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Bhujel B, Yang SS, Kim HR, Kim SB, Min BH, Choi BH, Han I. An Injectable Engineered Cartilage Gel Improves Intervertebral Disc Repair in a Rat Nucleotomy Model. Int J Mol Sci 2023; 24:3146. [PMID: 36834559 PMCID: PMC9966384 DOI: 10.3390/ijms24043146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Lower back pain is a major problem caused by intervertebral disc degeneration. A common surgical procedure is lumbar partial discectomy (excision of the herniated disc causing nerve root compression), which results in further disc degeneration, severe lower back pain, and disability after discectomy. Thus, the development of disc regenerative therapies for patients who require lumbar partial discectomy is crucial. Here, we investigated the effectiveness of an engineered cartilage gel utilizing human fetal cartilage-derived progenitor cells (hFCPCs) on intervertebral disc repair in a rat tail nucleotomy model. Eight-week-old female Sprague-Dawley rats were randomized into three groups to undergo intradiscal injection of (1) cartilage gel, (2) hFCPCs, or (3) decellularized extracellular matrix (ECM) (n = 10/each group). The treatment materials were injected immediately after nucleotomy of the coccygeal discs. The coccygeal discs were removed six weeks after implantation for radiologic and histological analysis. Implantation of the cartilage gel promoted degenerative disc repair compared to hFCPCs or hFCPC-derived ECM by increasing the cellularity and matrix integrity, promoting reconstruction of nucleus pulposus, restoring disc hydration, and downregulating inflammatory cytokines and pain. Our results demonstrate that cartilage gel has higher therapeutic potential than its cellular or ECM component alone, and support further translation to large animal models and human subjects.
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Affiliation(s)
- Basanta Bhujel
- Department of Biomedical Science, College of Life Sciences, CHA University, Seongnam 13496, Republic of Korea
| | | | | | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Byoung-Hyun Min
- ATEMs Inc., Seoul 02447, Republic of Korea
- Wake Forest Institute of Regenerative Medicine, School of Medicine, Wake Forest University, Winston Salem, NC 27101, USA
| | - Byung Hyune Choi
- ATEMs Inc., Seoul 02447, Republic of Korea
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon 22212, Republic of Korea
| | - Inbo Han
- Department of Neurosurgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 13496, Republic of Korea
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Hu MH, Yang KC, Chen CW, Chu PH, Chang YL, Sun YH, Lin FH, Yang SH. Multilayer Electrospun-Aligned Fibroin/Gelatin Implant for Annulus Fibrosus Repair: An In Vitro and In Vivo Evaluation. Biomedicines 2022; 10:biomedicines10092107. [PMID: 36140208 PMCID: PMC9495938 DOI: 10.3390/biomedicines10092107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Annulus fibrosus (AF) damage is proven to prompt intervertebral disc (IVD) degeneration, and unrepaired AF lesions after surgical discectomy may boost herniation of the nucleus pulposus (NP) which may lead to further compression of neural structures. Moreover, vascular and neural ingrowth may occur within the defect which is known as a possible reason for discogenic pain. Due to a limited healing capacity, an effective strategy to repair and close the AF defect is necessary. In this study, using electrospinning technology, two nature polymers, silk fibroin and gelatin, were linked to imitate the unique lamellae structure of native AF. Our findings revealed that a multilayer electrospun-aligned fibroin/gelatin scaffold with mechanical and morphological properties mimicking those of native AF lamellae have been developed. The average diameter of the nanofiber is 162.9 ± 38.8 nm. The young’s modulus is around 6.70 MPa with an ultimate tensile strength of around 1.81 MP along preferred orientation. The in vitro test confirmed its biocompatibility and ability to maintain cell viability and colonization. Using a porcine model, we demonstrated that the multilayer-aligned scaffold offered a crucial microenvironment to induce collagen fibrous tissue production within native AF defect. In the implant-repaired AF, H&E staining showed homogeneous fibroblast-like cell infiltration at the repaired defect with very little vascular ingrowth, which was confirmed by magnetic resonance imaging findings. Picrosirius red staining and immunohistochemical staining against type I collagen revealed positively stained fibrous tissue in an aligned pattern within the implant-integrated site. Relative to the intact control group, the disc height index of the serial X-ray decreased significantly in both the injury control and implant group at 4 weeks and 8 weeks (p < 0.05) which indicated this scaffold may not reverse the degenerative process. However, the results of the discography showed that the effectiveness of annulus repair of the implant group is much superior to that of the untreated group. The scaffold, composed with nature fibroin/gelatin polymers, could potentially enhance AF healing that could prevent IVD recurrent herniation, as well as neural and neovascular ingrowth after discectomy surgeries.
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Affiliation(s)
- Ming-Hsiao Hu
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
| | - Kai-Chiang Yang
- Department of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chih-Wei Chen
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
- Department of Biomedical Engineering, National Taiwan University, Taipei 106216, Taiwan
| | - Po-Han Chu
- Department of Biomedical Engineering, National Taiwan University, Taipei 106216, Taiwan
| | - Yun-Liang Chang
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
| | - Yuan-Hui Sun
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
| | - Feng-Huei Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei 106216, Taiwan
| | - Shu-Hua Yang
- Department of Orthopedics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 63981)
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Constant C, Hom WW, Nehrbass D, Carmel E, Albers CE, Deml MC, Gehweiler D, Lee Y, Hecht A, Grad S, Iatridis JC, Zeiter S. Comparison and optimization of sheep in vivo intervertebral disc injury model. JOR Spine 2022; 5:e1198. [PMID: 35783908 PMCID: PMC9238284 DOI: 10.1002/jsp2.1198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022] Open
Abstract
Background The current standard of care for intervertebral disc (IVD) herniation, surgical discectomy, does not repair annulus fibrosus (AF) defects, which is partly due to the lack of effective methods to do so and is why new repair strategies are widely investigated and tested preclinically. There is a need to develop a standardized IVD injury model in large animals to enable comparison and interpretation across preclinical study results. The purpose of this study was to compare in vivo IVD injury models in sheep to determine which annulus fibrosus (AF) defect type combined with partial nucleus pulposus (NP) removal would better mimic degenerative human spinal pathologies. Methods Six skeletally mature sheep were randomly assigned to one of the two observation periods (1 and 3 months) and underwent creation of 3 different AF defect types (slit, cruciate, and box-cut AF defects) in conjunction with 0.1 g NP removal in three lumbar levels using a lateral retroperitoneal surgical approach. The spine was monitored by clinical CT scans pre- and postoperatively, at 2 weeks and euthanasia, and by magnetic resonance imaging (MRI) and histology after euthanasia to determine the severity of degeneration (disc height loss, Pfirrmann grading, semiquantitative histopathology grading). Results All AF defects led to significant degenerative changes detectable on CT and MR images, produced bulging of disc tissue without disc herniation and led to degenerative and inflammatory histopathological changes. However, AF defects were not equal in terms of disc height loss at 3 months postoperatively; the cruciate and box-cut AF defects showed significantly decreased disc height compared to their preoperative height, with the box-cut defect creating the greatest disc height loss, while the slit AF defect showed restoration of normal preoperative disc height. Conclusions The tested IVD injury models do not all generate comparable disc degeneration but can be considered suitable IVD injury models to investigate new treatments. Results of the current study clearly indicate that slit AF defect should be avoided if disc height is used as one of the main outcomes; additional confirmatory studies may be warranted to generalize this finding.
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Affiliation(s)
| | - Warren W. Hom
- Department of OrthopaedicsIcahn School of Medicine, Mount Sinai Health SystemNew YorkNew YorkUSA
| | | | - Eric‐Norman Carmel
- Département de sciences cliniques, Faculté de médecine vétérinaireUniversité de MontréalSaint‐HyacintheCanada
| | - Christoph E. Albers
- Department of Orthopaedic Surgery & TraumatologyInselspital, University Hospital BernBernSwitzerland
| | - Moritz C. Deml
- Department of Orthopaedic Surgery & TraumatologyInselspital, University Hospital BernBernSwitzerland
| | | | - Yunsoo Lee
- Department of OrthopaedicsIcahn School of Medicine, Mount Sinai Health SystemNew YorkNew YorkUSA
| | - Andrew Hecht
- Department of OrthopaedicsIcahn School of Medicine, Mount Sinai Health SystemNew YorkNew YorkUSA
| | | | - James C. Iatridis
- Department of OrthopaedicsIcahn School of Medicine, Mount Sinai Health SystemNew YorkNew YorkUSA
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Liu Y, Gao GM, Yang KY, Nong LM. Construction of tissue-engineered nucleus pulposus by stimulation with periodic mechanical stress and BMP-2. iScience 2022; 25:104405. [PMID: 35633940 PMCID: PMC9136668 DOI: 10.1016/j.isci.2022.104405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/22/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Intervertebral disc (IVD) degeneration, which is common among elderly individuals, mainly manifests as low back pain and is caused by structural deterioration of the nucleus pulposus (NP) due to physiological mechanical stress. NP mesenchymal stem cells (NPMSCs) around the IVD endplate have multidirectional differentiation potential and can be used for tissue repair. To define favorable conditions for NPMSC proliferation and differentiation into chondroid cells for NP repair, the present study simulated periodic mechanical stress (PMS) of the NP under physiological conditions using MSC chondrogenic differentiation medium and recombinant human BMP-2 (rhBMP-2). rhBMP-2 effectively promoted NPMSC proliferation and differentiation. To clarify the mechanism of action of rhBMP-2, integrin alpha 1 (ITG A1) and BMP-2 were inhibited. PMS regulated the BMP-2/Smad1/RUNX2 pathway through ITG A1 and promoted NPMSC proliferation and differentiation. During tissue-engineered NP construction, PMS can effectively reduce osteogenic differentiation and promote extracellular matrix protein synthesis to enhance structural NP recovery. Extraction of NPMSCs from degenerated nucleus pulposus NPMSCs cultured in vitro by simulating physiological mechanical stress ITG A1 to promote proliferation and differentiation of NPMSCs through BMP-2/Smad1/RUNX2 Injectable tissue-engineered nucleus pulposus
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Lumbar Intervertebral Disc Herniation: Annular Closure Devices and Key Design Requirements. Bioengineering (Basel) 2022; 9:bioengineering9020047. [PMID: 35200401 PMCID: PMC8869316 DOI: 10.3390/bioengineering9020047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
Lumbar disc herniation is one of the most common degenerative spinal conditions resulting in lower back pain and sciatica. Surgical treatment options include microdiscectomy, lumbar fusion, total disc replacement, and other minimally invasive approaches. At present, microdiscectomy procedures are the most used technique; however, the annulus fibrosus is left with a defect that without treatment may contribute to high reherniation rates and changes in the biomechanics of the lumbar spine. This paper aims to review current commercially available products that mechanically close the annulus including the AnchorKnot® suture-passing device and the Barricaid® annular closure device. Previous studies and reviews have focused mainly on a biomimetic biomaterials approach and have described some mechanical and biological requirements for an active annular repair/regeneration strategy but are still far away from clinical implementation. Therefore, in this paper we aim to create a design specification for a mechanical annular closure strategy by identifying the most important mechanical and biological design parameters, including consideration of material selection, preclinical testing requirements, and requirements for clinical implementation.
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Kirnaz S, Singh S, Capadona C, Lintz M, Goldberg JL, McGrath LB, Medary B, Sommer F, Bonassar LJ, Härtl R. Innovative Biological Treatment Methods for Degenerative Disc Disease. World Neurosurg 2021; 157:282-299. [PMID: 34929786 DOI: 10.1016/j.wneu.2021.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
Low back pain is the leading cause of work absences and years lived with disability, and it is often associated with degenerative disc disease. In recent years, biological treatment approaches such as the use of growth factors, cell injections, annulus fibrosus (AF) repair, nucleus pulposus replacement, and tissue-engineered discs have been explored as means for preventing or reversing degenerative disc disease. Both animal and clinical studies have shown promising results for cell-based therapy on the grounds of its regenerative potential. Clinical data also indicate that stem cell injection is safe when appropriately performed, albeit its long-term safety and efficacy are yet to be explored. Numerous challenges also remain to be overcome, such as isolating, differentiating, and preconditioning the disc cells, as well as managing the nutrient-deficient and oxygen-deficient micromilieu of the intervertebral disc (IVD). AF repair methods including devices used in clinical trials have shown success in decreasing reherniation rates and improving overall clinical outcomes. In addition, recent studies that combined AF repair and nucleus pulposus replacement have shown improved biomechanical stability in IVDs after the combined treatment. Tissue-engineered IVDs for total disc replacement are still being developed, and future studies are necessary to overcome the challenges in their delivery, efficacy, and safety.
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Affiliation(s)
- Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Sunidhi Singh
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Charisse Capadona
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Marianne Lintz
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Lynn B McGrath
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA; Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
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Peredo AP, Gullbrand SE, Smith HE, Mauck RL. Putting the Pieces in Place: Mobilizing Cellular Players to Improve Annulus Fibrosus Repair. TISSUE ENGINEERING. PART B, REVIEWS 2021; 27:295-312. [PMID: 32907498 PMCID: PMC10799291 DOI: 10.1089/ten.teb.2020.0196] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The intervertebral disc (IVD) is an integral load-bearing tissue that derives its function from its composite structure and extracellular matrix composition. IVD herniations involve the failure of the annulus fibrosus (AF) and the extrusion of the nucleus pulposus beyond the disc boundary. Disc herniations can impinge the neural elements and cause debilitating pain and loss of function, posing a significant burden on individual patients and society as a whole. Patients with persistent symptoms may require surgery; however, surgical intervention fails to repair the ruptured AF and is associated with the risk for reherniation and further disc degeneration. Given the limitations of AF endogenous repair, many attempts have been made toward the development of effective repair approaches that reestablish IVD function. These methods, however, fail to recapitulate the composition and organization of the native AF, ultimately resulting in inferior tissue mechanics and function over time and high rates of reherniation. Harnessing the cellular function of cells (endogenous or exogenous) at the repair site through the provision of cell-instructive cues could enhance AF tissue regeneration and, ultimately, improve healing outcomes. In this study, we review the diverse approaches that have been developed for AF repair and emphasize the potential for mobilizing the appropriate cellular players at the site of injury to improve AF healing. Impact statement Conventional treatments for intervertebral disc herniation fail to repair the annulus fibrosus (AF), increasing the risk for recurrent herniation. The lack of repair devices in the market has spurred the development of regenerative approaches, yet most of these rely on a scarce endogenous cell population to repair large injuries, resulting in inadequate regeneration. This review identifies current and developing strategies for AF repair and highlights the potential for harnessing cellular function to improve AF regeneration. Ideal cell sources, differentiation strategies, and delivery methods are discussed to guide the design of repair systems that leverage specialized cells to achieve superior outcomes.
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Affiliation(s)
- Ana P. Peredo
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Sarah E. Gullbrand
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Harvey E. Smith
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Sloan SR, Wipplinger C, Kirnaz S, Navarro-Ramirez R, Schmidt F, McCloskey D, Pannellini T, Schiavinato A, Härtl R, Bonassar LJ. Combined nucleus pulposus augmentation and annulus fibrosus repair prevents acute intervertebral disc degeneration after discectomy. Sci Transl Med 2021; 12:12/534/eaay2380. [PMID: 32161108 DOI: 10.1126/scitranslmed.aay2380] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
Tissue-engineered approaches for the treatment of early-stage intervertebral disc degeneration have shown promise in preclinical studies. However, none of these therapies has been approved for clinical use, in part because each therapy targets only one aspect of the intervertebral disc's composite structure. At present, there is no reliable method to prevent intervertebral disc degeneration after herniation and subsequent discectomy. Here, we demonstrate the prevention of degeneration and maintenance of mechanical function in the ovine lumbar spine after discectomy by combining strategies for nucleus pulposus augmentation using hyaluronic acid injection and repair of the annulus fibrosus using a photocrosslinked collagen patch. This combined approach healed annulus fibrosus defects, restored nucleus pulposus hydration, and maintained native torsional and compressive stiffness up to 6 weeks after injury. These data demonstrate the necessity of a combined strategy for arresting intervertebral disc degeneration and support further translation of combinatorial interventions to treat herniations in the human spine.
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Affiliation(s)
- Stephen R Sloan
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Sertaç Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Franziska Schmidt
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Duncan McCloskey
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Tania Pannellini
- Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY 10065, USA
| | | | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA. .,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
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Mern DS, Walsen T, Beierfuß A, Thomé C. Animal models of regenerative medicine for biological treatment approaches of degenerative disc diseases. Exp Biol Med (Maywood) 2020; 246:483-512. [PMID: 33175609 DOI: 10.1177/1535370220969123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Degenerative disc disease (DDD) is a painful, chronic and progressive disease, which is characterized by inflammation, structural and biological deterioration of the intervertebral disc (IVD) tissues. DDD is specified as cell-, age-, and genetic-dependent degenerative process that can be accelerated by environmental factors. It is one of the major causes of chronic back pain and disability affecting millions of people globally. Current treatment options, such as physical rehabilitation, pain management, and surgical intervention, can provide only temporary pain relief. Different animal models have been used to study the process of IVD degeneration and develop therapeutic options that may restore the structure and function of degenerative discs. Several research works have depicted considerable progress in understanding the biological basis of disc degeneration and the therapeutic potentials of cell transplantation, gene therapy, applications of supporting biomaterials and bioactive factors, or a combination thereof. Since animal models play increasingly significant roles in treatment approaches of DDD, we conducted an electronic database search on Medline through June 2020 to identify, compare, and discuss publications regarding biological therapeutic approaches of DDD that based on intradiscal treatment strategies. We provide an up-to-date overview of biological treatment strategies in animal models including mouse, rat, rabbit, porcine, bovine, ovine, caprine, canine, and primate models. Although no animal model could profoundly reproduce the clinical conditions in humans; animal models have played important roles in specifying our knowledge about the pathophysiology of DDD. They are crucial for developing new therapy approaches for clinical applications.
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Affiliation(s)
| | - Tanja Walsen
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Anja Beierfuß
- Laboratory Animal Facility, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck A-6020, Austria
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10
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Virk S, Chen T, Meyers KN, Lafage V, Schwab F, Maher SA. Comparison of biomechanical studies of disc repair devices based on a systematic review. Spine J 2020; 20:1344-1355. [PMID: 32092506 PMCID: PMC9063717 DOI: 10.1016/j.spinee.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A variety of solutions have been suggested as candidates for the repair of the annulus fibrosis (AF), with the ability to withstand physiological loads of paramount importance. PURPOSE The objective of our study was to capture the scope of biomechanical test models of AF repairs. We hypothesized that common test parameters would emerge. STUDY DESIGN Systematic Review METHODS: PubMed and EMBASE databases were searched for studies in English including the keywords "disc repair AND animal models," "disc repair AND cadaver spines," "intervertebral disc AND biomechanics," and "disc repair AND biomechanics." This list was further limited to those studies which included biomechanical results from annular repair in animal or human spinal segments from the cervical, thoracic, lumbar and/or coccygeal (tail) segments. For each study, the method used to measure the biomechanical property and biomechanical test results were documented. RESULTS A total of 2,607 articles were included within our initial analysis. Twenty-two articles met our inclusion criteria. Significant variability in terms of species tested, measurements used to quantify annular repair strength, and the method/direction/magnitude that forces were applied to a repaired annulus were found. Bovine intervertebral disc was most commonly used model (6 of 22 studies) and the most common mechanical property reported was the force required for failure of the disc repair device (15 tests). CONCLUSIONS Our hypothesis was rejected; no common features were identified across AF biomechanical models and as a result it was not possible to compare results of preclinical testing of annular repair devices. Our analysis suggests that a standardized biomechanical model that can be repeatably executed across multiple laboratories is required for the mechanical screening of candidates for AF repair. CLINICAL SIGNIFICANCE This literature review provides a summary of preclinical testing of annular repair devices for clinicians to properly evaluate the safety/efficacy of developing technology designed to repair annular defects after disc herniations.
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Affiliation(s)
- Sohrab Virk
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York,Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - Tony Chen
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY,Department of Biomechanics, Hospital for Special Surgery, New York, USA
| | | | - Virginie Lafage
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York
| | - Frank Schwab
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York
| | - Suzanne A. Maher
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY,Department of Biomechanics, Hospital for Special Surgery, New York, USA
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11
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Dang L, Zhu J, Liu Z, Liu X, Jiang L, Wei F, Song C. A new approach to the treatment of spinal instability: Fusion or structural reinforcement without surgery? Med Hypotheses 2020; 144:109900. [PMID: 32562916 DOI: 10.1016/j.mehy.2020.109900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Spinal instability related low back pain is a common condition resulting from degeneration and loss of stiffness of the intervertebral joint. In order to restore stability, highly invasive surgical fusion is needed for patients who are not responding to conservative treatment. Given the risk and complications of surgery, there has been the urge for improvement with a less invasive solution. Formation of vertebral body osteophytes is a common observation that has been treated as a degenerative condition. However, recent studies have associated it with reduced motion of spinal segments. Unlike the traditional view, we regard it as adaptive reactions aiming to repair and hypothesize that the spinal segments could be stabilized or fused by intentionally induced osteophytes growth at the mobile parts of the intervertebral joint. This could be achieved by injecting Bone Morphogenetic Proteins to the anterior ends of the vertebral bodies and/or the facet joints on both sides of two consecutive vertebrae percutaneously. If verified, it would be the first time that fusion could be achieved without surgery. Hence it would provide a valuable alternative to current treatments of spinal instability. Preliminary test in favor of this hypothesis is presented and we recommend that a formal study with sufficient number of samples is needed for verification.
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Affiliation(s)
- Lei Dang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Jinglin Zhu
- Department of Orthopedics, Beijing Shijitan Hospital, No. 10 Tieyi Rd., Yangfangdian Subdistrict, Haidian District, Beijing, PR China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Liang Jiang
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Feng Wei
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China
| | - Chunli Song
- Department of Orthopedics, Peking University 3rd Hospital, Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd., Haidian District, Beijing 100191, PR China.
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12
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Hussain I, Sloan SR, Wipplinger C, Navarro-Ramirez R, Zubkov M, Kim E, Kirnaz S, Bonassar LJ, Härtl R. Mesenchymal Stem Cell-Seeded High-Density Collagen Gel for Annular Repair: 6-Week Results From In Vivo Sheep Models. Neurosurgery 2020; 85:E350-E359. [PMID: 30476218 DOI: 10.1093/neuros/nyy523] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/04/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Our group has previously demonstrated in vivo annulus fibrosus repair in animal models using an acellular, riboflavin crosslinked, high-density collagen (HDC) gel. OBJECTIVE To assess if seeding allogenic mesenchymal stem cells (MSCs) into this gel yields improved histological and radiographic benefits in an in vivo sheep model of annular injury. METHODS Fifteen lumbar intervertebral discs (IVDs) were randomized into 4 groups: intact, injury only, injury + acellular gel treatment, or injury + MSC-seeded gel treatment. Sheep were sacrificed at 6 wk. Disc height index (DHI), Pfirrmann grade, nucleus pulposus area, and T2 relaxation time (T2-RT) were calculated for each IVD and standardized to healthy controls from the same sheep. Quantitative histological assessment was also performed using the Han scoring system. RESULTS All treated IVDs retained gel plugs on gross assessment and there were no adverse perioperative complications. The MSC-seeded gel treatment group demonstrated statistically significant improvement over other experimental groups in DHI (P = .002), Pfirrmann grade (P < .001), and T2-RT (P = .015). There was a trend for greater Han scores in the MSC-seeded gel-treated discs compared with injury only and acellular gel-treated IVDs (P = .246). CONCLUSION MSC-seeded HDC gel can be delivered into injured IVDs and maintained safely in live sheep to 6 wk. Compared with no treatment and acellular HDC gel, our data show that MSC-seeded HDC gel improves outcomes in DHI, Pfirrmann grade, and T2-RT. Histological analysis shows improved annulus fibrosus and nucleus pulposus reconstitution and organization over other experimental groups as well.
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Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Stephen R Sloan
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Micaella Zubkov
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Eliana Kim
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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13
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Jiang EY, Sloan SR, Wipplinger C, Kirnaz S, Härtl R, Bonassar LJ. Proteoglycan removal by chondroitinase ABC improves injectable collagen gel adhesion to annulus fibrosus. Acta Biomater 2019; 97:428-436. [PMID: 31425894 DOI: 10.1016/j.actbio.2019.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/24/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Abstract
Intervertebral disc (IVD) herniations are currently treated with interventions that leave the IVD with persistent lesions prone to further herniations. Annulus fibrosus (AF) repair has become of interest as a method to seal defects in the IVD and prevent reherniation, but this requires strong adhesion of the implanted biomaterial to the native AF tissue. Our group has previously developed a high-density collagen (HDC) gel for AF repair and tested its efficacy in vivo, but its adhesion to the AF could be improved. Increased cell adhesion to cartilage has previously been reported through chondroitinase ABC (ChABC) digestion, which removes proteoglycans and increases access to cell binding motifs. Such approaches could also increase biomaterial adhesion to tissue, but the effects of ChABC digestion on AF have yet to be investigated. In this study, ovine AF tissue was digested with either 10 U/mL ChABC or saline for up to 10 min and the effect of this treatment on collagen adhesion between AF tissue samples was investigated by histology and mechanical testing in a lap-shear configuration. ChABC digestion removed proteoglycans within the AF in a time-dependent fashion and enhanced adhesion of the HDC gel to the AF. ChABC digestion increased the elastic toughness and total shear energy of the HDC gel-AF interface by 88% and 46% respectively. ChABC treatment enhanced the adhesion of the HDC gel to the AF without significantly decreasing native AF cell viability. Thus, ChABC digestion is a viable method to improve adhesion of biomaterials for AF repair. STATEMENT OF SIGNIFICANCE: Intervertebral disc herniations are currently treated with interventions that leave persistent lesions in the annulus fibrosus that are prone to further herniations. Annular repair is a promising method to seal lesions and prevent reherniation, but requires strong adhesion of the implanted biomaterial to native annulus fibrosus. Since large proteoglycans like aggrecan occupy regions of the extracellular matrix between collagen fibers in the annulus fibrosus, we hypothesized that removing proteoglycans via chondroitinase digestion would increase the adhesion of annular repair hydrogels. This investigation demonstrated that chondroitinase removed proteoglycans within annulus fibrosus tissue, enhanced the interaction of an injected collagen gel with the native tissue, and mechanically improved adhesion between the collagen gel and annulus fibrosus. This is the first study of its kind to evaluate the biochemical and mechanical effects of short-term chondroitinase digestion on annulus fibrosus tissue.
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14
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Gluais M, Clouet J, Fusellier M, Decante C, Moraru C, Dutilleul M, Veziers J, Lesoeur J, Dumas D, Abadie J, Hamel A, Bord E, Chew SY, Guicheux J, Le Visage C. In vitro and in vivo evaluation of an electrospun-aligned microfibrous implant for Annulus fibrosus repair. Biomaterials 2019; 205:81-93. [PMID: 30909111 DOI: 10.1016/j.biomaterials.2019.03.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/21/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
Abstract
Annulus fibrosus (AF) impairment is associated with reherniation, discogenic pain, and disc degeneration after surgical partial discectomy. Due to a limited intrinsic healing capacity, defects in the AF persist over time and it is hence necessary to adopt an appropriate strategy to close and repair the damaged AF. In this study, a cell-free biodegradable scaffold made of polycaprolactone (PCL), electrospun, aligned microfibers exhibited high levels of cell colonization, alignment, and AF-like extracellular matrix deposition when evaluated in an explant culture model. The biomimetic multilayer fibrous scaffold was then assessed in an ovine model of AF impairment. After 4 weeks, no dislocation of the implants was detected, and only one sample out of six showed a partial delamination. Histological and immunohistochemical analyses revealed integration of the implant with the surrounding tissue as well as homogeneously aligned collagen fiber organization within each lamella compared to the disorganized and scarcer fibrous tissue in a randomly organized control fibrous scaffold. In conclusion, this biomimetic electrospun implant exhibited promising properties in terms of AF defect closure, with AF-like neotissue formation that fully integrated with the surrounding ovine tissue.
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Affiliation(s)
- Maude Gluais
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France
| | - Johann Clouet
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France; CHU Nantes, Pharmacie Centrale, PHU 11, Nantes, F-44093, France; Université de Nantes, UFR Sciences Biologiques et Pharmaceutiques, Nantes, F-44035, France
| | - Marion Fusellier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, F-44307, France
| | - Cyrille Decante
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; CHU Nantes, Service de Chirurgie Infantile, PHU5, Nantes, F-44093, France
| | - Constantin Moraru
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; CHU Nantes, Service de Neurotraumatologie, PHU4 OTONN, Nantes, F-44093, France
| | - Maeva Dutilleul
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France; INSERM, UMS 016, CNRS 3556, Structure Fédérative de Recherche François Bonamy, SC3M Facility, CHU Nantes, Université de Nantes, Nantes, F-44042, France
| | - Joëlle Veziers
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France; INSERM, UMS 016, CNRS 3556, Structure Fédérative de Recherche François Bonamy, SC3M Facility, CHU Nantes, Université de Nantes, Nantes, F-44042, France; CHU Nantes, PHU4 OTONN, Nantes, F-44093, France
| | - Julie Lesoeur
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France; INSERM, UMS 016, CNRS 3556, Structure Fédérative de Recherche François Bonamy, SC3M Facility, CHU Nantes, Université de Nantes, Nantes, F-44042, France
| | - Dominique Dumas
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), UMR 7365 CNRS - Université de Lorraine, Vandœuvre-lès-Nancy, F54505, France; UMS2008 IBSLor - CNRS-UL-INSERM Plateforme d'Imagerie et de Biophysique Cellulaire PTIBC-IBISA, Vandœuvre-lès-Nancy, F54505, France
| | - Jérôme Abadie
- Animal Cancers as Models for Research in Comparative Oncology (AMaROC), ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, F-44307, France
| | - Antoine Hamel
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; CHU Nantes, Service de Chirurgie Infantile, PHU5, Nantes, F-44093, France
| | - Eric Bord
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; CHU Nantes, Service de Neurotraumatologie, PHU4 OTONN, Nantes, F-44093, France
| | - Sing Yian Chew
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 637459, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, 308232, Singapore
| | - Jérôme Guicheux
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France; CHU Nantes, PHU4 OTONN, Nantes, F-44093, France
| | - Catherine Le Visage
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France; Université de Nantes, UFR Odontologie, Nantes, F-44042, France.
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15
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Huang YC, Hu Y, Li Z, Luk KDK. Biomaterials for intervertebral disc regeneration: Current status and looming challenges. J Tissue Eng Regen Med 2018; 12:2188-2202. [PMID: 30095863 DOI: 10.1002/term.2750] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/21/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
A biomaterial-based strategy is employed to regenerate the degenerated intervertebral disc, which is considered a major generator of neck and back pain. Although encouraging enhancements in the anatomy and kinematics of the degenerative disc have been gained by biomaterials with various formulations in animals, the number of biomaterials tested in humans is rare. At present, most studies that involve the use of newly developed biomaterials focus on regeneration of the degenerative disc, but not pain relief. In this review, we summarise the current state of the art in the field of biomaterial-based regeneration or repair for the nucleus pulposus, annulus fibrosus, and total disc transplantation in animals and humans, and we then provide essential suggestions for the development and clinical translation of biomaterials for disc regeneration. It is important for researchers to consider the commonly neglected issues instead of concentrating solely on biomaterial development and fabrication.
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Affiliation(s)
- Yong-Can Huang
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, Orthopaedic Research Center, Peking University Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.,Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Zhen Li
- AO Research Institute Davos, Davos, Switzerland
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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16
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Stich S, Möller A, Cabraja M, Krüger JP, Hondke S, Endres M, Ringe J, Sittinger M. Chemokine CCL25 Induces Migration and Extracellular Matrix Production of Anulus Fibrosus-Derived Cells. Int J Mol Sci 2018; 19:ijms19082207. [PMID: 30060561 PMCID: PMC6121557 DOI: 10.3390/ijms19082207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 12/17/2022] Open
Abstract
Intervertebral disc degeneration is a major source of back pain. For intervertebral disc regeneration after herniation a fast closure of anulus fibrosus (AF) defects is crucial. Here, the use of the C-C motif chemokine ligand 25 (CCL)25 in comparison to differentiation factors such as transforming growth factor (TGF)β3, bone morphogenetic protein (BMP)2, BMP7, BMP12, and BMP14 (all in concentrations of 10, 50 and 100 ng/mL) was tested in an in vitro micro mass pellet model with isolated and cultivated human AF-cells (n = 3) to induce and enhance AF-matrix formation. The pellets were differentiated (serum-free) with supplementation of the factors. After 28 days all used factors induced proteoglycan production (safranin O staining) and collagen type I production (immunohistochemical staining) in at least one of the tested concentrations. Histomorphometric scoring revealed that TGFβ3 delivered the strongest induction of proteoglycan production in all three concentrations. Furthermore, it was the only factor able to facilitate collagen type II production, even higher than in native tissue samples. CCL25 was also able to induce proteoglycan and collagen type I production comparable to several BMPs. CCL25 could additionally induce migration of AF-cells in a chemotaxis assay and therefore possibly aid in regeneration processes after disc herniation by recruiting AF-cells.
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Affiliation(s)
- Stefan Stich
- Tissue Engineering Laboratory, Berlin-Brandenburg Center for Regenerative Therapies, and Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.
| | - Anke Möller
- Tissue Engineering Laboratory, Berlin-Brandenburg Center for Regenerative Therapies, and Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.
| | - Mario Cabraja
- Department of Spinal Surgery, VivantesAuguste-Viktoria-Hospital, 12157 Berlin, Germany.
| | | | - Sylvia Hondke
- TransTissue Technologies GmbH, 10117 Berlin, Germany.
| | | | - Jochen Ringe
- Tissue Engineering Laboratory, Berlin-Brandenburg Center for Regenerative Therapies, and Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.
| | - Michael Sittinger
- Tissue Engineering Laboratory, Berlin-Brandenburg Center for Regenerative Therapies, and Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.
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17
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Sloan SR, Lintz M, Hussain I, Hartl R, Bonassar LJ. Biologic Annulus Fibrosus Repair: A Review of Preclinical In Vivo Investigations. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:179-190. [PMID: 29105592 DOI: 10.1089/ten.teb.2017.0351] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lower back pain, the leading cause of workplace absences and disability, is often attributed to intervertebral disc degeneration, in which nucleus pulposus (NP) herniates through lesions in the annulus fibrosus (AF) and impinges on the spinal cord and surrounding nerves. Surgeons remove extruded NP via discectomy when indicated by local/radicular pain supported by radiographic evidence; however, current interventions do not alter the underlying disease or seal the AF. The reported rates of recurrent herniation or pain following discectomy cases range from 5% to 25%, which has pushed spine research in recent years toward annular repair and closure strategies. Synthetic implants designed to mechanically seal the AF have been subject to large animal and clinical trials, with limited success in preventing recurrent herniation. Like gold standard interventions, purely mechanical devices fail to promote tissue integration, long-term healing, or restore native biomechanical function to the spine. Biological repair strategies utilizing principles of tissue engineering have demonstrated success in overcoming the inadequacies of current interventions and mechanical implants, yet, none has reached clinical or proof-of-concept trials in humans. In this review, we will discuss annular repair strategies promoting biological healing that have been implemented in small and large animal models in vivo, and ways to enhance the efficacy of these treatments.
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Affiliation(s)
- Stephen R Sloan
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York
| | - Marianne Lintz
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York
| | - Ibrahim Hussain
- 2 Department of Neurological Surgery, Weill Cornell Brain and Spine Center , New York-Presbyterian Hospital, New York, New York
| | - Roger Hartl
- 2 Department of Neurological Surgery, Weill Cornell Brain and Spine Center , New York-Presbyterian Hospital, New York, New York
| | - Lawrence J Bonassar
- 1 Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York.,3 Sibley School of Mechanical and Aerospace Engineering, Cornell University , Ithaca, New York
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18
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Kang R, Li H, Xi Z, Ringgard S, Baatrup A, Rickers K, Sun M, Le DQS, Wang M, Xie L, Xie Y, Chen M, Bünger C. Surgical repair of annulus defect with biomimetic multilamellar nano/microfibrous scaffold in a porcine model. J Tissue Eng Regen Med 2017; 12:164-174. [PMID: 27943601 DOI: 10.1002/term.2384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/15/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022]
Abstract
Annulus defect is associated with reherniation and disc degeneration after discectomy; currently there is no effective treatment that addresses this problem. The annulus is a hierarchical lamellar structure, where each lamella consists of aligned collagen fibres, which are parallel and tilted at 30° to the spinal axis. In this study, a biomimetic biodegradable scaffold consisting of multilamellar nano/microfibres, sharing nanotopography and microporosity similar to the native lamellar structure, was assessed in a porcine model, aided by sealing with fascia and medical glue and subsequent suture fixation. After 6- and 12-week observation, we found that this treatment restored nucleus volume and slowed down disc degeneration, as indicated by magnetic resonance imaging of T1/T2-weighted, T2-mapping, T1-ρ imaging. Histological analysis showed aligned collagen fibres organized in the scaffold and integrated with surrounding native annulus tissue. The autologous bone marrow concentrate-seeded scaffolds showed slightly earlier collagen fibre formation at 6 weeks. This novel treatment could efficiently close the annulus defect with newly formed, organized and integrated collagen fibres in a porcine model. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- R Kang
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - H Li
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
| | - Z Xi
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - S Ringgard
- The MR Research Centre, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - A Baatrup
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
| | - K Rickers
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
| | - M Sun
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
| | - D Q S Le
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
| | - M Wang
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
| | - L Xie
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Y Xie
- Nanjing University of Chinese Medicine Hanlin College, Taizhou, China
| | - M Chen
- Department of Engineering, Interdisciplinary Nanoscience Center, Aarhus University, Aarhus, Denmark
| | - C Bünger
- Orthopaedic Research Lab, Aarhus University, Aarhus, Denmark
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19
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Bowles RD, Setton LA. Biomaterials for intervertebral disc regeneration and repair. Biomaterials 2017; 129:54-67. [PMID: 28324865 DOI: 10.1016/j.biomaterials.2017.03.013] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/05/2017] [Accepted: 03/10/2017] [Indexed: 12/11/2022]
Abstract
The intervertebral disc contributes to motion, weight bearing, and flexibility of the spine, but is susceptible to damage and morphological changes that contribute to pathology with age and injury. Engineering strategies that rely upon synthetic materials or composite implants that do not interface with the biological components of the disc have not met with widespread use or desirable outcomes in the treatment of intervertebral disc pathology. Here we review bioengineering advances to treat disc disorders, using cell-supplemented materials, or acellular, biologically based materials, that provide opportunity for cell-material interactions and remodeling in the treatment of intervertebral disc disorders. While a field still in early development, bioengineering-based strategies employing novel biomaterials are emerging as promising alternatives for clinical treatment of intervertebral disc disorders.
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Affiliation(s)
- Robert D Bowles
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA.
| | - Lori A Setton
- Department of Biomedical Engineering & Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO 63130, USA.
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20
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Martin JT, Kim DH, Milby AH, Pfeifer CG, Smith LJ, Elliott DM, Smith HE, Mauck RL. In vivo performance of an acellular disc-like angle ply structure (DAPS) for total disc replacement in a small animal model. J Orthop Res 2017; 35:23-31. [PMID: 27227357 PMCID: PMC7593895 DOI: 10.1002/jor.23310] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
Total intervertebral disc replacement with a biologic engineered disc may be an alternative to spinal fusion for treating end-stage disc disease. In previous work, we developed disc-like angle ply structures (DAPS) that replicate the structure and function of the native disc and a rat tail model to evaluate DAPS in vivo. Here, we evaluated a strategy in which, after in vivo implantation, endogenous cells could colonize the acellular DAPS and form an extracellular matrix organized by the DAPS topographical template. To do so, acellular DAPS were implanted into the caudal spines of rats and evaluated over 12 weeks by mechanical testing, histology, and microcomputed tomography. An external fixation device was used to stabilize the implant site and various control groups were included to evaluate the effect of immobilization. There was robust tissue formation within the DAPS after implantation and compressive mechanical properties of the implant matched that of the native motion segment. Immobilization provided a stable site for fibrous tissue formation after either a discectomy or a DAPS implantation, but bony fusion eventually resulted, with segments showing intervertebral bridging after long-term implantation, a process that was accelerated by the implanted DAPS. Thus, while compressive mechanical properties were replicated after DAPS implantation, methods to actively prevent fusion must be developed. Future work will focus on limiting fusion by remobilizing the motion segment after a period of integration, delivering pro-chondrogenic factors, and pre-seeding DAPS with cells prior to implantation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:23-31, 2017.
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Affiliation(s)
- John T. Martin
- Department of Orthopaedic Surgery, University of Pennsylvania, 426 B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia 19104-6081 Pennsylvania,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, Pennsylvania,Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dong Hwa Kim
- Department of Orthopaedic Surgery, University of Pennsylvania, 426 B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia 19104-6081 Pennsylvania
| | - Andrew H. Milby
- Department of Orthopaedic Surgery, University of Pennsylvania, 426 B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia 19104-6081 Pennsylvania,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - Christian G. Pfeifer
- Department of Orthopaedic Surgery, University of Pennsylvania, 426 B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia 19104-6081 Pennsylvania,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, Pennsylvania,Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Lachlan J. Smith
- Department of Orthopaedic Surgery, University of Pennsylvania, 426 B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia 19104-6081 Pennsylvania,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, Pennsylvania,Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dawn M. Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware
| | - Harvey E. Smith
- Department of Orthopaedic Surgery, University of Pennsylvania, 426 B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia 19104-6081 Pennsylvania,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, Pennsylvania,Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, University of Pennsylvania, 426 B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia 19104-6081 Pennsylvania,Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, Pennsylvania,Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, Pennsylvania,Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
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Moriguchi Y, Alimi M, Khair T, Manolarakis G, Berlin C, Bonassar LJ, Härtl R. Biological Treatment Approaches for Degenerative Disk Disease: A Literature Review of In Vivo Animal and Clinical Data. Global Spine J 2016; 6:497-518. [PMID: 27433434 PMCID: PMC4947401 DOI: 10.1055/s-0036-1571955] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVE Degenerative disk disease (DDD) has a negative impact on quality of life and is a major cause of morbidity worldwide. There has been a growing interest in the biological repair of DDD by both researchers and clinicians alike. To generate an overview of the recent progress in reparative strategies for the treatment of DDD highlighting their promises and limitations, a comprehensive review of the current literature was performed elucidating data from in vivo animal and clinical studies. METHODS Articles and abstracts available in electronic databases of PubMed, Web of Science, and Google Scholar as of December 2014 were reviewed. Additionally, data from unpublished, ongoing clinical trials was retrieved from clinicaltrials.gov and available abstracts from research forums. Data was extracted from the most recent in vivo animal or clinical studies involving any of the following: (1) treatment with biomolecules, cells, or tissue-engineered constructs and (2) annulus fibrosus repair. RESULTS Seventy-five articles met the inclusion criteria for review. Among these, 17 studies involved humans; 37, small quadrupeds; and 21, large quadrupeds. Findings from all treatments employed demonstrated improvement either in regenerative capacity or in pain attenuation, with the exception of one clinical study. CONCLUSION Published clinical studies on cell therapy have reported encouraging results in the treatment of DDD and resultant back pain. We expect new data to emerge in the near future as treatments for DDD continue to evolve in parallel to our greater understanding of disk health and pathology.
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Affiliation(s)
- Yu Moriguchi
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - Marjan Alimi
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - Thamina Khair
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - George Manolarakis
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - Connor Berlin
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - Lawrence J. Bonassar
- Department of Biomedical Engineering, Cornell University, Ithaca, New York, United States
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, United States
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22
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Zhao CM, Chen Q, Zhang WJ, Huang AB, Zhang W, Yang HL, Zhang ZM. 17β-Estradiol Protects Rat Annulus Fibrosus Cells Against Apoptosis via α1 Integrin-Mediated Adhesion to Type I Collagen: An In-vitro Study. Med Sci Monit 2016; 22:1375-83. [PMID: 27108411 PMCID: PMC4846184 DOI: 10.12659/msm.897906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background 17β-Estradiol (E2) has been reported to protect annulus fibrosus (AF) cells in vitro against interleukin-1β (IL-1β)-induced apoptosis in a concentration-dependent manner. However, its time-response effect remains unexplored. In addition, integrin α2/collagen II interaction has been reported to influence the apoptosis of nucleus pulposus cells in vitro. Thus, we hypothesized that integrin α1/collagen II might play a role in exerting the anti-apoptosis effect by E2. The aim of the current study was to further investigate the anti-apoptotic effect of E2 and determine the role of integrin α1/collagen II interaction. Material/Methods Rat AF cells were primary cultured and used for the following experiments. AF cells were identified by immunocytochemistry of type I collagen. Cell apoptosis was detected by fluorescence-activated cell sorter (FACS) analysis. The activity of active caspase-3 was determined by use of a caspase-3 detection kit. AF cell adhesion to type I collagen was determined by cell adhesion assay. Protein level of integrin subunit α1 was quantified by Western blot and mRNA expression was determined by real-time qPCR. Results The immunocytochemistry of type I collagen revealed that cell purity was eligible for the following experiments with 98% of purity. FACS analysis indicated time-dependent anti-apoptosis effect of E2 at time points of 6 h, 12 h, and 24 h, which was confirmed by Caspase-3 activity. Furthermore, cell adhesion assay showed that E2 significantly increased cell binding to 95% of control, and qPCR and Western blot analysis showed that E2 effectively upregulated integrin α1. However, estrogen receptor antagonist ICI182780 prohibited the effect of E2. Conclusions This study shows that E2 protects against apoptosis in a time-dependent manner, and α1 integrin-mediated adhesion to collagen II is essential for estrogen-dependent anti-apoptosis in rat annulus fibrosus cells in vitro.
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Affiliation(s)
- Chun-Ming Zhao
- Department of Orthopedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu, China (mainland)
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University School of Medicine, Shanghai, China (mainland)
| | - Wen-Jie Zhang
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu, China (mainland)
| | - Ai-Bing Huang
- Department of Orthopedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu, China (mainland)
| | - Wei Zhang
- Department of Orthopedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu, China (mainland)
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhi-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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23
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The effect of annular repair on the failure strength of the porcine lumbar disc after needle puncture and punch injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:906-12. [PMID: 26553105 DOI: 10.1007/s00586-015-4316-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose was to quantify the structural integrity of annulus fibrosis (AF) after injuries with repair. METHODS Punctures in the AF of 6-month-old porcine spine specimens were made with 18-, 20-, 22-, 24-, and 26-gauge needles. Leakage testing was performed immediately after needle puncture (Group 1), after the puncture was repaired with a modified purse-string suture (MPSS) (Group 2), and after needle puncture with immediate repair (Group 3). Punch injuries repaired with the MPSS alone, or with an AF graft and MPSS were also examined. RESULTS There was no leakage from 26-gauge needle punctures. Pressures at which the nucleus pulposus leaked from the 24-, 22-, 20- and 18-gauge needle punctures (Group 1) were 4.28, 2.03, 1.27, and 1.06 MPa, respectively. Failure pressure after repair (Group 2, 3) was significantly greater than without (Group 1). Failure pressure in Group 3 was much greater than in Group 2 with 18- and 20-gauge punctures. Punch injury repaired with a graft and MPSS had significantly greater failure pressure than repair with MPSS alone (1.88 vs. 1.02 MPa, p = 0.0001). CONCLUSIONS The MPSS can restore the mechanical integrity of the AF after needle puncture. An annular graft along with a MPSS may increase the structural integrity of the AF after a punch injury. As this was an acute animal study, the measurements and results may not directly translate to the human intervertebral disc.
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24
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Grunert P, Borde BH, Towne SB, Moriguchi Y, Hudson KD, Bonassar LJ, Härtl R. Riboflavin crosslinked high-density collagen gel for the repair of annular defects in intervertebral discs: An in vivo study. Acta Biomater 2015; 26:215-24. [PMID: 26116448 DOI: 10.1016/j.actbio.2015.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/06/2015] [Accepted: 06/06/2015] [Indexed: 12/19/2022]
Abstract
Open annular defects compromise the ability of the annulus fibrosus to contain nuclear tissue in the disc space, and therefore lead to disc herniation with subsequent degenerative changes to the entire intervertebral disc. This study reports the use of riboflavin crosslinked high-density collagen gel for the repair of annular defects in a needle-punctured rat-tail model. High-density collagen has increased stiffness and greater hydraulic permeability than conventional low-density gels; riboflavin crosslinking further increases these properties. This study found that treating annular defects with crosslinked high-density collagen inhibited the progression of disc degeneration over 18 weeks compared to untreated control discs. Histological sections of FITC-labeled collagen gel revealed an early tight attachment to host annular tissue. The gel was subsequently infiltrated by host fibroblasts which remodeled it into a fibrous cap that bridged the outer disrupted annular fibers and partially repaired the defect. This repair tissue enhanced retention of nucleus pulposus tissue, maintained physiological disc hydration, and preserved hydraulic permeability, according to MRI, histological, and mechanical assessments. Degenerative changes were partially reversed in treated discs, as indicated by an increase in nucleus pulposus size and hydration between weeks 5 and 18. The collagen gel appeared to work as an instant sealant and by enhancing the intrinsic healing capabilities of the host tissue.
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Affiliation(s)
- Peter Grunert
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Brandon H Borde
- Department of Biomedical Engineering, Cornell University, United States
| | - Sara B Towne
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Yu Moriguchi
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | | | - Lawrence J Bonassar
- Department of Biomedical Engineering, Cornell University, United States; Sibley School of Mechanical and Aerospace Engineering, Cornell University, United States
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States.
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Abstract
STUDY DESIGN Animal in vivo study. OBJECTIVE To test the capability of high-density collagen gel to repair annular defects. SUMMARY OF BACKGROUND DATA Annular defects are associated with spontaneous disc herniations and disc degeneration, which can lead to significant morbidity. Persistent annular defects after surgical discectomies can increase reherniation rates. Several synthetic and biological materials have been developed for annular repair. This is the first study to test an injectable biomaterial in vivo. METHODS We punctured caudal intervertebral discs in 42 athymic rats, using an 18-gauge needle to create an annular defect. High-density collagen (HDC), either alone or cross-linked with riboflavin (RF), was injected into the defect. There were 4 separate study groups: HDC, HDC cross-linked with either 0.25 mM RF or 0.50 mM RF, and a negative control that was punctured and not treated. The animals were followed for 5 weeks; radiographs were used to assess disc heights and magnetic resonance images were used to evaluate degenerative changes. We developed an algorithm on the basis of T2-relaxation time measurements to assess the size of the nucleus pulposus. Tails were collected for histological analysis to evaluate disc degeneration and measure the cross-sectional area of the nucleus pulposus. RESULTS After 5 weeks, the control and the uncross-linked HDC groups both showed signs of progressive degenerative changes with minimal or no residual nucleus pulposus tissue in the disc space. Cross-linking significantly improved the ability of HDC gels to repair annular defects. The 0.50 mM RF cross-linked group showed only a slight decrease in nuclear tissue when compared with healthy discs, with no signs of intervertebral disc (IVD) degeneration. The annulus fibrosus was partially repaired by a fibrous cap that bridged the defect. Host fibroblasts infiltrated and remodeled the injected collagen. CONCLUSION HDC is capable of repairing annular defects induced by needle puncture. The stiffness of HDC can be modified by riboflavin cross-linking and seems to positively affect the repair mechanism. These results need to be replicated in a larger animal model. LEVEL OF EVIDENCE N/A.
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26
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Platelet-rich plasma induces annulus fibrosus cell proliferation and matrix production. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:745-53. [PMID: 24469887 DOI: 10.1007/s00586-014-3198-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE Platelet-rich plasma (PRP) contains growth factors and creates a 3D structure upon clotting; PRP or platelet lysate (PL) might be considered for annulus fibrosus (AF) repair. METHODS Bovine AF cells were cultured with 25% PRP, 50% PRP, 25% PL, 50% PL, or 10% FBS. After 2 and 4 days, DNA, glycosaminoglycan (GAG), and mRNA levels were analyzed. Histology was performed after injection of PRP into an AF defect in a whole disc ex vivo. RESULTS By day 4, significant increases in DNA content were observed in all treatment groups. All groups also showed elevated GAG synthesis, with highest amounts at 50% PL. Collagen I and II expression was similar between groups; aggrecan, decorin, and versican expression was highest at 25% PL. Injection of PRP into the AF defect resulted in an increased matrix synthesis. CONCLUSIONS Platelet-rich preparations increased the matrix production and cell number and may therefore be considered to promote AF repair.
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27
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Hegewald AA, Medved F, Feng D, Tsagogiorgas C, Beierfuß A, Schindler GAK, Trunk M, Kaps C, Mern DS, Thomé C. Enhancing tissue repair in annulus fibrosus defects of the intervertebral disc: analysis of a bio‐integrative annulus implant in an
in‐vivo
ovine model. J Tissue Eng Regen Med 2013; 9:405-14. [DOI: 10.1002/term.1831] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 05/05/2013] [Accepted: 09/02/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Aldemar Andres Hegewald
- Department of Neurosurgery University Medical Centre Mannheim, Heidelberg University Mannheim Germany
- Department of Neurosurgery Innsbruck Medical University Innsbruck Austria
| | - Fabian Medved
- Department of Neurosurgery University Medical Centre Mannheim, Heidelberg University Mannheim Germany
| | - Daxiong Feng
- Department of Neurosurgery University Medical Centre Mannheim, Heidelberg University Mannheim Germany
- Spinal Surgery Department The Affiliated Hospital of Luzhou Medical College Luzhou Sichuan Province P R China
| | - Charalambos Tsagogiorgas
- Department of Anaesthesiology and Critical Care Medicine University Medical Centre Mannheim, Heidelberg University Mannheim Germany
| | - Anja Beierfuß
- Department of Small Animal Surgery and Ophthalmology Ludwig Maximilian's University Munich Munich Germany
| | | | - Marcus Trunk
- Institute of Pathology University Medical Centre Mannheim, Heidelberg University Mannheim Germany
| | | | - Demissew Shenegelegn Mern
- Department of Neurosurgery University Medical Centre Mannheim, Heidelberg University Mannheim Germany
| | - Claudius Thomé
- Department of Neurosurgery Innsbruck Medical University Innsbruck Austria
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28
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Reitmaier S, Schmidt H, Ihler R, Kocak T, Graf N, Ignatius A, Wilke HJ. Preliminary investigations on intradiscal pressures during daily activities: an in vivo study using the merino sheep. PLoS One 2013; 8:e69610. [PMID: 23894509 PMCID: PMC3722231 DOI: 10.1371/journal.pone.0069610] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose Currently, no studies exist, which attest the suitability of the ovine intervertebral disc as a biomechanical in vivo model for preclinical tests of new therapeutic strategies of the human disc. By measuring the intradiscal pressure in vivo, the current study attempts to characterize an essential biomechanical parameter to provide a more comprehensive physiological understanding of the ovine intervertebral disc. Methods Intradiscal pressure (IDP) was measured for 24 hours within the discs L2-L3 and L4-L5 via a piezo-resistive pressure sensor in one merino sheep. The data were divided into an activity and a recovery phase and the corresponding average pressures for both phases were determined. Additionally, IDPs for different static and dynamic activities were analyzed and juxtaposed to human data published previously. After sacrificing the sheep, the forces corresponding to the measured IDPs were examined ex vivo in an axial compression test. Results The temporal patterns of IDP where pressure decreased during activity and increased during rest were comparable between humans and sheep. However, large differences were observed for different dynamic activities such as standing up or walking. Here, IDPs averaged 3.73 MPa and 1.60 MPa respectively, approximately two to four times higher in the ovine disc compared to human. These IDPs correspond to lower ex vivo derived axial compressive forces for the ovine disc in comparison to the human disc. For activity and rest, average ovine forces were 130 N and 58 N, compared to human forces of 400-600 N and 100 N, respectively. Conclusions In vivo IDPs were found to be higher in the ovine than in the human disc. In contrast, axial forces derived ex vivo were markedly lower in comparison to humans. Both should be considered in future preclinical tests of intradiscal therapies using the sheep. The techniques used in the current study may serve as a protocol for measuring IDP in a variety of large animal models.
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Affiliation(s)
- Sandra Reitmaier
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm, Germany.
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29
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Guterl CC, See EY, Blanquer SB, Pandit A, Ferguson SJ, Benneker LM, Grijpma DW, Sakai D, Eglin D, Alini M, Iatridis JC, Grad S. Challenges and strategies in the repair of ruptured annulus fibrosus. Eur Cell Mater 2013; 25:1-21. [PMID: 23283636 PMCID: PMC3655691 DOI: 10.22203/ecm.v025a01] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Lumbar discectomy is the surgical procedure most frequently performed for patients suffering from low back pain and sciatica. Disc herniation as a consequence of degenerative or traumatic processes is commonly encountered as the underlying cause for the painful condition. While discectomy provides favourable outcome in a majority of cases, there are conditions where unmet requirements exist in terms of treatment, such as large disc protrusions with minimal disc degeneration; in these cases, the high rate of recurrent disc herniation after discectomy is a prevalent problem. An effective biological annular repair could improve the surgical outcome in patients with contained disc herniations but otherwise minor degenerative changes. An attractive approach is a tissue-engineered implant that will enable/stimulate the repair of the ruptured annulus. The strategy is to develop three-dimensional scaffolds and activate them by seeding cells or by incorporating molecular signals that enable new matrix synthesis at the defect site, while the biomaterial provides immediate closure of the defect and maintains the mechanical properties of the disc. This review is structured into (1) introduction, (2) clinical problems, current treatment options and needs, (3) biomechanical demands, (4) cellular and extracellular components, (5) biomaterials for delivery, scaffolding and support, (6) pre-clinical models for evaluation of newly developed cell- and material-based therapies, and (7) conclusions. This article highlights that an interdisciplinary approach is necessary for successful development of new clinical methods for annulus fibrosus repair. This will benefit from a close collaboration between research groups with expertise in all areas addressed in this review.
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Affiliation(s)
- Clare C. Guterl
- Department of Orthopaedics, Mount Sinai Medical Centre, New York, NY, USA,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Eugene Y. See
- Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Sebastien B.G. Blanquer
- Department of Biomaterials Science and Technology, University of Twente, Enschede, The Netherlands,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Abhay Pandit
- Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Stephen J. Ferguson
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Lorin M. Benneker
- Department of Orthopaedic Surgery, University of Bern, Bern, Switzerland,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Dirk W. Grijpma
- Department of Biomaterials Science and Technology, University of Twente, Enschede, The Netherlands,Department of Biomedical Engineering, University Medical Centre Groningen and University of Groningen, Groningen, The Netherlands,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - David Eglin
- AO Research Institute Davos, Davos, Switzerland,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Mauro Alini
- AO Research Institute Davos, Davos, Switzerland,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - James C. Iatridis
- Department of Orthopaedics, Mount Sinai Medical Centre, New York, NY, USA,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, Davos, Switzerland,Collaborative Research Partner Annulus Fibrosus Rupture Program of AO Foundation, Davos, Switzerland,Address for correspondence: Sibylle Grad, PhD, AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland, Telephone Number: +41 81 414 2480, FAX Number: +41 81 414 2288,
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Schmidt H, Reitmaier S. Is the ovine intervertebral disc a small human one? A finite element model study. J Mech Behav Biomed Mater 2012; 17:229-41. [PMID: 23127644 DOI: 10.1016/j.jmbbm.2012.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 09/03/2012] [Accepted: 09/10/2012] [Indexed: 11/27/2022]
Abstract
The sheep is one of the most frequently used animal models for experimental intervertebral disc research questions. Although there are large differences in size between human and ovine discs, recent in vivo and in vitro studies indicate similarities in the internal disc stresses. The present finite element model study, therefore, intended to detect the parameters that, despite the different geometry, ensure mechanical comparability between both species. At first, a finite element model of the human L4-L5 lumbar intervertebral disc was developed. The predicted displacement and nucleus pressure response were validated with experimental in vivo and in vitro data. Starting with adapting the model geometry from the human to the ovine disc, several material and biochemical parameters, which might contribute to the preservation of the mechanical disc response across both species, were successively adapted to ovine properties. Replacing the geometry yielded a substantially higher disc stiffness and lower nucleus pressure compared to in vitro measurements performed on ovine discs. Additional reduction of annulus and nucleus elasticity led to an improved correlation between model predictions and measurements. Changes in the glycosaminoglycan content and endplate permeability improved the predicted pressure, but only slightly affected the displacement response. Only the combination of all parameters resulted in a good agreement between the predictions and measurements. This study demonstrated that there are profound differences between model predictions and in vitro results if an ovine simulation is run with human material properties. However, once the species-specific material properties are included, the predictions fit the in vitro results. Therefore, it seems that the human and ovine disc is functionally adapted to produce similar internal stresses, despite the large variation in geometry.
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Affiliation(s)
- Hendrik Schmidt
- Julius Wolff Institut Charité-Universitätsmedizin Berlin, CVK, Institutsgebäude Süd/Südstraße 2, Augustenburger Platz 1, 13353 Berlin, Germany.
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31
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Woiciechowsky C, Abbushi A, Zenclussen ML, Casalis P, Krüger JP, Freymann U, Endres M, Kaps C. Regeneration of nucleus pulposus tissue in an ovine intervertebral disc degeneration model by cell-free resorbable polymer scaffolds. J Tissue Eng Regen Med 2012; 8:811-20. [PMID: 22865642 DOI: 10.1002/term.1582] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 05/25/2012] [Accepted: 06/26/2012] [Indexed: 01/07/2023]
Abstract
Degeneration of intervertebral discs (IVDs) occurs frequently and is often associated with lower back pain. Recent treatment options are limited and treat the symptoms rather than regenerate the degenerated disc. Cell-free, freeze-dried resorbable polyglycolic acid (PGA)-hyaluronan implants were used in an ovine IVD degeneration model. The nucleus pulposus of the IVD was partially removed, endoscopically. PGA-hyaluronan implants were immersed in autologous sheep serum and implanted into the disc defect. Animals with nucleotomy only served as controls. The T2-weighted/fat suppression sequence signal intensity index of the operated discs, as assessed by magnetic resonance imaging (MRI), showed that implantation of the PGA-hyaluronan implant improved (p = 0.0066) the MRI signal compared to controls at 6 months after surgery. Histological analysis by haematoxylin and eosin and safranin O staining showed the ingrowth of cells with typical chondrocytic morphology, even cell distribution, and extracellular matrix rich in proteoglycan. Histomorphometric analyses confirmed that the implantation of the PGA-hyaluronan scaffolds improved (p = 0.027) the formation of regenerated tissue after nucleotomy. Disc heights remained stable in discs with nucleotomy only as well as after implantation of the implant. In conclusion, implantation of cell-free polymer-based implants after nucleotomy induces nucleus pulposus tissue regeneration and improves disc water content in the ovine model.
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Affiliation(s)
- Christian Woiciechowsky
- Tissue Engineering Laboratory, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Germany; Spine Centre Berlin, Germany
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Comparison of the immature sheep spine and the growing human spine: a spondylometric database for growth modulating research. Spine (Phila Pa 1976) 2010; 35:E1262-72. [PMID: 20938392 DOI: 10.1097/brs.0b013e3181e24196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A comparative study on growth of the sheep and human spine. OBJECTIVE To validate the immature sheep spine as model for the growing human spine and to yield a database for planning and interpretation of future animal experiments. SUMMARY OF BACKGROUND DATA With the current change of paradigm to nonfusion strategies for pediatric spine deformities, experimental surgery on spines of growing goats, sheep, and pigs has gained importance as preclinical proof-of-concept test. However, despite the proceeding use of animals, there is a lack of knowledge regarding the growth of the sheep spine and the relation to the human spine. METHODS Thoracic and lumbar cadaver spines were harvested from 50 Swiss alpine sheep. Specimens were obtained from newborn, 1, 3, 6, 9 and 12, 15 and 18 months old female sheep. Direct spondylometry yielded vertebral body heights, widths, and depths and spinal canal size, which were compared to pooled data on human spine growth retrieved from the literature. RESULTS Sheep spine growth ceases at age 15 to 18 months, which corresponds to a time-lapse model of human growth. Main growth occurs within the first 3 to 6 months of life, as opposed to human spines with maximal growth during the first 4 years and puberty. The relation between sheep and human vertebral shape is continuously changing with growth: at birth, sheep vertebrae are twice as tall, but equally wide and deep. At skeletal maturity, height is 15% to 25% bigger in sheep, but width 15% to 30% and depth 30% to 50% are smaller. CONCLUSION The immature sheep spine offers fast effects if growth-modulating interventions are performed within the first 3 to 6 months of age. The differences in vertebral shapes and further distinctions between human and sheep spines such as biomechanics, facet anatomy, and rib cage morphology have to be considered when interpreting results after experimental surgery.
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