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Cui M, Sun Y, Zhang X, Yang P, Jiang W. Osteochondral tissue engineering in translational practice: histological assessments and scoring systems. Front Bioeng Biotechnol 2024; 12:1434323. [PMID: 39157444 PMCID: PMC11327087 DOI: 10.3389/fbioe.2024.1434323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024] Open
Abstract
Osteochondral lesions are common pathological alterations in synovial joints. Different techniques have been designed to achieve osteochondral repair, and tissue-engineered osteochondral grafts have shown the most promise. Histological assessments and related scoring systems are crucial for evaluating the quality of regenerated tissue, and the interpretation and comparison of various repair techniques require the establishment of a reliable and widely accepted histological method. To date, there is still no consensus on the type of histological assessment and scoring system that should be used for osteochondral repair. In this review, we summarize common osteochondral staining methods, discuss the criteria regarding high-quality histological images, and assess the current histological scoring systems for osteochondral regeneration. Safranin O/Fast green is the most widely used staining method for the cartilage layer, whereas Gomori and Van Gieson staining detect new bone formation. We suggest including the graft-host interface and more sections together with the basic histological information for images. An ideal scoring system should analyze both the cartilage and bone regions, especially for the subchondral bone plate. Furthermore, histological assessments should be performed over a longer period of time to minimize discrepancies caused by defect size and animal species.
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Affiliation(s)
- Mengying Cui
- The Second Hospital of Jilin University, Jilin, China
| | - Yang Sun
- Orthopedic Medical Center, The Second Hospital of Jilin University, Jilin, China
| | | | - Pengju Yang
- Orthopedic Medical Center, The Second Hospital of Jilin University, Jilin, China
| | - Weibo Jiang
- Orthopedic Medical Center, The Second Hospital of Jilin University, Jilin, China
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Zhang L, Dai W, Gao C, Wei W, Huang R, Zhang X, Yu Y, Yang X, Cai Q. Multileveled Hierarchical Hydrogel with Continuous Biophysical and Biochemical Gradients for Enhanced Repair of Full-Thickness Osteochondral Defect. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2209565. [PMID: 36870325 DOI: 10.1002/adma.202209565] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/31/2023] [Indexed: 05/12/2023]
Abstract
The repair of hierarchical osteochondral defect requires sophisticated gradient reestablishment; however, few strategies for continuous gradient casting consider the relevance to clinical practice regarding cell adaptability, multiple gradient elements, and precise gradient mirroring native tissue. Here, a hydrogel with continuous gradients in nano-hydroxyapatite (HA) content, mechanical, and magnetism is developed using synthesized superparamagnetic HA nanorods (MagHA) that easily respond to a brief magnetic field. To precisely reconstruct osteochondral tissue, the optimized gradient mode is calculated according to magnetic resonance imaging (MRI) of healthy rabbit knees. Then, MagHA are patterned to form continuous biophysical and biochemical gradients, consequently generating incremental HA, mechanical, and electromagnetic cues under an external magnetic stimulus. To make such depth-dependent biocues work, an adaptable hydrogel is developed to facilitate cell infiltration. Furthermore, this approach is applied in rabbit full-thickness osteochondral defects equipped with a local magnetic field. Surprisingly, this multileveled gradient composite hydrogel repairs osteochondral unit in a perfect heterogeneous feature, which mimics the gradual cartilage-to-subchondral transition. Collectively, this is the first study that combines an adaptable hydrogel with magneto-driven MagHA gradients to achieve promising outcomes in osteochondral regeneration.
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Affiliation(s)
- Liwen Zhang
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Wenli Dai
- Peking University Third Hospital, Beijing, 100191, China
| | - Chenyuan Gao
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Wei Wei
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Ruiran Huang
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Xin Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, 100191, China
| | - Yingjie Yu
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Xiaoping Yang
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Qing Cai
- State Key Laboratory of Organic-Inorganic Composites, Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100029, China
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Karami P, Stampoultzis T, Guo Y, Pioletti DP. A guide to preclinical evaluation of hydrogel-based devices for treatment of cartilage lesions. Acta Biomater 2023; 158:12-31. [PMID: 36638938 DOI: 10.1016/j.actbio.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
The drive to develop cartilage implants for the treatment of major defects in the musculoskeletal system has resulted in a major research thrust towards developing biomaterial devices for cartilage repair. Investigational devices for the restoration of articular cartilage are considered as significant risk materials by regulatory bodies and therefore proof of efficacy and safety prior to clinical testing represents a critical phase of the multidisciplinary effort to bridge the gap between bench and bedside. To date, review articles have thoroughly covered different scientific facets of cartilage engineering paradigm, but surprisingly, little attention has been given to the preclinical considerations revolving around the validation of a biomaterial implant. Considering hydrogel-based cartilage products as an example, the present review endeavors to provide a summary of the critical prerequisites that such devices should meet for cartilage repair, for successful implantation and subsequent preclinical validation prior to clinical trials. Considerations pertaining to the choice of appropriate animal model, characterization techniques for the quantitative and qualitative outcome measures, as well as concerns with respect to GLP practices are also extensively discussed. This article is not meant to provide a systematic review, but rather to introduce a device validation-based roadmap to the academic investigator, in anticipation of future healthcare commercialization. STATEMENT OF SIGNIFICANCE: There are significant challenges around translation of in vitro cartilage repair strategies to approved therapies. New biomaterial-based devices must undergo exhaustive investigations to ensure their safety and efficacy prior to clinical trials. These considerations are required to be applied from early developmental stages. Although there are numerous research works on cartilage devices and their in vivo evaluations, little attention has been given into the preclinical pathway and the corresponding approval processes. With a focus on hydrogel devices to concretely illustrate the preclinical path, this review paper intends to highlight the various considerations regarding the preclinical validation of hydrogel devices for cartilage repair, from regulatory considerations, to implantation strategies, device performance aspects and characterizations.
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Affiliation(s)
- Peyman Karami
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Theofanis Stampoultzis
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Yanheng Guo
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Dominique P Pioletti
- Laboratory of Biomechanical Orthopedics, Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland.
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Mukherjee P, Roy S, Ghosh D, Nandi SK. Role of animal models in biomedical research: a review. Lab Anim Res 2022; 38:18. [PMID: 35778730 PMCID: PMC9247923 DOI: 10.1186/s42826-022-00128-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
The animal model deals with the species other than the human, as it can imitate the disease progression, its’ diagnosis as well as a treatment similar to human. Discovery of a drug and/or component, equipment, their toxicological studies, dose, side effects are in vivo studied for future use in humans considering its’ ethical issues. Here lies the importance of the animal model for its enormous use in biomedical research. Animal models have many facets that mimic various disease conditions in humans like systemic autoimmune diseases, rheumatoid arthritis, epilepsy, Alzheimer’s disease, cardiovascular diseases, Atherosclerosis, diabetes, etc., and many more. Besides, the model has tremendous importance in drug development, development of medical devices, tissue engineering, wound healing, and bone and cartilage regeneration studies, as a model in vascular surgeries as well as the model for vertebral disc regeneration surgery. Though, all the models have some advantages as well as challenges, but, present review has emphasized the importance of various small and large animal models in pharmaceutical drug development, transgenic animal models, models for medical device developments, studies for various human diseases, bone and cartilage regeneration model, diabetic and burn wound model as well as surgical models like vascular surgeries and surgeries for intervertebral disc degeneration considering all the ethical issues of that specific animal model. Despite, the process of using the animal model has facilitated researchers to carry out the researches that would have been impossible to accomplish in human considering the ethical prohibitions.
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Affiliation(s)
- P Mukherjee
- Department of Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences, Mohanpur, Nadia, India
| | - S Roy
- Department of Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences, Mohanpur, Nadia, India
| | - D Ghosh
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India
| | - S K Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India.
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Morscheid YP, Venkatesan JK, Schmitt G, Orth P, Zurakowski D, Speicher-Mentges S, Menger MD, Laschke MW, Cucchiarini M, Madry H. rAAV-Mediated Human FGF-2 Gene Therapy Enhances Osteochondral Repair in a Clinically Relevant Large Animal Model Over Time In Vivo. Am J Sports Med 2021; 49:958-969. [PMID: 33606561 DOI: 10.1177/0363546521988941] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral defects, if left untreated, do not heal and can potentially progress toward osteoarthritis. Direct gene transfer of basic fibroblast growth factor 2 (FGF-2) with the clinically adapted recombinant adeno-associated viral (rAAV) vectors is a powerful tool to durably activate osteochondral repair processes. PURPOSE To examine the ability of an rAAV-FGF-2 construct to target the healing processes of focal osteochondral injury over time in a large translational model in vivo versus a control gene transfer condition. STUDY DESIGN Controlled laboratory study. METHODS Standardized osteochondral defects created in the knee joints of adult sheep were treated with an rAAV human FGF-2 (hFGF-2) vector by direct administration into the defect relative to control (reporter) rAAV-lacZ gene transfer. Osteochondral repair was monitored using macroscopic, histological, immunohistological, and biochemical methods and by micro-computed tomography after 6 months. RESULTS Effective, localized prolonged FGF-2 overexpression was achieved for 6 months in vivo relative to the control condition without undesirable leakage of the vectors outside the defects. Such rAAV-mediated hFGF-2 overexpression significantly increased the individual histological parameter "percentage of new subchondral bone" versus lacZ treatment, reflected in a volume of mineralized bone per unit volume of the subchondral bone plate that was equal to a normal osteochondral unit. Also, rAAV-FGF-2 significantly improved the individual histological parameters "defect filling,""matrix staining," and "cellular morphology" and the overall cartilage repair score versus the lacZ treatment and led to significantly higher cell densities and significantly higher type II collagen deposition versus lacZ treatment. Likewise, rAAV-FGF-2 significantly decreased type I collagen expression within the cartilaginous repair tissue. CONCLUSION The current work shows the potential of direct rAAV-mediated FGF-2 gene therapy to enhance osteochondral repair in a large, clinically relevant animal model over time in vivo. CLINICAL RELEVANCE Delivery of therapeutic (hFGF-2) rAAV vectors in sites of focal injury may offer novel, convenient tools to enhance osteochondral repair in the near future.
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Affiliation(s)
- Yannik P Morscheid
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Jagadeesh K Venkatesan
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Gertrud Schmitt
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Patrick Orth
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - David Zurakowski
- Department of Anesthesiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Susanne Speicher-Mentges
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
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Physioxia Expanded Bone Marrow Derived Mesenchymal Stem Cells Have Improved Cartilage Repair in an Early Osteoarthritic Focal Defect Model. BIOLOGY 2020; 9:biology9080230. [PMID: 32824442 PMCID: PMC7463623 DOI: 10.3390/biology9080230] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022]
Abstract
Focal early osteoarthritis (OA) or degenerative lesions account for 60% of treated cartilage defects each year. The current cell-based regenerative treatments have an increased failure rate for treating degenerative lesions compared to traumatic defects. Mesenchymal stem cells (MSCs) are an alternative cell source for treating early OA defects, due to their greater chondrogenic potential, compared to early OA chondrocytes. Low oxygen tension or physioxia has been shown to enhance MSC chondrogenic matrix content and could improve functional outcomes of regenerative therapies. The present investigation sought to develop a focal early OA animal model to evaluate cartilage regeneration and hypothesized that physioxic MSCs improve in vivo cartilage repair in both, post-trauma and focal early OA defects. Using a rabbit model, a focal defect was created, that developed signs of focal early OA after six weeks. MSCs cultured under physioxia had significantly enhanced in vitro MSC chondrogenic GAG content under hyperoxia with or without the presence of interleukin-1β (IL-1β). In both post-traumatic and focal early OA defect models, physioxic MSC treatment demonstrated a significant improvement in cartilage repair score, compared to hyperoxic MSCs and respective control defects. Future investigations will seek to understand whether these results are replicated in large animal models and the underlying mechanisms involved in in vivo cartilage regeneration.
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Small-Diameter Subchondral Drilling Improves DNA and Proteoglycan Content of the Cartilaginous Repair Tissue in a Large Animal Model of a Full-Thickness Chondral Defect. J Clin Med 2020; 9:jcm9061903. [PMID: 32570841 PMCID: PMC7356183 DOI: 10.3390/jcm9061903] [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: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 01/02/2023] Open
Abstract
This study quantified changes in the DNA content and extracellular matrix composition of both the cartilaginous repair tissue and the adjacent cartilage in a large animal model of a chondral defect treated by subchondral drilling. Content of DNA, proteoglycans, and Type II and Type I collagen, as well as their different ratios were assessed at 6 months in vivo after treatment of full-thickness cartilage defects in the femoral trochlea of adult sheep with six subchondral drill holes, each of either 1.0 mm or 1.8 mm in diameter by biochemical analyses of the repair tissue and the adjacent cartilage and compared with the original cartilage. Only subchondral drilling which were 1.0 mm in diameter significantly increased both DNA and proteoglycan content of the repair tissue compared to the original cartilage. DNA content correlated with the proteoglycan and Type II collagen content within the repair tissue. Significantly higher amounts of Type I collagen within the repair tissue and significantly increased DNA, proteoglycan, and Type I collagen content in the adjacent cartilage were identified. These translational data support the use of small-diameter bone-cutting devices for marrow stimulation. Signs of early degeneration were present within the cartilaginous repair tissue and the adjacent cartilage.
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Wu T, Chen Y, Liu W, Tong KL, Suen CWW, Huang S, Hou H, She G, Zhang H, Zheng X, Li J, Zha Z. Ginsenoside Rb1/TGF-β1 loaded biodegradable silk fibroin-gelatin porous scaffolds for inflammation inhibition and cartilage regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 111:110757. [PMID: 32279738 DOI: 10.1016/j.msec.2020.110757] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/15/2020] [Indexed: 01/06/2023]
Abstract
Creating a microenvironment with low inflammation and favorable for the chondrogenic differentiation of endogenous stem cells plays an essential role in cartilage repairing. In the present study, we design a novel ginsenoside Rb1/TGF-β1 loaded silk fibroin-gelatin porous scaffold (GSTR) with the function of attenuating inflammation and promoting chondrogenesis. The scaffold has porous microstructure, proper mechanical strength, degradation rate and sustained release of Rb1 and TGF-β1. Rat bone marrow-derived mesenchymal stem cells (rBMSCs) seeded into GSTR scaffolds are homogeneously distributed and display a higher proliferation rate than non-loaded scaffolds (GS). GSTR scaffolds promote the chondrogenic differentiation of rBMSCs and suppress the expression of inflammation genes. Under the stimulation of IL-1β, the inflammation level of the chondrocytes seeded in GSTR scaffolds is also significantly down-regulated. Moreover, GSTR scaffolds implanted into the osteochondral defects in rats effectively promote the regeneration of hyaline cartilage 12 weeks after surgery when compared with other groups. It is demonstrated that this scaffold loaded with Rb1 and TGF-β1 can synergistically create a microenvironment favorable for cartilage regeneration by promoting the chondrogenesis and suppressing the inflammation levels in vivo. These results prove it has a great potential to develop this Rb1/TGF-β1 releasing scaffold into a novel and promising therapeutic for cartilage repair.
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Affiliation(s)
- Tingting Wu
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Yuanfeng Chen
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China.
| | - Wenping Liu
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Kui Leung Tong
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Chun-Wai Wade Suen
- Department of Genetics, University of Cambridge, Cambridge CB2 3EH, United Kingdom
| | - Shusen Huang
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Huige Hou
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Guorong She
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Huantian Zhang
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Xiaofei Zheng
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China
| | - Jieruo Li
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China.
| | - Zhengang Zha
- Institute of Orthopedic Diseases, Center for Joint Surgery and Sports Medicine, the First Affiliated Hospital, Jinan University, Guangzhou, PR China.
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Maglio M, Brogini S, Pagani S, Giavaresi G, Tschon M. Current Trends in the Evaluation of Osteochondral Lesion Treatments: Histology, Histomorphometry, and Biomechanics in Preclinical Models. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4040236. [PMID: 31687388 PMCID: PMC6803751 DOI: 10.1155/2019/4040236] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/23/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023]
Abstract
Osteochondral lesions (OCs) are typically of traumatic origins but are also caused by degenerative conditions, in primis osteoarthritis (OA). On the other side, OC lesions themselves, getting worse over time, can lead to OA, indicating that chondral and OC defects represent a risk factor for the onset of the pathology. Many animal models have been set up for years for the study of OC regeneration, being successfully employed to test different treatment strategies, from biomaterials and cells to physical and biological adjuvant therapies. These studies rely on a plethora of post-explant investigations ranging from histological and histomorphometric analyses to biomechanical ones. The present review aims to analyze the methods employed for the evaluation of OC treatments in each animal model by screening literature data within the last 10 years. According to the selected research criteria performed in two databases, 60 works were included. Data revealed that lapine (50% of studies) and ovine (23% of studies) models are predominant, and knee joints are the most used anatomical locations for creating OC defects. Analyses are mostly conducted on paraffin-embedded samples in order to perform histological/histomorphometric analyses by applying semiquantitative scoring systems and on fresh samples in order to perform biomechanical investigations by indentation tests on articular cartilage. Instead, a great heterogeneity is pointed out in terms of OC defect dimensions and animal's age. The choice of experimental times is generally adequate for the animal models adopted, although few studies adopt very long experimental times. Improvements in data reporting and in standardization of protocols would be desirable for a better comparison of results and for ethical reasons related to appropriate and successful animal experimentation.
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Affiliation(s)
- M. Maglio
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - S. Brogini
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - S. Pagani
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - G. Giavaresi
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - M. Tschon
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
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Xiao SP, Tang LS, Chen JY, Li ZT, Cheng GH, Chen QQ, Liu SH, Liu WG. Effect of Cross-Linked Hyaluronate Scaffold on Cartilage Repair: An In Vivo Study. Orthop Surg 2019; 11:679-689. [PMID: 31385411 PMCID: PMC6712381 DOI: 10.1111/os.12508] [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] [Received: 01/09/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 01/16/2023] Open
Abstract
Objective To determine the safety and effectiveness of a cross‐linked sodium hyaluronate (CHA) scaffold in cartilage repair. Methods Physicochemical properties of the scaffold were determined. The safety and effectiveness of the scaffold for cartilage repair were evaluated in a minipig model of a full‐thickness cartilage defect with microfracture surgery. Postoperative observation and hematological examination were used to evaluate the safety of the CHA scaffold implantation. Pathological examination as well as biomechanical testing, including Young's modulus, stress relaxation time, and creep time, were conducted at 6 and 12 months postsurgery to assess the effectiveness of the scaffold for cartilage repair. Furthermore, type II collagen and glycosaminoglycan content were determined to confirm the influence of the scaffold in the damaged cartilage tissue. Results The results showed that the routine hematological indexes of the experimental animals were within the normal physiological ranges, which confirmed the safety of CHA scaffold implantation. Based on macroscopic observation, it was evident that repair of the defective cartilage in the animal knee joint began during the 6 months postoperation and was gradually enhanced from the central to the surrounding region. The repair smoothness and color of the 12‐month cartilage samples from the operation area were better than those of the 6‐month samples, and the results for the CHA scaffold implantation group were better than the control group. Greater cell degeneration and degeneration of the adjacent cartilage was found in the implantation group compared with the control group at both 6 and 12 months postoperation, evaluated by O'Driscoll Articular Cartilage Histology Scoring. Implantation with the CHA scaffold matrix promoted cartilage repair and improved its compression capacity. The type II collagen level in the CHA scaffold implantation group tended to be higher than that in the control group at 6 months (2.33 ± 1.50 vs 1.68 ± 0.56) and 12 months postsurgery (3.37 ± 1.70 vs 2.06 ± 0.63). The GAG content in the cartilage of the control group was significantly lower than that of the experimental group (2.17 ± 0.43 vs 3.64 ± 1.17, P = 0.002 at 6 months and 2.27 ± 0.38 vs 4.12 ± 1.02, P = 0.002 at 12 months). Type II collagen and glycosaminoglycan content also demonstrated that CHA was beneficial for the accumulation of both these vital substances in the cartilage tissue. Conclusions The CHA scaffold displayed the ability to promote cartilage repair when applied in microfracture surgery, which makes it a promising material for application in the area of cartilage tissue engineering.
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Affiliation(s)
- Shi-Peng Xiao
- Department of Joint Surgery and Sports Medicine, The Second Hospital of Shandong University, Jinan, China
| | - Lian-Sheng Tang
- Key Laboratory of Biopharmaceuticals of Shandong Province, Shandong Academy of Pharmaceutical Sciences, Jinan, China.,Key Laboratory of Mucosal and Transdermal Drug Delivery Technology in Shandong Province, Shandong Freda Pharmaceutical Group, Jinan, China
| | - Jian-Ying Chen
- Key Laboratory of Biopharmaceuticals of Shandong Province, Shandong Academy of Pharmaceutical Sciences, Jinan, China.,Key Laboratory of Mucosal and Transdermal Drug Delivery Technology in Shandong Province, Shandong Freda Pharmaceutical Group, Jinan, China
| | - Zhong-Tao Li
- Sehandong Provincial Key Laboratory of Network Based Intelligent Computing, School of Information Science and Engineering, University of Jinan, Jinan, China
| | - Guang-Hui Cheng
- Central Research Laboratory, The Second Hospital of Shandong University, Jinan, China
| | - Qian-Qian Chen
- Key Laboratory of Biopharmaceuticals of Shandong Province, Shandong Academy of Pharmaceutical Sciences, Jinan, China
| | - Sheng-Hou Liu
- Department of Joint Surgery and Sports Medicine, The Second Hospital of Shandong University, Jinan, China
| | - Wen-Guang Liu
- Department of Joint Surgery and Sports Medicine, The Second Hospital of Shandong University, Jinan, China
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11
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Wang T, Nimkingratana P, Smith CA, Cheng A, Hardingham TE, Kimber SJ. Enhanced chondrogenesis from human embryonic stem cells. Stem Cell Res 2019; 39:101497. [PMID: 31326745 PMCID: PMC6745516 DOI: 10.1016/j.scr.2019.101497] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/17/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
Human embryonic stem cells (hESCs) have great potential for the repair of damaged articular cartilage. We developed a serum-free 14-day protocol for hESC differentiation into chondrocyte progenitors, which surprisingly lacked strong cartilage matrix production in in vitro tests. In order to direct these progenitors to a more mature phenotype, we investigated substituting different members of the TGFβ family in the protocol. Initially, we supplemented, or substituted GDF5 (day 11-14), with combinations of BMP7 and TGFβ-1, or -3, but these modifications yielded no improvement in matrix gene expression. However, replacing BMP4 with BMP2 (days 3-10 of the protocol) resulted in a more rapid increase in SOX9 gene expression and increased expression of chondrogenic genes SOX5, ACAN and COL2A1. The replacement of BMP4 with BMP2 also enhanced the formation of chondrogenic cell aggregates, with greater deposition of type II collagen. This change was not accompanied by hypertrophic chondrocyte marker COL10A1 expression. The results demonstrate that BMP2 has greater specificity for the generation of chondrogenic cells from hESCs than BMP4 and this was consistent in two hESC lines (HUES1 and MAN7). hESC-chondrogenic cells derived with either BMP2 or BMP4 were tested in vivo by implanting them in fibrin into osteochondral defects in the femur of RNU rats. Repaired cartilage tissue, positive for Safranin O and type II collagen was detected at 6 and 12 weeks with both cell sources, but the BMP2 cells scored higher for tissue quality (Pineda score). Therefore, BMP2 is more effective at driving chondrogenic differentiation from human pluripotent stem cells than BMP4 and the effect on the resulting chondroprogenitors is sustained in an in vivo setting.
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Affiliation(s)
- Tao Wang
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | | | | | - Aixin Cheng
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Timothy E Hardingham
- Wellcome Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Susan J Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, UK.
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12
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Xu J, Feng Q, Lin S, Yuan W, Li R, Li J, Wei K, Chen X, Zhang K, Yang Y, Wu T, Wang B, Zhu M, Guo R, Li G, Bian L. Injectable stem cell-laden supramolecular hydrogels enhance in situ osteochondral regeneration via the sustained co-delivery of hydrophilic and hydrophobic chondrogenic molecules. Biomaterials 2019; 210:51-61. [PMID: 31075723 DOI: 10.1016/j.biomaterials.2019.04.031] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/22/2019] [Accepted: 04/26/2019] [Indexed: 01/26/2023]
Abstract
Hydrogels have been widely used as the carrier material of therapeutic cell and drugs for articular cartilage repair. We previously demonstrated a unique host-guest macromer (HGM) approach to prepare mechanically resilient, self-healing and injectable supramolecular gelatin hydrogels free of chemical crosslinking. In this work, we show that compared with conventional hydrogels our supramolecular gelatin hydrogels mediate more sustained release of small molecular (kartogenin) and proteinaceous (TGF-β1) chondrogenic agents, leading to enhanced chondrogenesis of the encapsulated human bone marrow-derived mesenchymal stem cells (hBMSCs) in vitro and in vivo. More importantly, the supramolecular nature of our hydrogels allows injection of the pre-fabricated hydrogels containing the encapsulated hBMSCs and chondrogenic agents, and our data show that the injection process has little negative impact on the viability and chondrogenesis of the encapsulated cells and subsequent neocartilage development. Furthermore, the stem cell-laden supramolecular hydrogels administered via injection through a needle effectively promote the regeneration of both hyaline cartilage and subchondral bone in the rat osteochondral defect model. These results demonstrate that our supramolecular HGM hydrogels are promising delivery biomaterials of therapeutic agents and cells for cartilage repair via minimally invasive procedures. This unique capability of injecting cell-laden hydrogels to target sites will greatly facilitate stem cell therapies.
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Affiliation(s)
- Jianbin Xu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, PR China
| | - Qian Feng
- Fujian Provincial Key Laboratory of Advanced Materials Oriented Chemical Engineering, College of Chemistry and Materials Science, Fujian Normal University, Fuzhou, 350007, PR China
| | - Sien Lin
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, PR China
| | - Weihao Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Rui Li
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Jinming Li
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China; MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, 510631, PR China
| | - Kongchang Wei
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China; Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, Lerchenfeldstrasse 5, CH-9014 St. Gallen, Switzerland
| | - Xiaoyu Chen
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Kunyu Zhang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Yanhua Yang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Tianyi Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Bin Wang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Meiling Zhu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China
| | - Rui Guo
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Guangdong Provincial Engineering and Technological Research Center for Drug Carrier Development, Department of Biomedical Engineering, Jinan University, Guangzhou, 510632, PR China
| | - Gang Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China.
| | - Liming Bian
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, 518172, PR China; Center for Novel Biomaterials, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong, China.
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13
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Chen Y, Wu T, Huang S, Suen CWW, Cheng X, Li J, Hou H, She G, Zhang H, Wang H, Zheng X, Zha Z. Sustained Release SDF-1α/TGF-β1-Loaded Silk Fibroin-Porous Gelatin Scaffold Promotes Cartilage Repair. ACS APPLIED MATERIALS & INTERFACES 2019; 11:14608-14618. [PMID: 30938503 DOI: 10.1021/acsami.9b01532] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Continuous delivery of growth factors to the injury site is crucial to creating a favorable microenvironment for cartilage injury repair. In the present study, we fabricated a novel sustained-release scaffold, stromal-derived factor-1α (SDF-1α)/transforming growth factor-β1 (TGF-β1)-loaded silk fibroin-porous gelatin scaffold (GSTS). GSTS persistently releases SDF-1α and TGF-β1, which enhance cartilage repair by facilitating cell homing and chondrogenic differentiation. Scanning electron microscopy showed that GSTS is a porous microstructure and the protein release assay demonstrated the sustainable release of SDF-1α and TGF-β1 from GSTS. Bone marrow-derived mesenchymal stem cells (MSCs) maintain high in vitro cell activity and excellent cell distribution and phenotype after seeding into GSTS. Furthermore, MSCs acquired enhanced chondrogenic differentiation capability in the TGF-β1-loaded scaffolds (GSTS or GST: loading TGF-β1 only) and the conditioned medium from SDF-1α-loaded scaffolds (GSTS or GSS: loading SDF-1α only) effectively promoted MSCs migration. GSTS was transplanted into the osteochondral defects in the knee joint of rats, and it could promote cartilage regeneration and repair the cartilage defects at 12 weeks after transplantation. Our study shows that GSTS can facilitate in vitro MSCs homing, migration, chondrogenic differentiation and SDF-1α and TGF-β1 have a synergistic effect on the promotion of in vivo cartilage forming. This SDF-1α and TGF-β1 releasing GSTS have promising therapeutic potential in cartilage repair.
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Affiliation(s)
- Yuanfeng Chen
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Tingting Wu
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Shusen Huang
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Chun-Wai Wade Suen
- Department of Genetics , University of Cambridge , Cambridge CB2 3EH , United Kingdom
| | - Xin Cheng
- Department of Histology and Embryology, Joint Laboratory for Embryonic Development & Prenatal Medicine, Medical College , Jinan University , Guangzhou 510632 , Guangdong , P. R. China
| | - Jieruo Li
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Huige Hou
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Guorong She
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Huantian Zhang
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Huajun Wang
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Xiaofei Zheng
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
| | - Zhengang Zha
- Institute of Orthopedic Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital , Jinan University , Guangzhou 510630 , P. R. China
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14
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Reisbig NA, Pinnell E, Scheuerman L, Hussein H, Bertone AL. Synovium extra cellular matrices seeded with transduced mesenchymal stem cells stimulate chondrocyte maturation in vitro and cartilage healing in clinically-induced rat-knee lesions in vivo. PLoS One 2019; 14:e0212664. [PMID: 30861010 PMCID: PMC6414009 DOI: 10.1371/journal.pone.0212664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 02/07/2019] [Indexed: 12/19/2022] Open
Abstract
Osteoarthritis (OA) is a progressive disease associated with cartilage injury and its inherently limited repair capability. Synovium-based cellular constructs (sConstructs) are proposed as possible treatments. Equine sConstructs were produced from decellularized synovium-based extracellular matrix scaffolds (sECM) seeded with synovium-derived mesenchymal stem cells (sMSC), and engineered to express green fluorescent protein (GFP), or bone morphogenetic protein-2 (BMP-2). Survival, distribution, and chondrogenic potential of the sConstructs in vitro and in vivo were assessed. sConstructs in co-culture with chondrocytes increased chondrocyte proliferation, viability, and Col II production, greatest in BMP-2-sConstructs. Chondrocyte presence increased the production of hyaluronic acid (HA), proteoglycan (PG), and BMP-2 by the sConstructs in a positive feedback loop. sECM alone, or GFP- or BMP-2-sConstructs were implanted in synovium adjacent to clinically created full-thickness rat-knee cartilage lesions. At 5 weeks, the lesion area and implants were resected. Gross anatomy, adjacent articulate cartilage growth and subchondral bone repair were scored; and peripheral, central and cartilage lesion measurements taken. For all scores and measurements, sConstruct implants were significantly greater than controls, greatest with the BMP-2-sConstructs. Immunohistochemistry demonstrated migration of endogenous cells into the sECM, with greater cellularity in the constructs with intense positive GFP staining confirming engraftment of implanted sMSC and continued gene expression. In summary, exposing cartilage to sConstructs was chondrogenic in vitro and in vivo, and resulted in substantially increased growth in vivo. This effect was mediated, in part, by soluble ECM and cell factors and upregulation of anabolic growth proteins, such as BMP-2. This work is "proof of concept" that sConstructs surgically implanted adjacent to cartilage damage can significantly improve cartilage and subchondral bone repair, and potentially prevent the progression of OA.
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Affiliation(s)
- Nathalie A. Reisbig
- Comparative Orthopedics Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Erin Pinnell
- Comparative Orthopedics Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Logan Scheuerman
- Comparative Orthopedics Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Hayam Hussein
- Comparative Orthopedics Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Alicia L. Bertone
- Comparative Orthopedics Research Laboratory, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
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15
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Stem Cells for Cartilage Repair: Preclinical Studies and Insights in Translational Animal Models and Outcome Measures. Stem Cells Int 2018. [PMID: 29535784 PMCID: PMC5832141 DOI: 10.1155/2018/9079538] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Due to the restricted intrinsic capacity of resident chondrocytes to regenerate the lost cartilage postinjury, stem cell-based therapies have been proposed as a novel therapeutic approach for cartilage repair. Moreover, stem cell-based therapies using mesenchymal stem cells (MSCs) or induced pluripotent stem cells (iPSCs) have been used successfully in preclinical and clinical settings. Despite these promising reports, the exact mechanisms underlying stem cell-mediated cartilage repair remain uncertain. Stem cells can contribute to cartilage repair via chondrogenic differentiation, via immunomodulation, or by the production of paracrine factors and extracellular vesicles. But before novel cell-based therapies for cartilage repair can be introduced into the clinic, rigorous testing in preclinical animal models is required. Preclinical models used in regenerative cartilage studies include murine, lapine, caprine, ovine, porcine, canine, and equine models, each associated with its specific advantages and limitations. This review presents a summary of recent in vitro data and from in vivo preclinical studies justifying the use of MSCs and iPSCs in cartilage tissue engineering. Moreover, the advantages and disadvantages of utilizing small and large animals will be discussed, while also describing suitable outcome measures for evaluating cartilage repair.
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16
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Oláh T, Reinhard J, Gao L, Goebel LKH, Madry H. Reliable landmarks for precise topographical analyses of pathological structural changes of the ovine tibial plateau in 2-D and 3-D subspaces. Sci Rep 2018; 8:75. [PMID: 29311696 PMCID: PMC5758565 DOI: 10.1038/s41598-017-18426-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/06/2017] [Indexed: 11/09/2022] Open
Abstract
Selecting identical topographical locations to analyse pathological structural changes of the osteochondral unit in translational models remains difficult. The specific aim of the study was to provide objectively defined reference points on the ovine tibial plateau based on 2-D sections of micro-CT images useful for reproducible sample harvesting and as standardized landmarks for landmark-based 3-D image registration. We propose 5 reference points, 11 reference lines and 12 subregions that are detectable macroscopically and on 2-D micro-CT sections. Their value was confirmed applying landmark-based rigid and affine 3-D registration methods. Intra- and interobserver comparison showed high reliabilities, and constant positions (standard errors < 1%). Spatial patterns of the thicknesses of the articular cartilage and subchondral bone plate were revealed by measurements in 96 individual points of the tibial plateau. As a case study, pathological phenomena 6 months following OA induction in vivo such as osteophytes and areas of OA development were mapped to the individual subregions. These new reference points and subregions are directly identifiable on tibial plateau specimens or macroscopic images, enabling a precise topographical location of pathological structural changes of the osteochondral unit in both 2-D and 3-D subspaces in a region-appropriate fashion relevant for translational investigations.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Jan Reinhard
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Lars K H Goebel
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany.,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany.
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17
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Lin S, Lee WYW, Feng Q, Xu L, Wang B, Man GCW, Chen Y, Jiang X, Bian L, Cui L, Wei B, Li G. Synergistic effects on mesenchymal stem cell-based cartilage regeneration by chondrogenic preconditioning and mechanical stimulation. Stem Cell Res Ther 2017; 8:221. [PMID: 28974254 PMCID: PMC5627486 DOI: 10.1186/s13287-017-0672-5] [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] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/04/2017] [Accepted: 09/13/2017] [Indexed: 01/14/2023] Open
Abstract
Background Mesenchymal stem cells (MSCs) hold promising translational potential in cartilage regeneration. However, the efficacy of MSC-based tissue engineering is not satisfactory in the treatment of cartilage defect because of the inevitable cellular functional changes during ex vivo cell expansion. How to maintain the chondrogenic capacity of MSCs to improve their therapeutic outcomes remains an outstanding question. Methods Bone marrow-derived MSCs were firstly primed in chondrogenic induction medium which was then replaced with normal growth medium to attain the manipulated cells (M-MSCs). Methacrylated hyaluronic acid (MeHA) was synthesized as a scaffold to encapsulate the cells. The MSC- or M-MSC-laden constructs were treated with dynamic compressive loading (DL) in a bioreactor or with free loading (FL) for 14 days. Afterwards, the constructs were implanted in nude mice or rat models of osteochondral defects to test their efficiency in cartilage regeneration or repair. Results Data showed that the resulting M-MSCs exhibited superior chondrogenic differentiation potential and survivability compared with untreated MSCs. More importantly, we found that DL significantly promoted neocartilage formation in the MeHA hydrogel encapsulated with M-MSCs after 30 days of implantation in nude mice. Furthermore, the constructs laden with M-MSCs after DL for 14 days significantly enhanced cartilage healing in a rat model of osteochondral defect. Conclusions Findings from this study highlight the importance of maintaining chondrogenic potential of MSCs by in-vitro chondrogenic preconditioning and a synergistic effect of mechanical stimulation in cartilage engineering, which may shed light on the stem cell-based tissue engineering for cartilage repair. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0672-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sien Lin
- Department of Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.,Department of Pharmacology and Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, China.,Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Wayne Yuk Wai Lee
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 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
| | - Qian Feng
- Department of Mechanical and Automation Engineering, the Chinese University of Hong Kong, Hong Kong, China
| | - Liangliang Xu
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Bin Wang
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Gene Chi Wai Man
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yuanfeng Chen
- Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Xiaohua Jiang
- Key Laboratory for Regenerative Medicine of Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Liming Bian
- Department of Mechanical and Automation Engineering, the Chinese University of Hong Kong, Hong Kong, China
| | - Liao Cui
- Department of Pharmacology and Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, China.
| | - Bo Wei
- Department of Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.
| | - Gang Li
- Department of Pharmacology and Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, China. .,Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 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. .,Key Laboratory for Regenerative Medicine of Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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18
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Definition of a Critical Size Osteochondral Knee Defect and its Negative Effect on the Surrounding Articular Cartilage in the Rat. Osteoarthritis Cartilage 2017; 25:1531-1540. [PMID: 28506841 PMCID: PMC5754326 DOI: 10.1016/j.joca.2017.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/13/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Joint trauma is predisposing to the incidence of osteoarthritis (OA) of the knee. There is a limited knowledge on the impact of posttraumatic osteochondral defects on the whole joint. This study was designed to define a critical size osteochondral defect in the knee of rats and to investigate a possible association between osteochondral defects and degeneration of the surrounding joint surface. METHODS Cylindrical osteochondral defects of different sizes were created in the knee joint of rats. The natural course of these lesions was studied by macroscopic observation, histology, and immunohistochemistry. Gene expression of the articular cartilage surrounding the defects in vivo and of articular chondrocytes cultured in vitro in IL1β and fibroblast growth factor 2 (FGF2) supplemented media was evaluated by quantitative polymerase chain reaction (qPCR). RESULTS In defects of 0.9 mm diameter, spontaneous joint surface healing was observed but also upward advancing of the subchondral bone plate at 16 weeks. Larger 1.4 mm diameter defects were critical size, not resulting in successful healing at any time point. Importantly, the articular cartilage surrounding the defects expressed FGF2 and IL1β, but not ACAN and Col2. Chondrocytes cultured in IL1β and FGF2 supplemented media lost the natural fibroblast growth factor receptors - FGFr1/FGFr3 balance and showed decreased viability. CONCLUSIONS A critical size osteochondral defect was defined as 1.4 mm in diameter in rat. Subchondral bone plate advancement occured rapidly. The articular cartilage surrounding osteochondral defects showed catabolic activity with expression of IL1β, FGF2 and a disturbed FGFr1/FGFr3 balance, potentially initiating a process of early osteoarthritic disease.
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19
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Feng Q, Lin S, Zhang K, Dong C, Wu T, Huang H, Yan X, Zhang L, Li G, Bian L. Sulfated hyaluronic acid hydrogels with retarded degradation and enhanced growth factor retention promote hMSC chondrogenesis and articular cartilage integrity with reduced hypertrophy. Acta Biomater 2017; 53:329-342. [PMID: 28193542 DOI: 10.1016/j.actbio.2017.02.015] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 12/22/2022]
Abstract
Recently, hyaluronic acid (HA) hydrogels have been extensively researched for delivering cells and drugs to repair damaged tissues, particularly articular cartilage. However, the in vivo degradation of HA is fast, thus limiting the clinical translation of HA hydrogels. Furthermore, HA cannot bind proteins with high affinity because of the lack of negatively charged sulfate groups. In this study, we conjugated tunable amount of sulfate groups to HA. The sulfated HA exhibits significantly slower degradation by hyaluronidase compared to the wild type HA. We hypothesize that the sulfation reduces the available HA octasaccharide substrate needed for the effective catalytic action of hyaluronidase. Moreover, the sulfated HA hydrogels significantly improve the protein sequestration, thereby effectively extending the availability of the proteinaceous drugs in the hydrogels. In the following in vitro study, we demonstrate that the HA hydrogel sulfation exerts no negative effect on the viability of encapsulated human mesenchymal stem cells (hMSCs). Furthermore, the sulfated HA hydrogels promote the chondrogenesis and suppresses the hypertrophy of encapsulated hMSCs both in vitro and in vivo. Moreover, intra-articular injections of the sulfated HA hydrogels avert the cartilage abrasion and hypertrophy in the animal osteoarthritic joints. Collectively, our findings demonstrate that the sulfated HA is a promising biomaterial for the delivery of therapeutic agents to aid the regeneration of injured or diseased tissues and organs. STATEMENT OF SIGNIFICANCE In this paper, we conjugated sulfate groups to hyaluronic acid (HA) and demonstrated the slow degradation and growth factor delivery of sulfated HA. Furthermore, the in vitro and in vivo culture of hMSCs laden HA hydrogels proved that the sulfation of HA hydrogels not only promotes the chondrogenesis of hMSCs but also suppresses hypertrophic differentiation of the chondrogenically induced hMSCs. The animal OA model study showed that the injected sulfated HA hydrogels significantly reduced the cartilage abrasion and hypertrophy in the animal OA joints. We believe that this study will provide important insights into the design and optimization of the HA-based hydrogels as the scaffold materials for cartilage regeneration and OA treatment in clinical setting.
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Affiliation(s)
- Qian Feng
- Division of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong
| | - Sien Lin
- Division of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Department of Orthopaedic and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, 999077, Hong Kong
| | - Kunyu Zhang
- Division of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong
| | - Chaoqun Dong
- Division of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong
| | - Tianyi Wu
- Division of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Department of Orthopaedic and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, 999077, Hong Kong
| | - Heqin Huang
- Division of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong
| | - Xiaohui Yan
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong
| | - Li Zhang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong
| | - Gang Li
- Department of Orthopaedic and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, 999077, Hong Kong
| | - Liming Bian
- Division of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong; Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong; China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, PR China; Centre for Novel Biomaterials, The Chinese University of Hong Kong, Shatin, New Territories, 999077, Hong Kong.
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20
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Small animal models to understand pathogenesis of osteoarthritis and use of stem cell in cartilage regeneration. Cell Biochem Funct 2017; 35:3-11. [DOI: 10.1002/cbf.3246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/06/2016] [Accepted: 12/04/2016] [Indexed: 01/05/2023]
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Orth P, Duffner J, Zurakowski D, Cucchiarini M, Madry H. Small-Diameter Awls Improve Articular Cartilage Repair After Microfracture Treatment in a Translational Animal Model. Am J Sports Med 2016; 44:209-19. [PMID: 26546301 DOI: 10.1177/0363546515610507] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Microfracture is the most commonly applied arthroscopic marrow stimulation procedure. HYPOTHESIS Articular cartilage repair is improved when the subchondral bone is perforated by small-diameter microfracture awls compared with larger awls. STUDY DESIGN Controlled laboratory study. METHODS Standardized rectangular (4 × 8 mm) full-thickness chondral defects (N = 24) were created in the medial femoral condyle of 16 adult sheep and debrided down to the subchondral bone plate. Three treatment groups (n = 8 defects each) were tested: 6 microfracture perforations using small-diameter awls (1.0 mm; group 1), large-diameter awls (1.2 mm; group 2), or without perforations (debridement control; group 3). Osteochondral repair was assessed at 6 months in vivo using established macroscopic, histological, immunohistochemical, biochemical, and micro-computed tomography analyses. RESULTS Compared with control defects, histological cartilage repair was always improved after both microfracture techniques (P < .023). Application of 1.0-mm microfracture awls led to a significantly improved histological overall repair tissue quality (7.02 ± 0.70 vs 9.03 ± 0.69; P = .008) and surface grading (1.05 ± 0.28 vs 2.10 ± 0.19; P = .001) compared with larger awls. The small-diameter awl decreased relative bone volume of the subarticular spongiosa (bone volume/tissue volume ratio: 23.81% ± 3.37% vs 30.58% ± 2.46%; P = .011). Subchondral bone cysts and intralesional osteophytes were frequently observed after either microfracture treatment. Macroscopic grading, DNA, proteoglycan, and type I and type II collagen contents as well as degenerative changes within the adjacent cartilage remained unaffected by the awl diameter. CONCLUSION Small-diameter microfracture awls improve articular cartilage repair in the translational sheep model more effectively than do larger awls. CLINICAL RELEVANCE These data support the use of small microfracture instruments for the surgical treatment of cartilage defects and warrant prolonged clinical investigations.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany
| | - Julia Duffner
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany
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Madry H, Ochi M, Cucchiarini M, Pape D, Seil R. Large animal models in experimental knee sports surgery: focus on clinical translation. J Exp Orthop 2015; 2:9. [PMID: 26914877 PMCID: PMC4545948 DOI: 10.1186/s40634-015-0025-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/25/2015] [Indexed: 02/06/2023] Open
Abstract
Large animal models play a crucial role in sports surgery of the knee, as they are critical for the exploration of new experimental strategies and the clinical translation of novel techniques. The purpose of this contribution is to provide critical aspects of relevant animal models in this field, with a focus on paediatric anterior cruciate ligament (ACL) reconstruction, high tibial osteotomy, and articular cartilage repair. Although there is no single large animal model strictly replicating the human knee joint, the sheep stifle joint shares strong similarities. Studies in large animal models of paediatric ACL reconstruction identified specific risk factors associated with the different surgical techniques. The sheep model of high tibial osteotomy is a powerful new tool to advance the understanding of the effect of axial alignment on the lower extremity on specific issues of the knee joint. Large animal models of both focal chondral and osteochondral defects and of osteoarthritis have brought new findings about the mechanisms of cartilage repair and treatment options. The clinical application of a magnetic device for targeted cell delivery serves as a suitable example of how data from such animal models are directly translated into in clinical cartilage repair. As novel insights from studies in these translational models will advance the basic science, close cooperation in this important field of clinical translation will improve current reconstructive surgical options and open novel avenues for regenerative therapies of musculoskeletal disorders.
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Affiliation(s)
- Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Bldg 37, Kirrbergerstr. 1, D-66421, Homburg, Germany.
- Cartilage Net of the Greater Region, Homburg, Germany.
- Department of Orthopaedic Surgery, Saarland University Medical Center and Saarland University, D-66421, Homburg/Saar, Germany.
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Bldg 37, Kirrbergerstr. 1, D-66421, Homburg, Germany.
- Cartilage Net of the Greater Region, Homburg, Germany.
| | - Dietrich Pape
- Cartilage Net of the Greater Region, Homburg, Germany.
- Department of Orthopaedic Surgery, Centre Hospitalier du Luxembourg, L-1460, Luxembourg, Luxembourg.
- Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg, Centre Médical de la Fondation Norbert Metz, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg.
| | - Romain Seil
- Cartilage Net of the Greater Region, Homburg, Germany.
- Department of Orthopaedic Surgery, Centre Hospitalier du Luxembourg, L-1460, Luxembourg, Luxembourg.
- Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg, Centre Médical de la Fondation Norbert Metz, 76 rue d'Eich, L-1460, Luxembourg, Luxembourg.
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Orth P, Peifer C, Goebel L, Cucchiarini M, Madry H. Comprehensive analysis of translational osteochondral repair: Focus on the histological assessment. ACTA ACUST UNITED AC 2015; 50:19-36. [PMID: 26515165 DOI: 10.1016/j.proghi.2015.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 12/15/2022]
Abstract
Articular cartilage guarantees for an optimal functioning of diarthrodial joints by providing a gliding surface for smooth articulation, weight distribution, and shock absorbing while the subchondral bone plays a crucial role in its biomechanical and nutritive support. Both tissues together form the osteochondral unit. The structural assessment of the osteochondral unit is now considered the key standard procedure for evaluating articular cartilage repair in translational animal models. The aim of this review is to give a detailed overview of the different methods for a comprehensive evaluation of osteochondral repair. The main focus is on the histological assessment as the gold standard, together with immunohistochemistry, and polarized light microscopy. Additionally, standards of macroscopic, non-destructive imaging such as high resolution MRI and micro-CT, biochemical, and molecular biological evaluations are addressed. Potential pitfalls of analysis are outlined. A second focus is to suggest recommendations for osteochondral evaluation.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Carolin Peifer
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Lars Goebel
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Henning Madry
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
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24
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Bonasia DE, Marmotti A, Massa ADF, Ferro A, Blonna D, Castoldi F, Rossi R. Intra- and inter-observer reliability of ten major histological scoring systems used for the evaluation of in vivo cartilage repair. Knee Surg Sports Traumatol Arthrosc 2015; 23:2484-93. [PMID: 24714975 DOI: 10.1007/s00167-014-2975-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/30/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE In the last two decades, many surgical techniques have been described for articular cartilage repair. Reliable histological scoring systems are fundamental tools to evaluate new procedures. Several histological scoring systems have been described, and these can be divided in elementary and comprehensive scores, according to the number of sub-items. The aim of this study was to test the inter- and intra-observer reliability of ten main scores used for the histological evaluation of in vivo cartilage repair. The authors tested the starting hypothesis that elementary scores would show superior intra- and inter-observer reliability compared with comprehensive scores. METHODS Fifty histological sections obtained from the trochlea of New Zealand Rabbit and stained with Safranin-O fast green were used. The histological sections were analysed by 4 observers: 2 experienced in cartilage histology and 2 inexperienced. Histological evaluations were performed at time 1 and time 2, separated by a 30-day interval. The following scores were used: Mankin, O'Driscoll, Pineda, Wakitani, Fortier, Selleres, ICRS, ICRSII, Oswestry (OsScore) and modified O'Driscoll. Intra- and inter-observer reliability were evaluated for each score. In addition, the pavement-ceiling effect and the Bland-Altman Coefficient of Repeatability were then evaluated for each sub-item of every score. RESULTS Intra-observer reliability was high for all observers in every score, even though the reliability was significantly lower for non-expert observers compared with expert counterparts. In terms of Coefficient of Repeatability, some scores performed better (O'Driscoll, Modified O'Driscoll and ICRSII) than others (Fortier, Seller). Inter-observer reliability was high for all observers in every score, but significantly lower for non-expert compared with expert observers. CONCLUSIONS In expert hands, all the scores showed high intra- and inter-observer reliability, independently of the complexity. Although every score has advantages and disadvantages, ICRSII, O'Driscoll and Modified O'Driscoll scores should be preferred for the evaluation of in vivo cartilage repair in animal models.
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Affiliation(s)
- Davide Edoardo Bonasia
- AO Citta' della Salute e della Scienza, Azienda Ospedaliera CTO, Universita' degli Studi di Torino, Via Lamarmora 26, 10128, Turin, Italy,
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25
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Vilela CA, Correia C, Oliveira JM, Sousa RA, Espregueira-Mendes J, Reis RL. Cartilage Repair Using Hydrogels: A Critical Review of in Vivo Experimental Designs. ACS Biomater Sci Eng 2015; 1:726-739. [DOI: 10.1021/acsbiomaterials.5b00245] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- C. A. Vilela
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Life
and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- Orthopaedic
Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - C. Correia
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Guimarães, Portugal
| | - J. M. Oliveira
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - R. A. Sousa
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Guimarães, Portugal
| | - J. Espregueira-Mendes
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Life
and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- Clínica
do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal
| | - R. L. Reis
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Guimarães, Portugal
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Abstract
Osteoarthritis (OA) is unquestionably one of the most important chronic health issues in humans, affecting millions of individuals and costing billions of dollars annually. Despite widespread awareness of this disease and its devastating impact, the pathogenesis of early OA is not completely understood, hampering the development of effective tools for early diagnosis and disease-modifying therapeutics. Most human tissue available for study is obtained at the time of joint replacement, when OA lesions are end stage and little can be concluded about the factors that played a role in disease development. To overcome this limitation, over the past 50 years, numerous induced and spontaneous animal models have been utilized to study disease onset and progression, as well as to test novel therapeutic interventions. Reflecting the heterogeneity of OA itself, no single "gold standard" animal model for OA exists; thus, a challenge for researchers lies in selecting the most appropriate model to answer a particular scientific question of interest. This review provides general considerations for model selection, as well as important features of species such as mouse, rat, guinea pig, sheep, goat, and horse, which researchers should be mindful of when choosing the "best" animal model for their intended purpose. Special consideration is given to key variations in pathology among species as well as recommended guidelines for reporting the histologic features of each model.
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Affiliation(s)
- A M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, USA
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27
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Evaluation and analysis of graft hypertrophy by means of arthroscopy, biochemical MRI and osteochondral biopsies in a patient following autologous chondrocyte implantation for treatment of a full-thickness-cartilage defect of the knee. Arch Orthop Trauma Surg 2015; 135:819-30. [PMID: 25762093 DOI: 10.1007/s00402-015-2194-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Indexed: 02/09/2023]
Abstract
Graft hypertrophy represents a characteristic complication following autologous chondrocyte implantation (ACI) for treatment of cartilage defects. Although some epidemiological data suggest that incidence is associated with first-generation ACI using autologous chondrocyte implantation, it has also been reported in other technical modifications of ACI using different biomaterials. Nevertheless, it has not been described in autologous, non-periosteum, implant-free associated ACI. In addition, little is known about histological and T2-relaxation appearance of graft hypertrophy. The present case report provides a rare case of extensive graft hypertrophy following ACI using an autologous spheres technique with clinical progression over time. Detailed clinical, MR tomographic and histological evaluation has been performed, which demonstrates a high quality of repair tissue within the hypertrophic as well as non-hypertrophic transplanted areas of the repair tissue. No expression of collagen type X (a sign of chondrocyte hypertrophy), only slight changes of the subchondral bone and a nearly normal cell-matrix ratio suggest that tissue within the hypertrophic area does not significantly differ from intact and high-quality repair tissue and therefore seems not to cause graft hypertrophy. This is in contrast to the assumption that histological hypertrophy might cause or contribute to an overwhelming growth of the repair tissue within the transplantation site. Data presented in this manuscript might contribute to further explain the etiology of graft hypertrophy following ACI.
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28
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Goebel L, Müller A, Bücker A, Madry H. High resolution MRI imaging at 9.4 Tesla of the osteochondral unit in a translational model of articular cartilage repair. BMC Musculoskelet Disord 2015; 16:91. [PMID: 25888208 PMCID: PMC4404065 DOI: 10.1186/s12891-015-0543-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/27/2015] [Indexed: 12/13/2022] Open
Abstract
Background Non-destructive structural evaluation of the osteochondral unit is challenging. Here, the capability of high-field magnetic resonance imaging (μMRI) at 9.4 Tesla (T) was explored to examine osteochondral repair ex vivo in a preclinical large animal model. A specific aim of this study was to detect recently described alterations of the subchondral bone associated with cartilage repair. Methods Osteochondral samples of medial femoral condyles from adult ewes containing full-thickness articular cartilage defects treated with marrow stimulation were obtained after 6 month in vivo and scanned in a 9.4 T μMRI. Ex vivo imaging of small osteochondral samples (typical volume: 1–2 cm3) at μMRI was optimised by variation of repetition time (TR), time echo (TE), flip angle (FA), spatial resolution and number of excitations (NEX) from standard MultiSliceMultiEcho (MSME) and three-dimensional (3D) spoiled GradientEcho (SGE) sequences. Results A 3D SGE sequence with the parameters: TR = 10 ms, TE = 3 ms, FA = 10 °, voxel size = 120 × 120 × 120 μm3 and NEX = 10 resulted in the best fitting for sample size, image quality, scanning time and artifacts. An isovolumetric voxel shape allowed for multiplanar reconstructions. Within the osteochondral unit articular cartilage, cartilaginous repair tissue and bone marrow could clearly be distinguished from the subchondral bone plate and subarticular spongiosa. Specific alterations of the osteochondral unit associated with cartilage repair such as persistent drill holes, subchondral bone cysts, sclerosis of the subchondral bone plate and of the subarticular spongiosa and intralesional osteophytes were precisely detected. Conclusions High resolution, non-destructive ex vivo analysis of the entire osteochondral unit in a preclinical large animal model that is sufficient for further analyses is possible using μMRI at 9.4 T. In particular, 9.4 T is capable of accurately depicting alterations of the subchondral bone that are associated with osteochondral repair.
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Affiliation(s)
- Lars Goebel
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, Homburg/Saar, D-66421, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Building 37, Homburg/Saar, D-66421, Germany. .,Cartilage Net of the Greater Region, University of the Greater Region, Homburg/Saar, D-66421, Germany.
| | - Andreas Müller
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Building 57, Homburg/Saar, D-66421, Germany.
| | - Arno Bücker
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Building 57, Homburg/Saar, D-66421, Germany.
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, Homburg/Saar, D-66421, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Building 37, Homburg/Saar, D-66421, Germany. .,Cartilage Net of the Greater Region, University of the Greater Region, Homburg/Saar, D-66421, Germany.
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29
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Trachtenberg JE, Vo TN, Mikos AG. Pre-clinical characterization of tissue engineering constructs for bone and cartilage regeneration. Ann Biomed Eng 2014; 43:681-96. [PMID: 25319726 DOI: 10.1007/s10439-014-1151-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/06/2014] [Indexed: 12/16/2022]
Abstract
Pre-clinical animal models play a crucial role in the translation of biomedical technologies from the bench top to the bedside. However, there is a need for improved techniques to evaluate implanted biomaterials within the host, including consideration of the care and ethics associated with animal studies, as well as the evaluation of host tissue repair in a clinically relevant manner. This review discusses non-invasive, quantitative, and real-time techniques for evaluating host-materials interactions, quality and rate of neotissue formation, and functional outcomes of implanted biomaterials for bone and cartilage tissue engineering. Specifically, a comparison will be presented for pre-clinical animal models, histological scoring systems, and non-invasive imaging modalities. Additionally, novel technologies to track delivered cells and growth factors will be discussed, including methods to directly correlate their release with tissue growth.
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Affiliation(s)
- Jordan E Trachtenberg
- Department of Bioengineering, Rice University, MS 142, P.O. Box 1892, Houston, TX, 77251-1892, USA
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30
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Goebel L, Zurakowski D, Müller A, Pape D, Cucchiarini M, Madry H. 2D and 3D MOCART scoring systems assessed by 9.4 T high-field MRI correlate with elementary and complex histological scoring systems in a translational model of osteochondral repair. Osteoarthritis Cartilage 2014; 22:1386-95. [PMID: 25278050 DOI: 10.1016/j.joca.2014.05.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/30/2014] [Accepted: 05/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the 2D and 3D MOCART system obtained with 9.4 T high-field magnetic resonance imaging (MRI) for the ex vivo analysis of osteochondral repair in a translational model and to correlate the data with semiquantitative histological analysis. METHODS Osteochondral samples representing all levels of repair (sheep medial femoral condyles; n = 38) were scanned in a 9.4 T high-field MRI. The 2D and adapted 3D MOCART systems were used for grading after point allocation to each category. Each score was correlated with corresponding reconstructions between both MOCART systems. Data were next correlated with corresponding categories of an elementary (Wakitani) and a complex (Sellers) histological scoring system as gold standards. RESULTS Correlations between most 2D and 3D MOCART score categories were high, while mean total point values of 3D MOCART scores tended to be 15.8-16.1 points higher compared to the 2D MOCART scores based on a Bland-Altman analysis. "Defect fill" and "total points" of both MOCART scores correlated with corresponding categories of Wakitani and Sellers scores (all P ≤ 0.05). "Subchondral bone plate" also correlated between 3D MOCART and Sellers scores (P < 0.001). CONCLUSIONS Most categories of the 2D and 3D MOCART systems correlate, while total scores were generally higher using the 3D MOCART system. Structural categories "total points" and "defect fill" can reliably be assessed by 9.4 T MRI evaluation using either system, "subchondral bone plate" using the 3D MOCART score. High-field MRI is valuable to objectively evaluate osteochondral repair in translational settings.
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Affiliation(s)
- L Goebel
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, 66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Building 37, 66421 Homburg/Saar, Germany.
| | - D Zurakowski
- Departments of Anesthesia and Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
| | - A Müller
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Building 57, 66421 Homburg/Saar, Germany.
| | - D Pape
- Department of Orthopaedic Surgery, Centre Hospitalier, Clinique d'Eich, 76, Rue d'Eich, L-1460 Luxembourg, Luxembourg.
| | - M Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, 66421 Homburg/Saar, Germany.
| | - H Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, 66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Building 37, 66421 Homburg/Saar, Germany.
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31
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Cheng A, Kapacee Z, Peng J, Lu S, Lucas RJ, Hardingham TE, Kimber SJ. Cartilage repair using human embryonic stem cell-derived chondroprogenitors. Stem Cells Transl Med 2014; 3:1287-94. [PMID: 25273540 DOI: 10.5966/sctm.2014-0101] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In initial work, we developed a 14-day culture protocol under potential GMP, chemically defined conditions to generate chondroprogenitors from human embryonic stem cells (hESCs). The present study was undertaken to investigate the cartilage repair capacity of these cells. The chondrogenic protocol was optimized and validated with gene expression profiling. The protocol was also applied successfully to two lines of induced pluripotent stem cells (iPSCs). Chondrogenic cells derived from hESCs were encapsulated in fibrin gel and implanted in osteochondral defects in the patella groove of nude rats, and cartilage repair was evaluated by histomorphology and immunocytochemistry. Genes associated with chondrogenesis were upregulated during the protocol, and pluripotency-related genes were downregulated. Aggregation of chondrogenic cells was accompanied by high expression of SOX9 and strong staining with Safranin O. Culture with PluriSln1 was lethal for hESCs but was tolerated by hESC chondrogenic cells, and no OCT4-positive cells were detected in hESC chondrogenic cells. iPSCs were also shown to generate chondroprogenitors in this protocol. Repaired tissue in the defect area implanted with hESC-derived chondrogenic cells was stained for collagen II with little collagen I, but negligible collagen II was observed in the fibrin-only controls. Viable human cells were detected in the repair tissue at 12 weeks. The results show that chondrogenic cells derived from hESCs, using a chemically defined culture system, when implanted in focal defects were able to promote cartilage repair. This is a first step in evaluating these cells for clinical application for the treatment of cartilage lesions.
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Affiliation(s)
- Aixin Cheng
- Faculty of Life Sciences and Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom; Institute of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zoher Kapacee
- Faculty of Life Sciences and Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom; Institute of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiang Peng
- Faculty of Life Sciences and Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom; Institute of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shibi Lu
- Faculty of Life Sciences and Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom; Institute of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Robert J Lucas
- Faculty of Life Sciences and Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom; Institute of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Timothy E Hardingham
- Faculty of Life Sciences and Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom; Institute of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Susan J Kimber
- Faculty of Life Sciences and Wellcome Trust Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom; Institute of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
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Lam J, Lu S, Lee EJ, Trachtenberg JE, Meretoja VV, Dahlin RL, van den Beucken JJJP, Tabata Y, Wong ME, Jansen JA, Mikos AG, Kasper FK. Osteochondral defect repair using bilayered hydrogels encapsulating both chondrogenically and osteogenically pre-differentiated mesenchymal stem cells in a rabbit model. Osteoarthritis Cartilage 2014; 22:1291-300. [PMID: 25008204 PMCID: PMC4150851 DOI: 10.1016/j.joca.2014.06.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/02/2014] [Accepted: 06/25/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the ability of cell-laden bilayered hydrogels encapsulating chondrogenically and osteogenically (OS) pre-differentiated mesenchymal stem cells (MSCs) to effect osteochondral defect repair in a rabbit model. By varying the period of chondrogenic pre-differentiation from 7 (CG7) to 14 days (CG14), the effect of chondrogenic differentiation stage on osteochondral tissue repair was also investigated. METHODS Rabbit MSCs were subjected to either chondrogenic or osteogenic pre-differentiation, encapsulated within respective chondral/subchondral layers of a bilayered hydrogel construct, and then implanted into femoral condyle osteochondral defects. Rabbits were randomized into one of four groups (MSC/MSC, MSC/OS, CG7/OS, and CG14/OS; chondral/subchondral) and received two similar constructs bilaterally. Defects were evaluated after 12 weeks. RESULTS All groups exhibited similar overall neo-tissue filling. The delivery of OS cells when compared to undifferentiated MSCs in the subchondral construct layer resulted in improvements in neo-cartilage thickness and regularity. However, the addition of CG cells in the chondral layer, with OS cells in the subchondral layer, did not augment tissue repair as influenced by the latter when compared to the control. Instead, CG7/OS implants resulted in more irregular neo-tissue surfaces when compared to MSC/OS implants. Notably, the delivery of CG7 cells, when compared to CG14 cells, with OS cells stimulated morphologically superior cartilage repair. However, neither osteogenic nor chondrogenic pre-differentiation affected detectable changes in subchondral tissue repair. CONCLUSIONS Cartilage regeneration in osteochondral defects can be enhanced by MSCs that are chondrogenically and osteogenically pre-differentiated prior to implantation. Longer chondrogenic pre-differentiation periods, however, lead to diminished cartilage repair.
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Affiliation(s)
- Johnny Lam
- Department of Bioengineering, Rice University, Houston, TX
| | - Steven Lu
- Department of Bioengineering, Rice University, Houston, TX
| | - Esther J. Lee
- Department of Bioengineering, Rice University, Houston, TX
| | | | | | | | | | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Mark E. Wong
- Department of Surgery, Division of Oral and Maxillofacial Surgery, The University of Texas School of Dentistry, Houston, TX
| | - John A. Jansen
- Department of Biomaterials, Radboud umc, Nijmegen, The Netherlands
| | - Antonios G. Mikos
- Department of Bioengineering, Rice University, Houston, TX,Corresponding Authors: Antonios G. Mikos, Ph.D., Department of Bioengineering, Rice University, P.O. Box 1892, MS-142, Houston, TX 77251-1892, w: 713-348-5355, , F. Kurtis Kasper, Ph.D., Department of Bioengineering, Rice University, P.O. Box 1892, MS-142, Houston, TX 77251-1892, w: 713-348-3027,
| | - F. Kurtis Kasper
- Department of Bioengineering, Rice University, Houston, TX,Corresponding Authors: Antonios G. Mikos, Ph.D., Department of Bioengineering, Rice University, P.O. Box 1892, MS-142, Houston, TX 77251-1892, w: 713-348-5355, , F. Kurtis Kasper, Ph.D., Department of Bioengineering, Rice University, P.O. Box 1892, MS-142, Houston, TX 77251-1892, w: 713-348-3027,
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Ziegler R, Goebel L, Cucchiarini M, Pape D, Madry H. Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part II: standard and overcorrection do not cause articular cartilage degeneration. Knee Surg Sports Traumatol Arthrosc 2014; 22:1666-77. [PMID: 23340838 DOI: 10.1007/s00167-013-2410-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/14/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate whether medial open wedge high tibial osteotomy (HTO) results in structural changes in the articular cartilage in the lateral tibiofemoral compartment of adult sheep. METHODS Three experimental groups received biplanar osteotomies of the right proximal tibiae: (a) closing wedge HTO (4.5° of tibial varus), (b) opening wedge HTO (4.5° tibial valgus; standard correction), and (c) opening wedge HTO (9.5° of valgus; overcorrection), each of which was compared to the contralateral knees that only received an arthrotomy. After 6 months, the macroscopic and microscopic characteristics of the articular cartilage of the lateral tibiofemoral compartment were assessed. RESULTS The articular cartilage in the central region of the lateral tibial plateau in sheep had a higher safranin O staining intensity and was 4.6-fold thicker than in the periphery (covered by the lateral meniscus). No topographical variation in the type-II collagen immunoreactivity was seen. All lateral tibial plateaus showed osteoarthritic changes in regions not covered by the lateral meniscus. No osteoarthritis was seen in the peripheral submeniscal regions of the lateral tibial plateau and the lateral femoral condyle. Opening wedge HTO resulting in both standard and overcorrection was not associated with significant macroscopic and microscopic structural changes between groups in the articular cartilage of the lateral tibial plateau and femoral condyle after 6 months in vivo. CONCLUSION Opening wedge HTO resulting in both standard and overcorrection is a safe procedure for the articular cartilage in an intact lateral tibiofemoral compartment of adult sheep at 6 months postoperatively.
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Affiliation(s)
- Raphaela Ziegler
- Center of Experimental Orthopaedics, Saarland University, Kirrbergerstr. 1, Bldg 37, 66421, Homburg, Saar, Germany
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Truong MD, Chung JY, Kim YJ, Jin LH, Kim BJ, Choi BH, Min BH. Histomorphochemical comparison of microfracture as a first-line and a salvage procedure: is microfracture still a viable option for knee cartilage repair in a salvage situation? J Orthop Res 2014; 32:802-10. [PMID: 24676881 DOI: 10.1002/jor.22592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/13/2014] [Indexed: 02/04/2023]
Abstract
Microfracture is considered as the first-line procedure for knee cartilage repair, but the results of microfracture seem less predictable and rather controversial in a salvage situation. Thus, the purpose of the study was to histomorphochemically compare microfracture as a salvage procedure with microfracture as a first-line procedure in a rabbit model. We hypothesized that microfracture in a salvage situation would result in histomorphochemically inferior cartilage repair compared to microfracture as a first-line procedure, and the inferiority would be attributed to less migration of reparable marrow cells to the defect due to destruction of microarchitecture of the subchondral bone. Thirty-six New Zealand white rabbits were divided into three groups: (i) untreated full-thickness chondral defect, (ii) single microfracture treatment (first microfracture group), and (iii) repeated microfracture in 8 weeks after the first procedure (second microfracture group). In each group, rabbits were sacrificed at the end of 8 weeks, and osteochondral specimens at the repair sites were obtained for histomorphochemical analysis. Results showed that microfracture as a salvage procedure resulted in overall inferior cartilage repair histomorphochemically compared with microfracture as a first-line procedure, which correlated with deteriorative changes in the quality of underlying subchondral bone rather than intrinsic incapability to recruit the reparative cells in the defect area. In conclusion, although a comparable number of reparable cells and a mechanically weakened subchondral bone are anticipated, more study is necessary to clearly determine when a microfracture should be performed in a situation.
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Affiliation(s)
- Minh-Dung Truong
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
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35
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Nosewicz TL, Reilingh ML, Wolny M, van Dijk CN, Duda GN, Schell H. Influence of basal support and early loading on bone cartilage healing in press-fitted osteochondral autografts. Knee Surg Sports Traumatol Arthrosc 2014; 22:1445-51. [PMID: 23479055 DOI: 10.1007/s00167-013-2453-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/18/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE The influence of basal graft support combined to early loading following an osteochondral autograft procedure is unclear. It was hypothesized that bottomed grafts may allow for early mobilization by preventing graft subsidence and leading to better healing. METHODS Osteochondral autografts were press fitted in the femoral condyles of 24 sheep (one graft per animal). In the unbottomed group (n = 12), a gap of 2 mm was created between graft and recipient bone base. In the bottomed group (n = 12), the graft firmly rested on recipient bone. Animals were allowed immediate postoperative weightbearing. Healing times were 3 and 6 months per group (n = 6 per subgroup). After killing, histological and histomorphometric analyses were performed. RESULTS Unbottomed grafts at 3 months showed significantly more graft subsidence (P = 0.024), significantly less mineralized bone (P = 0.028) and significantly worse cartilage and subchondral bone plate healing (P = 0.034) when compared to bottomed grafts. At 6 months, no differences were seen. Compared to the native situation, unbottomed grafts showed significantly more graft subsidence (P = 0.024), whereas bottomed grafts did not. Cystic lesions were seen in both groups. Osteoclasts were closely related to the degree of bone remodelling. CONCLUSION In the animal model, in the case of early loading, bottomed osteochondral autografts have less chance of graft subsidence. Evident subsidence negatively influences the histological healing process. In the osteochondral autograft procedure, full graft support should be aimed for. This may allow for early mobilization, diminish graft subsidence and improve long-term integration.
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Affiliation(s)
- Tomasz L Nosewicz
- Julius Wolff Institute and Center for Musculoskeletal Surgery and Berlin-Brandenburg Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Forum 4, Postbox 24, 13353, Berlin, Germany,
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36
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Fang H, Beier F. Mouse models of osteoarthritis: modelling risk factors and assessing outcomes. Nat Rev Rheumatol 2014; 10:413-21. [PMID: 24662645 DOI: 10.1038/nrrheum.2014.46] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Osteoarthritis (OA) is a prevalent musculoskeletal disease that results in pain and low quality of life for patients, as well as enormous medical and socioeconomic burdens. The molecular mechanisms responsible for the initiation and progression of OA are still poorly understood. As such, mouse models of the disease are having increasingly important roles in OA research owing to the advancements of microsurgical techniques and the use of genetically modified mice, as well as the development of novel assessment tools. In this Review, we discuss available mouse models of OA and applicable assessment tools in studies of experimental OA.
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Affiliation(s)
- Hang Fang
- Department of Orthopaedics, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China
| | - Frank Beier
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada
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Chang EY, Pallante-Kichura AL, Bae WC, Du J, Statum S, Wolfson T, Gamst AC, Cory E, Amiel D, Bugbee WD, Sah RL, Chung CB. Development of a Comprehensive Osteochondral Allograft MRI Scoring System (OCAMRISS) with Histopathologic, Micro-Computed Tomography, and Biomechanical Validation. Cartilage 2014; 5:16-27. [PMID: 24489999 PMCID: PMC3904392 DOI: 10.1177/1947603513514436] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To describe and apply a semi-quantitative MRI scoring system for multi-feature analysis of cartilage defect repair in the knee by osteochondral allografts, and to correlate this scoring system with histopathologic, micro-computed tomography (μCT), and biomechanical reference standards using a goat repair model. DESIGN Fourteen adult goats had two osteochondral allografts implanted into each knee: one in the medial femoral condyle (MFC) and one in the lateral trochlea (LT). At 12 months, goats were euthanized and MRI was performed. Two blinded radiologists independently rated nine primary features for each graft, including cartilage signal, fill, edge integration, surface congruity, calcified cartilage integrity, subchondral bone plate congruity, subchondral bone marrow signal, osseous integration, and presence of cystic changes. Four ancillary features of the joint were also evaluated, including opposing cartilage, meniscal tears, synovitis, and fat-pad scarring. Comparison was made with histological and μCT reference standards as well as biomechanical measures. Interobserver agreement and agreement with reference standards was assessed. Cohen's kappa, Spearman's correlation, and Kruskal-Wallis tests were used as appropriate. RESULTS There was substantial agreement (κ>0.6, p<0.001) for each MRI feature and with comparison against reference standards, except for cartilage edge integration (κ=0.6). There was a strong positive correlation between MRI and reference standard scores (ρ=0.86, p<0.01). OCAMRISS was sensitive to differences in outcomes between the types of allografts. CONCLUSIONS We have described a comprehensive MRI scoring system for osteochondral allografts and have validated this scoring system with histopathologic and μCT reference standards as well as biomechanical indentation testing.
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Affiliation(s)
- Eric Y. Chang
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA,Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | | | - Won C. Bae
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Tanya Wolfson
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Anthony C. Gamst
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Esther Cory
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - David Amiel
- Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - William D. Bugbee
- Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, CA, USA,Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Robert L. Sah
- Department of Bioengineering, University of California, San Diego, CA, USA,Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Christine B. Chung
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA,Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
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Orth P, Meyer HL, Goebel L, Eldracher M, Ong MF, Cucchiarini M, Madry H. Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle. J Orthop Res 2013; 31:1772-9. [PMID: 23813860 DOI: 10.1002/jor.22418] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/05/2013] [Indexed: 02/04/2023]
Abstract
Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics, Saarland University, Building 37-38, D-66421, Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Madry H, Rey-Rico A, Venkatesan JK, Johnstone B, Cucchiarini M. Transforming growth factor Beta-releasing scaffolds for cartilage tissue engineering. TISSUE ENGINEERING PART B-REVIEWS 2013; 20:106-25. [PMID: 23815376 DOI: 10.1089/ten.teb.2013.0271] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The maintenance of a critical threshold concentration of transforming growth factor beta (TGF-β) for a given period of time is crucial for the onset and maintenance of chondrogenesis. Thus, the development of scaffolds that provide temporal and/or spatial control of TGF-β bioavailability has appeal as a mechanism to induce the chondrogenesis of stem cells in vitro and in vivo for articular cartilage repair. In the past decade, many types of scaffolds have been designed to advance this goal: hydrogels based on polysaccharides, hyaluronic acid, and alginate; protein-based hydrogels such as fibrin, gelatin, and collagens; biopolymeric gels and synthetic polymers; and solid and hybrid composite (hydrogel/solid) scaffolds. In this study, we review the progress in developing strategies to deliver TGF-β from scaffolds with the aim of enhancing chondrogenesis. In the future, such scaffolds could prove critical for tissue engineering cartilage, both in vitro and in vivo.
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Affiliation(s)
- Henning Madry
- 1 Center of Experimental Orthopaedics, Saarland University , Homburg, Germany
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40
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Orth P, Zurakowski D, Alini M, Cucchiarini M, Madry H. Reduction of sample size requirements by bilateral versus unilateral research designs in animal models for cartilage tissue engineering. Tissue Eng Part C Methods 2013; 19:885-91. [PMID: 23510128 DOI: 10.1089/ten.tec.2012.0699] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Advanced tissue engineering approaches for articular cartilage repair in the knee joint rely on translational animal models. In these investigations, cartilage defects may be established either in one joint (unilateral design) or in both joints of the same animal (bilateral design). We hypothesized that a lower intraindividual variability following the bilateral strategy would reduce the number of required joints. Standardized osteochondral defects were created in the trochlear groove of 18 rabbits. In 12 animals, defects were produced unilaterally (unilateral design; n=12 defects), while defects were created bilaterally in 6 animals (bilateral design; n=12 defects). After 3 weeks, osteochondral repair was evaluated histologically applying an established grading system. Based on intra- and interindividual variabilities, required sample sizes for the detection of discrete differences in the histological score were determined for both study designs (α=0.05, β=0.20). Coefficients of variation (%CV) of the total histological score values were 1.9-fold increased following the unilateral design when compared with the bilateral approach (26 versus 14%CV). The resulting numbers of joints needed to treat were always higher for the unilateral design, resulting in an up to 3.9-fold increase in the required number of experimental animals. This effect was most pronounced for the detection of small-effect sizes and estimating large standard deviations. The data underline the possible benefit of bilateral study designs for the decrease of sample size requirements for certain investigations in articular cartilage research. These findings might also be transferred to other scoring systems, defect types, or translational animal models in the field of cartilage tissue engineering.
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Affiliation(s)
- Patrick Orth
- 1 Center of Experimental Orthopaedics, Saarland University , Homburg/Saar, Germany
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41
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Madry H, Kaul G, Zurakowski D, Vunjak-Novakovic G, Cucchiarini M. Cartilage constructs engineered from chondrocytes overexpressing IGF-I improve the repair of osteochondral defects in a rabbit model. Eur Cell Mater 2013; 25:229-47. [PMID: 23588785 PMCID: PMC4476264 DOI: 10.22203/ecm.v025a17] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Tissue engineering combined with gene therapy is a promising approach for promoting articular cartilage repair. Here, we tested the hypothesis that engineered cartilage with chondrocytes overexpressing a human insulin-like growth factor I (IGF-I) gene can enhance the repair of osteochondral defects, in a manner dependent on the duration of cultivation. Genetically modified chondrocytes were cultured on biodegradable polyglycolic acid scaffolds in dynamic flow rotating bioreactors for either 10 or 28 d. The resulting cartilaginous constructs were implanted into osteochondral defects in rabbit knee joints. After 28 weeks of in vivo implantation, immunoreactivity to ß-gal was detectable in the repair tissue of defects that received lacZ constructs. Engineered cartilaginous constructs based on IGF-I-overexpressing chondrocytes markedly improved osteochondral repair compared with control (lacZ) constructs. Moreover, IGF-I constructs cultivated for 28 d in vitro significantly promoted osteochondral repair vis-à-vis similar constructs cultivated for 10 d, leading to significantly decreased osteoarthritic changes in the cartilage adjacent to the defects. Hence, the combination of spatially defined overexpression of human IGF-I within a tissue-engineered construct and prolonged bioreactor cultivation resulted in most enhanced articular cartilage repair and reduction of osteoarthritic changes in the cartilage adjacent to the defect. Such genetically enhanced tissue engineering provides a versatile tool to evaluate potential therapeutic genes in vivo and to improve our comprehension of the development of the repair tissue within articular cartilage defects. Insights gained with additional exploration using this model may lead to more effective treatment options for acute cartilage defects.
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Affiliation(s)
- Henning Madry
- Centre of Experimental Orthopaedics, Saarland University, Homburg, Germany,Department of Orthopaedic Surgery, Saarland University, Homburg, Germany,Address for correspondence: Henning Madry Centre of Experimental Orthopaedics Medical Faculty Building 37 Saarland University D-66421 Homburg, Germany Telephone Number: +49-6841-1624515 FAX Number: +49-6841-1624988
| | - Gunter Kaul
- Centre of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - David Zurakowski
- Departments of Anaesthesia and Surgery, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Magali Cucchiarini
- Centre of Experimental Orthopaedics, Saarland University, Homburg, Germany
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Orth P, Cucchiarini M, Zurakowski D, Menger MD, Kohn DM, Madry H. Parathyroid hormone [1-34] improves articular cartilage surface architecture and integration and subchondral bone reconstitution in osteochondral defects in vivo. Osteoarthritis Cartilage 2013; 21:614-24. [PMID: 23353669 DOI: 10.1016/j.joca.2013.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/07/2013] [Accepted: 01/12/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The 1-34 amino acid segment of the parathyroid hormone (PTH [1-34]) mediates anabolic effects in chondrocytes and osteocytes. The aim of this study was to investigate whether systemic application of PTH [1-34] improves the repair of non-osteoarthritic, focal osteochondral defects in vivo. DESIGN Standardized cylindrical osteochondral defects were bilaterally created in the femoral trochlea of rabbits (n = 8). Daily subcutaneous injections of 10 μg PTH [1-34]/kg were given to the treatment group (n = 4) for 6 weeks, controls (n = 4) received saline. Articular cartilage repair was evaluated by macroscopic, biochemical, histological and immunohistochemical analyses. Reconstitution of the subchondral bone was assessed by micro-computed tomography. Effects of PTH [1-34] on synovial membrane, apoptosis, and expression of the PTH receptor (PTH1R) were determined. RESULTS Systemic PTH [1-34] increased PTH1R expression on both, chondrocytes and osteocytes within the repair tissue. PTH [1-34] ameliorated the macro- and microscopic aspect of the cartilaginous repair tissue. It also enhanced the thickness of the subchondral bone plate and the microarchitecture of the subarticular spongiosa within the defects. No significant correlations were established between these coexistent processes. Apoptotic levels, synovial membrane, biochemical composition of the repair tissue, and type-I/II collagen immunoreactivity remained unaffected. CONCLUSIONS PTH [1-34] emerges as a promising agent in the treatment of focal osteochondral defects as its systemic administration simultaneously stimulates articular cartilage and subchondral bone repair. Importantly, both time-dependent mechanisms of repair did not correlate significantly at this early time point and need to be followed over prolonged observation periods.
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Affiliation(s)
- P Orth
- Center of Experimental Orthopaedics, Saarland University, Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
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Abstract
Tissue engineering (TE) has promise as a biological solution and a disease modifying treatment for arthritis. Although cartilage can be generated by TE, substantial inter- and intra-donor variability makes it impossible to guarantee optimal, reproducible results. TE cartilage must be able to perform the functions of native tissue, thus mechanical and biological properties approaching those of native cartilage are likely a pre-requisite for successful implantation. A quality-control assessment of these properties should be part of the implantation release criteria for TE cartilage. Release criteria should certify that selected tissue properties have reached certain target ranges, and should be predictive of the likelihood of success of an implant in vivo. Unfortunately, it is not currently known which properties are needed to establish release criteria, nor how close one has to be to the properties of native cartilage to achieve success. Achieving properties approaching those of native cartilage requires a clear understanding of the target properties and reproducible assessment methodology. Here, we review several main aspects of quality control as it applies to TE cartilage. This includes a look at known mechanical and biological properties of native cartilage, which should be the target in engineered tissues. We also present an overview of the state of the art of tissue assessment, focusing on native articular and TE cartilage. Finally, we review the arguments for developing and validating non-destructive testing methods for assessing TE products.
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Affiliation(s)
- Joseph M. Mansour
- Skeletal Research Center, Department of Biology Case Western Reserve University Cleveland, OH, 44106
| | - Jean F. Welter
- Skeletal Research Center, Department of Biology Case Western Reserve University Cleveland, OH, 44106
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44
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Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: Analysis of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2013; 21:39-48. [PMID: 22898914 DOI: 10.1007/s00167-012-2176-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 07/30/2012] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate whether medial open wedge high tibial osteotomy (HTO) results in structural and biochemical changes in the lateral meniscus in adult sheep. METHODS Three experimental groups with biplanar osteotomies of the right proximal tibiae were tested: (a) closing wedge HTO resulting in 4.5° of tibial varus, (b) open wedge HTO resulting in 4.5° of tibial valgus (standard correction) and (c) open wedge HTO resulting in 9.5° of valgus (overcorrection), each of which was compared to the contralateral knees with normal limb axes. After 6 months, the lateral menisci were macroscopically and microscopically evaluated. The proteoglycan and DNA contents of the red-red and white-white zones of the anterior, middle and posterior third were determined. RESULTS Semiquantitative macroscopic and microscopic grading revealed no structural differences between groups. The red-red zone of the middle third of the lateral menisci of animals that underwent overcorrection exhibited a significant 0.7-fold decrease in mean DNA contents compared with the control knee without HTO (P = 0.012). Comparative estimation of the DNA and proteoglycan contents and proteoglycan/DNA ratios of all other parts and zones of the lateral menisci did not reveal significant differences between groups. CONCLUSION Open wedge HTO does not lead to significant macroscopic and microscopic structural changes in the lateral meniscus after 6 months in vivo. Overcorrection significantly decreases the proliferative activity of the cells in the red-red zone of the middle third in the sheep model.
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Ng VY, Jump SS, Santangelo KS, Russell DS, Bertone AL. Genetic engineering of juvenile human chondrocytes improves scaffold-free mosaic neocartilage grafts. Clin Orthop Relat Res 2013; 471:26-38. [PMID: 23008026 PMCID: PMC3528904 DOI: 10.1007/s11999-012-2615-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 09/12/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current cartilage transplantation techniques achieve suboptimal restoration and rely on patient donor cells or living grafts of chondrocytes. PURPOSE We sought to enhance allogeneic grafts by testing mosaics of genetically engineered and naïve juvenile human chondrocytes (jCh). METHODS We obtained specimens from three humans and performed three experiments (two in vitro, one in vivo). We compared neocartilage with and without (1) supplemented serum-free medium (chondrocyte differentiation medium [CDM]), (2) adenoviral BMP-2 (AdBMP-2) transduction, and (3) varying ratios (0.1-1) of transduced and naïve jCh. We compared (4) healing with mosaic grafts with naïve neocartilage or marrow stimulation in immunosuppressed rats. For each of 10 in vitro treatment groups, we had six replicates for each human, and for each of three in vivo treatment groups, we had four replicates for one human. We scored the histology with the semiquantitative Bern score. RESULTS AdBMP-2 and naïve neocartilage growth in CDM were histologically superior (Bern score, 5.2 versus 3.7; 8.0 versus 1.8) and size (8.0 versus 6.1; 7.9 versus 2.2 mg) to standard medium. In CDM, AdBMP-2 decreased viability (76% versus 90%), but increased BMP-2 production (619 ng/mL versus 43 pg/mL). Ten percent and 25% AdBMP-2 transduction had Bern scores of 6.8 and 6.5 and viability of 84% and 83%, respectively. Twenty-five percent mosaic grafts provided better healing histologically than marrow stimulation or naive neocartilage. CONCLUSIONS Low-level AdBMP-2 and CDM augment neocartilage parameters in vitro and vivo. CLINICAL RELEVANCE Genetic augmentation of jCh and creation of mosaic neocartilage may improve graft viability and articular healing compared with naïve neocartilage.
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Affiliation(s)
- Vincent Y. Ng
- />Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Seth S. Jump
- />Sports Medicine Center, The Ohio State University Wexner Medical Center, Columbus, OH USA
- />Department of Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, OH USA
| | - Kelly S. Santangelo
- />Department of Veterinary Biosciences, The Ohio State University, Columbus, OH USA
| | - Duncan S. Russell
- />Department of Veterinary Biosciences, The Ohio State University, Columbus, OH USA
| | - Alicia L. Bertone
- />Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH USA
- />Sports Medicine Center, The Ohio State University Wexner Medical Center, Columbus, OH USA
- />Department of Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, OH USA
- />College of Veterinary Medicine, The Ohio State University, 601 Tharp Street, Columbus, OH 43210 USA
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Failed cartilage repair for early osteoarthritis defects: a biochemical, histological and immunohistochemical analysis of the repair tissue after treatment with marrow-stimulation techniques. Knee Surg Sports Traumatol Arthrosc 2012; 20:2315-24. [PMID: 22222614 DOI: 10.1007/s00167-011-1853-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/18/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To examine the entire repair tissue resulting from marrow-stimulation techniques in patients with early osteoarthritis. METHODS The repair tissue and adjacent articular cartilage after failed marrow-stimulation techniques (microfracture and Pridie drilling) of 5 patients (47-65 years old) with cartilage defects and radiographic early osteoarthritis (Kellgren-Lawrence grading 1 and 2) was removed during total joint arthroplasty (mean time until analysis: 8.8 months), analysed by histology, polarized light microscopy, immunohistochemistry, biochemistry and by histological score systems. RESULTS Macroscopic cartilage repair assessment revealed ICRS grades of II (nearly normal) and III (abnormal). Cartilage defects were mostly completely filled with a fibrocartilaginous tissue that had small and large fissures. Cartilage-specific stains of the repair tissue were more intense than the surrounding native cartilage but reduced compared with normal articular cartilage. The subchondral bone was incompletely restored. A new tidemark was absent. The repair tissue always showed positive immunoreactivity for types II and X collagen, and was sometimes positive for type I collagen. Proteoglycan contents of the repair tissue were generally higher than of the surrounding cartilage. The repair tissue was always more cellular than the adjacent articular cartilage. Histological scoring of the repair tissue revealed a mean Sellers score of 17.6 ± 3.0 and an ICRS grading of 7-9. CONCLUSION Failed marrow stimulation of articular cartilage defects in patients with early osteoarthritis is characterized by fibrocartilaginous repair. The balance of cell number to extracellular matrix is shifted towards an increased cell number in this tissue. Articular cartilage repair did not reach the quality of normal hyaline articular cartilage. LEVEL OF EVIDENCE IV.
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Orth P, Cucchiarini M, Kaul G, Ong MF, Gräber S, Kohn DM, Madry H. Temporal and spatial migration pattern of the subchondral bone plate in a rabbit osteochondral defect model. Osteoarthritis Cartilage 2012; 20:1161-9. [PMID: 22771776 DOI: 10.1016/j.joca.2012.06.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/24/2012] [Accepted: 06/21/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Upward migration of the subchondral bone plate is associated with osteochondral repair. The aim of this study was to quantitatively monitor the sequence of subchondral bone plate advancement in a lapine model of spontaneous osteochondral repair over a 1-year period and to correlate these findings with articular cartilage repair. DESIGN Standardized cylindrical osteochondral defects were created in the rabbit trochlear groove. Subchondral bone reconstitution patterns were identified at five time points. Migration of the subchondral bone plate and areas occupied by osseous repair tissue were determined by histomorphometrical analysis. Tidemark formation and overall cartilage repair were correlated with the histomorphometrical parameters of the subchondral bone. RESULTS The subchondral bone reconstitution pattern was cylindrical at 3 weeks, infundibuliform at 6 weeks, plane at 4 and 6 months, and hypertrophic after 1 year. At this late time point, the osteochondral junction advanced 0.19 [95% confidence intervals (CI) 0.10-0.30] mm above its original level. Overall articular cartilage repair was significantly improved by 4 and 6 months but degraded after 1 year. Subchondral bone plate migration correlated with tidemark formation (r = 0.47; P < 0.0001), but not with the overall score of the repair cartilage (r = 0.11; P > 0.44). CONCLUSIONS The subchondral bone plate is reconstituted in a distinct chronological order. The lack of correlation suggests that articular cartilage repair and subchondral bone reconstitution proceed at a different pace and that the advancement of the subchondral bone plate is not responsible for the diminished articular cartilage repair in this model.
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Affiliation(s)
- P Orth
- Center of Experimental Orthopaedics, Saarland University, Homburg/Saar, Germany.
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Goebel L, Orth P, Müller A, Zurakowski D, Bücker A, Cucchiarini M, Pape D, Madry H. Experimental scoring systems for macroscopic articular cartilage repair correlate with the MOCART score assessed by a high-field MRI at 9.4 T--comparative evaluation of five macroscopic scoring systems in a large animal cartilage defect model. Osteoarthritis Cartilage 2012; 20:1046-55. [PMID: 22698442 DOI: 10.1016/j.joca.2012.05.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 04/11/2012] [Accepted: 05/30/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a new macroscopic scoring system which allows for an overall judgment of experimental articular cartilage repair and compare it with four existing scoring systems and high-field magnetic resonance imaging (MRI). METHODS A new macroscopic scoring system was developed to assess the repair of cartilage defects. Cartilage repair was graded by three observers with different experience in cartilage research at 2-3 time points and compared with the protocol A of the international cartilage repair society (ICRS) cartilage repair assessment score, the Oswestry arthroscopy score, and macroscopic grading systems designed by Jung and O'Driscoll. Parameters were correlated with the two-dimensional (2D) magnetic resonance observation of cartilage repair tissue (MOCART) score based on a 9.4 T MRI as an external reference standard. RESULTS All macroscopic scores exhibited high intra- and interobserver reliability and high internal correlation. The newly developed macroscopic scoring system had the highest intraobserver [0.866 ≤ intraclass correlation (ICC) ≤ 0.895] and the highest interobserver reliability (ICC = 0.905) for "total points". Here, Cronbach's alpha indicated good homogeneity and functioning of the items (mean = 0.782). "Total points" of the 2D MOCART score correlated with all macroscopic scores (all P < 0.0001). The newly developed macroscopic scoring system yielded the highest correlation for the MRI parameter "defect fill" (rho = 0.765; all P < 0.0001). CONCLUSIONS "Total points" and "defect fill", two clinically relevant indicators of cartilage repair, can be reliably and directly assessed by macroscopic evaluation, using either system. These data support the use of macroscopic assessment to precisely judge cartilage repair in preclinical large animal models.
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Affiliation(s)
- L Goebel
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany.
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