Multi-potent differentiation of human purified muscle-derived cells: potential for tissue regeneration

Cell therapy in joint disorders

Context:

Articular cartilage possesses poor natural healing mechanisms, and a variety of non-cell-based and cell-based treatments aim to promote regeneration of hyaline cartilage.

Data Sources:

A review of the literature to December 2013 using PubMed with search criteria including the keywords stem cell, cell therapy, cell transplantation, cartilage, chondral, and chondrogenic.

Study Selection:

Forty-five articles were identified that employed local mesenchymal stem cell (MSC) therapy for joint disorders in humans. Nine comparative studies were identified, consisting of 3 randomized trials, 5 cohort studies, and 1 case-control study.

Study Type:

Clinical review.

Level of Evidence:

Level 4.

Data Extraction:

Studies were assessed for stem cell source, method of implantation, comparison groups, and concurrent surgical techniques.

Results:

Two studies comparing MSC treatment to autologous chondrocyte implantation found similar efficacy. Three studies reported clinical benefits with intra-articular MSC injection over non-MSC controls for cases undergoing debridement with or without marrow stimulation, although a randomized study found no significant clinical difference at 2-year follow-up but reported better 18-month magnetic resonance imaging and histologic scores in the MSC group. No human studies have compared intra-articular MSC therapy to non-MSC techniques for osteoarthritis in the absence of surgery.

Conclusion:

Mesenchymal stem cell–based therapies appear safe and effective for joint disorders in large animal preclinical models. Evidence for use in humans, particularly, comparison with more established treatments such as autologous chondrocyte implantation and microfracture, is limited.

Bearing arms against osteoarthritis and sarcopenia: when cartilage and skeletal muscle find common interest in talking together

Osteoarthritis, a disease characterized by cartilage degradation, abnormal subchondral bone remodelling and some grade of inflammation, and sarcopenia, a condition of pathological muscle weakness associated with altered muscle mass, strength, and function, are prevalent disorders in elderly people. There is increasing evidence that decline in lower limb muscle strength is associated with knee or hip osteoarthritis in a context of pain, altered joint stability, maladapted postures and defective neuromuscular communication. At the cellular and molecular levels, chondrocytes and myoblasts share common pathological targets and pathways, and the close anatomical location of both cell types suggest a possibility of paracrine communication. In this review, we examine the relationship between osteoarthritis and sarcopenia in the musculoskeletal field, and discuss the potential advantage of concomitant therapies, or how each disorder may benefit from treatment of the other.

Potential role of vascular smooth muscle cell-like progenitor cell therapy in the suppression of experimental abdominal aortic aneurysms

Abdominal aortic aneurysms (AAA) are a growing problem worldwide, yet there is no known medical therapy. The pathogenesis involves degradation of the elastic lamina by two combined mechanisms: increased degradation of elastin by matrix metalloproteinases (MMP) and decreased formation of elastin due to apoptosis of vascular smooth muscle cells (VSMC). In this study, we set out to examine the potential role of stem cells in the attenuation of AAA formation by inhibition of these pathogenetic mechanisms. Muscle-derived stem cells from murine skeletal muscles were isolated and stimulated with PDGF-BB in vitro for differentiation to VSMC-like progenitor cells (VSMC-PC). These cells were implanted in to elastase-induced AAAs in rats. The cell therapy group had decreased rate of aneurysm formation compared to control, and MMP expression at the genetic, protein and enzymatic level were also significantly decreased. Furthermore, direct implantation of VSMC-PCs in the intima of harvested aortas was visualized under immunofluorescent staining, suggesting that these cells were responsible for the inhibition of MMPs and consequent attenuation of AAA formation. These results show a promising role of stem cell therapy for the treatment of AAAs, and with further studies, may be able to reach clinical significance.

Chondrogenesis of myoblasts in biodegradable poly-lactide-co-glycolide scaffolds

Myoblasts are considered to be an alternative cell source for cell-based meniscal repair due to their multiple differentiation potentials. This study addresses the chondrogenic differentiation of myoblasts seeded into poly-lactide-co-glycolide (PLGA) scaffolds following implantation in a subcutaneous pocket of nude mice. Canine myoblasts isolated from a Beagle were expanded and seeded into PLGA scaffolds and cultured in cartilage-derived morphogenetic protein-2 (CDMP-2) and transforming growth factor-β1 (TGF-β1)-containing medium for 2 weeks in vitro. The constructs were implanted into a subcutaneous pocket of 24 combined immunodeficiency mice and harvested after 8 and 12 weeks, respectively. Hematoxylin and eosin staining of the sections of the engineered cartilage at 8 and 12 weeks revealed the regeneration of fibrocartilage. Immunohistochemical staining confirmed a similar distribution of collagen type Ⅱ in the engineered cartilage as the normal meniscus. At 12 weeks, expression of mRNAs for type Ⅰ collagen, type Ⅱ collagen and aggrecan was detected by RT-PCR. The compressive moduli of engineered cartilage reached 85.72% of the normal meniscus at 12 weeks, with a high level of glycosaminoglycan (GAG) content (no statistical difference from normal). Myoblast-seeded PLGA scaffolds express a stable chondrogenic phenotype in a heterotopic model of cartilage transplantation and represent a suitable tool for tissue engineering of cartilage.

Isolation, characterization, and differentiation of stem cells for cartilage regeneration

The goal of tissue engineering is to create a functional replacement for tissues damaged by injury or disease. In many cases, impaired tissues cannot provide viable cells, leading to the investigation of stem cells as a possible alternative. Cartilage, in particular, may benefit from the use of stem cells since the tissue has low cellularity and cannot effectively repair itself. To address this need, researchers are investigating the chondrogenic capabilities of several multipotent stem cell sources, including adult and extra-embryonic mesenchymal stem cells (MSCs), embryonic stem cells (ESCs), and induced pluripotent stem cells (iPSCs). Comparative studies indicate that each cell type has advantages and disadvantages, and while direct comparisons are difficult to make, published data suggest some sources may be more promising for cartilage regeneration than others. In this review, we identify current approaches for isolating and chondrogenically differentiating MSCs from bone marrow, fat, synovium, muscle, and peripheral blood, as well as cells from extra-embryonic tissues, ESCs, and iPSCs. Additionally, we assess chondrogenic induction with growth factors, identifying standard cocktails used for each stem cell type. Cell-only (pellet) and scaffold-based studies are also included, as is a discussion of in vivo results.

Repair of meniscal defect using an induced myoblast-loaded polyglycolic acid mesh in a canine model

Defects of the meniscus greatly alter knee function and predispose the joint to degenerative changes. The purpose of this study was to test a recently developed cell-scaffold combination for the repair of a critical-size defect in the canine medial meniscus. A bilateral, complete resection of the anterior horn of the medial meniscus was performed in 18 Beagle canines. A PLGA scaffold was implanted into the defect of one knee of 6 canines and the contralateral defect was left untreated. Scaffolds loaded with autologous myoblasts and cultured in a chondrogenic medium for 14 days were implanted in a second series of 12 canines. Empty scaffolds were implanted in the contralateral knees. Menisci were harvested at 12 weeks. Untreated defects had a muted fibrous healing response. Defects treated with cell-free implants also showed predominantly fibrous tissue, whereas fibrocartilage was present in several scaffolds. The thickness of the repair tissue after treatment with cell-free scaffolds was significantly greater compared to the controls (p<0.05). Pre-cultured implants integrated with the host tissue, and 9 of 12 contained meniscus-like fibrocartilage when compared to 2 of the 12 controls (p<0.05). The thickness of the pre-cultured implant repair tissue was greater compared to the controls (p<0.05). This study demonstrates the repair of a critical size meniscal defect using a stem cell and scaffold-based tissue engineering approach.

Expression of the stem cell marker nestin in pre/hypertrophic chondrocytes in osteochondroma

The pathogenesis of osteochondroma, the most common benign bone tumour, is not fully known. To date, regulation of nestin protein levels in osteochondromas and normal growth plates has not been reported. This study used immunohistochemical analysis to detect nestin protein levels in 48 osteochondromas and 13 normal growth plates (eight fetal and five postnatal). Nestin protein was mainly restricted to prehypertrophic and hypertrophic chondrocytes in osteochondroma. Nestin levels were significantly higher in osteochondromas in adolescents (age range 4 - 18 years, n = 32) than in osteochondromas in young adults (age range 20 - 28 years, n = 11), and significantly higher in osteochondromas in young adults than in those in older adults (age range 40 - 77 years; n = 5). Nestin protein was not present in normal growth plates. The presence of nestin protein parallels the biological behaviour of osteochondromas and is restricted to prehypertrophic and hypertrophic chondrocytes, indicating that these nestin-positive cells may be central to osteochondroma development.

Characterization of smooth muscle differentiation of purified human skeletal muscle-derived cells

The purpose of this study is to characterize the smooth muscle differentiation of purified human muscle-derived cells (hMDCs). The isolation and purification of hMDCs were conducted by modified preplate technique and Dynal CD34 cell selection. Smooth muscle cell differentiation was induced by the use of smooth muscle induction medium (SMIM) and low-serum medium. The gene expressions at the mRNA and protein levels of undifferentiated and differentiated hMDCs were tested by RT-PCR, Western blot and immunofluorescence studies. Western blot and immunofluorescence studies demonstrated the purified hMDCs cultured in SMIM for 4 weeks and expressed significant amount of smooth muscle myosin heavy chain (MHC) and α-smooth muscle actin (ASMA). The cells cultured in low-serum medium for 4 weeks also expressed ASMA, while the control group did not. RT-PCR analysis showed increased gene expression of smooth muscle markers, such as ASMA, Calponin, SM22, Caldesmon, Smoothelin and MHC when purified hMDCs were exposed to SMIM for 2 and 4 weeks when compared to the controls. In conclusion, we confirmed the smooth muscle differentiation capability of purified hMDCs. The gene expression of smooth muscle differentiation of purified hMDCs was characterized. These cells may be potential biomaterials for human tissue regeneration.