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Dong Y, Li J, Jiang Q, He S, Wang B, Yi Q, Cheng X, Gao X, Bai Y. Structure, ingredient, and function-based biomimetic scaffolds for accelerated healing of tendon-bone interface. J Orthop Translat 2024; 48:70-88. [PMID: 39185339 PMCID: PMC11342074 DOI: 10.1016/j.jot.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/11/2024] [Accepted: 07/16/2024] [Indexed: 08/27/2024] Open
Abstract
Background Tendon-bone interface (TBI) repair is slow and challenging owing to its hierarchical structure, gradient composition, and complex function. In this work, enlightened by the natural characteristics of TBI microstructure and the demands of TBI regeneration, a structure, composition, and function-based scaffold was fabricated. Methods: The biomimetic scaffold was designed based on the "tissue-inducing biomaterials" theory: (1) a porous scaffold was created with poly-lactic-co-glycolic-acid, nano-hydroxyapatite and loaded with BMP2-gelatinmp to simulate the bone (BP); (2) a hydrogel was produced from sodium alginate, type I collagen, and loaded with TGF-β3 to simulate the cartilage (CP); (3) the L-poly-lactic-acid fibers were oriented to simulate the tendon (TP). The morphology of tri-layered constructs, gelation kinetics, degradation rate, release kinetics and mechanical strength of the scaffold were characterized. Then, bone marrow mesenchymal stem cells (MSCs) and tenocytes (TT-D6) were cultured on the scaffold to evaluate its gradient differentiation inductivity. A rat Achilles tendon defect model was established, and BMSCs seeded on scaffolds were implanted into the lesionsite. The tendon-bone lesionsite of calcaneus at 4w and 8w post-operation were obtained for gross observation, radiological evaluation, biomechanical and histological assessment. Results The hierarchical microstructures not only endowed the scaffold with gradual composition and mechanical properties for matching the regional biophysical characteristics of TBI but also exhibited gradient differentiation inductivity through providing regional microenvironment for cells. Moreover, the scaffold seeded with cells could effectively accelerate healing in rat Achilles tendon defects, attributable to its enhanced differentiation performance. Conclusion The hierarchical scaffolds simulating the structural, compositional, and cellular heterogeneity of natural TBI tissue performed therapeutic effects on promoting regeneration of TBI and enhancing the healing quality of Achilles tendon. The translational potential of this article The novel scaffold showed the great efficacy on tendon to bone healing by offering a structural and compositional microenvironment. The results meant that the hierarchical scaffold with BMSCs may have a great potential for clinical application.
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Affiliation(s)
- YuHan Dong
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - JiangFeng Li
- Institute of Burn Research, Southwest Hospital & State Key Lab of Trauma, Burn and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Qiang Jiang
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - SiRong He
- School of Basic Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Bin Wang
- Institute of Life Sciences, Chongqing Medical University, Chongqing, 400016, China
| | - QiYing Yi
- Laboratory Animal Center, Chongqing Medical University, Chongqing, 400016, China
| | - XiTing Cheng
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - Xiang Gao
- College of Stomatology, Chongqing Medical University, Chongqing, 400016, China
| | - Yan Bai
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
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Najafi Z, Rahmanian-Devin P, Baradaran Rahimi V, Nokhodchi A, Askari VR. Challenges and opportunities of medicines for treating tendon inflammation and fibrosis: A comprehensive and mechanistic review. Fundam Clin Pharmacol 2024:e12999. [PMID: 38468183 DOI: 10.1111/fcp.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/20/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Tendinopathy refers to conditions characterized by collagen degeneration within tendon tissue, accompanied by the proliferation of capillaries and arteries, resulting in reduced mechanical function, pain, and swelling. While inflammation in tendinopathy can play a role in preventing infection, uncontrolled inflammation can hinder tissue regeneration and lead to fibrosis and impaired movement. OBJECTIVES The inability to regulate inflammation poses a significant limitation in tendinopathy treatment. Therefore, an ideal treatment strategy should involve modulation of the inflammatory process while promoting tissue regeneration. METHODS The current review article was prepared by searching PubMed, Scopus, Web of Science, and Google Scholar databases. Several treatment approaches based on biomaterials have been developed. RESULTS This review examines various treatment methods utilizing small molecules, biological compounds, herbal medicine-inspired approaches, immunotherapy, gene therapy, cell-based therapy, tissue engineering, nanotechnology, and phototherapy. CONCLUSION These treatments work through mechanisms of action involving signaling pathways such as transforming growth factor-beta (TGF-β), mitogen-activated protein kinases (MAPKs), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), all of which contribute to the repair of injured tendons.
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Affiliation(s)
- Zohreh Najafi
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouria Rahmanian-Devin
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Nokhodchi
- Lupin Pharmaceutical Research Center, 4006 NW 124th Ave., Coral Springs, Florida, Florida, 33065, USA
- Pharmaceutics Research Laboratory, School of Life Sciences, University of Sussex, Brighton, BN1 9QJ, UK
| | - Vahid Reza Askari
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Kremen TJ, Shi BY, Wu SY, Sundberg O, Sriram V, Kim W, Sheyn D, Lyons KM, Wang W, McKenna CE, Nishimura I. Biologically-coupled bisphosphonate chaperones effectively deliver molecules to the site of soft tissue-bone healing. J Orthop Res 2023; 41:2250-2260. [PMID: 37087676 DOI: 10.1002/jor.25579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/26/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
Tendon injuries are common and often treated surgically, however, current tendon repair healing results in poorly organized fibrotic tissue. While certain growth factors have been reported to improve both the strength and organization of the repaired enthesis, their clinical applicability is severely limited due to a lack of appropriate delivery strategies. In this study, we evaluated a recently developed fluorescent probe, Osteoadsorptive Fluorogenic Sentinel-3 that is composed of a bone-targeting bisphosphonate (BP) moiety linked to fluorochrome and quencher molecules joined via a cathepsin K-sensitive peptide sequence. Using a murine Achilles tendon-to-bone repair model, BP-based and/or Ctsk-coupled imaging probes were applied either locally or systemically. Fluorescence imaging was used to quantify the resultant signal in vivo. After tendon-bone repair, animals that received either local or systemic administration of imaging probes demonstrated significantly higher fluorescence signal at the repair site compared to the sham surgery group at all time points (p < 0.001), with signal peaking at 7-10 days after surgery. Our findings demonstrate the feasibility of using a novel BP-based targeting and Ctsk-activated delivery of molecules to the site of tendon-to-bone repair and creates a foundation for further development of this platform as an effective strategy to deliver bioactive molecules to sites of musculoskeletal injury.
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Affiliation(s)
- Thomas J Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brendan Y Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shannon Y Wu
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Oskar Sundberg
- Department of Chemistry, University of Southern California, Los Angeles, California, USA
| | - Varun Sriram
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dmitriy Sheyn
- Orthopaedic Stem Cell Research Laboratory, Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karen M Lyons
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Molecular, Cellular, and Developmental Biology, University of California, Los Angeles, California, USA
| | - Weiguang Wang
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Charles E McKenna
- Department of Chemistry, University of Southern California, Los Angeles, California, USA
| | - Ichiro Nishimura
- Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, University of California, Los Angeles, California, USA
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Li H, Luo S, Li H, Pan H, Jiang L, Chen Y, Chen H, Feng Z, Li S. From fetal tendon regeneration to adult therapeutic modalities: TGF-β3 in scarless healing. Regen Med 2023; 18:809-822. [PMID: 37671630 DOI: 10.2217/rme-2023-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Tendon injuries are common disorders that can significantly impact people's lives. Unfortunately, the limited regenerative ability of tendons results in tissue healing in a scar-mediated manner. The current therapeutic strategies fail to fully recover the functions of the injured tendons, and as such, the conception of 'scarless healing' has gained prominent attention in the field of regenerative medicine. Interestingly, injured fetal tendons possess the capability to heal through regeneration, which builds an ideal blueprint for adult tendon regeneration. Studies have shown that fetal biochemical cues have the potential to improve adult tendon healing. Here we review the biological factors that contribute to fetal tendon regeneration and how manipulation of these biochemical cues in the adult tendon healing process could achieve regeneration.
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Affiliation(s)
- Hanyue Li
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Shengyu Luo
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Hongtao Li
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Hongyu Pan
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Li Jiang
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Yixuan Chen
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Hui Chen
- Geriatric department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Zhenhua Feng
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University
| | - Sen Li
- School of Physical Education, Southwest Medical University, Luzhou, China
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5
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Li X, Ren Y, Xue Y, Zhang Y, Liu Y. Nanofibrous scaffolds for the healing of the fibrocartilaginous enthesis: advances and prospects. NANOSCALE HORIZONS 2023; 8:1313-1332. [PMID: 37614124 DOI: 10.1039/d3nh00212h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
With the current developmental advancements in nanotechnology, nanofibrous scaffolds are being widely used. The healing of fibrocartilaginous enthesis is a slow and complex process, and while existing treatments have a certain effect on promoting their healing, these are associated with some limitations. The nanofibrous scaffold has the advantages of easy preparation, wide source of raw materials, easy adjustment, easy modification, can mimic the natural structure and morphology of the fibrocartilaginous enthesis, and has good biocompatibility, which can compensate for existing treatments and be combined with them to promote the repair of fibrocartilaginous enthesis. The nanofibrous scaffold can promote the healing of fibrocartilaginous enthesis by controlling the morphology and ensuring controlled drug release. Hence, the use of nanofibrous scaffold with stimulative response features in the musculoskeletal system has led us to imagine its potential application in fibrocartilaginous enthesis. Therefore, the healing of fibrocartilaginous enthesis based on a nanofibrous scaffold may be a novel therapeutic approach.
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Affiliation(s)
- Xin Li
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yan Ren
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China.
| | - Yueguang Xue
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China.
| | - Yiming Zhang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China.
| | - Ying Liu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China.
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6
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Bolam SM, Zhu MF, Lim KS, Konar S, Oliver MH, Buckels E, Matthews BG, Callon KE, Woodfield T, Workman J, Monk AP, Coleman B, Cornish J, Munro JT, Musson DS. Combined Growth Factor Hydrogel Enhances Rotator Cuff Enthesis Healing in Rat But Not Sheep Model. Tissue Eng Part A 2023; 29:449-459. [PMID: 37171123 DOI: 10.1089/ten.tea.2022.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
We hypothesized that a combined growth factor hydrogel would improve chronic rotator cuff tear healing in a rat and sheep model. Insulin-like growth factor 1, transforming growth factor β1, and parathyroid hormone were combined into a tyraminated poly-vinyl-alcohol (PVA-Tyr) hydrogel and applied directly at the enthesis. In total, 30 Sprague-Dawley rats and 16 Romney ewes underwent unilateral rotator cuff tenotomy and then delayed repairs were performed after 3-4 weeks. The animals were divided into a control group (repair alone) and treatment group. The rotator cuffs were harvested at 12 weeks after surgery for biomechanical and histological analyses of the repair site. In the rat model, the stress at failure and Young's modulus were higher in the treatment group in comparison with the control group (73% improvement, p = 0.010 and 56% improvement, p = 0.028, respectively). Histologically, the repaired entheses in the treatment group demonstrated improved healing with higher semi-quantitative scores (10.1 vs. 6.55 of 15, p = 0.032). In the large animal model, there was no observable treatment effect. This PVA-Tyr bound growth factor system holds promise for improving rotator cuff healing. However, our approach was not scalable from a small to a large animal model. Further tailoring of this growth factor delivery system is still required. Level of Evidence: Basic Science Study; Biomechanics and Histology; Animal Model Impact Statement Previous studies using single-growth factor treatment to improve enthesis healing after rotator cuff repair have reported promising, but inconsistent results. A novel approach is to combine multiple growth factors using controlled-release hydrogels that mimic the normal healing process. In this study, we report that a combined growth factor hydrogel can improve the histological quality and strength of rotator cuff repair in a rat chronic tear model. This novel hydrogel growth factor treatment has the potential to be used in human clinical applications to improve healing after rotator cuff repair.
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Affiliation(s)
- Scott M Bolam
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - Mark F Zhu
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - Khoon S Lim
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Subhajit Konar
- Department of Medicine, University of Auckland, Grafton, New Zealand
| | - Mark H Oliver
- Liggins Institute, University of Auckland, Grafton, New Zealand
| | - Emma Buckels
- Department of Molecular Medicine and Pathology, University of Auckland, Grafton, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Grafton, New Zealand
| | - Brya G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, Grafton, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Grafton, New Zealand
| | - Karen E Callon
- Department of Medicine, University of Auckland, Grafton, New Zealand
| | - Tim Woodfield
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Josh Workman
- Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Grafton, New Zealand
| | - Brendan Coleman
- Department of Orthopedic Surgery, Middlemore Hospital, Otahuhu, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Grafton, New Zealand
| | - Jacob T Munro
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - David S Musson
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Nutrition and Dietetics, University of Auckland, Grafton, New Zealand
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7
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Watanabe G, Yamamoto M, Taniguchi S, Sugiyama Y, Hirouchi H, Ishizuka S, Kitamura K, Mizoguchi T, Takayama T, Hayashi K, Abe S. Chronological Changes in the Expression and Localization of Sox9 between Achilles Tendon Injury and Functional Recovery in Mice. Int J Mol Sci 2023; 24:11305. [PMID: 37511063 PMCID: PMC10379325 DOI: 10.3390/ijms241411305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/03/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Tendons help transmit forces from the skeletal muscles and bones. However, tendons have inferior regenerative ability compared to muscles. Despite studies on the regeneration of muscles and bone tissue, only a few have focused on tendinous tissue regeneration, especially tendon regeneration. Sex-determining region Y-box transcription factor 9 (Sox9) is an SRY-related transcription factor with a DNA-binding domain and is an important control factor for cartilage formation. Sox9 is critical to the early-to-middle stages of tendon development. However, how Sox9 participates in the healing process after tendon injury is unclear. We hypothesized that Sox9 is expressed in damaged tendons and is crucially involved in restoring tendon functions. We constructed a mouse model of an Achilles tendon injury by performing a 0.3 mm wide partial excision in the Achilles tendon of mice, and chronologically evaluated the function restoration and localization of the Sox9 expressed in the damaged sites. The results reveal that Sox9 was expressed simultaneously with the formation of the pre-structure of the epitenon, an essential part of the tendinous tissue, indicating that its expression is linked to the functional restoration of tendons. Lineage tracing for Sox9 expressed during tendon restoration revealed the tendon restoration involvement of cells that switched into Sox9-expressing cells after tendon injury. The stem cells involved in tendon regeneration may begin to express Sox9 after injury.
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Affiliation(s)
- Genji Watanabe
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Masahito Yamamoto
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Shuichirou Taniguchi
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Yuki Sugiyama
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Hidetomo Hirouchi
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Satoshi Ishizuka
- Department of Pharmacology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Kei Kitamura
- Department of Histology and Developmental Biology, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Toshihide Mizoguchi
- Oral Health Science Center, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
| | - Takashi Takayama
- Department of Dentistry, The Jikei University School of Medicine, 3-19-18 Nishi-shinnbashi, Minato, Tokyo 105-8471, Japan
| | - Katsuhiko Hayashi
- Department of Dentistry, The Jikei University School of Medicine, 3-19-18 Nishi-shinnbashi, Minato, Tokyo 105-8471, Japan
| | - Shinichi Abe
- Department of Anatomy, Tokyo Dental College, 2-9-18 Kandamisaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan
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8
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Fu S, Lan Y, Wang G, Bao D, Qin B, Zheng Q, Liu H, Wong VKW. External stimulation: A potential therapeutic strategy for tendon-bone healing. Front Bioeng Biotechnol 2023; 11:1150290. [PMID: 37064229 PMCID: PMC10102526 DOI: 10.3389/fbioe.2023.1150290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Injuries at the tendon-bone interface are very common in the field of sports medicine, and healing at the tendon-bone interface is complex. Injuries to the tendon-bone interface can seriously affect a patient’s quality of life, so it is essential to restore stability and promote healing of the tendon-bone interface. In addition to surgical treatment, the healing of tendons and bones can also be properly combined with extracorporeal stimulation therapy during the recovery process. In this review, we discuss the effects of extracorporeal shock waves (ESWs), low-intensity pulsed ultrasound (LIPUS), and mechanical stress on tendon-bone healing, focusing on the possible mechanisms of action of mechanical stress on tendon-bone healing in terms of transcription factors and biomolecules. The aim is to provide possible therapeutic approaches for subsequent clinical treatment.
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Affiliation(s)
- Shijie Fu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Dr. Neher’s Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
| | - Yujian Lan
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Guoyou Wang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dingsu Bao
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Bo Qin
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Qiu Zheng
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Huan Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- *Correspondence: Huan Liu, ; Vincent Kam Wai Wong,
| | - Vincent Kam Wai Wong
- Dr. Neher’s Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
- *Correspondence: Huan Liu, ; Vincent Kam Wai Wong,
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9
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Ozone K, Minegishi Y, Takahata K, Takahashi H, Yoneno M, Hattori S, Xianglan L, Oka Y, Murata K, Kanemura N. Eccentric contraction-dominant exercise leads to molecular biological changes in enthesis and enthesopathy-like morphological changes. J Orthop Res 2023; 41:511-523. [PMID: 35716158 DOI: 10.1002/jor.25399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Entheses, which are tendon-to-bone attachment sites in the musculoskeletal system, play important roles in optimizing the mechanical stress and force transmitted from the muscle to the bone. Sports-related enthesopathy shows pathological features, including hyperplasia of the fibrocartilage (FC) region in the enthesis. The amount of exercise and type of muscle contraction during movement is involved in the pathogenesis of sports-related enthesopathy; however, the details of this condition are unclear. Here we examined the molecular pathways involved in the morphological changes of the muscle-tendon-enthesis complex and enthesis FC region in the supraspinatus muscle enthesis of mice under different exercise conditions. Following intervention, morphological changes in the muscle-tendon-enthesis complex were initiated in the eccentric contraction-dominant exercise group at 2 weeks, with activation of the transforming growth factor-β (TGFβ) superfamily pathway predicted by proteome and ingenuity pathway analyses. Histological and molecular biological analyses confirmed the activation of the TGFβ/bone morphogenetic protein (BMP)-Smad pathway. The concentric contraction-dominant exercise group showed no change in the morphology of the muscle-tendon-enthesis complex or activation of the TGFβ/BMP-Smad pathway, despite overuse exercise. Statement of Clinical Significance: These results suggest that eccentric contraction-dominant exercise induces sports-related enthesopathy-like morphological changes in the early stages as well as molecular biological changes, mainly in the transforming growth factor-β superfamily pathway in enthesis. Statement of Clinical Significance: These results suggest that eccentric contraction-dominant exercise induces sports-related enthesopathy-like morphological changes in the early stages as well as molecular biological changes, mainly in the transforming growth factor-β superfamily pathway in enthesis.
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Affiliation(s)
- Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kei Takahata
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Haruna Takahashi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Moe Yoneno
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Shinya Hattori
- Nanotechnology Innovation Station, National Institute for Materials Science, Tsukuba, Japan
| | - Li Xianglan
- Nanotechnology Innovation Station, National Institute for Materials Science, Tsukuba, Japan
| | - Yuichiro Oka
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
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10
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Jiang Q, Wang L, Liu Z, Su J, Tang Y, Tan P, Zhu X, Zhang K, Ma X, Jiang J, Zhao J, Lin H, Zhang X. Canine ACL reconstruction with an injectable hydroxyapatite/collagen paste for accelerated healing of tendon-bone interface. Bioact Mater 2023; 20:1-15. [PMID: 35633878 PMCID: PMC9123091 DOI: 10.1016/j.bioactmat.2022.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
Healing of an anterior cruciate ligament (ACL) autologous graft in a bone tunnel occurs through the formation of fibrovascular scar tissue, which is structurally and compositionally inferior to normal fibrocartilaginous insertion and thus may increase the reconstruction failure and the rate of failure recurrence. In this study, an injectable hydroxyapatite/type I collagen (HAp/Col Ⅰ) paste was developed to construct a suitable local microenvironment to accelerate the healing of bone-tendon interface. Physicochemical characterization demonstrated that the HAp/Col Ⅰ paste was injectable, uniform and stable. The in vitro cell culture illustrated that the paste could promote MC3T3-E1 cells proliferation and osteogenic expression. The results of a canine ACL reconstruction study showed that the reconstructive ACL had similar texture and color as the native ACL. The average width of the tunnel, total bone volume, bone volume/tissue volume and trabecular number acquired from micro-CT analysis suggested that the healing of tendon-bone interface in experimental group was better than that in control group. The biomechanical test showed the maximal loads in experimental group achieved approximately half of native ACL's maximal load at 24 weeks. According to histological examination, Sharpey fibers could be observed as early as 12 weeks postoperatively while a typical four-layer transitional structure of insertion site was regenerated at 48 weeks in the experimental group. The injectable HAp/Col Ⅰ paste provided a biomimetic scaffold and microenvironment for early cell attachment and proliferation, further osteogenic expression and extracellular matrix deposition, and in vivo structural and functional regeneration of the tendon-bone interface. A stable and injectable HAp/Col I paste was designed, optimized and characterized. The paste was applied in ACL reconstruction with an established standard operation procedure. Provided the safety and efficacy evidence for ACL reconstruction, and healing of tendon-bone interface was accelerated.
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11
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Yang C, Teng Y, Geng B, Xiao H, Chen C, Chen R, Yang F, Xia Y. Strategies for promoting tendon-bone healing: Current status and prospects. Front Bioeng Biotechnol 2023; 11:1118468. [PMID: 36777256 PMCID: PMC9911882 DOI: 10.3389/fbioe.2023.1118468] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
Tendon-bone insertion (TBI) injuries are common, primarily involving the rotator cuff (RC) and anterior cruciate ligament (ACL). At present, repair surgery and reconstructive surgery are the main treatments, and the main factor determining the curative effect of surgery is postoperative tendon-bone healing, which requires the stable combination of the transplanted tendon and the bone tunnel to ensure the stability of the joint. Fibrocartilage and bone formation are the main physiological processes in the bone marrow tract. Therefore, therapeutic measures conducive to these processes are likely to be applied clinically to promote tendon-bone healing. In recent years, biomaterials and compounds, stem cells, cell factors, platelet-rich plasma, exosomes, physical therapy, and other technologies have been widely used in the study of promoting tendon-bone healing. This review provides a comprehensive summary of strategies used to promote tendon-bone healing and analyses relevant preclinical and clinical studies. The potential application value of these strategies in promoting tendon-bone healing was also discussed.
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Affiliation(s)
- Chenhui Yang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China,Department of Orthopedic, Tianshui Hand and Foot Surgery Hospital, Tianshui, China
| | - Yuanjun Teng
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China
| | - Bin Geng
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China
| | - Hefang Xiao
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China
| | - Changshun Chen
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China
| | - Rongjin Chen
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China
| | - Fei Yang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China
| | - Yayi Xia
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China,The Second School of Clinical Medical, Lanzhou University, Lanzhou, China,*Correspondence: Yayi Xia,
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12
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Walia B, Li T, Crosio G, Montero A, Huang A. Axin2-lineage cells contribute to neonatal tendon regeneration. Connect Tissue Res 2022; 63:530-543. [PMID: 35180018 PMCID: PMC9491382 DOI: 10.1080/03008207.2022.2036732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/17/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Tendon injuries are a challenging clinical problem with few treatment options. Identifying the molecular regulators of tendon is required for the development of new therapies. While the Wnt pathway is critical for the maintenance and differentiation of many tissues, the role of Wnt signaling in tendon cell biology remains largely unexplored. METHODS The effects of Wnt activation were tested in vitro using neonatal tendon-derived cells cultured in 2D and 3D conditions. The inducible Axin2CreERT2 was then used to label Axin2+ cells in vivo and cells were traced during neonatal tendon regeneration. RESULTS We showed that activation of Wnt signaling results in proliferation of neonatal tendon cells. While tendon marker expression was inhibited by Wnt activation under 2D conditions, Scx expression was not affected under 3D uniaxial tension, suggesting that the microenvironment contextualizes tendon cell response to Wnt signaling. Using an in vivo model of neonatal tendon regeneration, we further showed that Wnt signaling cells comprise a subpopulation of tenocyte and epitenon cells that proliferate after injury and are recruited during regeneration. DISCUSSION Collectively, these studies suggest that Wnt signaling may play a role in tendon cell proliferation, differentiation, and regeneration.
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Affiliation(s)
- B. Walia
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - T.M. Li
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - G. Crosio
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - A.M. Montero
- Department of Orthopedic Surgery, Columbia University, New York, NY
| | - A.H. Huang
- Department of Orthopedic Surgery, Columbia University, New York, NY
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13
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Zhu M, Lin Tay M, Lim KS, Bolam SM, Tuari D, Callon K, Dray M, Cornish J, Woodfield TBF, Munro JT, Coleman B, Musson DS. Novel Growth Factor Combination for Improving Rotator Cuff Repair: A Rat In Vivo Study. Am J Sports Med 2022; 50:1044-1053. [PMID: 35188803 DOI: 10.1177/03635465211072557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The lack of healing at the repaired tendon-bone interface is an important cause of failure after rotator cuff repair. While augmentation with growth factors (GFs) has demonstrated promise, the ideal combination must target all 3 tissue types at the tendon-bone interface. HYPOTHESIS The GF combination of transforming growth factor beta 1, Insulin-like growth factor 1, and parathyroid hormone will promote tenocyte proliferation and differentiation and improve the biomechanical and histological quality of the repaired tendon-bone interface. STUDY DESIGN Controlled laboratory study. METHODS In vitro, human tenocytes were cultured in the presence of the GF combination for 72 hours, and cell growth assays and the expression of genes specific to tendon, cartilage, and bone were analyzed. In vivo, adult rats (N = 46) underwent detachment and repair of the left supraspinatus tendon. A PVA-tyramine gel was used to deliver the GF combination to the tendon-bone interface. Histological, biomechanical, and RNA microarray analysis was performed at 6 and 12 weeks after surgery. Immunohistochemistry for type II and X collagen was performed at 12 weeks. RESULTS When treated with the GF combination in vitro, human tenocytes proliferated 1.5 times more than control (P = .04). The expression of scleraxis increased 65-fold (P = .013). The expression of Sox-9 (P = .011), type I collagen (P = .021), fibromodulin (P = .0075), and biglycan (P = .010) was also significantly increased, while the expression of PPARγ was decreased (P = .007). At 6 and 12 weeks postoperatively, the quality of healing on histology was significantly higher in the GF group, with the formation of a more mature tendon-bone interface, as confirmed by immunohistochemistry for type II and X collagen. The GF group achieved a load at failure and Young modulus >1.5 times higher at both time points. Microarrays at 6 weeks demonstrated upregulation of genes involved in leukocyte aggregation (S100A8, S100A9) and tissue mineralization (Bglap, serglycin, Fam20c). CONCLUSION The GF combination promoted protendon and cartilage responses in human tenocytes in vitro; it also improved the histological appearance and mechanical properties of the repair in vivo. Microarrays of the tendon-bone interface identified inflammatory and mineralization pathways affected by the GF combination, providing novel therapeutic targets for further research. CLINICAL RELEVANCE The use of this GF combination is translatable to patients and may improve healing after rotator cuff repair.
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Affiliation(s)
- Mark Zhu
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mei Lin Tay
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Khoon S Lim
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Scott M Bolam
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Donna Tuari
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Karen Callon
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Michael Dray
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand
| | - Jillian Cornish
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tim B F Woodfield
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jacob T Munro
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Counties Manukau Health, Auckland, New Zealand
| | - David S Musson
- Bone and Joint Laboratory, School of Medicine, University of Auckland, Auckland, New Zealand
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14
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Jiang N, Mao M, Li X, Zhang W, He J, Li D. Advanced biofabrication strategies for biomimetic composite scaffolds to regenerate ligament‐bone interface. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Nan Jiang
- State Key Laboratory for Manufacturing Systems Engineering Xi’an Jiaotong University Xi’an Shaanxi China
- Department of Surgical Oncology Shaanxi Provincial People’s Hospital (Third Hospital of Medical College of Xi’an Jiaotong University) Xi’an Shaanxi China
| | - Mao Mao
- State Key Laboratory for Manufacturing Systems Engineering Xi’an Jiaotong University Xi’an Shaanxi China
- NMPA Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices Xi’an Jiaotong University Xi’an Shaanxi China
| | - Xiao Li
- State Key Laboratory for Manufacturing Systems Engineering Xi’an Jiaotong University Xi’an Shaanxi China
- NMPA Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices Xi’an Jiaotong University Xi’an Shaanxi China
| | - Weijie Zhang
- Department of Knee Joint Surgery Hong Hui Hospital Health Science Center Xi’an Jiaotong University Xi’an Shaanxi China
| | - Jiankang He
- State Key Laboratory for Manufacturing Systems Engineering Xi’an Jiaotong University Xi’an Shaanxi China
- NMPA Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices Xi’an Jiaotong University Xi’an Shaanxi China
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering Xi’an Jiaotong University Xi’an Shaanxi China
- NMPA Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices Xi’an Jiaotong University Xi’an Shaanxi China
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15
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Moser HL, Abraham AC, Howell K, Laudier D, Zumstein MA, Galatz LM, Huang AH. Cell lineage tracing and functional assessment of supraspinatus tendon healing in an acute repair murine model. J Orthop Res 2021; 39:1789-1799. [PMID: 32497311 PMCID: PMC7714710 DOI: 10.1002/jor.24769] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/27/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023]
Abstract
Rotator cuff supraspinatus tendon injuries are common with high rates of anatomic failure after surgical repair. The purpose of the study was to define clinically relevant features of a mouse model of supraspinatus tendon injury to determine painful, functional, and structural outcomes; we further investigated two cell populations mediating healing using genetic lineage tracing after full detachment and repair of the supraspinatus tendon in mice. The pain was assessed using the mouse grimace scale and function by gait analysis and tensile testing. Histological and microCT analyses were used to determine enthesis/tendon and bone structure, respectively. Lineage tracing was carried out using inducible Cre lines for ScxCreERT2 (tendon cells) and αSMACreERT2 (myofibroblasts and mesenchymal progenitors). Mice only expressed pain transiently after surgery despite long-term impairment of functional and structural properties. Gait, tensile mechanical properties, and bone properties were significantly reduced after injury and repair. Lineage tracing showed relatively few Scx lin tendon cells while αSMA lin cells contributed strongly to scar formation. Despite surgical reattachment of healthy tendon, lineage tracing revealed poor preservation of supraspinatus tendon after acute injury and loss of tendon structure, suggesting that tendon degeneration is also a key impediment of successful rotator cuff repair. Scar formation after surgery is mediated largely by αSMA lin cells and results in permanently reduced functional and structural properties.
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Affiliation(s)
- Helen L. Moser
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA,Inselspital, Bern University Hospital, University of Bern, Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, 3010 Bern, Switzerland
| | - Adam C. Abraham
- Columbia University Irving Medical Center, Department of Orthopedic Surgery, New York, NY 10032, USA
| | - Kristen Howell
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Damien Laudier
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Matthias A. Zumstein
- Inselspital, Bern University Hospital, University of Bern, Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, 3010 Bern, Switzerland,Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, 3006 Bern, Switzerland
| | - Leesa M. Galatz
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Alice H. Huang
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
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16
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Huang S, Xiang X, Qiu L, Wang L, Zhu B, Guo R, Tang X. Transfection of TGF-β shRNA by Using Ultrasound-targeted Microbubble Destruction to Inhibit the Early Adhesion Repair of Rats Wounded Achilles Tendon In vitro and In vivo. Curr Gene Ther 2021; 20:71-81. [PMID: 32416687 DOI: 10.2174/1566523220666200516165828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Tendon injury is a major orthopedic disorder. Ultrasound-targeted microbubble destruction (UTMD) provides a promising method for gene transfection, which can be used for the treatment of injured tendons. OBJECTIVE The purpose of this study was to investigate the optimal transforming growth factor beta (TGF-β) short hairpin RNA (shRNA) sequence and transfection conditions using UTMD in vitro and to identify its ability for inhibiting the early adhesion repair of rats wounded achilles tendons in vivo. METHODS The optimal sequence was selected analyzing under a fluorescence microscope and quantitative real-time reverse transcription polymerase chain reaction in vitro. In vivo, 40 rats with wounded Achilles tendons were divided into five groups: (1) control group, (2) plasmid group (3) plasmid + ultrasound group, (4) plasmid + microbubble group, (5) plasmid + microbubble + ultrasound group, and were euthanized at 14 days post treatment. TGF-β expression was evaluated using adhesion scores and pathological examinations. RESULTS The optimal condition for UTMD delivery in vitro was 1W/cm2 of output intensity and a 30% duty cycle with 60 s irradiation time (P < 0.05). The transfection efficiency of the plasmid in group 5 was higher than that in other groups (P < 0.05). Moreover, the lowest adhesion index score and the least expression of TGF-β were shown in group 5 (P < 0.05). When compared with the other groups, group 5 had a milder inflammatory reaction. CONCLUSION The results suggested that UTMD delivery of TGF-β shRNA offers a promising treatment approach for a tendon injury in vivo.
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Affiliation(s)
- Songya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Xi Xiang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Liyun Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Bihui Zhu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
| | - Xinyi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
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17
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Wang D, Zhang X, Huang S, Liu Y, Fu BSC, Mak KKL, Blocki AM, Yung PSH, Tuan RS, Ker DFE. Engineering multi-tissue units for regenerative Medicine: Bone-tendon-muscle units of the rotator cuff. Biomaterials 2021; 272:120789. [PMID: 33845368 DOI: 10.1016/j.biomaterials.2021.120789] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022]
Abstract
Our body systems are comprised of numerous multi-tissue units. For the musculoskeletal system, one of the predominant functional units is comprised of bone, tendon/ligament, and muscle tissues working in tandem to facilitate locomotion. To successfully treat musculoskeletal injuries and diseases, critical consideration and thoughtful integration of clinical, biological, and engineering aspects are necessary to achieve translational bench-to-bedside research. In particular, identifying ideal biomaterial design specifications, understanding prior and recent tissue engineering advances, and judicious application of biomaterial and fabrication technologies will be crucial for addressing current clinical challenges in engineering multi-tissue units. Using rotator cuff tears as an example, insights relevant for engineering a bone-tendon-muscle multi-tissue unit are presented. This review highlights the tissue engineering strategies for musculoskeletal repair and regeneration with implications for other bone-tendon-muscle units, their derivatives, and analogous non-musculoskeletal tissue structures.
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Affiliation(s)
- Dan Wang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Shuting Huang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yang Liu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Bruma Sai-Chuen Fu
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Anna Maria Blocki
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Patrick Shu-Hang Yung
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Rocky S Tuan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Dai Fei Elmer Ker
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR.
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18
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Hypoxia-Induced Mesenchymal Stem Cells Exhibit Stronger Tenogenic Differentiation Capacities and Promote Patellar Tendon Repair in Rabbits. Stem Cells Int 2020; 2020:8822609. [PMID: 33133195 PMCID: PMC7591963 DOI: 10.1155/2020/8822609] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/29/2020] [Accepted: 09/24/2020] [Indexed: 12/13/2022] Open
Abstract
Tendon injury is a common but tough medical problem. Unsatisfactory clinical results have been reported in tendon repair using mesenchymal stem cell (MSC) therapy, creating a need for a better strategy to induce MSCs to tenogenic differentiation. This study was designed to examine the effect of hypoxia on the tenogenic differentiation of different MSCs and their tenogenic differentiation capacities under hypoxia condition in vitro and to investigate the in vivo inductility of hypoxia in tenogenesis. Adipose tissue-derived MSCs (AMSCs) and bone marrow-derived MSCs (BMSCs) were isolated and characterized. The expression of hypoxia-induced factor-1 alpha (Hif-1α) was examined to confirm the establishment of hypoxia condition. qRT-PCR, western blot, and immunofluorescence staining were used to evaluate the expression of tendon-associated marker Col-1a1, Col-3a1, Dcn, and Tnmd in AMSCs and BMSCs under hypoxia condition, compared with Tgf-β1 induction. In vivo, a patellar tendon injury model was established. Normoxic and hypoxic BMSCs were cultured and implanted. Histological, biomechanical, and transmission electron microscopy analyses were performed to assess the improved healing effect of hypoxic BMSCs on tendon injury. Our in vitro results showed that hypoxia remarkably increased the expression of Hif-1α and that hypoxia not only promoted a significant increase in tenogenic markers in both AMSCs and BMSCs compared with the normoxia group but also showed higher inductility compared with Tgf-β1. In addition, hypoxic BMSCs exhibited higher potential of tenogenic differentiation than hypoxic AMSCs. Our in vivo results demonstrated that hypoxic BMSCs possessed better histological and biomechanical properties than normoxic BMSCs, as evidenced by histological scores, patellar tendon biomechanical parameters, and the range and average of collagen fibril diameters. These findings suggested that hypoxia may be a practical and reliable strategy to induce tenogenic differentiation of BMSCs for tendon repair and could enhance the effectiveness of MSCs therapy in treating tendon injury.
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19
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Gerasimenko AY, Zhurbina NN, Cherepanova NG, Semak AE, Zar VV, Fedorova YO, Eganova EM, Pavlov AA, Telyshev DV, Selishchev SV, Glukhova OE. Frame Coating of Single-Walled Carbon Nanotubes in Collagen on PET Fibers for Artificial Joint Ligaments. Int J Mol Sci 2020; 21:ijms21176163. [PMID: 32859107 PMCID: PMC7503285 DOI: 10.3390/ijms21176163] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022] Open
Abstract
The coating formation technique for artificial knee ligaments was proposed, which provided tight fixation of ligaments of polyethylene terephthalate (PET) fibers as a result of the healing of the bone channel in the short-term period after implantation. The coating is a frame structure of single-walled carbon nanotubes (SWCNT) in a collagen matrix, which is formed by layer-by-layer solidification of an aqueous dispersion of SWCNT with collagen during spin coating and controlled irradiation with IR radiation. Quantum mechanical method SCC DFTB, with a self-consistent charge, was used. It is based on the density functional theory and the tight-binding approximation. The method established the optimal temperature and time for the formation of the equilibrium configurations of the SWCNT/collagen type II complexes to ensure maximum binding energies between the nanotube and the collagen. The highest binding energies were observed in complexes with SWCNT nanometer diameter in comparison with subnanometer SWCNT. The coating had a porous structure-pore size was 0.5-6 μm. The process of reducing the mass and volume of the coating with the initial biodegradation of collagen after contact with blood plasma was demonstrated. This is proved by exceeding the intensity of the SWCNT peaks G and D after contact with the blood serum in the Raman spectrum and by decreasing the intensity of the main collagen bands in the SWCNT/collagen complex frame coating. The number of pores and their size increased to 20 μm. The modification of the PET tape with the SWCNT/collagen coating allowed to increase its hydrophilicity by 1.7 times compared to the original PET fibers and by 1.3 times compared to the collagen coating. A reduced hemolysis level of the PET tape coated with SWCNT/collagen was achieved. The SWCNT/collagen coating provided 2.2 times less hemolysis than an uncoated PET implant. MicroCT showed the effective formation of new bone and dense connective tissue around the implant. A decrease in channel diameter from 2.5 to 1.7 mm was detected at three and, especially, six months after implantation of a PET tape with SWCNT/collagen coating. MicroCT allowed us to identify areas for histological sections, which demonstrated the favorable interaction of the PET tape with the surrounding tissues. In the case of using the PET tape coated with SWCNT/collagen, more active growth of connective tissue with mature collagen fibers in the area of implantation was observed than in the case of only collagen coating. The stimulating effect of SWCNT/collagen on the formation of bone trabeculae around and inside the PET tape was evident in three and six months after implantation. Thus, a PET tape with SWCNT/collagen coating has osteoconductivity as well as a high level of hydrophilicity and hemocompatibility.
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Affiliation(s)
- Alexander Yu. Gerasimenko
- Institute of Biomedical Systems, National Research University of Electronic Technology MIET, Shokin Square 1, Zelenograd, 124498 Moscow, Russia; (N.N.Z.); (Y.O.F.); (D.V.T.); (S.V.S.)
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya street 2-4, 119991 Moscow, Russia
- Correspondence: (A.Y.G.); (O.E.G.); Tel.: +7-9267029778 (A.Y.G.)
| | - Natalia N. Zhurbina
- Institute of Biomedical Systems, National Research University of Electronic Technology MIET, Shokin Square 1, Zelenograd, 124498 Moscow, Russia; (N.N.Z.); (Y.O.F.); (D.V.T.); (S.V.S.)
| | - Nadezhda G. Cherepanova
- Department of Morphology and Veterinary Expertise, Russian State Agrarian University—Moscow Timiryazev Agricultural Academy, Timiryazevskaya street 49, 127550 Moscow, Russia; (N.G.C.); (A.E.S.)
| | - Anna E. Semak
- Department of Morphology and Veterinary Expertise, Russian State Agrarian University—Moscow Timiryazev Agricultural Academy, Timiryazevskaya street 49, 127550 Moscow, Russia; (N.G.C.); (A.E.S.)
| | - Vadim V. Zar
- Department of Traumatology and Orthopedics, M.F. Vladimirskii Moscow Regional Research and Clinical Institute, Shepkina street 61/2, 129110 Moscow, Russia;
| | - Yulia O. Fedorova
- Institute of Biomedical Systems, National Research University of Electronic Technology MIET, Shokin Square 1, Zelenograd, 124498 Moscow, Russia; (N.N.Z.); (Y.O.F.); (D.V.T.); (S.V.S.)
- Research Laboratory of Promising Processes, Scientific-Manufacturing Complex “Technological Centre”, 1-7 Shokin Square, 124498 Moscow, Russia
| | - Elena M. Eganova
- Micro- and Nanosystems Research and Development Department, Institute of Nanotechnology of Microelectronics of the Russian Academy of Sciences, 32A Leninsky Prospekt, 119991 Moscow, Russia; (E.M.E.); (A.A.P.)
| | - Alexander A. Pavlov
- Micro- and Nanosystems Research and Development Department, Institute of Nanotechnology of Microelectronics of the Russian Academy of Sciences, 32A Leninsky Prospekt, 119991 Moscow, Russia; (E.M.E.); (A.A.P.)
| | - Dmitry V. Telyshev
- Institute of Biomedical Systems, National Research University of Electronic Technology MIET, Shokin Square 1, Zelenograd, 124498 Moscow, Russia; (N.N.Z.); (Y.O.F.); (D.V.T.); (S.V.S.)
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya street 2-4, 119991 Moscow, Russia
| | - Sergey V. Selishchev
- Institute of Biomedical Systems, National Research University of Electronic Technology MIET, Shokin Square 1, Zelenograd, 124498 Moscow, Russia; (N.N.Z.); (Y.O.F.); (D.V.T.); (S.V.S.)
| | - Olga E. Glukhova
- Institute for Bionic Technologies and Engineering, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya street 2-4, 119991 Moscow, Russia
- Department of Physics, Saratov State University, Astrakhanskaya street 83, 410012 Saratov, Russia
- Correspondence: (A.Y.G.); (O.E.G.); Tel.: +7-9267029778 (A.Y.G.)
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Kaji DA, Howell KL, Balic Z, Hubmacher D, Huang AH. Tgfβ signaling is required for tenocyte recruitment and functional neonatal tendon regeneration. eLife 2020; 9:51779. [PMID: 32501213 PMCID: PMC7324157 DOI: 10.7554/elife.51779] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
Tendon injuries are common with poor healing potential. The paucity of therapies for tendon injuries is due to our limited understanding of the cells and molecular pathways that drive tendon regeneration. Using a mouse model of neonatal tendon regeneration, we identified TGFβ signaling as a major molecular pathway that drives neonatal tendon regeneration. Through targeted gene deletion, small molecule inhibition, and lineage tracing, we elucidated TGFβ-dependent and TGFβ-independent mechanisms underlying tendon regeneration. Importantly, functional recovery depended on canonical TGFβ signaling and loss of function is due to impaired tenogenic cell recruitment from both Scleraxis-lineage and non-Scleraxis-lineage sources. We show that TGFβ signaling is directly required in neonatal tenocytes for recruitment and that TGFβ ligand is positively regulated in tendons. Collectively, these results show a functional role for canonical TGFβ signaling in tendon regeneration and offer new insights toward the divergent cellular activities that distinguish regenerative vs fibrotic healing.
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Affiliation(s)
- Deepak A Kaji
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Kristen L Howell
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Zerina Balic
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Dirk Hubmacher
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Alice H Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, United States
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Repair of Rotator Cuff Tendon Defects in Aged Rats Using a Growth Factor Injectable Gel Scaffold. Arthroscopy 2020; 36:629-637. [PMID: 31784364 DOI: 10.1016/j.arthro.2019.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if the tendon-specific crosslinking gelatin (Col-Tgel) impregnated with growth factors promotes tendon healing at the bone interface and in a tendon window model. METHODS Two different Col-Tgel formulations were first tested in vitro by evaluating cell morphology and tendogenic differentiation. After the optimum formulation was determined, the gel was mixed with either transforming growth factor-β3 (TGF-β3) or growth differentiation factor-7 (GDF-7) growth factor and prepared for injections. Window defects were induced in 12 animals, which were randomized into the following treatments: (1) sham, (2) empty Col-Tgel, (3) Col-Tgel containing TGF-β3, or (4) Col-Tgel containing GDF-7. Based on these results, the sham, empty Col-Tgel, and Col-Tgel containing TGF-β3 were applied to the supraspinatus repair interface. Tendons were analyzed biomechanically and histologically using hematoxylin and eosin and Masson's trichrome staining. RESULTS In the window defect model, histologic scores were the best in rats treated with TGF-β3 containing Col-Tgel, followed by the empty Col-Tgel scaffold, and finally the sham control. The GDF-7 Col-Tgel was not further tested because occasional ectopic cartilage and bone formation was found in the prior window defect model. In the supraspinatus repair model, there was no statistical difference (P > .05) in the biomechanical strength among the 3 treatment groups, but load-to-failure ratio improved when TGF-β3 was added to the scaffold, suggesting improved tendon healing. CONCLUSIONS This pilot study evaluated the performance of an injectable gel tendon graft in a population of retired breeder rats. The results suggest that Col-Tgel containing TGF-β3 may be a useful adjunctive treatment for surgical repair of full-thickness rotator cuff tears. Histologic and biomechanical scores suggest that Col-Tgel containing TGF-β3 promotes tendon healing. CLINICAL RELEVANCE The results of this study suggest that shoulders injected with Col-Tgel may be a useful adjunctive treatment for repair of rotator cuff tears.
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22
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Reifenrath J, Wellmann M, Kempfert M, Angrisani N, Welke B, Gniesmer S, Kampmann A, Menzel H, Willbold E. TGF-β3 Loaded Electrospun Polycaprolacton Fibre Scaffolds for Rotator Cuff Tear Repair: An in Vivo Study in Rats. Int J Mol Sci 2020; 21:E1046. [PMID: 32033294 PMCID: PMC7036781 DOI: 10.3390/ijms21031046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/21/2022] Open
Abstract
Biological factors such as TGF-β3 are possible supporters of the healing process in chronic rotator cuff tears. In the present study, electrospun chitosan coated polycaprolacton (CS-g-PCL) fibre scaffolds were loaded with TGF-β3 and their effect on tendon healing was compared biomechanically and histologically to unloaded fibre scaffolds in a chronic tendon defect rat model. The biomechanical analysis revealed that tendon-bone constructs with unloaded scaffolds had significantly lower values for maximum force compared to native tendons. Tendon-bone constructs with TGF-β3-loaded fibre scaffolds showed only slightly lower values. In histological evaluation minor differences could be observed. Both groups showed advanced fibre scaffold degradation driven partly by foreign body giant cell accumulation and high cellular numbers in the reconstructed area. Normal levels of neutrophils indicate that present mast cells mediated rather phagocytosis than inflammation. Fibrosis as sign of foreign body encapsulation and scar formation was only minorly present. In conclusion, TGF-β3-loading of electrospun PCL fibre scaffolds resulted in more robust constructs without causing significant advantages on a cellular level. A deeper investigation with special focus on macrophages and foreign body giant cells interactions is one of the major foci in further investigations.
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Affiliation(s)
- Janin Reifenrath
- Department of Orthopaedic Surgery, Hannover Medical School, Anna–von–Borries Str. 1–3, 30625 Hannover, Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
| | - Mathias Wellmann
- Department of Orthopaedic Surgery, Hannover Medical School, Anna–von–Borries Str. 1–3, 30625 Hannover, Germany
| | - Merle Kempfert
- Department of Orthopaedic Surgery, Hannover Medical School, Anna–von–Borries Str. 1–3, 30625 Hannover, Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
| | - Nina Angrisani
- Department of Orthopaedic Surgery, Hannover Medical School, Anna–von–Borries Str. 1–3, 30625 Hannover, Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
| | - Bastian Welke
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Haubergstraße 3, 30625 Hannover, Germany
| | - Sarah Gniesmer
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
- Clinic for Cranio–Maxillo–Facial Surgery, Hannover Medical School, Carl–Neuberg–Straße 1, 30625 Hannover, Germany
| | - Andreas Kampmann
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
- Clinic for Cranio–Maxillo–Facial Surgery, Hannover Medical School, Carl–Neuberg–Straße 1, 30625 Hannover, Germany
| | - Henning Menzel
- Institute for Technical Chemistry, Braunschweig University of Technology, Hagenring 30, 38106 Braunschweig, Germany
| | - Elmar Willbold
- Department of Orthopaedic Surgery, Hannover Medical School, Anna–von–Borries Str. 1–3, 30625 Hannover, Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany
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23
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Kalinichenko SG, Matveeva NY, Kostiv RY, Edranov SS. The topography and proliferative activity of cells immunoreactive to various growth factors in rat femoral bone tissues after experimental fracture and implantation of titanium implants with bioactive biodegradable coatings. Biomed Mater Eng 2019; 30:85-95. [PMID: 30562891 DOI: 10.3233/bme-181035] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND Biodegradable implant coatings promote proliferation and expression of BMP-2, VEGF, and TGF-β2 genes and enhance BMP-2, VEGF, and TGF-β2 regulatory effects at different stages of reparative osteogenesis. OBJECTIVE To study the topography and ratio of PCNA-, VEGF-, BMP-2-, and TGF-β2-immunoreactive cells in rat femoral bone after closed fracture and implantation of titanium implants with biodegradable calcium phosphate and hydroxyapatite coatings. METHODS Standard titanium implant screws and similar implants with bioactive coatings were used. A total of 18 rats were randomly divided into three groups, two experimental and a control one. The rats in the first experimental group were implanted with implants without specific coating, while those in the second group, with implants with specific coatings. The control rats were subjected to the same fracture as the experimental ones without subsequent implantation. On days 7, 14, and 30 of experiment, the rats were sampled for histological examination. Histological sections were prepared and processed for PCNA, BMP-2, VEGF, and TGF-β2 immunoreactivity. RESULTS In the regeneration zone, PCNA-immunoreactive cells substantially outnumbered other immunoreactive cell types. During the first two weeks after fracture, in the immediate vicinity of implant surface, the rate of VEGF production increased in osteoblast subpopulations and level of TGF-32 immunoreactivity decreased in chondroblasts. The level of TGF-32 was maximum on day 30 of experiment. BMP-2-immunoreactive osteocytes were found in the zone of external general plates. They accumulated at implants with calcium phosphate coating. Their number gradually increased by day 30 of experiment. CONCLUSIONS The present data suggest that biodegradable implant coatings promote proliferation and expression of BMP-2, VEGF, and TGF-β2 genes and enhance BMP-2, VEGF, and TGF-β2 regulatory effects at different stages of reparative osteogenesis.
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Affiliation(s)
- Sergei G Kalinichenko
- Department of Histology, Cytology and Embryology, Pacific State Medical University, Vladivostok, Russia
| | - Natalya Yu Matveeva
- Department of Histology, Cytology and Embryology, Pacific State Medical University, Vladivostok, Russia
| | - Roman Ye Kostiv
- Department of Histology, Cytology and Embryology, Pacific State Medical University, Vladivostok, Russia
| | - Sergey S Edranov
- Department of Histology, Cytology and Embryology, Pacific State Medical University, Vladivostok, Russia
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Baldwin M, Snelling S, Dakin S, Carr A. Augmenting endogenous repair of soft tissues with nanofibre scaffolds. J R Soc Interface 2019; 15:rsif.2018.0019. [PMID: 29695606 DOI: 10.1098/rsif.2018.0019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022] Open
Abstract
As our ability to engineer nanoscale materials has developed we can now influence endogenous cellular processes with increasing precision. Consequently, the use of biomaterials to induce and guide the repair and regeneration of tissues is a rapidly developing area. This review focuses on soft tissue engineering, it will discuss the types of biomaterial scaffolds available before exploring physical, chemical and biological modifications to synthetic scaffolds. We will consider how these properties, in combination, can provide a precise design process, with the potential to meet the requirements of the injured and diseased soft tissue niche. Finally, we frame our discussions within clinical trial design and the regulatory framework, the consideration of which is fundamental to the successful translation of new biomaterials.
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Affiliation(s)
- Mathew Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Snelling
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephanie Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Calejo I, Costa-Almeida R, Reis RL, Gomes ME. Enthesis Tissue Engineering: Biological Requirements Meet at the Interface. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:330-356. [DOI: 10.1089/ten.teb.2018.0383] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Isabel Calejo
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Raquel Costa-Almeida
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L. Reis
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Center for Regenerative and Precision Medicine, Headquarters at University of Minho, Guimarães, Portugal
| | - Manuela E. Gomes
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Center for Regenerative and Precision Medicine, Headquarters at University of Minho, Guimarães, Portugal
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26
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Rothrauff BB, Smith CA, Ferrer GA, Novaretti JV, Pauyo T, Chao T, Hirsch D, Beaudry MF, Herbst E, Tuan RS, Debski RE, Musahl V. The effect of adipose-derived stem cells on enthesis healing after repair of acute and chronic massive rotator cuff tears in rats. J Shoulder Elbow Surg 2019; 28:654-664. [PMID: 30527883 DOI: 10.1016/j.jse.2018.08.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic massive rotator cuff tears heal poorly and often retear. This study investigated the effect of adipose-derived stem cells (ADSCs) and transforming growth factor-β3 (TGF-β3) delivered in 1 of 2 hydrogels (fibrin or gelatin methacrylate [GelMA]) on enthesis healing after repair of acute or chronic massive rotator cuff tears in rats. METHODS Adult male Lewis rats underwent bilateral transection of the supraspinatus and infraspinatus tendons with intramuscular injection of botulinum toxin A (n = 48 rats). After 8 weeks, animals received 1 of 8 interventions (n = 12 shoulders/group): (1) no repair, (2) repair only, or repair augmented with (3) fibrin, (4) GelMA, (5) fibrin + ADSCs, (6) GelMA + ADSCs, (7) fibrin + ADSCs + TGF-β3, or (8) GelMA + ADSCs + TGF-β3. An equal number of animals underwent acute tendon transection and immediate application of 1 of 8 interventions. Enthesis healing was evaluated 4 weeks after the repair by microcomputed tomography, histology, and mechanical testing. RESULTS Increased bone loss and reduced structural properties were seen in chronic compared with acute tears. Bone mineral density of the proximal humerus was higher in repairs of chronic tears augmented with fibrin + ADSCs and GelMA + ADSCs than in unrepaired chronic tears. Similar improvement was not seen in acute tears. No intervention enhanced histologic appearance or structural properties in acute or chronic tears. CONCLUSIONS Surgical repair augmented with ADSCs may provide more benefit in chronic tears compared with acute tears, although there was no added benefit to supplementing ADSCs with TGF-β3.
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Affiliation(s)
- Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine A Smith
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerald A Ferrer
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - João V Novaretti
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thierry Pauyo
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tom Chao
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Hirsch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mason F Beaudry
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rocky S Tuan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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27
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Li X, Pongkitwitoon S, Lu H, Lee C, Gelberman R, Thomopoulos S. CTGF induces tenogenic differentiation and proliferation of adipose-derived stromal cells. J Orthop Res 2019; 37:574-582. [PMID: 30756417 PMCID: PMC6467286 DOI: 10.1002/jor.24248] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
Intrasynovial tendons are paucicellular and hypovascular, resulting in a poor response to injury. Surgical repair of ruptured or lacerated tendons often lead to complications such as adhesions, repair site gapping, and repair site rupture. Adipose-derived stem cells (ASCs) have shown promise for enhancing tendon repair, as they have the capacity to differentiate into tendon fibroblasts and augment the healing response. Furthermore, connective tissue growth factor (CTGF) has been shown to promote tendon regeneration via the stimulation of endogenous tendon stem cells. Here, we evaluated the potential of CTGF to promote tenogenic differentiation of ASCs in vitro. Gene and protein expression, cell proliferation, and FAK and ERK1/2 signaling were assessed. CTGF increased tenogenic genes in mouse ASCs in a dose- and time-dependent manner. Western blot and immunostaining analyses demonstrated increases in tenogenic protein expression in CTGF-treated ASCs at all timepoints studied. CTGF increased ASC proliferation in a dose-dependent manner. CTGF induced phosphorylation of ERK1/2 within 5 min and FAK within 15 min; both signals persisted for 120 min. Blocking FAK and ERK1/2 pathways by selective inhibitors SCH772984 and PF573228, respectively, attenuated the CTGF-induced tenogenic differentiation and proliferation of ASCs. These results suggest that CTGF induces tenogenic differentiation of ASCs via the FAK and ERK1/2 pathway. Statement of clinical significance: Although prior research has led to advances in tendon operative techniques and rehabilitation methods, clinical outcomes after tendon repair remain variable, with high rates of repair site gapping or rupture. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Xiaoning Li
- Xiangya Hospital, Central South University, Changsha, PR China,Department of Orthopedic Surgery, Columbia University, 650W 168th St, New York 10032 New York,Department of Biomedical Engineering, Columbia University, 650W 168th St, New York 10032 New York
| | - Suphannee Pongkitwitoon
- Department of Orthopedic Surgery, Columbia University, 650W 168th St, New York 10032 New York,Department of Biomedical Engineering, Columbia University, 650W 168th St, New York 10032 New York
| | - Hongbin Lu
- Xiangya Hospital, Central South University, Changsha, PR China
| | - Chang Lee
- College of Dental Medicine, Columbia University, New York, New York
| | - Richard Gelberman
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, 650W 168th St, New York 10032 New York,Department of Biomedical Engineering, Columbia University, 650W 168th St, New York 10032 New York
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28
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Use of stem cells and growth factors in rotator cuff tendon repair. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:747-757. [PMID: 30627922 DOI: 10.1007/s00590-019-02366-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
The management of rotator cuff tears continues to prove challenging for orthopaedic surgeons. Such tears affect most age groups and can lead to significant morbidity in patients. The aetiology of these tears is likely to be multifactorial; however, an understanding of the mechanisms involved is still under review. Despite advancements in surgical operative techniques and the materials used, post-operative recurrence rates after surgical repair remain high. A growing area of research surrounds biological adjuncts used to improve the healing potential of the repaired tissues. This review of recent publications focuses on the strengths and limitations of using stem cells and growth factors in rotator cuff repair.
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Xiang X, Leng Q, Tang Y, Wang L, Huang J, Zhang Y, Qiu L. Ultrasound-Targeted Microbubble Destruction Delivery of Insulin-Like Growth Factor 1 cDNA and Transforming Growth Factor Beta Short Hairpin RNA Enhances Tendon Regeneration and Inhibits Scar Formation In Vivo. HUM GENE THER CL DEV 2018; 29:198-213. [PMID: 30359117 DOI: 10.1089/humc.2018.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Ultrasound-targeted microbubble destruction (UTMD), which has been successfully used for the treatment of many diseases, offers a promising noninvasive approach for target-specific gene delivery. This study investigated the UTMD delivery of insulin-like growth factor 1 (IGF-1) cDNA and transforming growth factor beta (TGF-β) short hairpin RNA for Achilles tendon injury in rats. Briefly, 168 rats with an injured Achilles tendon were randomly divided into seven groups: (1) IGF-1 + UTMD, (2) TGF-β + UTMD, (3) IGF-1 + TGF-β + UTMD, (4) control, (5) IGF-1, (6) TGF-β, and (7) IGF-1 + TGF-β. At 2, 4, 8, and 12 weeks post treatment, six rats from each group were euthanized. IGF-1 expression and TGF-β expression were evaluated using an adhesion index score, pathological examination, quantitative real-time reverse transcription polymerase chain reaction, Western blotting, and biomechanical measurement. The lowest adhesion index score, the lightest inflammation, the highest 4,6-diamidino-2-phenylindole nuclear counter signals, the highest IGF-1 expression, and the lowest TGF-β expression were observed in group 3 (p < 0.05). Furthermore, higher expression of IGF-1 mRNA was observed in groups 1 and 3, while lower expression of TGF-β mRNA was observed in groups 2 and 3 (p < 0.05). The UTMD groups showed a higher transfection efficiency than the groups without UTMD. Downregulation of type III collagen and upregulation of type I collagen were observed in groups 1-3. Moreover, during weeks 4, 8, and 12, greater maximum load and tensile stress were observed in group 3 compared to the other groups (p < 0.05), while the highest tendon stiffness was observed in week 12 (p < 0.05). To conclude, the results suggest that UTMD delivery of IGF-1 and TGF-β offers a promising treatment approach for tendon injury in vivo.
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Affiliation(s)
- Xi Xiang
- 1 Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Qianying Leng
- 2 Department of Ultrasound, West China School of Public Health No.4 West China Teaching Hospital of Sichuan University, Chengdu, China
| | - Yuanjiao Tang
- 1 Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Liyun Wang
- 1 Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Jianbo Huang
- 3 Ultrasonic Clinical Imaging Drug Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zhang
- 4 Core Facility, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- 1 Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
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Bianco ST, Moser HL, Galatz LM, Huang AH. Biologics and stem cell-based therapies for rotator cuff repair. Ann N Y Acad Sci 2018; 1442:35-47. [PMID: 30008172 DOI: 10.1111/nyas.13918] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022]
Abstract
The rotator cuff is composed of several distinct muscles and tendons that function in concert to coordinate shoulder motion. Injuries to these tendons frequently result in permanent dysfunction and persistent pain. Despite considerable advances in operation techniques, surgical repair alone still does not fully restore rotator cuff function. This review focuses on recent research in the use of biologics and stem cell-based therapies to augment repair, highlighting promising avenues for future work and remaining challenges. While a number of animal models are used for rotator cuff studies, the anatomy of the rotator cuff varies dramatically between species. Since the rodent rotator cuff shares the most anatomical features with the human, this review will focus primarily on rodent models to enable consistent interpretation of outcome measures.
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Affiliation(s)
- Spencer T Bianco
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Helen L Moser
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York.,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leesa M Galatz
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alice H Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
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31
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Mistry J, Henn RF, Etcheson JI, Gwam CU, George NE, Delanois RE. Biologic Therapies as Adjunctive Treatments in Rotator Cuff Repair. JBJS Rev 2018; 6:e1. [PMID: 29979232 DOI: 10.2106/jbjs.rvw.17.00149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jaydev Mistry
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer I Etcheson
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Chukwuweike U Gwam
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nicole E George
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Yoon JP, Lee CH, Jung JW, Lee HJ, Lee YS, Kim JY, Park GY, Choi JH, Chung SW. Sustained Delivery of Transforming Growth Factor β1 by Use of Absorbable Alginate Scaffold Enhances Rotator Cuff Healing in a Rabbit Model. Am J Sports Med 2018. [PMID: 29543511 DOI: 10.1177/0363546518757759] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The failure rate for healing after rotator cuff repair is relatively high. PURPOSE To establish a system for sustained release of transforming growth factor β1 (TGF-β1) using an alginate scaffold and evaluate the effects of the sustained release of TGF-β1 on rotator cuff healing in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS Before the in vivo animal study, a standard MTS assay was performed to evaluate cell proliferation and metabolic activity on the alginate scaffold. Additionally, an enzyme-linked immunosorbent assay was performed to confirm the capacity of the sustained release of TGF-β1-containing alginate scaffold. Once the in vitro studies were completed, bilateral supraspinatus tendon repairs were performed in 48 rabbits that were allocated to 3 groups (n = 16 each) (group 1, supraspinatus repair only; group 2, supraspinatus repair with TGF-β1 single injection; group 3, supraspinatus repair with TGF-β1 sustained release via an alginate-based delivery system). Biomechanical and histological analyses were performed to evaluate the quality of tendon-to-bone healing at 12 weeks after rotator cuff repair. RESULTS The cell proliferation rate of the alginate scaffold was 122.30% compared with the control (fresh medium) group, which confirmed that the alginate sheet had no cytotoxicity and enhanced cell proliferation. Additionally, the level of TGF-β1 was found to increase with time on the alginate scaffold. Biomechanically, group 3 exhibited a significantly heightened ultimate failure load compared with groups 1 and 2 (group 1, 74.89 ± 29.82 N; group 2, 80.02 ± 34.42 N; group 3, 108.32 ± 32.48 N; P = .011) and more prevalent midsubstance tear compared with group 1 ( P = .028). However, no statistical differences were found in the cross-sectional area of the supraspinatus tendon (group 1, 32.74 ± 9.38; group 2, 33.76 ± 8.89; group 3, 34.80 ± 14.52; P = .882) and ultimate stress (group 1, 2.62 ± 1.13 MPa; group 2, 2.99 ± 1.81 MPa; group 3, 3.62 ± 2.24 MPa; P = .317). Histologically, group 3 exhibited a significantly heightened modified total Bonar score (group 1, 5.00 ± 1.54; group 2, 6.12 ± 1.85; group 3, 7.50 ± 1.31; P = .001). In addition, the tendon-to-bone interface for group 3 demonstrated better collagen orientation, continuity, and organization, and the area of new fibrocartilage formation was more evident in group 3. CONCLUSION At 12 weeks after rotator cuff repair, the authors found improved biomechanical and histological outcomes for sustained release of TGF-β1 using alginate scaffold in a rabbit model. CLINICAL RELEVANCE The alginate-bound growth factor delivery system might improve healing after rotator cuff repair in humans.
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Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Chang-Hwa Lee
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Wook Jung
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Yong-Soo Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ja-Yeon Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ga Young Park
- Department of Bio-fibers and Materials Science, College of Agriculture and Life Science, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Hyun Choi
- Department of Bio-fibers and Materials Science, College of Agriculture and Life Science, Kyungpook National University, Daegu, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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Jensen PT, Lambertsen KL, Frich LH. Assembly, maturation, and degradation of the supraspinatus enthesis. J Shoulder Elbow Surg 2018; 27:739-750. [PMID: 29329904 DOI: 10.1016/j.jse.2017.10.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/22/2017] [Accepted: 10/27/2017] [Indexed: 02/01/2023]
Abstract
The development of the rotator cuff enthesis is still poorly understood. The processes in the early and late developmental steps are gradually elucidated, but it is still unclear how cell activities are coordinated during development and maturation of the structured enthesis. This review summarizes current knowledge about development and age-related degradation of the supraspinatus enthesis. Healing and repair of an injured and degenerated supraspinatus enthesis also remain a challenge, as the original graded transitional tissue of the fibrocartilaginous insertion is not re-created after the tendon is surgically reattached to bone. Instead, mechanically inferior and disorganized tissue forms at the healing site because of scar tissue formation. Consequently, the enthesis never reaches mechanical properties comparable to those of the native enthesis. So far, no novel biologic healing approach has been successful in enhancing healing of the injured enthesis. The results revealed in this review imply the need for further research to pave the way for better treatment of patients with rotator cuff disorder.
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Affiliation(s)
- Peter T Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kate L Lambertsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Lars H Frich
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.
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Narayanan G, Nair LS, Laurencin CT. Regenerative Engineering of the Rotator Cuff of the Shoulder. ACS Biomater Sci Eng 2018; 4:751-786. [PMID: 33418763 DOI: 10.1021/acsbiomaterials.7b00631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rotator cuff tears often heal poorly, leading to re-tears after repair. This is in part attributed to the low proliferative ability of the resident cells (tendon fibroblasts and tendon-stem cells) upon injury to the rotator cuff tissue and the low vascularity of the tendon insertion. In addition, surgical outcomes of current techniques used in clinical settings are often suboptimal, leading to the formation of neo-tissue with poor biomechanics and structural characteristics, which results in re-tears. This has prompted interest in a new approach, which we term as "Regenerative Engineering", for regenerating rotator cuff tendons. In the Regenerative Engineering paradigm, roles played by stem cells, scaffolds, growth factors/small molecules, the use of local physical forces, and morphogenesis interplayed with clinical surgery techniques may synchronously act, leading to synergistic effects and resulting in successful tissue regeneration. In this regard, various cell sources such as tendon fibroblasts and adult tissue-derived stem cells have been isolated, characterized, and investigated for regenerating rotator cuff tendons. Likewise, numerous scaffolds with varying architecture, geometry, and mechanical characteristics of biologic and synthetic origin have been developed. Furthermore, these scaffolds have been also fabricated with biochemical cues (growth factors and small molecules), facilitating tissue regeneration. In this Review, various strategies to regenerate rotator cuff tendons using stem cells, advanced materials, and factors in the setting of physical forces under the Regenerative Engineering paradigm are described.
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Affiliation(s)
- Ganesh Narayanan
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
| | - Lakshmi S Nair
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Cato T Laurencin
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Connecticut Institute for Clinical and Translational Science, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
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35
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You X, Shen Y, Yu W, He Y. Enhancement of tendon‑bone healing following rotator cuff repair using hydroxyapatite with TGFβ1. Mol Med Rep 2018; 17:4981-4988. [PMID: 29393349 PMCID: PMC5865958 DOI: 10.3892/mmr.2018.8499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/15/2017] [Indexed: 12/22/2022] Open
Abstract
The formation of fibrocartilage at the healing site following a rotator cuff tear repair is a major problem in the field of tendon-bone healing. The present study aimed to enhance the healing of the tendon-bone interface following rotator-cuff tear repair by the interposition of hydroxyapatite (HA) encapsulated with transforming growth factor β1 (TGFβ1). Using an acute rotator cuff repair model, rats were divided into three groups: i) Repair only (control); ii) HA group; and iii) HA-TGFβ1 group. Animals were sacrificed at 2, 4 and 8 weeks following surgery. Micro-computed tomography (CT), histomorphometric analyses and biomechanical tests were used to evaluate the supraspinatus tendon-bone complex. The micro-CT images revealed notable novel bone formation in the groups treated with HA-TGFβ1. The histomorphometric analyses demonstrated improved fibrocartilage formation and collagen organization at the tendon-bone interface. The HA-TGFβ1 combination significantly improved the area of fibrocartilage, particularly at early time points (2 and 4 weeks). There was a significantly greater load-to-failure force achieved in the HA and HA-TGFβ1 groups compared with the control group at 4 and 8 weeks. Augmentation of the ceramic powder with HA-TGFβ1 at the tendon-bone interface was demonstrated to strengthen the healing entheses, increase bone and fibrocartilage formation and improve collagen organization compared with surgical repair alone. Local application of HA-TGFβ1 demonstrates potential in improving tendon-bone healing following rotator cuff repair.
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Affiliation(s)
- Xiebo You
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yueqin Shen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Science, Shanghai 200050, P.R. China
| | - Weihan Yu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yaohua He
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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36
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Wang X, Xie L, Crane J, Zhen G, Li F, Yang P, Gao M, Deng R, Wang Y, Jia X, Fan C, Wan M, Cao X. Aberrant TGF-β activation in bone tendon insertion induces enthesopathy-like disease. J Clin Invest 2018; 128:846-860. [PMID: 29355842 DOI: 10.1172/jci96186] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/07/2017] [Indexed: 02/05/2023] Open
Abstract
Enthesopathy is a disorder of bone, tendon, or ligament insertion. It represents one-fourth of all tendon-ligament diseases and is one of the most difficult tendon-ligament disorders to treat. Despite its high prevalence, the exact pathogenesis of this condition remains unknown. Here, we show that TGF-β was activated in both a semi-Achilles tendon transection (SMTS) mouse model and in a dorsiflexion immobilization (DI) mouse model of enthesopathy. High concentrations of active TGF-β recruited mesenchymal stromal stem cells (MSCs) and led to excessive vessel formation, bone deterioration, and fibrocartilage calcification. Transgenic expression of active TGF-β1 in bone also induced enthesopathy with a phenotype similar to that observed in SMTS and DI mice. Systemic inhibition of TGF-β activity by injection of 1D11, a TGF-β-neutralizing antibody, but not a vehicle antibody, attenuated the excessive vessel formation and restored uncoupled bone remodeling in SMTS mice. 1D11-treated SMTS fibrocartilage had increased proteoglycan and decreased collagen X and matrix metalloproteinase 13 expression relative to control antibody treatment. Notably, inducible knockout of the TGF-β type II receptor in mouse MSCs preserved the bone microarchitecture and fibrocartilage composition after SMTS relative to the WT littermate controls. Thus, elevated levels of active TGF-β in the enthesis bone marrow induce the initial pathological changes of enthesopathy, indicating that TGF-β inhibition could be a potential therapeutic strategy.
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Affiliation(s)
- Xiao Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Liang Xie
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Janet Crane
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gehua Zhen
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fengfeng Li
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ping Yang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Obstetrics and Gynecology, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Manman Gao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Spinal Surgery/Orthopedic Research Institute, First Affiliated Hospital, Sun Yat-sen University, Guandong, China
| | - Ruoxian Deng
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yiguo Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xiaohua Jia
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Cunyi Fan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Mei Wan
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xu Cao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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37
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Arimura H, Shukunami C, Tokunaga T, Karasugi T, Okamoto N, Taniwaki T, Sakamoto H, Mizuta H, Hiraki Y. TGF-β1 Improves Biomechanical Strength by Extracellular Matrix Accumulation Without Increasing the Number of Tenogenic Lineage Cells in a Rat Rotator Cuff Repair Model. Am J Sports Med 2017; 45:2394-2404. [PMID: 28586631 DOI: 10.1177/0363546517707940] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transforming growth factor β1 (TGF-β1) positively regulates the tenogenic marker genes scleraxis ( Scx) and tenomodulin ( Tnmd) in mesenchymal progenitors in vitro. However, little is known about the effect of TGF-β1 on the expression of tenogenic markers during rotator cuff (RC) healing in rats. HYPOTHESIS TGF-β1 improves the biomechanical properties and histological maturity of reparative tissue in a rat RC repair model by stimulating the growth of tenogenic cells. STUDY DESIGN Controlled laboratory study. METHODS Adult male Sprague-Dawley rats (N = 180) underwent unilateral supraspinatus tendon-to-bone surgical repair and were randomly treated with a gelatin hydrogel presoaked in TGF-β1 (100 ng) or phosphate-buffered saline. The effects of TGF-β1 on RC healing were investigated at 2, 4, 6, 8, and 12 weeks postoperatively by immunostaining for proliferating cell nuclear antigen, by real-time reverse transcription polymerase chain reaction and in situ hybridization or immunostaining for enthesis-related markers (SRY-box containing gene 9 [ Sox9], Scx, and Tnmd), and by real-time reverse transcription polymerase chain reaction and immunostaining for type I and III collagen. At 6 and 12 weeks postoperatively, biomechanical testing, micro-computed tomography, and biochemical analysis were also performed. At 2 and 4 weeks postoperatively, mesenchymal stem cell-related markers, phospho-Smad2, and matrix metalloproteinase 9 (MMP-9) and MMP-13 were assessed by immunostaining. RESULTS The TGF-β1-treated group had significantly higher ultimate load to failure and tissue volume at 6 and 12 weeks postoperatively and a higher collagen content at 12 weeks compared with the saline group. Tendon-related gene expression, histological maturity, cell proliferation, and mesenchymal stem cell-related marker immunoreactivity were not affected by exogenously administrated TGF-β1 at all time points. In the TGF-β1-treated group, the percentage of phospho-Smad2-positive cells within the healing tissue increased, whereas the expression of MMP-9 and MMP-13 significantly decreased at 2 and 4 weeks postoperatively. CONCLUSION TGF-β1 enhances formation of tough fibrous tissues at the healing site by inhibiting MMP-9 and MMP-13 expression to increase collagen accumulation but without the growth of tenogenic lineage cells. CLINICAL RELEVANCE These findings suggest that TGF-β1 could be used for enhancing biomechanical strength after RC surgical repair.
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Affiliation(s)
- Hitoshi Arimura
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Chisa Shukunami
- Department of Mechanical System Engineering, Graduate School of Science and Technology, Kumamoto University, Kumamoto, Japan
| | - Takuya Tokunaga
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tatsuki Karasugi
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Nobukazu Okamoto
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takuya Taniwaki
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidetoshi Sakamoto
- Department of Mechanical System Engineering, Doshisha University, Kyoto, Japan
| | - Hiroshi Mizuta
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Hiraki
- Department of Cellular Differentiation, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
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38
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39
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Giotis D, Aryaei A, Vasilakakos T, Paschos NK. Effectiveness of Biologic Factors in Shoulder Disorders. Open Orthop J 2017; 11:163-182. [PMID: 28400884 PMCID: PMC5366381 DOI: 10.2174/1874325001711010163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 12/17/2022] Open
Abstract
Background: Shoulder pathology can cause significant pain, discomfort, and loss of function that all interfere with activities of daily living and may lead to poor quality of life. Primary osteoarthritis and rotator cuff diseases with its sequalae are the main culprits. Management of shoulder disorders using biological factors gained an increasing interest over the last years. This interest reveals the need of effective treatments for shoulder degenerative disorders, and highlights the importance of a comprehensive and detailed understanding of the rapidly increasing knowledge in the field. Methods: This study will describe most of the available biology-based strategies that have been recently developed, focusing on their effectiveness in animal and clinical studies. Results: Data from in vitro work will also be briefly presented; in order to further elucidate newly acquired knowledge regarding mechanisms of tissue degeneration and repair that would probably drive translational work in the next decade. The role of platelet rich-plasma, growth factors, stem cells and other alternative treatments will be described in an evidence-based approach, in an attempt to provide guidelines for their clinical application. Finally, certain challenges that biologic treatments face today will be described as an initiative for future strategies. Conclusion: The application of different growth factors and mesenchymal stem cells appears as promising approaches for enhancing biologic repair. However, data from clinical studies are still limited, and future studies need to improve understanding of the repair process in cellular and molecular level and evaluate the effectiveness of biologic factors in the management of shoulder disorders.
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Affiliation(s)
- Dimitrios Giotis
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Ashkan Aryaei
- Department of Biomedical Engineering, University of California, Davis, USA
| | - Theofanis Vasilakakos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Nikolaos K Paschos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, USA
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40
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Rothrauff BB, Pauyo T, Debski RE, Rodosky MW, Tuan RS, Musahl V. The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:318-335. [PMID: 28084902 DOI: 10.1089/ten.teb.2016.0446] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The torn rotator cuff remains a persistent orthopedic challenge, with poor outcomes disproportionately associated with chronic, massive tears. Degenerative changes in the tissues that comprise the rotator cuff organ, including muscle, tendon, and bone, contribute to the poor healing capacity of chronic tears, resulting in poor function and an increased risk for repair failure. Tissue engineering strategies to augment rotator cuff repair have been developed in an effort to improve rotator cuff healing and have focused on three principal aims: (1) immediate mechanical augmentation of the surgical repair, (2) restoration of muscle quality and contractility, and (3) regeneration of native enthesis structure. Work in these areas will be reviewed in sequence, highlighting the relevant pathophysiology, developmental biology, and biomechanics, which must be considered when designing therapeutic applications. While the independent use of these strategies has shown promise, synergistic benefits may emerge from their combined application given the interdependence of the tissues that constitute the rotator cuff organ. Furthermore, controlled mobilization of augmented rotator cuff repairs during postoperative rehabilitation may provide mechanotransductive cues capable of guiding tissue regeneration and restoration of rotator cuff function. Present challenges and future possibilities will be identified, which if realized, may provide solutions to the vexing condition of chronic massive rotator cuff tears.
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Affiliation(s)
- Benjamin B Rothrauff
- 1 Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Thierry Pauyo
- 3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Richard E Debski
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Mark W Rodosky
- 3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Rocky S Tuan
- 1 Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Volker Musahl
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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41
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Deprés-Tremblay G, Chevrier A, Snow M, Hurtig MB, Rodeo S, Buschmann MD. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development. J Shoulder Elbow Surg 2016; 25:2078-2085. [PMID: 27554609 DOI: 10.1016/j.jse.2016.06.009] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Rotator cuff tears are the most common musculoskeletal injury occurring in the shoulder. Current surgical repair fails to heal in 20% to 95% of patients, depending on age, size of the tear, smoking, time of repair, tendon quality, muscle quality, healing response, and surgical treatments. These problems are worsened by the limited healing potential of injured tendons attributed to the presence of degenerative changes and relatively poor vascularity of the cuff tendons. Development of new techniques to treat rotator cuff tears requires testing in animal models to assess safety and efficacy before clinical testing. Hence, it is important to evaluate appropriate animal models for rotator cuff research with degeneration of tendons, muscular atrophy, and fatty infiltration similar to humans. This report reviews current clinical treatments and preclinical approaches for rotator cuff tear repair. The review will focus on current clinical surgical treatments, new repair strategies under clinical and preclinical development, and will also describe different animal models available for rotator cuff research. These findings and future directions for rotator cuff tear repair will be discussed.
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Affiliation(s)
| | - Anik Chevrier
- Chemical Engineering Department, Polytechnique Montréal, Montreal, QC, Canada
| | - Martyn Snow
- Department of Arthroscopy, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Mark B Hurtig
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Scott Rodeo
- Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA
| | - Michael D Buschmann
- Biomedical Engineering Institute, Polytechnique Montréal, Montreal, QC, Canada; Chemical Engineering Department, Polytechnique Montréal, Montreal, QC, Canada.
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Díaz Heredia J, Ruiz Iban MA, Martínez-Botas J, Valencia Mora M, Cuéllar Ayestaran A, Moros Marco S, Ruiz Díaz R. Growth factor expression after supraspinatus tear: a quantitative polymerase chain reaction (PCR) study in rats. Arch Orthop Trauma Surg 2016; 136:1563-1570. [PMID: 27457722 DOI: 10.1007/s00402-016-2518-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the temporal expression pattern of three different growth factors (VEGF, IL-1β, and TGF-1β) in a supraspinatus tendon lesion in an animal model. The hypothesis of this study is that there are variations in the expression of these factors in the first 8 weeks after injury. MATERIALS AND METHODS A full thickness defect was made in the supraspinatus tendon of 40 rat shoulders. The animal were sacrificed at 0, 3, 7, 14 and 56 days after injury and three tissue samples were obtained: bone from the tendon footprint; the supraspinatus tendon stump, and a fragment of the myotendinous junction. After mRNA extraction, quantitative PCR analysis was performed, and the expression of three different growth factors were evaluated in each zone. RESULTS There was an increased expression of IL-1β during the first week after injury at all levels evaluated with a clear peak in the first day after injury. There was also a significant increase in TGF-1β expression levels all along the first week in the three zones. There were no variations in VEGF expression in the three zones along the 8 weeks. CONCLUSION IL-1β was expressed predominantly in the initial stages after injury; TGF initiated its expression after the initial phase since day three, whereas VEGF remained basically unchanged during the entire process.
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Affiliation(s)
- Jorge Díaz Heredia
- Unidad de Hombro y Codo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - M A Ruiz Iban
- Unidad de Hombro y Codo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Martínez-Botas
- Servicio de Bioquímica-Investigación, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - M Valencia Mora
- Servicio de Traumatología y Cirugía Ortopédica, Fundación Jiménez Díaz, Madrid, Spain
| | - A Cuéllar Ayestaran
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Galdakao Usansolo, Galdakao, Spain
| | - S Moros Marco
- Servicio de Traumatología y Cirugía Ortopédica, Hospital MAZ, Zaragoza, Spain
| | - R Ruiz Díaz
- Unidad de Hombro y Codo, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Walden G, Liao X, Donell S, Raxworthy MJ, Riley GP, Saeed A. A Clinical, Biological, and Biomaterials Perspective into Tendon Injuries and Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2016; 23:44-58. [PMID: 27596929 PMCID: PMC5312458 DOI: 10.1089/ten.teb.2016.0181] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tendon injury is common and debilitating, and it is associated with long-term pain and ineffective healing. It is estimated to afflict 25% of the adult population and is often a career-ending disease in athletes and racehorses. Tendon injury is associated with high morbidity, pain, and long-term suffering for the patient. Due to the low cellularity and vascularity of tendon tissue, once damage has occurred, the repair process is slow and inefficient, resulting in mechanically, structurally, and functionally inferior tissue. Current treatment options focus on pain management, often being palliative and temporary and ending in reduced function. Most treatments available do not address the underlying cause of the disease and, as such, are often ineffective with variable results. The need for an advanced therapeutic that addresses the underlying pathology is evident. Tissue engineering and regenerative medicine is an emerging field that is aimed at stimulating the body's own repair system to produce de novo tissue through the use of factors such as cells, proteins, and genes that are delivered by a biomaterial scaffold. Successful tissue engineering strategies for tendon regeneration should be built on a foundation of understanding of the molecular and cellular composition of healthy compared with damaged tendon, and the inherent differences seen in the tissue after disease. This article presents a comprehensive clinical, biological, and biomaterials insight into tendon tissue engineering and regeneration toward more advanced therapeutics.
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Affiliation(s)
- Grace Walden
- 1 School of Pharmacy, University of East Anglia, Norwich, United Kingdom
| | - Xin Liao
- 1 School of Pharmacy, University of East Anglia, Norwich, United Kingdom
| | - Simon Donell
- 2 Norfolk and Norwich University Hospital, Norwich, United Kingdom .,3 Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Mike J Raxworthy
- 4 Neotherix Limited, York, United Kingdom .,5 University of Leeds, Leeds, United Kingdom
| | - Graham P Riley
- 6 School of Biological Sciences, University of East Anglia, Norwich, United Kingdom
| | - Aram Saeed
- 1 School of Pharmacy, University of East Anglia, Norwich, United Kingdom
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Lee KW, Lee JS, Kim YS, Shim YB, Jang JW, Lee KI. Effective healing of chronic rotator cuff injury using recombinant bone morphogenetic protein-2 coated dermal patch in vivo. J Biomed Mater Res B Appl Biomater 2016; 105:1840-1846. [PMID: 27228085 DOI: 10.1002/jbm.b.33716] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 11/06/2022]
Abstract
Biologic augmentation for rotator cuff repair is a challenging treatment in patients with chronic large, massive, and irreparable rotator cuff injuries. Particularly, the use of an extracellular matrix (ECM) patch such as dermal tissue offered improved biomechanical properties in previous studies. Cytokines induce cell chemotaxis, proliferation, matrix synthesis, and cell differentiation. Moreover, osteoinductive growth factors such as bone morphogenetic protein-2 (BMP-2) affect the formation of new bone and fibrocartilage in lesions. However, the effects of using a dermal patch in combination with BMP-2 have not been evaluated to date, although many researchers have recognized the importance thereof. In this study, rhBMP-2-coated dermal patch (1 cm × 2 cm) isolated from human cadaveric donor was inserted in a rabbit model of chronic rotator cuff injury for in vivo evaluation. Bone mineral density and biomechanical strength were tested and histological and histomorphometric analyses were performed. The results showed that insertion of an rhBMP-2-coated acellular dermal patch not only significantly ameliorated new bone formation, it also improved biomechanical properties such as ultimate tensile strength. Thus, the use of this combination may improve the chronic rotator cuff injury-healing rate and clinical outcomes after rotator cuff repair. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1840-1846, 2017.
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Affiliation(s)
- Kwang-Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Jung-Soo Lee
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Young-Sik Kim
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Young-Bock Shim
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Ju-Woong Jang
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Kwang-Il Lee
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
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Murray IR, LaPrade RF, Musahl V, Geeslin AG, Zlotnicki JP, Mann BJ, Petrigliano FA. Biologic Treatments for Sports Injuries II Think Tank-Current Concepts, Future Research, and Barriers to Advancement, Part 2: Rotator Cuff. Orthop J Sports Med 2016; 4:2325967116636586. [PMID: 27099865 PMCID: PMC4820026 DOI: 10.1177/2325967116636586] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Rotator cuff tears are common and result in considerable morbidity. Tears within the tendon substance or at its insertion into the humeral head represent a considerable clinical challenge because of the hostile local environment that precludes healing. Tears often progress without intervention, and current surgical treatments are inadequate. Although surgical implants, instrumentation, and techniques have improved, healing rates have not improved, and a high failure rate remains for large and massive rotator cuff tears. The use of biologic adjuvants that contribute to a regenerative microenvironment have great potential for improving healing rates and function after surgery. This article presents a review of current and emerging biologic approaches to augment rotator cuff tendon and muscle regeneration focusing on the scientific rationale, preclinical, and clinical evidence for efficacy, areas for future research, and current barriers to advancement and implementation.
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Affiliation(s)
| | | | - Volker Musahl
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew G Geeslin
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Jason P Zlotnicki
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Barton J Mann
- Author deceased.; American Orthopaedic Society for Sports Medicine, Rosemont, Illinois, USA
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Gilotra MN, Shorofsky MJ, Stein JA, Murthi AM. Healing of rotator cuff tendons using botulinum toxin A and immobilization in a rat model. BMC Musculoskelet Disord 2016; 17:127. [PMID: 26979873 PMCID: PMC4791755 DOI: 10.1186/s12891-016-0978-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background We evaluated effects of botulinum toxin A (Botox) and cast immobilization on tendon healing in a rat model. Injection of Botox into rat supraspinatus was hypothesized to reduce muscle active force and improved healing. Methods Eighty-four supraspinatus tendons were surgically transected and repaired in 42 Sprague-Dawley rats (transosseous technique). After repair, supraspinatus muscle was injected with saline or Botox (3 or 6 U/kg). Half the shoulders were cast-immobilized for the entire postoperative period; half were allowed free cage activity. Histology was examined at 2, 4, 8, and 12 weeks. A healing zone cross-sectional area was measured, and biomechanical testing of repair strength and tendon viscoelastic properties was conducted at 4 and 12 weeks. Results Botox alone and cast immobilization alone exhibited increased ultimate load compared with controls (saline injection, no immobilization) at 4 weeks. No difference in ultimate load occurred between Botox-only and cast-only groups. At 12 weeks, the Botox (6 U/kg) plus cast immobilization group was significantly weakest (p < 0.05). A trend was shown toward decreased healing zone cross-sectional areas in casted groups. Conclusions Supraspinatus Botox injection after rotator cuff repair might help protect the repair. However, cast immobilization plus Botox administration is harmful to rotator cuff healing in a rat tendon model.
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Affiliation(s)
- Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Michael J Shorofsky
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jason A Stein
- Department of Orthopaedics and Sports Medicine, MedStar Union Memorial Hospital, Baltimore, MD, 21218, USA
| | - Anand M Murthi
- Department of Orthopaedics and Sports Medicine, MedStar Union Memorial Hospital, Baltimore, MD, 21218, USA
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Zhang P, Han F, Li Y, Chen J, Chen T, Zhi Y, Jiang J, Lin C, Chen S, Zhao P. Local delivery of controlled-release simvastatin to improve the biocompatibility of polyethylene terephthalate artificial ligaments for reconstruction of the anterior cruciate ligament. Int J Nanomedicine 2016; 11:465-78. [PMID: 26869789 PMCID: PMC4734794 DOI: 10.2147/ijn.s95032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The Ligament Advanced Reinforcement System has recently been widely used as the primary graft of choice in anterior cruciate ligament (ACL) reconstruction. But the biological graft-bone healing still remains a problem. Previous studies have shown that simvastatin (SIM) stimulates bone formation. The objective of this study was to investigate whether surface coating with collagen containing low-dose SIM microsphere could enhance the surface biocompatibility of polyethylene terephthalate (PET) artificial ligaments to accelerate graft-to-bone healing. The in vitro studies demonstrated that bone marrow stromal cells on the collagen-coated PET scaffolds (COL/PET) and simvastatin/collagen-coated PET scaffolds (SIM/COL/PET) proliferated vigorously. Compared with the PET group and the COL/PET group, SIM could induce bone marrow stromal cells' osteoblastic differentiation, high alkaline phosphatase activity, more mineralization deposition, and more expression of osteoblast-related genes, such as osteocalcin, runt-related transcription factor 2, bone morphogenetic protein-2, and vascular endothelial growth factor, in the SIM/COL/PET group. In vivo, rabbits received ACL reconstruction with different scaffolds. Histological analysis demonstrated that graft-bone healing was significantly greater with angiogenesis and osteogenesis in the SIM/COL/PET group than the other groups. In addition, biomechanical testing at the eighth week demonstrated a significant increase in the ultimate failure load and stiffness in the SIM/COL/PET group. The low dose of SIM-sustained release from SIM/COL/PET promoted the graft-bone healing via its effect on both angiogenesis and osteogenesis. This study suggested that collagen containing low-dose SIM microsphere coating on the surface of PET artificial ligaments could be potentially applied for ACL reconstruction.
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Affiliation(s)
- Peng Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Fei Han
- Shanghai East Hospital, The Institute for Biomedical Engineering and Nanoscience, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yunlong Zhi
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jia Jiang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Chao Lin
- Shanghai East Hospital, The Institute for Biomedical Engineering and Nanoscience, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Peng Zhao
- Shanghai East Hospital, The Institute for Biomedical Engineering and Nanoscience, School of Medicine, Tongji University, Shanghai, People’s Republic of China
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Gilotra M, Nguyen T, Christian M, Davis D, Henn RF, Hasan SA. Botulinum toxin is detrimental to repair of a chronic rotator cuff tear in a rabbit model. J Orthop Res 2015; 33:1152-7. [PMID: 25626677 DOI: 10.1002/jor.22836] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 01/19/2015] [Indexed: 02/04/2023]
Abstract
Re-tear continues to be a problem after rotator cuff repair. Intramuscular botulinum toxin (Botox) injection can help optimize tension at the repair site to promote healing but could have an adverse effect on the degenerated muscle in a chronic tear. We hypothesized that Botox injection would improve repair characteristics without adverse effect on the muscle in a chronic rotator cuff tear model. The supraspinatus tendon of both shoulders in 14 rabbits underwent delayed repair 12 weeks after transection. One shoulder was treated with intramuscular Botox injection and the other with a saline control injection. Six weeks after repair, outcomes were based on biomechanics, histology, and magnetic resonance imaging. Botox-treated repairs were significantly weaker (2.64 N) than control repairs (5.51 N, p = 0.03). Eighty percent of Botox-treated repairs and 40% of control repairs healed with some partial defect. Fatty infiltration of the supraspinatus was present in all shoulders (Goutallier Grade 3 or 4) but was increased in the setting of Botox. This study provides additional support for the rabbit supraspinatus model of chronic cuff tear, showing consistent fatty infiltration. Contrary to our hypothesis, Botox had a negative effect on repair strength and might increase fatty infiltration.
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Affiliation(s)
- Mohit Gilotra
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Thao Nguyen
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Matthew Christian
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Derik Davis
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
| | - Syed Ashfaq Hasan
- Department of Orthopaedics, University of Maryland, Maryland, Baltimore
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A biomechanical and histological comparison of the suture bridge and conventional double-row techniques of the repair of full-thickness rotator cuff tears in a rabbit model. BMC Musculoskelet Disord 2015; 16:148. [PMID: 26076895 PMCID: PMC4466809 DOI: 10.1186/s12891-015-0601-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/27/2015] [Indexed: 12/20/2022] Open
Abstract
Background The suture bridge (SB) technique and conventional double-row (DR) are both effective in repair of full-thickness rotator cuff tears . However, increasing numbers of scholars believe that the SB technique produces better results than conventional DR because of the higher bone-tendon contact area and pressure. However, The clinical outcomes have been mixed and little direct evidence has been supplied in vivo. This study was designed using the SB and DR techniques to determine which is the better technique. Methods Sixty-four New Zealand white rabbits were randomly divided into 2 groups, the SB group and DR group. SB and DR were then used to repair their rotator cuff tears. Rabbits were then sacrificed at the 2nd, 4th, or 8th week after surgery and a histological comparison was made. The biomechanical comparison was made at the 8th week. Results The load to failure of the SB group was 134.59 ± 17.69 N at the 8th postoperative week, and that was significantly higher than in the DR group (103.83 ± 6.62, P = 0.001), but both repair groups remained lower than in the control group (199.25 ± 14.81). Histological evaluation showed that both the SB and DR groups healed at the bone-tendon interface. But there were subtle differences between the two groups in the structure and morphology of collagen fibers and cartilage cells at bone-tendon interface. In general, the collagen fibers of the SB group were more compact than those of the DR group at all times tested. At the 4th and 8th weeks, the collagen fibers and cartilage cells in the SB group were arranged in a column modality, but those in the DR group were distributed horizontally. Conclusion The SB technique facilitated healing more effectively than the conventional DR technique. The difference in morphology of collagen fibers and cartilage cells may be related to the difference in bone-tendon contact pressure.
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Andarawis-Puri N, Flatow EL, Soslowsky LJ. Tendon basic science: Development, repair, regeneration, and healing. J Orthop Res 2015; 33:780-4. [PMID: 25764524 PMCID: PMC4427041 DOI: 10.1002/jor.22869] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/16/2015] [Indexed: 02/04/2023]
Abstract
Tendinopathy and tendon rupture are common and disabling musculoskeletal conditions. Despite the prevalence of these injuries, a limited number of investigators are conducting fundamental, basic science studies focused on understanding processes governing tendinopathies and tendon healing. Development of effective therapeutics is hindered by the lack of fundamental guiding data on the biology of tendon development, signal transduction, mechanotransduction, and basic mechanisms underlying tendon pathogenesis and healing. To propel much needed progress, the New Frontiers in Tendon Research Conference, co-sponsored by NIAMS/NIH, the Orthopaedic Research Society, and the Icahn School of Medicine at Mount Sinai, was held to promote exchange of ideas between tendon researchers and basic science experts from outside the tendon field. Discussed research areas that are underdeveloped and represent major hurdles to the progress of the field will be presented in this review. To address some of these outstanding questions, conference discussions and breakout sessions focused on six topic areas (Cell Biology and Mechanics, Functional Extracellular Matrix, Development, Mechano-biology, Scarless Healing, and Mechanisms of Injury and Repair), which are reviewed in this special issue and briefly presented in this review. Review articles in this special issue summarize the progress in the field and identify essential new research directions.
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Affiliation(s)
- Nelly Andarawis-Puri
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, New York 10029
| | - Evan L. Flatow
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1188, New York, New York 10029
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
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