Current Advances in the Regeneration of Degenerated Articular Cartilage: A Literature Review on Tissue Engineering and Its Recent Clinical Translation

Ginkgolide A enhances FoxO1 expression and reduces endoplasmic reticulum stress to mitigate osteoarthritis in mice

This study aimed to investigate the effects of Ginkgolide A (GA) on chondrocytes under oxidative stress and to elucidate its potential molecular mechanisms. Using a destabilization of the medial meniscus (DMM) model in mice and an in vitro osteoarthritis (OA) model induced by tert-butyl hydroperoxide (TBHP) in chondrocytes, we validated the therapeutic efficacy and underlying mechanisms of GA. Potential OA targets of GA were identified through network pharmacology, Gene Ontology (GO) analysis, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Further exploration into the effects on endoplasmic reticulum stress (ERS), apoptosis, extracellular matrix (ECM) degradation, and Forkhead Box O1 (FoxO1) related pathways was conducted using Western blotting, immunofluorescence, TUNEL staining, flow cytometry, X-ray, micro-computed tomography (Micro-CT) analysis, and histological staining. The results demonstrated that GA upregulated FoxO1 expression and inhibited ERS-related signaling pathways, thereby reducing apoptosis and ECM degradation. In conclusion, GA significantly alleviated OA symptoms both in vitro and in vivo, suggesting its potential as a therapeutic agent for OA.

Boosting chondrocyte bioactivity with ultra-sulfated glycopeptide supramolecular polymers

Although autologous chondrocyte transplantation can be effective in articular cartilage repair, negative side effects limit the utility of the treatment, such as long recovery times, poor engraftment or chondrogenic dedifferentiation, and cell leakage. Peptide-based supramolecular polymers have emerged as promising bioactive systems to promote tissue regeneration through cell signaling and dynamic behavior. We report here on the development of a series of glycopeptide amphiphile supramolecular nanofibers with chondrogenic bioactivity. These supramolecular polymers were found to have the ability to boost TGFβ-1 signaling by displaying galactosamine moieties with differing degrees of sulfation on their surfaces. We were also able to encapsulate chondrocytes with these nanostructures as single cells without affecting viability and proliferation. Among the monomers tested, assemblies of trisulfated glycopeptides led to elevated expression of chondrogenic markers relative to those with lower degrees of sulfation that mimic chondroitin sulfate repeating units. We hypothesize the enhanced bioactivity is rooted in specific interactions of the supramolecular assemblies with TGFβ-1 and its consequence on cell signaling, which may involve elevated levels of supramolecular motion as a result of high charge in trisulfated glycopeptide amphiphiles. Our findings suggest that supramolecular polymers formed by the ultra-sulfated glycopeptide amphiphiles could provide better outcomes in chondrocyte transplantation therapies for cartilage regeneration. STATEMENT OF SIGNIFICANCE: This study prepares glycopeptide amphiphiles conjugated at their termini with chondroitin sulfate mimetic residues with varying degrees of sulfation that self-assemble into supramolecular nanofibers in aqueous solution. These supramolecular polymers encapsulate chondrocytes as single cells through intimate contact with cell surface structures, forming artificial matrix that can localize the growth factor TGFβ-1 in the intercellular environment. A high degree of sulfation on the glycopeptide amphiphile is found to be critical in elevating chondrogenic cellular responses that supersede the efficacy of natural chondroitin sulfate. This work demonstrates that supramolecular assembly of a unique molecular structure designed to mimic chondroitin sulfate successfully boosts chondrocyte bioactivity by single cell encapsulation, suggesting a new avenue implementing chondrocyte transplantation with supramolecular nanomaterials for cartilage regeneration.

Rapidly Degrading Hydrogels to Support Biofabrication and 3D Bioprinting Using Cartilage Microtissues

In recent years, there has been increased interest in the use of cellular spheroids, microtissues, and organoids as biological building blocks to engineer functional tissues and organs. Such microtissues are typically formed by the self-assembly of cellular aggregates and the subsequent deposition of a tissue-specific extracellular matrix (ECM). Biofabrication and 3D bioprinting strategies using microtissues may require the development of supporting hydrogels and bioinks to spatially localize such biological building blocks in 3D space and hence enable the engineering of geometrically defined tissues. Therefore, the aim of this work was to engineer scaled-up, geometrically defined cartilage grafts by combining multiple cartilage microtissues within a rapidly degrading oxidized alginate (OA) supporting hydrogel and maintaining these constructs in dynamic culture conditions. To this end, cartilage microtissues were first independently matured for either 2 or 4 days and then combined in the presence or absence of a supporting OA hydrogel. Over 6 weeks in static culture, constructs engineered using microtissues that were matured independently for 2 days generated higher amounts of glycosaminoglycans (GAGs) compared to those matured for 4 days. Histological analysis revealed intense staining for GAGs and negative staining for calcium deposits in constructs generated by using the supporting OA hydrogel. Less physical contraction was also observed in constructs generated in the presence of the supporting gel; however, the remnants of individual microtissues were more observable, suggesting that even the presence of a rapidly degrading hydrogel may delay the fusion and/or the remodeling of the individual microtissues. Dynamic culture conditions were found to modulate ECM synthesis following the OA hydrogel encapsulation. We also assessed the feasibility of 3D bioprinting of cartilage microtissues within OA based bioinks. It was observed that the microtissues remained viable after extrusion-based bioprinting and were able to fuse after 48 h, particularly when high microtissue densities were used, ultimately generating a cartilage tissue that was rich in GAGs and negative for calcium deposits. Therefore, this work supports the use of OA as a supporting hydrogel/bioink when using microtissues as biological building blocks in diverse biofabrication and 3D bioprinting platforms.

Functional Scaffolds for Bone Tissue Regeneration: A Comprehensive Review of Materials, Methods, and Future Directions

Bone tissue regeneration is a rapidly evolving field aimed at the development of biocompatible materials and devices, such as scaffolds, to treat diseased and damaged osseous tissue. Functional scaffolds maintain structural integrity and provide mechanical support at the defect site during the healing process, while simultaneously enabling or improving regeneration through amplified cellular cues between the scaffold and native tissues. Ample research on functionalization has been conducted to improve scaffold-host tissue interaction, including fabrication techniques, biomaterial selection, scaffold surface modifications, integration of bioactive molecular additives, and post-processing modifications. Each of these methods plays a crucial role in enabling scaffolds to not only support but actively participate in the healing and regeneration process in bone and joint surgery. This review provides a state-of-the-art, comprehensive overview of the functionalization of scaffold-based strategies used in tissue engineering, specifically for bone regeneration. Critical issues and obstacles are highlighted, applications and advances are described, and future directions are identified.

A Systematic Review of Human Amnion Enhanced Cartilage Regeneration in Full-Thickness Cartilage Defects

Cartilage defects present a significant challenge in orthopedic medicine, often leading to pain and functional impairment. To address this, human amnion, a naturally derived biomaterial, has gained attention for its potential in enhancing cartilage regeneration. This systematic review aims to evaluate the efficacy of human amnion in enhancing cartilage regeneration for full-thickness cartilage defects. An electronic search was conducted on MEDLINE-PubMed, Web of Science (WoS), and the Scopus database up to 27 December 2023 from 2007. A total of 401 articles were identified. After removing 125 duplicates and excluding 271 articles based on predetermined criteria, only 5 articles remained eligible for inclusion in this systematic review. All five eligible articles conducted in vivo studies utilizing rabbits as subjects. Furthermore, analysis of the literature reveals an increasing trend in the frequency of utilizing human amnion for the treatment of cartilage defects. Various forms of human amnion were utilized either alone or seeded with cells prior to implantation. Histological assessments and macroscopic observations indicated usage of human amnion improved cartilage repair outcomes. All studies highlighted the positive results despite using different forms of amnion tissues. This systematic review underscores the promising role of human amnion as a viable option for enhancing cartilage regeneration in full-thickness cartilage defects, thus offering valuable insights for future research and clinical applications in orthopedic tissue engineering.

Recent advancements in cartilage tissue engineering innovation and translation

Articular cartilage was expected to be one of the first successfully engineered tissues, but today, cartilage repair products are few and they exhibit considerable limitations. For example, of the cell-based products that are available globally, only one is marketed for non-knee indications, none are indicated for severe osteoarthritis or rheumatoid arthritis, and only one is approved for marketing in the USA. However, advances in cartilage tissue engineering might now finally lead to the development of new cartilage repair products. To understand the potential in this field, it helps to consider the current landscape of tissue-engineered products for articular cartilage repair and particularly cell-based therapies. Advances relating to cell sources, bioactive stimuli and scaffold or scaffold-free approaches should now contribute to progress in therapeutic development. Engineering for an inflammatory environment is required because of the need for implants to withstand immune challenge within joints affected by osteoarthritis or rheumatoid arthritis. Bringing additional cartilage repair products to the market will require an understanding of the translational vector for their commercialization. Advances thus far can facilitate the future translation of engineered cartilage products to benefit the millions of patients who suffer from cartilage injuries and arthritides.

Recent advances in 3D bioprinted cartilage-mimicking constructs for applications in tissue engineering

Human cartilage tissue can be categorized into three types: hyaline cartilage, elastic cartilage and fibrocartilage. Each type of cartilage tissue possesses unique properties and functions, which presents a significant challenge for the regeneration and repair of damaged tissue. Bionics is a discipline in which humans study and imitate nature. A bionic strategy based on comprehensive knowledge of the anatomy and histology of human cartilage is expected to contribute to fundamental study of core elements of tissue repair. Moreover, as a novel tissue-engineered technology, 3D bioprinting has the distinctive advantage of the rapid and precise construction of targeted models. Thus, by selecting suitable materials, cells and cytokines, and by leveraging advanced printing technology and bionic concepts, it becomes possible to simultaneously realize multiple beneficial properties and achieve improved tissue repair. This article provides an overview of key elements involved in the combination of 3D bioprinting and bionic strategies, with a particular focus on recent advances in mimicking different types of cartilage tissue.

Articular Cartilage Regeneration by Hyaline Chondrocytes: A Case Study in Equine Model and Outcomes

Cartilage injury defects in animals and humans result in the development of osteoarthritis and the progression of joint deterioration. Cell isolation from equine hyaline cartilage and evaluation of their ability to repair equine joint cartilage injuries establish a new experimental protocol for an alternative approach to osteochondral lesions treatment. Chondrocytes (CCs), isolated from the autologous cartilage of the trachea, grown in the laboratory, and subsequently arthroscopically implanted into the lesion site, were used to regenerate a chondral lesion of the carpal joint of a horse. Biopsies of the treated cartilage taken after 8 and 13 months of implantation for histological and immunohistochemical evaluation of the tissue demonstrate that the tissue was still immature 8 months after implantation, while at 13 months it was organized almost similarly to the original hyaline cartilage. Finally, a tissue perfectly comparable to native articular cartilage was detected 24 months after implantation. Histological investigations demonstrate the progressive maturation of the hyaline cartilage at the site of the lesion. The hyaline type of tracheal cartilage, used as a source of CCs, allows for the repair of joint cartilage injuries through the neosynthesis of hyaline cartilage that presents characteristics identical to the articular cartilage of the original tissue.

Effect of autogenous osteochondral mosaicplasty on the balance control of patients with cartilage defects of the knee: a pilot study

BACKGROUND

Autogenous osteochondral mosaicplasty (AOM) is a widely used optimal surgical technique for cartilage repair in young patients with focal articular cartilage defects. However, the alterations in balance control in these patients after AOM have not been sufficiently investigated. This study aimed to compare different balance control performances between the patients with knee cartilage defects and healthy controls before and after AOM, as well as evaluate the influence of AOM on balance control in these patients.

METHODS

Static posturographic tests were performed in twenty-four patients who were scheduled for AOM two weeks pre-, three months, and one year postoperatively, along with thirty matched controls, respectively. All participants underwent posturography under four standing conditions: eyes open and closed, without and with foam support to assess the balance control ability. Subsequently, patient-reported outcome measures (PROMs) were synchronously obtained and analyzed.

RESULTS

Compared to the control subjects, less efficient balance control was observed in study patients at three testing phases (p < 0.05), whereas no alterations in postural control were visible in these patients within a year following AOM (p > 0.05). Significant improvements were found in all PROMs such as the International Knee Documentation Committee, the Lysholm Knee Score, and the visual analogue scale in the study patients postoperatively (p < 0.01).

CONCLUSION

The results indicated that patients with knee cartilage defects have a prominent balance control deficit compared to healthy individuals. Furthermore, AOM does not improve balance control in these patients for at least one year postoperatively, and more effective approaches for postural regulation are required for the management of cartilage defect patients.

Biomimetic biphasic scaffolds in osteochondral tissue engineering: Their composition, structure and consequences

Approaches to the design and construction of biomimetic scaffolds for osteochondral tissue, show increasing advances. Considering the limitations of this tissue in terms of repair and regeneration, there is a need to develop appropriately designed scaffolds. A combination of biodegradable polymers especially natural polymers and bioactive ceramics, shows promise in this field. Due to the complicated architecture of this tissue, biphasic and multiphasic scaffolds containing two or more different layers, could mimic the physiology and function of this tissue with a higher degree of similarity. The purpose of this review article is to discuss the approaches focused on the application of biphasic scaffolds for osteochondral tissue engineering, common methods of combining layers and the ultimate consequences of their use in patients were discussed.

Cellular therapy and tissue engineering for cartilage repair

Articular cartilage (AC) has limited capacity for repair. The first attempt to repair cartilage using tissue engineering was reported in 1977. Since then, cell-based interventions have entered clinical practice in orthopaedics, and several tissue engineering approaches to repair cartilage are in the translational pipeline towards clinical application. Classically, these involve a scaffold, substrate or matrix to provide structure, and cells such as chondrocytes or mesenchymal stromal cells to generate the tissue. We discuss the advantages and drawbacks of the use of various cell types, natural and synthetic scaffolds, multiphasic or gradient-based scaffolds, and self-organizing or self-assembling scaffold-free systems, for the engineering of cartilage constructs. Several challenges persist including achieving zonal tissue organization and integration with the surrounding tissue upon implantation. Approaches to improve cartilage thickness, organization and mechanical properties include mechanical stimulation, culture under hypoxic conditions, and stimulation with growth factors or other macromolecules. In addition, advanced technologies such as bioreactors, biosensors and 3D bioprinting are actively being explored. Understanding the underlying mechanisms of action of cell therapy and tissue engineering approaches will help improve and refine therapy development. Finally, we discuss recent studies of the intrinsic cellular and molecular mechanisms of cartilage repair that have identified novel signals and targets and are inspiring the development of molecular therapies to enhance the recruitment and cartilage reparative activity of joint-resident stem and progenitor cells. A one-fits-all solution is unrealistic, and identifying patients who will respond to a specific targeted treatment will be critical.

Numerical Simulation Study on Relationship between the Fracture Mechanisms and Residual Membrane Stresses of Metallic Material

The distribution and dissipation energies in fracture mechanisms were a critical challenge to derive, especially for this ultra-thin sample. The membrane failure, which is the end of the fracture mechanisms, is a result of the cone wave reflections from the backend membrane boundaries. These reflections delay the failure processes due to the shock impacts. To compare these results with the experimental work, a numerical simulation was conducted for these processes. The cylinder-shaped rigid projectile was impacted using a frictionless Lagrange solver. The target was a cartridge brass circle plate clamped at its perimeter, and its zone was refined to a ten-times higher meshing density for better analysis. The erosion and cut-off controls involved a zero-gap interaction condition and an instantaneous geometric erosion strain of 200%. Due to the maximum projectile velocity of 382 m/s having the slowest perforation, the target thickness was found to be 5.5 mm. The fracture mechanism phenomena, such as tensile, compressive, through-thickness, and growth in-plane delamination, propagating delamination, and local punch shear waves were observed. After deducting tensile and flexural strengths from the last experiment, a total residual membrane stress of 650 MPa was found. This result indicated a relationship between the fracture mechanisms and residual membrane stresses of metallic material.

Structural Characterization Analyses of Low Brass Filler Biomaterial for Hard Tissue Implanted Scaffold Applications

A biomaterial was created for hard tissue implanted scaffolds as a translational therapeutic approach. The existing biomaterials containing titanium dioxide filler posed a risk of oxygen gas vacancy. This will block the canaliculars, leading to a limit on the nutrient fluid supply. To overcome this problem, low brass was used as an alternative filler to eliminate the gas vacancy. Low brass with composition percentages of 0%, 2%, 5%, 15%, and 30% was filled into the polyester urethane liquidusing the metallic filler polymer reinforced method. The structural characterizations of the low brass filler biomaterial were investigated by Field Emission Scanning Electron Microscopy. The results showed the surface membrane strength was higher than the side and cross-section. The composition shapes found were hexagon for polyester urethane and peanut for low brass. Low brass stabilised polyester urethane in biomaterials by the formation of two 5-ringed tetrahedral crystal structures. The average pore diameter was 308.9 nm, which is suitable for articular cartilage cells. The pore distribution was quite dispersed, and its curve had a linear relationship between area and diameter, suggestive of the sphere-shaped pores. The average porosities were different between using FESEM results of 6.04% and the calculated result of 3.28%. In conclusion, this biomaterial had a higher surface membrane strength and rather homogeneous dispersed pore structures.