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Al-Namnam NM, Luczak AT, Yang I, Li X, Lucas M, Hall AC, Simpson AHR. Chondroprotection of articular cartilage integrity: Utilizing ultrasonic scalpel and hyperosmolar irrigation solution during cutting. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100499. [PMID: 39076683 PMCID: PMC11284703 DOI: 10.1016/j.ocarto.2024.100499] [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: 12/14/2023] [Accepted: 06/25/2024] [Indexed: 07/31/2024] Open
Abstract
Objectives Ultrasonic (US) cutting of cartilage in orthopaedic surgery has received little attention despite its potential to reduce chondrocyte death which could enhance cartilage repair. We aimed to investigate whether an ultrasonically-vibrating scalpel to cut human articular cartilage could reduce chondrocyte death, and to determine if hyper-osmolarity could provide chondroprotection during the procedure. Methods A scalpel (no. 15) was mounted on an ultrasonic transducer to resonate at 35 kHz with 30 μm vibrational displacement. Thirty-six fresh human femoral cartilage samples were divided into four groups based on ultrasonic activation (US or non-US) and saline osmolarity (300 or 600 mOsm/L). Cell viability was assessed using a live/dead cell assay and analysed quantitatively by confocal microscopy. Histology illustrated tissue surface changes at the cut site. Results The overall chondrocyte death percentage at both the US and non-US cut sites showed comparable results (p > 0.05) in both osmolarities. However, the zone of chondrocyte death was reduced by 31 ± 5% and 36 ± 6%, respectively, when comparing US cutting at 300 mOsm/L and 600 mOsm/L to the control group (non-US cutting; 300 mOsm/L) (p < 0.05). The width of the cut was consistent at both sites, regardless of the method of cutting. Conclusion Cutting human cartilage with US in the presence of 300 or 600 mOsm/L media was chondroprotective compared to normal (non-US) scalpel cutting in 300 mOsm/L medium. These results suggest chondroprotection can be achieved while cutting using a US scalpel and raised osmolarity, potentially improving cartilage regeneration and repair following injury.
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Affiliation(s)
| | - Aneta T. Luczak
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - Irene Yang
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - Xuan Li
- James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - Margaret Lucas
- James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - Andrew C. Hall
- Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - A. Hamish R.W. Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, Edinburgh, UK
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2
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Oladeji LO, Stoker AM, Kuroki K, Stannard JP, Cook JL. Making the Case for Hyperosmolar Saline Arthroscopic Irrigation Fluids: A Systematic Review of Basic Science, Translational, and Clinical Evidence. J Knee Surg 2024; 37:512-522. [PMID: 37879356 DOI: 10.1055/a-2198-8131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Commonly used isotonic arthroscopic irrigation fluids, such as normal saline or lactated Ringer's, were initially formulated for intravenous administration so they do not replicate the physiologic properties of healthy synovial fluid. Synovial fluid plays an important role in regulating joint homeostasis such that even transient disruptions in its composition and physiology can be detrimental. Previous studies suggest that hyperosmolar solutions may be a promising alternative to traditional isotonic fluids. This manuscript sought to systematically review and synthesize previously published basic science, translational, and clinical studies on the use of hyperosmolar arthroscopic irrigation fluids to delineate the optimal fluid for clinical use. A systematic literature search of MEDLINE/PubMed and Embase databases was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. The search phrases were: ("cartilage" AND "hyperosmolar"); ("arthroscopy" OR "arthroscopic" AND "hyperosmolar"). The titles, abstracts, and full texts were screened for studies on hyperosmolar solutions and articular cartilage. Study quality was assessed, and relevant data were collected. A meta-analysis was not performed due to study heterogeneity. A risk of bias assessment was performed on the included translational and clinical studies. There were 10 basic science studies, 2 studies performed in translational animal models, and 2 clinical studies included in this review. Of the basic science studies, 7 utilized a mechanical injury model. The translational studies were carried out in the canine shoulder and equine stifle (knee) joint. Clinical studies were performed in the shoulder and knee. Multiple basic science, translational, and clinical studies highlight the short-term safety, cost-effectiveness, and potential benefits associated with use of hyperosmolar solutions for arthroscopic irrigation. Further work is needed to develop and validate the ideal formulation for a hyperosmolar irrigation solution with proven long-term benefits for patients undergoing arthroscopic surgeries.
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Affiliation(s)
- Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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3
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Unterguggenberger C, Jahangir S, Salzmann GM, Stoddart MJ, Grad S, Schmal H, Kubosch EJ. Response of Articular Cartilage to Hyperosmolar Stress: Report of an Ex Vivo Injury Model. Am J Sports Med 2024; 52:1596-1607. [PMID: 38581200 DOI: 10.1177/03635465241241089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND Physiological 0.9% saline is commonly used as an irrigation fluid in modern arthroscopy. There is a growing body of evidence that a hyperosmolar saline solution has chondroprotective effects, especially if iatrogenic injury occurs. PURPOSE To (1) corroborate the superiority of a hyperosmolar saline solution regarding chondrocyte survival after mechanical injury and (2) observe the modulatory response of articular cartilage to osmotic stress and injury. STUDY DESIGN Controlled laboratory study. METHODS Osteochondral explants were isolated from bovine stifle joints and exposed to either 0.9% saline (308 mOsm) or hyperosmolar saline (600 mOsm) and then damaged with a sharp dermatome blade to attain a confined full-thickness cartilage injury site, incubated in the same fluids for another 3 hours, and transferred to chondropermissive medium for further culture for 1 week. Chondrocyte survival was assessed by confocal imaging, while the cellular response was evaluated over 1 week by relative gene expression for apoptotic and inflammatory markers and mediator release into the medium. RESULTS The full-thickness cartilage cut resulted in a confined zone of cell death that mainly affected superficial zone chondrocytes. Injured samples that were exposed to hyperosmolar saline showed less expansion of cell death in both the axial (P < .007) and the coronal (P < .004) plane. There was no progression of cell death during the following week of culture. Histological assessment revealed an intact cartilage matrix and normal chondrocyte morphology. Inflammatory and proapoptotic genes were upregulated on the first days postexposure with a notable downregulation toward day 7. Mediator release into the medium was concentrated on day 3. CONCLUSION This in vitro cartilage injury model provides further evidence for the chondroprotective effect of a hyperosmolar saline irrigation fluid, as well as novel data on the capability of articular cartilage to quickly regain joint homeostasis after osmotic stress and injury. CLINICAL RELEVANCE Raising the osmolarity of an irrigating solution may be a simple and safe strategy to protect articular cartilage during arthroscopic surgery.
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Affiliation(s)
- Clemens Unterguggenberger
- AO Research Institute Davos, Davos Platz, Switzerland
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | | | - Gian M Salzmann
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
- Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland
| | | | - Sibylle Grad
- AO Research Institute Davos, Davos Platz, Switzerland
| | - Hagen Schmal
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Eva Johanna Kubosch
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
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4
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Govindaraj K, Meteling M, van Rooij J, Becker M, van Wijnen AJ, van den Beucken JJJP, Ramos YFM, van Meurs J, Post JN, Leijten J. Osmolarity-Induced Altered Intracellular Molecular Crowding Drives Osteoarthritis Pathology. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2306722. [PMID: 38213111 PMCID: PMC10953583 DOI: 10.1002/advs.202306722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/08/2023] [Indexed: 01/13/2024]
Abstract
Osteoarthritis (OA) is a multifactorial degenerative joint disease of which the underlying mechanisms are yet to be fully understood. At the molecular level, multiple factors including altered signaling pathways, epigenetics, metabolic imbalance, extracellular matrix degradation, production of matrix metalloproteinases, and inflammatory cytokines, are known to play a detrimental role in OA. However, these factors do not initiate OA, but are mediators or consequences of the disease, while many other factors causing the etiology of OA are still unknown. Here, it is revealed that microenvironmental osmolarity can induce and reverse osteoarthritis-related behavior of chondrocytes via altered intracellular molecular crowding, which represents a previously unknown mechanism underlying OA pathophysiology. Decreased intracellular crowding is associated with increased sensitivity to proinflammatory triggers and decreased responsiveness to anabolic stimuli. OA-induced lowered intracellular molecular crowding could be renormalized via exposure to higher extracellular osmolarity such as those found in healthy joints, which reverse OA chondrocyte's sensitivity to catabolic stimuli as well as its glycolytic metabolism.
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Affiliation(s)
- Kannan Govindaraj
- Department of Developmental BioengineeringFaculty of Science and Technology, Technical Medical CentreUniversity of TwenteDrienerlolaan 5Enschede7522NBThe Netherlands
| | - Marieke Meteling
- Department of Developmental BioengineeringFaculty of Science and Technology, Technical Medical CentreUniversity of TwenteDrienerlolaan 5Enschede7522NBThe Netherlands
| | - Jeroen van Rooij
- Department of Internal MedicineErasmus MCDr. Molewaterplein 40Rotterdam3015GDThe Netherlands
| | - Malin Becker
- Department of Developmental BioengineeringFaculty of Science and Technology, Technical Medical CentreUniversity of TwenteDrienerlolaan 5Enschede7522NBThe Netherlands
| | | | | | - Yolande F. M. Ramos
- Department of Biomedical Data SciencesSection Molecular EpidemiologyLUMCEinthovenweg 20Leiden2333 ZCThe Netherlands
| | - Joyce van Meurs
- Department of Internal MedicineErasmus MCDr. Molewaterplein 40Rotterdam3015GDThe Netherlands
- Department of Orthopedics & Sports MedicineErasmus MCDr. Molewaterplein 40Rotterdam3015GDThe Netherlands
| | - Janine N. Post
- Department of Developmental BioengineeringFaculty of Science and Technology, Technical Medical CentreUniversity of TwenteDrienerlolaan 5Enschede7522NBThe Netherlands
| | - Jeroen Leijten
- Department of Developmental BioengineeringFaculty of Science and Technology, Technical Medical CentreUniversity of TwenteDrienerlolaan 5Enschede7522NBThe Netherlands
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5
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Hlas A, Ganesh V, Marks J, He R, Salem AK, Buckwalter JA, Duchman KR, Shin K, Martin JA, Seol D. Buffering Mitigates Chondrocyte Oxidative Stress, Metabolic Dysfunction, and Death Induced by Normal Saline: Formulation of a Novel Arthroscopic Irrigant. Int J Mol Sci 2024; 25:1286. [PMID: 38279286 PMCID: PMC10816598 DOI: 10.3390/ijms25021286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
For decades, surgeons have utilized 0.9% normal saline (NS) for joint irrigation to improve visualization during arthroscopic procedures. This continues despite mounting evidence that NS exposure impairs chondrocyte metabolism and compromises articular cartilage function. We hypothesized that chondrocyte oxidative stress induced by low pH is the dominant factor driving NS toxicity, and that buffering NS to increase its pH would mitigate these effects. Effects on chondrocyte viability, reactive oxygen species (ROS) production, and overall metabolic function were assessed. Even brief exposure to NS caused cell death, ROS overproduction, and disruption of glycolysis, pentose phosphate, and tricarboxylic acid (TCA) cycle pathways. NS also stimulated ROS overproduction in synovial cells that could adversely alter the synovial function and subsequently the entire joint health. Buffering NS with 25 mM 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid (HEPES) significantly increased chondrocyte viability, reduced ROS production, and returned metabolite levels to near control levels while also reducing ROS production in synovial cells. These results confirm that chondrocytes and synoviocytes are vulnerable to insult from the acidic pH of NS and demonstrate that adding a buffering agent to NS averts many of its most harmful effects.
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Affiliation(s)
- Arman Hlas
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA;
| | - Venkateswaran Ganesh
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (V.G.); (J.M.); (J.A.B.); (K.R.D.)
- Roy J. Carver Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Jaison Marks
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (V.G.); (J.M.); (J.A.B.); (K.R.D.)
- Roy J. Carver Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Rui He
- Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA; (R.H.); (A.K.S.)
| | - Aliasger K. Salem
- Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA; (R.H.); (A.K.S.)
| | - Joseph A. Buckwalter
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (V.G.); (J.M.); (J.A.B.); (K.R.D.)
| | - Kyle R. Duchman
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (V.G.); (J.M.); (J.A.B.); (K.R.D.)
| | - Kyungsup Shin
- Department of Orthodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA 52242, USA;
| | - James A. Martin
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (V.G.); (J.M.); (J.A.B.); (K.R.D.)
- Roy J. Carver Department of Biomedical Engineering, College of Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Dongrim Seol
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (V.G.); (J.M.); (J.A.B.); (K.R.D.)
- Department of Orthodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA 52242, USA;
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6
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Oladeji LO, Stannard JP, Smith MJ, Ma R, Skelley NW, Sherman SL, Cook JL. Prospective Randomized Controlled Clinical Trial Comparing Hyperosmolar Saline to Standard Isotonic Irrigation Fluid for Arthroscopic Knee Surgery: Initial Clinical Outcomes. J Knee Surg 2022. [PMID: 35688444 DOI: 10.1055/s-0042-1749655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Numerous in vitro studies suggest higher osmolarity irrigation fluids potentiate a chondroprotective environment, and a recent clinical study using hyperosmolar saline for shoulder arthroscopy reported potential clinical advantages. This prospective randomized double-blind controlled clinical trial was designed to assess initial clinical outcomes associated with use of a hyperosmolar irrigation solution in patients undergoing arthroscopic knee surgery. With institutional review board approval and informed consent, patients scheduled for arthroscopic knee surgery were randomized to surgery with either isotonic lactated Ringer's (273 mOsm/L) or hyperosmolar saline (593 mOsm/L) irrigation solution. Outcomes included perioperative blood pressure, knee girth, visual analogue scale (VAS) pain scores, and narcotic pain medication consumption. Forty-six patients underwent arthroscopic knee surgery with isotonic (n = 23) or hyperosmolar (n = 23) irrigation fluids. There were 11 males and 12 females (mean age = 44.0 years) in the isotonic cohort and 8 males and 15 females (mean age = 40.2 years) in the hyperosmolar cohort. There were no significant differences with respect to surgical duration (pump time) or amount of irrigation fluid used between the two cohorts. There were no significant differences with respect to change in knee girth, blood pressure, or VAS pain scores. However, patients treated with hyperosmolar saline consumed less narcotic medication on postoperative day 3 (4.0 ± 7.6 vs. 15.5 ± 17.4 mg, p = 0.01). The results of this randomized clinical trial suggest that a hyperosmolar irrigation solution is safe and relatively inexpensive for use in patients undergoing arthroscopic knee surgery and contributes to a reduction in initial postoperative narcotic pain medication consumption. A hyperosmolar saline irrigation fluid was not associated with any detrimental effects on the execution of the surgical procedure, postoperative pain, or periarticular fluid extravasation. Taken together with previous basic science, translational, and clinical studies, hyperosmolar saline irrigation fluid is promising alternative to traditional isotonic irrigation fluids for knee arthroscopy. This study is a prospective trial and reflects level of evidence I.
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Affiliation(s)
- Lasun O Oladeji
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Matthew J Smith
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Richard Ma
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Nathan W Skelley
- Sanford Health Orthopaedics and Sports Medicine, University of South Dakota Medical Center, Sioux Falls, South Dakota
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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7
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Arabiyat AS, Chen H, Erndt-Marino J, Burkhard K, Scola L, Fleck A, Wan LQ, Hahn MS. Hyperosmolar Ionic Solutions Modulate Inflammatory Phenotype and sGAG Loss in a Cartilage Explant Model. Cartilage 2021; 13:713S-721S. [PMID: 32975437 PMCID: PMC8804856 DOI: 10.1177/1947603520961167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the effects of hyperosmolar sodium (Na+), lithium (Li+) and potassium (K+) on catabolic and inflammatory osteoarthritis (OA) markers and sulfated glycosaminoglycan (sGAG) loss in TNF-α-stimulated cartilage explants. METHODS Explants from bovine stifle joints were stimulated with TNF-α for 1 day to induce cartilage degradation followed by supplementation with 50 mM potassium chloride (KCl), 50 mM lithium chloride (LiCl), 50 mM sodium chloride (NaCl), or 100 nM dexamethasone for an additional 6 days. We assessed the effect of TNF-α stimulation and hyperosmolar ionic treatment on sGAG loss and expression of OA-associated proteins: ADAMTS-5, COX-2, MMP-1, MMP-13, and VEGF. RESULTS TNF-α treatment increased sGAG loss (P < 0.001) and expression of COX-2 (P = 0.018), MMP-13 (P < 0.001), and VEGF (P = 0.017) relative to unstimulated controls. Relative to activated controls, LiCl and dexamethasone treatment attenuated sGAG loss (P = 0.008 and P = 0.042, respectively) and expression of MMP-13 (P = 0.005 and P = 0.036, respectively). In contrast, KCl treatment exacerbated sGAG loss (P = 0.032) and MMP-1 protein expression (P = 0.010). NaCl treatment, however, did not alter sGAG loss or expression of OA-related proteins. Comparing LiCl and KCl treatment shows a potent reduction (P < 0.05) in catabolic and inflammatory mediators following LiCl treatment. CONCLUSION These results suggest that these ionic species elicit varying responses in TNF-α-stimulated explants. Cumulatively, these findings support additional studies of hyperosmolar ionic solutions for potential development of novel intraarticular injections targeting OA.
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Affiliation(s)
- Ahmad S. Arabiyat
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute (RPI), Troy, NY, USA
- Center for Biotechnology and
Interdisciplinary Studies, Rensselaer Polytechnic Institute (RPI), Troy, NY,
USA
| | - Hongyu Chen
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute (RPI), Troy, NY, USA
- Center for Biotechnology and
Interdisciplinary Studies, Rensselaer Polytechnic Institute (RPI), Troy, NY,
USA
| | - Josh Erndt-Marino
- Department of Biomedical Engineering,
Tufts University, Medford, MA, USA
| | - Katie Burkhard
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute (RPI), Troy, NY, USA
| | - Lisa Scola
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute (RPI), Troy, NY, USA
| | - Allison Fleck
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute (RPI), Troy, NY, USA
- Center for Biotechnology and
Interdisciplinary Studies, Rensselaer Polytechnic Institute (RPI), Troy, NY,
USA
| | - Leo Q. Wan
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute (RPI), Troy, NY, USA
- Center for Biotechnology and
Interdisciplinary Studies, Rensselaer Polytechnic Institute (RPI), Troy, NY,
USA
| | - Mariah S. Hahn
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute (RPI), Troy, NY, USA
- Center for Biotechnology and
Interdisciplinary Studies, Rensselaer Polytechnic Institute (RPI), Troy, NY,
USA
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8
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Styczynska-Soczka K, Amin AK, Simpson AHW, Hall AC. Optimization and Validation of a Human Ex Vivo Femoral Head Model for Preclinical Cartilage Research and Regenerative Therapies. Cartilage 2021; 13:386S-397S. [PMID: 32567330 PMCID: PMC8721618 DOI: 10.1177/1947603520934534] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Articular cartilage is incapable of effective repair following injury or during osteoarthritis. While there have been developments in cartilage repair technologies, there is a need to advance biologically relevant models for preclinical testing of biomaterial and regenerative therapies. This study describes conditions for the effective ex vivo culture of the whole human femoral head. DESIGN Fresh, viable femoral heads were obtained from femoral neck fractures and cultured for up to 10 weeks in (a) Dulbecco's modified Eagle's medium (DMEM); (b) DMEM + mixing; (c) DMEM + 10% human serum (HS); (d) DMEM + 10% HS + mixing. The viability, morphology, volume, and density of fluorescently labelled in situ chondrocytes and cartilage surface roughness were assessed by confocal microscopy. Cartilage histology was studied for glycosaminoglycan content using Alcian blue and collagen content using picrosirius red. RESULTS Chondrocyte viability remained at >95% in DMEM + 10% HS. In DMEM alone, viability remained high for ~4 weeks and then declined. For the other conditions, superficial zone chondrocyte viability fell to <35% at 10 weeks with deeper zones being relatively unaffected. In DMEM + 10% HS at 10 weeks, the number of chondrocytes possessing cytoplasmic processes increased compared with DMEM (P = 0.017). Alcian blue labeling decreased (P = 0.02) and cartilage thinned (P ≤ 0.05); however, there was no change to surface roughness, chondrocyte density, chondrocyte volume, or picrosirius red labeling (P > 0.05). CONCLUSIONS In this ex vivo model, chondrocyte viability was maintained in human femoral heads for up to 10 weeks in culture, a novel finding not previously reported. This human model could prove invaluable for the exploration, development, and assessment of preclinical cartilage repair and regenerative therapies.
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Affiliation(s)
| | - Anish K. Amin
- Department of Trauma and Orthopaedic
Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - A. Hamish W. Simpson
- Department of Trauma and Orthopaedic
Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Andrew C. Hall
- Biomedical Sciences, Edinburgh Medical
School, University of Edinburgh, Edinburgh, Scotland, UK,Andrew C. Hall, Biomedical Sciences,
Edinburgh Medical School, University of Edinburgh, Hugh Robson Building, George
Square, Edinburgh, EH8 9XD, Scotland, UK.
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9
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Amin AK, Hall AC. Editorial Commentary: Raising the Osmolarity of Arthroscopic Irrigating Solutions May Be Chondroprotective: We Must Be Kind to Joints During Arthroscopy! Arthroscopy 2020; 36:3058-3060. [PMID: 33276892 DOI: 10.1016/j.arthro.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023]
Abstract
The irrigation of joints during arthroscopic procedures typically uses a non-physiological solution. This replaces the natural synovial fluid and rapidly subjects the connective tissues to an alien hypo-osmotic environment in which cartilage cells are far more sensitive to iatrogenic injury. Raising the osmolarity of the irrigating solution may be a simple, safe, and effective chondroprotective strategy.
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10
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Oladeji LO, Stoker AM, Stannard JP, Cook JL. Use of a Hyperosmolar Saline Solution to Mitigate Proinflammatory and Degradative Responses of Articular Cartilage and Meniscus for Application to Arthroscopic Surgery. Arthroscopy 2020; 36:3050-3057. [PMID: 32693010 DOI: 10.1016/j.arthro.2020.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/01/2020] [Accepted: 07/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study was designed to evaluate differences in proinflammatory and degradative mediator production and extracellular matrix degradation from osteoarthritic knee articular cartilage and meniscus explants treated with either hyperosmolar saline or isotonic saline. METHODS 6 mm-diameter full-thickness explants were created from articular cartilage and menisci recovered after patients underwent knee surgery. One explant half was treated for 3 hours with hyperosmolar saline (600 mOsm/L) and the corresponding half with isotonic saline (300 mOsm/L). Explants were subsequently cultured for 3 days in tissue culture media. On day 3, media were collected for biomarker analyses. Results were normalized to tissue wet weight and analyzed statistically. RESULTS Articular cartilage was collected from 10 patients (5 male, 5 female; mean age = 66.9 years) and menisci were collected from 8 patients (2 male, 6 female; mean age = 66 years). Articular cartilage media concentrations of monocyte chemoattractant protein-1 (P = .001) and interleukin (IL)-6 (P = .049) were significantly lower in explants treated with hyperosmolar saline. Meniscus media concentrations of prostaglandin E2 (P = .008), monocyte chemoattractant protein-1 (P = .011), IL-6 (P = .029), IL-8 (P = .012), matrix metalloproteinase-2 (P = .011), and glycosaminoglycan (P = .008) were significantly lower in explants treated with hyperosmolar saline. CONCLUSIONS Treatment of cartilage and meniscus explants with hyperosmolar saline effectively mitigated key proinflammatory mediator production, as well as degradative mediator production and glycosaminoglycan loss from meniscus, with no detrimental effects noted compared to isotonic saline. CLINICAL RELEVANCE These results suggest that hyperosmolar saline irrigation fluid may provide a safe alternative to standard isotonic saline irrigation fluid, and could mitigate untoward effects associated with inflammatory responses after standard-of-care knee arthroscopy.
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Affiliation(s)
- Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A..
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Compton J, Slattery M, Coleman M, Westermann R. Iatrogenic Articular Cartilage Injury in Arthroscopic Hip and Knee Videos and the Potential for Cartilage Cell Death When Simulated in a Bovine Model. Arthroscopy 2020; 36:2114-2121. [PMID: 32145300 PMCID: PMC9126109 DOI: 10.1016/j.arthro.2020.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the incidence and characterize the severity of iatrogenic cartilage injuries. METHODS Technique videos of arthroscopic femoral acetabular impingement procedures and meniscus repairs on VuMedi (n = 85) and Arthroscopy Techniques (n = 45) were reviewed and iatrogenic cartilage injuries were identified and graded (minor, intermediate, and major injury) by 2 independent reviewers. To demonstrate that even minor injuries on a cellular scale result in damage, a bovine osteochondral explant was used to create comparable minor iatrogenic injuries at varied forces that do not disrupt the articular surface (1.5 N, 2.5 N, and 9.8 N). Dead chondrocytes at the site of injury were stained with ethidium homodimer-2 and imaged with an Olympus FV1000 confocal microscope. χ2 tests were used for analysis; all results with P < .05 were considered significant. RESULTS In total, 130 videos of arthroscopic meniscus and femoral acetabular impingement procedures were analyzed and the incidence of iatrogenic cartilage injury was 73.8%. There were 110 (70.0%) minor, 35 (22.3%) intermediate, and 11 (7.0%) major iatrogenic injuries. All forces tested in the minor injury bovine model resulted in chondrocyte death at the site of contact. CONCLUSIONS Iatrogenic articular cartilage injuries are common in arthroscopy, occurring in more than 70% of the surgeon-published instructional videos analyzed. At least some chondrocyte death occurs with minor simulated iatrogenic injuries (1.5 N). CLINICAL RELEVANCE The high rate of cartilage damage during arthroscopic technique videos likely under-represents the true incidence in clinical practice. Cell death occurs in the bovine minor injury model with minimal contact forces. This suggests iatrogenic cartilage damage during arthroscopy could contribute to clinical outcomes.
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Affiliation(s)
- Jocelyn Compton
- University of Iowa Hospitals and Clinics, Department of Orthopedic Surgery, 200 Hawkins Drive, Iowa City, IA 52242
| | - Michael Slattery
- Roy J and Lucille A Carver College of Medicine, 375 Newton Rd, Iowa City, IA 52242, Site of Research:University of Iowa Hospitals and Clinics, Department of Orthopedic Surgery, 200 Hawkins Drive, Iowa City, IA 52242
| | - Mitchell Coleman
- University of Iowa Hospitals and Clinics, Department of Orthopedic Surgery, 200 Hawkins Drive, Iowa City, IA 52242
| | - Robert Westermann
- University of Iowa Hospitals and Clinics, Department of Orthopedic Surgery, 200 Hawkins Drive, Iowa City, IA 52242
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12
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Erndt-Marino J, Yeisley DJ, Chen H, Levin M, Kaplan DL, Hahn MS. Interferon-Gamma Stimulated Murine Macrophages In Vitro: Impact of Ionic Composition and Osmolarity and Therapeutic Implications. Bioelectricity 2020; 2:48-58. [PMID: 32292895 PMCID: PMC7107958 DOI: 10.1089/bioe.2019.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Injections of osmolytes are promising immunomodulatory treatments for medical benefit, although the rationale and underlying mechanisms are often lacking. The goals of the present study were twofold: (1) to clarify the anti-inflammatory role of the potassium ion and (2) to begin to decouple the effects that ionic strength, ionic species, and osmolarity have on macrophage biology. Materials and Methods: RAW 264.7 murine macrophages were encapsulated in three-dimensional, poly(ethylene glycol) diacrylate hydrogels and activated with interferon-gamma to yield M(IFN). Gene and protein profiles were made of M(IFN) exposed to different hyperosmolar treatments (80 mM potassium gluconate, 80 mM sodium gluconate, and 160 mM sucrose). Results: Relative to M(IFN), all hyperosmolar treatments suppressed expression of pro-inflammatory markers (nitric oxide synthase-2 [NOS-2], tumor necrosis factor-alpha, monocyte chemoattractant protein-1 [MCP-1]) and increased messenger RNA (mRNA) expression of the pleiotropic and angiogenic markers interleukin-6 (IL-6) and vascular endothelial growth factor-A (VEGF), respectively. Ionic osmolytes also demonstrated a greater level of change compared to the nonionic treatments, with mRNA levels of IL-6 the most significantly affected. M(IFN) exposed to K+ exhibited the lowest levels of NOS-2 and MCP-1, and this ion limited IL-6 release induced by osmolarity. Conclusion: Cumulatively, these data suggest that osmolyte composition, ionic strength, and osmolarity are all parameters that can influence therapeutic outcomes. Future work is necessary to further decouple and mechanistically understand the influence that these biophysical parameters have on cell biology, including their impact on other macrophage functions, intracellular osmolyte composition, and cellular and organellular membrane potentials.
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Affiliation(s)
- Joshua Erndt-Marino
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts
- Department of Biology, Allen Discovery Center at Tufts University, Tufts University, Medford, Massachusetts
| | - Daniel J. Yeisley
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | - Hongyu Chen
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
| | - Michael Levin
- Department of Biology, Allen Discovery Center at Tufts University, Tufts University, Medford, Massachusetts
| | - David L. Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts
- Department of Biology, Allen Discovery Center at Tufts University, Tufts University, Medford, Massachusetts
| | - Mariah S. Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York
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Henderson E, Clements DN, Johnson CI. An in vitro study of the effect of the optimal irrigation solution conditions during canine articular surgery. Vet Res Commun 2019; 44:1-7. [PMID: 31788728 DOI: 10.1007/s11259-019-09765-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 09/13/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To establish whether chondrocyte viability, matrix degradation and the induction of proteolytic gene expression in canine cartilage is independent of irrigation fluid osmolality and time following exposure to the irrigation fluid. METHODS Canine cartilage explants were exposed to one of three different solution types i) Culture medium (270-280 mOsmol/kg) ii) NaCl 0.9% (302 mOsmol/kg) iii) NaCl 0.9% with sucrose (600 mOsmol/kg). Chondrocyte viability and selected proteolytic gene expression were measured at two time points; immediately following exposure and 24 h following exposure. The media samples at 24 h following exposure were assessed for sulphated glycosaminoglycan (sGAG) release. RESULTS In all samples, no cell death was observed across the superficial or deeper layers of the cartilage. When adjusting for time, gene expression was not shown to be dependent on solution type. However for all solution types, Matrix Metalloproteinase 13 (MMP13) and A Disintegrin and Metalloproteinase with Thrombospondin Motifs 5 (ADAMTS5) expression was significantly decreased in cartilage samples at 24 h post exposure comparatively to samples tested immediately post exposure. No significant differences were identified in the relative sGAG release between the solution types. CLINICAL SIGNIFCANCE Arthroscopic solution irrigation of cartilage explants had no effect on cell viability or proteinase production. At present there is no indication to optimise irrigation fluid osmolarity, as conventional arthroscopic solution was not deleterious to healthy cartilage in this model.
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Affiliation(s)
- E Henderson
- Lumbry Park Veterinary Specialists, Selborne Road, Alton, Hampshire, GU34 3HL, UK.
| | - D N Clements
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Roslin, EH25 9RG, UK
| | - C I Johnson
- Centre for Applied Anatomy, University of Bristol, Southwell Street, Bristol, BS2 8EJ, UK
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Erndt-Marino J, Trinkle E, Hahn MS. Hyperosmolar Potassium (K +) Treatment Suppresses Osteoarthritic Chondrocyte Catabolic and Inflammatory Protein Production in a 3-Dimensional In Vitro Model. Cartilage 2019; 10:186-195. [PMID: 28992763 PMCID: PMC6425543 DOI: 10.1177/1947603517734028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The main goal of this study was to provide a proof-of-concept demonstrating that hyperosmolar K+ solutions can limit production of catabolic and inflammatory mediators in human osteoarthritic chondrocytes (OACs). METHODS A 3-dimensional in vitro model with poly(ethylene glycol) diacrylate (PEGDA) hydrogels was used. Catabolic and pro-inflammatory protein production from encapsulated OACs was assessed following culture for 1 or 7 days in the presence or absence of 80 mM K+ gluconate, 80 mM sodium (Na+) gluconate, or 160 mM sucrose, each added to culture media (final osmolarity ~490 mOsm). RESULTS Relative to untreated controls, OACs treated with hyperosmolar (80 mM Na+ gluconate or 160 mM sucrose) solutions produced lower levels of catabolic and inflammatory mediators in a marker- and time-dependent manner (i.e., MMP-9 after 1 day; MCP-1 after 7 days ( P ≤ 0.015)). In contrast, OAC treatment with 80 mM K+ gluconate reduced catabolic and inflammatory mediators to a greater extent (both the number of markers and degree of suppression) relative to untreated, Na+ gluconate, or sucrose controls (i.e., MMP-3, -9, -13, TIMP-1, MCP-1, and IL-8 after 1 day; MMP-1, -3, -9, -13, TIMP-1, MCP-1, and IL-8 after 7 days ( P ≤ 0.029). CONCLUSIONS Hyperosmolar K+ solutions are capable of attenuating protein production of catabolic and inflammatory OA markers, providing the proof-of-concept needed for further development of a K+-based intra-articular injection for OA treatment. Moreover, K+ performed significantly better than Na+- or sucrose-based solutions, supporting the application of K+ toward improving irrigation solutions for joint surgery.
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Affiliation(s)
- Josh Erndt-Marino
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Erik Trinkle
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Mariah S. Hahn
- Department of Biomedical Engineering,
Rensselaer Polytechnic Institute, Troy, NY, USA,Mariah S. Hahn, Department of Biomedical
Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180,
USA.
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Sardana V, Burzynski J, Scuderi GR. The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review. J Orthop 2019; 16:158-165. [PMID: 30886464 DOI: 10.1016/j.jor.2019.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 02/17/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Arthroscopic surgery has become an important and popular orthopedic procedure for numerous joint disorders. Continuous irrigation is performed to replace synovial fluid for optimal joint distension and clear visualization of the synovial cavity. Irrigation solutions may, however, negatively impact articular cartilage and chondrocyte viability. This systematic review aims to compare different irrigating solutions and their properties to determine whether one is superior in its effects on articular cartilage and chondrocytes. Methods A systematic literature review was conducted. The online databases: Embase, Medline, HealthStar, Emcare and PubMed were searched from 1946 to August 2018. Methodological index for non-randomized studies (MINORS) was used to assess methodological quality of the included studies. Results Sixteen studies met the inclusion/exclusion criteria and were included in this review. Although the studies used different criteria to define superiority, solution superiority was based on results that focused on articular cartilage and chondrocyte viability. Seven of the sixteen included studies compared Ringer's/lactate solution or Ringer's lactate to normal saline. Three found Ringer's solution or Ringer's lactate to be superior to saline, whereas, three studies found no significant differences and one study found Ringer's lactate to be inferior to saline only when their osmolarities differed. Four studies compared ionic to non-ionic solutions. Two of the four studies demonstrated non-ionic solutions to be superior, one had demonstrated no significant differences between solutions, while one had mixed results. Six of the sixteen included studies compared differing osmolarities. One found no statistically significant differences between solutions of differing osmolarities, whereas, the remaining five studies found superiority with hyperosmolarity. Two of the sixteen included studies examined the effects of different temperatures. Both studies concluded that the use of a warmer (more physiological) temperature is more ideal. Two of the sixteen studies included in this review compared solutions with differing pH levels. Both studies concluded on the importance of utilizing the more physiological solutions for arthroscopic procedures. Conclusion Ringer's Lactate and Ringer's Solution as well as non-ionic solutions may have merit over the use of the normal saline for irrigation. Hyperosmolarity, warmer solutions and ones with more physiological pH values may be beneficial when considering potential effects on articular cartilage and chondrocytes. The current review demonstrated trends found in the current literature, which require human studies - preferably high quality RCTs -to make recommendations that aid surgeons in making the best decision regarding the ideal irrigation solution to use on their patients. Level of evidence Level IV, Systematic review of Level IV studies.
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Affiliation(s)
- Vandit Sardana
- Lenox Hill Hospital, 100 East 77th Street, 11th Floor, New York, NY, 10075, USA
| | - Joanna Burzynski
- School of Rehabilitation Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Giles R Scuderi
- Lenox Hill Hospital, 100 East 77th Street, 11th Floor, New York, NY, 10075, USA
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Lin YC, Hall AC, Simpson AHRW. A novel organ culture model of a joint for the evaluation of static and dynamic load on articular cartilage. Bone Joint Res 2018; 7:205-212. [PMID: 29922437 PMCID: PMC5987700 DOI: 10.1302/2046-3758.73.bjr-2017-0320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The purpose of this study was to create a novel ex vivo organ culture model for evaluating the effects of static and dynamic load on cartilage. METHODS The metatarsophalangeal joints of 12 fresh cadaveric bovine feet were skinned and dissected aseptically, and cultured for up to four weeks. Dynamic movement was applied using a custom-made machine on six joints, with the others cultured under static conditions. Chondrocyte viability and matrix glycosaminoglycan (GAG) content were evaluated by the cell viability probes, 5-chloromethylfluorescein diacetate (CMFDA) and propidium iodide (PI), and dimethylmethylene blue (DMMB) assay, respectively. RESULTS Chondrocyte viability in the static model decreased significantly from 89.9% (sd 2.5%) (Day 0) to 66.5% (sd 13.1%) (Day 28), 94.7% (sd 1.1%) to 80. 9% (sd 5.8%) and 80.1% (sd 3.0%) to 46.9% (sd 8.5%) in the superficial quarter, central half and deep quarter of cartilage, respectively (p < 0.001 in each zone; one-way analysis of variance). The GAG content decreased significantly from 6.01 μg/mg (sd 0.06) (Day 0) to 4.71 μg/mg (sd 0.06) (Day 28) (p < 0.001; one-way analysis of variance). However, with dynamic movement, chondrocyte viability and GAG content were maintained at the Day 0 level over the four-week period without a significant change (chondrocyte viability: 92.0% (sd 4.0%) (Day 0) to 89.9% (sd 0.2%) (Day 28), 93.1% (sd 1.5%) to 93.8% (sd 0.9%) and 85.6% (sd 0.8%) to 84.0% (sd 2.9%) in the three corresponding zones; GAG content: 6.18 μg/mg (sd 0.15) (Day 0) to 6.06 μg/mg (sd 0.09) (Day 28)). CONCLUSION Dynamic joint movement maintained chondrocyte viability and cartilage GAG content. This long-term whole joint culture model could be of value in providing a more natural and controlled platform for investigating the influence of joint movement on articular cartilage, and for evaluating novel therapies for cartilage repair.Cite this article: Y-C. Lin, A. C. Hall, A. H. R. W. Simpson. A novel organ culture model of a joint for the evaluation of static and dynamic load on articular cartilage. Bone Joint Res 2018;7:205-212. DOI: 10.1302/2046-3758.73.BJR-2017-0320.
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Affiliation(s)
- Y-C. Lin
- Department of Orthopaedic Surgery, University of Edinburgh, The Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK and Taipei Medical University-Shuang Ho Hospital, Zhonghe District, New Taipei City, 23561, Taiwan
| | - A. C. Hall
- Centre for Integrative Physiology, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh EH8 9XD, UK
| | - A. H. R. W. Simpson
- Department of Orthopaedics, University of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
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17
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Lin YC, Hall AC, Smith IDM, Salter DM, Simpson AHRW. Mapping Chondrocyte Viability, Matrix Glycosaminoglycan, and Water Content on the Surface of a Bovine Metatarsophalangeal Joint. Cartilage 2016; 7:193-203. [PMID: 27047642 PMCID: PMC4797237 DOI: 10.1177/1947603515613848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine if there were variations in chondrocyte viability, matrix glycosaminoglycan (GAG), and water content between different areas of the articular surface of a bovine metatarsophalangeal joint, a common and reliable source of articular cartilage for experimental study, which may compromise the validity of using multiple samples from different sites within the joint. METHODS Nine fresh cadaveric bovine metatarsophalangeal joints were obtained. From each joint, 16 osteochondral explants were taken from 4 facets, yielding a total of 144 cartilage specimens for evaluation of chondrocyte viability, matrix GAG, and water content. A less invasive method for harvesting osteochondral explants and for processing the biopsy for the assessment of chondrocyte viability was developed, which maintained maximal viability within each cartilage explant. RESULTS There was no significant difference between the 16 biopsy sites from the different areas of the joint surface with respect to chondrocyte viability, matrix GAG and water content. Pooled data of all samples from each joint established the baseline values of chondrocyte viability to be 89.4% ± 3.8%, 94.4% ± 2.2%, and 77.9% ± 7.8%, in the superficial quarter, central half, and deep quarter (with regard to depth from the articular surface), respectively. The matrix GAG content of bovine articular cartilage was 6.06 ± 0.41 μg/mg cartilage, and the cartilage water content was 72.4% ± 1.5%. There were also no significant differences of these 3 variables between the different joints. CONCLUSION It is thus reasonable to compare biopsies obtained from different sites, as a biopsy from one site would be considered representative of the whole joint.
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Affiliation(s)
- Yi-Cheng Lin
- Department of Orthopaedic and Trauma Surgery, The University of Edinburgh, Edinburgh, UK,Department of Orthopedic Surgery, Taipei Medical University – Shuang Ho Hospital, New Taipei City, Taiwan,Yi-Cheng Lin, Department of Orthopedic Surgery, Taipei Medical University – Shuang Ho Hospital, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
| | - Andrew C. Hall
- Centre for Integrative Physiology, The University of Edinburgh, Edinburgh, UK
| | - Innes D. M. Smith
- Centre for Integrative Physiology, The University of Edinburgh, Edinburgh, UK
| | - Donald M. Salter
- Department of Pathology, The University of Edinburgh, Edinburgh, UK
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The use of hyperosmotic saline for chondroprotection: implications for orthopaedic surgery and cartilage repair. Osteoarthritis Cartilage 2015; 23:469-77. [PMID: 25497864 DOI: 10.1016/j.joca.2014.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/11/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Articular cartilage may experience iatrogenic injury during routine orthopaedic/arthroscopic procedures. This could cause chondrocyte death, leading to cartilage degeneration and posttraumatic osteoarthritis. In an in vitro cartilage injury model, chondrocyte death was reduced by increasing the osmolarity of normal saline (NS), the most commonly-used irrigation solution. Here, we studied the effect of hyperosmolar saline (HS) on chondrocyte viability and cartilage repair in an in vivo injury model. DESIGN Cartilage injury was induced by a single scalpel cut along the patellar groove of 8 week old rats in the absence of irrigation or with either NS (300 mOsm) or HS (600 mOsm). The percentage of cell death (PCD) within the injured area was assessed using confocal microscopy. Repair from injury was evaluated by histology/immunostaining, and inflammatory response by histology, cytokine array analysis and ELISA (enzyme-linked immunosorbent assay). RESULTS The PCD in saline-irrigated joints was increased compared to non-irrigated (NI) joints [PCD = 20.8% (95%CI; 14.5, 27.1); PCD = 9.14% (95%CI; 6.3, 11.9); P = 0.0017]. However, hyperosmotic saline reduced chondrocyte death compared to NS (PCD = 10.4% (95%CI; 8.5, 12.3) P = 0.0024). Repair score, type II collagen and aggrecan levels, and injury width, were significantly improved with hyperosmotic compared to NS. Mild synovitis and similar changes in serum cytokine profile occurred in all operated joints irrespective of experimental group. CONCLUSIONS Hyperosmotic saline significantly reduced the chondrocyte death associated with scalpel-induced injury and enhanced cartilage repair. This irrigation solution might be useful as a simple chondroprotective strategy and may also reduce unintentional cartilage injury during articular reconstructive surgery and promote integrative cartilage repair, thereby reducing the risk of posttraumatic osteoarthritis.
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Huang Y, Zhang Y, Ding X, Liu S, Sun T. Osmolarity influences chondrocyte repair after injury in human articular cartilage. J Orthop Surg Res 2015; 10:19. [PMID: 25626354 PMCID: PMC4326434 DOI: 10.1186/s13018-015-0158-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 01/08/2015] [Indexed: 11/14/2022] Open
Abstract
Background The purpose was to determine the influence of irrigation solution osmolarity on articular chondrocytes survival and metabolic state following mechanical injury. Methods Osteochondral explants were harvested from patients undergoing total knee arthroplasty for osteoarthritis and then cut through their full thickness to establish mechanical injury models. Cartilage explants were incubated in irrigation solutions (saline and balanced salt) with different osmolarities (180, 280, 380, 580 mOsm/L) for 2 h. The percentage of cell death (100 × number of dead cells/number of dead and live cells) was quantified with the laser confocal microscopy. The terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay was performed to detect apoptosis index of injured cartilage. The contents of proteoglycan elution were determined by spectrophotometer at 530 nm, and HIF-1α and type II collagen mRNA yields were quantified with real-time PCR. Results In situ dead chondrocytes were mainly localized to the superficial tangential region of injured cartilage edge after mechanical injury. The percentage of cell death was decreased, and proteoglycan elution was gradually reduced with the increasing of osmolarity. The apoptosis indices of TUNEL assay in different osmolarities had no significant difference (P = 0.158). HIF-1α and type II collagen mRNA yields were the least for chondrocytes exposed to 180 mOsm/L medium and were the greatest for chondrocytes exposed to 380 mOsm/L medium. Compared with the saline group, the cell death of superficial zone was significantly decreased (P = 0.001) and contents of proteoglycan elution were also significantly decreased (P = 0.045) in the balanced salt. HIF-1α (P = 0.017) and type II collagen (P = 0.034) mRNA yields in the chondrocytes exposed to the balanced salt were significantly more than the saline group. Conclusion The osmolarity of irrigation solutions plays an important role in the survival and metabolic state of chondrocytes following mechanical injury, and the chondrocyte death is not caused by apoptosis. Increasing osmolarity of irrigation solutions may be chondroprotective with decreasing the chondrocyte death, reducing inhibition of metabolism and proteoglycan elution, ultimately preventing cartilage degeneration and promoting integrative repair.
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Affiliation(s)
- Yuelong Huang
- Arthritis Clinic and Research Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Yujun Zhang
- Clinic Molecular Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Xiaoquan Ding
- Arthritis Clinic and Research Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Songyang Liu
- Arthritis Clinic and Research Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Tiezheng Sun
- Arthritis Clinic and Research Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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Synergy between Piezo1 and Piezo2 channels confers high-strain mechanosensitivity to articular cartilage. Proc Natl Acad Sci U S A 2014; 111:E5114-22. [PMID: 25385580 DOI: 10.1073/pnas.1414298111] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Diarthrodial joints are essential for load bearing and locomotion. Physiologically, articular cartilage sustains millions of cycles of mechanical loading. Chondrocytes, the cells in cartilage, regulate their metabolic activities in response to mechanical loading. Pathological mechanical stress can lead to maladaptive cellular responses and subsequent cartilage degeneration. We sought to deconstruct chondrocyte mechanotransduction by identifying mechanosensitive ion channels functioning at injurious levels of strain. We detected robust expression of the recently identified mechanosensitive channels, PIEZO1 and PIEZO2. Combined directed expression of Piezo1 and -2 sustained potentiated mechanically induced Ca(2+) signals and electrical currents compared with single-Piezo expression. In primary articular chondrocytes, mechanically evoked Ca(2+) transients produced by atomic force microscopy were inhibited by GsMTx4, a PIEZO-blocking peptide, and by Piezo1- or Piezo2-specific siRNA. We complemented the cellular approach with an explant-cartilage injury model. GsMTx4 reduced chondrocyte death after mechanical injury, suggesting a possible therapy for reducing cartilage injury and posttraumatic osteoarthritis by attenuating Piezo-mediated cartilage mechanotransduction of injurious strains.
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Hindle P, Hall AC, Biant LC. Viability of chondrocytes seeded onto a collagen I/III membrane for matrix-induced autologous chondrocyte implantation. J Orthop Res 2014; 32:1495-502. [PMID: 25088008 DOI: 10.1002/jor.22701] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/30/2014] [Indexed: 02/04/2023]
Abstract
Cell viability is crucial for effective cell-based cartilage repair. The aim of this study was to determine the effect of handling the membrane during matrix-induced autologous chondrocyte implantation surgery on the viability of implanted chondrocytes. Images were acquired under five conditions: (i) Pre-operative; (ii) Handled during surgery; (iii) Cut edge; (iv) Thumb pressure applied; (v) Heavily grasped with forceps. Live and dead cell stains were used. Images were obtained for cell counting and morphology. Mean cell density was 6.60 × 10(5) cells/cm(2) (5.74-7.11 × 10(5) ) in specimens that did not have significant trauma decreasing significantly in specimens that had been grasped with forceps (p < 0.001) or cut (p = 0.004). Cell viability on delivery grade membrane was 75.1%(72.4-77.8%). This dropped to 67.4%(64.1-69.7%) after handling (p = 0.002), 56.3%(51.5-61.6%) after being thumbed (p < 0.001) and 28.8%(24.7-31.2%) after crushing with forceps (p < 0.001). When cut with scissors there was a band of cell death approximately 275 µm in width where cell viability decreased to 13.7%(10.2-18.2%, p < 0.001). Higher magnification revealed cells without the typical rounded appearance of chondrocytes. We found that confocal laser-scanning microscope (CLSM) can be used to quantify and image the fine morphology of cells on a matrix-induced autologous chondrocyte implantation (MACI) membrane. Careful handling of the membrane is essential to minimise chondrocyte death during surgery.
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Affiliation(s)
- Paul Hindle
- Department of Trauma and Orthopaedic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, The United Kingdom; Centre for Integrative Physiology, School of Biomedical Sciences, The University of Edinburgh, Edinburgh, Edinburgh, The United Kingdom
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Smith IDM, Winstanley JP, Milto KM, Doherty CJ, Czarniak E, Amyes SGB, Simpson AHRW, Hall AC. Rapid in situ chondrocyte death induced by Staphylococcus aureus toxins in a bovine cartilage explant model of septic arthritis. Osteoarthritis Cartilage 2013; 21:1755-65. [PMID: 23896315 DOI: 10.1016/j.joca.2013.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/29/2013] [Accepted: 07/17/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess in situ chondrocyte viability following exposure to a laboratory strain and clinical isolates of Staphylococcus aureus. METHODS Bovine cartilage explants were cultured in the presence of S. aureus 8325-4 (laboratory strain), clinical S. aureus isolates or non-infected culture medium of pH values 7.4, 6.4 and 5.4. All clinical isolates were isolated from the joint aspirates of patients presenting with S. aureus-induced septic arthritis (SA). At designated time points, in situ chondrocyte viability was assessed within defined regions-of-interest in the axial and coronal plane following live- and dead-cell image acquisition using the fluorescent probes 5-chloromethylfluorescein diacetate (CMFDA) and propidium iodide (PI), respectively, and confocal laser-scanning microscopy (CLSM). Cartilage water content, following S. aureus 8325-4 exposure, was obtained by measuring cartilage wet and dry weights. RESULTS S. aureus 8325-4 and clinical S. aureus isolates rapidly reduced in situ chondrocyte viability (>45% chondrocyte death at 40 h). The increased acidity, observed during bacterial culture, had a minimal effect on chondrocyte viability. Chondrocyte death commenced within the superficial zone (SZ) and rapidly progressed to the deep zone (DZ). Simultaneous exposure of SZ and DZ chondrocytes to S. aureus 8325-4 toxins found SZ chondrocytes to be more susceptible to the toxins than DZ chondrocytes. Cartilage water content was not significantly altered compared to non-infected controls. CONCLUSIONS Toxins released by S. aureus have a rapid and fatal action on in situ chondrocytes in this experimental model of SA. These data advocate the prompt and thorough removal of bacteria and their toxins during the treatment of SA.
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Affiliation(s)
- I D M Smith
- Centre for Integrative Physiology, The University of Edinburgh, Edinburgh, UK; Musculoskeletal Research Unit, Department of Orthopaedic and Trauma Surgery, The University of Edinburgh, Edinburgh, UK.
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Repair of Osteochondral Defects with Rehydrated Freeze-Dried Oligo[Poly(Ethylene Glycol) Fumarate] Hydrogels Seeded with Bone Marrow Mesenchymal Stem Cells in a Porcine Model. Tissue Eng Part A 2013; 19:1852-61. [DOI: 10.1089/ten.tea.2012.0621] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gulihar A, Bryson DJ, Taylor GJS. Effect of different irrigation fluids on human articular cartilage: an in vitro study. Arthroscopy 2013; 29:251-6. [PMID: 23265689 DOI: 10.1016/j.arthro.2012.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 07/25/2012] [Accepted: 07/31/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to examine the effect of different irrigation fluids on human articular cartilage. METHODS Femoral heads were obtained from 9 patients with fractured neck of femur (mean age, 89 years; 7 female) and tibial plateaus from 2 female patients at the time of total knee replacement (mean age, 73 years). Chrondral explants were harvested and exposed to 1 of 4 different irrigation fluids for 1 hour: Ringer's solution, normal saline (0.9% NaCl), 1.5% glycine, or 5% mannitol. M199 culture medium was used as a positive control, and 0.5% bupivicaine, previously shown to be harmful to articular cartilage, as a negative control. After exposure, explants were incubated with radiolabeled sulfate ((35)S0(4)), and uptake was measured after 16 hours as an indicator of proteoglycan synthesis. RESULTS (35)S0(4) uptake was inhibited 10% by Ringer's solution (P = .3), 24% by 1.5% glycine (P = .08), 31% by 5% mannitol (P = .03), 35% by normal saline (P = .04), and 90% by 0.5% bupivacaine (P < .001), compared with the M199 control. Comparisons of the different solutions showed that all solutions were less inhibitory than 0.5% bupivacaine (P < .001). The only significant difference was that between normal saline and Ringer's solution (P = .03). CONCLUSIONS In an in vitro model of human articular cartilage, Ringer's solution had the least effect on cartilage metabolism, and normal saline caused the greatest inhibition of cartilage metabolism. CLINICAL RELEVANCE Normal saline, the most commonly used irrigation fluid, may have an inhibitory effect on proteoglycan metabolism in articular cartilage. Additional studies are required to assess the potential damage to cartilage from normal saline in the clinical setting.
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Affiliation(s)
- Abhinav Gulihar
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, England.
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