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Ning C, Li P, Gao C, Fu L, Liao Z, Tian G, Yin H, Li M, Sui X, Yuan Z, Liu S, Guo Q. Recent advances in tendon tissue engineering strategy. Front Bioeng Biotechnol 2023; 11:1115312. [PMID: 36890920 PMCID: PMC9986339 DOI: 10.3389/fbioe.2023.1115312] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Tendon injuries often result in significant pain and disability and impose severe clinical and financial burdens on our society. Despite considerable achievements in the field of regenerative medicine in the past several decades, effective treatments remain a challenge due to the limited natural healing capacity of tendons caused by poor cell density and vascularization. The development of tissue engineering has provided more promising results in regenerating tendon-like tissues with compositional, structural and functional characteristics comparable to those of native tendon tissues. Tissue engineering is the discipline of regenerative medicine that aims to restore the physiological functions of tissues by using a combination of cells and materials, as well as suitable biochemical and physicochemical factors. In this review, following a discussion of tendon structure, injury and healing, we aim to elucidate the current strategies (biomaterials, scaffold fabrication techniques, cells, biological adjuncts, mechanical loading and bioreactors, and the role of macrophage polarization in tendon regeneration), challenges and future directions in the field of tendon tissue engineering.
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Affiliation(s)
- Chao Ning
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Pinxue Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Cangjian Gao
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Liwei Fu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiyao Liao
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Guangzhao Tian
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Han Yin
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Muzhe Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiang Sui
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuyun Liu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Quanyi Guo
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options. J Exp Orthop 2018; 5:38. [PMID: 30251203 PMCID: PMC6153202 DOI: 10.1186/s40634-018-0145-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/26/2018] [Indexed: 01/01/2023] Open
Abstract
The treatment of painful chronic tendinopathy is challenging. Multiple non-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, the injections of platelet-rich plasma autologous blood or cortisone have become increasingly favored. However, there is little scientific evidence from human studies supporting injection treatment. As the last resort, intra- or peritendinous open or endoscopic surgery are employed even though these also show varying results. This ESSKA basic science committee current concepts review follows the first part on the biology, biomechanics and anatomy of tendinopathies, to provide a comprehensive overview of the latest treatment options for tendinopathy as reported in the literature.
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Delalande A, Kotopoulis S, Postema M, Midoux P, Pichon C. Sonoporation: mechanistic insights and ongoing challenges for gene transfer. Gene 2013; 525:191-9. [PMID: 23566843 DOI: 10.1016/j.gene.2013.03.095] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/27/2013] [Accepted: 03/07/2013] [Indexed: 11/29/2022]
Abstract
Microbubbles first developed as ultrasound contrast agents have been used to assist ultrasound for cellular drug and gene delivery. Their oscillation behavior during ultrasound exposure leads to transient membrane permeability of surrounding cells, facilitating targeted local delivery. The increased cell uptake of extracellular compounds by ultrasound in the presence of microbubbles is attributed to a phenomenon called sonoporation. In this review, we summarize current state of the art concerning microbubble-cell interactions and cellular effects leading to sonoporation and its application for gene delivery. Optimization of sonoporation protocol and composition of microbubbles for gene delivery are discussed.
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Abstract
The rotator cuff enthesis is not reestablished after a rotator cuff repair. Instead, a scar-mediated healing response occurs at the tendon-bone interface, which is notably weaker than the native enthesis and thus more prone to failure. Biological augmentation through growth factors, AASs, biomimetic scaffolds, or siRNA therapy has the potential to enhance the healing response. The ultimate key, however, is in determining which of these enables a more regenerative healing response of the native tissue rather than enhanced production of scar tissue. In addition, the optimal combination of factors, dosing, and delivery methods remains to be clearly elucidated. Biological augmentation and tissue engineering for tendon healing remains promising, but much work still needs to be done.
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Ultrasound and microbubble-assisted gene delivery: recent advances and ongoing challenges. Ther Deliv 2012; 3:1199-215. [PMID: 23116012 DOI: 10.4155/tde.12.100] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Having first been developed for ultrasound imaging, nowadays, microbubbles are proposed as tools for ultrasound-assisted gene delivery, too. Their behavior during ultrasound exposure causes transient membrane permeability of surrounding cells, facilitating targeted local delivery. The increased cell uptake of extracellular compounds by ultrasound in the presence of microbubbles is attributed to a phenomenon called sonoporation. Sonoporation has been successfully applied to deliver nucleic acids in vitro and in vivo in a variety of therapeutic applications. However, the biological and physical mechanisms of sonoporation are still not fully understood. In this review, we discuss recent data concerning microbubble--cell interactions leading to sonoporation and we report on the progress in ultrasound-assisted therapeutic gene delivery in different organs. In addition, we outline ongoing challenges of this novel delivery method for its clinical use.
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Delalande A, Bouakaz A, Renault G, Tabareau F, Kotopoulis S, Midoux P, Arbeille B, Uzbekov R, Chakravarti S, Postema M, Pichon C. Ultrasound and microbubble-assisted gene delivery in Achilles tendons: Long lasting gene expression and restoration of fibromodulin KO phenotype. J Control Release 2011; 156:223-30. [DOI: 10.1016/j.jconrel.2011.08.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/13/2011] [Accepted: 08/14/2011] [Indexed: 11/16/2022]
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Ricchetti ET, Reddy SC, Ansorge HL, Zgonis MH, Van Kleunen JP, Liechty KW, Soslowsky LJ, Beredjiklian PK. Effect of interleukin-10 overexpression on the properties of healing tendon in a murine patellar tendon model. J Hand Surg Am 2008; 33:1843-52. [PMID: 19084188 PMCID: PMC7985602 DOI: 10.1016/j.jhsa.2008.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 07/19/2008] [Accepted: 07/25/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Interleukin-10 (IL-10) is a potent anti-inflammatory cytokine shown to inhibit scar formation in fetal wound healing. The role of IL-10 in adult tendon healing and scar formation, however, remains unknown. The objective of this study is to investigate the effect of IL-10 overexpression on the properties of adult healing tendon using a well-established murine model of tendon injury and a lentiviral-mediated method of IL-10 overexpression. METHODS A murine model of patellar tendon injury was used and animals divided into 3 groups. Mice received bilateral patellar tendon injections with a lentiviral vector containing an IL-10 transgene (n = 34) or no transgene (n = 34). Control mice (n = 34) received injections of sterile saline. All animals then were subjected to bilateral, central patellar tendon injuries 2 days after injection and were killed at 5, 10, 21, and 42 days after injury. IL-10 content was analyzed by immunohistochemistry (n = 4/group). Tendon healing was evaluated by histology (n = 4/group) and biomechanical analysis (n = 10/group). RESULTS Overexpression of IL-10 in patellar tendon was confirmed after injection of the lentiviral vector. IL-10 immunostaining was increased at day 10 in the IL-10 group relative to that in controls. Histologically, there was no significant difference in angular deviation between groups at day 21, but a trend toward decreased angular deviation in controls relative to that in empty vector group mice was seen at day 42. Biomechanically, the IL-10 group showed significantly increased maximum stress at day 42 relative to that in controls. Percent relaxation showed a trend toward an increase at day 10 and a significant increase at day 42 in the IL-10 group relative to that in controls. CONCLUSIONS This study demonstrates successful gene transfer of IL-10 into adult murine patellar tendon using a lentiviral vector. Although the effects of overexpression of IL-10 on adult tendon healing have not yet been fully elucidated, the current study may help to further clarify the mechanisms of tendon injury and repair.
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Affiliation(s)
- Eric T. Ricchetti
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | - Sudheer C. Reddy
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | - Heather L. Ansorge
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | - Miltiadis H. Zgonis
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
| | | | - Kenneth W. Liechty
- The Center for Fetal Research, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA
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Abstract
The clinical challenges of skeletal regenerative medicine have motivated significant advances in cellular and tissue engineering in recent years. In particular, advances in molecular biology have provided the tools necessary for the design of gene-based strategies for skeletal tissue repair. Consequently, genetic engineering has emerged as a promising method to address the need for sustained and robust cellular differentiation and extracellular matrix production. As a result, gene therapy has been established as a conventional approach to enhance cellular activities for skeletal tissue repair. Recent literature clearly demonstrates that genetic engineering is a principal factor in constructing effective methods for tissue engineering approaches to bone, cartilage, and connective tissue regeneration. This review highlights this literature, including advances in the development of efficacious gene carriers, novel cell sources, successful delivery strategies, and optimal target genes. The current status of the field and the challenges impeding the clinical realization of these approaches are also discussed.
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Affiliation(s)
- Charles A Gersbach
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
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Zhu B, Cao Y, Xin KQ, Wang XT, Summerhayes IC, Liu PY, Tang JB. Tissue reactions of adenoviral, adeno-associated viral, and liposome-plasmid vectors in tendons and comparison with early-stage healing responses of injured flexor tendons. J Hand Surg Am 2006; 31:1652-60. [PMID: 17145387 DOI: 10.1016/j.jhsa.2006.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 09/10/2006] [Accepted: 09/13/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE Delivery of growth factor genes that may substantially increase the healing rate of injured digital flexor tendons is a new application of gene therapy. Adenoviral, adeno-associated viral (AAV), and liposome-plasmid vectors have been used to deliver genes to tendons, but the tendon reactions to these vectors--particularly in contrast to the healing responses in the injured tendons--were unknown. This study was designed to compare the tissue reactions of the earlier-mentioned vectors in tendons with the healing responses of injured flexor tendons. METHODS Forty-two flexor digitorum profundus tendons of 6 New Zealand white rabbits were used. Eighteen tendons were divided into 3 groups of 6 each and injected with different vectors: adenoviral vector, AAV2-luciferase vector, or pCMV-beta vector with liposome. Another 12 tendons were cut and repaired. At 3, 7, and 14 days, the tendons were harvested and stained with hematoxylin and eosin. Normal flexor tendons were harvested as controls. RESULTS The tissue reactions of the liposome-plasmid vector in tendons were the most prominent among the 3 vectors tested. The adenoviral vector elicited a moderate degree of tissue reaction. The AAV2 vector caused remarkable reactions in epitenon but almost no reactions in endotenon. Early-stage tissue reactions were more robust in the injured tendons. Compared with early-stage inflammatory and healing responses, the reactions elicited by these vectors were less severe. CONCLUSIONS The 3 gene delivery systems tested elicit less severe tissue reactions in flexor tendons compared with early-stage inflammatory changes in injured tendons. Adenoviral and AAV vectors elicit less severe tissue reactions than liposome-plasmid vectors. The AAV2 vector appears to cause almost no reaction in endotenon. In terms of tissue reactions, the adenoviral and AAV2 vectors, in particular AAV2, are suitable gene delivery systems for future gene transfer to the tendon in vivo.
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Affiliation(s)
- Bei Zhu
- Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
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Affiliation(s)
- Brian C Toolan
- University of Chicago Medical Center, 5841 South Maryland Avenue, MC 3079, IL 60637, USA.
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Huang D, Balian G, Chhabra AB. Tendon tissue engineering and gene transfer: the future of surgical treatment. J Hand Surg Am 2006; 31:693-704. [PMID: 16713828 DOI: 10.1016/j.jhsa.2005.10.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 10/19/2005] [Accepted: 10/21/2005] [Indexed: 02/02/2023]
Abstract
Technologic improvements in the field of tissue engineering are leading to new potential developments in the currently used approaches to treat tendon injuries including difficult clinical scenarios such as zone II flexor tendon injuries of the hand and the mutilated hand with extensive tendon defects. A combination of mesenchymal (adult stem) cells, growth factors, and bioresorbable polymers can provide a solution for the treatment of difficult tendon injuries. Extensive research is needed to show that the extracellular matrix produced in response to the cell/growth factor/polymer composites in vivo is effective and functional as a regenerate tissue. Further exciting advances are foreseen in cell-based genetic engineering with the transfer of DNA to the site of tendon lacerations. These treatment modalities require improved safety precautions to reduce the risks and enhance the benefits of gene therapy.
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Affiliation(s)
- Deqing Huang
- Department of Orthopaedic Surgery, Orthopaedic Research Laboratories, University of Virginia Hand Center, Charlottesville 22908, USA
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13
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Abstract
Tendinopathy affects millions of people in athletic and occupational settings and is a nemesis for patients and physicians. Mechanical loading is a major causative factor for tendinopathy; however, the exact mechanical loading conditions (magnitude, frequency, duration, loading history, or some combinations) that cause tendinopathy are poorly defined. Exercise animal model studies indicate that repetitive mechanical loading induces inflammatory and degenerative changes in tendons, but the cellular and molecular mechanisms responsible for such changes are not known. Injection animal model studies show that collagenase and inflammatory agents (inflammatory cytokines and prostaglandin E1 and E2) may be involved in tendon inflammation and degeneration; however, whether these molecules are involved in the development of tendinopathy because of mechanical loading remains to be verified. Finally, despite improved treatment modalities, the clinical outcome of treatment of tendinopathy is unpredictable, as it is not clear whether a specific modality treats the symptoms or the causes. Research is required to better understand the mechanisms of tendinopathy at the tissue, cellular, and molecular levels and to develop new scientifically based modalities to treat tendinopathy more effectively.
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Affiliation(s)
- James H-C Wang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Rahaman MN, Mao JJ. Stem cell-based composite tissue constructs for regenerative medicine. Biotechnol Bioeng 2005; 91:261-84. [PMID: 15929124 DOI: 10.1002/bit.20292] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A major task of contemporary medicine and dentistry is restoration of human tissues and organs lost to diseases and trauma. A decade-long intense effort in tissue engineering has provided the proof of concept for cell-based replacement of a number of individual tissues such as the skin, cartilage, and bone. Recent work in stem cell-based in vivo restoration of multiple tissue phenotypes by composite tissue constructs such as osteochondral and fibro-osseous grafts has demonstrated probable clues for bioengineered replacement of complex anatomical structures consisting of multiple cell lineages such as the synovial joint condyle, tendon-bone complex, bone-ligament junction, and the periodontium. Of greater significance is a tangible contribution by current attempts to restore the structure and function of multitissue structures using cell-based composite tissue constructs to the understanding of ultimate biological restoration of complex organs such as the kidney or liver. The present review focuses on recent advances in stem cell-based composite tissue constructs and attempts to outline challenges for the manipulation of stem cells in tailored biomaterials in alignment with approaches potentially utilizable in regenerative medicine of human tissues and organs.
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Affiliation(s)
- Mohamed N Rahaman
- Department of Bioengineering, University of Illinois at Chicago, 851 S. Morgan St., Chicago, Illinois 60607, USA
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Dai KR, Xu XL, Tang TT, Zhu ZA, Yu CF, Lou JR, Zhang XL. Repairing of goat tibial bone defects with BMP-2 gene-modified tissue-engineered bone. Calcif Tissue Int 2005; 77:55-61. [PMID: 16007479 DOI: 10.1007/s00223-004-0095-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 12/22/2004] [Indexed: 10/25/2022]
Abstract
Bone defects larger than a critical size are major challenges in orthopedic medicine. We combined tissue-engineered bone and gene therapy to provide osteoprogenitor cells, osteoinductive factors, and osteo-conductive carrier for ideal bone regeneration in critical-sized bone defects. Goat diaphyseal bone defects were repaired with tissue and genetically engineered bone implants, composed of biphasic calcined bone (BCB) and autologous bone marrow derived mesenchymal stem cells (BMSC) transduced with human bone morphogenetic protein-2 (hBMP-2). Twenty six goats with tibial bone defects were divided into groups receiving implants by using a combination of BCB and BMSCs with or without the hBMP-2 gene. In eight goats that were treated with BCB that contained hBMP-2 transduced BMSC, five had complete healing and three showed partial healing. Goats in other experimental groups had only slight or no healing. Furthermore, the area and biochemical strength of the callus in the bone defects were significantly better in animals treated with genetically engineered implants. We concluded that the combination of genetic and tissue engineering provides an innovative way for treating critical-sized bone defects.
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Affiliation(s)
- K R Dai
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Second Medical University, 639 Zhizaoju Road, Shanghai 200011, P.R.China.
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Mehta V, Kang Q, Luo J, He TC, Haydon RC, Mass DP. Characterization of adenovirus-mediated gene transfer in rabbit flexor tendons. J Hand Surg Am 2005; 30:136-41. [PMID: 15680569 DOI: 10.1016/j.jhsa.2004.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Accepted: 08/16/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE Adenoviral vector-based gene therapy is a promising technique for the delivery of growth factors to tendons. The objective of this study was to determine whether rabbit flexor tendons could be transduced effectively by adenoviral vectors and whether the introduction of adenoviral vectors would cause a notable local inflammatory response. METHODS Recombinant adenoviruses expressing green fluorescent protein (AdGFP) or BMP-13 (AdBMP-13) were constructed and 3 different viral titers (1 x 10(7), 1 x 10(8), and 1 x 10(9)) were tested in this study. The second through fifth tendons of the forepaws and hindpaws of a New Zealand white rabbit were identified surgically and injected with different viral titers of adenoviruses. The fifth tendon was used as a control. The tendons were harvested 12 days after surgery. The retrieved tendons were sectioned to measure transgene expression, as well as for histologic evaluation. RESULTS At all tested viral titers an efficient dose-dependent transgene expression was detected in all samples at 12 days after injection. At the highest dose the injection sites were notable for lymphocytic infiltration, suggesting that injected adenoviral vectors can illicit some local inflammatory response. Lymphocytic infiltration was much less apparent, however, in the tendons injected with lower titers of adenoviral vectors. There was no evidence of a massive inflammatory response and/or cell death. CONCLUSIONS Our findings show that adenovirus-based gene therapy is an efficient means of gene delivery to rabbit flexor tendons. Transduction efficiency of transgenes was dose dependent across the tested titers, although adenovirus-induced inflammation was notable only at the highest titer. This indicates that efficient gene transfer without notable local inflammatory response may be achieved by using the lower titers. Although adenovirus-induced inflammation can be minimized by using lower viral titers, its impact on adhesion formation in the long term remains unknown.
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Affiliation(s)
- Vishal Mehta
- Molecular Oncology Laboratory, Department of Surgery, The University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
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Goh JCH, Ouyang HW, Teoh SH, Chan CKC, Lee EH. Tissue-engineering approach to the repair and regeneration of tendons and ligaments. ACTA ACUST UNITED AC 2004; 9 Suppl 1:S31-44. [PMID: 14511469 DOI: 10.1089/10763270360696969] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Affiliation(s)
- Shital N Parikh
- Division of Pediatric Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Jayankura M, Boggione C, Frisén C, Boyer O, Fouret P, Saillant G, Klatzmann D. In situ gene transfer into animal tendons by injection of naked DNA and electrotransfer. J Gene Med 2003; 5:618-24. [PMID: 12825201 DOI: 10.1002/jgm.389] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Degenerative or traumatic tendon injuries are extremely common but often heal poorly, not restoring the normal function of the injured tissues. Gene transfer could improve the repair process, by permitting local production of therapeutic substances, e.g. growth factors. METHODS AND RESULTS Injection of a plasmid carrying the lacZ marker gene was performed into the Achilles tendons of rat and mouse, and the patellar tendons of rabbit. At 48 h, transduced cells were found in the injected zones of the tendons but represented a minority of the tendon cells. A kinetics study in rats permitted observation of a gradual decrease with time in the beta-gal-expressing cell number; at day 42 no more gene expression was detected. Noteworthy, no inflammatory reaction was observed. We then investigated whether electrotransfer could improve gene transfer efficacy in rat tendon by delivering in situ electric pulses after DNA injection. Gene transfer was improved at best by approximately 50% under certain electrical conditions (200 V for 10 ms or 1200 V for 100 micro s). Finally, multiple injections of plasmid permitted an increase in the number of transduced cells by approximately 400%. CONCLUSIONS In situ injection of naked DNA into tendons is a very simple technique that permits delivery of genes with a duration of expression sufficient for clinical application aimed at modulating healing or restoration of a degenerative tendon. Despite a low transfer efficiency, this method should be compatible with clinical applications aimed at delivering therapeutic substances acting at low concentration.
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Affiliation(s)
- Marc Jayankura
- Laboratoire de biologie et thérapeutique des pathologies immunitaires (Université Pierre et Marie Curie/CNRS UMR 7087), Hôpital de la Pitié-Salpêtrière, 83 Bd de l'hôpital, 75013 Paris, France
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Abstract
The linear organization of collagen fibers in tendons results in optimal stiffness and strength at low strains under tensile load. However, this organization makes repairing ruptured or lacerated tendons extremely difficult. Current suturing techniques to join split ends of tendons, while providing sufficient mechanical strength to prevent gapping, are inadequate to carry normal loads. Immobilization protocols necessary to restore tendon congruity result in scar formation at the repair site and peripheral adhesions that limit excursion. These problems are reviewed to emphasize the need for novel approaches to tendon repair, one of which is the development of biomimetic tendons. The objective of the empirical work described here was to produce biologically-based, biocompatible tendon replacements with appropriate mechanical properties to enable immediate mobilization following surgical repair. Nor-dihydroguaiaretic acid (NDGA), a di-catechol from creosote bush, caused a dose dependent increase in the material properties of reconstituted collagen fibers, achieving a 100-fold increase in strength and stiffness over untreated fibers. The maximum tensile strength of the optimized NDGA treated fibers averaged 90 MPa; the elastic modulus of these fibers averaged 580 MPa. These properties were independent of strain rates ranging from 0.60 to 600 mm/min. Fatigue tests established that neither strength nor stiffness were affected after 80 k cycles at 5% strain. Treated fibers were not cytotoxic to tendon fibroblasts. Fibroblasts attached and proliferated on NDGA treated collagen normally. NDGA-fibers did not elicit a foreign body response nor did they stimulate an immune reaction during six weeks in vivo. The fibers survived 6 weeks with little evidence of fragmentation or degradation. The polymerization scheme described here produces a fiber-reinforced NDGA-polymer with mechanical properties approaching an elastic solid. The strength, stiffness and fatigue properties of the NDGA-treated fibers are comparable to those of tendon. These fibers are biocompatible with tendon fibroblasts and elicit little rejection or antigenic response in vivo. These results indicate that NDGA polymerization may provide a viable approach for producing collagenous materials that can be used to bridge gaps in ruptured or lacerated tendons. The tendon-like properties of the NDGA-fiber would allow early mobilization after surgical repair. We predict that timely loading of parted tendons joined by this novel biomaterial will enhance mechanically driven production of neo-tendon by the colonizing fibroblasts and result in superior repair and rapid return to normal properties.
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Affiliation(s)
- Thomas J Koob
- Skeletal Biology Section, Center for Research in Skeletal Development and Pediatric Orthopaedics, Shriners Hospital for Children, 12502 North Pine Drive, Tampa, FL 33612, USA.
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Hildebrand KA, Jia F, Woo SLY. Response of donor and recipient cells after transplantation of cells to the ligament and tendon. Microsc Res Tech 2002; 58:34-8. [PMID: 12112420 DOI: 10.1002/jemt.10114] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The mechanical properties of healing ligaments and tendons are not comparable to those of normal tissue. To improve the quality of the ligament healing, therapeutic strategies include gene transfer or placement of mesenchymal stem cells at the healing site. Studies show that marker genes, growth factors, and antisense oligonucleotides can be delivered to both normal and healing ligaments and tendons by gene transfer. Cells with and without genetic modification have been successfully transplanted to ligaments and tendons and remain viable. Tendon healing can be improved using collagen gel implants seeded with autologous mesenchymal stem cells. Even though these early results are encouraging, more work is required regarding the response of the recipient site to donor cells or vectors.
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Affiliation(s)
- Kevin A Hildebrand
- Alberta Heritage Foundation for Medical Research, University of Calgary, Calgary, Canada T2N 4N1
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22
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Abstract
Transfer of therapeutic genes into muscle tissue has promise for the treatment of a variety of muscular dystrophies. Various vectors have been used to deliver genes to skeletal muscle but their application has faced several major limitations including: (1) the lack of transgene persistence caused by the immune rejection of transduced myofibers and/or vector toxicity, and (2) the maturation dependence of viral transduction. While the immunorejection and/or cytotoxic problems are being overcome with the development of new vectors, maturation-dependent viral transduction is still a major hurdle in gene transfer to skeletal muscle. Poor adenoviral transduction in mature myofibers has been attributed to: (1) the extracellular matrix of mature myofibers may form a physical barrier and prevent the passage of large viral particles; (2) viral receptors are down-regulated with muscle maturation; and (3) loss of myoblasts with muscle maturation, which serve as intermediaries in the viral transduction. In this review, we will focus on recent developments in overcoming those hurdles of gene therapy in skeletal muscle, especially to adenovirus (Ad), including: (1) new mutant vectors lacking all viral genes to decrease immunogenicity, and hence, improve persistence of transgene expression in muscle in vivo; (2) using tissue specific promoters to evade immunorejection; (3) permeabilization of the extracellular matrix; (4) modifying the viral receptors in mature myofibers; and (5) myoblast or muscle stem cell mediated ex vivo gene transfer.
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Affiliation(s)
- Baohong Cao
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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23
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Abstract
Gene therapy has the potential to transform musculoskeletal medicine. Orthopaedists have been ready to incorporate innovations in medicine and engineering into their surgical practice, frequently before having full information. There is no reason to doubt the rapid acceptance of gene therapy by the orthopaedic profession. Caution is needed in incorporating gene therapy into standard practice because of the lack of knowledge and risks that are greater than for previous innovations.
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Affiliation(s)
- W H Bunch
- Beeson Divinity School, Samford University, Birmingham, AL, USA
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