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Qiu R, Cai K, Zhang K, Ying Y, Hu H, Jiang G, Luo K. The current status and development trend of hydrogel application in spinal surgery. J Mater Chem B 2024; 12:1730-1747. [PMID: 38294330 DOI: 10.1039/d3tb02613b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Spinal diseases often result in compromised mobility and diminished quality of life due to the intricate anatomy surrounding the nervous system. Medication and surgical interventions remain the primary treatment methods for spinal conditions. However, currently available medications have limited efficacy in treating spinal surgical diseases and cannot achieve a complete cure. Furthermore, surgical intervention frequently results in inevitable alterations and impairments to the initial anatomical integrity of the spinal structure, accompanied by the consequential loss of certain physiological functionalities. Changes in spine surgery treatment concepts and modalities in the last decade have led to a deepening of minimally invasive treatment, with treatment strategies focusing more on repairing and reconstructing the patient's spine and preserving physiological functions. Therefore, developing novel and more efficient treatment strategies to reduce spinal lesions and iatrogenic injuries is essential. In recent years, significant advancements in biomedical research have led to the discovery that hydrogels possess excellent biocompatibility, biodegradability, and adjustable mechanical properties. The application of hydrogel-based biotechnology in spinal surgery has demonstrated remarkable therapeutic potential. This review presents the therapeutic strategies for spinal diseases based on hydrogel tissue engineering technology.
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Affiliation(s)
- Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Hangtian Hu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
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Koo YW, Lim CS, Darai A, Lee J, Kim W, Han I, Kim GH. Shape-memory collagen scaffold combined with hyaluronic acid for repairing intervertebral disc. Biomater Res 2023; 27:26. [PMID: 36991502 DOI: 10.1186/s40824-023-00368-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IVDD) is a common cause of chronic low back pain (LBP) and a socioeconomic burden worldwide. Conservative therapies and surgical treatments provide only symptomatic pain relief without promoting intervertebral disc (IVD) regeneration. Therefore, the clinical demand for disc regenerative therapies for disc repair is high. METHODS In this study, we used a rat tail nucleotomy model to develop mechanically stable collagen-cryogel and fibrillated collagen with shape-memory for use in minimally invasive surgery for effective treatment of IVDD. The collagen was loaded with hyaluronic acid (HA) into a rat tail nucleotomy model. RESULTS The shape-memory collagen structures exhibited outstanding chondrogenic activities, having completely similar physical properties to those of a typical shape-memory alginate construct in terms of water absorption, compressive properties, and shape-memorability behavior. The treatment of rat tail nucleotomy model with shape-memory collagen-cryogel/HA alleviated mechanical allodynia, maintained a higher concentration of water content, and preserved the disc structure by restoring the matrix proteins. CONCLUSION According to these results, the collagen-based structure could effectively repair and maintain the IVD matrix better than the controls, including HA only and shape-memory alginate with HA.
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Affiliation(s)
- Young Won Koo
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea
| | - Chang Su Lim
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-Si, Gyeonggi-Do, 13496, Republic of Korea
| | - Anjani Darai
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-Si, Gyeonggi-Do, 13496, Republic of Korea
| | - JiUn Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea
| | - Wonjin Kim
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea
| | - Inbo Han
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-Si, Gyeonggi-Do, 13496, Republic of Korea.
| | - Geun Hyung Kim
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, 16419, Republic of Korea.
- Department of Biophysics, Institute of Quantum Biophysics , Sungkyunkwan University, Suwon, 16419, Republic of Korea.
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3
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Demott CJ, Grunlan MA. Emerging polymeric material strategies for cartilage repair. J Mater Chem B 2022; 10:9578-9589. [PMID: 36373438 DOI: 10.1039/d2tb02005j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cartilage is found throughout the body, serving an array of essential functions. Owing to the limited healing capacity of cartilage, damage or degeneration is often permanent and so requires clinical intervention. Established surgical techniques generally rely on biological grafting. However, recent advances in polymeric materials provide an encouraging alternative to overcome limits of auto- and allografts. For regenerative engineering of cartilage, a polymeric scaffold ideally supports and instructs tissue regeneration while also providing mechanical integrity. Scaffolds direct regeneration via chemical and mechanical cues, as well as delivery and support of exogenous cells and bioactive factors. Advanced polymeric scaffolds aim to direct regeneration locally, replicating the heterogeneities of native tissues. Alternatively, new cartilage-mimetic hydrogels have potential to serve as synthetic cartilage replacements. Prepared as multi-network or composite hydrogels, the most promising candidates have simultaneously realized the hydration, mechanical, and tribological properties of native cartilage. Collectively, the recent rise in polymers for cartilage regeneration and replacement proposes a changing paradigm, with a new generation of materials paving the way for improved clinical outcomes.
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Materials Science & Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Chemistry, Texas A&M University, College Station, TX 77843-3003, USA.
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4
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Panebianco CJ, Rao S, Hom WW, Meyers JH, Lim TY, Laudier DM, Hecht AC, Weir MD, Weiser JR, Iatridis JC. Genipin-crosslinked fibrin seeded with oxidized alginate microbeads as a novel composite biomaterial strategy for intervertebral disc cell therapy. Biomaterials 2022; 287:121641. [PMID: 35759923 PMCID: PMC9758274 DOI: 10.1016/j.biomaterials.2022.121641] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/02/2022]
Abstract
Discectomy procedures alleviate disability caused by intervertebral disc (IVD) herniation, but do not repair herniation-induced annulus fibrosus (AF) defects. Cell therapy shows promise for IVD repair, yet cell delivery biomaterials capable of sealing AF defects and restoring biomechanical function have poor biological performance. To balance the biomechanical and biological demands of IVD cell delivery biomaterials, we engineered an injectable composite biomaterial using cell-laden, degradable oxidized alginate (OxAlg) microbeads (MBs) to deliver AF cells within high-modulus genipin-crosslinked fibrin (FibGen) hydrogels (FibGen + MB composites). Conceptually, the high-modulus FibGen would immediately stabilize injured IVDs, while OxAlg MBs would protect and release cells required for long-term healing. We first showed that AF cells microencapsulated in OxAlg MBs maintained high viability and, upon release, displayed phenotypic AF cell morphology and gene expression. Next, we created cell-laden FibGen + MB composites and demonstrated that OxAlg MBs functionalized with RGD peptides (MB-RGD) minimized AF cell apoptosis and retained phenotypic gene expression. Further, we showed that cell-laden FibGen + MB composites are biomechanically stable and promote extracellular matrix (ECM) synthesis in long-term in vitro culture. Lastly, we evaluated cell-laden FibGen + MB-RGD composites in a long-term bovine caudal IVD organ culture bioreactor and found that composites had low herniation risk, provided superior biomechanical and biological repair to discectomy controls, and retained anabolic cells within the IVD injury space. This novel injectable composite hydrogel strategy shows promise as an IVD cell delivery sealant with potentially broad applications for its capacity to balance biomechanical and biological performance.
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Affiliation(s)
- Christopher J Panebianco
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanjna Rao
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York, NY, USA
| | - Warren W Hom
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James H Meyers
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tiffany Y Lim
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Damien M Laudier
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Hecht
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D Weir
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Jennifer R Weiser
- Department of Chemical Engineering, The Cooper Union for the Advancement of Science and Art, New York, NY, USA
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Zhang D, Feng M, Liu W, Yu J, Wei X, Yang K, Zhan J, Peng W, Luo M, Han T, Jin Z, Yin H, Sun K, Yin X, Zhu L. From Mechanobiology to Mechanical Repair Strategies: A Bibliometric Analysis of Biomechanical Studies of Intervertebral Discs. J Pain Res 2022; 15:2105-2122. [PMID: 35923841 PMCID: PMC9342884 DOI: 10.2147/jpr.s361938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Neck pain and low back pain are major challenges in public health, and intervertebral disc (IVD) biomechanics is an important multidisciplinary field. To date, no bibliometric literature review of the relevant literature has been performed, so we explored the emerging trends, landmark studies, and major contributors to IVD biomechanics research. We searched the Web of Science core collection (1900–2022) using keywords mainly composed of “biomechanics” and “intervertebral disc” to conduct a bibliometric analysis of original papers and their references, focusing on citations, authors, journals, and countries/regions. A co-citation analysis and clustering of the references were also completed. A total of 3189 records met the inclusion criteria. In the co-citation network, cluster #0, labeled as “annulus fibrosus tissue engineering”, and cluster #1, labeled as “micromechanical environment”, were the biggest clusters. References by MacLean et al and Holzapfel et al were positioned exactly between them and had high betweenness centrality. There existed a research topic evolution between mechanobiology and mechanical repair strategies of IVDs, and the latter had been identified as an emerging trend in IVD biomechanics. Numerous landmark studies had contributed to several fields, including mechanical testing of normal and pathological IVDs, mechanical evaluation of new repair strategies and development of finite element model. Adams MA was the author most cited by IVD biomechanics papers. Spine, the European Spine Journal, and the Journal of Biomechanics were the three journals where the most original articles and their references have been published. The United States has contributed most to the literature (n = 1277 papers); however, the research output of China is increasing. In conclusion, the present study suggests that IVD repair is an emerging trend in IVD biomechanics.
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Affiliation(s)
- Dian Zhang
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Minshan Feng
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Wei Liu
- Department of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Jie Yu
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Xu Wei
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Kexin Yang
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Jiawen Zhan
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Wei Peng
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Mingyi Luo
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Tao Han
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Zhefeng Jin
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - He Yin
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Kai Sun
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Xunlu Yin
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
- Correspondence: Xunlu Yin; Liguo Zhu, Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, 100102, People’s Republic of China, Email ;
| | - Liguo Zhu
- Department of Spinal Surgery, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
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Caldeira J, Celiz A, Newell N. A biomechanical testing method to assess tissue adhesives for annulus closure. J Mech Behav Biomed Mater 2022; 129:105150. [PMID: 35272150 DOI: 10.1016/j.jmbbm.2022.105150] [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: 05/13/2021] [Revised: 01/12/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
Intervertebral disc (IVD) degeneration has been linked to Low Back Pain (LBP) which affects over 80% of the population ranking first in terms of disability worldwide. Degeneration progresses with age and is often accompanied by annulus fibrosus (AF) tearing and nucleus pulposus (NP) herniation. Existing therapies fail to restore IVD function and may worsen AF defects, increasing the risk of reherniation in nearly 30% of patients. Current AF closure options are ineffective, presenting biological or mechanical limitations. Bioadhesives have potential use in this area, however methods to assess performance are limited. Herein, we propose a biomechanical testing method to assess bioadhesives' capacity to seal AF tears. Two candidate bioadhesives to seal AF tears were evaluated; a tough hydrogel adhesive, and a cyanoacrylate-based glue. The adhesion energy at the interface between bovine discs and the tough hydrogel adhesive was quantified using a peel test (n=4). An experimental method to measure the burst pressure of IVDs was then developed. This method was used to quantify the burst pressure of intact (n=7), injured (AF punctured with a 21G needle; n=7), and sealed IVDs (after applying either the tough hydrogel adhesive patch as a sealant; n=5, or the cyanoacrylate-based glue over the AF tear; n=6). The tough adhesive yielded a strong adhesion energy of 239 ± 49 J/m2 during the peel tests. A maximum pressure of 13.2 ± 3.8 MPa was observed for intact discs in the burst pressure tests, which reduced by 61.4% to 5.1 ± 1.5 MPa in the injured IVDs (p < 0.01)). Application of a cyanoacrylate-based glue to injured IVDs did not recover the burst pressure with statistical significance, however, application of the tough adhesive to injured IVDs, restored burst pressure to 12.3 ± 4.5 MPa, which was not significantly different to the intact burst pressures. In this study, a simple biomechanical method to assess the performance of bioadhesives to seal AF tears based upon burst pressure has been established. Using this method it was found that a tough hydrogel adhesive was able to seal an AF injury, such that the IVD burst pressures were similar to those measured in intact specimens. This method can be used to provide a biomechanical assessment of bioadhesives under high magnitude loading and can complement existing cyclic testing methods that are currently used to assess AF closure devices, improving their assessment before clinical use.
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Affiliation(s)
- Joana Caldeira
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; INEB, Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Adam Celiz
- Department of Bioengineering, Imperial College London, UK
| | - Nicolas Newell
- Department of Bioengineering, Imperial College London, UK.
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Kasamkattil J, Gryadunova A, Martin I, Barbero A, Schären S, Krupkova O, Mehrkens A. Spheroid-Based Tissue Engineering Strategies for Regeneration of the Intervertebral Disc. Int J Mol Sci 2022; 23:2530. [PMID: 35269672 PMCID: PMC8910276 DOI: 10.3390/ijms23052530] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Degenerative disc disease, a painful pathology of the intervertebral disc (IVD), often causes disability and reduces quality of life. Although regenerative cell-based strategies have shown promise in clinical trials, none have been widely adopted clinically. Recent developments demonstrated that spheroid-based approaches might help overcome challenges associated with cell-based IVD therapies. Spheroids are three-dimensional multicellular aggregates with architecture that enables the cells to differentiate and synthesize endogenous ECM, promotes cell-ECM interactions, enhances adhesion, and protects cells from harsh conditions. Spheroids could be applied in the IVD both in scaffold-free and scaffold-based configurations, possibly providing advantages over cell suspensions. This review highlights areas of future research in spheroid-based regeneration of nucleus pulposus (NP) and annulus fibrosus (AF). We also discuss cell sources and methods for spheroid fabrication and characterization, mechanisms related to spheroid fusion, as well as enhancement of spheroid performance in the context of the IVD microenvironment.
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Affiliation(s)
- Jesil Kasamkattil
- Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (J.K.); (A.G.); (S.S.); (A.M.)
| | - Anna Gryadunova
- Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (J.K.); (A.G.); (S.S.); (A.M.)
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; (I.M.); (A.B.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; (I.M.); (A.B.)
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; (I.M.); (A.B.)
| | - Stefan Schären
- Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (J.K.); (A.G.); (S.S.); (A.M.)
| | - Olga Krupkova
- Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (J.K.); (A.G.); (S.S.); (A.M.)
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; (I.M.); (A.B.)
- Lepage Research Institute, University of Prešov, 17. Novembra 1, 081 16 Prešov, Slovakia
| | - Arne Mehrkens
- Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland; (J.K.); (A.G.); (S.S.); (A.M.)
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Yamada K, Iwasaki N, Sudo H. Biomaterials and Cell-Based Regenerative Therapies for Intervertebral Disc Degeneration with a Focus on Biological and Biomechanical Functional Repair: Targeting Treatments for Disc Herniation. Cells 2022; 11:602. [PMID: 35203253 PMCID: PMC8870062 DOI: 10.3390/cells11040602] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is a common cause of low back pain and most spinal disorders. As IVD degeneration is a major obstacle to the healthy life of so many individuals, it is a major issue that needs to be overcome. Currently, there is no clinical treatment for the regeneration of degenerated IVDs. However, recent advances in regenerative medicine and tissue engineering suggest the potential of cell-based and/or biomaterial-based IVD regeneration therapies. These treatments may be indicated for patients with IVDs in the intermediate degenerative stage, a point where the number of viable cells decreases, and the structural integrity of the disc begins to collapse. However, there are many biological, biomechanical, and clinical challenges that must be overcome before the clinical application of these IVD regeneration therapies can be realized. This review summarizes the basic research and clinical trials literature on cell-based and biomaterial-based IVD regenerative therapies and outlines the important role of these strategies in regenerative treatment for IVD degenerative diseases, especially disc herniation.
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Affiliation(s)
- Katsuhisa Yamada
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (K.Y.); (N.I.)
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (K.Y.); (N.I.)
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
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Fu B, Wang X, Chen Z, Jiang N, Guo Z, Zhang Y, Zhang S, Liu X, Liu L. Improved myocardial performance in infarcted rat heart by injection of disulfide-cross-linked chitosan hydrogels loaded with basic fibroblast growth factor. J Mater Chem B 2022; 10:656-665. [PMID: 35014648 DOI: 10.1039/d1tb01961a] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Myocardial infarction (MI) has been considered as the leading cause of cardiovascular-related deaths worldwide. Basic fibroblast growth factor (bFGF) is a member of the fibroblast growth factor family that promotes angiogenesis after MI; however, it has poor clinical efficacy due to proteolytic degradation, low drug accumulation, and severe drug-induced side effects. In this study, an injectable disulfide-cross-linked chitosan hydrogel loaded with bFGF was prepared via a thiol-disulfide exchange reaction for MI treatment. The thiol-disulfide exchange reaction between pyridyl disulfide-modified carboxymethyl chitosan (CMCS-S-S-Py) and reduced BSA (rBSA) was carried out under physiological conditions (37 °C and pH 7.4). The mechanical properties of the disulfide-cross-linked chitosan hydrogel were evaluated based on the molar ratio of the pyridyl disulfide groups of CMCS-S-S-Py and the thiol groups of rBSA. The disulfide-cross-linked chitosan hydrogel showed good swelling performance, rapid glutathione-triggered degradation behavior and well-defined cell proliferation towards NIH 3T3 fibroblast cells. In the process of establishing a rat MI model, the squeezing heart method was used to make the operation more accurate and the mortality of rats was decreased by using a ventilator. The disulfide-cross-linked chitosan hydrogel loaded with bFGF (bFGF-hydrogel) was injected into a peri-infarcted area of cardiac tissue immediately following MI. Echocardiography demonstrated that the left ventricular functions were improved by the bFGF-hydrogel after 28 days of treatment. Histological results revealed that the hydrogel significantly reduced the fibrotic area of MI, and this was further improved by the bFGF-hydrogel treatment. TUNEL and immunohistochemical staining results showed that the bFGF-hydrogel had a more synergistic effect on antiapoptosis and proangiogenesis than using either bFGF or the hydrogel alone.
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Affiliation(s)
- Bo Fu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China. .,Tianjin Medical University, Tianjin 300203, P. R. China
| | - Xiaobei Wang
- Department of Materials Engineering, North China Institute of Aerospace Engineering, Langfang 065000, P. R. China
| | - Zhengda Chen
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China. .,Tianjin Medical University, Tianjin 300203, P. R. China
| | - Nan Jiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China.
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China.
| | - Yuhui Zhang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China.
| | - Shaopeng Zhang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China.
| | - Xiankun Liu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China.
| | - Li Liu
- Key Laboratory of Functional Polymer Materials, Ministry of Education, Institute of Polymer Chemistry, College of Chemistry, Nankai University, Tianjin 300071, P. R. China.
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10
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Kawamura T, Yunoki S, Ohyabu Y, Uraoka T, Muramatsu K. Crosslinking Efficacy and Cytotoxicity of Genipin and Its Activated Form Prepared by Warming It in a Phosphate Buffer: A Comparative Study. MATERIALS 2021; 14:ma14216600. [PMID: 34772122 PMCID: PMC8585344 DOI: 10.3390/ma14216600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 01/14/2023]
Abstract
The aim of the present study was to compare the acute and cumulative cytotoxicity of intact (n-GE) and warmed genipin (w-GE), while investigating the differences in crosslinking capabilities of these two genipins by rheological and mechanical tests. The n-GE solution was prepared by dissolving genipin powder in a sodium phosphate buffer solution. The w-GE solution was prepared by warming the n-GE solution at 37 °C for 24 h. The mechanical tests for chitosan (CH)/genipin gels showed the crosslinking rate of w-GE was much greater than that of n-GE up until 6 h after preparation, whereas the degree of crosslinking of CH/n-GE gels became higher at 12 h. The ISO 10993-5 standard method, which is established specifically for evaluating cumulative cytotoxicity, determined equivalent IC50 for w-GE (0.173 mM) and n-GE (0.166 mM). On the other hand, custom-made cytotoxicity tests using a WST-8 assay after 1 h of cultivation showed that the acute cytotoxicity of w-GE was significantly higher than that of n-GE at concentrations between 0.1–5 mM. The acute cytotoxicity of w-GE should be taken into consideration in its practical uses, despite the fact that the much faster crosslinking of w-GE is useful as an effective cross linker for in-situ forming gels.
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Affiliation(s)
- Takeya Kawamura
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute (TIRI), 2-4-10 Aomi, Koto-ku, Tokyo 135-0064, Japan; (T.K.); (Y.O.)
- School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun 350-0394, Japan;
| | - Shunji Yunoki
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute (TIRI), 2-4-10 Aomi, Koto-ku, Tokyo 135-0064, Japan; (T.K.); (Y.O.)
- Correspondence:
| | - Yoshimi Ohyabu
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute (TIRI), 2-4-10 Aomi, Koto-ku, Tokyo 135-0064, Japan; (T.K.); (Y.O.)
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8514, Japan;
| | - Kazuaki Muramatsu
- School of Science and Engineering, Tokyo Denki University, Ishizaka, Hatoyama-cho, Hiki-gun 350-0394, Japan;
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11
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Peredo AP, Gullbrand SE, Smith HE, Mauck RL. Putting the Pieces in Place: Mobilizing Cellular Players to Improve Annulus Fibrosus Repair. TISSUE ENGINEERING. PART B, REVIEWS 2021; 27:295-312. [PMID: 32907498 PMCID: PMC10799291 DOI: 10.1089/ten.teb.2020.0196] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The intervertebral disc (IVD) is an integral load-bearing tissue that derives its function from its composite structure and extracellular matrix composition. IVD herniations involve the failure of the annulus fibrosus (AF) and the extrusion of the nucleus pulposus beyond the disc boundary. Disc herniations can impinge the neural elements and cause debilitating pain and loss of function, posing a significant burden on individual patients and society as a whole. Patients with persistent symptoms may require surgery; however, surgical intervention fails to repair the ruptured AF and is associated with the risk for reherniation and further disc degeneration. Given the limitations of AF endogenous repair, many attempts have been made toward the development of effective repair approaches that reestablish IVD function. These methods, however, fail to recapitulate the composition and organization of the native AF, ultimately resulting in inferior tissue mechanics and function over time and high rates of reherniation. Harnessing the cellular function of cells (endogenous or exogenous) at the repair site through the provision of cell-instructive cues could enhance AF tissue regeneration and, ultimately, improve healing outcomes. In this study, we review the diverse approaches that have been developed for AF repair and emphasize the potential for mobilizing the appropriate cellular players at the site of injury to improve AF healing. Impact statement Conventional treatments for intervertebral disc herniation fail to repair the annulus fibrosus (AF), increasing the risk for recurrent herniation. The lack of repair devices in the market has spurred the development of regenerative approaches, yet most of these rely on a scarce endogenous cell population to repair large injuries, resulting in inadequate regeneration. This review identifies current and developing strategies for AF repair and highlights the potential for harnessing cellular function to improve AF regeneration. Ideal cell sources, differentiation strategies, and delivery methods are discussed to guide the design of repair systems that leverage specialized cells to achieve superior outcomes.
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Affiliation(s)
- Ana P. Peredo
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Sarah E. Gullbrand
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Harvey E. Smith
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Robert L. Mauck
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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12
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Peng Y, Qing X, Shu H, Tian S, Yang W, Chen S, Lin H, Lv X, Zhao L, Chen X, Pu F, Huang D, Cao X, Shao Z, Yp, Zs, Xc, Yp, Yp, Xq, Hs, St, Wy, Yp, Xq, Hs, St, Hl, Xl, Lz, Xc, Fp, Sc, Yp, Xq, Hs, St, Yp, Xq, Wy, Hl, Xl, Lz, Xc, Fp, Sc, Hdh, Wy, Hl, Xl, Lz, Xc, Fp, Sc, Hdh, Zs, Xc. Proper animal experimental designs for preclinical research of biomaterials for intervertebral disc regeneration. BIOMATERIALS TRANSLATIONAL 2021; 2:91-142. [PMID: 35836965 PMCID: PMC9255780 DOI: 10.12336/biomatertransl.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Abstract
Low back pain is a vital musculoskeletal disease that impairs life quality, leads to disability and imposes heavy economic burden on the society, while it is greatly attributed to intervertebral disc degeneration (IDD). However, the existing treatments, such as medicines, chiropractic adjustments and surgery, cannot achieve ideal disc regeneration. Therefore, advanced bioactive therapies are implemented, including stem cells delivery, bioreagents administration, and implantation of biomaterials etc. Among these researches, few reported unsatisfying regenerative outcomes. However, these advanced therapies have barely achieved successful clinical translation. The main reason for the inconsistency between satisfying preclinical results and poor clinical translation may largely rely on the animal models that cannot actually simulate the human disc degeneration. The inappropriate animal model also leads to difficulties in comparing the efficacies among biomaterials in different reaches. Therefore, animal models that better simulate the clinical charateristics of human IDD should be acknowledged. In addition, in vivo regenerative outcomes should be carefully evaluated to obtain robust results. Nevertheless, many researches neglect certain critical characteristics, such as adhesive properties for biomaterials blocking annulus fibrosus defects and hyperalgesia that is closely related to the clinical manifestations, e.g., low back pain. Herein, in this review, we summarized the animal models established for IDD, and highlighted the proper models and parameters that may result in acknowledged IDD models. Then, we discussed the existing biomaterials for disc regeneration and the characteristics that should be considered for regenerating different parts of discs. Finally, well-established assays and parameters for in vivo disc regeneration are explored.
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Affiliation(s)
- Yizhong Peng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiangcheng Qing
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hongyang Shu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China,Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Shuo Tian
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wenbo Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Songfeng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Hui Lin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Lv
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Lei Zhao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xi Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Feifei Pu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Donghua Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xu Cao
- Department of Orthopaedic Surgery, Institute for Cell Engineering, Johns Hopkins University, Baltimore, MD, USA,Corresponding authors: Zengwu Shao, ; Xu Cao,
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China,Corresponding authors: Zengwu Shao, ; Xu Cao,
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13
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Abstract
Flexible bioelectronics have promising applications in electronic skin, wearable devices, biomedical electronics, etc. Hydrogels have unique advantages for bioelectronics due to their tissue-like mechanical properties and excellent biocompatibility. Particularly, conductive and tissue adhesive hydrogels can self-adhere to bio-tissues and have great potential in implantable wearable bioelectronics. This review focuses on the recent progress in tissue adhesive hydrogel bioelectronics, including the mechanism and preparation of tissue adhesive hydrogels, the fabrication strategies of conductive hydrogels, and tissue adhesive hydrogel bioelectronics and applications. Some perspectives on tissue adhesive hydrogel bioelectronics are provided at the end of the review.
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Affiliation(s)
- Shengnan Li
- Key Laboratory of Polymeric Composite and Functional Materials of Ministry of Education, Guangdong Functional Biomaterials Engineering Technology Research Center, Guangzhou Key Laboratory of Flexible Electronic Materials and Wearable Devices, School of Materials Science and Engineering, Sun Yat-sen University, 135 Xingang Road West, Guangzhou 510275, China.
| | - Yang Cong
- College of Materials Science and Chemical Engineering, Ningbo University of Technology, Ningbo 315201, China
| | - Jun Fu
- Key Laboratory of Polymeric Composite and Functional Materials of Ministry of Education, Guangdong Functional Biomaterials Engineering Technology Research Center, Guangzhou Key Laboratory of Flexible Electronic Materials and Wearable Devices, School of Materials Science and Engineering, Sun Yat-sen University, 135 Xingang Road West, Guangzhou 510275, China.
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14
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Mishan MA, Balagholi S, Chamani T, Feizi S, Soheili ZS, Rezaei Kanavi M. Potential of a novel scaffold composed of human platelet lysate and fibrin for human corneal endothelial cells. Cell Tissue Bank 2021; 23:171-183. [PMID: 33939123 DOI: 10.1007/s10561-021-09931-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Cell-based therapies have been emerged to find innovative solutions for corneal endothelial dysfunction. The aim of this study is to investigate the suitability of a blended scaffold containing human platelet lysate (HPL) and fibrin not only for cultivating human corneal endothelial cells (HCECs) but also for serving as a scaffold for the respected cells. We isolated HCECs from human donors and encapsulated the cells with three concentrations of HPL/Fibrin scaffold, namely HPL/Fibrin 1, HPL/Fibrin 2 and HPL/Fibrin 3, by adding 28.9, 57.8 and 86.7 mg/dl of fibrinogen to HPL to obtain a final percentage of 10, 20 and 30 % of fibrinogen, respectively. SEM imaging and swelling test were done to characterize the scaffolds. Cell viability assay and cell counting were performed on the cells. HCECs were characterized by morphology and immunocytochemistry. SEM imaging on freeze-dried scaffolds showed higher porosity of HPL/Fibrin 1 and HPL/Fibrin 2 than HPL/Fibrin 3, but larger pores were observed only in HPL/Fibrin 1. Cellular attachment and morphology on HPL/Fibrin 1 were appropriate by SEM imaging. A higher swelling rate was observed in HPL/Fibrin 1. After 3 and 5 days, higher numbers of cells were observed specifically in HPL/Fibrin 1. A higher expression of Na+/K+-ATPase, ZO-1 and vimentin proteins was detected in the HPL/Fibrin 1-cultured HCECs as compared with control (no scaffold). HPL/Fibrin can be used as a suitable scaffold for HCECs while preserving the cells viability. Further investigations are necessitated to approve the beneficial effects of the suggested scaffold for delivering and transplantation of cultivated HCECs into the anterior chamber of the eye.
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Affiliation(s)
- Mohammad Amir Mishan
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard Street, Boostan 9 Street, Pasdaran Avenue, 1666673111, Tehran, Iran
| | - Sahar Balagholi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | | | - Sepehr Feizi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No.23, Paidarfard Street, Boostan 9 Street, Pasdaran Avenue, 1666673111, Tehran, Iran.
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15
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Yu Y, Xu S, Li S, Pan H. Genipin-cross-linked hydrogels based on biomaterials for drug delivery: a review. Biomater Sci 2021; 9:1583-1597. [PMID: 33443245 DOI: 10.1039/d0bm01403f] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Genipin is a naturally occurring nontoxic cross-linker, which has been widely used for drug delivery due to its excellent biocompatibility, admirable biodegradability and stable cross-linked attributes. These advantages led to its extensive application in the fabrication of hydrogels for drug delivery. This review describes the physicochemical characteristics and pharmacological activities of genipin and attempts to elucidate the detailed mechanisms of the cross-linking reaction between genipin and biomaterials. The current article entails a general review of the different biomaterials cross-linked by genipin: chitosan and its derivatives, collagen, gelatin, etc. The genipin-cross-linked hydrogels for various pharmaceutical applications, including ocular drug delivery, buccal drug delivery, oral drug delivery, anti-inflammatory drug delivery, and antibiotic and antifungal drug delivery, are reported. Finally, the future research directions and challenges of genipin-cross-linked hydrogels for pharmaceutical applications are also discussed in this review.
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Affiliation(s)
- Yibin Yu
- School of Pharmacy, Liaoning University, Shenyang 110036, China. and Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325001, China
| | - Shuo Xu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Sanming Li
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Hao Pan
- School of Pharmacy, Liaoning University, Shenyang 110036, China.
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16
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Evaluating the effect of a post-processing algorithm in detection of annular fissure on MR imaging. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2150-2156. [PMID: 33683440 DOI: 10.1007/s00586-021-06793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Visualization of annular fissures on MRI is becoming increasingly important but remains challenging. Our purpose was to test whether an image processing algorithm could improve detection of annular fissures. MATERIALS AND METHODS In this retrospective study, two neuroradiologists identified 56 IVDs with annular fissures and 97 IVDs with normal annulus fibrosus in lumbar spine MRIs of 101 patients (58 M, 43 F; age ± SD 15.1 ± 3.0 years). Signal intensities of diseased and normal annulus fibrosus, and contrast-to-noise ratio between them on sagittal T2-weighted images were calculated before and after processing with a proprietary software. Effect of processing on detection of annular fissures by two masked neuroradiologists was also studied for IVDs with Pfirrmann grades of ≤ 2 and > 2. RESULTS Mean (SD) signal baseline intensities of diseased and normal annulus fibrosus were 57.6 (23.3) and 24.4 (7.8), respectively (p < 0.001). Processing increased (p < 0.001) the mean (SD) intensity of diseased annulus to 110.6 (47.9), without affecting the signal intensity of normal annulus (p = 0.14). Mean (SD) CNR between the diseased and normal annulus increased (p < 0.001) from 11.8 (14.1) to 29.6 (29.1). Both masked readers detected more annular fissures after processing in IVDs with Pfirrmann grade of ≤ 2 and > 2, with an apparent increased sensitivity and decreased specificity using predefined image-based human categorization as a reference standard. CONCLUSIONS Image processing improved CNR of annular fissures and detection rate of annular fissures. However, further studies with a more stringent reference standard are needed to assess its effect on sensitivity and specificity.
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17
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Meftahpour V, Malekghasemi S, Baghbanzadeh A, Aghebati-Maleki A, Pourakbari R, Fotouhi A, Aghebati-Maleki L. Platelet lysate: a promising candidate in regenerative medicine. Regen Med 2021; 16:71-85. [PMID: 33543999 DOI: 10.2217/rme-2020-0065] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human platelet lysate has attracted much interest from many researchers as it is growth-factor rich for cell expansion, which is employed as a new therapeutic strategy. Not only are human platelet lysates used for cell therapy, but they are also used for the completion of basal media in mesenchymal stem cell cultures. Due to the presence of a large number of growth factors, platelet lysates have potential roles in wound healing, treatment of ocular graft-versus-host disease, osteoarthritis, Parkinson's disease, tendon regeneration, infertility, androgenetic alopecia, nerve repair and regenerative tissue, such as bone regeneration. In this review, we summarize that platelet lysates could be valuable candidates for the treatment of a variety of diseases in regenerative medicine.
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Affiliation(s)
- Vafa Meftahpour
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, 51656 65811, Iran
| | - Somaiyeh Malekghasemi
- Department of Basic Oncology, Oncology Institute, Hacettepe University, Sihhiye, Ankara, TR-06100, Turkey
| | - Amir Baghbanzadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, 51656 65811, Iran
| | - Ali Aghebati-Maleki
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, 51656 65811, Iran
| | - Ramin Pourakbari
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, 51656 65811, Iran
| | - Ali Fotouhi
- Department of Orthopedic Surgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, 51656 65811, Iran
| | - Leili Aghebati-Maleki
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, 51656 65811, Iran.,Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, 51656 65811, Iran
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18
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DiStefano TJ, Shmukler JO, Danias G, Iatridis JC. The Functional Role of Interface Tissue Engineering in Annulus Fibrosus Repair: Bridging Mechanisms of Hydrogel Integration with Regenerative Outcomes. ACS Biomater Sci Eng 2020; 6:6556-6586. [PMID: 33320618 PMCID: PMC7809646 DOI: 10.1021/acsbiomaterials.0c01320] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hydrogels are extraordinarily versatile by design and can enhance repair in diseased and injured musculoskeletal tissues. Biological fixation of these constructs is a significant determinant factor that is critical to the clinical success and functionality of regenerative technologies for musculoskeletal repair. In the context of an intervertebral disc (IVD) herniation, nucleus pulposus tissue protrudes through the ruptured annulus fibrosus (AF), consequentially impinging on spinal nerve roots and causing debilitating pain. Discectomy is the surgical standard of care to treat symptomatic herniation; however these procedures do not repair AF defects, and these lesions are a significant risk factor for recurrent herniation. Advances in tissue engineering utilize adhesive hydrogels as AF sealants; however these repair strategies have yet to progress beyond preclinical animal models because these biomaterials are often plagued by poor integration with AF tissue and lead to large variability in repair outcomes. These critical barriers to translation motivate this article to review the material composition of hydrogels that have been evaluated in situ for AF repair, proposed mechanisms of how these biomaterials interface with AF tissue, and their functional outcomes after treatment in order to inform the development of new hydrogels for AF repair. In this systematic review, we identify 18 hydrogel formulations evaluated for AF repair, all of which demonstrate large heterogeneity in their interfacing mechanisms and reported outcome measures to assess the effectiveness of repair. Hydrogels that covalently bond to AF tissue were found to be the most successful in improving IVD biomechanical properties from the injured state, but none were able to restore properties to the intact state suggesting that new repair strategies with innovative surface chemistries are an important future direction. We additionally review biomechanical evaluation methods and recommend standardization in the field of AF tissue engineering to establish mechanical benchmarks for translation and ensure clinical feasibility.
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Affiliation(s)
- Tyler J DiStefano
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Jennifer O Shmukler
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - George Danias
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
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19
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Fujii K, Lai A, Korda N, Hom WW, Evashwick-Rogler TW, Nasser P, Hecht AC, Iatridis JC. Ex-vivo biomechanics of repaired rat intervertebral discs using genipin crosslinked fibrin adhesive hydrogel. J Biomech 2020; 113:110100. [PMID: 33142205 DOI: 10.1016/j.jbiomech.2020.110100] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/02/2020] [Accepted: 10/17/2020] [Indexed: 12/14/2022]
Abstract
Microdiscectomy is the current standard surgical treatment for intervertebral disc (IVD) herniation, however annulus fibrosus (AF) defects remain unrepaired which can alter IVD biomechanical properties and lead to reherniation, IVD degeneration and recurrent back pain. Genipin-crosslinked fibrin (FibGen) hydrogel is an injectable AF sealant previously shown to partially restore IVD motion segment biomechanical properties. A small animal model of herniation and repair is needed to evaluate repair potential for early-stage screening of IVD repair strategies prior to more costly large animal and eventual human studies. This study developed an ex-vivo rat caudal IVD herniation model and characterized torsional, axial tension-compression and stress relaxation biomechanical properties before and after herniation injury with or without repair using FibGen. Injury group involved an annular defect followed by removal of nucleus pulposus tissue to simulate a severe herniation while Repaired group involved FibGen injection. Injury significantly altered axial range of motion, neutral zone, torsional stiffness, torque range and stress-relaxation biomechanical parameters compared to Intact. FibGen repair restored the stress-relaxation parameters including effective hydraulic permeability indicating it effectively sealed the IVD defect, and there was a trend for improved tensile stiffness and axial neutral zone length. This study demonstrated a model for studying IVD herniation injury and repair strategies using rat caudal IVDs ex-vivo and demonstrated FibGen sealed IVDs to restore water retention and IVD pressurization. This ex-vivo small animal model may be modified for future in-vivo studies to screen IVD repair strategies using FibGen and other IVD repair biomaterials as an augment to additional large animal and human IVD testing.
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Affiliation(s)
- Kengo Fujii
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Alon Lai
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nimrod Korda
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Warren W Hom
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas W Evashwick-Rogler
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Philip Nasser
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew C Hecht
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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20
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Tryfonidou MA, de Vries G, Hennink WE, Creemers LB. "Old Drugs, New Tricks" - Local controlled drug release systems for treatment of degenerative joint disease. Adv Drug Deliv Rev 2020; 160:170-185. [PMID: 33122086 DOI: 10.1016/j.addr.2020.10.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) and chronic low back pain (CLBP) caused by intervertebral disc (IVD) degeneration are joint diseases that have become major causes for loss of quality of life worldwide. Despite the unmet need, effective treatments other than invasive, and often ineffective, surgery are lacking. Systemic administration of drugs entails suboptimal local drug exposure in the articular joint and IVD. This review provides an overview of the potency of biomaterial-based drug delivery systems as novel treatment modality, with a focus on the biological effects of drug release systems that have reached translation at the level of in vivo models and relevant ex vivo models. These studies have shown encouraging results of biomaterial-based local delivery of several types of drugs, mostly inhibitors of inflammatory cytokines or other degenerative factors. Prevention of inflammation and degeneration and pain relief was achieved, although mainly in small animal models, with interventions applied at an early disease stage. Less convincing data were obtained with the delivery of regenerative factors. Multidisciplinary efforts towards tackling the discord between in vitro and in vivo release, combined with adaptations in the regulatory landscape may be needed to enhance safe and expeditious introduction of more and more effective controlled release-based treatments with the OA and CLBP patients.
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21
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DiStefano TJ, Shmukler JO, Danias G, Di Pauli von Treuheim T, Hom WW, Goldberg DA, Laudier DM, Nasser PR, Hecht AC, Nicoll SB, Iatridis JC. Development of a two-part biomaterial adhesive strategy for annulus fibrosus repair and ex vivo evaluation of implant herniation risk. Biomaterials 2020; 258:120309. [PMID: 32823020 DOI: 10.1016/j.biomaterials.2020.120309] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/31/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022]
Abstract
Intervertebral disc (IVD) herniation causes pain and disability, but current discectomy procedures alleviate pain without repairing annulus fibrosus (AF) defects. Tissue engineering strategies seal AF defects by utilizing hydrogel systems to prevent recurrent herniation, however current biomaterials are limited by poor adhesion to wetted tissue surfaces or low failure strength resulting in considerable risk of implant herniation upon spinal loading. Here, we developed a two-part repair strategy comprising a dual-modified (oxidized and methacrylated) glycosaminoglycan that can chemically adsorb an injectable interpenetrating network hydrogel composed of fibronectin-conjugated fibrin and poly (ethylene glycol) diacrylate (PEGDA) to covalently bond the hydrogel to AF tissue. We show that dual-modified hyaluronic acid imparts greater adhesion to AF tissue than dual-modified chondroitin sulfate, where the degree of oxidation is more strongly correlated with adhesion strength than methacrylation. We apply this strategy to an ex vivo bovine model of discectomy and demonstrate that PEGDA molecular weight tunes hydrogel mechanical properties and affects herniation risk, where IVDs repaired with low-modulus hydrogels composed of 20kDa PEGDA failed at levels at or exceeding discectomy, the clinical standard of care. This strategy bonds injectable hydrogels to IVD extracellular matrix proteins, is optimized to seal AF defects, and shows promise for IVD repair.
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Affiliation(s)
- Tyler J DiStefano
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer O Shmukler
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Danias
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Warren W Hom
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David A Goldberg
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Damien M Laudier
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip R Nasser
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Hecht
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven B Nicoll
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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22
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Advanced Strategies for the Regeneration of Lumbar Disc Annulus Fibrosus. Int J Mol Sci 2020; 21:ijms21144889. [PMID: 32664453 PMCID: PMC7402314 DOI: 10.3390/ijms21144889] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022] Open
Abstract
Damage to the annulus fibrosus (AF), the outer region of the intervertebral disc (IVD), results in an undesirable condition that may accelerate IVD degeneration causing low back pain. Despite intense research interest, attempts to regenerate the IVD have failed so far and no effective strategy has translated into a successful clinical outcome. Of particular significance, the failure of strategies to repair the AF has been a major drawback in the regeneration of IVD and nucleus replacement. It is unlikely to secure regenerative mediators (cells, genes, and biomolecules) and artificial nucleus materials after injection with an unsealed AF, as IVD is exposed to significant load and large deformation during daily activities. The AF defects strongly change the mechanical properties of the IVD and activate catabolic routes that are responsible for accelerating IVD degeneration. Therefore, there is a strong need to develop effective therapeutic strategies to prevent or reconstruct AF damage to support operational IVD regenerative strategies and nucleus replacement. By the way of this review, repair and regenerative strategies for AF reconstruction, their current status, challenges ahead, and future outlooks were discussed.
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23
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Amiryaghoubi N, Noroozi Pesyan N, Fathi M, Omidi Y. Injectable thermosensitive hybrid hydrogel containing graphene oxide and chitosan as dental pulp stem cells scaffold for bone tissue engineering. Int J Biol Macromol 2020; 162:1338-1357. [PMID: 32561280 DOI: 10.1016/j.ijbiomac.2020.06.138] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
Here, we fabricated thermosensitive injectable hydrogel containing poly (N-isopropylacrylamide) (PNIPAAm)-based copolymer/graphene oxide (GO) composite with different feed ratio to chitosan (CS) as a natural polymer through physical and chemical crosslinking for the proliferation and differentiation of the human dental pulp stem cells (hDPSCs) to the osteoblasts. The PNIPAAm copolymer/GO composite was synthesized by free-radical copolymerization of (N-isopropylacrylamide) (NIPAAm), itaconic acid (IA) and maleic anhydride-modified poly(ethylene glycol) (PEG) in the presence of GO and used for the preparation of the hydrogels. The formulated hydrogels were evaluated for the porous architecture, rheological behavior, compressive strength, swelling property, in vitro degradation, hemocompatibility, biocompatibility, and differentiation. The hydrogel could enhance the deposition of minerals and the activity of alkaline phosphatase (ALP), in large part attributable to the oxygen and amine-containing functional groups of GO and CS. The engineered hydrogel could also upregulate the expression of the Runt-related transcription factor 2 and osteocalcin in the hDPSCs cultivated in both the normal and osteogenic media. It seems to promote the absorption of osteogenic inducer too. Based on our findings, the engineered hydrogel demonstrated the osteogenic potential, upon which it is proposed as a constructing scaffold in bone tissue engineering for the transplantation of hDPSCs.
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Affiliation(s)
- Nazanin Amiryaghoubi
- Department of Organic Chemistry, Faculty of Chemistry, Urmia University, 57159 Urmia, Iran; Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader Noroozi Pesyan
- Department of Organic Chemistry, Faculty of Chemistry, Urmia University, 57159 Urmia, Iran.
| | - Marziyeh Fathi
- Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yadollah Omidi
- Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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24
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Panebianco C, DiStefano T, Mui B, Hom W, Iatridis J. Crosslinker concentration controls TGFβ-3 release and annulus fibrosus cell apoptosis in genipin-crosslinked fibrin hydrogels. Eur Cell Mater 2020; 39:211-226. [PMID: 32396210 PMCID: PMC7372750 DOI: 10.22203/ecm.v039a14] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Back pain is a leading cause of global disability associated with intervertebral disc (IVD) pathologies. Discectomy alleviates disabling pain caused by IVD herniation without repairing annulus fibrosus (AF) defects, which can cause accelerated degeneration and recurrent pain. Biological therapies show promise for IVD repair but developing high-modulus biomaterials capable of providing biomechanical stabilisation and delivering biologics remains an unmet challenge. The present study identified critical factors and developed an optimal formulation to enhance the delivery of AF cells and transforming growth beta-3 (TGFβ-3) in genipin-crosslinked fibrin (FibGen) hydrogels. Part 1 showed that AF cells encapsulated in TGFβ-3-supplemented high-modulus FibGen synthesised little extracellular matrix (ECM) but could release TGFβ-3 at physiologically relevant levels. Part 2 showed that AF cells underwent apoptosis when encapsulated in FibGen, even after reducing fibrin concentration from 70 to 5 mg/mL. Mechanistic experiments, modifying genipin concentration and integrin binding site presence demonstrated that genipin crosslinking caused AF cell apoptosis by inhibiting cell-biomaterial binding. Adding integrin binding sites with fibronectin partially rescued apoptosis, indicating genipin also caused acute cytotoxicity. Part 3 showed that FibGen formulations with 1 mg/mL genipin had enhanced ECM synthesis when supplemented with fibronectin and TGFβ-3. In conclusion, FibGen could be used for delivering biologically active compounds and AF cells, provided that formulations supplied additional sites for cell-biomaterial binding and genipin concentrations were low. Results also highlighted a need for developing strategies that protect cells against acute crosslinker cytotoxicity to overcome challenges of engineering high-modulus cell carriers for musculoskeletal tissues that experience high mechanical demands.
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Affiliation(s)
| | | | | | | | - J.C. Iatridis
- Address for correspondence: James C. Iatridis, PhD, 1468 Madison Avenue-Annenberg Building, floor 20, Room A20-086, New York, 10029 NY, USA., Telephone number: +1 2122411517
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25
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Mandal A, Clegg JR, Anselmo AC, Mitragotri S. Hydrogels in the clinic. Bioeng Transl Med 2020; 5:e10158. [PMID: 32440563 PMCID: PMC7237140 DOI: 10.1002/btm2.10158] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022] Open
Abstract
Injectable hydrogels are one of the most widely investigated and versatile technologies for drug delivery and tissue engineering applications. Hydrogels' versatility arises from their tunable structure, which has been enabled by considerable advances in fields such as materials engineering, polymer science, and chemistry. Advances in these fields continue to lead to invention of new polymers, new approaches to crosslink polymers, new strategies to fabricate hydrogels, and new applications arising from hydrogels for improving healthcare. Various hydrogel technologies have received regulatory approval for healthcare applications ranging from cancer treatment to aesthetic corrections to spinal fusion. Beyond these applications, hydrogels are being studied in clinical settings for tissue regeneration, incontinence, and other applications. Here, we analyze the current clinical landscape of injectable hydrogel technologies, including hydrogels that have been clinically approved or are currently being investigated in clinical settings. We summarize our analysis to highlight key clinical areas that hydrogels have found sustained success in and further discuss challenges that may limit their future clinical translation.
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Affiliation(s)
- Abhirup Mandal
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMassachusettsUSA
- Wyss Institute for Biologically Inspired Engineering, Harvard UniversityCambridgeMassachusettsUSA
| | - John R. Clegg
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMassachusettsUSA
- Wyss Institute for Biologically Inspired Engineering, Harvard UniversityCambridgeMassachusettsUSA
| | - Aaron C. Anselmo
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Samir Mitragotri
- John A. Paulson School of Engineering and Applied SciencesHarvard UniversityCambridgeMassachusettsUSA
- Wyss Institute for Biologically Inspired Engineering, Harvard UniversityCambridgeMassachusettsUSA
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26
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Nucleus replacement could get a new chance with annulus closure. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1733-1741. [DOI: 10.1007/s00586-020-06419-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose
Disc herniations are usually treated by decompression of the spinal nerves via a partial nucleotomy. As a consequence of reduced disc height (DH), reduced intradiscal pressure (IDP) and increased range of motion (ROM), accelerated degeneration may occur. Nucleus replacement implants are intended to restore those values, but are associated with the risk of extrusion.
Methods
In six fresh frozen lumbar spinal segments (L2-3/L3-4/L4-5/L5-S1, age median 64.5 years (57–72), Pfirrmann grade 2–3), a prolapse was provoked through a box defect (6 × 10 mm) in the annulus. The herniated nucleus material was removed and replaced by a novel collagen-based nucleus implant. An annulus closure device sealed the defect. ROM, neutral zone (NZ) and IDP were measured in the (1) intact and (2) defect state, (3) postoperatively and (4) after cyclic loading (n = 100,000 cycles) applying pure moments (± 7.5 Nm) in flexion–extension, lateral bending and axial rotation. Additionally, the change in DH was determined. Extrusion of implants or nucleus material was evaluated macroscopically.
Results
In all specimens, a prolapse could be provoked which decreased DH. Subsequent nucleotomy changed ROM/NZ and IDP considerably. Initial values could be restored by the implantation. Macroscopically, none of the implants nor nucleus material did migrate after cyclic loading.
Conclusions
In this study, a prolapse followed by a nucleotomy resulted in a biomechanical destabilisation. Implantation of the nucleus replacement combined with an annulus closure restored the intact condition without showing signs of extrusion nor migration after cyclic loading. Hence, nucleus replacements could have a new chance in combination with annulus closure devices.
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27
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Ao Q, Wang S, He Q, Ten H, Oyama K, Ito A, He J, Javed R, Wang A, Matsuno A. Fibrin Glue/Fibronectin/Heparin-Based Delivery System of BMP2 Induces Osteogenesis in MC3T3-E1 Cells and Bone Formation in Rat Calvarial Critical-Sized Defects. ACS APPLIED MATERIALS & INTERFACES 2020; 12:13400-13410. [PMID: 32091872 DOI: 10.1021/acsami.0c01371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Bone morphogenetic proteins (BMPs) have been used to promote bone formation in many clinical scenarios. However, the BMPs are inherently unstable in vivo and therefore need to be combined with carriers for controlled delivery. In this study, an innovative and efficient fibrin glue/fibronectin/heparin (FG/Fn/Hep)-based delivery system was developed for controlled release of BMP2. The incorporation of heparin can significantly slow the release of BMP2 without substantially affecting the structure and stiffness of the FG/Fn. The BMP2 release from the FG/Fn/Hep-BMP2 hydrogel is largely dominated by hydrogel degradation rather than simple diffusion. In vitro release experiments and MC3T3-E1 cell induction experiments showed that BMP2 can be released steadily and can induce MC3T3-E1 cells to differentiate into osteoblasts efficiently. This process is characterized by the significantly increased expression of calcium deposits, alkaline phosphatase, runt-related transcription factor-2, osteopontin, osteocalcin, and collagen I in comparison with the negative control. In vivo assessments revealed that the FG/Fn/Hep-BMP2 hydrogel significantly promotes bone regeneration in a rat calvarial critical-sized defect model. Our investigation indicates that FG/Fn/Hep-BMP2 hydrogel holds promise to be used as an alternative biomaterial for the repair of bone defects.
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Affiliation(s)
- Qiang Ao
- Department of Tissue Engineering, China Medical University, Shenyang 110122, China
- Institute of Regulatory Science for Medical Device, National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Shilin Wang
- Department of Tissue Engineering, China Medical University, Shenyang 110122, China
| | - Qing He
- State Key Laboratory of Biomembrane and Membrane Biotechnology, School of Life Sciences, Tsinghua University, Beijing 100084, China
| | - Hirotomo Ten
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo 163-8001, Japan
| | - Kenichi Oyama
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo 163-8001, Japan
| | - Akihiro Ito
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo 163-8001, Japan
| | - Jing He
- Department of Tissue Engineering, China Medical University, Shenyang 110122, China
| | - Rabia Javed
- Department of Tissue Engineering, China Medical University, Shenyang 110122, China
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, School of Medicine, University of California, Davis, Sacramento, California 95817, United States
| | - Akira Matsuno
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo 163-8001, Japan
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28
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Long RG, Ferguson SJ, Benneker LM, Sakai D, Li Z, Pandit A, Grijpma DW, Eglin D, Zeiter S, Schmid T, Eberli U, Nehrbass D, Di Pauli von Treuheim T, Alini M, Iatridis JC, Grad S. Morphological and biomechanical effects of annulus fibrosus injury and repair in an ovine cervical model. JOR Spine 2020; 3:e1074. [PMID: 32211587 PMCID: PMC7084058 DOI: 10.1002/jsp2.1074] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/17/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
Tissue engineering repair of annulus fibrosus (AF) defects has the potential to prevent disability and pain from intervertebral disc (IVD) herniation and its progression to degeneration. Clinical translation of AF repair methods requires assessment in long-term large animal models. An ovine AF injury model was developed using cervical spinal levels and a biopsy-type AF defect to assess composite tissue engineering repair in 1-month and 12-month studies. The repair used a fibrin hydrogel crosslinked with genipin (FibGen) to seal defects, poly(trimethylene carbonate) (PTMC) scaffolds to replace lost AF tissue, and polyurethane membranes to prevent herniation. In the 1-month study, PTMC scaffolds sealed with FibGen herniated with polyurethane membranes. When applied alone, FibGen integrated with the surrounding AF tissue without herniation, showing promise for long-term studies. The 12-month long-term study used only FibGen which showed fibrous healing, biomaterial resorption and no obvious hydrogel-related complications. However, the 2 mm biopsy punch injury condition also exhibited fibrotic healing at 12 months. Both untreated and FibGen treated groups showed equivalency with no detectable differences in histological grades of proteoglycans, cellular morphology, IVD structure and blood vessel formation, biomechanical properties including torque range and axial range of motion, Pfirrmann grade, IVD height, and quantitative scores of vertebral body changes from clinical computed tomography. The biopsy-type injury caused endplate defects with a high prevalence of osteophytes in all groups and no nucleus herniation, indicating that the biopsy-type injury requires further refinement, such as reduction to a slit-type defect that could penetrate the full depth of the AF without damaging the endplate. Results demonstrate translational feasibility of FibGen for AF repair to seal AF defects, although future study with a more refined injury model is required to validate the efficacy of FibGen before translation.
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Affiliation(s)
- Rose G. Long
- Department of GeneticsHarvard Medical SchoolBostonMassachusetts
| | | | - Lorin M. Benneker
- Department for Orthopaedic Surgery, Spine Unit, InselspitalUniversity Hospital of BernBernSwitzerland
| | - Daisuke Sakai
- Department of Orthopaedic SurgeryTokai University School of MedicineKanagawaJapan
| | - Zhen Li
- AO Research Institute DavosDavos PlatzSwitzerland
| | - Abhay Pandit
- CÚRAM, Center for Research in Medical DevicesNational University of IrelandGalwayIreland
| | - Dirk W. Grijpma
- University of Twente, Technical Medical CentreDepartment of Biomaterials Science and TechnologyFaculty of Science and TechnologyEnschedeThe Netherlands
| | - David Eglin
- AO Research Institute DavosDavos PlatzSwitzerland
| | | | - Tanja Schmid
- AO Research Institute DavosDavos PlatzSwitzerland
| | | | | | | | - Mauro Alini
- AO Research Institute DavosDavos PlatzSwitzerland
| | - James C. Iatridis
- Leni & Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew York
| | - Sibylle Grad
- AO Research Institute DavosDavos PlatzSwitzerland
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29
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Wang Z, Liu H, Luo W, Cai T, Li Z, Liu Y, Gao W, Wan Q, Wang X, Wang J, Wang Y, Yang X. Regeneration of skeletal system with genipin crosslinked biomaterials. J Tissue Eng 2020; 11:2041731420974861. [PMID: 33294154 PMCID: PMC7705197 DOI: 10.1177/2041731420974861] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
Abstract
Natural biomaterials, such as collagen, gelatin, and chitosan, are considered as promising candidates for use in tissue regeneration treatment, given their similarity to natural tissues regarding components and structure. Nevertheless, only receiving a crosslinking process can these biomaterials exhibit sufficient strength to bear high tensile loads for use in skeletal system regeneration. Recently, genipin, a natural chemical compound extracted from gardenia fruits, has shown great potential as a reliable crosslinking reagent, which can reconcile the crosslinking effect and biosafety profile simultaneously. In this review, we briefly summarize the genipin extraction process, biosafety, and crosslinking mechanism. Subsequently, the applications of genipin regarding aiding skeletal system regeneration are discussed in detail, including the advances and technological strategies for reconstructing cartilage, bone, intervertebral disc, tendon, and skeletal muscle tissues. Finally, based on the specific pharmacological functions of genipin, its potential applications, such as its use in bioprinting and serving as an antioxidant and anti-tumor agent, and the challenges of genipin in the clinical applications in skeletal system regeneration are also presented.
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Affiliation(s)
- Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Wenbin Luo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Tianyang Cai
- College of Rehabilitation, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Zuhao Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Yuzhe Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Weinan Gao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Qian Wan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Xianggang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Yanbing Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Xiaoyu Yang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
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30
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Liu C, Jin Z, Ge X, Zhang Y, Xu H. Decellularized Annulus Fibrosus Matrix/Chitosan Hybrid Hydrogels with Basic Fibroblast Growth Factor for Annulus Fibrosus Tissue Engineering. Tissue Eng Part A 2019; 25:1605-1613. [PMID: 30929614 PMCID: PMC6919252 DOI: 10.1089/ten.tea.2018.0297] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Low back pain caused by degenerative disc disease affects many people worldwide and brings huge economical burden. Thus, attentions have focused on annulus fibrosus (AF) tissue engineering for treatment of intervertebral disc degeneration. To engineer a functional replacement for the AF, it is important to fabricate scaffolds that mimic the structural and mechanical properties of native tissue. AF-derived stem cells are promising seed cells for AF tissue engineering due to their tissue specificity. In the present study, decellularized AF matrix (DAFM)/chitosan hybrid hydrogels were fabricated using genipin as a crosslinker. AF stem cells were cultured on hydrogel scaffolds with or without basic fibroblast growth factor (bFGF), and cell proliferation, morphology, gene expression, and AF tissue synthesis were examined. Overall, more collagen-I, collagen-II, and aggrecan were secreted by AF stem cells grown on hydrogels with bFGF compared to those without. These results support the application of DAFM/chitosan hybrid hydrogels as an appropriate candidate for AF tissue engineering. Furthermore, incorporation of bFGF into hydrogels promoted AF-related tissue synthesis.
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Affiliation(s)
- Chen Liu
- Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Zhongxing Jin
- Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Xin Ge
- Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Yu Zhang
- Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Hongguang Xu
- Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, Wuhu, China
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31
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Wang Q, Jiang J, Xiong YL. Genipin-Aided Protein Cross-linking to Modify Structural and Rheological Properties of Emulsion-Filled Hempseed Protein Hydrogels. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:12895-12903. [PMID: 31682429 DOI: 10.1021/acs.jafc.9b05665] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Genipin, a natural electrophilic cross-linker, was applied (5, 10, 20, and 30 mM) to modify hempseed protein isolate (HPI). Genipin treatments resulted in general losses of total sulfhydryls (up to 2.9 nmol/mg) and free amines (up to 77.3 nmol/mg). Surface hydrophobicity decreased by nearly 90% with 30 mM genipin, corresponding to similar tryptophan fluorescence quenching. The genipin treatment converted HPI into highly cross-linked polymers. Hydrogels formed with such polymers when also incorporated with hemp oil emulsions exhibited substantially enhanced gelling ability: up to 3.3- and 2.6-fold increases, respectively, in gel strength and gel elasticity over genipin-untreated protein. The genipin-modified composite gels also exhibited superior water-holding capacity. Microstructural analysis revealed a compact gel network filled with protein-coated oil globules that interacted intimately with the protein matrix when treated with genipin. Such gels remained readily digestible. Hence, genipin-treated hemp protein hydrogels show promise as functional food components.
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Affiliation(s)
- Qingling Wang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, and Synergetic Innovation Center of Food Safety and Nutrition , at Jiangnan University , Wuxi , Jiangsu 214122 , China
| | - Jiang Jiang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, and Synergetic Innovation Center of Food Safety and Nutrition , at Jiangnan University , Wuxi , Jiangsu 214122 , China
| | - Youling L Xiong
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, and Synergetic Innovation Center of Food Safety and Nutrition , at Jiangnan University , Wuxi , Jiangsu 214122 , China
- Department of Animal and Food Sciences , University of Kentucky , Lexington , Kentucky 40546 , United States
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Roberts IV, Bukhary D, Valdivieso CYL, Tirelli N. Fibrin Matrices as (Injectable) Biomaterials: Formation, Clinical Use, and Molecular Engineering. Macromol Biosci 2019; 20:e1900283. [PMID: 31769933 DOI: 10.1002/mabi.201900283] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/14/2019] [Indexed: 12/19/2022]
Abstract
This review focuses on fibrin, starting from biological mechanisms (its production from fibrinogen and its enzymatic degradation), through its use as a medical device and as a biomaterial, and finally discussing the techniques used to add biological functions and/or improve its mechanical performance through its molecular engineering. Fibrin is a material of biological (human, and even patient's own) origin, injectable, adhesive, and remodellable by cells; further, it is nature's most common choice for an in situ forming, provisional matrix. Its widespread use in the clinic and in research is therefore completely unsurprising. There are, however, areas where its biomedical performance can be improved, namely achieving a better control over mechanical properties (and possibly higher modulus), slowing down degradation or incorporating cell-instructive functions (e.g., controlled delivery of growth factors). The authors here specifically review the efforts made in the last 20 years to achieve these aims via biomimetic reactions or self-assembly, as much via formation of hybrid materials.
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Affiliation(s)
- Iwan Vaughan Roberts
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Deena Bukhary
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,Department of Pharmaceutical Science, Faculty of Pharmacy, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | | | - Nicola Tirelli
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,Laboratory of Polymers and Biomaterials, Fondazione Istituto Italiano di Tecnologia, via Morego 30, 16163, Genova, Italy
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Jiang EY, Sloan SR, Wipplinger C, Kirnaz S, Härtl R, Bonassar LJ. Proteoglycan removal by chondroitinase ABC improves injectable collagen gel adhesion to annulus fibrosus. Acta Biomater 2019; 97:428-436. [PMID: 31425894 DOI: 10.1016/j.actbio.2019.08.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/24/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Abstract
Intervertebral disc (IVD) herniations are currently treated with interventions that leave the IVD with persistent lesions prone to further herniations. Annulus fibrosus (AF) repair has become of interest as a method to seal defects in the IVD and prevent reherniation, but this requires strong adhesion of the implanted biomaterial to the native AF tissue. Our group has previously developed a high-density collagen (HDC) gel for AF repair and tested its efficacy in vivo, but its adhesion to the AF could be improved. Increased cell adhesion to cartilage has previously been reported through chondroitinase ABC (ChABC) digestion, which removes proteoglycans and increases access to cell binding motifs. Such approaches could also increase biomaterial adhesion to tissue, but the effects of ChABC digestion on AF have yet to be investigated. In this study, ovine AF tissue was digested with either 10 U/mL ChABC or saline for up to 10 min and the effect of this treatment on collagen adhesion between AF tissue samples was investigated by histology and mechanical testing in a lap-shear configuration. ChABC digestion removed proteoglycans within the AF in a time-dependent fashion and enhanced adhesion of the HDC gel to the AF. ChABC digestion increased the elastic toughness and total shear energy of the HDC gel-AF interface by 88% and 46% respectively. ChABC treatment enhanced the adhesion of the HDC gel to the AF without significantly decreasing native AF cell viability. Thus, ChABC digestion is a viable method to improve adhesion of biomaterials for AF repair. STATEMENT OF SIGNIFICANCE: Intervertebral disc herniations are currently treated with interventions that leave persistent lesions in the annulus fibrosus that are prone to further herniations. Annular repair is a promising method to seal lesions and prevent reherniation, but requires strong adhesion of the implanted biomaterial to native annulus fibrosus. Since large proteoglycans like aggrecan occupy regions of the extracellular matrix between collagen fibers in the annulus fibrosus, we hypothesized that removing proteoglycans via chondroitinase digestion would increase the adhesion of annular repair hydrogels. This investigation demonstrated that chondroitinase removed proteoglycans within annulus fibrosus tissue, enhanced the interaction of an injected collagen gel with the native tissue, and mechanically improved adhesion between the collagen gel and annulus fibrosus. This is the first study of its kind to evaluate the biochemical and mechanical effects of short-term chondroitinase digestion on annulus fibrosus tissue.
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Du ZC, Zhu LX. A Heterologous Fibrin Glue Enhances the Closure Effect of Surgical Suture on the Repair of Annulus Fibrous Defect in a Sheep Model. Curr Med Sci 2019; 39:597-603. [PMID: 31346996 DOI: 10.1007/s11596-019-2079-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/25/2019] [Indexed: 12/20/2022]
Abstract
Improving the closure effect of surgical suture for repair of annulus fibrosus defects remains an unsolved problem. A new type of porcine fibrin glue was reported for the repair of annulus fibrous defects in sheep models in this study. Continuous axial loading test showed that this glue could effectively improve the closure effect of surgical suture for annulus fibrous defect. Magnetic resonance imaging (MRI) of the lumbar spine confirmed that, compared with non-fibrin glue treated intervertebral discs, it contributed to preservation of the nucleus pulposus and maintained the physiological hydration of the intervertebral discs. Moreover, histomorphology evaluation showed that the porcine fibrin glue could partially reverse degeneration of the injured intervertebral discs. Taken together, porcine fibrin glue can effectively enhance the closure effect of surgical suture on annulus fibrosus, improve the repair effect and slow down the degeneration of the intervertebral disc, and provide a potential therapeutic strategy for degenerative intervertebral disc disease.
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Affiliation(s)
- Zhi-Cai Du
- Southern Medical University, Guangzhou, 510515, China.,Department of Minimally Invasive Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010030, China
| | - Li-Xin Zhu
- Southern Medical University, Guangzhou, 510515, China. .,Department of Orthopaedic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
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Hom WW, Tschopp M, Lin HA, Nasser P, Laudier DM, Hecht AC, Nicoll SB, Iatridis JC. Composite biomaterial repair strategy to restore biomechanical function and reduce herniation risk in an ex vivo large animal model of intervertebral disc herniation with varying injury severity. PLoS One 2019; 14:e0217357. [PMID: 31136604 PMCID: PMC6538241 DOI: 10.1371/journal.pone.0217357] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022] Open
Abstract
Back pain commonly arises from intervertebral disc (IVD) damage including annulus fibrosus (AF) defects and nucleus pulposus (NP) loss. Poor IVD healing motivates developing tissue engineering repair strategies. This study evaluated a composite injectable IVD biomaterial repair strategy using carboxymethylcellulose-methylcellulose (CMC-MC) and genipin-crosslinked fibrin (FibGen) that mimic NP and AF properties, respectively. Bovine ex vivo caudal IVDs were evaluated in cyclic compression-tension, torsion, and compression-to-failure tests to determine IVD biomechanical properties, height loss, and herniation risk following experimentally-induced severe herniation injury and discectomy (4 mm biopsy defect with 20% NP removed). FibGen with and without CMC-MC had failure strength similar to discectomy injury suggesting no increased risk compared to surgical procedures, yet no biomaterials improved axial or torsional biomechanical properties suggesting they were incapable of adequately restoring AF tension. FibGen had the largest failure strength and was further evaluated in additional discectomy injury models with varying AF defect types (2 mm biopsy, 4 mm cruciate, 4 mm biopsy) and NP removal volume (0%, 20%). All simulated discectomy defects significantly compromised failure strength and biomechanical properties. The 0% NP removal group had mean values of axial biomechanical properties closer to intact levels than defects with 20% NP removed but they were not statistically different and 0% NP removal also decreased failure strength. FibGen with and without CMC-MC failed at super-physiological stress levels above simulated discectomy suggesting repair with these tissue engineered biomaterials may perform better than discectomy alone, although restored biomechanical function may require additional healing with the potential application of these biomaterials as sealants and cell/drug delivery carriers.
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Affiliation(s)
- Warren W. Hom
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Melanie Tschopp
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Huizi A. Lin
- Department of Biomedical Engineering, The City College of New York, New York, New York, United States of America
| | - Philip Nasser
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Damien M. Laudier
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Andrew C. Hecht
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Steven B. Nicoll
- Department of Biomedical Engineering, The City College of New York, New York, New York, United States of America
| | - James C. Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
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Gupta N, Cruz MA, Nasser P, Rosenberg JD, Iatridis JC. Fibrin-Genipin Hydrogel for Cartilage Tissue Engineering in Nasal Reconstruction. Ann Otol Rhinol Laryngol 2019; 128:640-646. [PMID: 30862177 DOI: 10.1177/0003489419836667] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Nasal reconstruction is limited by the availability of autologous cartilage. The aim is to investigate an adhesive biomaterial for tissue engineering of nasal cartilage by evaluating mechanical properties of hydrogels made of fibrin crosslinked with genipin as compared to native tissue. METHODS Hydrogels of fibrin, fibrin-genipin, and fibrin-genipin with extracellular matrix (ECM) particles were created and evaluated with mechanical testing to determine compression, tensile, and shear properties. Rabbit nasal septal cartilage was harvested and tested in these modalities for comparison. Transmission electron microscopy characterized hydrogel structure. RESULTS Fibrin-genipin gels had higher compressive, tensile, and shear moduli compared to fibrin alone or fibrin-genipin with ECM. However, all hydrogel formulations had lower moduli than the rabbit nasal septal cartilage. Electron microscopy showed genipin crosslinking increased structural density of the hydrogel and that cartilage ECM created larger structural features with lower crosslinking density. CONCLUSION The addition of genipin significantly improved mechanical properties of fibrin hydrogels by increasing the compressive, tensile, and shear moduli. The addition of cartilage ECM, which can add native structure and composition, resulted in decreased moduli values. Fibrin-genipin is a bioactive and biomechanically stable hydrogel that may offer promise as a scaffold for cartilage tissue engineering in nasal reconstruction, yet further augmentation is required to match material properties of native nasal cartilage.
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Affiliation(s)
- Nikita Gupta
- 1 Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,2 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY, USA
| | - Michelle A Cruz
- 3 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip Nasser
- 3 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua D Rosenberg
- 1 Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James C Iatridis
- 3 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Marques CF, Olhero SM, Torres PM, Abrantes JC, Fateixa S, Nogueira HI, Ribeiro IA, Bettencourt A, Sousa A, Granja PL, Ferreira JM. Novel sintering-free scaffolds obtained by additive manufacturing for concurrent bone regeneration and drug delivery: Proof of concept. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 94:426-436. [DOI: 10.1016/j.msec.2018.09.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/01/2018] [Accepted: 09/18/2018] [Indexed: 02/08/2023]
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Scheibler AG, Götschi T, Widmer J, Holenstein C, Steffen T, Camenzind RS, Snedeker JG, Farshad M. Feasibility of the annulus fibrosus repair with in situ gelating hydrogels - A biomechanical study. PLoS One 2018; 13:e0208460. [PMID: 30521633 PMCID: PMC6283563 DOI: 10.1371/journal.pone.0208460] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/17/2018] [Indexed: 12/19/2022] Open
Abstract
The surgical standard of care for lumbar discectomy leaves the annulus fibrosus (AF) defect unrepaired, despite considerable risk for a recurrent herniation. Identification of a viable defect repair strategy has until now been elusive. The scope of this ex vivo biomechanical study was to evaluate crosslinking hydrogels as potentially promising AF defect sealants, and provide a baseline for their use in combination with collagen scaffolds that restore disc volume. This study directly compared genipin crosslinked fibrin hydrogel (FibGen) as a promising preclinical candidate against a clinically available adhesive composed of glutaraldehyde and albumin (BioGlue). Forty-two bovine coccygeal functional spine units (FSU) were randomly allocated into four groups, namely untreated (control, n = 12), repaired with either one of the tested hydrogels (BioGlue, n = 12; FibGen, n = 12), or FibGen used in combination with a collagen hydrogel scaffold (FibGen+Scaffold, n = 6). All specimens underwent a moderate mechanical testing protocol in intact, injured and repaired states. After completion of the moderate testing protocol, the samples underwent a ramp-to-failure test. Lumbar discectomy destabilized the FSU as quantified by increased torsional range of motion (28.0° (19.1, 45.1) vs. 41.39° (27.3, 84.9), p<0.001), torsional neutral zone (3.1° (1.2, 7.7) vs. 4.8° (2.1, 12.1), Z = -3.49, p < 0.001), hysteresis(24.4 J (12.8, 76.0) vs. 27.6 J (16.4, 54.4), Z = -2.61, p = 0.009), with loss of both disc height (7.0 mm (5.0, 10.5) vs 6.1 mm (4.0, 9.3), Z = -5.16, p < 0.001) and torsional stiffness (0.76 Nmdeg-1 (0.38, 1.07) vs. 0.66 Nmdeg-1 (0.38, 0.97), Z = -3.98, p < 0.001). Most FibGen repaired AF endured the entire testing procedure whereas only a minority of BioGlue repaired AF and all FibGen+Scaffold repaired AF failed (6/10 vs. 3/12 vs. 0/6 respectively, p = 0.041). Both BioGlue and FibGen+Scaffold repaired AF partially restored disc height (0.47 mm (0.07, 2.41), p = 0.048 and 1.52 mm (0.41, 2.57), p = 0.021 respectively) compared to sham treatment (0.08 mm (-0.63, 0.88)) whereas FibGen-only repaired AF had no such effect (0.04 mm (-0.73, 1.13), U = 48.0, p = 1). The AF injury model demonstrated considerable change of FSU mechanics that could be partially restored by use of an AF sealant. While inclusion of a volumetric collagen scaffold led to repair failure, use of FibGen alone demonstrated clinically relevant promise for prevention of mechanical reherniation, outperforming an FDA approved sealant in this ex vivo test series.
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Affiliation(s)
- Anne-Gita Scheibler
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Claude Holenstein
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Thomas Steffen
- Musculoskeletal Research Unit (MSRU), Center for Applied Biotechnology & Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Roland S. Camenzind
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jess G. Snedeker
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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Moriguchi Y, Borde B, Berlin C, Wipplinger C, Sloan SR, Kirnaz S, Pennicooke B, Navarro-Ramirez R, Khair T, Grunert P, Kim E, Bonassar L, Härtl R. In vivo annular repair using high-density collagen gel seeded with annulus fibrosus cells. Acta Biomater 2018; 79:230-238. [PMID: 29981494 DOI: 10.1016/j.actbio.2018.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 05/25/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim is assessing the in vivo efficacy of annulus fibrosus (AF) cells seeded into collagen by enhancing the reparative process around annular defects and preventing further degeneration in a rat-tail model. SUMMARY OF BACKGROUND DATA Treating disc herniation with discectomy may relieve the related symptoms but does not address the underlying pathology. The persistent annular defect may lead to re-herniation and further degeneration. We recently demonstrated that riboflavin crosslinked high-density collagen gels (HDC) can facilitate annular repair in vivo. METHODS 42 rats, tail disc punctured with an 18-gauge needle, were divided into 3 groups: untreated (n = 6), injected with crosslinked HDC (n = 18), and injected with AF cell-laden crosslinked HDC (n = 18). Ovine AF cells were mixed with HDC gels prior to injection. X-rays and MRIs were conducted over 5 weeks, determining disc height index (DHI), nucleus pulposus (NP) size, and hydration. Histological assessments evaluated the viability of implanted cells and degree of annular repair. RESULTS Although average DHIs of both HDC gel groups were higher than those of the puncture control group at 5 weeks, the retention of disc height, NP size and hydration at 1 and 5 weeks was significant for the cellular group compared to the punctured, and at 5 weeks to the acellular group. Histological assessment indicated that AF cell-laden HDC gels have accelerated reparative sealing compared to acellular HDC gels. CONCLUSIONS AF cell-laden HDC gels have the ability of better repairing annular defects than acellular gels after needle puncture. STATEMENT OF SIGNIFICANCE This project addresses the compelling demand of a sufficient treatment strategy for degenerative disc disease (DDD) perpetuated by annulus fibrosus (AF) injury, a major cause of morbidity and burden to health care systems. Our study is designed to answer the question of whether injectable, photo-crosslinked, high density collagen gels can seal defects in the annulus fibrosus of rats and prevent disc degeneration. Furthermore, we investigated whether the healing of AF defects will be enhanced by the delivery of AF cells (fibrochondrocytes) to these defects. The use of cell-laden collagen gels in spine surgery holds promise for a wide array of applications, from current discectomy procedures to future nucleus pulposus reparative therapies, and our group is excited about this potential.
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Yang JJ, Li F, Hung KC, Hsu SH, Wang JL. Intervertebral disc needle puncture injury can be repaired using a gelatin–poly (γ-glutamic acid) hydrogel: an in vitro bovine biomechanical validation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2631-2638. [DOI: 10.1007/s00586-018-5727-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/08/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022]
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Leon-Valdivieso CY, Wedgwood J, Lallana E, Donno R, Roberts I, Ghibaudi M, Tirella A, Tirelli N. Fibroblast migration correlates with matrix softness. A study in knob-hole engineered fibrin. APL Bioeng 2018; 2:036102. [PMID: 31069320 PMCID: PMC6481723 DOI: 10.1063/1.5022841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/21/2018] [Indexed: 02/01/2023] Open
Abstract
The invasion of a matrix by migrating cells is a key step in its remodelling. At least in 2D migration models, cells tend to localize in stiffer areas (durotaxis). Here, we show that mechanical properties affect differently the 3D migration rate: non-proteolytic 3D cell migration is facilitated in softer matrices. In these gels, the modulus was varied by introducing defects in fibres, leaving largely intact the nanostructure. The matrices derive from fibrin via functionalization with a bioinert polymer [poly(ethylene glycol), PEG] through an affinity mechanism identical to that presiding to fibrin own self-assembly. Peptidic end groups on PEG were used to bind fibrinogen globular D regions [GPRP (glycine-proline-arginine-proline) for a holes, GHRP (glycine-histidine-arginine-proline) for b holes; Kd evaluated via isothermal titration calorimetry or fluorescence anisotropy]. In a dose-dependent manner, both PEGylated peptides decreased gel stiffness, but most other properties at a macroscopic [e.g., overall elastic character, strain hardening, and high (>0.5) Poisson ratio] or nano/micro level (fibre dimension and pore size) were largely unaffected, suggesting that the softening effect was due to the introduction of defects within fibres, rather than to differences in the network architecture. In these matrices, the key determinant of fibroblast migration was found to be the elastic modulus, rather than the identity or the dose of the PEGylated peptide; softer materials allowed a faster invasion, even if this meant a higher content of non-adhesive PEG. This does not conflict with fibroblast durotaxis (where stiffness controls accumulation but not necessarily the speed of migration) and indicates a way to fine tune the speed of cell colonization.
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Affiliation(s)
| | - Jennifer Wedgwood
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
| | - Enrique Lallana
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
| | - Roberto Donno
- Laboratory of Polymers and Biomaterials, Fondazione Istituto Italiano di Tecnologia, via Morego 30, 16163 Genova, Italy
| | - Iwan Roberts
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
| | | | - Annalisa Tirella
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
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Zhu W, Chuah YJ, Wang DA. Bioadhesives for internal medical applications: A review. Acta Biomater 2018; 74:1-16. [PMID: 29684627 DOI: 10.1016/j.actbio.2018.04.034] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/08/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
Bioadhesives such as tissue adhesives, hemostatic agents, and tissue sealants have gained increasing popularity in different areas of clinical operations during the last three decades. Bioadhesives can be categorized into internal and external ones according to their application conditions. External bioadhesives are generally applied in topical medications such as wound closure and epidermal grafting. Internal bioadhesives are mainly used in intracorporal conditions with direct contact to internal environment including tissues, organs and body fluids, such as chronic organ leak repair and bleeding complication reduction. This review focuses on internal bioadhesives that, in contrast with external bioadhesives, emphasize much more on biocompatibility and adhesive ability to wet surfaces rather than on gluing time and intensity. The crosslinking mechanisms of present internal bioadhesives can be generally classified as follows: 1) chemical conjugation between reactive groups; 2) free radical polymerization by light or redox initiation; 3) biological or biochemical coupling with specificity; and 4) biomimetic adhesion inspired from natural phenomena. In this review, bioadhesive products of each class are summarized and discussed by comparing their designs, features, and applications as well as their prospects for future development. STATEMENT OF SIGNIFICANCE Despite the emergence of numerous novel bioadhesive formulations in recent years, thus far, the classification of internal and external bioadhesives has not been well defined and universally acknowledged. Many of the formulations have been proposed for treatment of several diseases even though they are not applicable for such conditions. This is because of the lack of a systematic standard or evaluation protocol during the development of a new adhesive product. In this review, the definition of internal and external bioadhesives is given for the first time, and with a focus on internal bioadhesives, the criteria of an ideal internal bioadhesive are adequately discussed; this is followed by the review of recently developed internal bioadhesives based on different gluing mechanisms.
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Affiliation(s)
- Wenzhen Zhu
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637457, Singapore
| | - Yon Jin Chuah
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 637335, Singapore
| | - Dong-An Wang
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637457, Singapore.
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Frauchiger DA, May RD, Bakirci E, Tekari A, Chan SCW, Wöltje M, Benneker LM, Gantenbein B. Genipin-Enhanced Fibrin Hydrogel and Novel Silk for Intervertebral Disc Repair in a Loaded Bovine Organ Culture Model. J Funct Biomater 2018; 9:E40. [PMID: 29937524 PMCID: PMC6163705 DOI: 10.3390/jfb9030040] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 12/20/2022] Open
Abstract
(1) Background: Intervertebral disc (IVD) repair represents a major challenge. Using functionalised biomaterials such as silk combined with enforced hydrogels might be a promising approach for disc repair. We aimed to test an IVD repair approach by combining a genipin-enhanced fibrin hydrogel with an engineered silk scaffold under complex load, after inducing an injury in a bovine whole organ IVD culture; (2) Methods: Bovine coccygeal IVDs were isolated from ~1-year-old animals within four hours post-mortem. Then, an injury in the annulus fibrosus was induced by a 2 mm biopsy punch. The repair approach consisted of genipin-enhanced fibrin hydrogel that was used to fill up the cavity. To seal the injury, a Good Manufacturing Practise (GMP)-compliant engineered silk fleece-membrane composite was applied and secured by the cross-linked hydrogel. Then, IVDs were exposed to one of three loading conditions: no load, static load and complex load in a two-degree-of-freedom bioreactor for 14 days. Followed by assessing DNA and matrix content, qPCR and histology, the injured discs were compared to an uninjured control IVD that underwent the same loading profiles. In addition, the genipin-enhanced fibrin hydrogel was further investigated with respect to cytotoxicity on human stem cells, annulus fibrosus, and nucleus pulposus cells; (3) Results: The repair was successful as no herniation could be detected for any of the three loading conditions. Disc height was not recovered by the repair DNA and matrix contents were comparable to a healthy, untreated control disc. Genipin resulted being cytotoxic in the in vitro test but did not show adverse effects when used for the organ culture model; (4) Conclusions: The current study indicated that the combination of the two biomaterials, i.e., genipin-enhanced fibrin hydrogel and an engineered silk scaffold, was a promising approach for IVD repair. Furthermore, genipin-enhanced fibrin hydrogel was not suitable for cell cultures; however, it was highly applicable as a filler material.
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Affiliation(s)
- Daniela A Frauchiger
- Tissue & Organ Mechano Biology, Institute for Surgical Technology and Biomechanics, University of Bern, 3012 Bern, Switzerland.
| | - Rahel D May
- Tissue & Organ Mechano Biology, Institute for Surgical Technology and Biomechanics, University of Bern, 3012 Bern, Switzerland.
| | - Ezgi Bakirci
- Tissue & Organ Mechano Biology, Institute for Surgical Technology and Biomechanics, University of Bern, 3012 Bern, Switzerland.
| | - Adel Tekari
- Tissue & Organ Mechano Biology, Institute for Surgical Technology and Biomechanics, University of Bern, 3012 Bern, Switzerland.
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sfax 3018, Tunisia.
| | - Samantha C W Chan
- Tissue & Organ Mechano Biology, Institute for Surgical Technology and Biomechanics, University of Bern, 3012 Bern, Switzerland.
| | - Michael Wöltje
- Institute of Textile Machinery and High Performance Material Technology, TU Dresden, 01062 Dresden, Germany.
| | - Lorin M Benneker
- Department of Orthopaedic Surgery and Traumatology, Spine Unit, Insel Hospital, Bern University Hospital, Bern 3010, Switzerland.
| | - Benjamin Gantenbein
- Tissue & Organ Mechano Biology, Institute for Surgical Technology and Biomechanics, University of Bern, 3012 Bern, Switzerland.
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Long RG, Zderic I, Gueorguiev B, Ferguson SJ, Alini M, Grad S, Iatridis JC. Effects of Level, Loading Rate, Injury and Repair on Biomechanical Response of Ovine Cervical Intervertebral Discs. Ann Biomed Eng 2018; 46:1911-1920. [PMID: 29926304 DOI: 10.1007/s10439-018-2077-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/13/2018] [Indexed: 12/15/2022]
Abstract
A need exists for pre-clinical large animal models of the spine to translate biomaterials capable of repairing intervertebral disc (IVD) defects. This study characterized the effects of cervical spinal level, loading rate, injury and repair with genipin-crosslinked fibrin (FibGen) on axial and torsional mechanics in an ovine cervical spine model. Cervical IVDs C2-C7 from nine animals were tested with cyclic tension-compression (- 240 to 100 N) and cyclic torsion (± 2° and ± 4°) tests at three rates (0.1, 1 and 2 Hz) in intact, injured and repaired conditions. Intact IVDs from upper cervical levels (C2-C4) had significantly higher torque range and torsional stiffness and significantly lower axial range of motion (ROM) and tensile compliance than IVDs from lower cervical levels (C5-C7). A tenfold increase in loading rate significantly increased torque range and torsional stiffness 4-8% (depending on amplitude) (p < 0.001). When normalized to intact, FibGen significantly restored torque range (FibGen: 0.96 ± 0.14, Injury: 0.88 ± 0.14, p = 0.03) and axial ROM (FibGen: 1.00 ± 0.05, Injury: 1.04 ± 0.15, p = 0.02) compared to Injury, with a values of 1 indicating full repair. Cervical spinal level must be considered for controlling biomechanical evaluations, and FibGen restored some torsional and axial biomechanical properties to intact levels.
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Affiliation(s)
- Rose G Long
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland.,Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, New York, NY, 10029-6574, USA
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | | | - Mauro Alini
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | - Sibylle Grad
- AO Research Institute Davos, Clavadelstrasse 8, 7270, Davos, Switzerland
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1188, New York, NY, 10029-6574, USA.
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45
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Mascarinas A, Harrison J, Boachie-Adjei K, Lutz G. Regenerative Treatments for Spinal Conditions. Phys Med Rehabil Clin N Am 2018; 27:1003-1017. [PMID: 27788898 DOI: 10.1016/j.pmr.2016.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A literature review of clinical and translational studies was performed to provide an overview of current concepts on regenerative treatments for spinal conditions, including platelet rich plasma and stem cell treatments to treat low back pain.
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Affiliation(s)
- Angelie Mascarinas
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA
| | - Julian Harrison
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA
| | - Kwadwo Boachie-Adjei
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA
| | - Gregory Lutz
- Department of Physiatry, Hospital for Special Surgery, 429 East 75th Street, 3rd Floor, New York, NY 10021, USA.
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Natural Origin Materials for Osteochondral Tissue Engineering. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1058:3-30. [DOI: 10.1007/978-3-319-76711-6_1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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47
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Cruz MA, McAnany S, Gupta N, Long RG, Nasser P, Eglin D, Hecht AC, Illien-Junger S, Iatridis JC. Structural and Chemical Modification to Improve Adhesive and Material Properties of Fibrin-Genipin for Repair of Annulus Fibrosus Defects in Intervertebral Disks. J Biomech Eng 2018; 139:2625781. [PMID: 28464119 DOI: 10.1115/1.4036623] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Indexed: 01/07/2023]
Abstract
Annulus fibrosus (AF) defects from intervertebral disk (IVD) herniation and degeneration are commonly associated with back pain. Genipin-crosslinked fibrin hydrogel (FibGen) is an injectable, space-filling AF sealant that was optimized to match AF shear properties and partially restored IVD biomechanics. This study aimed to enhance mechanical behaviors of FibGen to more closely match AF compressive, tensile, and shear properties by adjusting genipin crosslink density and by creating a composite formulation by adding Poly(D,L-lactide-co-glycolide) (PDLGA). This study also evaluated effects of thrombin concentration and injection technique on gelation kinetics and adhesive strength. Increasing FibGen genipin concentration from 1 to 36 mg/mL significantly increased adhesive strength (∼5 to 35 kPa), shear moduli (∼10 to 110 kPa), and compressive moduli (∼25 to 150 kPa) with concentration-dependent effects, and spanning native AF properties. Adding PDLGA to FibGen altered the material microstructure on electron microscopy and nearly tripled adhesive strength, but did not increase tensile moduli, which remained nearly 5× below native AF, and had a small increase in shear moduli and significantly decreased compressive moduli. Increased thrombin concentration decreased gelation rate to < 5 min and injection methods providing a structural FibGen cap increased pushout strength by ∼40%. We conclude that FibGen is highly modifiable with tunable mechanical properties that can be formulated to be compatible with human AF compressive and shear properties and gelation kinetics and injection techniques compatible with clinical discectomy procedures. However, further innovations, perhaps with more efficient fiber reinforcement, will be required to enable FibGen to match AF tensile properties.
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Affiliation(s)
- Michelle A Cruz
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, NY 10029
| | - Steven McAnany
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, NY 10029
| | - Nikita Gupta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1189, New York, NY 10029
| | - Rose G Long
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, NY 10029
| | - Philip Nasser
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, NY 10029
| | - David Eglin
- Biomaterials and Tissue Engineering, AO Research Institute Davos, Davos CH-7270, Switzerland
| | - Andrew C Hecht
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, NY 10029
| | - Svenja Illien-Junger
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, NY 10029
| | - James C Iatridis
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, NY 10029 e-mail:
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Campos F, Bonhome-Espinosa AB, Vizcaino G, Rodriguez IA, Duran-Herrera D, López-López MT, Sánchez-Montesinos I, Alaminos M, Sánchez-Quevedo MC, Carriel V. Generation of genipin cross-linked fibrin-agarose hydrogel tissue-like models for tissue engineering applications. ACTA ACUST UNITED AC 2018; 13:025021. [PMID: 29420310 DOI: 10.1088/1748-605x/aa9ad2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The generation of biomimetic and biocompatible artificial tissues is the basic research objective for tissue engineering (TE). In this sense, the biofabrication of scaffolds that resemble the tissues' extracellular matrix is an essential aim in this field. Uncompressed and nanostructured fibrin-agarose hydrogels (FAH and NFAH, respectively) have emerged as promising scaffolds in TE, but their structure and biomechanical properties must be improved in order to broaden their TE applications. Here, we generated and characterized novel membrane-like models with increased structural and biomechanical properties based on the chemical cross-linking of FAH and NFAH with genipin (GP at 0.1%, 0.25%, 0.5% and 0.75%). Furthermore, the scaffolds were subjected to rheological (G, G', G″ modulus), ultrastructural and ex vivo biocompatibility analyses. Results showed that all GP concentrations increased the stiffness (G) and especially the elasticity (G') of FAH and NFAH. Ultrastructural analyses demonstrated that GP and nanostructuration of FAH allowed us to control the porosity of FAH. In addition, biological studies revealed that higher concentration of GP (0.75%) started to compromise the cell function and viability. Finally, this study demonstrated the possibility to generate natural and biocompatible FAH and NFAH with improved structural and biomechanical properties by using 0.1%-0.5% of GP. However, further in vivo studies are needed in order to demonstrate the biocompatibility, biodegradability and regeneration capability of these cross-linked scaffolds.
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Affiliation(s)
- Fernando Campos
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada and Instituto de Investigación Biosanitaria Ibs.GRANADA, Spain
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49
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Cruz MA, Hom WW, DiStefano TJ, Merrill R, Torre OM, Lin HA, Hecht AC, Illien-Junger S, Iatridis JC. Cell-Seeded Adhesive Biomaterial for Repair of Annulus Fibrosus Defects in Intervertebral Discs. Tissue Eng Part A 2018; 24:187-198. [PMID: 29214889 DOI: 10.1089/ten.tea.2017.0334] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Defects in the annulus fibrosus (AF) of intervertebral discs allow nucleus pulposus tissue to herniate causing painful disability. Microdiscectomy procedures remove herniated tissue fragments, but unrepaired defects remain allowing reherniation or progressive degeneration. Cell therapies show promise to enhance repair, but methods are undeveloped and carriers are required to prevent cell leakage. To address this challenge, this study developed and evaluated genipin-crosslinked fibrin (FibGen) as an adhesive cell carrier optimized for AF repair that can deliver cells, match AF material properties, and have low risk of extrusion during loading. Part 1 determined that feasibility of bovine AF cells encapsulated in high concentration FibGen (F140G6: 140 mg/mL fibrinogen; 6 mg/mL genipin) for 7 weeks could maintain high viability, but had little proliferation or matrix deposition. Part 2 screened tissue mechanics and in situ failure testing of nine FibGen formulations (fibrin: 35-140 mg/mL; genipin: 1-6 mg/mL). F140G6 formulation matched AF shear and compressive properties and significantly improved failure strength in situ. Formulations with reduced genipin also exhibited satisfactory material properties and failure behaviors warranting further biological screening. Part 3 screened AF cells encapsulated in four FibGen formulations for 1 week and found that reduced genipin concentrations increased cell viability and glycosaminoglycan production. F70G1 (70 mg/mL fibrinogen; 1 mg/mL genipin) demonstrated balanced biological and biomechanical performance warranting further testing. We conclude that FibGen has potential to serve as an adhesive cell carrier to repair AF defects with formulations that can be tuned to enhance biomechanical and biological performance; future studies are required to develop strategies to enhance matrix production.
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Affiliation(s)
- Michelle A Cruz
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Warren W Hom
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Tyler J DiStefano
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Robert Merrill
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Olivia M Torre
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Huizi A Lin
- 2 Department of Biomedical Engineering, The City College of New York , New York, New York
| | - Andrew C Hecht
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Svenja Illien-Junger
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
| | - James C Iatridis
- 1 Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai , New York, New York
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50
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Abstract
Genipin is a natural plant-derived compound that covalently cross-links biopolymers into lattice networks with good biocompatibility, controllable swelling, and mechanical properties. This protocol describes the genipin cross-linking of elastic proteins, including tropoelastin and elastin-based polypeptides, through steps of elastin phase-separation upon addition of salt and heat, centrifugation to rapidly concentrate the dense protein phase, and incubation. This method is applicable for the fabrication of elastic materials suitable for use as scaffolds for biomedical applications.
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Affiliation(s)
- Lisa D Muiznieks
- Molecular Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
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