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Yan W, Xu X, Xu Q, Sun Z, Lv Z, Wu R, Yan W, Jiang Q, Shi D. Chondral Defects Cause Kissing Lesions in a Porcine Model. Cartilage 2021; 13:692S-702S. [PMID: 32830514 PMCID: PMC8804867 DOI: 10.1177/1947603520951636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the development of kissing lesions 12 months after the generation of full-thickness chondral defects. DESIGN Eight minipigs were randomized into 2 groups: the Φ8.5 mm full-thickness chondral defect group (8.5FT group) and the Φ6.5 mm full-thickness chondral defect group (6.5FT group). The Φ8.5 mm or Φ6.5 mm full-thickness chondral defects were prepared in the medial femoral condyle. Knee magnetic resonance imaging (MRI) was performed before sacrifice. India ink staining was performed to macroscopically assess kissing lesions. Histologic staining (hematoxylin-eosin [HE], safranin O/fast green, toluidine blue staining) and immunohistochemistry (collagen I, collagen II, collagen X, MMP-3) were performed. Microcomputed tomography analysis was completed to assess subchondral bone alterations. RESULTS Obvious kissing lesions were observed on the tibial plateau. Knee MRI demonstrated high cartilage signal intensity in the medial femoral condyle and opposite tibial plateau. HE staining demonstrated cartilage fibrillation and prominent cell death. The depletion of safranin O, toluidine blue staining, and collagen II was observed in the kissing lesion areas. The kissing lesion areas demonstrated increased collagen I, Collagen X, and MMP-3 expression. The 8.5FT group showed a significantly lower mean trabecular number (2.80 1/mm) than the control group (3.26 1/mm). The 6.5FT group showed a significantly increased mean trabecular thickness (0.54 mm) and a decreased mean trabecular number (2.71 1/mm) compared to the control group (0.32 mm; 3.26 1/mm). CONCLUSIONS Obvious kissing lesions were observed on the tibial plateau. Knee MRI demonstrated high cartilage signal The presented findings support the development of kissing lesions caused by full-thickness chondral defects.
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Affiliation(s)
- Wenqiang Yan
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
| | - Xingquan Xu
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
| | - Qian Xu
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
| | - Ziying Sun
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
| | - Zhongyang Lv
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
| | - Rui Wu
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
| | - Wenjin Yan
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
- Laboratory for Bone and Joint Disease,
Model Animal Research Center (MARC), Nanjing University, Nanjing, Jiangsu,
China
| | - Dongquan Shi
- State Key Laboratory of Pharmaceutical
Biotechnology, Department of Sports Medicine and Adult Reconstructive Surgery,
Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical
School, Nanjing, Jiangsu, China
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2
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González Vázquez AG, Blokpoel Ferreras LA, Bennett KE, Casey SM, Brama PAJ, O'Brien FJ. Systematic Comparison of Biomaterials-Based Strategies for Osteochondral and Chondral Repair in Large Animal Models. Adv Healthc Mater 2021; 10:e2100878. [PMID: 34405587 DOI: 10.1002/adhm.202100878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/16/2021] [Indexed: 01/10/2023]
Abstract
Joint repair remains a major challenge in orthopaedics. Recent progress in biomaterial design has led to the fabrication of a plethora of promising devices. Pre-clinical testing of any joint repair strategy typically requires the use of large animal models (e.g., sheep, goat, pig or horse). Despite the key role of such models in clinical translation, there is still a lack of consensus regarding optimal experimental design, making it difficult to draw conclusions on their efficacy. In this context, the authors performed a systematic literature review and a risk of bias assessment on large animal models published between 2010 and 2020, to identify key experimental parameters that significantly affect the biomaterial therapeutic outcome and clinical translation potential (including defect localization, animal age/maturity, selection of controls, cell-free versus cell-laden). They determined that mechanically strong biomaterials perform better at the femoral condyles; while highlighted the importance of including native tissue controls to better evaluate the quality of the newly formed tissue. Finally, in cell-laded biomaterials, the pre-culture conditions played a more important role in defect repair than the cell type. In summary, here they present a systematic evaluation on how the experimental design of preclinical models influences biomaterial-based therapeutic outcomes in joint repair.
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Affiliation(s)
- Arlyng G. González Vázquez
- Tissue Engineering Research Group Department of Anatomy and Regenerative Medicine Royal College of Surgeons in Ireland (RCSI) Dublin 2 D02 YN77 Ireland
- Advanced Materials Bio‐Engineering Research Centre (AMBER) RCSI and TCD Dublin 2 D02 PN40 Ireland
| | - Lia A. Blokpoel Ferreras
- Tissue Engineering Research Group Department of Anatomy and Regenerative Medicine Royal College of Surgeons in Ireland (RCSI) Dublin 2 D02 YN77 Ireland
- Advanced Materials Bio‐Engineering Research Centre (AMBER) RCSI and TCD Dublin 2 D02 PN40 Ireland
| | | | - Sarah M. Casey
- Tissue Engineering Research Group Department of Anatomy and Regenerative Medicine Royal College of Surgeons in Ireland (RCSI) Dublin 2 D02 YN77 Ireland
- Advanced Materials Bio‐Engineering Research Centre (AMBER) RCSI and TCD Dublin 2 D02 PN40 Ireland
| | - Pieter AJ Brama
- School of Veterinary Medicine University College Dublin (UCD) Dublin 4 D04 V1W8 Ireland
| | - Fergal J. O'Brien
- Tissue Engineering Research Group Department of Anatomy and Regenerative Medicine Royal College of Surgeons in Ireland (RCSI) Dublin 2 D02 YN77 Ireland
- Advanced Materials Bio‐Engineering Research Centre (AMBER) RCSI and TCD Dublin 2 D02 PN40 Ireland
- Trinity Centre for Biomedical Engineering Trinity Biomedical Sciences Institute Trinity College Dublin (TCD) Dublin 2 D02 PN40 Ireland
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3
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Systematic Postoperative Assessment of a Minimally-Invasive Sheep Model for the Treatment of Osteochondral Defects. Life (Basel) 2020; 10:life10120332. [PMID: 33297497 PMCID: PMC7762399 DOI: 10.3390/life10120332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022] Open
Abstract
To assess the clinical course of a sheep stifle joint model for osteochondral (OC) defects, medial femoral condyles (MFC) were exposed without patella luxation using medial parapatellar skin (3–4 cm) and deep incisions (2–3 cm). Two defects (7 mm diameter; 10 mm depth; OC punch) were left empty or refilled with osteochondral autologous transplantation cylinders (OATS) and explanted after six weeks. Incision-to-suture time, anesthesia time, and postoperative wound or impairment scores were compared to those in sham-operated animals. Implant performance was assessed by X-ray, micro-computed tomography, histology, and immunohistology (collagens 1, 2; aggrecan). There were no surgery-related infections or patellar luxations. Operation, anesthesia, and time to complete stand were short (0.5, 1.4, and 1.5 h, respectively). The wound trauma score was low (0.4 of maximally 4; day 7). Empty-defect and OATS animals reached an impairment score of 0 significantly later than sham animals (7.4 and 4.0 days, respectively, versus 1.5 days). Empty defects showed incomplete healing and dedifferentiation/heterotopic differentiation; OATS-filled defects displayed advanced bone healing with remaining cartilage gaps and orthotopic expression of bone and cartilage markers. Minimally-invasive, medial parapatellar surgery of OC defects on the sheep MFC allows rapid and low-trauma recovery and appears well-suited for implant testing.
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Vukasovic A, Asnaghi MA, Kostesic P, Quasnichka H, Cozzolino C, Pusic M, Hails L, Trainor N, Krause C, Figallo E, Filardo G, Kon E, Wixmerten A, Maticic D, Pellegrini G, Kafienah W, Hudetz D, Smith T, Martin I, Ivkovic A, Wendt D. Bioreactor-manufactured cartilage grafts repair acute and chronic osteochondral defects in large animal studies. Cell Prolif 2019; 52:e12653. [PMID: 31489992 PMCID: PMC6869519 DOI: 10.1111/cpr.12653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Bioreactor-based production systems have the potential to overcome limitations associated with conventional tissue engineering manufacturing methods, facilitating regulatory compliant and cost-effective production of engineered grafts for widespread clinical use. In this work, we established a bioreactor-based manufacturing system for the production of cartilage grafts. MATERIALS & METHODS All bioprocesses, from cartilage biopsy digestion through the generation of engineered grafts, were performed in our bioreactor-based manufacturing system. All bioreactor technologies and cartilage tissue engineering bioprocesses were transferred to an independent GMP facility, where engineered grafts were manufactured for two large animal studies. RESULTS The results of these studies demonstrate the safety and feasibility of the bioreactor-based manufacturing approach. Moreover, grafts produced in the manufacturing system were first shown to accelerate the repair of acute osteochondral defects, compared to cell-free scaffold implants. We then demonstrated that grafts produced in the system also facilitated faster repair in a more clinically relevant chronic defect model. Our data also suggested that bioreactor-manufactured grafts may result in a more robust repair in the longer term. CONCLUSION By demonstrating the safety and efficacy of bioreactor-generated grafts in two large animal models, this work represents a pivotal step towards implementing the bioreactor-based manufacturing system for the production of human cartilage grafts for clinical applications. Read the Editorial for this article on doi:10.1111/cpr.12625.
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Affiliation(s)
- Andreja Vukasovic
- Department of Histology and Embriology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Maria Adelaide Asnaghi
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Petar Kostesic
- Clinic for Surgery, Ophthalmology & Orthopaedics, Veterinary Faculty, University of Zagreb, Zagreb, Croatia
| | - Helen Quasnichka
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | | | - Maja Pusic
- Department of Histology and Embriology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | | | | | | | | | - Anke Wixmerten
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Drazen Maticic
- Clinic for Surgery, Ophthalmology & Orthopaedics, Veterinary Faculty, University of Zagreb, Zagreb, Croatia
| | | | - Wael Kafienah
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Damir Hudetz
- Department of Orthopaedic Surgery, University Hospital "Sveti Duh," Zagreb, Croatia
| | - Tim Smith
- Octane Biotech, Kingston, Ontario, Canada
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alan Ivkovic
- Department of Orthopaedic Surgery, University Hospital "Sveti Duh," Zagreb, Croatia
| | - David Wendt
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland.,Cellec Biotek AG, Basel, Switzerland
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5
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Dwivedi G, Chevrier A, Hoemann CD, Buschmann MD. Injectable freeze‐dried chitosan‐platelet‐rich‐plasma implants improve marrow‐stimulated cartilage repair in a chronic‐defect rabbit model. J Tissue Eng Regen Med 2019; 13:599-611. [DOI: 10.1002/term.2814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/07/2018] [Accepted: 01/14/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Garima Dwivedi
- Biomedical Engineering Institute, Ecole Polytechnique de Montreal Montreal Quebec Canada
| | - Anik Chevrier
- Chemical Engineering Department, Ecole Polytechnique de Montreal Montreal Quebec Canada
| | - Caroline D. Hoemann
- Biomedical Engineering Institute, Ecole Polytechnique de Montreal Montreal Quebec Canada
- Chemical Engineering Department, Ecole Polytechnique de Montreal Montreal Quebec Canada
| | - Michael D. Buschmann
- Biomedical Engineering Institute, Ecole Polytechnique de Montreal Montreal Quebec Canada
- Chemical Engineering Department, Ecole Polytechnique de Montreal Montreal Quebec Canada
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Vilela CA, Correia C, Oliveira JM, Sousa RA, Espregueira-Mendes J, Reis RL. Cartilage Repair Using Hydrogels: A Critical Review of in Vivo Experimental Designs. ACS Biomater Sci Eng 2015; 1:726-739. [DOI: 10.1021/acsbiomaterials.5b00245] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- C. A. Vilela
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Life
and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- Orthopaedic
Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - C. Correia
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Guimarães, Portugal
| | - J. M. Oliveira
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - R. A. Sousa
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Guimarães, Portugal
| | - J. Espregueira-Mendes
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Life
and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- Clínica
do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal
| | - R. L. Reis
- 3B’s
Research Group, University of Minho, Guimarães, Portugal
- ICVS/3B’s−PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Guimarães, Portugal
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7
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Anderson JA, Little D, Toth AP, Moorman CT, Tucker BS, Ciccotti MG, Guilak F. Stem cell therapies for knee cartilage repair: the current status of preclinical and clinical studies. Am J Sports Med 2014; 42:2253-61. [PMID: 24220016 PMCID: PMC4019709 DOI: 10.1177/0363546513508744] [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 Articular cartilage damage of the knee is common, causing significant morbidity worldwide. Many adult tissues contain cells that are able to differentiate into multiple cell types, including chondrocytes. These stem cells have gained significant attention over the past decade and may become frontline management for cartilage defects in the very near future. PURPOSE The role of stem cells in the treatment of knee osteochondral defects was reviewed. Recent animal and clinical studies were reviewed to determine the benefits and potential outcomes of using stem cells for cartilage defects. STUDY DESIGN Literature review. METHODS A PubMed search was undertaken. The key phrase "stem cells and knee" was used. The search included reviews and original articles over an unlimited time period. From this search, articles outlining animal and clinical trials were selected. A search of current clinical trials in progress was performed on the clinicaltrials.gov website, and "stem cells and knee" was used as the search phrase. RESULTS Stem cells have been used in many recent in vitro and animal studies. A number of cell-based approaches for cartilage repair have progressed from preclinical animal studies into clinical trials. CONCLUSION The use of stem cells for the treatment of cartilage defects is increasing in animal and clinical studies. Methods of delivery of stem cells to the knee's cartilage vary from direct injection to implantation with scaffolds. While these approaches are highly promising, there is currently limited evidence of a direct clinical benefit, and further research is required to assess the overall outcome of stem cell therapies for knee cartilage repair.
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Affiliation(s)
- John A. Anderson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
,Rothman Institute Cartilage Center, Rothman Institute, Philadelphia, Pennsylvania.
,Address correspondence to Rothman Institute Cartilage Center, 925 Chestnut Street, Philadelphia, PA 19107 ()
| | - Dianne Little
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alison P. Toth
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Claude T. Moorman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Bradford S. Tucker
- Rothman Institute Cartilage Center, Rothman Institute, Philadelphia, Pennsylvania
| | - Michael G. Ciccotti
- Rothman Institute Cartilage Center, Rothman Institute, Philadelphia, Pennsylvania
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Caminal M, Fonseca C, Peris D, Moll X, Rabanal RM, Barrachina J, Codina D, García F, Cairó JJ, Gòdia F, Pla A, Vives J. Use of a chronic model of articular cartilage and meniscal injury for the assessment of long-term effects after autologous mesenchymal stromal cell treatment in sheep. N Biotechnol 2014; 31:492-8. [PMID: 25063342 DOI: 10.1016/j.nbt.2014.07.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/28/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
Regenerative therapies using adult stem cells have attracted great interest in the recent years and offer a promising alternative to current surgical practices. In this report, we evaluated the safety and efficacy of an autologous cell-based treatment of osteoarthritis using mesenchymal stromal cells expanded from bone marrow aspirates that were administered intra-articularly. Ten 2-year old ewes were divided in two groups (for analysis at 6 and 12 months, respectively). Full thickness articular cartilage defects of approximately 60mm(2) were created arthroscopically in the medial femorotibial condyles and a meniscal tear in the anterior horn of the medial meniscus in the 20 hind legs. Intra-articular injection of 4 mL of either treatment (a suspension of cells) or control (same as treatment, without cells) were applied one month after generating a chronic condition similar to human pathology. Animals were monitored radiographically, by MRI and ultrasound scanning; and macroscopic and histological analyses were conducted at 6 and 12 months. Furthermore a full necropsy was performed at 12 months post-treatment. The intra-articular injection of autologous MSC was safe, as judged by the lack of local or systemic adverse effects during the clinical follow-up and by a full necropsy performed at 12 months post-treatment. Evidence of regeneration of articular cartilage and meniscus was case-dependent but statistically significant improvement was found in specific macroscopic and histological parameters. Such parameters included colour, rigidity, cell distribution and hyaline quality of the refill tissue as well as the structure of subchondral bone.
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Affiliation(s)
- Marta Caminal
- Divisió de Teràpies Avançades/XCELIA, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, Barcelona 08005, Spain
| | - Carla Fonseca
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - David Peris
- Grup d'Enginyeria Cel·lular i Tissular, Departament d'Enginyeria Química, Escola d'Enginyers, Universitat Autònoma de Barcelona, Edifici Q, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Xavier Moll
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Rosa M Rabanal
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Josep Barrachina
- Hospital ASEPEYO, Avinguda Alcalde Barnils, 54-60, Sant Cugat del Vallès, Barcelona 08174, Spain
| | - David Codina
- Hospital ASEPEYO, Avinguda Alcalde Barnils, 54-60, Sant Cugat del Vallès, Barcelona 08174, Spain
| | - Félix García
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Universitat Autònoma de Barcelona, Edifici V, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Jordi J Cairó
- Grup d'Enginyeria Cel·lular i Tissular, Departament d'Enginyeria Química, Escola d'Enginyers, Universitat Autònoma de Barcelona, Edifici Q, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Francesc Gòdia
- Grup d'Enginyeria Cel·lular i Tissular, Departament d'Enginyeria Química, Escola d'Enginyers, Universitat Autònoma de Barcelona, Edifici Q, Campus de la UAB, 08193 Bellaterra, Cerdanyola del Vallès, Spain
| | - Arnau Pla
- Divisió de Teràpies Avançades/XCELIA, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, Barcelona 08005, Spain
| | - Joaquim Vives
- Divisió de Teràpies Avançades/XCELIA, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, Barcelona 08005, Spain.
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Orth P, Meyer HL, Goebel L, Eldracher M, Ong MF, Cucchiarini M, Madry H. Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle. J Orthop Res 2013; 31:1772-9. [PMID: 23813860 DOI: 10.1002/jor.22418] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/05/2013] [Indexed: 02/04/2023]
Abstract
Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics, Saarland University, Building 37-38, D-66421, Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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10
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Orth P, Madry H. A low morbidity surgical approach to the sheep femoral trochlea. BMC Musculoskelet Disord 2013; 14:5. [PMID: 23286467 PMCID: PMC3539878 DOI: 10.1186/1471-2474-14-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 12/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ovine stifle joint is an important location for investigations on the repair of articular cartilage defects in preclinical large animals. The classical medial parapatellar approach to the femoral trochlea is hazardous because of the high risk of postoperative patellar luxation. Here, we describe a low morbidity surgical exposure of the ovine trochlea without the necessity for intraoperative patellar luxation. METHODS Bilateral surgical exposure of the femoral trochlea of the sheep stifle joint was performed using the classical medial parapatellar approach with intraoperative lateral patellar luxation and transection of the medial patellar retinaculum in 28 ovine stifle joints. A low morbidity approach was performed bilaterally in 116 joints through a mini-arthrotomy without the need to transect the medial patellar retinaculum or the oblique medial vastus muscle nor surgical patellar luxation. Postoperatively, all 72 animals were monitored to exclude patellar luxations and deep wound infections. RESULTS The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet. No postoperative patellar luxations were observed compared to a postoperative patellar luxation rate of 25% experienced with the classical medial parapatellar approach and a re-luxation rate of 80% following revision surgery. No signs of lameness, wound infections, or empyema were observed for both approaches. CONCLUSIONS The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach. It is therefore suitable to create articular cartilage defects on the femoral trochlea without the risk of postoperative patellar luxation.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Saar, Germany
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11
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Local anaesthetics and chondrotoxicty: What is the evidence? Knee Surg Sports Traumatol Arthrosc 2012; 20:2294-301. [PMID: 22134409 DOI: 10.1007/s00167-011-1804-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 11/17/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years. METHODS We have reviewed the available basic science literature focusing on the studies assessing the effect of exposing articular chondrocytes to local anaesthetic agents. We attempt to highlight the key findings and, where possible, extrapolate the laboratory findings to the operating theatre. RESULTS Basic science reports are analysed according to their setting of either in vitro, ex vivo or in vivo and according to cell line. A majority of work to date has been done using in vitro models. Only a small number of in vivo models using animal cell lines have been used and the best of these have conflicting results with regard lasting toxicity secondary to local anaesthetic exposure. CONCLUSIONS Numerous reports suggest a toxic effect of local anaesthetic agents on articular chondrocytes, however, further work is warranted to establish the precise mechanism of toxicity and whether or not single bolus administration results in long-term deleterious outcomes. Determining the ideal in vitro model will help in extrapolating laboratory data to the operating theatre.
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Marquass B, Schulz R, Hepp P, Zscharnack M, Aigner T, Schmidt S, Stein F, Richter R, Osterhoff G, Aust G, Josten C, Bader A. Matrix-associated implantation of predifferentiated mesenchymal stem cells versus articular chondrocytes: in vivo results of cartilage repair after 1 year. Am J Sports Med 2011; 39:1401-12. [PMID: 21527412 DOI: 10.1177/0363546511398646] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of predifferentiated mesenchymal stem cells (MSC) leads to better histological results compared with undifferentiated MSC in sheep. This raises the need for a longer term follow-up study and comparison with a clinically established method. HYPOTHESIS We hypothesized that chondrogenic in vitro predifferentiation of autologous MSC embedded in a collagen I hydrogel leads to better structural repair of a chronic osteochondral defect in an ovine stifle joint after 1 year. We further hypothesized that resulting histological results would be comparable with those of chondrocyte-seeded matrix-associated autologous chondrocyte transplantation (MACT). STUDY DESIGN Controlled laboratory study. METHODS Predifferentiation period of ovine MSC within collagen gel in vitro was defined by assessment of several cellular and molecular biological parameters. For the animal study, 2 osteochondral lesions (7-mm diameter) were created at the medial femoral condyles of the hind legs in 9 sheep. Implantation of MSC gels was performed 6 weeks after defect creation. Thirty-six defects were divided into 4 treatment groups: (1) chondrogenically predifferentiated MSC gels (pre-MSC gels), (2) undifferentiated MSC gels (un-MSC gels), (3) MACT gels, and (4) untreated controls (UC). Histological, immunohistochemical, and radiological evaluations followed after 12 months. RESULTS After 12 months in vivo, pre-MSC gels showed significantly better histological outcome compared with un-MSC gels and UC. Compared with MACT gels, the overall scores were higher for O'Driscoll and International Cartilage Repair Society (ICRS). The repair tissue of the pre-MSC group showed immunohistochemical detection of interzonal collagen type II staining. Radiological evaluation supported superior bonding of pre-MSC gels to perilesional native cartilage. Compared with previous work by our group, no degradation of the repair tissue between 6 and 12 months in vivo, particularly in pre-MSC gels, was observed. CONCLUSION Repair of chronic osteochondral defects with collagen hydrogels composed of chondrogenically predifferentiated MSC shows no signs of degradation after 1 year in vivo. In addition, pre-MSC gels lead to partially superior histological results compared with articular chondrocytes. CLINICAL RELEVANCE The results suggest an encouraging method for future treatment of focal osteochondral defects without donor site morbidity by harvesting articular chondrocytes.
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Affiliation(s)
- Bastian Marquass
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany.
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Schmitt A, Imhoff AB, Vogt S. Predifferentiated mesenchymal stem cells for osteochondral defects: letter. Am J Sports Med 2011; 39:NP12-3; author reply NP13-5. [PMID: 21636725 DOI: 10.1177/0363546511410382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Hurtig MB, Buschmann MD, Fortier LA, Hoemann CD, Hunziker EB, Jurvelin JS, Mainil-Varlet P, McIlwraith CW, Sah RL, Whiteside RA. Preclinical Studies for Cartilage Repair: Recommendations from the International Cartilage Repair Society. Cartilage 2011; 2:137-52. [PMID: 26069576 PMCID: PMC4300779 DOI: 10.1177/1947603511401905] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Investigational devices for articular cartilage repair or replacement are considered to be significant risk devices by regulatory bodies. Therefore animal models are needed to provide proof of efficacy and safety prior to clinical testing. The financial commitment and regulatory steps needed to bring a new technology to clinical use can be major obstacles, so the implementation of highly predictive animal models is a pressing issue. Until recently, a reductionist approach using acute chondral defects in immature laboratory species, particularly the rabbit, was considered adequate; however, if successful and timely translation from animal models to regulatory approval and clinical use is the goal, a step-wise development using laboratory animals for screening and early development work followed by larger species such as the goat, sheep and horse for late development and pivotal studies is recommended. Such animals must have fully organized and mature cartilage. Both acute and chronic chondral defects can be used but the later are more like the lesions found in patients and may be more predictive. Quantitative and qualitative outcome measures such as macroscopic appearance, histology, biochemistry, functional imaging, and biomechanical testing of cartilage, provide reliable data to support investment decisions and subsequent applications to regulatory bodies for clinical trials. No one model or species can be considered ideal for pivotal studies, but the larger animal species are recommended for pivotal studies. Larger species such as the horse, goat and pig also allow arthroscopic delivery, and press-fit or sutured implant fixation in thick cartilage as well as second look arthroscopies and biopsy procedures.
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Osterhoff G, Löffler S, Steinke H, Feja C, Josten C, Hepp P. Comparative anatomical measurements of osseous structures in the ovine and human knee. Knee 2011; 18:98-103. [PMID: 20188573 DOI: 10.1016/j.knee.2010.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/29/2010] [Accepted: 02/01/2010] [Indexed: 02/02/2023]
Abstract
The ovine stifle has been increasingly used as a large animal model for the human knee. Still, comparative anatomical measurements of the knee in sheep and humans are missing. Thus, the purpose of this study was to describe and measure the osseous anatomy of the ovine stifle in comparison to the human knee. Twenty-four stifles of skeletal-mature merino-sheep and 24 human cadaver knees were obtained and distances between selected anatomical structures of the distal femur, the proximal tibia, and the patella were measured digitally and documented. Based on these, intercondylar ratio, tibial aspect ratio, patella aspect ratio and the cortical index were calculated. Regarding epicondylar width, lateral condylar width, medial condylar width and the tibial dimensions, the ovine stifle can be considered as a human knee scaled down by one third. However, sheep have a smaller trochlear width and a narrower femoral intercondylar notch than humans resulting in lower relative values for intercondylar width and intercondylar height. The distal femur's cortical index is the same in both species. In contrast, sheep have a massive bone stock below their tibial plateau and a proximal tibial shaft with remarkably thick cortical bone. The ovine stifle can be regarded as a useful model for the human knee. However, future studies should consider the differences in the femoral intercondylar notch width, the patellofemoral joint's biomechanics and the proximal tibia's cortical bone stock.
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Affiliation(s)
- Georg Osterhoff
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
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Marquass B, Somerson JS, Hepp P, Aigner T, Schwan S, Bader A, Josten C, Zscharnack M, Schulz RM. A novel MSC-seeded triphasic construct for the repair of osteochondral defects. J Orthop Res 2010; 28:1586-99. [PMID: 20973061 DOI: 10.1002/jor.21173] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mesenchymal stem cells (MSC) are increasingly replacing chondrocytes in tissue engineering based research for treatment of osteochondral defects. The aim of this work was to determine whether repair of critical-size chronic osteochondral defects in an ovine model using MSC-seeded triphasic constructs would show results comparable to osteochondral autografting (OATS). Triphasic implants were engineered using a beta-tricalcium phosphate osseous phase, an intermediate activated plasma phase, and a collagen I hydrogel chondral phase. Autologous MSCs were used to seed the implants, with chondrogenic predifferentiation of the cells used in the cartilage phase. Osteochondral defects of 4.0 mm diameter were created bilaterally in ovine knees (n = 10). Six weeks later, half of the lesions were treated with OATS and half with triphasic constructs. The knees were dissected at 6 or 12 months. With the chosen study design we were not able to demonstrate significant differences between the histological scores of both groups. Subcategory analysis of O'Driscoll scores showed superior cartilage bonding in the 6-month triphasic group compared to the autograft group. The 12-month autograft group showed superior cartilage matrix morphology compared to the 12-month triphasic group. Macroscopic and biomechanical analysis showed no significant differences at 12 months. Autologous MSC-seeded triphasic implants showed comparable repair quality to osteochondral autografts in terms of histology and biomechanical testing.
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Affiliation(s)
- B Marquass
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
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Zscharnack M, Hepp P, Richter R, Aigner T, Schulz R, Somerson J, Josten C, Bader A, Marquass B. Repair of chronic osteochondral defects using predifferentiated mesenchymal stem cells in an ovine model. Am J Sports Med 2010; 38:1857-69. [PMID: 20508078 DOI: 10.1177/0363546510365296] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of mesenchymal stem cells (MSCs) to treat osteochondral defects caused by sports injuries or disease is of particular interest. However, there is a lack of studies in large-animal models examining the benefits of chondrogenic predifferentiation in vitro for repair of chronic osteochondral defects. HYPOTHESIS Chondrogenic in vitro predifferentiation of autologous MSCs embedded in a collagen I hydrogel currently in clinical trial use for matrix-associated autologous chondrocyte transplantation facilitates the regeneration of a chronic osteochondral defect in an ovine stifle joint. STUDY DESIGN Controlled laboratory study. METHODS The optimal predifferentiation period of ovine MSCs within the type I collagen hydrogel in vitro was defined by assessment of several cellular and molecular biological parameters. For the animal study, osteochondral lesions (diameter 7 mm) were created at the medial femoral condyles of the hind legs in 10 merino sheep. To achieve a chronic defect model, implantation of the ovine MSCs/hydrogel constructs was not performed until 6 weeks after defect creation. The 40 defects were divided into 4 treatment groups: (1) chondrogenically predifferentiated ovine MSC/hydrogel constructs (preMSC-gels), (2) undifferentiated ovine MSC/hydrogel constructs (unMSC-gels), (3) cell-free collagen hydrogels (CF-gels), and (4) untreated controls (UCs). Evaluation followed after 6 months. RESULTS With regard to proteoglycan content, cell count, gel contraction, apoptosis, compressive properties, and progress of chondrogenic differentiation, a differentiation period of 14 days in vitro was considered optimal. After 6 months in vivo, the defects treated with preMSC-gels showed significantly better histologic scores with morphologic characteristics of hyaline cartilage such as columnarization and presence of collagen type II. CONCLUSION Matrix-associated autologous chondrocyte transplantation with predifferentiated MSCs may be a promising approach for repair of focal, chronic osteochondral defects. CLINICAL RELEVANCE The results suggest an encouraging method for future treatment of focal osteochondral defects to prevent progression to osteoarthritis.
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Affiliation(s)
- Matthias Zscharnack
- Department of Cell Techniques and Applied Stem Cell Biology, Center of Biotechnology and Biomedicine, University of Leipzig, Deutscher Platz 5, D-04103 Leipzig, Germany.
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