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Guarnera D, Restaino F, Vannozzi L, Trucco D, Mazzocchi T, Worwąg M, Gapinski T, Lisignoli G, Zaffagnini S, Russo A, Ricotti L. Arthroscopic device with bendable tip for the controlled extrusion of hydrogels on cartilage defects. Sci Rep 2024; 14:19904. [PMID: 39191817 DOI: 10.1038/s41598-024-70426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
Advanced tools for the in situ treatment of articular cartilage lesions are attracting a growing interest in both surgery and bioengineering communities. The interest is particularly high concerning the delivery of cell-laden hydrogels. The tools currently available in the state-of-the-art hardly find an effective compromise between treatment accuracy and invasiveness. This paper presents a novel arthroscopic device provided with a bendable tip for the controlled extrusion of cell-laden hydrogels. The device consists of a handheld extruder and a supply unit that allows the extrusion of hydrogels. The extruder is equipped with a disposable, bendable nitinol tip (diameter: 4 mm, length: 92 mm, maximum bending angle: 90°) that guarantees access to hard-to-reach areas of the joint, which are difficult to get to, with conventional arthroscopic instruments. The tip accommodates a biocompatible polymer tube that is directly connected to the cartridge containing the hydrogel, whose plunger is actuated by a volumetric or pneumatic supply unit (both tested, in this study). Three different chondrocyte-laden hydrogels (RGD-modified Vitrogel®, methacrylated gellan gum, and an alginate-gelatine blend) were considered. First, the performance of the device in terms of resolution in hydrogel delivery was assessed, finding values in the range between 4 and 102 µL, with better performance found for the pneumatic supply unit and no significant differences between straight tip and bent tip conditions. Finite element simulations suggested that the shear stresses and pressure levels generated during the extrusion process were compatible with a safe deposition of the hydrogels. Biological analyses confirmed a high chondrocyte viability over a 7-day period after the extrusion of the three cell-laden hydrogel types, with no differences between the two supply units. The arthroscopic device was finally tested ex vivo by nine orthopedic surgeons on human cadaver knees. The device allowed surgeons to easily deliver hydrogels even in hard-to-reach cartilage areas. The outcomes of a questionnaire completed by the surgeons demonstrated a high usability of the device, with an overall preference for the pneumatic supply unit. Our findings provide evidence supporting the future arthroscopic device translation in pre-clinical and clinical scenarios, dealing with osteoarticular treatments.
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Affiliation(s)
- Daniele Guarnera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy.
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy.
| | - Francesco Restaino
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
| | - Lorenzo Vannozzi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
| | - Diego Trucco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
- IRCCS Istituto Ortopedico Rizzoli, SC Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, Via di Barbiano, 1/10, 40136, Bologna, Italy
| | | | - Michał Worwąg
- Vimex Endoscopy, Ul. Toruńska 27, 44-122, Gliwice, Poland
| | - Tomasz Gapinski
- Lega Medical Sp. Z o. O, ul. Majowa 11, 44-217, Rybnik, Poland
| | - Gina Lisignoli
- IRCCS Istituto Ortopedico Rizzoli, SC Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, Via di Barbiano, 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, Orthopaedic and Traumatologic Clinic, Via di Barbiano, 1/10, 40136, Bologna, Italy
| | - Alessandro Russo
- IRCCS Istituto Ortopedico Rizzoli, Orthopaedic and Traumatologic Clinic, Via di Barbiano, 1/10, 40136, Bologna, Italy
| | - Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta' 33, 56127, Pisa, Italy
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Tierney L, Kuiper JH, Roberts S, Snow M, Williams M, Harrington MB, Harrison P, Gallacher P, Jermin P, Wright KT. Lower cell number, lateral defect location and milder grade are associated with improved autologous chondrocyte implantation outcome. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39189122 DOI: 10.1002/ksa.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE To investigate patient demographic, injury and surgery/treatment-associated factors that can influence the patient-reported outcome (Lysholm score), following autologous chondrocyte implantation (ACI) in a large, 'real-world', nonuniform, prospective data examined retrospectively. METHODS Knee patients treated at the Robert Jones and Agnes Hunt Orthopaedic Hospital, UK, using ACI between 1996 and 2020 were eligible. All longitudinal postoperative Lysholm scores collected between 1 and 23 years after ACI treatment and before any second major procedure (e.g., arthroplasty) were included. Multilevel longitudinal models were built investigating the association of short-term (1 year) or long-term trends in Lysholm score with baseline demographic, clinical and cell-culture variables, namely age, gender, smoker status, body mass index, baseline Lysholm score, time from surgery, defect grade, diameter and location, number of defects, previous microfracture, patch/scaffold type, associated procedure(s), number of cells implanted and their passage number. RESULTS Following filtering, 306 of the 427 knee ACI procedures reviewed were suitable for inclusion. Factors shown to result in higher postoperative Lysholm scores in the short term were lower patient age, higher baseline Lysholm scores, fewer implanted cells and a lateral femoral defect location. The factor which was associated with higher long-term postoperative Lysholm scores was a milder defect grade. Additionally, the failure rate in this cohort was explored and it was found that 73/306 (24%) of patients experienced joint failure according to our definition. Furthermore, the outcome was not influenced by coincidental procedures in this cohort of patients. CONCLUSIONS This study has identified a number of baseline factors associated with patient-reported outcomes following ACI and shows that treatment of associated pathology at the time of surgery potentially restores patient outcomes to a similar level as those with no associated pathologies. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lauren Tierney
- School of Pharmacy and Bioengineering, Centre for Regenerative Medicine Research, Keele University, Staffordshire, UK
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Jan H Kuiper
- School of Pharmacy and Bioengineering, Centre for Regenerative Medicine Research, Keele University, Staffordshire, UK
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Sally Roberts
- School of Pharmacy and Bioengineering, Centre for Regenerative Medicine Research, Keele University, Staffordshire, UK
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Martyn Snow
- School of Pharmacy and Bioengineering, Centre for Regenerative Medicine Research, Keele University, Staffordshire, UK
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Mike Williams
- School of Pharmacy and Bioengineering, Centre for Regenerative Medicine Research, Keele University, Staffordshire, UK
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Mateus B Harrington
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Paul Harrison
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Pete Gallacher
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Paul Jermin
- School of Pharmacy and Bioengineering, Centre for Regenerative Medicine Research, Keele University, Staffordshire, UK
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Karina T Wright
- School of Pharmacy and Bioengineering, Centre for Regenerative Medicine Research, Keele University, Staffordshire, UK
- Oswestry Keele Orthopaedic Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
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Singh D, Lindsay S, Gurbaxani S, Crawford A, Claeyssens F. Elastomeric Porous Poly(glycerol sebacate) Methacrylate (PGSm) Microspheres as 3D Scaffolds for Chondrocyte Culture and Cartilage Tissue Engineering. Int J Mol Sci 2023; 24:10445. [PMID: 37445620 DOI: 10.3390/ijms241310445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Cartilage defects can be difficult to treat; therefore, tissue engineering of cartilage is emerging as a promising potential therapy. One interesting area of research explores the delivery of cells to the cartilage defect via scaffold-based cell delivery vehicles and microsurgery. This study explores the use of novel poly(glycerol sebacate) methacrylate (PGSm)-polymerised high internal phase emulsion (polyHIPE) microspheres as scaffolds with embedded cells for cartilage tissue engineering. Porous microsphere scaffolds (100 µm-1 mm diameter) were produced from emulsions consisting of water and a methacrylate-based photocurable resin of poly(glycerol sebacate). These resins were used in conjunction with a T-junction fluidic device and an ultraviolet (UV) curing lamp to produce porous microspheres with a tuneable size. This technique produced biodegradable PGSm microspheres with similar mechanical properties to cartilage. We further explore these microspheres as scaffolds for three-dimensional culture of chondrocytes. The microspheres proved to be very efficient scaffolds for primary chondrocyte culture and were covered by a dense extracellular matrix (ECM) network during the culture period, creating a tissue disk. The presence of glycosaminoglycans (GAGs) and collagen-II was confirmed, highlighting the utility of the PGSm microspheres as a delivery vehicle for chondrocytes. A number of imaging techniques were utilised to analyse the tissue disk and develop methodologies to characterise the resultant tissue. This study highlights the utility of porous PGSm microspheres for cartilage tissue engineering.
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Affiliation(s)
- Dharaminder Singh
- Kroto Research Institute, Department of Materials Science and Engineering, The University of Sheffield, Broad Lane, Sheffield S3 7HQ, UK
| | - Sarah Lindsay
- School of Clinical Dentistry, The University of Sheffield, Claremont Crescent, Sheffield S10 2TN, UK
| | - Shruti Gurbaxani
- School of Clinical Dentistry, The University of Sheffield, Claremont Crescent, Sheffield S10 2TN, UK
| | - Aileen Crawford
- School of Clinical Dentistry, The University of Sheffield, Claremont Crescent, Sheffield S10 2TN, UK
| | - Frederik Claeyssens
- Kroto Research Institute, Department of Materials Science and Engineering, The University of Sheffield, Broad Lane, Sheffield S3 7HQ, UK
- Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield S10 2TN, UK
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Al-Maslamani NA, Oldershaw R, Tew S, Curran J, D’Hooghe P, Yamamoto K, Horn HF. Chondrocyte De-Differentiation: Biophysical Cues to Nuclear Alterations. Cells 2022; 11:cells11244011. [PMID: 36552775 PMCID: PMC9777101 DOI: 10.3390/cells11244011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Autologous chondrocyte implantation (ACI) is a cell therapy to repair cartilage defects. In ACI a biopsy is taken from a non-load bearing area of the knee and expanded in-vitro. The expansion process provides the benefit of generating a large number of cells required for implantation; however, during the expansion these cells de-differentiate and lose their chondrocyte phenotype. In this review we focus on examining the de-differentiation phenotype from a mechanobiology and biophysical perspective, highlighting some of the nuclear mechanics and chromatin changes in chondrocytes seen during the expansion process and how this relates to the gene expression profile. We propose that manipulating chondrocyte nuclear architecture and chromatin organization will highlight mechanisms that will help to preserve the chondrocyte phenotype.
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Affiliation(s)
- Noor A. Al-Maslamani
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Correspondence:
| | - Rachel Oldershaw
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Simon Tew
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Jude Curran
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
| | - Pieter D’Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha P.O. Box 29222, Qatar
| | - Kazuhiro Yamamoto
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Henning F. Horn
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha P.O. Box 34110, Qatar
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5
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de Jong WC, Penn TW. Single-Surgery Co-Implantation of Autologous Primary Articular Chondrocytes with Bone Marrow Cells in the Treatment of Articular Cartilage Lesions: Observations from the Operating Room on Tissue Input and Cell Output. Cartilage 2022; 13:32-42. [PMID: 36278377 PMCID: PMC9924989 DOI: 10.1177/19476035221132259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Single-surgery variants of autologous chondrocyte implantation to repair cartilage are emerging, but practical data on such procedures are scarce. We set out to describe a 1-stage autologous chondrocyte co-implantation procedure and include quantitative characteristics of the biopsy tissues collected and of the cells obtained from those tissues in the operating room. DESIGN Data concerning patient age, articular cartilage lesion size and location, as well as measurements of cartilage biopsy mass, bone marrow aspirate volume, and the cell yields harvested from those biopsies were intraoperatively collected for 141 patients. RESULTS The mean patient age was 35.7 ± 9.8 years, and the mean total lesion size was 4.0 ± 3.1 cm2. Cartilage biopsy mass ranged from 0.19 to 2.0 gram and provided a mean yield of 1.23 × 106 chondrocytes/gram. Bone marrow aspirate volume ranged from 7.2 to 62 milliliters and provided a mean yield of 7.18 × 106 mononuclear cells/mL. The cell yields did not correlate with patient age, which ranged from 12 to 57 years. The mean primary chondrocyte supply was 272 thousand per cm2 of lesion, ranging from 10.4 thousand to 1.07 million per cm2. The total cell supply was kept at 9 million cells per cm2 of lesion by adding mononuclear cells to the chondrocytes. The mean tissue processing time was 100 ± 19 minutes, which was frequently used to perform concurrent interventions. CONCLUSION Single-surgery co-implantation of clinically relevant numbers of autologous primary articular chondrocytes and bone marrow cells is feasible for a wide range of ages and lesion sizes.
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Affiliation(s)
- Willem Cornelis de Jong
- Cartilage Repair Systems, LLC, New
York, NY, USA,Willem Cornelis de Jong, c/o Cartilage
Repair Systems B.V., Breullaan 1, 3971 NG Driebergen-Rijsenburg, The
Netherlands.
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Towards Clinical Translation of In Situ Cartilage Engineering Strategies: Optimizing the Critical Facets of a Cell-Laden Hydrogel Therapy. Tissue Eng Regen Med 2022; 20:25-47. [PMID: 36244053 PMCID: PMC9852400 DOI: 10.1007/s13770-022-00487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Articular cartilage repair using implantable photocrosslinkable hydrogels laden with chondrogenic cells, represents a promising in situ cartilage engineering approach for surgical treatment. The development of a surgical procedure requires a minimal viable product optimized for the clinical scenario. In our previous work we demonstrated how gelatin based photocrosslinkable hydrogels in combination with infrapatellar derived stem cells allow the production of neocartilage in vitro. In this study, we aim to optimize the critical facets of the in situ cartilage engineering therapy: the cell source, the cell isolation methodology, the cell expansion protocol, the cell number, and the delivery approach. METHODS We evaluated the impact of the critical facets of the cell-laden hydrogel therapy in vitro to define an optimized protocol that was then used in a rabbit model of cartilage repair. We performed cells counting and immunophenotype analyses, chondrogenic potential evaluation via immunostaining and gene expression, extrusion test analysis of the photocrosslinkable hydrogel, and clinical assessment of cartilage repair using macroscopic and microscopic scores. RESULTS We identified the adipose derived stem cells as the most chondrogenic cells source within the knee joint. We then devised a minimally manipulated stem cell isolation procedure that allows a chondrogenic population to be obtained in only 85 minutes. We found that cell expansion prior to chondrogenesis can be reduced to 5 days after the isolation procedure. We characterized that at least 5 million of cells/ml is needed in the photocrosslinkable hydrogel to successfully trigger the production of neocartilage. The maximum repairable defect was calculated based on the correlation between the number of cells retrievable with the rapid isolation followed by 5-day non-passaged expansion phase, and the minimum chondrogenic concentration in photocrosslinkable hydrogel. We next optimized the delivery parameters of the cell-laden hydrogel therapy. Finally, using the optimized procedure for in situ tissue engineering, we scored superior cartilage repair when compared to the gold standard microfracture approach. CONCLUSION This study demonstrates the possibility to repair a critical size articular cartilage defect by means of a surgical streamlined procedure with optimized conditions.
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Non-destructive, continuous monitoring of biochemical, mechanical, and structural maturation in engineered tissue. Sci Rep 2022; 12:16227. [PMID: 36171228 PMCID: PMC9519952 DOI: 10.1038/s41598-022-18702-x] [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: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 11/08/2022] Open
Abstract
Regulatory guidelines for tissue engineered products require stringent characterization during production and necessitate the development of novel, non-destructive methods to quantify key functional parameters for clinical translation. Traditional assessments of engineered tissues are destructive, expensive, and time consuming. Here, we introduce a non-destructive, inexpensive, and rapid sampling and analysis system that can continuously monitor the mechanical, biochemical, and structural properties of a single sample over extended periods of time. The label-free system combines the imaging modalities of fluorescent lifetime imaging and ultrasound backscatter microscopy through a fiber-based interface for sterile monitoring of tissue quality. We tested the multimodal system using tissue engineered articular cartilage as an experimental model. We identified strong correlations between optical and destructive testing. Combining FLIm and UBM results, we created a novel statistical model of tissue homogeneity that can be applied to tissue engineered constructs prior to implantation. Continuous monitoring of engineered tissues with this non-destructive system has the potential for in-process monitoring of tissue engineered products, reducing costs and improving quality controls in research, manufacturing, and clinical applications.
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Muthuchamy M, Subramanian K, Padhiar C, Dhanraj AK, Desireddy S. Feasibility study on intact human umbilical cord Wharton's jelly as a scaffold for human autologous chondrocyte: In-vitro study. Int J Artif Organs 2022; 45:936-944. [PMID: 35982588 DOI: 10.1177/03913988221118102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Placental tissue is an established biomaterial used in many clinical applications. However, its use for tissue engineering purposes has not been fully realized. Though articular cartilage extracellular matrix (ECM)-derived oriented scaffolds for cartilage tissue engineering were developed, resources are a hindrance to its application. In this regard, the present study investigated the feasibility of using intact decellularized human umbilical cord Wharton's jelly (hUC-WJ) as a new material for chondrocyte carrier in cartilage tissue engineering. The developed hUC-WJ scaffold provides a good microenvironment for the attachment, viability, and delivery of seeded human autologous chondrocytes. It has an advantage over other biomaterials in terms of abundant availability and similar biochemistry to cartilage ECM. MATERIALS AND METHODS hUC-WJ obtained from fresh human placenta were decellularized and gamma sterilized. Human cartilage tissue was obtained from the patients with a total knee replacement. The chondrocytes were isolated and expanded in-vitro and seeded onto the hUC-WJ scaffold. The efficiency of the decellularized tissue as a delivery system for human cartilage cells was investigated by histology, immunohistochemistry, cell count, flow cytometry, and scanning electron microscopy (SEM). RESULTS The results showed that the decellularized hUC-WJ scaffold has supported the microenvironment for chondrocyte attachment and viability without losing its phenotype. In addition, the cells were spread through the hUC-WJ scaffold as confirmed by histology and SEM. CONCLUSION Based on obtained results, the hUC-WJ scaffold has great potential as a 3D scaffold for human autologous chondrocyte carriers in tissue engineering and regenerative medicine applications.
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Affiliation(s)
- Muthuraman Muthuchamy
- Centre for Drug Discovery and Development, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India.,LifeCell International Private Limited, Chennai, Tamil Nadu, India
| | - Kumaran Subramanian
- Centre for Drug Discovery and Development, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India.,Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Chirayu Padhiar
- LifeCell International Private Limited, Chennai, Tamil Nadu, India
| | | | - Swathi Desireddy
- LifeCell International Private Limited, Chennai, Tamil Nadu, India
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9
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Holwein C, Jungmann P, Suchowierski J, Gersing A, Wörtler K, Brucker P, Angele P, Imhoff A, Vogt S. Sandwich Technique for Large Osteochondral Lesions of the Knee. Cartilage 2022; 13:19476035221102571. [PMID: 35906752 PMCID: PMC9340910 DOI: 10.1177/19476035221102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years. DESIGN Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). RESULTS Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up (P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant (P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months (P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months (P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up (P < 0.05) but did not correlate with clinical scores or defect filling. CONCLUSION MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery.
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Affiliation(s)
- C. Holwein
- Orthopädisch-Unfallchirurgisches Zentrum, Alb Fils Kliniken GmbH, Göppingen, Germany,Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,C. Holwein, Rohrbachstraße 11, 73337 Bad Überkingen, Germany.
| | - P.M. Jungmann
- Zentrales Röntgeninstitut Kantonsspital Graubünden, Spital Davos AG, Davos, Switzerland
| | - J. Suchowierski
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - A.S. Gersing
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany,Institut für Neuroradiologie, Klinikum der Universität München, München, Germany
| | - K. Wörtler
- Institut für diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - P.U. Brucker
- MVZ ATOS Klinik München, München, Germany,Orthopädie in der Ottostraße, München, Germany
| | - P. Angele
- Klinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany,Sporthopaedicum Regensburg, Regensburg, Germany
| | - A.B. Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - S. Vogt
- Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung, Augsburg, Germany
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Effects of Growth Factor Combinations TGFβ3, GDF5 and GDF6 on the Matrix Synthesis of Nucleus Pulposus and Nasoseptal Chondrocyte Self-Assembled Microtissues. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There has been significant interest in identifying alternative cell sources and growth factor stimulation to improve matrix synthesis for disc repair. Recent work has identified nasoseptal chondrocytes (NC) as a possible alternative cell source with significant matrix-forming abilities. While various growth factors such as members of the TGFβ superfamily have been explored to enhance matrix formation, no consensus exists as to the optimum growth factor needed to induce cells towards a discogenic phenotype. This study assessed both nucleus pulposus (NP) and NC microtissues of different densities (1000, 2500 or 5000 cells/microtissue) stimulated by individual or combinations of the growth factors TGFβ3, GDF5, and GDF6. Lower cell densities result in increased sGAG/DNA and collagen/DNA levels due to higher nutrient availability levels. Our findings suggest that growth factors exert differential effects on matrix synthesis depending on the cell type. NP cells were found to be relatively insensitive to the different growth factor types examined in isolation or in combination. Overall, NCs exhibited a higher propensity to form extracellular matrix compared to NP cells. In addition, stimulating NC-microtissues with GDF5 or TGFβ3 alone induced enhanced matrix formation and may be an appropriate growth factor to stimulate this cell type for disc regeneration.
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Levingstone TJ, Moran C, Almeida HV, Kelly DJ, O'Brien FJ. Layer-specific stem cell differentiation in tri-layered tissue engineering biomaterials: Towards development of a single-stage cell-based approach for osteochondral defect repair. Mater Today Bio 2021; 12:100173. [PMID: 34901823 PMCID: PMC8640516 DOI: 10.1016/j.mtbio.2021.100173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 12/26/2022] Open
Abstract
Successful repair of osteochondral defects is challenging, due in part to their complex gradient nature. Tissue engineering approaches have shown promise with the development of layered scaffolds that aim to promote cartilage and bone regeneration within the defect. The clinical potential of implanting these scaffolds cell-free has been demonstrated, whereby cells from the host bone marrow MSCs infiltrate the scaffolds and promote cartilage and bone regeneration within the required regions of the defect. However, seeding the cartilage layer of the scaffold with a chondrogenic cell population prior to implantation may enhance cartilage tissue regeneration, thus enabling the treatment of larger defects. Here the development of a cell seeding approach capable of enhancing articular cartilage repair without the requirement for in vitro expansion of the cell population is explored. The intrinsic ability of a tri-layered scaffold previously developed in our group to direct stem cell differentiation in each layer of the scaffold was first demonstrated. Following this, the optimal chondrogenic cell seeding approach capable of enhancing the regenerative capacity of the tri-layered scaffold was demonstrated with the highest levels of chondrogenesis achieved with a co-culture of rapidly isolated infrapatellar fat pad MSCs (FPMSCs) and chondrocytes (CCs). The addition of FPMSCs to a relatively small number of CCs led to a 7.8-fold increase in the sGAG production over chondrocytes in mono-culture. This cell seeding approach has the potential to be delivered within a single-stage approach, without the requirement for costly in vitro expansion of harvested cells, to achieve rapid repair of osteochondral defects. Tri-layered scaffold capable of directing layer specific stem cell differentiation. Potential of cell seeding regimes to enhance chondrogenic repair explored. Optimal cell seeding regime was an infrapatellar fat pad MSC:chondrocyte coculture. Adding infrapatellar fat pad MSCs to chondrocytes led to >7-fold increase in sGAG. This cell-seeded scaffold has potential for rapid repair of osteochondral defects.
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Affiliation(s)
- Tanya J. Levingstone
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin, 2, Ireland
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin, 9, Ireland
- Centre for Medical Engineering Research (MEDeng), Dublin City University, Dublin, 9, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, Dublin, 9, Ireland
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, 2, Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Ireland
| | - Conor Moran
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin, 2, Ireland
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, 2, Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Ireland
| | - Henrique V. Almeida
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, 2, Ireland
- iBET, Instituto de Biologia Experimental e Tecnológica, 2781-901, Oeiras, Portugal
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157, Oeiras, Portugal
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, 2, Ireland
| | - Daniel J. Kelly
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin, 9, Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, 2, Ireland
| | - Fergal J. O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin, 2, Ireland
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, 2, Ireland
- Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Ireland
- Corresponding author. Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin, 2, Ireland.
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12
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Dudman J, Ferreira AM, Gentile P, Wang X, Dalgarno K. Microvalve Bioprinting of MSC-Chondrocyte Co-Cultures. Cells 2021; 10:cells10123329. [PMID: 34943837 PMCID: PMC8699323 DOI: 10.3390/cells10123329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/28/2021] [Accepted: 11/23/2021] [Indexed: 12/05/2022] Open
Abstract
Recent improvements within the fields of high-throughput screening and 3D tissue culture have provided the possibility of developing in vitro micro-tissue models that can be used to study diseases and screen potential new therapies. This paper reports a proof-of-concept study on the use of microvalve-based bioprinting to create laminar MSC-chondrocyte co-cultures to investigate whether the use of MSCs in ACI procedures would stimulate enhanced ECM production by chondrocytes. Microvalve-based bioprinting uses small-scale solenoid valves (microvalves) to deposit cells suspended in media in a consistent and repeatable manner. In this case, MSCs and chondrocytes have been sequentially printed into an insert-based transwell system in order to create a laminar co-culture, with variations in the ratios of the cell types used to investigate the potential for MSCs to stimulate ECM production. Histological and indirect immunofluorescence staining revealed the formation of dense tissue structures within the chondrocyte and MSC-chondrocyte cell co-cultures, alongside the establishment of a proliferative region at the base of the tissue. No stimulatory or inhibitory effect in terms of ECM production was observed through the introduction of MSCs, although the potential for an immunomodulatory benefit remains. This study, therefore, provides a novel method to enable the scalable production of therapeutically relevant micro-tissue models that can be used for in vitro research to optimise ACI procedures.
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Affiliation(s)
- Joseph Dudman
- School of Engineering, Newcastle University, Newcastle upon Tyne NE3 1PS, UK; (J.D.); (A.M.F.); (P.G.)
| | - Ana Marina Ferreira
- School of Engineering, Newcastle University, Newcastle upon Tyne NE3 1PS, UK; (J.D.); (A.M.F.); (P.G.)
| | - Piergiorgio Gentile
- School of Engineering, Newcastle University, Newcastle upon Tyne NE3 1PS, UK; (J.D.); (A.M.F.); (P.G.)
| | - Xiao Wang
- Translational and Clinical Research Institute, Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - Kenneth Dalgarno
- School of Engineering, Newcastle University, Newcastle upon Tyne NE3 1PS, UK; (J.D.); (A.M.F.); (P.G.)
- Correspondence:
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Atelocollagen-Embedded Chondrocyte Precursors as a Treatment for Grade-4 Cartilage Defects of the Femoral Condyle: A Case Series with up to 9-Year Follow-Up. Biomolecules 2021; 11:biom11070942. [PMID: 34202002 PMCID: PMC8301975 DOI: 10.3390/biom11070942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 12/22/2022] Open
Abstract
We demonstrated the safety and efficacy of autologous chondrocyte precursor (CP) cell therapy in repairing Grade 4 cartilage defects of medial femoral condyles. The autologous bone marrow mesenchymal stem cells of each participant were isolated, amplified, and then differentiated into CPs in atelocollagen. Neotissues made of CPs were implanted into cartilage defects with an average cell density of 4.9 ± 2.1 × 106 cells/cm2 through arthrotomy. The knee function was evaluated with the International Knee Documentation Committee (IKDC) subjective knee form. Patients' knee functions significantly improved by the 28th week (IKDC score = 68.3 ± 12.1), relative to the initial functionality before the CP therapy (IKDC score = 46.1 ± 16.4, p-value = 0.0014). Nine of these twelve patients maintained good knee functions for 9 years post-implantation (IKDC score = 69.8 ± 12.3) at levels higher than the pre-implantation values (p-value = 0.0018). Patients were evaluated with MRI and arthroscopy, and the defective sites exhibited a smooth surface without a gap between the implant and host tissue. This study demonstrates that autologous CPs successfully engraft into the host tissue and result in the re-formation of hyaline-like cartilage, thereby improving the impaired knee functions. Most importantly, no adverse event was reported during this long-term follow-up period.
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Katoh S, Yoshioka H, Senthilkumar R, Preethy S, Abraham SJK. Enhanced miRNA-140 expression of osteoarthritis-affected human chondrocytes cultured in a polymer based three-dimensional (3D) matrix. Life Sci 2021; 278:119553. [PMID: 33932445 DOI: 10.1016/j.lfs.2021.119553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/20/2021] [Accepted: 04/21/2021] [Indexed: 01/05/2023]
Abstract
AIMS We have evaluated the potential of a three-dimensional (3D) thermoreversible gelation polymer (TGP) matrix in enhancing miRNA 140 expression (a biomarker correlating with homeostasis and cartilage regeneration) during the in vitro expansion of osteoarthritis (OA)-affected human chondrocytes. MATERIALS AND METHODS OA-chondrocytes were cultured in two-dimensional (2D) monolayer followed by culture in 3D-TGP. miRNA 140 expression levels in cell culture supernatant followed by expression in the cell lysate of both 2D and 3D-TGP cultures were analyzed. KEY FINDINGS The expression of miRNA 140 in cell culture supernatant from the 3D-TGP group was 0.001 to 0.002% that in 2D culture supernatant while in the cell lysate, miRNA 140 expression in the 3D-TGP was nearly 30-fold higher than that of 2D group. SIGNIFICANCE The 3D-TGP matrix allows enhanced expression of miRNA 140 in OA-affected human chondrocytes in vitro which after necessary validations can be applied in clinical transplantation to significantly improve the outcome.
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Affiliation(s)
- Shojiro Katoh
- Edogawa Evolutionary Lab of Science, Edogawa Hospital Campus, 2-24-18, Higashi Koiwa, Edogawa, Tokyo 133-0052, Japan; Department of Orthopaedic Surgery, Edogawa Hospital, 2-24-18, Higashi Koiwa, Edogawa, Tokyo 133-0052, Japan
| | - Hiroshi Yoshioka
- Mebiol Inc., 1-25-8, Nakahara, Hiratsuka 254-0075, Kanagawa, Japan
| | - Rajappa Senthilkumar
- The Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai 600034, Tamil Nadu, India
| | - Senthilkumar Preethy
- The Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai 600034, Tamil Nadu, India
| | - Samuel J K Abraham
- The Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai 600034, Tamil Nadu, India; JBM Inc., 3-1-14, Higashi Koiwa, Edogawa, Tokyo 133-0052, Japan; University of Yamanashi -Faculty of Medicine, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan; GN Corporation Co. Ltd., 3-8, Wakamatsu, Kofu, Yamanashi 400-0866, Japan.
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15
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Jung M, Karampinos DC, Holwein C, Suchowierski J, Diallo TD, Gersing AS, Bamberg F, Baumann FA, Ruschke S, Jungmann PM. Quantitative 3-T Magnetic Resonance Imaging After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting of the Knee: The Importance of Subchondral Bone Parameters. Am J Sports Med 2021; 49:476-486. [PMID: 33427489 DOI: 10.1177/0363546520980134] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) is an effective surgical treatment for osteochondral defects. Quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as noninvasive biomarkers to assess the biochemical composition of cartilage repair tissue. PURPOSE To evaluate the association of quantitative MRI parameters of cartilage repair tissue and subchondral bone marrow with magnetic resonance morphologic and clinical outcomes after MACI with ABG of the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Qualitative and quantitative 3 T MRI of the knee was performed in 21 patients (16 male) at 2.5 years after MACI with ABG at the medial (18/21) or lateral (3/21) femoral condyle for the treatment of osteochondral defects. Morphologic MRI sequences were assessed using MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. T2 relaxation time measurements for the assessment of cartilage repair tissue (CRT2) were obtained. Single-voxel magnetic resonance spectroscopy was performed in underlying subchondral bone marrow (BM) and at both central femoral condyles. The presence of pain and Tegner scores were noted. Statistical analyses included Student t tests, correlation analyses, and multivariate regression models. RESULTS The mean defect size was 4.9 ± 1.9 cm2. At a follow-up of 2.5 ± 0.3 years, 9 of 21 patients were asymptomatic. Perfect defect filling was achieved in 66.7% (14/21) of patients. MOCART 2.0 scores (74.1 ± 18.4) did not indicate pain (68.3 ± 19.0 [pain] vs 81.7 ± 15.4 [no pain]; P = .102). However, knee pain was present in 85.7% (6/7) of patients with deep bony defects (odds ratio, 8.0; P = .078). Relative CRT2 was higher in hypertrophic cartilage repair tissue than in repair tissue with normal filling (1.54 ± 0.42 vs 1.13 ± 0.21, respectively; P = .022). The underlying BM edema-like lesion (BMEL) volume was larger in patients with underfilling compared with patients with perfect defect filling (1.87 ± 1.32 vs 0.31 ± 0.51 cm3, respectively; P = .002). Patients with severe pain showed a higher BMEL volume (1.2 ± 1.3 vs 0.2 ± 0.4 cm3, respectively; P = .046) and had a higher BM water fraction (26.0% ± 12.3% vs 8.6% ± 8.1%, respectively; P = .026) than did patients without pain. CONCLUSION Qualitative and quantitative MRI parameters including the presence of subchondral defects, CRT2, BMEL volume, and BM water fraction were correlated with cartilage repair tissue quality and clinical symptoms. Therefore, the integrity of subchondral bone was associated with outcomes after osteochondral transplantation.
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Affiliation(s)
- Matthias Jung
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Joachim Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Frederic A Baumann
- Department of Clinical and Interventional Angiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Ruschke
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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16
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Gersing AS, Holwein C, Suchowierski J, Feuerriegel G, Gassert FT, Baum T, Karampinos DC, Schwaiger BJ, Makowski MR, Burgkart R, Woertler K, Imhoff AB, Jungmann PM. Cartilage T 2 Relaxation Times and Subchondral Trabecular Bone Parameters Predict Morphological Outcome After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting. Am J Sports Med 2020; 48:3573-3585. [PMID: 33200942 DOI: 10.1177/0363546520965987] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quantitative magnetic resonance (MR) imaging techniques are established for evaluation of cartilage composition and trabecular bone microstructure at the knee. It remains unclear whether quantitative MR parameters predict the midterm morphological outcome after matrix-associated chondrocyte implantation (MACI) with autologous bone grafting (ABG). PURPOSE To assess longitudinal changes and associations of the biochemical composition of cartilage repair tissue, the subchondral bone architecture, and morphological knee joint abnormalities on 3-T MR imaging after MACI with ABG at the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Knees of 18 patients (28.7 ± 8.4 years [mean ± SD]; 5 women) were examined preoperatively and 3, 6, 12, and 24 months after MACI and ABG using 3-T MR imaging. Cartilage composition was assessed using T2 relaxation time measurements. Subchondral bone microstructure was quantified using a 3-dimensional phase-cycled balanced steady-state free precision sequence. Trabecular bone parameters were calculated using a dual threshold algorithm (apparent bone fraction, apparent trabecular number, and apparent trabecular separation). Morphological abnormalities were assessed using the MOCART (magnetic resonace observation of cartilage repair tissue) score, the WORMS (Whole-Organ Magnetic Resonance Imaging Score), and the CROAKS (Cartilage Repair Osteoarthritis Knee Score). Clinical symptoms were assessed using the Tegner activity and Lysholm knee scores. Statistical analyses were performed by using multiple linear regression analysis. RESULTS Total WORMS (P = .02) and MOCART (P = .001) scores significantly improved over 24 months after MACI. Clinical symptoms were significantly associated with the presence of bone marrow edema pattern abnormalities 24 months after surgery (P = .035). Overall there was a good to excellent radiological outcome found after 24 months (MOCART score, 88.8 ± 10.1). Cartilage repair T2 values significantly decreased between 12 and 24 months after MACI (P = .009). Lower global T2 values after 3 months were significantly associated with better MOCART scores after 24 months (P = .04). Moreover, trabecular bone parameters after 3 months were significantly associated with the total WORMS after 24 months (apparent bone fraction, P = .048; apparent trabecular number, P = .013; apparent trabecular separation, P = .013). CONCLUSION After MACI with ABG, early postoperative quantitative assessment of biochemical composition of cartilage and microstructure of subchondral bone may predict the outcome after 24 months. The perioperative global joint cartilage matrix quality is essential for proper proliferation of the repair tissue, reflected by MOCART scores. The subchondral bone quality of the ABG site is essential for proper maturation of the cartilage repair tissue, reflected by cartilage T2 values.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Neuroradiology, University Hospital of Munich (LMU), Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | - Joachim Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M Jungmann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Korpershoek JV, Vonk LA, Kester EC, Creemers LB, de Windt TS, Kip MMA, Saris DBF, Custers RJH. Efficacy of one-stage cartilage repair using allogeneic mesenchymal stromal cells and autologous chondron transplantation (IMPACT) compared to nonsurgical treatment for focal articular cartilage lesions of the knee: study protocol for a crossover randomized controlled trial. Trials 2020; 21:842. [PMID: 33036661 PMCID: PMC7547426 DOI: 10.1186/s13063-020-04771-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Articular cartilage defects in the knee have poor intrinsic healing capacity and may lead to functional disability and osteoarthritis (OA). "Instant MSC Product accompanying Autologous Chondron Transplantation" (IMPACT) combines rapidly isolated recycled autologous chondrons with allogeneic MSCs in a one-stage surgery. IMPACT was successfully executed in a first-in-man investigator-driven phase I/II clinical trial in 35 patients. The purpose of this study is to compare the efficacy of IMPACT to nonsurgical treatment for the treatment of large (2-8 cm2) articular cartilage defects in the knee. METHODS Sixty patients will be randomized to receive nonsurgical care or IMPACT. After 9 months of nonsurgical care, patients in the control group are allowed to receive IMPACT surgery. The Knee Injury and Osteoarthritis Outcome Score (KOOS), pain (numeric rating scale, NRS), and EuroQol five dimensions five levels (EQ5D-5 L) will be used to compare outcomes at baseline and 3, 6, 9, 12, and 18 months after inclusion. Cartilage formation will be assessed at baseline, and 6 and 18 months after inclusion using MRI. An independent rheumatologist will monitor the onset of a potential inflammatory response. (Severe) adverse events will be recorded. Lastly, the difference between IMPACT and nonsurgical care in terms of societal costs will be assessed by monitoring healthcare resource use and productivity losses during the study period. A health economic model will be developed to estimate the incremental cost-effectiveness ratio of IMPACT vs. nonsurgical treatment in terms of costs per quality adjusted life year over a 5-year time horizon. DISCUSSION This study is designed to evaluate the efficacy of IMPACT compared to nonsurgical care. Additionally, safety of IMPACT will be assessed in 30 to 60 patients. Lastly, this study will evaluate the cost-effectiveness of IMPACT compared to nonsurgical care. TRIAL REGISTRATION NL67161.000.18 [Registry ID: CCMO] 2018#003470#27 [EU-CTR; registered on 26 March 2019] NCT04236739 [ ClinicalTrials.gov ] [registered after start of inclusion; 22 January 2020].
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Affiliation(s)
- J. V. Korpershoek
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - L. A. Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
- Present Address: CO.DON AG, Warthestraße 21, D-14513 Teltow, Germany
| | - E. C. Kester
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - L. B. Creemers
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - T. S. de Windt
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - M. M. A. Kip
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Technohal, Hallenweg 5, 7522 NH Enschede, The Netherlands
| | - D. B. F. Saris
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - R. J. H. Custers
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
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Childs PG, Reid S, Salmeron-Sanchez M, Dalby MJ. Hurdles to uptake of mesenchymal stem cells and their progenitors in therapeutic products. Biochem J 2020; 477:3349-3366. [PMID: 32941644 PMCID: PMC7505558 DOI: 10.1042/bcj20190382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/15/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
Twenty-five years have passed since the first clinical trial utilising mesenchymal stomal/stem cells (MSCs) in 1995. In this time academic research has grown our understanding of MSC biochemistry and our ability to manipulate these cells in vitro using chemical, biomaterial, and mechanical methods. Research has been emboldened by the promise that MSCs can treat illness and repair damaged tissues through their capacity for immunomodulation and differentiation. Since 1995, 31 therapeutic products containing MSCs and/or progenitors have reached the market with the level of in vitro manipulation varying significantly. In this review, we summarise existing therapeutic products containing MSCs or mesenchymal progenitor cells and examine the challenges faced when developing new therapeutic products. Successful progression to clinical trial, and ultimately market, requires a thorough understanding of these hurdles at the earliest stages of in vitro pre-clinical development. It is beneficial to understand the health economic benefit for a new product and the reimbursement potential within various healthcare systems. Pre-clinical studies should be selected to demonstrate efficacy and safety for the specific clinical indication in humans, to avoid duplication of effort and minimise animal usage. Early consideration should also be given to manufacturing: how cell manipulation methods will integrate into highly controlled workflows and how they will be scaled up to produce clinically relevant quantities of cells. Finally, we summarise the main regulatory pathways for these clinical products, which can help shape early therapeutic design and testing.
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Affiliation(s)
- Peter G. Childs
- Centre for the Cellular Microenvironment, Division of Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Glasgow, Glasgow G12 8QQ, U.K
- Centre for the Cellular Microenvironment, SUPA Department of Biomedical Engineering, University of Strathclyde, Glasgow G1 1QE, U.K
| | - Stuart Reid
- Centre for the Cellular Microenvironment, SUPA Department of Biomedical Engineering, University of Strathclyde, Glasgow G1 1QE, U.K
| | - Manuel Salmeron-Sanchez
- Centre for the Cellular Microenvironment, Division of Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Glasgow, Glasgow G12 8QQ, U.K
| | - Matthew J. Dalby
- Centre for the Cellular Microenvironment, Institute for Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, U.K
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19
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Kisiday JD, Liebig BE, Goodrich LR. Adult ovine chondrocytes in expansion culture adopt progenitor cell properties that are favorable for cartilage tissue engineering. J Orthop Res 2020; 38:1996-2005. [PMID: 32222117 PMCID: PMC8442064 DOI: 10.1002/jor.24671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/18/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Human chondrocytes in expansion culture can become progenitor-like in their ability to proliferate extensively and secrete neocartilage in chondrogenic culture. Sheep are used as a large animal model for cartilage tissue engineering, although for testing progenitor-like chondrocytes it is important that ovine chondrocytes resemble human in the ability to adopt progenitor properties. Here, we investigate whether ovine chondrocytes can adopt progenitor properties as indicated by rapid proliferation in a colony-forming fashion, and high levels of neocartilage secretion in chondrogenic culture. In conditions known to promote expansion of mesenchymal stromal cells, ovine chondrocytes proliferated through approximately 12 population doublings in 10 days. Time-lapse imaging indicated rapid proliferation in a colony-forming pattern. Expanded ovine chondrocytes that were seeded into agarose and cultured in chondrogenic medium accumulated neocartilage over 2 weeks, to a greater extent than primary chondrocytes. These data confirm that ovine chondrocytes resemble human chondrocytes in their ability to acquire progenitor properties that are important for cartilage tissue engineering. Given the broad interest in using progenitor cells to heal connective tissues, next we compared proliferation and trilineage differentiation of ovine chondrocytes, meniscus cells, and tenocytes. Meniscus cells and tenocytes experienced more than 13 population doublings in 10 days. In chondrogenic culture, cartilage matrix accumulation, and gene expression were largely similar among the cell types. All cell types resisted osteogenesis, while expanded tenocytes and meniscal cells were capable of adipogenesis. While ovine connective tissue cells demonstrated limited lineage plasticity, these data support the potential to promote certain progenitor properties with expansion.
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Affiliation(s)
- John D. Kisiday
- Department of Clinical Sciences, Orthopaedic Reserch CenterC. Wayne McIlwraith Translational Medicine Institute Fort Collins Colorado
| | - Bethany E. Liebig
- Department of Clinical Sciences, Orthopaedic Reserch CenterC. Wayne McIlwraith Translational Medicine Institute Fort Collins Colorado
| | - Laurie R. Goodrich
- Department of Clinical Sciences, Orthopaedic Reserch CenterC. Wayne McIlwraith Translational Medicine Institute Fort Collins Colorado
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20
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Learmonth DA, Costa PM, Veloso TR, Cunha CB, Cautela MP, Correia C, Vallejo MC, Sousa RA. Synthesis and biological evaluation of a bioinspired, tissue-adhesive gellan gum-based hydrogel designed for minimally invasive delivery and retention of chondrogenic cells. Biomater Sci 2020; 8:3697-3711. [PMID: 32483582 DOI: 10.1039/d0bm00286k] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A dopamine-modified, bioinspired gellan gum hydrogel (STM-148B) with improved physicochemical and biological characteristics, suitable for minimally invasive cell delivery and retention in the context of cartilage repair, is herein presented. STM-148B's putative game-changing design characteristics include a highly biocompatible, animal-free and chemically defined composition, reproducibility of manufacture and ease of formulation. STM-148B undergoes rapid ionic crossinking by physiologically relevant mono and divalent cations to form stable 3D hydrogels that possess excellent tissue adhesiveness, such that additional fixation aids are rendered superfluous. STM-148B hydrogels maintain viability of mammalian cells and further promote up-regulation of the expression of healthy chondrogenic extracellular matrix markers upon stimulation. STM-148B is currently undergoing pre-clinical safety and efficacy assessment as a medical device for cell delivery and retention focussing on regeneration of hyaline-like cartilage and may represent a valuable addition to the armamentarium of tissue-engineering therapies for treatment of focal cartilage lesions.
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Affiliation(s)
- David A Learmonth
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Parque de Ciência e Tecnologia Avepark, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.
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21
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Morgan BJ, Bauza-Mayol G, Gardner OFW, Zhang Y, Levato R, Archer CW, van Weeren R, Malda J, Conlan RS, Francis LW, Khan IM. Bone Morphogenetic Protein-9 Is a Potent Chondrogenic and Morphogenic Factor for Articular Cartilage Chondroprogenitors. Stem Cells Dev 2020; 29:882-894. [PMID: 32364057 PMCID: PMC7374587 DOI: 10.1089/scd.2019.0209] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Articular cartilage contains a subpopulation of tissue-specific progenitors that are an ideal cell type for cell therapies and generating neocartilage for tissue engineering applications. However, it is unclear whether the standard chondrogenic medium using transforming growth factor beta (TGFβ) isoforms is optimal to differentiate these cells. We therefore used pellet culture to screen progenitors from immature bovine articular cartilage with a number of chondrogenic factors and discovered that bone morphogenetic protein-9 (BMP9) precociously induces their differentiation. This difference was apparent with toluidine blue staining and confirmed by biochemical and transcriptional analyses with BMP9-treated progenitors exhibiting 11-fold and 5-fold greater aggrecan and collagen type II (COL2A1) gene expression than TGFβ1-treated progenitors. Quantitative gene expression analysis over 14 days highlighted the rapid and phased nature of BMP9-induced chondrogenesis with sequential activation of aggrecan then collagen type II, and negligible collagen type X gene expression. The extracellular matrix of TGFβ1-treated progenitors analyzed using atomic force microscopy was fibrillar and stiff whist BMP9-induced matrix of cells more compliant and correspondingly less fibrillar. Polarized light microscopy revealed an annular pattern of collagen fibril deposition typified by TGFβ1-treated pellets, whereas BMP9-treated pellets displayed a birefringence pattern that was more anisotropic. Remarkably, differentiated immature chondrocytes incubated as high-density cultures in vitro with BMP9 generated a pronounced anisotropic organization of collagen fibrils indistinguishable from mature adult articular cartilage, with cells in deeper zones arranged in columnar manner. This contrasted with cells grown with TGFβ1, where a concentric pattern of collagen fibrils was visualized within tissue pellets. In summary, BMP9 is a potent chondrogenic factor for articular cartilage progenitors and is also capable of inducing morphogenesis of adult-like cartilage, a highly desirable attribute for in vitro tissue-engineered cartilage.
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Affiliation(s)
- Ben J Morgan
- Centre of Nanohealth, Swansea University Medical School, Swansea, United Kingdom
| | | | - Oliver F W Gardner
- Centre of Nanohealth, Swansea University Medical School, Swansea, United Kingdom.,Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Yadan Zhang
- Centre of Nanohealth, Swansea University Medical School, Swansea, United Kingdom
| | - Riccardo Levato
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Charles W Archer
- Centre of Nanohealth, Swansea University Medical School, Swansea, United Kingdom
| | - Rene van Weeren
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Jos Malda
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Robert Steven Conlan
- Centre of Nanohealth, Swansea University Medical School, Swansea, United Kingdom
| | - Lewis W Francis
- Centre of Nanohealth, Swansea University Medical School, Swansea, United Kingdom
| | - Ilyas M Khan
- Centre of Nanohealth, Swansea University Medical School, Swansea, United Kingdom
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22
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De Moor L, Fernandez S, Vercruysse C, Tytgat L, Asadian M, De Geyter N, Van Vlierberghe S, Dubruel P, Declercq H. Hybrid Bioprinting of Chondrogenically Induced Human Mesenchymal Stem Cell Spheroids. Front Bioeng Biotechnol 2020; 8:484. [PMID: 32523941 PMCID: PMC7261943 DOI: 10.3389/fbioe.2020.00484] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023] Open
Abstract
To date, the treatment of articular cartilage lesions remains challenging. A promising strategy for the development of new regenerative therapies is hybrid bioprinting, combining the principles of developmental biology, biomaterial science, and 3D bioprinting. In this approach, scaffold-free cartilage microtissues with small diameters are used as building blocks, combined with a photo-crosslinkable hydrogel and subsequently bioprinted. Spheroids of human bone marrow-derived mesenchymal stem cells (hBM-MSC) are created using a high-throughput microwell system and chondrogenic differentiation is induced during 42 days by applying chondrogenic culture medium and low oxygen tension (5%). Stable and homogeneous cartilage spheroids with a mean diameter of 116 ± 2.80 μm, which is compatible with bioprinting, were created after 14 days of culture and a glycosaminoglycans (GAG)- and collagen II-positive extracellular matrix (ECM) was observed. Spheroids were able to assemble at random into a macrotissue, driven by developmental biology tissue fusion processes, and after 72 h of culture, a compact macrotissue was formed. In a directed assembly approach, spheroids were assembled with high spatial control using the bio-ink based extrusion bioprinting approach. Therefore, 14-day spheroids were combined with a photo-crosslinkable methacrylamide-modified gelatin (gelMA) as viscous printing medium to ensure shape fidelity of the printed construct. The photo-initiators Irgacure 2959 and Li-TPO-L were evaluated by assessing their effect on bio-ink properties and the chondrogenic phenotype. The encapsulation in gelMA resulted in further chondrogenic maturation observed by an increased production of GAG and a reduction of collagen I. Moreover, the use of Li-TPO-L lead to constructs with lower stiffness which induced a decrease of collagen I and an increase in GAG and collagen II production. After 3D bioprinting, spheroids remained viable and the cartilage phenotype was maintained. Our findings demonstrate that hBM-MSC spheroids are able to differentiate into cartilage microtissues and display a geometry compatible with 3D bioprinting. Furthermore, for hybrid bioprinting of these spheroids, gelMA is a promising material as it exhibits favorable properties in terms of printability and it supports the viability and chondrogenic phenotype of hBM-MSC microtissues. Moreover, it was shown that a lower hydrogel stiffness enhances further chondrogenic maturation after bioprinting.
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Affiliation(s)
- Lise De Moor
- Tissue Engineering Group, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sélina Fernandez
- Tissue Engineering Group, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Chris Vercruysse
- Tissue Engineering Group, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Liesbeth Tytgat
- Polymer Chemistry and Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Faculty of Sciences, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Mahtab Asadian
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Nathalie De Geyter
- Research Unit Plasma Technology, Department of Applied Physics, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry and Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Faculty of Sciences, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Peter Dubruel
- Polymer Chemistry and Biomaterials Research Group, Department of Organic and Macromolecular Chemistry, Faculty of Sciences, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Heidi Declercq
- Tissue Engineering Group, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Tissue Engineering Lab, Department of Development and Regeneration, Faculty of Medicine, KU Leuven Kulak, Kortrijk, Belgium
- *Correspondence: Heidi Declercq, ;
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23
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Safety and efficacy of matrix-associated autologous chondrocyte implantation with spheroid technology is independent of spheroid dose after 4 years. Knee Surg Sports Traumatol Arthrosc 2020; 28:1130-1143. [PMID: 31897548 DOI: 10.1007/s00167-019-05786-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 11/04/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of product dose in autologous chondrocyte implantation (ACI) for the treatment of full-thickness cartilage defects of the knee and to assess its influence on clinical and morphological mid-term outcome. METHODS Seventy-five patients were included in this single-blind, randomised, prospective, controlled clinical trial. Patients were assigned randomly to three different dose groups [low (3-7 spheroids/cm2), medium (10-30 spheroids/cm2), or high (40-70 spheroids/cm2)] and assessed using standardised clinical and morphological scoring systems (KOOS, IKDC, MOCART) for 4 years following the intervention. RESULTS The analysis population comprised 75 patients (22 women, 53 men) aged 34 ± 9 years. Defect sizes ranged from 2 to 10 cm2 following intraoperative debridement. The assessment of the primary variable 'overall KOOS' showed a statistically significant improvement, compared with baseline, for each dose group, i.e., at baseline the mean 'overall KOOS' scores were 60.4 ± 13.6, 59.6 ± 15.4, and 51.1 ± 15.4 for the low-, medium-, and high-dose groups, respectively, and 57.0 ± 15.2 for 'all patients'. After 48 months those values improved to 80.0 ± 14.7, 84.0 ± 14.9, and 66.9 ± 21.5 in the respective dose groups and 77.1 ± 18.6 for 'all patients'. Pairwise comparisons of these dose groups did not reveal any statistically significant differences. Likewise, assessment of the subjective IKDC score revealed no statistically significant differences between the three dose groups up to the 48-month visit. However, between 12 and 48 months there was a low, but steady, improvement in the low-dose group and a substantial amelioration in the medium-dose group. The mean MOCART total scores 3 months after treatment were 59.8 ± 10.9, 64.5 ± 10.3, and 64.7 ± 9.4 for the low-, medium-, and high-dose groups, and 62.9 ± 10.3 for 'all patients'; 48 months after treatment these were 73.9 ± 13.1, 78.0 ± 12.4, and 74.3 ± 14.0 for the respective dose groups and 75.5 ± 13.1 for 'all patients'. CONCLUSIONS Results of this study confirm the efficacy and safety of the applied "advanced therapy medicinal product"; no dose dependence was found either for the incidence or for the severity of any adverse reactions. All doses applied in the present study led to significant clinical improvement over time and can therefore be regarded as effective doses. The influence of product doses in the range investigated seems to be low and can be neglected. Thus, the authorised dose range of 10-70 spheroids/cm2 confirmed by this clinical trial offers a broad therapeutic window for the surgeon applying the product, thereby reducing the risk of over- or underdosing. LEVEL OF EVIDENCE I.
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24
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Nachtsheim J, Dursun G, Markert B, Stoffel M. Chondrocyte colonisation of a tissue-engineered cartilage substitute under a mechanical stimulus. Med Eng Phys 2019; 74:58-64. [PMID: 31611181 DOI: 10.1016/j.medengphy.2019.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/30/2019] [Accepted: 09/29/2019] [Indexed: 12/13/2022]
Abstract
Cell-free collagen scaffolds as cartilage substitute for small focal defects show promising results in first clinical studies. However, chondrocyte migration between scaffolds and the colonisation process of a cell-free implant is yet to be fully understood. We here focus on mechanobiological interdependencies between cell migration and mechanical stimulus in a 3D environment. We develop an in vitro model composed of a human chondrocyte-seeded collagen base and adjacent cell-free collagen type I scaffolds of varying collagen concentrations. Constructs are either cultured statically or dynamically under the influence of a physiological compression (0.5Hz, 0.5% initial strain). After 20 days we identify vital chondrocytes inside all collagen implants, proving that chondrocytes migrated from the underlying scaffold into the implants. Chondrocytes have not colonised the entire sample and are predominantly found in the bottom of the implant. In static culture conditions, a nearly equal cell number is found inside of all collagen scaffolds. In dynamic culture, the total amount of cells is increased by 30% to 320%, with the highest population in a commercial implant. Differences in cell population between the materials in dynamic culturing can be referred to differences in mechanical properties of the scaffolds, such as strain-rate insensitivity fostering the colonisation process.
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Affiliation(s)
- Julia Nachtsheim
- Institute of General Mechanics, RWTH Aachen University, Germany.
| | - Gözde Dursun
- Institute of General Mechanics, RWTH Aachen University, Germany
| | - Bernd Markert
- Institute of General Mechanics, RWTH Aachen University, Germany
| | - Marcus Stoffel
- Institute of General Mechanics, RWTH Aachen University, Germany
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25
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Viganò M, Lugano G, Colombini A, De Luca P, Perucca Orfei C, Ragni E, de Girolamo L. Evaluation of Different Seeding Methods for Cell-Seeded Collagen Matrix-Supported Autologous Chondrocyte Transplantation. JOINTS 2019; 6:215-219. [PMID: 31879717 PMCID: PMC6930127 DOI: 10.1055/s-0039-1693458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/10/2019] [Indexed: 11/26/2022]
Abstract
Purpose
The aim of the present study was to evaluate different methods for the intraoperative seeding of chondrocytes on commercially available collagen I/III matrix, in the context of cell-seeded collagen matrix-supported autologous chondrocyte transplantation (ACT-CS).
Methods
Human chondrocytes were enzymatically isolated from cartilage portion of discarded femoral heads of patients who underwent total hip replacement. Chondrocytes were cultured until passage 3, and then used for the experiments. The cells (5.0 × 10
5
) were suspended in two different volumes, 75 and 250 µL, and seeded on a matrix sample with a surface of 1 cm
2
by means of a micropipette. Moreover, the direct immersion of the matrix in the cell suspension was evaluated as a possible protocol for chondrocyte seeding. Cell adhesion was allowed for 10, 30, or 60 minutes in all samples before evaluation.
Results
Data showed that the seeding time did not affect cell viability and distribution, but there was a great difference between the two volumes of injection. In fact, the use of 75 µL significantly reduced cell viability with respect to both 250 µL seeding volume and the immersion protocol. Indeed, cell distribution resulted homogeneous in the samples seeded with the larger volume and with the immersion protocol.
Conclusion
The use of 250 µL/cm
2
volume or the immersion protocol for 10 minutes are valuable methods for chondrocyte seeding on collagen matrix in an intraoperative scenario.
Clinical Relevance
The protocol of chondrocyte seeding in ACT-CS is extremely variable among available literature reports. Chondrocytes adhesion to the matrix represents a crucial step in this methodology, and the present study provides in vitro indication for the choice of the seeding protocol in the context of ACT-CS.
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Affiliation(s)
- Marco Viganò
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Gaia Lugano
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Paola De Luca
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Enrico Ragni
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura de Girolamo
- Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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26
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Bhattacharjee A, Kuiper JH, Roberts S, Harrison PE, Cassar‐Pullicino VN, Tins B, Bajada S, Richardson JB. Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow-derived mesenchymal stromal cells. J Orthop Res 2019; 37:1303-1309. [PMID: 30474883 PMCID: PMC6590316 DOI: 10.1002/jor.24184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
The study reports the prospective outcome of treating severe recalcitrant fracture nonunion in patients with autologous bone marrow-derived mesenchymal stromal cells (BMSC) from 2003 to 2010 and analyze predictors of union. Autologous BMSC were culture expanded and inserted at nonunion site with or without carriers in addition to surgical stabilization of the fracture. Radiological union was ascertained by musculoskeletal radiologists on plain radiographs and/or CT scans. A logistic regression analysis was performed with cell-expansion parameters (cell numbers, cell doubling time) and known clinical factors (e.g., smoking and diabetes) as independent variables and fracture union as the dependent variable to identify the factors that influence bony healing. An Eq5D index score assessed the effect of treatment on general quality of health. A total of 35 patients (mean age 51+/-13 years) with established nonunion (median 2.9 years, 1-33) and, at least one failed nonunion surgery (median 4,1-14) received treatment. Fracture union was achieved in 21 patients (60%; 95%CI 44-75) at 2.6 years. Multiple penalized logistic regression revealed faster cell doubling time (p = 0.07), absence of diabetes (p = 0.003), less previous surgeries (p = 0.008), and lower age at cell implantation (p = 0.02) were significant predictors for fracture union. A significant increase in Eq5D index (p = 0.01) was noted with a mean rise of the score by 0.34 units (95%CI 0.11-0.58) at 1 year following the study. In summary, the study revealed cell doubling time as a novel in vitro parameter in conjunction with age, multiple surgeries, and diabetes as being significant predictors of the fracture union. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 37:1303-1309, 2019.
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Affiliation(s)
- Atanu Bhattacharjee
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK
| | - Jan H. Kuiper
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK,Institute for Science and Technology in MedicineKeele UniversityKeeleUK
| | - Sally Roberts
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK,Institute for Science and Technology in MedicineKeele UniversityKeeleUK
| | - Paul E. Harrison
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK
| | | | - Bernhard Tins
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK
| | - Stefan Bajada
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK
| | - James B. Richardson
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestryUK,Institute for Science and Technology in MedicineKeele UniversityKeeleUK
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27
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Campbell K, Naire S, Kuiper JH. A mathematical model of cartilage regeneration after chondrocyte and stem cell implantation - I: the effects of growth factors. J Tissue Eng 2019; 10:2041731419827791. [PMID: 30906518 PMCID: PMC6421619 DOI: 10.1177/2041731419827791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/09/2019] [Indexed: 01/16/2023] Open
Abstract
Autologous chondrocyte implantation is a cell-based therapy for treating chondral defects. The procedure begins by inserting chondrocytes into the defect region. The chondrocytes initiate healing by proliferating and depositing extracellular matrix, which allows them to migrate into the defect until it is completely filled with new cartilage. Mesenchymal stem cells can be used instead of chondrocytes with similar long-term results. The main differences are at early times since mesenchymal stem cells must first differentiate into chondrocytes before cartilage is formed. To better understand this repair process, we present a mathematical model of cartilage regeneration after cell therapy. We extend our previous work to include the cell-cell interaction between mesenchymal stem cells and chondrocytes via growth factors. Our results show that matrix formation is enhanced at early times in the presence of growth factors. This study reinforces the importance of mesenchymal stem cell and chondrocyte interaction in the cartilage healing process as hypothesised in experimental studies.
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Affiliation(s)
- Kelly Campbell
- School of Computing and Mathematics, Keele University, Keele, UK
| | - Shailesh Naire
- School of Computing and Mathematics, Keele University, Keele, UK
| | - Jan Herman Kuiper
- Institute for Science and Technology in Medicine, Keele University, Keele, UK
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
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28
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Francis SL, Di Bella C, Wallace GG, Choong PFM. Cartilage Tissue Engineering Using Stem Cells and Bioprinting Technology-Barriers to Clinical Translation. Front Surg 2018; 5:70. [PMID: 30547034 PMCID: PMC6278684 DOI: 10.3389/fsurg.2018.00070] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/08/2018] [Indexed: 01/08/2023] Open
Abstract
There is no long-term treatment strategy for young and active patients with cartilage defects. Early and effective joint preserving treatments in these patients are crucial in preventing the development of osteoarthritis. Tissue engineering over the past few decades has presented hope in overcoming the issues involved with current treatment strategies. Novel advances in 3D bioprinting technology have promoted more focus on efficient delivery of engineered tissue constructs. There have been promising in-vitro studies and several animal studies looking at 3D bioprinting of engineered cartilage tissue. However, to date there are still no human clinical trials using 3D printed engineered cartilage tissue. This review begins with discussion surrounding the difficulties with articular cartilage repair and the limitations of current clinical management options which have led to research in cartilage tissue engineering. Next, the major barriers in each of the 4 components of cartilage tissue engineering; cells, scaffolds, chemical, and physical stimulation will be reviewed. Strategies that may overcome these barriers will be discussed. Finally, we will discuss the barriers surrounding intraoperative delivery of engineered tissue constructs and possible solutions.
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Affiliation(s)
- Sam L Francis
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia.,Biofab 3D, Aikenhead Centre for Medical Discovery, Melbourne, VIC, Australia
| | - Claudia Di Bella
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia.,Biofab 3D, Aikenhead Centre for Medical Discovery, Melbourne, VIC, Australia
| | - Gordon G Wallace
- Biofab 3D, Aikenhead Centre for Medical Discovery, Melbourne, VIC, Australia.,Australian Research Council, Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Peter F M Choong
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Orthopaedics, St Vincent's Hospital, Melbourne, VIC, Australia.,Biofab 3D, Aikenhead Centre for Medical Discovery, Melbourne, VIC, Australia
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29
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Rim YA, Nam Y, Park N, Lee J, Park SH, Ju JH. Repair potential of nonsurgically delivered induced pluripotent stem cell-derived chondrocytes in a rat osteochondral defect model. J Tissue Eng Regen Med 2018; 12:1843-1855. [PMID: 29770595 DOI: 10.1002/term.2705] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 04/13/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022]
Abstract
Human induced pluripotent stem cells (hiPSCs) are thought to be an alternative cell source for future regenerative medicine. hiPSCs may allow unlimited production of cell types that have low turnover rates and are difficult to obtain such as autologous chondrocytes. In this study, we generated hiPSC-derived chondrogenic pellets, and chondrocytes were isolated. To confirm the curative effects, chondrogenic pellets and isolated chondrocytes were transplanted into rat joints with osteochondral defects. Isolated hiPSC-derived chondrocytes were delivered in the defect by a single intra-articular injection. The generated hiPSC-derived chondrogenic pellets had increased chondrogenic marker expression and accumulated extracellular matrix proteins. Chondrocytes were successfully isolated from the pellets. Alcian blue staining and collagen type II were detected in the cells. Chondrogenic marker expression was also increased in the isolated cells. Transplanted chondrogenic pellets and chondrocytes both had curative effects in the osteochondral defect rat model. Detection of human proteins in the joints proved that the cells were successfully delivered into the defect. Chondrogenic pellets or chondrocytes generated from hiPSCs have potential as regenerative medicine for cartilage recovery or regeneration. Chondrocytes isolated from hiPSC-derived chondrogenic pellets had curative effects in damaged cartilage. Injectable hiPSC-derived chondrocytes show the possibility of noninvasive delivery of regenerative medicine for cartilage recovery.
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Affiliation(s)
- Yeri Alice Rim
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoojun Nam
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Narae Park
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyeon Ju
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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30
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Aurich M, Hofmann GO, Gras F, Rolauffs B. Human osteochondritis dissecans fragment-derived chondrocyte characteristics ex vivo, after monolayer expansion-induced de-differentiation, and after re-differentiation in alginate bead culture. BMC Musculoskelet Disord 2018; 19:168. [PMID: 29793458 PMCID: PMC5968539 DOI: 10.1186/s12891-018-2079-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/07/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is a therapy for articular cartilage and osteochondral lesions that relies on notch- or trochlea-derived primary chondrocytes. An alternative cell source for ACI could be osteochondritis dissecans (OCD) fragment-derived chondrocytes. Assessing the potential of these cells, we investigated their characteristics ex vivo and after monolayer expansion, as monolayer expansion is an integral step of ACI. However, as monolayer expansion can induce de-differentiation, we asked whether monolayer-induced de-differentiation can be reverted through successive alginate bead culture. METHODS Chondrocytes were isolated from the OCD fragments of 15 patient knees with ICRS grades 3-4 lesions for ex vivo analyses, primary alginate bead culture, monolayer expansion, and alginate bead culture following monolayer expansion for attempting re-differentiation. We determined yield, viability, and the mRNA expression of aggrecan and type I, II, and X collagen. RESULTS OCD fragment-derived chondrocyte isolation yielded high numbers of viable cells with a low type I:II collagen expression ratio (< 1) and a relatively high aggrecan and type II and X collagen mRNA expression, indicating chondrogenic and hypertrophic characteristics. As expected, monolayer expansion induced de-differentiation. Alginate bead culture of monolayer-expanded cells significantly improved the expression profile of all genes investigated, being most successful in decreasing the hypertrophy marker type X collagen to 1.5% of its ex vivo value. However, the chondrogenic phenotype was not fully restored, as the collagen type I:II expression ratio decreased significantly but remained > 1. CONCLUSION OCD fragment derived human chondrocytes may hold not yet utilized clinical potential for cartilage repair.
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Affiliation(s)
- Matthias Aurich
- Center for Orthopaedic and Trauma Surgery, Klinikum Mittleres Erzgebirge, Alte Marienberger, Str. 52, 09405, Zschopau, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Germany
- Department of Biochemistry, Rush Medical College, 1735 W. Harrison St, Chicago, IL, 60612, USA
| | - Gunther O Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Florian Gras
- Department of Trauma, Hand and Reconstructive Surgery, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Bernd Rolauffs
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
- Massachusetts Institute of Technology, Center for Biomedical Engineering, 500 Technology Sq, Cambridge, MA, 02139, USA.
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Iwasa K, Reddi AH. Optimization of Methods for Articular Cartilage Surface Tissue Engineering: Cell Density and Transforming Growth Factor Beta Are Critical for Self-Assembly and Lubricin Secretion. Tissue Eng Part C Methods 2018; 23:389-395. [PMID: 28578597 DOI: 10.1089/ten.tec.2017.0121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Lubricin/superficial zone protein (SZP)/proteoglycan4 (PRG4) plays an important role in boundary lubrication in articular cartilage. Lubricin is secreted by superficial zone chondrocytes and synoviocytes of the synovium. The specific objective of this investigation is to optimize the methods for tissue engineering of articular cartilage surface. The aim of this study is to investigate the effect of cell density on the self-assembly of superficial zone chondrocytes and lubricin secretion as a functional assessment. DESIGN Superficial zone chondrocytes were cultivated as a monolayer at low, medium, and high densities. Chondrocytes at the three different densities were treated with transforming growth factor beta (TGF-β)1 twice a week or daily, and the accumulated lubricin in the culture medium was analyzed by immunoblots and quantitated by enzyme-linked immunosorbent assay (ELISA). RESULTS Cell numbers in low and medium densities were increased by TGF-β1; whereas cell numbers in high-density cell cultures were decreased by twice-a-week treatment of TGF-β1. On the other hand, the cell numbers were maintained by daily TGF-β treatment. Immunoblots and quantitation of lubricin by ELISA analysis indicated that TGF-β1 stimulated lubricin secretion by superficial zone chondrocytes at all densities with twice-a-week TGF-β treatment. It is noteworthy that the daily treatment of TGF-β1 increased lubricin much higher compared with twice-a-week treatment. CONCLUSIONS These data demonstrate that daily treatment is optimal for the TGF-β1 response in a higher density of monolayer cultures. These findings have implications for self-assembly of surface zone chondrocytes of articular cartilage for application in tissue engineering of articular cartilage surface.
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Affiliation(s)
- Kenjiro Iwasa
- Department of Orthopaedic Surgery, Lawrence Ellison Center for Tissue Regeneration and Repair, School of Medicine, University of California , Davis, Sacramento, California
| | - A Hari Reddi
- Department of Orthopaedic Surgery, Lawrence Ellison Center for Tissue Regeneration and Repair, School of Medicine, University of California , Davis, Sacramento, California
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Liu X, Meng H, Guo Q, Sun B, Zhang K, Yu W, Liu S, Wang Y, Jing X, Zhang Z, Peng J, Yang J. Tissue-derived scaffolds and cells for articular cartilage tissue engineering: characteristics, applications and progress. Cell Tissue Res 2018; 372:13-22. [PMID: 29368258 DOI: 10.1007/s00441-017-2772-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/23/2017] [Indexed: 12/22/2022]
Abstract
There are many factors to consider in the field of tissue engineering. For articular cartilage repair, this includes seed cells, scaffolds and chondrotrophic hormones. This review primarily focuses on the seed cells and scaffolds. Extracellular matrix proteins provide a natural scaffold for cell attachment, proliferation and differentiation. The structure and composition of tissue-derived scaffolds and native tissue are almost identical. As such, tissue-derived scaffolds hold great promise for biomedical applications. However, autologous tissue-derived scaffolds also have many drawbacks for transplantation, as harvesting autografts is limited to available donor sites and requires secondary surgery, therefore imparting additional damage to the body. This review summarizes and analyzes various cell sources and tissue-derived scaffolds applied in orthopedic tissue engineering.
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Affiliation(s)
- Xuejian Liu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- First Affiliated Hospital of Jiamusi University, Jiamusi University, Jiamusi, China
| | - Haoye Meng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Beijing Key Lab of Regenerative Medicine in Orthopaedics, Beijing, China
| | - Quanyi Guo
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Beijing Key Lab of Regenerative Medicine in Orthopaedics, Beijing, China
| | - Baichuan Sun
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- First Affiliated Hospital of Jiamusi University, Jiamusi University, Jiamusi, China
| | - Kaihong Zhang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Wen Yu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Beijing Key Lab of Regenerative Medicine in Orthopaedics, Beijing, China
| | - Shichen Liu
- First Affiliated Hospital of Jiamusi University, Jiamusi University, Jiamusi, China
| | - Yu Wang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Beijing Key Lab of Regenerative Medicine in Orthopaedics, Beijing, China
| | - Xiaoguang Jing
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- First Affiliated Hospital of Jiamusi University, Jiamusi University, Jiamusi, China
| | - Zengzeng Zhang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
- First Affiliated Hospital of Jiamusi University, Jiamusi University, Jiamusi, China
| | - Jiang Peng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China.
- Beijing Key Lab of Regenerative Medicine in Orthopaedics, Beijing, China.
| | - Jianhua Yang
- First Affiliated Hospital of Jiamusi University, Jiamusi University, Jiamusi, China.
- Longgang District People's Hospital of Shenzhen, Shenzhen, China.
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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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Aurich M, Hofmann GO, Rolauffs B. Tissue engineering-relevant characteristics of ex vivo and monolayer-expanded chondrocytes from the notch versus trochlea of human knee joints. INTERNATIONAL ORTHOPAEDICS 2017; 41:2327-2335. [PMID: 28828504 DOI: 10.1007/s00264-017-3615-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim was to analyse the biological characteristics of chondrocytes from the two biopsy sites notch vs. trochlea of human knee joints. The question was whether tissue engineering-relevant characteristics such as viability and mRNA expression profile would be comparable ex vivo and after monolayer expansion, as these are parts of routine autologous chondrocyte implantation (ACI). METHODS Biopsies from the intercondylar notch and the lateral aspect of the trochlea from 20 patients with ICRS grades 3 and 4 cartilage defects were harvested during arthroscopy. Collagen types 1, 2, and 10 mRNA were quantified by polymerase chain reaction. RESULTS Compared with notch chondrocytes, ex vivo trochlea chondrocytes had comparable cell numbers, vitality and aggrecan, collagen types 1, -2 and -10 mRNA expression. After monolayer expansion both notch and trochlea chondrocyte characteristics were comparably altered, regardless of their biopsy origin, and no significant differences in viability and mRNA expression were noted. CONCLUSIONS Collectively, these findings suggest that tissue engineering-relevant characteristics of notch and trochlea chondrocytes are comparable ex vivo and after monolayer expansion. Thus, trochlea chondrocytes promise clinical potential and chondrocytes for ACI could potentially be generated from both notch and trochlea biopsy sites.
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Affiliation(s)
- Matthias Aurich
- Center of Orthopaedic and Trauma Surgery, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Germany. .,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, 07747, Jena, Germany. .,Department of Biochemistry, Rush Medical College, 1735 W. Harrison St., Chicago, IL, 60612, USA.
| | - Gunther Olaf Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Bernd Rolauffs
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.,Massachusetts Institute of Technology, Center for Biomedical Engineering, 500 Technology Sq, Cambridge, MA, 02139, USA
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35
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Li Y, Fan Q, Jiang Y, Gong F, Xia H. Effects of insulin-like growth factor 1 and basic fibroblast growth factor on the morphology and proliferation of chondrocytes embedded in Matrigel in a microfluidic platform. Exp Ther Med 2017; 14:2657-2663. [PMID: 28962209 DOI: 10.3892/etm.2017.4808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 05/15/2017] [Indexed: 01/22/2023] Open
Abstract
An integrated microfluidic device was utilized in the present study to investigate the morphology and proliferation of rabbit articular chondrocytes embedded in Matrigel in the presence of insulin-like growth factor 1 (IGF-1) and/or basic fibroblast growth factor (bFGF). The microfluidic device was composed of two parallel channels and a central perfusion-based three-dimensional cell culture module. The rabbit chondrocytes were cultured for 2 weeks at series of concentration gradients of IGF-1 and/or bFGF, which were generated through a diffusion process. At the end of the experiment, the morphology and quantity of cells were measured. Since high expression of collagen II is essential to the function of hyaline cartilage, immunofluorescent images of collagen II expression prior to and after the experiments were gathered for each group. The mean fluorescence intensity ratio (MIR) of collagen II in each group was calculated. The MIRs of collagen II in chondrocytes treated with IGF-1 ranged from 0.6-0.81, those in the cells treated with bFGF ranged from 0.47-0.52, and those in cells treated with a combination of IGF-1 and bFGF ranged from 0.63-0.83. Chondrocyte aggregations were observed in the group treated with 75-100 ng/ml IGF-1 (3.46-fold proliferation ratio). Similarly, a 3.83-fold proliferation ratio was identified in chondrocytes treated with 2.5-5.0 ng/ml bFGF. The group treated with 50-75 ng/ml IGF-1 and 2.5-5.0 ng/ml bFGF exhibited the optimum increase in proliferation (4.83-fold proliferation ratio). The microfluidic device used in the present study can be easily adapted to investigate other growth factors at any concentration gradient. In addition, parallel experiments can be performed simultaneously with a small quantity of cells, making it an attractive platform for the high-throughput screening of cell culture parameters. This platform will aid in the optimization of culture conditions for the in vitro expansion of chondrocytes while maintaining their in vivo morphology, which will improve autologous chondrocyte implantation capabilities for the treatment of cartilage injury.
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Affiliation(s)
- Yuancheng Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116001, P.R. China
| | - Qinbo Fan
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116001, P.R. China
| | - Yong Jiang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116001, P.R. China
| | - Fuliang Gong
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116001, P.R. China
| | - Honggang Xia
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116001, P.R. China
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Richardson JB, Wright KT, Wales J, Kuiper JH, McCarthy HS, Gallacher P, Harrison PE, Roberts S. Efficacy and safety of autologous cell therapies for knee cartilage defects (autologous stem cells, chondrocytes or the two): randomized controlled trial design. Regen Med 2017. [PMID: 28635368 DOI: 10.2217/rme-2017-0032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM The main aim of this trial is to test the safety and efficacy of autologous stromal/stem cells, chondrocytes or the two combined in the treatment of knee cartilage defects. PATIENTS & METHODS Patients with symptomatic chondral/osteochondral defects will be randomized to cell therapy treatment with one of three cell populations (1:1:1). The primary efficacy outcome is a functional knee score (Lysholm) at 15 months post-treatment and the primary safety outcome is the incidence of adverse events. Secondary objectives are to analyze repair tissues, quality of life and cost-utility assessments. Exploratory objectives are to identify predictors for success/potency and dose-response relationships. RESULTS & CONCLUSION This trial has been carefully designed so that valuable scientific and clinical information can be gathered throughout and in the final analysis.
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Affiliation(s)
- James B Richardson
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.,Institute for Science & Technology in Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Karina T Wright
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.,Institute for Science & Technology in Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Johanna Wales
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Jan Herman Kuiper
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.,Institute for Science & Technology in Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Helen S McCarthy
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.,Institute for Science & Technology in Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Peter Gallacher
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Paul E Harrison
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
| | - Sally Roberts
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK.,Institute for Science & Technology in Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Studer D, Cavalli E, Formica FA, Kuhn GA, Salzmann G, Mumme M, Steinwachs MR, Laurent-Applegate LA, Maniura-Weber K, Zenobi-Wong M. Human chondroprogenitors in alginate-collagen hybrid scaffolds produce stable cartilage in vivo. J Tissue Eng Regen Med 2016; 11:3014-3026. [PMID: 27373220 DOI: 10.1002/term.2203] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/26/2016] [Accepted: 03/27/2016] [Indexed: 12/17/2022]
Abstract
The goal of this study was to evaluate human epiphyseal chondroprogenitor cells (ECPs) as a potential new cell source for cartilage regeneration. ECPs were compared to human bone marrow stromal cells (MSCs) and human adult articular chondrocytes (ACs) for their chondrogenic potential and phenotypic stability in vitro and in vivo. The cells were seeded in Optimaix-3D scaffolds at 5 × 104 cells/mm3 and gene expression, matrix production and mechanical properties were analysed up to 6 weeks. In vitro, ECPs synthesized consistently high collagen 2 and low collagen 10. AC-seeded constructs exhibited high donor variability in GAG/DNA values as well as in collagen 2 staining, but showed low collagen 10 production. MSCs, on the other hand, expressed high levels of collagen 2 but also of collagens 1 and 10, and were therefore not considered further. In vivo, there was considerable loss of matrix proteins in ECPs compared to in vitro cultured samples. To overcome this, a second implantation study investigated the effect of mixing cells with alginate prior to seeding in the scaffold. ECPs in alginate maintained their cartilage matrix and resisted mineralization and vessel infiltration better 6 weeks after subcutaneous implantation, whereas ACs lost their chondrogenic matrix completely. This study shows the great potential of ECPs as an off-the-shelf, highly chondrogenic cell type that produces stable cartilage in vivo. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Deborah Studer
- Cartilage Engineering and Regeneration, Institute for Biomechanics, Swiss Federal Institute of Technology Zürich (ETH Zürich), Zürich, Switzerland.,Cellular and Molecular Bioengineering Research Laboratory, Department of Chemical and Petroleum Engineering, University of Calgary, Canada
| | - Emma Cavalli
- Cartilage Engineering and Regeneration, Institute for Biomechanics, Swiss Federal Institute of Technology Zürich (ETH Zürich), Zürich, Switzerland
| | - Florian A Formica
- Cartilage Engineering and Regeneration, Institute for Biomechanics, Swiss Federal Institute of Technology Zürich (ETH Zürich), Zürich, Switzerland
| | - Gisela Anne Kuhn
- Institute for Biomechanics and ETH Phenomics Centre (EPIC), ETH Zürich, Switzerland
| | | | - Marcus Mumme
- Department of Biomedicine, University Hospital Basel, Switzerland
| | | | - Lee Ann Laurent-Applegate
- Department of Musculoskeletal Medicine, Regenerative Therapy Unit, University Hospital of Lausanne (CHUV), Epalinges, Switzerland
| | - Katharina Maniura-Weber
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Testing and Research, St.Gallen, Switzerland
| | - Marcy Zenobi-Wong
- Cartilage Engineering and Regeneration, Institute for Biomechanics, Swiss Federal Institute of Technology Zürich (ETH Zürich), Zürich, Switzerland
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Joergensen NL, Le DQS, Andersen OZ, Foss M, Danielsen CC, Foldager CB, Lind M, Lysdahl H. Topography-Guided Proliferation: Distinct Surface Microtopography Increases Proliferation of ChondrocytesIn Vitro. Tissue Eng Part A 2015; 21:2757-65. [DOI: 10.1089/ten.tea.2014.0697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Dang Quang Svend Le
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Foss
- Interdisciplinary Nanoscience Centre, iNANO, Aarhus University, Aarhus, Denmark
| | | | | | - Martin Lind
- Sports Trauma Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Lysdahl
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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39
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Lee P, Tran K, Chang W, Fang YL, Zhou G, Junka R, Shelke NB, Yu X, Kumbar SG. Bioactive polymeric scaffolds for osteochondral tissue engineering: in vitro
evaluation of the effect of culture media on bone marrow stromal cells. POLYM ADVAN TECHNOL 2015. [DOI: 10.1002/pat.3680] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Paul Lee
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology, 1 Castle Point on Hudson; Hoboken NJ 07030 USA
| | - Katelyn Tran
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology, 1 Castle Point on Hudson; Hoboken NJ 07030 USA
| | - Wei Chang
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology, 1 Castle Point on Hudson; Hoboken NJ 07030 USA
| | - Ya-Lin Fang
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology, 1 Castle Point on Hudson; Hoboken NJ 07030 USA
| | - Gan Zhou
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology, 1 Castle Point on Hudson; Hoboken NJ 07030 USA
| | - Radoslaw Junka
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology, 1 Castle Point on Hudson; Hoboken NJ 07030 USA
| | - Namdev B. Shelke
- Department of Orthopaedic Surgery; UConn Health; Farmington CT 06030 USA
- Institute for Regenerative Engineering; UConn Health; Farmington CT 06030 USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences; UConn Health; Farmington CT 06030 USA
| | - Xiaojun Yu
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology, 1 Castle Point on Hudson; Hoboken NJ 07030 USA
| | - Sangamesh G. Kumbar
- Department of Orthopaedic Surgery; UConn Health; Farmington CT 06030 USA
- Institute for Regenerative Engineering; UConn Health; Farmington CT 06030 USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences; UConn Health; Farmington CT 06030 USA
- Department of Biomedical Engineering; University of Connecticut; Storrs CT 06269 USA
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40
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Zak L, Albrecht C, Wondrasch B, Widhalm H, Vekszler G, Trattnig S, Marlovits S, Aldrian S. Results 2 Years After Matrix-Associated Autologous Chondrocyte Transplantation Using the Novocart 3D Scaffold: An Analysis of Clinical and Radiological Data. Am J Sports Med 2014; 42:1618-27. [PMID: 24817007 DOI: 10.1177/0363546514532337] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A range of scaffolds is available from various manufacturers for cartilage repair through matrix-associated autologous chondrocyte transplantation (MACT), with good medium- to long-term results. PURPOSE To evaluate clinical and magnetic resonance imaging (MRI) outcomes 2 years after MACT on the knee joint using the Novocart 3D scaffold based on a bilayered collagen type I sponge. STUDY DESIGN Case series; Level of evidence, 4. METHODS Of 28 initial patients, 23 were clinically and radiologically evaluated 24 months after transplantation. Indications for MACT were chondral or osteochondral lesions on the knee joint with a defect size >2 cm2, no instability, and no malalignment (axis deviation <5°). Then, MRI was performed on a 3-T scanner to assess the magnetic resonance observation of cartilage repair tissue (MOCART) and 3-dimensional (3D) MOCART scores. A variety of subjective scores (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Noyes sports activity rating scale, Tegner activity scale, and visual analog scale [VAS] for pain) were used for clinical evaluation. RESULTS Two years after MACT, the MRI evaluation showed a mean MOCART score of 73.2 ± 12.4 and a 3D MOCART score of 73.4 ± 9.7. Clinical results showed mean values of 69.8 ± 15.2 for the IKDC; 51.6 ± 21.2, 86.5 ± 13.9, 54.5 ± 23.6, 65.0 ± 8.0, and 91.5 ± 10.6 for the KOOS subscales (Quality of Life, Pain, Sports and Recreation, Symptoms, and Activities of Daily Living, respectively); 77.5 ± 12.7 for the Noyes scale; 4.4 ± 1.6 for the Tegner activity scale; and 1.8 ± 1.7 for the VAS, with statistically significant improvement in all scores other than KOOS-Symptoms. CONCLUSION Undergoing MACT using the Novocart 3D scaffold is an applicable method to treat large focal chondral and osteochondral defects, with good short-term clinical and radiological results.
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Affiliation(s)
- Lukas Zak
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Christian Albrecht
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Barbara Wondrasch
- Department of Health and Social Sciences, St Pölten University of Applied Sciences, St Pölten, Austria Norwegian Research Center for Active Rehabilitation, Department of Sport Medicine, Norwegian School for Sport Sciences, Oslo, Norway
| | - Harald Widhalm
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - György Vekszler
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Investigation performed at the Medical University of Vienna, Vienna, Austria
| | - Stefan Marlovits
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Silke Aldrian
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
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