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Smolyak G, Rodenhouse A, Nichols AEC, Ketonis C, Loiselle AE. Pharmacological Antagonism of Ccr2+ Cell Recruitment to Facilitate Regenerative Tendon Healing. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.15.603448. [PMID: 39071284 PMCID: PMC11275796 DOI: 10.1101/2024.07.15.603448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Successful tendon healing requires sufficient deposition and remodeling of new extracellular matrix at the site of injury, with this process mediating in part through fibroblast activation via communication with macrophages. Moreover, resolution of healing requires clearance or reversion of activated cells, with chronic interactions with persistent macrophages impairing resolution and facilitating the conversion the conversion to fibrotic healing. As such, modulation of the macrophage environment represents an important translational target to improve the tendon healing process. Circulating monocytes are recruited to sites of tissue injury, including the tendon, via upregulation of cytokines including Ccl2, which facilitates recruitment of Ccr2+ macrophages to the healing tendon. Our prior work has demonstrated that Ccr2-/- can modulate fibroblast activation and myofibroblast differentiation. However, this approach lacked temporal control and resulted in healing impairments. Thus, in the current study we have leveraged a Ccr2 antagonist to blunt macrophage recruitment to the healing tendon in a time-dependent manner. We first tested the effects of Ccr2 antagonism during the acute inflammatory phase and found that this had no effect on the healing process. In contrast, Ccr2 antagonism during the late inflammatory/ early proliferative period resulted in significant improvements in mechanical properties of the healing tendon. Collectively, these data demonstrate the temporally distinct impacts of modulating Ccr2+ cell recruitment and Ccr2 antagonism during tendon healing and highlight the translational potential of transient Ccr2 antagonism to improve the tendon healing process.
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Affiliation(s)
- Gilbert Smolyak
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Andrew Rodenhouse
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY 14642
| | - Anne E C Nichols
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY 14642
| | - Constantinos Ketonis
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY 14642
| | - Alayna E Loiselle
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY 14642
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Atarbashi-Moghadam F, Azadi A, Nokhbatolfoghahaei H, Taghipour N. Effect of simultaneous and sequential use of TGF-β1 and TGF-β3 with FGF-2 on teno/ligamentogenic differentiation of periodontal ligament stem cells. Arch Oral Biol 2024; 162:105956. [PMID: 38522213 DOI: 10.1016/j.archoralbio.2024.105956] [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] [Received: 12/31/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The periodontal ligament is a crucial part of the periodontium, and its regeneration is challenging. This study compares the effect of simultaneous and sequential use of FGF-2 and TGF-β1 with FGF-2 and TGF-β3 on the periodontal ligament stem cells (PDLSCs) teno/ligamentogenic differentiation. DESIGN This study comprises ten different groups. A control group with only PDLSCs; FGF-2 group containing PDLSCs with a medium culture supplemented with FGF-2 (50 ng/mL). In other experimental groups, different concentrations (5 ng/mL or 10 ng/mL) of TGF-β1&-β3 simultaneously or sequentially were combined with FGF-2 on the cultured PDLSCs. TGF-β was added to the medium after day 3 in the sequential groups. Methyl Thiazolyl Tetrazolium (MTT) assay on days 3, 5, and 7 and Quantitative Real-time Polymerase Chain Reaction (RT-qPCR) analysis after day 7 were conducted to investigate PLAP1, SCX, and COL3A1, RUNX2 genes. All experiments were conducted in a triplicate. The One-way and Two-way ANOVA with Tukey post hoc were utilized to analyze the results of the MTT and RT-qPCR tests, respectively. A p-value less than 0.05 is considered significant. RESULTS The proliferation of cells on days 3, 5, and 7 was not significantly different among different experimental groups (P > 0.05). A higher expression of the PLAP1, SCX, and COL3A1 have been seen in groups with sequential use of growth factors; among these groups, the group using 5 ng/mL of TGF-β3 led other groups with the most amount of significant upregulation in PLAP1(17.69 ± 1.11 fold; P < 0.0001), SCX (5.71 ± 0.38 fold; P < 0.0001), and COL1A3 (6.35 ± 0.39 fold; P < 0.0001) expression, compared to the control group. The expression of the RUNX2 decreased in all groups compared to the control group; this reduction was more in groups with sequential use of growth factors. CONCLUSION The sequential use of growth factors can be more effective than simultaneous use in teno/ligamentogenic differentiation of PDLSCs. Moreover, treatment with 5 ng/mL TGF-β3 after FGF-2 was more effective than TGF-β1.
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Affiliation(s)
- Fazele Atarbashi-Moghadam
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Dental Research Center, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Azadi
- DDS, Research Fellow, Dentofacial Deformities Research Center, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Nokhbatolfoghahaei
- Dental Research Center, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Taghipour
- Dental Research Center, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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3
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Melzer M, Niebert S, Heimann M, Ullm F, Pompe T, Scheiner-Bobis G, Burk J. Differential Smad2/3 linker phosphorylation is a crosstalk mechanism of Rho/ROCK and canonical TGF-β3 signaling in tenogenic differentiation. Sci Rep 2024; 14:10393. [PMID: 38710741 PMCID: PMC11074336 DOI: 10.1038/s41598-024-60717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
The transforming growth factor (TGF)-β3 is a well-known inducer for tenogenic differentiation, signaling via the Smad2/3 pathway. Furthermore, other factors like extracellular matrix or mechanical force can induce tenogenic differentiation and possibly alter the response to TGF-β3 by signaling via the Rho/ROCK pathway. The aim of this study was to investigate the interplay of Rho/ROCK and TGF-β3/Smad signaling in tenogenic differentiation, with the Smad2/3 molecule hypothesized as a possible interface. Cultured as monolayers or on collagen I matrices, mesenchymal stromal cells (MSC) were treated with the ROCK inhibitor Y-27632 (10 µM), TGF-β3 (10 ng/ml) or both combined. Control cells were cultured accordingly, without Y-27632 and/or without TGF-β3. At different time points, MSC were analyzed by real-time RT-PCR, immunofluorescence, and Western blot. Cultivation of MSC on collagen matrices and ROCK inhibition supported tenogenic differentiation and fostered the effect of TGF-β3. The phosphorylation of the linker region of Smad2 was reduced by cultivation on collagen matrices, but not by ROCK inhibition. The latter, however, led to increased phosphorylation of the linker region of Smad3. In conclusion, collagen matrices and the Rho/ROCK signaling pathway influence the TGF-β3/Smad2/3 pathway by regulating different phosphorylation sites of the Smad linker region.
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Affiliation(s)
- Michaela Melzer
- Equine Clinic (Surgery, Orthopedics), Faculty of Veterinary Medicine, Justus-Liebig-University, 35392, Giessen, Germany
| | - Sabine Niebert
- Institute of Physiology, Pathophysiology and Biophysics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Manuela Heimann
- Institute of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Justus-Liebig-University, 35392, Giessen, Germany
| | - Franziska Ullm
- Institute of Biochemistry, Faculty of Life Science, Leipzig University, 04103, Leipzig, Germany
- FILK Freiberg Institute GmbH, 09599, Freiberg, Germany
| | - Tilo Pompe
- Institute of Biochemistry, Faculty of Life Science, Leipzig University, 04103, Leipzig, Germany
| | - Georgios Scheiner-Bobis
- Institute of Biochemistry and Endocrinology, Faculty of Veterinary Medicine, Justus-Liebig-University, 35392, Giessen, Germany
| | - Janina Burk
- Institute of Physiology, Pathophysiology and Biophysics, University of Veterinary Medicine Vienna, Vienna, Austria.
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Xie X, Xu J, Ding D, Lin J, Han K, Wang C, Wang F, Zhao J, Wang L. Janus Membranes Patch Achieves High-Quality Tendon Repair: Inhibiting Exogenous Healing and Promoting Endogenous Healing. NANO LETTERS 2024; 24:4300-4309. [PMID: 38534038 DOI: 10.1021/acs.nanolett.4c00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
The imbalance between endogenous and exogenous healing is the fundamental reason for the poor tendon healing. In this study, a Janus patch was developed to promote endogenous healing and inhibit exogenous healing, leading to improved tendon repair. The upper layer of the patch is a poly(dl-lactide-co-glycolide)/polycaprolactone (PLGA/PCL) nanomembrane (PMCP-NM) modified with poly(2-methylacryloxyethyl phosphocholine) (PMPC), which created a lubricated and antifouling surface, preventing cell invasion and mechanical activation. The lower layer is a PLGA/PCL fiber membrane loaded with fibrin (Fb) (Fb-NM), serving as a temporary chemotactic scaffold to regulate the regenerative microenvironment. In vitro, the Janus patch effectively reduced 92.41% cell adhesion and 79.89% motion friction. In vivo, the patch inhibited tendon adhesion through the TGF-β/Smad signaling pathway and promoted tendon maturation. This Janus patch is expected to provide a practical basis and theoretical guidance for high-quality soft tissue repair.
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Affiliation(s)
- Xiaojing Xie
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Danzhi Ding
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
| | - Jing Lin
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Chaorong Wang
- Shanghai Frontier Science Research Center for Advanced Textiles, College of Textiles, Donghua University, Shanghai 201620, China
| | - Fujun Wang
- Shanghai Frontier Science Research Center for Advanced Textiles, College of Textiles, Donghua University, Shanghai 201620, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology of Ministry of Education College of Textiles, Donghua University, Shanghai 201620, China
- Shanghai Frontier Science Research Center for Advanced Textiles, College of Textiles, Donghua University, Shanghai 201620, China
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Najafi Z, Moosavi Z, Baradaran Rahimi V, Hashemitabar G, Askari VR. Evaluation of Anti-Nociceptive, Anti-Inflammatory, and Anti-Fibrotic effects of noscapine against a rat model of Achilles tendinopathy. Int Immunopharmacol 2024; 130:111704. [PMID: 38382264 DOI: 10.1016/j.intimp.2024.111704] [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] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
During tendinopathy, prolonged inflammation results in fibrosis and the adherence of tendons to the adjacent tissues, causing discomfort and movement disorders. As a natural compound, noscapine has several anti-inflammatory and anti-fibrotic properties. Therefore, we aimed to investigate the effects of noscapine against a rat model of tendinopathy. We created a surgical rat model of Achilles tendon damage to emulate tendinopathy. Briefly, an incision was made on the Achilles tendon, and it was then sutured using an absorbable surgical thread. Immediately, the injured area was topically treated with the vehicle, noscapine (0.2, 0.6, and 1.8 mg/kg), or dexamethasone (0.1 mg/kg) as a positive control. During the 19-day follow-up period, animals were assessed for weight, behavior, pain, and motor coordination testing. On day 20th, the rats were sacrificed, and the tendon tissue was isolated for macroscopic scoring, microscopic (H&E, Masson's trichrome, Ki67, p53) analyses, and cytokine secretion levels. The levels of macroscopic parameters, including thermal hyperalgesia, mechanical and cold allodynia, deterioration of motor coordination, tendon adhesion score, and microscopic indices, namely histological adhesion, vascular prominence and angiogenesis, and Ki67 and p53 levels, as well as fibrotic and inflammatory biomarkers (IL-6, TNF-α, TGF-β, VEGF) were significantly increased in the vehicle group compared to the sham group (P < 0.05-0.001 for all cases). In contrast, the administration of noscapine (0.2, 0.6, and 1.8 mg/kg) attenuated the pain, fibrosis, and inflammatory indices in a dose-dependent manner compared to the vehicle group (P < 0.05-0.001). Histological research indicated that noscapine 0.6 and 1.8 mg/kg had the most remarkable healing effects. Interestingly, two higher doses of noscapine had impacts similar to those of the positive control group in both clinical and paraclinical assessments. Taken together, our findings suggested that noscapine could be a promising medicine for treating tendinopathies.
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Affiliation(s)
- Zohreh Najafi
- Division of Biotechnology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Moosavi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Gholamreza Hashemitabar
- Division of Biotechnology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Vahid Reza Askari
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
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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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7
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Bao R, Wang S, Liu X, Tu K, Liu J, Huang X, Liu C, Zhou P, Liu S. Neuromorphic electro-stimulation based on atomically thin semiconductor for damage-free inflammation inhibition. Nat Commun 2024; 15:1327. [PMID: 38351088 PMCID: PMC10864345 DOI: 10.1038/s41467-024-45590-8] [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] [Received: 07/17/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
Inflammation, caused by accumulation of inflammatory cytokines from immunocytes, is prevalent in a variety of diseases. Electro-stimulation emerges as a promising candidate for inflammatory inhibition. Although electroacupuncture is free from surgical injury, it faces the challenges of imprecise pathways/current spikes, and insufficiently defined mechanisms, while non-optimal pathway or spike would require high current amplitude, which makes electro-stimulation usually accompanied by damage and complications. Here, we propose a neuromorphic electro-stimulation based on atomically thin semiconductor floating-gate memory interdigital circuit. Direct stimulation is achieved by wrapping sympathetic chain with flexible electrodes and floating-gate memory are programmable to fire bionic spikes, thus minimizing nerve damage. A substantial decrease (73.5%) in inflammatory cytokine IL-6 occurred, which also enabled better efficacy than commercial stimulator at record-low currents with damage-free to sympathetic neurons. Additionally, using transgenic mice, the anti-inflammation effect is determined by β2 adrenergic signaling from myeloid cell lineage (monocytes/macrophages and granulocytes).
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Affiliation(s)
- Rong Bao
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shuiyuan Wang
- Shanghai Key Lab for Future Computing Hardware and System, School of Microelectronics, Fudan University, Shanghai, 200433, China.
| | - Xiaoxian Liu
- Shanghai Key Lab for Future Computing Hardware and System, School of Microelectronics, Fudan University, Shanghai, 200433, China
| | - Kejun Tu
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, DCI Joint Team, Collaborative Innovation Center of IFSA, Department of Micro/Nano Electronics, Shanghai Jiao Tong university, Shanghai, 200240, China
| | - Jingquan Liu
- National Key Laboratory of Science and Technology on Micro/Nano Fabrication, DCI Joint Team, Collaborative Innovation Center of IFSA, Department of Micro/Nano Electronics, Shanghai Jiao Tong university, Shanghai, 200240, China
| | - Xiaohe Huang
- Shanghai Key Lab for Future Computing Hardware and System, School of Microelectronics, Fudan University, Shanghai, 200433, China
| | - Chunsen Liu
- Shanghai Key Lab for Future Computing Hardware and System, School of Microelectronics, Fudan University, Shanghai, 200433, China
| | - Peng Zhou
- Shanghai Key Lab for Future Computing Hardware and System, School of Microelectronics, Fudan University, Shanghai, 200433, China.
| | - Shen Liu
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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8
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Li H, Luo S, Wang H, Chen Y, Ding M, Lu J, Jiang L, Lyu K, Huang S, Shi H, Chen H, Li S. The mechanisms and functions of TGF-β1 in tendon healing. Injury 2023; 54:111052. [PMID: 37738787 DOI: 10.1016/j.injury.2023.111052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
Tendon injury accounts for 30% of musculoskeletal diseases and often leads to disability, pain, healthcare cost, and lost productivity. Following injury to tendon, tendon healing proceeds via three overlapping healing processes. However, due to the structural defects of the tendon itself, the tendon healing process is characterized by the formation of excessive fibrotic scar tissue, and injured tendons rarely return to native tendons, which can easily contribute to tendon reinjury. Moreover, the resulting fibrous scar is considered to be a precipitating factor for subsequent degenerative tendinopathy. Despite this, therapies are almost limited because underlying molecular mechanisms during tendon healing are still unknown. Transforming Growth Factor-β1 (TGF-β1) is known as one of most potent profibrogenic factors during tendon healing process. However, blockage TGF-β1 fails to effectively enhance tendon healing. A detailed understanding of real abilities of TGF-β1 involved in tendon healing can bring promising perspectives for therapeutic value that improve the tendon healing process. Thus, in this review, we describe recent efforts to identify and characterize the roles and mechanisms of TGF-β1 involved at each stage of the tendon healing and highlight potential roles of TGF-β1 leading to the fibrotic response to tendon injury.
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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
| | - Hao Wang
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yixuan Chen
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - MingZhe Ding
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Jingwei Lu
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Li Jiang
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Kexin Lyu
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Shilin Huang
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Houyin Shi
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Hui Chen
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Sen Li
- School of Physical Education, Southwest Medical University, Luzhou, China.
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Jie Li Z, Bing Luo C, Liang Wang H, Sun J, Qian Yang Q, Lang Zhou Y. Metformin suppressed tendon injury-induced adhesion via hydrogel-nanoparticle sustained-release system. Int J Pharm 2023; 642:123190. [PMID: 37391109 DOI: 10.1016/j.ijpharm.2023.123190] [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] [Received: 12/20/2022] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/02/2023]
Abstract
Tendon adhesion is one of the sequelae of tendon injury and can lead to disability in severe cases. Metformin is a commonly used antidiabetic drug. Some studies had shown that metformin could reduce tendon adhesion as well. Considering the characteristic of low absorption rate and short half-life, we established a sustained-release system, i.e., hydrogel-nanoparticle system to deliver metformin. In vitro, metformin could effectively suppress TGF-β1-induced cell proliferation and accelerate cell apoptosis, according to cell counting kit-8, flow cytometry, and 5-ethynyl-2'-deoxyuridine (EdU) staining studies. In vivo, hydrogel-nanoparticle/metformin system could significantly lower adhesion scores and improve the gliding function of repaired flexor tendons, as well as decrease the expression of fibrotic proteins Col1a1, Col3a1, and α-smooth muscle actin (α-SMA). Histological staining revealed that the inflammation had subsided and that the gap between the tendon and the surrounding tissue was wider in the hydrogel-nanoparticle/metformin treatment group. Finally, we speculated that effect of metformin on reducing tendon adhesion might be achieved by regulating both Smad and MAPK-TGF-β1 signaling pathways. In conclusion, metformin delivered through hydrogel-nanoparticle sustained-release system may be a promising strategy for coping with tendon adhesion.
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Affiliation(s)
- Zhi Jie Li
- Hand Surgery Research Center, Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Chun Bing Luo
- Hand Surgery Research Center, Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Hao Liang Wang
- Hand Surgery Research Center, Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Jie Sun
- Hand Surgery Research Center, Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Qian Qian Yang
- Hand Surgery Research Center, Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - You Lang Zhou
- Hand Surgery Research Center, Research Central of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China.
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10
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Liang W, Zhou C, Meng Y, Fu L, Zeng B, Liu Z, Ming W, Long H. An overview of the material science and knowledge of nanomedicine, bioscaffolds, and tissue engineering for tendon restoration. Front Bioeng Biotechnol 2023; 11:1199220. [PMID: 37388772 PMCID: PMC10306281 DOI: 10.3389/fbioe.2023.1199220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Tendon wounds are a worldwide health issue affecting millions of people annually. Due to the characteristics of tendons, their natural restoration is a complicated and lengthy process. With the advancement of bioengineering, biomaterials, and cell biology, a new science, tissue engineering, has developed. In this field, numerous ways have been offered. As increasingly intricate and natural structures resembling tendons are produced, the results are encouraging. This study highlights the nature of the tendon and the standard cures that have thus far been utilized. Then, a comparison is made between the many tendon tissue engineering methodologies proposed to date, concentrating on the ingredients required to gain the structures that enable appropriate tendon renewal: cells, growth factors, scaffolds, and scaffold formation methods. The analysis of all these factors enables a global understanding of the impact of each component employed in tendon restoration, thereby shedding light on potential future approaches involving the creation of novel combinations of materials, cells, designs, and bioactive molecules for the restoration of a functional tendon.
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Affiliation(s)
- Wenqing Liang
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, Zhejiang, China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, Zhejiang, China
| | - Yanfeng Meng
- Department of Orthopedics, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China
| | - Lifeng Fu
- Department of Orthopedics, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Bin Zeng
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, Zhejiang, China
| | - Zunyong Liu
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, Zhejiang, China
| | - Wenyi Ming
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, Zhejiang, China
| | - Hengguo Long
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, Zhejiang, China
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11
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McBeath R, Chung KC. Principles of Tendon Structure, Healing, and the Microenvironment. Hand Clin 2023; 39:119-129. [PMID: 37080644 DOI: 10.1016/j.hcl.2023.01.002] [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] [Indexed: 04/22/2023]
Abstract
Tendon is a strong viscoelastic tissue, responsible for conducting force from muscle to bone. In the hand, flexor tendons course through fibro-osseous sheaths, composed of an intricate tenosynovium and fibrocartilaginous pulley system. After flexor tendon laceration, changes occur in tendon force transduction as well as vascularity, affecting tendon healing on a tissue and cellular level. Tendon healing occurs through intrinsic and extrinsic mechanisms, which in combination with local anatomy, can predispose to adhesion formation. Understanding the relationship between microenvironmental cues and tendon healing on the cellular and tissue level will improve our knowledge and treatment of flexor tendon injuries.
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Affiliation(s)
- Rowena McBeath
- Philadelphia Hand to Shoulder Center, Philadelphia, PA, USA; Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 1500 East Medical Center Drive 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109, USA
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12
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Stem Cell Applications and Tenogenic Differentiation Strategies for Tendon Repair. Stem Cells Int 2023; 2023:3656498. [PMID: 36970597 PMCID: PMC10033217 DOI: 10.1155/2023/3656498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/25/2023] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
Tendons are associated with a high injury risk because of their overuse and age-related tissue degeneration. Thus, tendon injuries pose great clinical and economic challenges to the society. Unfortunately, the natural healing capacity of tendons is far from perfect, and they respond poorly to conventional treatments when injured. Consequently, tendons require a long period of healing and recovery, and the initial strength and function of a repaired tendon cannot be completely restored as it is prone to a high rate of rerupture. Nowadays, the application of various stem cell sources, including mesenchymal stem cells (MSCs) and embryonic stem cells (ESCs), for tendon repair has shown great potential, because these cells can differentiate into a tendon lineage and promote functional tendon repair. However, the mechanism underlying tenogenic differentiation remains unclear. Moreover, no widely adopted protocol has been established for effective and reproducible tenogenic differentiation because of the lack of definitive biomarkers for identifying the tendon differentiation cascades. This work is aimed at reviewing the literature over the past decade and providing an overview of background information on the clinical relevance of tendons and the urgent need to improve tendon repair; the advantages and disadvantages of different stem cell types used for boosting tendon repair; and the unique advantages of reported strategies for tenogenic differentiation, including growth factors, gene modification, biomaterials, and mechanical stimulation.
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13
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Waugh CM, Mousavizadeh R, Lee J, Screen HRC, Scott A. The impact of mild hypercholesterolemia on injury repair in the rat patellar tendon. J Orthop Res 2023. [PMID: 36866829 DOI: 10.1002/jor.25546] [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: 08/08/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Hypercholesterolemia is associated with tendon pathology and injury prevalence. Lipids can accumulate in the tendon's extracellular spaces, which may disrupt its hierarchical structure and the tenocytes physicochemical environment. We hypothesized that the tendon's ability to repair after injury would be attenuated with elevated cholesterol levels, leading to inferior mechanical properties. Fifty wild-type (sSD) and 50 apolipoprotein E knock-out rats (ApoE-/ - ) were given a unilateral patellar tendon (PT) injury at 12 weeks old; the uninjured limb served as a control. Animals were euthanized at 3-, 14,- or 42-days postinjury and PT healing was investigated. ApoE-/ - serum cholesterol was double that of SD rats (mean: 2.12 vs. 0.99 mg/mL, p < 0.001) and cholesterol level was related to the expression of several genes after injury; notably rats with higher cholesterol demonstrated a blunted inflammatory response. There was little physical evidence of tendon lipid content or differences in injury repair between groups, therefore we were not surprised that tendon mechanical or material properties did not differ between strains. The young age and the mild phenotype of our ApoE-/ - rats might explain these findings. Hydroxyproline content was positively related to total blood cholesterol, but this result did not translate to observable biomechanical differences, perhaps due to the narrow range of cholesterol levels observed. Tendon inflammatory and healing activity is modulated at the mRNA level even with a mild hypercholesterolemia. These important initial impacts need to be investigated as they may contribute to the known consequences of cholesterol on tendons in humans.
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Affiliation(s)
- Charlie M Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,School of Engineering and Materials Science, Queen Mary, University of London, London, UK
| | - Rouhollah Mousavizadeh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jenny Lee
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hazel R C Screen
- School of Engineering and Materials Science, Queen Mary, University of London, London, UK
| | - Alexander Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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14
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Ning C, Li P, Gao C, Fu L, Liao Z, Tian G, Yin H, Li M, Sui X, Yuan Z, Liu S, Guo Q. Recent advances in tendon tissue engineering strategy. Front Bioeng Biotechnol 2023; 11:1115312. [PMID: 36890920 PMCID: PMC9986339 DOI: 10.3389/fbioe.2023.1115312] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Tendon injuries often result in significant pain and disability and impose severe clinical and financial burdens on our society. Despite considerable achievements in the field of regenerative medicine in the past several decades, effective treatments remain a challenge due to the limited natural healing capacity of tendons caused by poor cell density and vascularization. The development of tissue engineering has provided more promising results in regenerating tendon-like tissues with compositional, structural and functional characteristics comparable to those of native tendon tissues. Tissue engineering is the discipline of regenerative medicine that aims to restore the physiological functions of tissues by using a combination of cells and materials, as well as suitable biochemical and physicochemical factors. In this review, following a discussion of tendon structure, injury and healing, we aim to elucidate the current strategies (biomaterials, scaffold fabrication techniques, cells, biological adjuncts, mechanical loading and bioreactors, and the role of macrophage polarization in tendon regeneration), challenges and future directions in the field of tendon tissue engineering.
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Affiliation(s)
- Chao Ning
- Chinese PLA Medical School, Beijing, China
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Pinxue Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Cangjian Gao
- Chinese PLA Medical School, Beijing, China
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Liwei Fu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiyao Liao
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Guangzhao Tian
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Han Yin
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Muzhe Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiang Sui
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuyun Liu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Quanyi Guo
- Chinese PLA Medical School, Beijing, China
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
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15
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Ben H, Luo C, Cheng J, Zeng CH, Zhou Y, Jeon IH, Sun Y. Absorbable suture knots on the supraspinatus tendon prevent adverse effects of nonabsorbable suture knots in a rat model. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07269-9. [PMID: 36484810 DOI: 10.1007/s00167-022-07269-9] [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: 05/05/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the absorbable and nonabsorbable suture knots on the tendon on bone-to-tendon healing during the early phase in a rat rotator cuff tear (RCT) model. METHODS Fifty-two male Sprague-Dawley rats (10 weeks old; mean weight, 380 g) were used in this study, and 51 of them were randomly assigned into three groups: absorbable suture group (ASG, n = 22), nonabsorbable suture group (NSG, n = 22), and sham surgery group (SSG, n = 7), and the remaining rat was used to take surgical pictures. Bilateral supraspinatus tendon tears were created and repaired immediately in ASG and NSG. Three rats from ASG and NSG were killed for Western blot and histological evaluation at 3 days, 1 week, and 4 weeks after surgery. At 4 weeks, four rats from each group were killed for biomechanical test, and three rats from SSG were used for histological evaluation. RESULTS Absorbable suture knots on the tendon completely degraded at 4 weeks. However, nonabsorbable suture knots remained intact between the tendon and articular side. ASG showed a stronger inflammatory reaction at 3 days and 1 week, but a weaker reaction at 4 weeks as confirmed by gross observation and Western blot. Besides, ASG showed superior biomechanical properties in terms of maximum load to failure and stiffness at 4 weeks. Modified Bonar score revealed superior maturity for tissue healing in ASG to that in NSG at 4 weeks. Furthermore, inferior bone-to-tendon interface and weakest link formation were observed in NSG on histologic images. CONCLUSION Absorbable suture knots on the tendon contributed to better mechanical properties compared with the nonabsorbable one after rotator cuff repair.
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Affiliation(s)
- Hui Ben
- Department of Hand Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, Nantong, 226001, Jiangsu, China.,Department of Orthopedic Surgery, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chunbing Luo
- Department of Hand Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, Nantong, 226001, Jiangsu, China
| | - Jiaqi Cheng
- Department of Spine Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, Nantong, China
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youlang Zhou
- Department of Hand Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, Nantong, 226001, Jiangsu, China
| | - In-Ho Jeon
- Department of Orthopedic Surgery, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yucheng Sun
- Department of Hand Surgery, College of Medicine, Affiliated Hospital of Nantong University, University of Nantong, Nantong, 226001, Jiangsu, China.
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16
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Li Y, Liu X, Liu X, Peng Y, Zhu B, Guo S, Wang C, Wang D, Li S. Transforming growth factor-β signalling pathway in tendon healing. Growth Factors 2022; 40:98-107. [PMID: 35707986 DOI: 10.1080/08977194.2022.2082294] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Transforming growth factor-β(TGF-β) plays an important but diverse role in tendon injuries, such as collagen synthesis, cell proliferation, cell differentiation, and cell adhesion, leading to tendon healing and tendon fibrosis. In the well-known canonical TGF-β signalling pathway, TGF-β activates Smad signalling through its two cell surface receptors, which leads to Smad-mediated transcriptional regulation and is also regulated by inhibitory Smads, forming a negative feedback regulatory pathway. In the context of the canonical TGF-β signalling mechanism mediated by Smad, the activated receptors also send signals through other signal transducers, which in the backdrop of TGF-β signaling are collectively known as non-Smad signalling pathways. Activated TGF-β binds to the receptor and acts through these signalling pathways. Understanding the mechanism of the TGF-β signalling pathway and its role in tendon repair is of great significance for targeting the TGF-β signalling pathway to accelerate tendon healing and reduce tendon fibrosis.
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Affiliation(s)
- Yujie Li
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Xinyue Liu
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Xueli Liu
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Yuanqiu Peng
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Bin Zhu
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Sheng Guo
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Chenglong Wang
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dingxuan Wang
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
| | - Sen Li
- Institute of Physical Education, Southwest Medical University, Luzhou, Sichuan, China
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
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17
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Huegel J, Chan PY, Weiss SN, Nuss CA, Raja H, Waldorff EI, Zhang N, Ryaby JT, Soslowsky LJ, Kuntz AF. Pulsed electromagnetic field therapy alters early healing in a rat model of rotator cuff injury and repair: Potential mechanisms. J Orthop Res 2022; 40:1593-1603. [PMID: 34657312 PMCID: PMC9013393 DOI: 10.1002/jor.25185] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff repair failure remains common due to poor tendon healing, particularly at the enthesis. We previously showed that pulsed electromagnetic field (PEMF) therapy improved the mechanical properties of the rat supraspinatus tendon postoperatively. However, little is known about the mechanisms behind PEMF-dependent contributions to improved healing in this injury model. The objective of this study was to determine the influence of PEMF treatment on tendon gene expression and cell composition, as well as bone microarchitecture and dynamic bone metabolism during early stages of healing. We hypothesized that PEMF treatment would amplify tendon-healing related signaling pathways while mitigating inflammation and improve bone metabolism at the repair site. Rats underwent rotator cuff injury and repair followed by assignment to either control (non-PEMF) or PEMF treatment groups. Gene and protein expression as well as tendon and bone histological assessments were performed 3, 7, 14, 21, and 28 days after injury. Gene expression data demonstrated an upregulation in the bone morphogenetic protein 2 signaling pathway and increases in pro-osteogenic genes at the insertion, supporting important processes to re-establish the tendon-bone interface. PEMF also downregulated genes related to a fibrotic healing response. Anti-inflammatory effects were demonstrated by both gene expression and macrophage phenotype. PEMF significantly increased the rate of kinetic bone formation directly adjacent to the tendon enthesis as well as the number of cuboidal surface osteoblasts (active osteoblasts) in the humeral head. This study has provided insight into how PEMF affects cellular and molecular processes in the supraspinatus tendon and adjacent bone after injury and repair.
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Affiliation(s)
- Julianne Huegel
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA USA
| | - Peter Y.W. Chan
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA USA
| | - Stephanie N. Weiss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA USA
| | - Courtney A. Nuss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA USA
| | - Harina Raja
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA USA
| | | | | | | | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Andrew F. Kuntz
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA USA,Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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18
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Enthesis Healing Is Dependent on Scaffold Interphase Morphology—Results from a Rodent Patellar Model. Cells 2022; 11:cells11111752. [PMID: 35681447 PMCID: PMC9179925 DOI: 10.3390/cells11111752] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
The use of multiphasic scaffolds to treat injured tendon-to-bone entheses has shown promising results in vitro. Here, we used two versions of a biphasic silk fibroin scaffold to treat an enthesis defect created in a rat patellar model in vivo. One version presented a mixed transition between the bony and the tendon end of the construct (S-MT) while this transition was abrupt in the second version (S-AT). At 12 weeks after surgery, the S-MT scaffold promoted better healing of the injured enthesis, with minimal undesired ossification of the insertion area. The expression of tenogenic and chondrogenic markers was sustained for longer in the S-MT-treated group and the tangent modulus of the S-MT-treated samples was similar to the native tissue at 12 weeks while that of the S-AT-treated enthesis was lower. Our study highlights the important role of the transition zone of multiphasic scaffolds in the treatment of complex interphase tissues such as the tendon-to-bone enthesis.
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19
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Zhou Q, Wang W, Yang F, Wang H, Zhao X, Zhou Y, Fu P, Xu Y. Disulfiram Suppressed Peritendinous Fibrosis Through Inhibiting Macrophage Accumulation and Its Pro-inflammatory Properties in Tendon Bone Healing. Front Bioeng Biotechnol 2022; 10:823933. [PMID: 35350176 PMCID: PMC8957921 DOI: 10.3389/fbioe.2022.823933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
The communication between macrophages and tendon cells plays a critical role in regulating the tendon-healing process. However, the potential mechanisms through which macrophages can control peritendinous fibrosis are unknown. Our data showed a strong pro-inflammatory phenotype of macrophages after a mouse tendon–bone injury. Moreover, by using a small-molecule compound library, we identified an aldehyde dehydrogenase inhibitor, disulfiram (DSF), which can significantly promote the transition of macrophage from M1 to M2 phenotype and decrease macrophage pro-inflammatory phenotype. Mechanistically, DSF targets gasdermin D (GSDMD) to attenuate macrophage cell pyroptosis, interleukin-1β, and high mobility group box 1 protein release. These pro-inflammatory cytokines and damage-associated molecular patterns are essential for regulating tenocyte and fibroblast proliferation, migration, and fibrotic activity. Deficiency or inhibition of GSDMD significantly suppressed peritendinous fibrosis formation around the injured tendon and was accompanied by increased regenerated bone and fibrocartilage compared with the wild-type littermates. Collectively, these findings reveal a novel pathway of GSDMD-dependent macrophage cell pyroptosis in remodeling fibrogenesis in tendon–bone injury. Thus, GSDMD may represent a potential therapeutic target in tendon–bone healing.
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Affiliation(s)
- Qi Zhou
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wei Wang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fujun Yang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.,The Fifth People's Hospital of Zunyi, Zunyi, China
| | - Hao Wang
- Department of Orthopaedics, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xiaodong Zhao
- Department of Orthopaedics, Weifang Traditional Chinese Hospital, Weifang, China
| | - Yiqin Zhou
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Peiliang Fu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yaozeng Xu
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou, China
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20
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Cetik RM, Yabanoglu Ciftci S, Arica B, Baysal I, Akarca Dizakar SO, Erbay Elibol FK, Gencer A, Demir T, Ayvaz M. Evaluation of the Effects of Transforming Growth Factor-Beta 3 (TGF-β3) Loaded Nanoparticles on Healing in a Rat Achilles Tendon Injury Model. Am J Sports Med 2022; 50:1066-1077. [PMID: 35188807 DOI: 10.1177/03635465211073148] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Achilles tendon (AT) midsubstance injuries may heal suboptimally, especially in athletes. Transforming growth factor-beta 3 (TGF-β3) shows promise because of its recently discovered tendinogenic effects. Using poly(lactic-co-glycolic acid)-b-poly(ethylene glycol) (PLGA-b-PEG) nanoparticles (NPs) may enhance the results by a sustained-release effect. HYPOTHESIS The application of TGF-β3 will enhance AT midsubstance healing, and the NP form will achieve better outcomes. STUDY DESIGN Controlled laboratory study. METHODS A total of 80 rats underwent unilateral AT transection and were divided into 4 groups: (1) control (C); (2) empty chitosan film (Ch); (3) chitosan film containing free TGF-β3 (ChT); and (4) chitosan film containing TGF-β3-loaded NPs (ChN). The animals were sacrificed at 3 and 6 weeks. Tendons were evaluated for morphology (length and cross-sectional area [CSA]), biomechanics (maximum load, stress, stiffness, and elastic modulus), histology, immunohistochemical quantification (types I and III collagen [COL1 and COL3]), and gene expression (COL1A1, COL3A1, scleraxis, and tenomodulin). RESULTS Morphologically, at 3 weeks, ChT (15 ± 2.7 mm) and ChN (15.6 ± 1.6 mm) were shorter than C (17.6 ± 1.8 mm) (P = .019 and = .004, respectively). At 6 weeks, the mean CSA of ChN (10.4 ± 1.9 mm2) was similar to that of intact tendons (6.4 ± 1.1 mm2) (P = .230), while the other groups were larger. Biomechanically, at 3 weeks, ChT (42.8 ± 4.9 N) had a higher maximum load than C (27 ± 9.1 N; P = .004) and Ch (29.2 ± 5.7 N; P = .005). At 6 weeks, ChN (26.9 ± 3.9 MPa) had similar maximum stress when compared with intact tendons (34.1 ± 7.8 MPa) (P = .121); the other groups were significantly lower. Histologically, at 6 weeks, the mean Movin score of ChN (4.5 ± 1.5) was lower than that of ChT (6.3 ± 1.8). Immunohistochemically, ChN had higher COL3 (1.469 ± 0.514) at 3 weeks and lower COL1 (1.129 ± 0.368) at 6 weeks. COL1A1 gene expression was higher in ChT and ChN at 3 weeks, but COL3A1 gene expression was higher in ChN. CONCLUSION The application of TGF-β3 had a positive effect on AT midsubstance healing, and the sustained-release NP form improved the outcomes, more specifically accelerating the remodeling process. CLINICAL RELEVANCE This study demonstrated the effectiveness of TGF-β3 on tendon healing on a rat model, which is an important step toward clinical use. The novel method of using PLGA-b-PEG NPs as a drug-delivery system with sustained-release properties had promising results.
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Affiliation(s)
- Riza Mert Cetik
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | | | - Betul Arica
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Ipek Baysal
- Hacettepe University Vocational School of Health Services, Ankara, Turkey
| | | | - Fatma Kubra Erbay Elibol
- TOBB ETÜ University of Economics and Technology, Department of Biomedical Engineering, Ankara, Turkey
| | - Ayse Gencer
- Hacettepe University Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Teyfik Demir
- TOBB ETÜ University of Economics and Technology, Department of Mechanical Engineering, Ankara, Turkey
| | - Mehmet Ayvaz
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
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21
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Tendon Tissue Repair in Prospective of Drug Delivery, Regenerative Medicines, and Innovative Bioscaffolds. Stem Cells Int 2021; 2021:1488829. [PMID: 34824586 PMCID: PMC8610661 DOI: 10.1155/2021/1488829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/09/2021] [Indexed: 02/06/2023] Open
Abstract
The natural healing capacity of the tendon tissue is limited due to the hypovascular and cellular nature of this tissue. So far, several conventional approaches have been tested for tendon repair to accelerate the healing process, but all these approaches have their own advantages and limitations. Regenerative medicine and tissue engineering are interdisciplinary fields that aspire to develop novel medical devices, innovative bioscaffold, and nanomedicine, by combining different cell sources, biodegradable materials, immune modulators, and nanoparticles for tendon tissue repair. Different studies supported the idea that bioscaffolds can provide an alternative for tendon augmentation with an enormous therapeutic potentiality. However, available data are lacking to allow definitive conclusion on the use of bioscaffolds for tendon regeneration and repairing. In this review, we provide an overview of the current basic understanding and material science in the field of bioscaffolds, nanomedicine, and tissue engineering for tendon repair.
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22
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Hou J, Yang R, Vuong I, Li F, Kong J, Mao HQ. Biomaterials strategies to balance inflammation and tenogenesis for tendon repair. Acta Biomater 2021; 130:1-16. [PMID: 34082095 DOI: 10.1016/j.actbio.2021.05.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/15/2021] [Accepted: 05/24/2021] [Indexed: 12/17/2022]
Abstract
Adult tendon tissue demonstrates a limited regenerative capacity, and the natural repair process leaves fibrotic scar tissue with inferior mechanical properties. Surgical treatment is insufficient to provide the mechanical, structural, and biochemical environment necessary to restore functional tissue. While numerous strategies including biodegradable scaffolds, bioactive factor delivery, and cell-based therapies have been investigated, most studies have focused exclusively on either suppressing inflammation or promoting tenogenesis, which includes tenocyte proliferation, ECM production, and tissue formation. New biomaterials-based approaches represent an opportunity to more effectively balance the two processes and improve regenerative outcomes from tendon injuries. Biomaterials applications that have been explored for tendon regeneration include formation of biodegradable scaffolds presenting topographical, mechanical, and/or immunomodulatory cues conducive to tendon repair; delivery of immunomodulatory or tenogenic biomolecules; and delivery of therapeutic cells such as tenocytes and stem cells. In this review, we provide the biological context for the challenges in tendon repair, discuss biomaterials approaches to modulate the immune and regenerative environment during the healing process, and consider the future development of comprehensive biomaterials-based strategies that can better restore the function of injured tendon. STATEMENT OF SIGNIFICANCE: Current strategies for tendon repair focus on suppressing inflammation or enhancing tenogenesis. Evidence indicates that regulated inflammation is beneficial to tendon healing and that excessive tissue remodeling can cause fibrosis. Thus, it is necessary to adopt an approach that balances the benefits of regulated inflammation and tenogenesis. By reviewing potential treatments involving biodegradable scaffolds, biological cues, and therapeutic cells, we contrast how each strategy promotes or suppresses specific repair steps to improve the healing outcome, and highlight the advantages of a comprehensive approach that facilitates the clearance of necrotic tissue and recruitment of cells during the inflammatory stage, followed by ECM synthesis and organization in the proliferative and remodeling stages with the goal of restoring function to the tendon.
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Zhang M, Liu H, Shi M, Zhang T, Lu W, Yang S, Cui Q, Li Z. Potential Mechanisms of the Impact of Hepatocyte Growth Factor Gene-Modified Tendon Stem Cells on Tendon Healing. Front Cell Dev Biol 2021; 9:659389. [PMID: 34222233 PMCID: PMC8250428 DOI: 10.3389/fcell.2021.659389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
The therapeutic impact of stem cells is potentially largely attributable to secretion of exosomes and soluble factors. The present study evaluates the impact of hepatocyte growth factor (HGF)-expressing tendon stem cells (TSCs) on tendon healing in a rat model. Patellar tendon TSCs were isolated and underwent transfection with lentiviral vectors containing HGF or green fluorescent protein (GFP) genes. In vivo, immunohistochemistry of tendons sampled 1 week postsurgery demonstrated that all stem cell-treated groups exhibited higher numbers of CD163+ M2 monocytes and IL-10+ cells (anti-inflammatory), and lower numbers of CCR7+ M1 monocytes and IL-6+ as well as COX-2+ cells (pro-inflammatory). Effects were most pronounced in the HGF-expressing TSCs (TSCs + HGF) treated group. Histology ± immunohistochemistry of tendons sampled 4 and 8 weeks postsurgery demonstrated that all stem cell-treated groups exhibited more ordered collagen fiber arrangement and lower levels of COLIII, α-SMA, TGF-β1, and fibronectin (proteins relevant to fibroscarring). Effects were most pronounced in the TSCs + HGF-treated group. For the in vitro study, isolated tendon fibroblasts pretreated with TGF-β1 to mimic the in vivo microenvironment of tendon injury were indirectly cocultured with TSCs, TSCs + GFP, or TSCs + HGF using a transwell system. Western blotting demonstrated that all stem cell types decreased TGF-β1-induced increases in fibroblast levels of COX-2, COLIII, and α-SMA, concomitant with decreased activation of major TGF-β1 signaling pathways (p38 MAPK, ERK1/2, but not Smad2/3). This effect was most pronounced for TSCs + HGF, which also decreased the TGF-β1-induced increase in activation of the Smad2/3 signaling pathway. The presence of specific inhibitors of these pathways during fibroblast TGF-β1 stimulation also attenuated increases in levels of COX-2, COLIII, and α-SMA. In conclusion, TSCs + HGF, which exhibit HGF overexpression, may promoting tendon healing via decreasing inflammation and fibrosis, perhaps partly via inhibiting TGF-β1-induced signaling. These findings identify a novel potential therapeutic strategy for tendon injuries, warranting additional research.
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Affiliation(s)
- Mingzhao Zhang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hengchen Liu
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Manyu Shi
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tingting Zhang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenjun Lu
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shulong Yang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qingbo Cui
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhaozhu Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Grol MW, Haelterman NA, Lim J, Munivez EM, Archer M, Hudson DM, Tufa SF, Keene DR, Lei K, Park D, Kuzawa CD, Ambrose CG, Eyre DR, Lee BH. Tendon and motor phenotypes in the Crtap-/- mouse model of recessive osteogenesis imperfecta. eLife 2021; 10:e63488. [PMID: 34036937 PMCID: PMC8186905 DOI: 10.7554/elife.63488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 05/24/2021] [Indexed: 01/22/2023] Open
Abstract
Osteogenesis imperfecta (OI) is characterized by short stature, skeletal deformities, low bone mass, and motor deficits. A subset of OI patients also present with joint hypermobility; however, the role of tendon dysfunction in OI pathogenesis is largely unknown. Using the Crtap-/- mouse model of severe, recessive OI, we found that mutant Achilles and patellar tendons were thinner and weaker with increased collagen cross-links and reduced collagen fibril size at 1- and 4-months compared to wildtype. Patellar tendons from Crtap-/- mice also had altered numbers of CD146+CD200+ and CD146-CD200+ progenitor-like cells at skeletal maturity. RNA-seq analysis of Achilles and patellar tendons from 1-month Crtap-/- mice revealed dysregulation in matrix and tendon marker gene expression concomitant with predicted alterations in TGF-β, inflammatory, and metabolic signaling. At 4-months, Crtap-/- mice showed increased αSMA, MMP2, and phospho-NFκB staining in the patellar tendon consistent with excess matrix remodeling and tissue inflammation. Finally, a series of behavioral tests showed severe motor impairments and reduced grip strength in 4-month Crtap-/- mice - a phenotype that correlates with the tendon pathology.
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Affiliation(s)
- Matthew William Grol
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Nele A Haelterman
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Joohyun Lim
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Elda M Munivez
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Marilyn Archer
- Department of Orthopaedics and Sports Medicine, University of WashingtonSeattleUnited States
| | - David M Hudson
- Department of Orthopaedics and Sports Medicine, University of WashingtonSeattleUnited States
| | - Sara F Tufa
- Shriners Hospital for ChildrenPortlandUnited States
| | | | - Kevin Lei
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Dongsu Park
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
| | - Cole D Kuzawa
- Department of Orthopaedic Surgery, UT Health Sciences CenterHoustonUnited States
| | - Catherine G Ambrose
- Department of Orthopaedic Surgery, UT Health Sciences CenterHoustonUnited States
| | - David R Eyre
- Department of Orthopaedics and Sports Medicine, University of WashingtonSeattleUnited States
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of MedicineHoustonUnited States
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25
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O'Brien C, Marr N, Thorpe C. Microdamage in the equine superficial digital flexor tendon. Equine Vet J 2021; 53:417-430. [PMID: 32772396 DOI: 10.1111/evj.13331] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022]
Abstract
The forelimb superficial digital flexor tendon (SDFT) is an energy-storing tendon that is highly susceptible to injury during activities such as galloping and jumping, such that it is one of the most commonly reported causes of lameness in the performance horse. This review outlines the biomechanical and biothermal effects of strain on the SDFT and how these contribute to the accumulation of microdamage. The effect of age-related alterations on strain response and subsequent injury risk is also considered. Given that tendon is a slowly healing and poorly regenerative tissue, prompt detection of early stages of pathology in vivo and timely adaptations to training protocols are likely to have a greater outcome than advances in treatment. Early screening tools and detection protocols could subsequently be of benefit in identifying subclinical signs of degeneration during the training programme. This provides an opportunity for preventative strategies to be implemented to minimise incidences of SDFT injury and reduce recovery periods in elite performance horses. Therefore, this review will focus on the modalities available to implement early screening and prevention protocols as opposed to methods to diagnose and treat injuries.
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Affiliation(s)
| | - Neil Marr
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Chavaunne Thorpe
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK
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Rajaraman V, Nallaswamy D, Ganapathy DM, Kachhara S. Osseointegration of Hafnium when Compared to Titanium - A Structured Review. Open Dent J 2021. [DOI: 10.2174/1874210602115010137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim:
This systematic review was conducted to analyse osseointegration of hafnium over conventional titanium.
Materials and Methods:
Search methodology was comprehended using PICO analysis and a comprehensive search was initiated in PubMed Central, Medline, Cochrane, Ovid, Science Direct, Copernicus and Google Scholar databases to identify the related literature. Randomised control trials, clinical studies, case control studies and animal studies were searched for osseointegration of hafnium coated titanium implants versus conventional titanium implants. Timeline was set to include all the manuscripts published till December 2018 in this review.
Clinical Significance:
Hafnium is a very promising surface coating intervention that can augment osseointegration in titanium implants. If research could be widened, including in vivo studies on hafnium as a metal for coating over dental implants or as a dental implant material itself to enhance better osseointegration, it could explore possibilities of this metal in the rehabilitation of both intra and extra oral defects and in medically compromised patients with poor quality of bone.
Results:
Out of the 25 articles obtained from the PICO based keyword search, 5 studies were excluded based on title and abstract. Out of the remaining 20 studies, 16 were excluded based on the inclusion and exclusion criteria of our interest and finally, 4 were included on the basis of core data.
Conclusion:
This systematic review observed hafnium metal exhibited superior osseointegration than titanium. Owing to its biocompatibility, hafnium could be an alternative to titanium, in the near future.
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Advanced technology-driven therapeutic interventions for prevention of tendon adhesion: Design, intrinsic and extrinsic factor considerations. Acta Biomater 2021; 124:15-32. [PMID: 33508510 DOI: 10.1016/j.actbio.2021.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Tendon adhesion formation describes the development of fibrotic tissue between the tendon and its surrounding tissues, which commonly occurs as a reaction to injury or surgery. Its impact on function and quality of life varies from negligible to severely disabling, depending on the affected area and extent of adhesion formed. Thus far, treatment options remain limited with prophylactic anti-inflammatory medications and revision surgeries constituting the only tools within the doctors' armamentarium - neither of which provides reliable outcomes. In this review, the authors aim to collate the current understanding of the pathophysiological mechanisms underlying tendon adhesion formation, highlighting the significant role ascribed to the inflammatory cascade in accelerating adhesion formation. The bulk of this article will then be dedicated to critically appraising different therapeutic structures like nanoparticles, hydrogels and fibrous membranes fabricated by various cutting-edge technologies for adhesion formation prophylaxis. Emphasis will be placed on the role of the fibrous membranes, their ability to act as drug delivery vehicles as well as the combination with other therapeutic structures (e.g., hydrogel or nanoparticles) or fabrication technologies (e.g., weaving or braiding). Finally, the authors will provide an opinion as to the future direction of the prevention of tendon adhesion formation in view of scaffold structure and function designs.
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28
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Chen J, Svensson J, Sundberg CJ, Ahmed AS, Ackermann PW. FGF gene expression in injured tendons as a prognostic biomarker of 1-year patient outcome after Achilles tendon repair. J Exp Orthop 2021; 8:20. [PMID: 33694106 PMCID: PMC7947072 DOI: 10.1186/s40634-021-00335-0] [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: 09/30/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Healing outcome after Achilles Tendon Rupture (ATR) is variable and unsatisfactory. Many ATR patients still exhibit pain, functional deficits and limitations in walking one-year post-surgery. The present study was designed to investigate the association between the expression of healing biomarkers and patient outcome after ATR. METHODS Tendon biopsies were collected from 25 ATR patients during surgery. At 1-year post surgery, all patients completed questionnaires; Achilles tendon Total Rupture Score (ATRS) and Foot and Ankle Outcome Score (FAOS), and were tested for functional outcomes by heel-rise test. In biopsies, FGF, COL III, FN, COL I and MMP-9 mRNA levels were assessed by quantitative RT-PCR while protein expression was studied by immunohistochemistry (IHC). RESULTS Our analysis confirmed the presence of FGF, COL III, FN, COL I and MMP-9 at mRNA and protein levels in tendon biopsies. FGF gene expression associated positively with improved total ATRS and better functional outcomes. Additionally, FGF mRNA levels were associated with less pain, less running limitations and less loss in physical activity. In addition, higher COL III mRNA expression was associated with more tendon strength. CONCLUSION Our findings indicate that FGF gene expression is associated with improved patient-reported outcome. FGF expression in surgical biopsies could potentially be used to assist the prognostic evaluation of patient outcome and may be used as a predictor for healing. However, further studies are needed to evaluate the role of FGF in Achilles tendon healing. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Junyu Chen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Joel Svensson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Carl-Johan Sundberg
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Aisha Siddiqah Ahmed
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.
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Tsiapalis D, Kearns S, Kelly JL, Zeugolis DI. Growth factor and macromolecular crowding supplementation in human tenocyte culture. BIOMATERIALS AND BIOSYSTEMS 2021; 1:100009. [PMID: 36825160 PMCID: PMC9934496 DOI: 10.1016/j.bbiosy.2021.100009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 01/20/2023] Open
Abstract
Cell-assembled tissue engineering strategies hold great potential in regenerative medicine, as three-dimensional tissue-like modules can be produced, even from a patient's own cells. However, the development of such implantable devices requires prolonged in vitro culture time, which is associated with cell phenotypic drift. Considering that the cells in vivo are subjected to numerous stimuli, multifactorial approaches are continuously gaining pace towards controlling cell fate during in vitro expansion. Herein, we assessed the synergistic effect of simultaneous and serial growth factor supplementation (insulin growth factor-1, platelet-derived growth factor ββ, growth differentiation factor 5 and transforming growth factor β3) to macromolecular crowding (carrageenan) in human tenocyte function; collagen synthesis and deposition; and gene expression. TGFβ3 supplementation (without/with carrageenan) induced the highest (among all groups) DNA content. In all cases, tenocyte proliferation was significantly increased as a function of time in culture, whilst metabolic activity was not affected. Carrageenan supplementation induced significantly higher collagen deposition than groups without carrageenan (without/with any growth factor). Of all the growth factors used, TGFβ3 induced the highest collagen deposition when used together with carrageenan in both simultaneous and serial fashion. At day 13, gene expression analysis revealed that TGFβ3 in serial supplementation to carrageenan upregulated the most and downregulated the least collagen- and tendon- related genes and upregulated the least and downregulated the most osteo-, chondro-, fibrosis- and adipose- related trans-differentiation genes. Collectively, these data clearly advocate the beneficial effects of multifactorial approaches (in this case, growth factor and macromolecular crowding supplementation) in the development of functional cell-assembled tissue surrogates.
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Affiliation(s)
- Dimitrios Tsiapalis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
| | | | | | - Dimitrios I. Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Corresponding authors.
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30
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Proceed with Caution: Mouse Deep Digit Flexor Tendon Injury Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3359. [PMID: 33552814 PMCID: PMC7859083 DOI: 10.1097/gox.0000000000003359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. The purpose of this study was to determine the feasibility of using mouse models for translational study of flexor tendon repair and reconstruction.
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Theodossiou SK, Murray JB, Hold LA, Courtright JM, Carper AM, Schiele NR. Akt signaling is activated by TGFβ2 and impacts tenogenic induction of mesenchymal stem cells. Stem Cell Res Ther 2021; 12:88. [PMID: 33499914 PMCID: PMC7836508 DOI: 10.1186/s13287-021-02167-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Tissue engineered and regenerative approaches for treating tendon injuries are challenged by the limited information on the cellular signaling pathways driving tenogenic differentiation of stem cells. Members of the transforming growth factor (TGF) β family, particularly TGFβ2, play a role in tenogenesis, which may proceed via Smad-mediated signaling. However, recent evidence suggests some aspects of tenogenesis may be independent of Smad signaling, and other pathways potentially involved in tenogenesis are understudied. Here, we examined the role of Akt/mTORC1/P70S6K signaling in early TGFβ2-induced tenogenesis of mesenchymal stem cells (MSCs) and evaluated TGFβ2-induced tenogenic differentiation when Smad3 is inhibited. Methods Mouse MSCs were treated with TGFβ2 to induce tenogenesis, and Akt or Smad3 signaling was chemically inhibited using the Akt inhibitor, MK-2206, or the Smad3 inhibitor, SIS3. Effects of TGFβ2 alone and in combination with these inhibitors on the activation of Akt signaling and its downstream targets mTOR and P70S6K were quantified using western blot analysis, and cell morphology was assessed using confocal microscopy. Levels of the tendon marker protein, tenomodulin, were also assessed. Results TGFβ2 alone activated Akt signaling during early tenogenic induction. Chemically inhibiting Akt prevented increases in tenomodulin and attenuated tenogenic morphology of the MSCs in response to TGFβ2. Chemically inhibiting Smad3 did not prevent tenogenesis, but appeared to accelerate it. MSCs treated with both TGFβ2 and SIS3 produced significantly higher levels of tenomodulin at 7 days and morphology appeared tenogenic, with localized cell alignment and elongation. Finally, inhibiting Smad3 did not appear to impact Akt signaling, suggesting that Akt may allow TGFβ2-induced tenogenesis to proceed during disruption of Smad3 signaling. Conclusions These findings show that Akt signaling plays a role in TGFβ2-induced tenogenesis and that tenogenesis of MSCs can be initiated by TGFβ2 during disruption of Smad3 signaling. These findings provide new insights into the signaling pathways that regulate tenogenic induction in stem cells. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02167-2.
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Affiliation(s)
- Sophia K Theodossiou
- Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, ID, 83844, Moscow, USA
| | - Jett B Murray
- Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, ID, 83844, Moscow, USA
| | - LeeAnn A Hold
- Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, ID, 83844, Moscow, USA
| | - Jeff M Courtright
- Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, ID, 83844, Moscow, USA
| | - Anne M Carper
- Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, ID, 83844, Moscow, USA
| | - Nathan R Schiele
- Chemical and Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, ID, 83844, Moscow, USA.
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Yuan H, Li X, Lee MS, Zhang Z, Li B, Xuan H, Li WJ, Zhang Y. Collagen and chondroitin sulfate functionalized bioinspired fibers for tendon tissue engineering application. Int J Biol Macromol 2020; 170:248-260. [PMID: 33359806 DOI: 10.1016/j.ijbiomac.2020.12.152] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/26/2020] [Accepted: 12/19/2020] [Indexed: 12/13/2022]
Abstract
Functional tendon tissue engineering depends on harnessing the biochemical and biophysical cues of the native tendon extracellular matrix. In this study, we fabricated highly-aligned poly(L-lactic acid) (PLLA) fibers with surfaces decorated by two of the crucial tendon ECM components, type 1 collagen (COL1) and chondroitin sulfate (CS), through a coaxial stable jet electrospinning approach. Effects of the biomimetic COL1-CS (shell)/PLLA (core) fibers on the tenogenic differentiation of human mesenchymal stem cells (hMSCs) in vitro were investigated. Higher rates of cell spreading and proliferation are observed on the aligned COL1-CS/PLLA fibers compared to that on the plain PLLA fibers. Expression of the tendon-associated genes scleraxis (SCX) and COL1 as well as protein tenomodulin (TNMD) are significantly increased. Introduction of mechanical stimulation gives rise to synergistic effect on tenogenic differentiation of hMSCs. Higher expression of TGF-β2, TGFβR-II, and Smad3 by the cells on the COL1-CS/PLLA fiber substrates are observed, which indicates that COL1-CS/PLLA ultrafine fibers dictate the hMSC tenogenic differentiation through activating the TGF-β signaling pathway. Animal study in rat Achilles tendon repair model corroborated the promoting role of COL1-CS/PLLA in regenerating a tendon-like tissue. Thus, our highly aligned biomimicking fibers may serve as an efficient scaffolding system for functional tendon regeneration.
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Affiliation(s)
- Huihua Yuan
- School of Life Sciences, Nantong University, Nantong, Jiangsu 226019, China; College of Chemistry, Chemical Engineering & Biotechnology, Donghua University, Shanghai 201620, China; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
| | - Xiaolei Li
- Department of Orthopedics and Orthopedic Institute, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, China
| | - Ming-Song Lee
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Zhuojun Zhang
- School of Life Sciences, Nantong University, Nantong, Jiangsu 226019, China
| | - Biyun Li
- School of Life Sciences, Nantong University, Nantong, Jiangsu 226019, China; College of Chemistry, Chemical Engineering & Biotechnology, Donghua University, Shanghai 201620, China
| | - Hongyun Xuan
- School of Life Sciences, Nantong University, Nantong, Jiangsu 226019, China
| | - Wan-Ju Li
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Yanzhong Zhang
- College of Chemistry, Chemical Engineering & Biotechnology, Donghua University, Shanghai 201620, China.
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Iwanaga Y, Morizaki Y, Uehara K, Tanaka S, Sakai T, Saito T. Robust Suture Combination for Rat Flexor Tendon Repair Model. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:354-358. [PMID: 35415525 PMCID: PMC8991537 DOI: 10.1016/j.jhsg.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose We aimed to develop a rat flexor tendon repair model that could be applied to experiments in similar clinical settings. Methods We prepared 3 different combinations of sutures in rat flexor tendons: group A had 3 single peripheral sutures plus a 2-strand core suture; group B had 3 figure-of-eight peripheral sutures alone; and group C had 3 figure-of-eight peripheral sutures plus a 2-strand core suture. We examined the in vitro tensile strength of the repaired tendons by a biomechanical test, the rerupture rate within 3 weeks, and histological findings in vivo. Results Group C displayed the greatest ultimate strength by the mechanical test. The flexor tendons in group C did not rerupture within 3 weeks after surgery, whereas many of those in groups A and B reruptured. Fibrous scar tissue was observed in the gap of the tendon stumps in groups A and B, but not in group C. Conclusions The combination of figure-of-eight peripheral sutures and a 2-strand core suture provided the repaired rat flexor tendon with enough strength to prevent rerupture without cast fixation or immobilization after surgery. Clinical relevance This combination of sutures is useful to reproduce flexor tendon repair similar to that performed in clinical settings and will contribute to various translational experiments in vivo.
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Sánchez-Sánchez JL, Calderón-Díez L, Herrero-Turrión J, Méndez-Sánchez R, Arias-Buría JL, Fernández-de-las-Peñas C. Changes in Gene Expression Associated with Collagen Regeneration and Remodeling of Extracellular Matrix after Percutaneous Electrolysis on Collagenase-Induced Achilles Tendinopathy in an Experimental Animal Model: A Pilot Study. J Clin Med 2020; 9:jcm9103316. [PMID: 33076550 PMCID: PMC7602800 DOI: 10.3390/jcm9103316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023] Open
Abstract
Percutaneous electrolysis is an emerging intervention proposed for the management of tendinopathies. Tendon pathology is characterized by a significant cell response to injury and gene expression. No study investigating changes in expression of those genes associated with collagen regeneration and remodeling of extracellular matrix has been conducted. The aim of this pilot study was to investigate gene expression changes after the application of percutaneous electrolysis on experimentally induced Achilles tendinopathy with collagenase injection in an animal model. Fifteen Sprague Dawley male rats were randomly divided into three different groups (no treatment vs. percutaneous electrolysis vs. needling). Achilles tendinopathy was experimentally induced with a single bolus of collagenase injection. Interventions consisted of 3 sessions (one per week) of percutaneous electrolysis or just needling. The rats were euthanized, and molecular expression of genes involved in tendon repair and remodeling, e.g., Cox2, Mmp2, Mmp9, Col1a1, Col3a1, Vegf and Scx, was examined at 28 days after injury. Histological tissue changes were determined with hematoxylin–eosin and safranin O analyses. The images of hematoxylin–eosin and Safranin O tissue images revealed that collagenase injection induced histological changes compatible with a tendinopathy. No further histological changes were observed after the application of percutaneous electrolysis or needling. A significant increase in molecular expression of Cox2, Mmp9 and Vegf genes was observed in Achilles tendons treated with percutaneous electrolysis to a greater extent than after just needling. The expression of Mmp2, Col1a1, Col3a1, or Scx genes also increased, but did not reach statistical significance. This animal study demonstrated that percutaneous electrolysis applied on an experimentally induced Achilles tendinopathy model could increase the expression of some genes associated with collagen regeneration and remodeling of extracellular matrix. The observed gene overexpression was higher with percutaneous electrolysis than with just needling.
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Affiliation(s)
- José Luis Sánchez-Sánchez
- Department of Physical Therapy, Universidad de Salamanca, 37007 Salamanca, Spain; (J.L.S.-S.); (L.C.-D.); (R.M.-S.)
| | - Laura Calderón-Díez
- Department of Physical Therapy, Universidad de Salamanca, 37007 Salamanca, Spain; (J.L.S.-S.); (L.C.-D.); (R.M.-S.)
- Physical Therapy Department, Mutua Accidentes Laborales, FREMAP, 37007 Salamanca, Spain
| | - Javier Herrero-Turrión
- Instituto de Neurociencias de Castilla y León, Universidad de Salamanca, 37007 Salamanca, Spain;
- Instituto Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, 37007 Salamanca, Spain
| | - Roberto Méndez-Sánchez
- Department of Physical Therapy, Universidad de Salamanca, 37007 Salamanca, Spain; (J.L.S.-S.); (L.C.-D.); (R.M.-S.)
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, 28922 Madrid, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
- Correspondence: ; Tel.: +34-91-488-88-84
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Farnebo S, Wiig M, Holm B, Ghafouri B. Differentially Expressed Proteins in Intra Synovial Compared to Extra Synovial Flexor Tendon Grafts in a Rabbit Tendon Transplantation Model. Biomedicines 2020; 8:biomedicines8100408. [PMID: 33053838 PMCID: PMC7650534 DOI: 10.3390/biomedicines8100408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022] Open
Abstract
Uncomplicated healing of grafts for tendon reconstruction remains an unsolved problem in hand surgery. Results are limited by adhesion formation and decreased strength properties, especially within the tight fibro-osseous sheath of the digits. This is especially problematic when an extra synovial tendon graft is used to replace an intra synovial flexor tendon. Compositional differences are likely to play an important role in these processes. The aim of this study was, therefore, to compare protein expression in pair-matched intra synovial tendon grafts with extra synovial tendon grafts, using a rabbit tendon injury model. We hypothesized that there would be significant differences in proteins critical for response to tensile loading and adhesion formation between the two groups. Using mass spectrometry and multivariate statistical data analysis, we found tissue-specific differences in 22 proteins, where 7 explained 93% (R2) of the variation, with a prediction of 81% (Q2). Among the highest discriminating proteins were Galectin, Histone H2A, and Periostin, which were found in a substantially larger amount in the extra synovial tendons compared to the intra synovial tendons. These findings may contribute to improved understanding of the differences in outcome seen after tendon reconstruction using tendon grafts with intra synovial and extra synovial grafts.
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Affiliation(s)
- Simon Farnebo
- Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University, SE 581 83 Linköping, Sweden
- Correspondence: (S.F.); (B.G.)
| | - Monica Wiig
- Department of Surgical Science, Hand Surgery, Uppsala University, and Uppsala University Hospital, 751 85 Uppsala, Sweden; (M.W.); (B.H.)
| | - Björn Holm
- Department of Surgical Science, Hand Surgery, Uppsala University, and Uppsala University Hospital, 751 85 Uppsala, Sweden; (M.W.); (B.H.)
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, SE 581 83 Linköping, Sweden
- Correspondence: (S.F.); (B.G.)
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Chu J, Lu M, Pfeifer CG, Alt V, Docheva D. Rebuilding Tendons: A Concise Review on the Potential of Dermal Fibroblasts. Cells 2020; 9:E2047. [PMID: 32911760 PMCID: PMC7563185 DOI: 10.3390/cells9092047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
Tendons are vital to joint movement by connecting muscles to bones. Along with an increasing incidence of tendon injuries, tendon disorders can burden the quality of life of patients or the career of athletes. Current treatments involve surgical reconstruction and conservative therapy. Especially in the elderly population, tendon recovery requires lengthy periods and it may result in unsatisfactory outcome. Cell-mediated tendon engineering is a rapidly progressing experimental and pre-clinical field, which holds great potential for an alternative approach to established medical treatments. The selection of an appropriate cell source is critical and remains under investigation. Dermal fibroblasts exhibit multiple similarities to tendon cells, suggesting they may be a promising cell source for tendon engineering. Hence, the purpose of this review article was in brief, to compare tendon to dermis tissues, and summarize in vitro studies on tenogenic differentiation of dermal fibroblasts. Furthermore, analysis of an open source Gene Expression Omnibus (GEO) data repository was carried out, revealing great overlap in the molecular profiles of both cell types. Lastly, a summary of in vivo studies employing dermal fibroblasts in tendon repair as well as pilot clinical studies in this area is included. Altogether, dermal fibroblasts hold therapeutic potential and are attractive cells for rebuilding injured tendons.
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Affiliation(s)
- Jin Chu
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
| | - Ming Lu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116023, China;
| | - Christian G. Pfeifer
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Volker Alt
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Denitsa Docheva
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
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K N, Ca V, Joseph J, U A, John A, Abraham A. Mesenchymal Stem Cells Seeded Decellularized Tendon Scaffold for Tissue Engineering. Curr Stem Cell Res Ther 2020; 16:155-164. [PMID: 32707028 DOI: 10.2174/1574888x15666200723123901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022]
Abstract
Tendon is a collagenous tissue to connect bone and muscle. Healing of damaged/injured tendon is the primary clinical challenge in musculoskeletal regeneration because they often react poorly to treatment. Tissue engineering (a triad strategy of scaffolds, cells and growth factors) may have the potential to improve the quality of tendon tissue healing under such impaired situations. Tendon tissue engineering aims to synthesize graft alternatives to repair the injured tendon. Biological scaffolds derived from decellularized tissue may be a better option as their biomechanical properties are similar to the native tissue. This review is designed to provide background information on the current challenges in curing torn/worn out the tendon and the clinical relevance of decellularized scaffolds for such applications.
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Affiliation(s)
- Niveditha K
- Department of Biochemistry, University of Kerala, Thiruvananthapuram, Kerala 695581, India
| | - Vineeth Ca
- Department of Biochemistry, University of Kerala, Thiruvananthapuram, Kerala 695581, India
| | - Josna Joseph
- Advanced Centre for Tissue Engineering, Department of Biochemistry, University of Kerala, Thiruvananthapuram, Kerala 695581, India
| | - Arun U
- Department of Biochemistry, University of Kerala, Thiruvananthapuram, Kerala 695581, India
| | - Annie John
- Advanced Centre for Tissue Engineering, Department of Biochemistry, University of Kerala, Thiruvananthapuram, Kerala 695581, India
| | - Annie Abraham
- Department of Biochemistry, University of Kerala, Thiruvananthapuram, Kerala 695581, India
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Wu YF, Chen C, Tang JB, Mao WF. Growth and Stem Cell Characteristics of Tendon-Derived Cells with Different Initial Seeding Densities: An In Vitro Study in Mouse Flexor Tendon Cells. Stem Cells Dev 2020; 29:1016-1025. [PMID: 32443957 DOI: 10.1089/scd.2020.0036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Tendon stem/progenitor cells (TSPCs) are considered promising seed cells for tendon regeneration. Previous studies reported that a low seeding density favors TSPC growth, whereas a high seeding density favors tenocyte growth. We aimed to distinguish TSPCs from tenocytes by seeding tendon-derived cells at a density gradient. In this study, tendon-derived cells were isolated from flexor digitorum profundus tendons of mice and seeded at the initial densities of 50, 500, 5,000, and 50,000/cm2. We found that distinct cell colonies were formed from cells with initial seeding densities of 50 and 500/cm2, but colonies were not discernible for cells seeded at 5,000 and 50,000/cm2. There was a positive correlation between cell proliferation rate and seeding density, but a negative correlation between cell senescence and seeding density. The cell proliferation rate decreased gradually during serial passages. All cells exhibited restricted differentiation potentials, and expressed stem cell markers and relatively high levels of tenogenic markers without notable differences among cells seeded at different densities. We concluded that a pure population of TSPCs could not be isolated from mouse digital flexor tendons through culturing cells at a density gradient. Cells seeded at low densities had very limited proliferative ability and did not show more prominent stem cell characteristics when compared with cells seeded at high densities.
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Affiliation(s)
- Ya Fang Wu
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China
| | - Chen Chen
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China
| | - Jin Bo Tang
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Feng Mao
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China.,Department of Anatomy, Medical School, Nantong University, Nantong, China
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Vasvani S, Kulkarni P, Rawtani D. Hyaluronic acid: A review on its biology, aspects of drug delivery, route of administrations and a special emphasis on its approved marketed products and recent clinical studies. Int J Biol Macromol 2020; 151:1012-1029. [DOI: 10.1016/j.ijbiomac.2019.11.066] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
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Flexor Tendon: Development, Healing, Adhesion Formation, and Contributing Growth Factors. Plast Reconstr Surg 2020; 144:639e-647e. [PMID: 31568303 DOI: 10.1097/prs.0000000000006048] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Management of flexor tendon injuries of the hand remains a major clinical problem. Even with intricate repair, adhesion formation remains a common complication. Significant progress has been made to better understand the mechanisms of healing and adhesion formation. However, there has been slow progress in the clinical prevention and reversal of flexor tendon adhesions. The goal of this article is to discuss recent literature relating to tendon development, tendon healing, and adhesion formation to identify areas in need of further research. Additional research is needed to understand and compare the molecular, cellular, and genetic mechanisms involved in flexor tendon morphogenesis, postoperative healing, and mechanical loading. Such knowledge is critical to determine how to improve repair outcomes and identify new therapeutic strategies to promote tissue regeneration and prevent adhesion formation.
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Liao X, Falcon ND, Mohammed AA, Paterson YZ, Mayes AG, Guest DJ, Saeed A. Synthesis and Formulation of Four-Arm PolyDMAEA-siRNA Polyplex for Transient Downregulation of Collagen Type III Gene Expression in TGF-β1 Stimulated Tenocyte Culture. ACS OMEGA 2020; 5:1496-1505. [PMID: 32010823 PMCID: PMC6990625 DOI: 10.1021/acsomega.9b03216] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
The natural healing process for tendon repair is associated with high upregulation of collagen type III, leading to scar tissue and tendon adhesions with functionally deficient tendons. Gene delivery systems are widely reported as potential nanotherapeutics to treat diseases, providing a promising approach to modulate collagen type III synthesis. This work investigates a proof-of-concept four-arm cationic polymer-siRNA polyplex to mediate a transient downregulation of collagen type III expression in a tendon cell culture system. The tendon culture system was first supplemented with TGF-β1 to stimulate the upregulation of collagen type III prior to silencing experiments. The four-arm poly[2-(dimethylamino) ethyl acrylate] (PDMAEA) polymer was successfully synthesized via RAFT polymerization and then mixed with siRNA to formulate the PDMAEA-siRNA polyplexes. The formation of the polyplex was optimized for the N:P ratio (10:1) and confirmed by agarose gel electrophoresis. The size and solution behavior of the polyplex were analyzed by dynamic light scattering and zeta potential, showing a hydrodynamic diameter of 155 ± 21 nm and overall positive charge of +30 mV at physiological pH. All the polyplex concentrations used had a minimal effect on the metabolic activity of cultured cells, indicating good biocompatibility. The dose and time effects of the TGF-β1 on collagen type III gene expressions were analyzed by qPCR, showing an optimal dose of 10 ng mL-1 TGF-β1 and 3-fold increase of COL3α1 expression at 48 h in cultured tenocytes. The PDMAEA-siRNA polyplex concept observed a limited yet successful and promising efficiency in silencing collagen type III at 48 h compared to PEI-siRNA. Therefore, this concept is a promising approach to reduce tissue scarring and adhesion following injuries.
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Affiliation(s)
- Xin Liao
- School
of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, U.K.
| | - Noelia D Falcon
- School
of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, U.K.
| | - Ali A Mohammed
- School
of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, U.K.
| | - Yasmin Z. Paterson
- Animal
Health Trust, Lanwades Park,
Kentford, Newmarket, Suffolk CB8 7UU, U.K.
- Department
of Veterinary Medicine, University of Cambridge, Cambridgeshire CB3 0ES, U.K.
| | | | - Deborah J. Guest
- Animal
Health Trust, Lanwades Park,
Kentford, Newmarket, Suffolk CB8 7UU, U.K.
| | - Aram Saeed
- School
of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, U.K.
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Zhou H, Jiang S, Li P, Shen H, Yang H, Xu S, Ye C, Chen M, Lu H. Improved tendon healing by a combination of Tanshinone IIA and miR-29b inhibitor treatment through preventing tendon adhesion and enhancing tendon strength. Int J Med Sci 2020; 17:1083-1094. [PMID: 32410838 PMCID: PMC7211157 DOI: 10.7150/ijms.44138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/05/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Despite significant advances in the materials and methods development used in surgical repair and postoperative rehabilitation, the adhesion formation remains the most common clinical problem in tendon injuries. Therefore, the development of novel therapies is necessary for targeting at preventing tendon adhesion formation and improving tendon strength. Methods: We used rat fibroblasts for in vitro experiments to determine the optimal concentration of TSA in rats, and then set up negative control group, TSA intervention group, mir-29b interference adenovirus intervention group and TSA and mir-29b interference adenovirus co-intervention group. By comparing cell proliferation and protein expression in different group, we verified the effect and mechanism of drugs on fibroblast function. At the same time, the Sprague-Dawley rat Achilles tendon model in vivo was established in this study, which was divided into sham operation group and operation group. Afterwards in the operation group, mir-29b inhibitor and placebo were injected every 3 days respectively. Then the injection inhibitor group was divided into 5 groups which mean TSA was injected into the marked area at 0, 6, 24 and 72 hours after operation for 1 week, finally all of the rats were died at 3 weeks after operation. Through the observation of general properties, histological observation of Achilles tendon injury, biomechanical test and cell and protein expression in rats' tendon cell, the effect of drugs on tendon adhesion formation was analyzed. Results: We demonstrated that the combination of miR-29b inhibitor and tanshinone IIA(TSA) could prevent tendon adhesion and also enhance tendon strength. Mechanically, the miR-29b inhibitor could activate the TGF-β/Smad3 pathway to trigger endogenous pathways and induce a high proliferation of fibroblast. Subsequently, we also found adding TSA after 6 hours of miR-29b treatment gave less cell cytotoxicity in our rat model with better outcome of less tendon adhesion and enhanced strength. Conclusion: We conclude that the use of miR-29b inhibitor at the end of the tendon break could initiate endogenous repair mechanism and subsequently use of TSA should be able to inhibit the exogenous repair mechanism. Therefore, the combination of both treatments could prevent tendon adhesion and ensure tendon strength. Our findings suggested that this approach would be a feasible approach for tendon repair.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
| | - Shuai Jiang
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
| | - Pengfei Li
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
| | - Hui Shen
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
| | - Hu Yang
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
| | - Shengquan Xu
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
| | - Chenyi Ye
- Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Mingjian Chen
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
| | - Hui Lu
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University. 79 Qingchun Road, Hangzhou, Zhejiang Province, P.R.China, 310003
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Frankewycz B, Cimino D, Andarawis-Puri N. Murine patellar tendon transplantation requires transosseous cerclage augmentation - development of a transplantation model for investigation of systemic and local drivers to healing. J Orthop Surg Res 2019; 14:410. [PMID: 31791383 PMCID: PMC6889740 DOI: 10.1186/s13018-019-1475-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background Tendon injuries are common musculoskeletal injuries that heal with scar tissue formation, often achieving reduced biomechanical and functional properties. The murine patellar tendon is a research tool that holds potential for investigating tendon healing and can be useful for exploring therapeutic strategies. Since healing is a complex process that results from the collaboration between the systemic and local tissue environment, a murine tendon transplantation model that can be applied to transgenic mice and genetic mutants would allow isolation of systemic versus local tendon factors in driving effective tendon healing. Preliminary studies have shown that transplantation with simple tendon sutures results in a proximalization of the patellar bone due to the involuntary quadriceps muscle force leading to tearing of the graft and failure of the knee extensor mechanism. To avoid this elongation of the graft, two cerclage techniques for murine patellar tendon transplantation were introduced and validated. Methods Three developed surgical techniques (no-cerclage-augmentation (NCA)), transfascial suture cerclage with encirclement of the patellar tendon (TFSC), and dual-cerclage-augmentation with a transosseous bone-to-bone cerclage through the patella bone and an additional musculotendinous cerclage (DCA)) were compared at 4 and 8 weeks macroscopically in regards to graft continuity, cerclage integrity, gap formation, and radiologically by measuring the patello-tibial distance and using a patella bone position grading system. Results The NCA group showed complete failure at 5–7 days after surgery. The TFSC has led to 69% functional failure of the cerclage. In contrast, the DCA with a has led to 78% success with improvement in patellar bone position and a similar patello-tibial distance to the naïve contralateral murine knees over the time period of 8 weeks. Conclusions This study shows that a bone-to-bone cerclage is necessary to maintain a desired graft length in murine patellar tendon models. This surgery technique can serve for future graft trans- and implantations in the murine patellar tendon.
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Affiliation(s)
- Borys Frankewycz
- Sibley School of Mechanical and Aerospace Engineering, College of Engineering, Cornell University, Ithaca, NY, USA. .,Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
| | - Daniel Cimino
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, College of Engineering, Cornell University, Ithaca, NY, USA.,Hospital of Special Surgery, New York, NY, USA
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A Tppp3 +Pdgfra + tendon stem cell population contributes to regeneration and reveals a shared role for PDGF signalling in regeneration and fibrosis. Nat Cell Biol 2019; 21:1490-1503. [PMID: 31768046 PMCID: PMC6895435 DOI: 10.1038/s41556-019-0417-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/27/2019] [Indexed: 12/27/2022]
Abstract
Tendon injuries cause prolonged disability and never recover completely. Current mechanistic understanding of tendon regeneration is limited. Here we use single cell transcriptomics to identify a tubulin polymerization-promoting protein family member 3-expressing (Tppp3+) cell population as potential tendon stem cells. Through inducible lineage tracing, we demonstrated that these cells can generate new tenocytes and self-renew upon injury. A fraction of Tppp3+ cells expresses platelet-derived growth factor receptor alpha (Pdfgra). Ectopic platelet-derived growth factor-AA (PDGF-AA) protein induces new tenocyte production while inactivation of Pdgfra in Tppp3+ cells blocks tendon regeneration. These results support Tppp3+Pdgfra+ cells as tendon stem cells. Unexpectedly, Tppp3−Pdgfra+ fibro-adipogenic progenitors coexist in tendon stem cell niche and give rise to fibrotic cells, revealing a clandestine origin of fibrotic scars in healing tendons. Our results explain why fibrosis occurs in injured tendons and present clinical challenges to enhance tendon regeneration without a concurrent increase in fibrosis by PDGF application.
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Conrad S, Weber K, Walliser U, Geburek F, Skutella T. Stem Cell Therapy for Tendon Regeneration: Current Status and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1084:61-93. [PMID: 30043235 DOI: 10.1007/5584_2018_194] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In adults the healing tendon generates fibrovascular scar tissue and recovers never histologically, mechanically, and functionally which leads to chronic and to degenerative diseases. In this review, the processes and mechanisms of tendon development and fetal regeneration in comparison to adult defect repair and degeneration are discussed in relation to regenerative therapeutic options. We focused on the application of stem cells, growth factors, transcription factors, and gene therapy in tendon injury therapies in order to intervene the scarring process and to induce functional regeneration of the lesioned tissue. Outlines for future therapeutic approaches for tendon injuries will be provided.
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Affiliation(s)
| | - Kathrin Weber
- Tierärztliches Zentrum für Pferde in Kirchheim Altano GmbH, Kirchheim unter Teck, Germany
| | - Ulrich Walliser
- Tierärztliches Zentrum für Pferde in Kirchheim Altano GmbH, Kirchheim unter Teck, Germany
| | - Florian Geburek
- Justus-Liebig-University Giessen, Faculty of Veterinary Medicine, Clinic for Horses - Department of Surgery, Giessen, Germany
| | - Thomas Skutella
- Institute for Anatomy and Cell Biology, Medical Faculty, University of Heidelberg, Heidelberg, Germany.
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Carrozzo U, Toniato M, Harrison A. Assessment of Noninvasive Low-Frequency Ultrasound as a Means of Treating Injuries to Suspensory Ligaments in Horses: A Research Paper. J Equine Vet Sci 2019; 80:80-89. [PMID: 31443840 DOI: 10.1016/j.jevs.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/12/2019] [Indexed: 01/09/2023]
Abstract
Therapeutic ultrasound is a noninvasive technique, which is well tolerated by horses, does not need sedation, and can easily be performed in a routine clinical setting. Twenty-three client-owned sport horses were recruited at Clinica Equina San Biagio and included in this case study. Treatment of the injured suspensory ligament apparatus was administered using an EQ Pro, low-frequency therapeutic unit (38 kHz). The noninvasive treatment consisted of massaging the injured area in combination with a traditional ultrasound gel while maintaining the head of the device in direct contact with the injured area. The results indicate that 20 of the 23 horses in this study benefitted from EQ Pro treatment and, following a routine rehabilitation program, returned to competition status: a success rate of 87%. Furthermore, treatment duration was 3.3 ± 0.4 weeks on average, with a healthy outcome as assessed by ultrasound at 6.8 ± 1.9 weeks. Among the 23 horses in this study, 65% of them benefitted from EQ Pro treatment of a duration of just ≤3.3 weeks. It is concluded that EQ Pro therapy is a promising and effective form of treatment for horses with suspensory ligament injury. It is furthermore rapid and easy to use in the Equine Veterinary Clinic setting and does not require sedation. Future studies should now focus on the mechanisms by which this new treatment activates the healing process of the suspensory ligaments of injured horses.
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Affiliation(s)
- Ugo Carrozzo
- Clinica Equina San Biagio, San Biagio di Argenta, FE, Italy.
| | - Matteo Toniato
- Clinica Equina San Biagio, San Biagio di Argenta, FE, Italy
| | - Adrian Harrison
- Department of Pathobiological Sciences, Faculty of Health & Medical Science, Copenhagen University, Frederiksberg C, Copenhagen, Denmark
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Nichols AEC, Best KT, Loiselle AE. The cellular basis of fibrotic tendon healing: challenges and opportunities. Transl Res 2019; 209:156-168. [PMID: 30776336 PMCID: PMC6545261 DOI: 10.1016/j.trsl.2019.02.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
Tendon injuries are common and can dramatically impair patient mobility and productivity, resulting in a significant socioeconomic burden and reduced quality of life. Because the tendon healing process results in the formation of a fibrotic scar, injured tendons never regain the mechanical strength of the uninjured tendon, leading to frequent reinjury. Many tendons are also prone to the development of peritendinous adhesions and excess scar formation, which further reduce tendon function and lead to chronic complications. Despite this, there are currently no treatments that adequately improve the tendon healing process due in part to a lack of information regarding the contributions of various cell types to tendon healing and how their activity may be modulated for therapeutic value. In this review, we summarize recent efforts to identify and characterize the distinct cell populations involved at each stage of tendon healing. In addition, we examine the mechanisms through which different cell populations contribute to the fibrotic response to tendon injury, and how these responses can be affected by systemic factors and comorbidities. We then discuss gaps in our current understanding of tendon fibrosis and highlight how new technologies and research areas are shedding light on this clinically important and intractable challenge. A better understanding of the complex cellular environment during tendon healing is crucial to the development of new therapies to prevent fibrosis and promote tissue regeneration.
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Affiliation(s)
- Anne E C Nichols
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
| | - Katherine T Best
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
| | - Alayna E Loiselle
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York.
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Shi Z, Wang Q, Jiang D. Extracellular vesicles from bone marrow-derived multipotent mesenchymal stromal cells regulate inflammation and enhance tendon healing. J Transl Med 2019; 17:211. [PMID: 31238964 PMCID: PMC6593555 DOI: 10.1186/s12967-019-1960-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/21/2019] [Indexed: 02/07/2023] Open
Abstract
Background Extracellular vesicles from bone marrow-derived multipotent mesenchymal stromal cells (BMSC-EVs) can play important roles in the repair of injured tissues. However, no reports have investigated the role and underlying mechanisms of BMSCs-EVs in the tendon repair process. We hypothesized that BMSC-EVs may play a role in modulating inflammation during tendon healing and improving tendon repair in a rat model of patellar tendon injury. Methods First, we created window defects in the patellar tendons of Sprague–Dawley rats. Rats (n = 16) were then randomly assigned to three groups: BMSC-EVs group, Fibrin group, and control group. Rats in the BMSC-EVs group were treated with BMSC-EVs and fibrin glue (25 µg in 10 µL). Rats in the fibrin group were treated with fibrin only, and those in the control group received no treatment. Histopathology, immunohistochemistry, and gene expression analyses were performed at 2 and 4 weeks after surgery. Results At 4 weeks, tendons treated with BMSC-EVs showed regularly aligned and compact collagen fibers as compared with the disrupted scar-like healing in rats in the fibrin and control groups. The expression of genes related to tendon matrix formation and tenogenic differentiation: collagen (COL)-1a1, scleraxis (SCX), and tenomodulin (TNMD) was significantly higher in the BMSC-EVs group than in the other two groups. With histopathology, we observed significantly higher numbers of CD146+ tendon stem cells and fewer numbers of apoptotic cells and C–C chemokine receptor type 7 (CCR7)-positive proinflammatory macrophages in the BMSC-EVs group. BMSC-EVs treatment also led to an increase in the expression of anti-inflammatory mediators (IL-10 and IL-4) at 2 weeks after surgery. Conclusions Overall, our findings show that the local administration of BMSC-EVs promotes tendon healing by suppressing inflammation and apoptotic cell accumulation and increasing the proportion of tendon-resident stem/progenitor cells. These findings provide a basis for the potential clinical use of BMSC-EVs in tendon repair.
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Affiliation(s)
- Zhengzhou Shi
- Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Qi Wang
- Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Dapeng Jiang
- Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Yao Z, Zheng W, Zhang X, Xiong H, Qian Y, Fan C. Hydroxycamptothecin Prevents Fibrotic Pathways in Fibroblasts In Vitro. IUBMB Life 2019; 71:653-662. [PMID: 30690843 DOI: 10.1002/iub.2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/12/2018] [Accepted: 12/29/2018] [Indexed: 01/23/2023]
Abstract
Peritendinous fibrosis, which leads to impaired tendon function, is a clinical problem worldwide, and it is urgent to explore potential ways to reduce the formation of peritendinous adhesion. Several studies have demonstrated the biological roles of hydroxycamptothecin (HCPT) in inhibiting fibrosis in different tissues. In this study, we investigated whether HCPT could inhibit tendon fibrosis in vitro. Our results revealed that HCPT inhibited transforming growth factor (TGF)-β1-induced cell viability of human fibroblasts, decreased excessive cell hyperproliferation and promoted fibroblasts apoptosis. In addition, HCPT treatment also inhibited expression of fibrosis genes COL3A1 and α-smooth muscle actin (α-SMA). In terms of mechanism, we pretreated fibroblasts with the endoplasmic reticulum stress (ER) inhibitor salubrinal and RNA-dependent protein kinase-like ER kinase (PERK) short hairpin RNA, these treatments abolished the inhibitory effects of HCPT on fibrosis, thereby suggesting that HCPT's inhibition of TGF-β1-induced tendon fibrosis might be mediated by the PERK signaling pathway in vitro. In conclusion, our results suggested that HCPT had protective effects on peritendinous tissue fibrosis and might be promising in future clinical applications. © 2019 IUBMB Life, 71(5):653-662, 2019.
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Affiliation(s)
- Zhixiao Yao
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Zheng
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiangqi Zhang
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hao Xiong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yun Qian
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Kovac M, Litvin YA, Aliev RO, Zakirova EY, Rutland CS, Kiyasov AP, Rizvanov AA. Gene Therapy Using Plasmid DNA Encoding VEGF164 and FGF2 Genes: A Novel Treatment of Naturally Occurring Tendinitis and Desmitis in Horses. Front Pharmacol 2018; 9:978. [PMID: 30233367 PMCID: PMC6127648 DOI: 10.3389/fphar.2018.00978] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022] Open
Abstract
This clinical study describes the intralesional application of the plasmid DNA encoding two therapeutic species-specific growth factors: vascular endothelial growth factor (VEGF164) and fibroblast growth factor 2 (FGF2) in seven horses to restore naturally occurring injuries of the superficial digital flexor tendon (SDFT) (tendinitis) and in three horses with suspensory ligament branch desmitis. Following application all horses were able to commence a more rapid exercise program in comparison to standardized exercise programs. Clinical observation and ultrasonic imaging was used to evaluate the regeneration rate of the tendon and ligament injury recovery and to confirm the safety of this gene therapy in horses, throughout a 12 month period. Follow-up data of the horses revealed a positive outcome including significant ultrasonographic and clinical improvements in 8 out of 10 horses with SDFT and suspensory ligament branch lesions, with return to their pre-injury level of performance by 2–6 months after the completion of treatment. The ninth horse initially presenting with severe suspensory ligament branch desmopathy, showed no significant ultrasonographic improvements in the first 2 months after treatment, however, it improved clinically and became less lame. The final horse, presenting with severe tendinitis of the SDFT returned to their pre-injury level of performance, but experienced re-injury 6 months after treatment. This data is highly promising, however, further research in experimental models, with the histopathological, immunohistochemical and gene expression evaluation of the equine tendon/ligament after gene therapy application is required in order to fully understand the mechanisms of action. This treatment and the significant clinical impacts observed represents an important advancement in the field of medicine.
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Affiliation(s)
- Milomir Kovac
- Moscow State Academy of Veterinary Medicine and Biotechnology, Moscow, Russia
| | - Yaroslav A Litvin
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Ruslan O Aliev
- Moscow State Academy of Veterinary Medicine and Biotechnology, Moscow, Russia
| | - Elena Y Zakirova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Catrin S Rutland
- School of Veterinary Medicine and Science, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andrey P Kiyasov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Albert A Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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