1
|
Rezasoltani Z, Dadarkhah A, Tabatabaee SM, Abdorrazaghi F, Kazempour Mofrad M, Kazempour Mofrad R. Therapeutic Effects of Intra-articular Botulinum Neurotoxin Versus Physical Therapy in Knee Osteoarthritis. Anesth Pain Med 2021; 11:e112789. [PMID: 34540630 PMCID: PMC8438713 DOI: 10.5812/aapm.112789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is the most common cause of chronic knee pain, and disability and different modalities have been used to improve pain and function. Botulinum toxin intra-articular injection is proposed to manage resistant joint pains. Objectives This study was carried out to compare therapeutic effects of intra-articular botulinum neurotoxin (BTX) versus physical therapy (PT) in KOA. Methods In this single-blind randomized clinical trial, patients with KOA attending to Imam-Reza Hospital, Tehran, Iran, from June 2018 to March 2019 were enrolled. Patients who met the inclusion criteria were randomly divided into BTX receiving a single intra-articular dose of 100 units (250 units from disport brand) and PT groups. The study was described for patients, and informed consent forms were received. For assessment of the pain and related severity, the VAS score and KOOS scales were used. Post-intervention assessment was done 1, 3, and 6 months after the intervention. The level of significance was set at α = 0.05. All data analyses were performed with SPSS version 26 for windows. Results In this study, 50 patients were randomly divided into BTX and PT groups. All patients completed the study, and there was no loss to follow-up. There was no significant difference between demographic data of the two groups, including age and BMI. The VAS score was similar in the two groups at the beginning. KOOS subscales were not significantly different, but the quality of life was better in the BTX than the PT group (86.2 ± 15 vs. 72.1 ± 11.5, P < 0.001). One month after the intervention, all KOOS subscales were improved in the BTX group in comparison to the PT group (P < 0.001). This difference was statistically significant in the 3rd (P < 0.001 in all comparisons except Sport/Rec subscale in which P = 0.02) and 6th months (P < 0.001) after the intervention, and the improvement in all KOOS subscales and VAS score were higher in the BTX group than the PT group. The trend of KOOS subscales and VAS score was improved over time in the BTX (P < 0.001 in all tests), but the PT group showed no improvement (P > 0.05) except for Sport/Rec and VAS score (P < 0.001). Conclusions Totally, it is concluded that the use of BTX can reduce pain and improve the function and quality of life in patients with KOA.
Collapse
Affiliation(s)
- Zahra Rezasoltani
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Afsaneh Dadarkhah
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
- Corresponding Author: Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Emam Reza Hospital, Aja University of Medical Sciences, 1411718541, Tehran, Iran.
| | - Seyed Morteza Tabatabaee
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Fateme Abdorrazaghi
- Physical Medicine and Rehabilitation Specialist, Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|
2
|
Maniar AR, Bhatnagar N, Mishra A, Vinchurkar K, Jain D. Rare Fungal Infection in Arthritic Knee After Stem Cell Injection Managed by Novel Staged Primary Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00070. [PMID: 33989236 DOI: 10.2106/jbjs.cc.20.00354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 72-year-old man with bilateral knee osteoarthritis treated elsewhere with bilateral intraarticular stem cell injections (SCIs) presented to us 2 months later with signs of infection in his left knee. Aspiration culture grew fungus Penicillium sp. First-stage total knee arthroplasty (TKA) included thorough joint debridement, lavage, standard bone cuts, and insertion of antibiotic-impregnated cement spacer. Second stage included spacer removal and final implantation. At the 1.5-year follow-up, he has a satisfactory clinical outcome without evidence of infection. CONCLUSION As far as we know, this is the first reported case of infective fungal arthritis secondary to intraarticular SCI successfully managed by a staged primary TKA.
Collapse
Affiliation(s)
- Adit R Maniar
- Department of Orthopaedics, Joint Replacement Fellow, Lilavati Hospital and Research Centre, Mumbai, India
| | - Nishit Bhatnagar
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
| | - Abhinav Mishra
- Department of Orthopaedics, Joint Replacement Fellow, Lilavati Hospital and Research Centre, Mumbai, India
| | - Kshitija Vinchurkar
- Department of Radiology, SRM Medical College and Research Centre, Tamil Nadu, India
| | - Ditesh Jain
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra (West), Mumbai, India
| |
Collapse
|
3
|
MacFarlane LA, Williams EE, Lenhard NK, Losina E, Katz JN. Factors influencing physician recommendation for intra‐articular therapies in osteoarthritis: A qualitative study. Arthritis Care Res (Hoboken) 2020; 74:617-625. [DOI: 10.1002/acr.24502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Lindsey A. MacFarlane
- Orthopedic and Arthritis Center for Outcomes Research Brigham and Women’s Hospital Boston MA USA
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women’s Hospital Boston MA USA
- Harvard Medical School Boston MA USA
| | - Emma E. Williams
- Orthopedic and Arthritis Center for Outcomes Research Brigham and Women’s Hospital Boston MA USA
| | - Nora K. Lenhard
- Orthopedic and Arthritis Center for Outcomes Research Brigham and Women’s Hospital Boston MA USA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research Brigham and Women’s Hospital Boston MA USA
- Harvard Medical School Boston MA USA
- Department of Orthopedic Surgery Brigham and Women’s Hospital Boston MA USA
- Department of Biostatistics Boston University School of Public Health Boston MA USA
- Section of Clinical Sciences Division of Rheumatology, Immunology and Allergy Brigham and Women’s Hospital Boston MA USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research Brigham and Women’s Hospital Boston MA USA
- Harvard Medical School Boston MA USA
- Department of Orthopedic Surgery Brigham and Women’s Hospital Boston MA USA
- Section of Clinical Sciences Division of Rheumatology, Immunology and Allergy Brigham and Women’s Hospital Boston MA USA
| |
Collapse
|
4
|
Geng Y, Chen J, Alahdal M, Chang C, Duan L, Zhu W, Mou L, Xiong J, Wang M, Wang D. Intra-articular injection of hUC-MSCs expressing miR-140-5p induces cartilage self-repairing in the rat osteoarthritis. J Bone Miner Metab 2020; 38:277-288. [PMID: 31760502 DOI: 10.1007/s00774-019-01055-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Currently, osteoarthritis (OA) receives global increasing attention because it associates severe joint pain and serious disability. Stem cells intra-articular injection therapy showed a potential therapeutic superiority to reduce OA development and to improve treating outputs. However, the long-term effect of stem cells intra-articular injection on the cartilage regeneration remains unclear. Recently, miR-140-5p was confirmed as a critical positive regulator in chondrogenesis. We hypothesized that hUC-MSCs overexpressing miR-140-5p have better therapeutic effect on osteoarthritis. MATERIALS AND METHODS To enhance stem cell chondrogenic differentiation, we have transfected human umbilical cord mesenchymal stem cells (hUC-MSCs) with miR-140-5p mimics and miR-140-5p lentivirus to overexpress miR-140-5p in a short term or a long term accordingly. Thereafter, MSCs proliferation, chondrogenic genes expression and extracellular matrix were assessed. Destabilization of the medial meniscus (DMM) surgery was performed on the knee joints of SD rats as an OA model, and then intra-articular injection of hUC-MSCs or hUC-MSCs transfected with miR-140-5p lentivirus was carried to evaluate the cartilage healing effect with histological staining and OARSI scores. The localization of hUC-MSCs after intra-articular injection was further confirmed by immunohistochemical staining. RESULTS Significant induction of chondrogenic differentiation in the miR-140-5p-hUC-MSCs (140-MSCs), while its proliferation was not influenced. Interestingly, intra-articular injection of 140-MSCs significantly enhanced articular cartilage self-repairing in comparison to normal hUC-MSCs. Moreover, we noticed that intra-articular injection of high 140-MSCs numbers reinforces cells assembling on the impaired cartilage surface and subsequently differentiated into chondrocytes. CONCLUSIONS In conclusion, these results indicate therapeutic superiority of hUC-MSCs overexpressing miR-140-5p to treat OA using intra-articular injection.
Collapse
Affiliation(s)
- Yiyun Geng
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
- Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, Guangdong Province, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518035, Guangdong Province, China
| | - Jinfu Chen
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
| | - Murad Alahdal
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
- Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, Guangdong Province, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Chongfei Chang
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
| | - Li Duan
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
- Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, Guangdong Province, China
| | - Weimin Zhu
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
| | - Lisha Mou
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
| | - Jianyi Xiong
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
- Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, Guangdong Province, China
| | - Manyi Wang
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
| | - Daping Wang
- The First Affiliated Hospital to Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China.
- Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, Guangdong Province, China.
| |
Collapse
|
5
|
Turajane T, Chaveewanakorn U, Fongsarun W, Aojanepong J, Papadopoulos KI. Avoidance of Total Knee Arthroplasty in Early Osteoarthritis of the Knee with Intra-Articular Implantation of Autologous Activated Peripheral Blood Stem Cells versus Hyaluronic Acid: A Randomized Controlled Trial with Differential Effects of Growth Factor Addition. Stem Cells Int 2017; 2017:8925132. [PMID: 29056974 PMCID: PMC5625803 DOI: 10.1155/2017/8925132] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/25/2017] [Accepted: 08/24/2017] [Indexed: 02/08/2023] Open
Abstract
In this randomized controlled trial, in early osteoarthritis (OA) that failed conservative intervention, the need for total knee arthroplasty (TKA) and WOMAC scores were evaluated, following a combination of arthroscopic microdrilling mesenchymal cell stimulation (MCS) and repeated intra-articular (IA) autologous activated peripheral blood stem cells (AAPBSCs) with growth factor addition (GFA) and hyaluronic acid (HA) versus IA-HA alone. Leukapheresis-harvested AAPBSCs were administered as three weekly IA injections combined with HA and GFA (platelet-rich plasma [PRP] and granulocyte colony-stimulating factor [hG-CSF]) and MCS in group 1 and in group 2 but without hG-CSF while group 3 received IA-HA alone. Each group of 20 patients was evaluated at baseline and at 1, 6, and, 12 months. At 12 months, all patients in the AAPBSC groups were surgical intervention free compared to three patients needing TKA in group 3 (p < 0.033). Total WOMAC scores showed statistically significant improvements at 6 and 12 months for the AAPBSC groups versus controls. There were no notable adverse events. We have shown avoidance of TKA in the AAPBSC groups at 12 months and potent, early, and sustained symptom alleviation through GFA versus HA alone. Differential effects of hG-CSF were noted with an earlier onset of symptom alleviation throughout.
Collapse
Affiliation(s)
- Thana Turajane
- 1Department of Orthopedic Surgery, Police General Hospital, Bangkok, Thailand
| | | | | | - Jongjate Aojanepong
- 3Department of Gynecology and Obstetrics, Police General Hospital, Bangkok, Thailand
| | | |
Collapse
|
6
|
Jo CH, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC, Kim JE, Shim H, Shin JS, Shin IS, Ra JC, Oh S, Yoon KS. Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial. Stem Cells 2014; 32:1254-66. [PMID: 24449146 DOI: 10.1002/stem.1634] [Citation(s) in RCA: 606] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/26/2013] [Accepted: 11/16/2013] [Indexed: 12/12/2022]
Abstract
Mesenchymal stem cells (MSCs) are known to have a potential for articular cartilage regeneration. However, most studies focused on focal cartilage defect through surgical implantation. For the treatment of generalized cartilage loss in osteoarthritis, an alternative delivery strategy would be more appropriate. The purpose of this study was to assess the safety and efficacy of intra-articular injection of autologous adipose tissue derived MSCs (AD-MSCs) for knee osteoarthritis. We enrolled 18 patients with osteoarthritis of the knee and injected AD MSCs into the knee. The phase I study consists of three dose-escalation cohorts; the low-dose (1.0 × 10(7) cells), mid-dose (5.0 × 10(7)), and high-dose (1.0 × 10(8)) group with three patients each. The phase II included nine patients receiving the high-dose. The primary outcomes were the safety and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 6 months. Secondary outcomes included clinical, radiological, arthroscopic, and histological evaluations. There was no treatment-related adverse event. The WOMAC score improved at 6 months after injection in the high-dose group. The size of cartilage defect decreased while the volume of cartilage increased in the medial femoral and tibial condyles of the high-dose group. Arthroscopy showed that the size of cartilage defect decreased in the medial femoral and medial tibial condyles of the high-dose group. Histology demonstrated thick, hyaline-like cartilage regeneration. These results showed that intra-articular injection of 1.0 × 10(8) AD MSCs into the osteoarthritic knee improved function and pain of the knee joint without causing adverse events, and reduced cartilage defects by regeneration of hyaline-like articular cartilage.
Collapse
Affiliation(s)
- Chris Hyunchul Jo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Uth K, Trifonov D. Stem cell application for osteoarthritis in the knee joint: A minireview. World J Stem Cells 2014; 6:629-636. [PMID: 25426260 PMCID: PMC4178263 DOI: 10.4252/wjsc.v6.i5.629] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 08/31/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Knee osteoarthritis is a chronic, indolent disease that will affect an ever increasing number of patients, especially the elderly and the obese. It is characterized by degeneration of the cartilage substance inside the knee which leads to pain, stiffness and tenderness. By some estimations in 2030, only in the United States, this medical condition will burden 67 million people. While conventional treatments like physiotherapy or drugs offer temporary relief of clinical symptoms, restoration of normal cartilage function has been difficult to achieve. Moreover, in severe cases of knee osteoarthritis total knee replacement may be required. Total knee replacements come together with high effort and costs and are not always successful. The aim of this review is to outline the latest advances in stem cell therapy for knee osteoarthritis as well as highlight some of the advantages of stem cell therapy over traditional approaches aimed at restoration of cartilage function in the knee. In addition to the latest advances in the field, challenges associated with stem cell therapy regarding knee cartilage regeneration and chondrogenesis in vitro and in vivo are also outlined and analyzed. Furthermore, based on their critical assessment of the present academic literature the authors of this review share their vision about the future of stem cell applications in the treatment of knee osteoarthritis.
Collapse
|
8
|
Cuervo B, Rubio M, Sopena J, Dominguez JM, Vilar J, Morales M, Cugat R, Carrillo JM. Hip osteoarthritis in dogs: a randomized study using mesenchymal stem cells from adipose tissue and plasma rich in growth factors. Int J Mol Sci 2014; 15:13437-60. [PMID: 25089877 PMCID: PMC4159804 DOI: 10.3390/ijms150813437] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 02/06/2023] Open
Abstract
Purpose: The aim of this study was to compare the efficacy and safety of a single intra-articular injection of adipose mesenchymal stem cells (aMSCs) versus plasma rich in growth factors (PRGF) as a treatment for reducing symptoms in dogs with hip osteoarthritis (OA). Methods: This was a randomized, multicenter, blinded, parallel group. Thirty-nine dogs with symptomatic hip OA were assigned to one of the two groups, to receive aMSCs or PRGF. The primary outcome measures were pain and function subscales, including radiologic assessment, functional limitation and joint mobility. The secondary outcome measures were owners’ satisfaction questionnaire, rescue analgesic requirement and overall safety. Data was collected at baseline, then, 1, 3 and 6 months post-treatment. Results: OA degree did not vary within groups. Functional limitation, range of motion (ROM), owner’s and veterinary investigator visual analogue scale (VAS), and patient’s quality of life improved from the first month up to six months. The aMSCs group obtained better results at 6 months. There were no adverse effects during the study. Our findings show that aMSCs and PRGF are safe and effective in the functional analysis at 1, 3 and 6 months; provide a significant improvement, reducing dog’s pain, and improving physical function. With respect to basal levels for every parameter in patients with hip OA, aMSCs showed better results at 6 months.
Collapse
Affiliation(s)
- Belen Cuervo
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
| | - Monica Rubio
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
| | - Joaquin Sopena
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
| | - Juan Manuel Dominguez
- Department of Animal Medicine and Surgery, University of Cordoba, 14071 Cordoba, Spain.
| | - Jose Vilar
- Department of Animal Medicine and Surgery, University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain.
| | - Manuel Morales
- Department of Animal Medicine and Surgery, University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain.
| | - Ramón Cugat
- Garcia Cugat Foundation CEU UCH Chair of Medicine and Regenerative Surgery, 08006 Barcelona, Spain.
| | - Jose Maria Carrillo
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
| |
Collapse
|
9
|
Turajane T, Thitiset T, Honsawek S, Chaveewanakorn U, Aojanepong J, Papadopoulos KI. Assessment of chondrogenic differentiation potential of autologous activated peripheral blood stem cells on human early osteoarthritic cancellous tibial bone scaffold. Musculoskelet Surg 2014; 98:35-43. [PMID: 24178764 DOI: 10.1007/s12306-013-0303-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/17/2013] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Current therapeutic regimens in osteoarthritis (OA) address mainly pain but not the slow progressive degradation of the extracellular matrix (ECM) and the loss of a chondrogenic phenotype in articular cartilage. In the present study, using an early OA cancellous bone scaffold, we aimed to uncover evidence of the successful hyaline cartilage regenerative capacity of autologous human granulocyte colony-stimulating factor (hG-CSF)-activated peripheral blood stem cells (AAPBSC) with growth factor addition. MATERIALS AND METHODS AAPBSC were harvested in ten patients (median age 58 years, 8 females), and flow cytometry was performed for cell surface markers. Arthroscopically obtained cancellous bone scaffold specimens were seeded with AAPBSC. In Group 1, the scaffold was seeded with AAPBSC only, in Group 2, AAPBSC plus hyaluronic acid (HA), and in Group 3, AAPBSC plus HA, hG-CSF, and double-centrifuged platelet-rich plasma (PRP). The specimens were analyzed for cell attachment and proliferation by the fluorometric quantification of cellular DNA assay and scanning electron microscopy. Chondrogenic gene expression was determined by reverse transcriptase-polymerase chain reaction (RT-PCR) of Sox9, collagen type II (COL-2), and aggrecan. Histological sections of scaffold constructs for cartilaginous matrix formation were stained with toluidine blue (proteoglycan) and safranin O (sGAG) after 3 weeks. RESULTS AAPBSC displayed especially high levels of CD29 and CD44 surface markers, as well as CD90, and CD105, while only a small proportion expressed CD34. Almost half of the seeded cells attached on the bone scaffolds in all three groups (not statistically significant), whereas the means of cell proliferation on day 7 compared to day 1 were statistically significant difference with the order of increase as group 3 > group 2 > group 1. RT-PCR showed statistically significant sequential increases in Sox9, COL-2, and Aggrecan all being highest in group 3. Histological analysis demonstrated cells in the cancellous bone scaffold with a round morphology, and ECM was positively stained by toluidine blue and safranin O indicating increased proteoglycan and glycosaminoglycan content, respectively, in the newly formed cartilage matrix. CONCLUSIONS AAPBSC initiated chondrocyte differentiation on an autologous cancellous bone scaffold, and the addition of PRP and hG-CSF further stimulated cell proliferation toward a chondrocyte phenotype with potentiated Sox9 transcription resulting in sequential COL-2 and aggrecan mRNA increases that ultimately resulted in histologically confirmed increased proteoglycan and glucosaminoglycan content in newly formed hyaline cartilage.
Collapse
Affiliation(s)
- T Turajane
- Department of Orthopedic Surgery, Stem Cell Research and Treatment Center, Police General Hospital, Bangkok, Thailand
| | | | | | | | | | | |
Collapse
|
10
|
Iqbal S, Jacobs U, Akhtar A, Macfarlane R, Waseem M. A history of shoulder surgery. Open Orthop J 2013; 7:305-9. [PMID: 24082968 PMCID: PMC3785029 DOI: 10.2174/1874325001307010305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 02/01/2013] [Accepted: 02/09/2013] [Indexed: 11/25/2022] Open
Abstract
Shoulder surgery has emerged from being a marginalised sub-speciality to being an area of much research and advancement within the last seventy years. This has been despite the complexity of the joint, and success majorly rests on parallel development of biomedical technology. This article looks at the past and present of shoulder surgery and discusses future directions in the speciality.
Collapse
Affiliation(s)
- S Iqbal
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | | | | | | | | |
Collapse
|
11
|
Lee HH, O'Malley MJ, Friel NA, Payne KA, Qiao C, Xiao X, Chu CR. Persistence, localization, and external control of transgene expression after single injection of adeno-associated virus into injured joints. Hum Gene Ther 2013; 24:457-66. [PMID: 23496155 PMCID: PMC3631018 DOI: 10.1089/hum.2012.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 03/07/2013] [Indexed: 01/11/2023] Open
Abstract
A single intra-articular injection of adeno-associated virus (AAV) results in stable and controllable transgene expression in normal rat knees. Because undamaged joints are unlikely to require treatment, the study of AAV delivery in joint injury models is crucial to potential therapeutic applications. This study tests the hypotheses that persistent and controllable AAV-transgene expression are (1) highly localized to the cartilage when AAV is injected postinjury and (2) localized to the intra-articular soft tissues when AAV is injected preinjury. Two AAV injection time points, postinjury and preinjury, were investigated in osteochondral defect and anterior cruciate ligament transection models of joint injury. Rats injected with AAV tetracycline response element (TRE)-luciferase received oral doxycycline for 7 days. Luciferase expression was evaluated longitudinally for 6 months. Transgene expression was persistent and controllable with oral doxycycline for 6 months in all groups. However, the location of transgene expression was different: postinjury AAV-injected knees had luciferase expression highly localized to the cartilage, while preinjury AAV-injected knees had more widespread signal from intra-articular soft tissues. The differential transgene localization between preinjury and postinjury injection can be used to optimize treatment strategies. Highly localized postinjury injection appears advantageous for treatments targeting repair cells. The more generalized and controllable reservoir of transgene expression following AAV injection before anterior cruciate ligament transection (ACLT) suggests an intriguing concept for prophylactic delivery of joint protective factors to individuals at high risk for early osteoarthritis (OA). Successful external control of intra-articular transgene expression provides an added margin of safety for these potential clinical applications.
Collapse
Affiliation(s)
- Hannah H. Lee
- Cartilage Restoration Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15313
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15313
| | - Michael J. O'Malley
- Cartilage Restoration Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15313
| | - Nicole A. Friel
- Cartilage Restoration Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15313
| | - Karin A. Payne
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15313
- Department of Orthopedic Surgery, University of Colorado Denver, Aurora, CO 80045
| | - Chunping Qiao
- Division of Molecular Pharmaceutics, School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599
| | - Xiao Xiao
- Division of Molecular Pharmaceutics, School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599
| | - Constance R. Chu
- Cartilage Restoration Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15313
- Department of Orthopedic Surgery, Stanford University, Stanford, CA 94305
| |
Collapse
|