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Ciardulli MC, Marino L, Lovecchio J, Giordano E, Forsyth NR, Selleri C, Maffulli N, Porta GD. Tendon and Cytokine Marker Expression by Human Bone Marrow Mesenchymal Stem Cells in a Hyaluronate/Poly-Lactic-Co-Glycolic Acid (PLGA)/Fibrin Three-Dimensional (3D) Scaffold. Cells 2020; 9:E1268. [PMID: 32443833 PMCID: PMC7291129 DOI: 10.3390/cells9051268] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 01/19/2023] Open
Abstract
We developed a (three-dimensional) 3D scaffold, we named HY-FIB, incorporating a force-transmission band of braided hyaluronate embedded in a cell localizing fibrin hydrogel and poly-lactic-co-glycolic acid (PLGA) nanocarriers as transient components for growth factor controlled delivery. The tenogenic supporting capacity of HY-FIB on human-Bone Marrow Mesenchymal Stem Cells (hBM-MSCs) was explored under static conditions and under bioreactor-induced cyclic strain conditions. HY-FIB elasticity enabled to deliver a mean shear stress of 0.09 Pa for 4 h/day. Tendon and cytokine marker expression by hBM-MSCs were studied. Results: hBM-MSCs embedded in HY-FIB and subjected to mechanical stimulation, resulted in a typical tenogenic phenotype, as indicated by type 1 Collagen fiber immunofluorescence. RT-qPCR showed an increase of type 1 Collagen, scleraxis, and decorin gene expression (3-fold, 1600-fold, and 3-fold, respectively, at day 11) in dynamic conditions. Cells also showed pro-inflammatory (IL-6, TNF, IL-12A, IL-1β) and anti-inflammatory (IL-10, TGF-β1) cytokine gene expressions, with a significant increase of anti-inflammatory cytokines in dynamic conditions (IL-10 and TGF-β1 300-fold and 4-fold, respectively, at day 11). Mechanical signaling, conveyed by HY-FIB to hBM-MSCs, promoted tenogenic gene markers expression and a pro-repair cytokine balance. The results provide strong evidence in support of the HY-FIB system and its interaction with cells and its potential for use as a predictive in vitro model.
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Affiliation(s)
- Maria C. Ciardulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (L.M.); (C.S.); (N.M.)
| | - Luigi Marino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (L.M.); (C.S.); (N.M.)
| | - Joseph Lovecchio
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Via dell’Università 50, 47522 Cesena (FC), Italy; (J.L.); (E.G.)
| | - Emanuele Giordano
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Via dell’Università 50, 47522 Cesena (FC), Italy; (J.L.); (E.G.)
| | - Nicholas R. Forsyth
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK;
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (L.M.); (C.S.); (N.M.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (L.M.); (C.S.); (N.M.)
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB, UK;
- Centre for Sport and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine, London E1 4NL, UK
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; (M.C.C.); (L.M.); (C.S.); (N.M.)
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 84084 Fisciano (SA), Italy
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Silva M, Ferreira FN, Alves NM, Paiva MC. Biodegradable polymer nanocomposites for ligament/tendon tissue engineering. J Nanobiotechnology 2020; 18:23. [PMID: 32000800 PMCID: PMC6993465 DOI: 10.1186/s12951-019-0556-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023] Open
Abstract
Ligaments and tendons are fibrous tissues with poor vascularity and limited regeneration capacity. Currently, a ligament/tendon injury often require a surgical procedure using auto- or allografts that present some limitations. These inadequacies combined with the significant economic and health impact have prompted the development of tissue engineering approaches. Several natural and synthetic biodegradable polymers as well as composites, blends and hybrids based on such materials have been used to produce tendon and ligament scaffolds. Given the complex structure of native tissues, the production of fiber-based scaffolds has been the preferred option for tendon/ligament tissue engineering. Electrospinning and several textile methods such as twisting, braiding and knitting have been used to produce these scaffolds. This review focuses on the developments achieved in the preparation of tendon/ligament scaffolds based on different biodegradable polymers. Several examples are overviewed and their processing methodologies, as well as their biological and mechanical performances, are discussed.
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Affiliation(s)
- Magda Silva
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's, Associate PT Government Laboratory, Braga/Guimarães, Portugal
- Department of Polymer Engineering, Institute for Polymers and Composites/i3N, University of Minho, 4800-058, Guimarães, Portugal
- 2C2T-Centre of Textile Science and Technology, University of Minho, 4800-058, Guimarães, Portugal
| | - Fernando N Ferreira
- 2C2T-Centre of Textile Science and Technology, University of Minho, 4800-058, Guimarães, Portugal
| | - Natália M Alves
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, 4805-017, Guimarães, Portugal.
- ICVS/3B's, Associate PT Government Laboratory, Braga/Guimarães, Portugal.
| | - Maria C Paiva
- Department of Polymer Engineering, Institute for Polymers and Composites/i3N, University of Minho, 4800-058, Guimarães, Portugal.
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Abstract
Introduction. Tendons are specialised, heterogeneous connective tissues, which represent a significant healthcare challenge after injury. Primary surgical repair is the gold standard modality of care; however, it is highly dependent on the extent of injuries. Tissue engineering represents an alternative solution for good tissue integration and regeneration. In this review, we look at the advanced biomaterial composites employed to improve cellular growth while providing appropriate mechanical properties for tendon and ligament repair. Methodology. Comprehensive literature searches focused on advanced composite biomaterials for tendon and ligament tissue engineering. Studies were categorised depending on the application. Results. In the literature, a range of natural and/or synthetic materials have been combined to produce composite scaffolds tendon and ligament tissue engineering. In vitro and in vivo assessment demonstrate promising cellular integration with sufficient mechanical strength. The biological properties were improved with the addition of growth factors within the composite materials. Most in vivo studies were completed in small-scale animal models. Conclusions. Advanced composite materials represent a promising solution to the challenges associated with tendon and ligament tissue engineering. Nevertheless, these approaches still demonstrate limitations, including the necessity of larger-scale animal models to ease future clinical translation and comprehensive assessment of tissue response after implantation.
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Mohamed A, Oliva F, Nardoni S, Maffulli N. Failed synthetic graft after acute Achilles tendon repair. Muscles Ligaments Tendons J 2017; 7:396-402. [PMID: 29264352 DOI: 10.11138/mltj/2017.7.2.396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The present case report aimed to determine the results of Flexor Hallucis Longus (FHL) transfer as a second surgery after synthetic tissue reinforcement graft (Artelon®) implanted to a primary repaired Achilles tendon (AT), that was undertaken by another orthopedic. One year post-operative the patient was referred to us with retrocalcaneal pain and difficulty in walking, associated with stiffness and significant impairment of daily living activities. Methods MRI and full clinical examination were the outcome measures applied before and 1 year after surgery. Removal of the synthetic graft and subsequent FHL autologous transfer was undertaken and the graft was sent for histology examination. After removing the below knee leg cast, patient started rehabilitation program supervised by a trained physiotherapist. Results The patient was allowed to return to his normal activities at the sixth post-operative month, 1 year post-surgery MRI showed correct position of the autograft in the calcaneous bone and in the centre of the native AT plus reduced oedema of the AT body, with clinical improvement of the patient who reported no pain and was able to walk on tiptoes. Conclusion Synthetic patch augmentation to enhance tendon healing should be subjected to proper investigation before using it in routine parctice, as it may act as a barrier against proper tendon healing. Level of evidence V.
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Affiliation(s)
- Asmaa Mohamed
- Department of Physical and Rehabilitation Medicine, School of Medicine, University of Rome "Tor Vergata", Italy Physical medicine, Rheumatology and rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Stefano Nardoni
- Department of Pathology "San Filippo Neri Hospital" Rome, Italy
| | - Nicola Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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Liu Y, Suen CW, Zhang JF, Li G. Current concepts on tenogenic differentiation and clinical applications. J Orthop Translat 2017; 9:28-42. [PMID: 29662797 PMCID: PMC5822963 DOI: 10.1016/j.jot.2017.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 12/16/2022] Open
Abstract
Tendon is a tissue that transmits force from muscle to bone. Chronic or acute tendon injuries are very common, and are always accompanied by pain and a limited range of motion in patients. In clinical settings, management of tendon injuries still remains a big challenge. Cell therapies, such as the application of stem cells for tenogenic differentiation, were suggested to be an ideal strategy for clinical translation. However, there is still a lack of specific methods for tenogenic differentiation due to the limited understanding of tendon biology currently. This review focuses on the summary of current published strategies for tenogenic differentiation, such as the application of growth factors, mechanical stimulation, biomaterials, coculture, or induced pluripotent stem cells. Current clinical applications of stem cells for treatment of tendon injuries and their limitations have also been discussed in this review.
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Affiliation(s)
- Yang Liu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Chun-Wai Suen
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jin-fang Zhang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Gang Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Stem Cells and Regenerative Medicine Laboratory, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
- Corresponding author. Department of Orthopaedics and Traumatology and Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.Department of Orthopaedics and Traumatology and Li Ka Shing Institute of Health SciencesPrince of Wales HospitalThe Chinese University of Hong Kong30-32 Ngan Shing StreetShatinNew TerritoriesHong Kong, China
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Locke RC, Abraham AC, Killian ML. Orthopedic Interface Repair Strategies Based on Native Structural and Mechanical Features of the Multiscale Enthesis. ACS Biomater Sci Eng 2016; 3:2633-2643. [PMID: 32832593 DOI: 10.1021/acsbiomaterials.6b00599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The enthesis is an organ that connects a soft, aligned tissue (tendon/ligament) to a hard, amorphous tissue (bone) via a fibrocartilage interface. Mechanically, the enthesis sustains a dynamic loading environment that includes tensile, compressive, and shear forces. The structural components of the enthesis act to minimize stress concentrations and control stretch at the interface. Current surgical repair of the enthesis, such as in rotator cuff repair and anterior cruciate ligament reconstruction, aim to bridge the gap between the injured ends via reattachment of soft-to-hard tissues or graft replacement. In this review, we discuss the multiscale, morphological, and mechanical characteristics of the fibrocartilage attachment. Additionally, we review historical and recent clinical approaches to treating enthesis injury. Lastly, we explore new technological advancements in tissue-engineered biomaterials that have shown promise in preclinical studies.
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Affiliation(s)
- Ryan C Locke
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Adam C Abraham
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York 10032, United States
| | - Megan L Killian
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716, United States
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Willett NJ, Krishnan L, Li MTA, Guldberg RE, Warren GL. Guidelines for Models of Skeletal Muscle Injury and Therapeutic Assessment. Cells Tissues Organs 2016; 202:214-226. [PMID: 27825151 DOI: 10.1159/000445345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/19/2022] Open
Abstract
Volumetric muscle loss (VML) injuries present a large clinical challenge with a significant need for new interventions. While there have been numerous reviews on muscle injury models, few have critically evaluated VML models. The objective of this review is to discuss current preclinical models of VML in terms of models, analytical outcomes, and therapeutic interventions, and to provide guidelines for the future use of preclinical VML models. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel.
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Oryan A, Moshiri A, Meimandi-Parizi A, Maffulli N. Role of xenogenous bovine platelet gel embedded within collagen implant on tendon healing: an in vitro and in vivo study. Exp Biol Med (Maywood) 2014; 240:194-210. [PMID: 25341879 DOI: 10.1177/1535370214554532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Surgical reconstruction of large Achilles tendon defects is demanding. Platelet concentrates may be useful to favor healing in such conditions. The characteristics of bovine platelet-gel embedded within a collagen-implant were determined in vitro, and its healing efficacy was examined in a large Achilles tendon defect in rabbits. Two cm of the left Achilles tendon of 60 rabbits were excised, and the animals were randomly assigned to control (no implant), collagen-implant, or bovine-platelet-gel-collagen-implant groups. The tendon edges were maintained aligned using a Kessler suture. No implant was inserted in the control group. In the two other groups, a collagen-implant or bovine-platelet-gel-collagen-implant was inserted in the defect. The bioelectricity and serum platelet-derived growth factor levels were measured weekly and at 60 days post injury, respectively. After euthanasia at 60 days post injury, the tendons were tested at macroscopic, microscopic, and ultrastructural levels, and their dry matter and biomechanical performances were also assessed. Another 60 rabbits were assigned to receive no implant, a collagen-implant, or a bovine-platelet-gel-collagen-implant, euthanized at 10, 20, 30, and 40 days post injury, and their tendons were evaluated grossly and histologically to determine host-graft interactions. Compared to the control and collagen-implant, treatment with bovine-platelet-gel-collagen-implant improved tissue bioelectricity and serum platelet-derived growth factor levels, and increased cell proliferation, differentiation, and maturation. It also increased number, diameter, and density of the collagen fibrils, alignment and maturation of the collagen fibrils and fibers, biomechanical properties and dry matter content of the injured tendons at 60 days post injury. The bovine-platelet-gel-collagen-implant also increased biodegradability, biocompatibility, and tissue incorporation behavior of the implant compared to the collagen-implant alone. This treatment also decreased tendon adhesion, muscle fibrosis, and atrophy, and improved the physical activity of the animals. The bovine-platelet-gel-collagen-implant was effective in neotenon formation in vivo, which may be valuable in the clinical setting.
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Affiliation(s)
- Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, 71345, Iran
| | - Ali Moshiri
- Division of Surgery and Radiology, Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, 71345, Iran
| | - Abdolhamid Meimandi-Parizi
- Division of Surgery and Radiology, Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, 71345, Iran
| | - Nicola Maffulli
- University of Salerno, Faculty of Medicine and Surgery, Department of Musculoskeletal Medicine and Surgery, and Centre for Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, University of London, Queen Mary, E1 4DG, UK
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Moshiri A, Oryan A, Meimandi-Parizi A, Koohi-Hosseinabadi O. Effectiveness of xenogenous-based bovine-derived platelet gel embedded within a three-dimensional collagen implant on the healing and regeneration of the Achilles tendon defect in rabbits. Expert Opin Biol Ther 2014; 14:1065-89. [PMID: 24840092 PMCID: PMC4743604 DOI: 10.1517/14712598.2014.915305] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Tissue engineering is an option in reconstructing large tendon defects and managing their healing and regeneration. We designed and produced a novel xenogeneic-based bovine platelet, embedded it within a tissue-engineered collagen implant (CI) and applied it in an experimentally induced large tendon defect model in rabbits to test whether bovine platelets could stimulate tendon healing and regeneration in vivo. METHODS One hundred twenty rabbits were randomly divided into two experimental and pilot groups. In all the animals, the left Achilles tendon was surgically excised and the tendon edges were aligned by Kessler suture. Each group was then divided into three groups of control (no implant), treated with CI and treated with collagen-platelet implant. The pilot groups were euthanized at 10, 15, 30 and 40 days post-injury (DPI), and their gross and histologic characteristics were evaluated to study host-graft interaction mechanism. To study the tendon healing and its outcome, the experimental animals were tested during the experiment using hematologic, ultrasonographic and various methods of clinical examinations and then euthanized at 60 DPI and their tendons were evaluated by gross pathologic, histopathologic, scanning electron microscopic, biophysical and biochemical methods. RESULTS Bovine platelets embedded within a CI increased inflammation at short term while it increased the rate of implant absorption and matrix replacement compared with the controls and CI alone. Treatment also significantly increased diameter, density, amount, alignment and differentiation of the collagen fibrils and fibers and approximated the water uptake and delivery behavior of the healing tendons to normal contralaterals (p < 0.05). Treatment also improved echogenicity and homogenicity of the tendons and reduced peritendinous adhesion, muscle fibrosis and atrophy, and therefore, it improved the clinical scores and physical activity related to the injured limb when compared with the controls (p < 0.05). CONCLUSION The bovine platelet gel embedded within the tissue-engineered CI was effective in healing, modeling and remodeling of the Achilles tendon in rabbit. This strategy may be a valuable option in the clinical setting.
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Affiliation(s)
- Ali Moshiri
- Division of Surgery and Radiology, Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University , Shiraz , Iran +98 9123409835 ;
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