radiographic score, new bone growth and lamellar bone percentage were highly correlated. The present outcomes were further confirmed by toluidine blue and von Kossa staining. According to these in vivo findings, the Hyaff 11 scaffold is an appropriate carrier vehicle for the repair of bone defects; additionally, it can significantly accelerate bone mineralisation in combination with BMSCs and bFGF.

Delivering on the promise of bone morphogenetic proteins

The advent of bone growth factors has been widely anticipated since their successful production using recombinant DNA technology. Bone morphogenetic proteins (BMPs) are an important class of bone growth factors and will be the focus of this article. In the near future these therapeutics might revolutionize how clinicians treat such diverse orthopedic applications as the healing of broken bones, increasing bone density lost through aging, and strengthening the spine. These potent proteins require application directly at the site of repair via a delivery system. The choice of delivery system has a profound effect on the clinical outcome. In the past decade, researchers have focused on developing efficient delivery systems and advancing these factors from the bench to the clinic.