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Kalbhenn J, Marx O, Müller-Peltzer K, Kunze M, Bürkle H, Bansbach J. [Pregnant women with COVID-19 ARDS on the intensive care unit]. Anaesthesiologie 2024:10.1007/s00101-024-01405-5. [PMID: 38671334 DOI: 10.1007/s00101-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 02/29/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19 patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. OBJECTIVE Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). MATERIAL AND METHODS We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of a German university hospital between March and November 2021. RESULTS The cohort included 9 patients with a mean age of 30.3 years (range 26-40 years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had a PaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, a total of 47 prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth. CONCLUSION High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia a more viable alternative, especially in severe disease.
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Affiliation(s)
- J Kalbhenn
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland
| | - O Marx
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland
| | - K Müller-Peltzer
- Klinik für Radiologie, Universitätsklinik Freiburg, Freiburg, Deutschland
| | - M Kunze
- Klinik für Frauenheilkunde, Geburtshilfe und Perinatologie, Universitätsklinik Freiburg, Freiburg, Deutschland
| | - H Bürkle
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland
| | - J Bansbach
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinik Freiburg, Hugstetter Str. 55, Freiburg, Deutschland.
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Lan X, Ma Z, Kunze M, Mulet-Sierra A, Osswald M, Ansari K, Seikaly H, Boluk Y, Adesida AB. The Effect of Crosslinking Density on Nasal Chondrocytes' Redifferentiation. Ann Biomed Eng 2023:10.1007/s10439-023-03184-3. [PMID: 37005947 DOI: 10.1007/s10439-023-03184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023]
Abstract
Hydrogels appear to be an attractive class of biomaterial for cartilage tissue engineering due to their high water content, excellent biocompatibility, tunable stiffness, etc. The crosslinking density of the hydrogel can affect their viscoelastic property, and therefore potentially impact the chondrogenic phenotype of re-differentiated chondrocytes in a 3D microenvironment through physical cues. To understand the effect of crosslinking densities on chondrocytes phenotype and cellular interaction with the hydrogel, this study utilized a clinical grade thiolate hyaluronic acid and thiolate gelatin (HA-Gel) hydrogel, crosslinked with poly(ethylene glycol) diacrylate to create various crosslinking densities. The HA-Gel hydrogels were then mixed with human nasal chondrocytes to generate neocartilage in vitro. The influence of the hydrogel crosslinking density and the viscoelastic property on the cell behaviours on the gene and matrix levels were evaluated using biochemistry assays, histology, quantitative polymerase chain reaction (qPCR) and next-generation sequencing (RNA seq). In general, the differences in the storage modulus of the HA-Gel hydrogel are not enough to alter the cartilaginous gene expression of chondrocytes. However, a positively correlated trend of PPAR-γ gene expression to the crosslinking density was measured by qPCR. The RNA-seq results have shown that 178 genes are significantly negatively correlated and 225 genes are positively correlated to the crosslinking density, which is worth investigating in the future studies.
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Affiliation(s)
- Xiaoyi Lan
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Zhiyao Ma
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada
| | - Martin Osswald
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, AB, Canada
- Department of Surgery, Division of Otolaryngology, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada
| | - Khalid Ansari
- Department of Surgery, Division of Otolaryngology, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada
| | - Yaman Boluk
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada.
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada.
- Department of Surgery, Division of Otolaryngology, Faculty of Medicine & Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada.
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Li DX, Ma Z, Szojka ARA, Lan X, Kunze M, Mulet-Sierra A, Westover L, Adesida AB. Non-hypertrophic chondrogenesis of mesenchymal stem cells through mechano-hypoxia programing. J Tissue Eng 2023; 14:20417314231172574. [PMID: 37216035 PMCID: PMC10192798 DOI: 10.1177/20417314231172574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/09/2023] [Indexed: 05/24/2023] Open
Abstract
Cartilage tissue engineering aims to generate functional replacements to treat cartilage defects from damage and osteoarthritis. Human bone marrow-derived mesenchymal stem cells (hBM-MSC) are a promising cell source for making cartilage, but current differentiation protocols require the supplementation of growth factors like TGF-β1 or -β3. This can lead to undesirable hypertrophic differentiation of hBM-MSC that progress to bone. We have found previously that exposing engineered human meniscus tissues to physiologically relevant conditions of the knee (mechanical loading and hypoxia; hence, mechano-hypoxia conditioning) increased the gene expression of hyaline cartilage markers, SOX9 and COL2A1, inhibited hypertrophic marker COL10A1, and promoted bulk mechanical property development. Adding further to this protocol, we hypothesize that combined mechano-hypoxia conditioning with TGF-β3 growth factor withdrawal will promote stable, non-hypertrophic chondrogenesis of hBM-MSC embedded in an HA-hydrogel. We found that the combined treatment upregulated many cartilage matrix- and development-related markers while suppressing many hypertrophic- and bone development-related markers. Tissue level assessments with biochemical assays, immunofluorescence, and histochemical staining confirmed the gene expression data. Further, mechanical property development in the dynamic compression treatment shows promise toward generating functional engineered cartilage through more optimized and longer culture conditions. In summary, this study introduced a novel protocol to differentiate hBM-MSC into stable, cartilage-forming cells.
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Affiliation(s)
- David Xinzheyang Li
- Department of Surgery, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Civil and Environmental
Engineering, Faculty of Engineering, AB, University of Alberta, Edmonton, AB,
Canada
| | - Zhiyao Ma
- Department of Surgery, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Alexander RA Szojka
- Department of Surgery, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Xiaoyi Lan
- Department of Surgery, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Civil and Environmental
Engineering, Faculty of Engineering, AB, University of Alberta, Edmonton, AB,
Canada
| | - Melanie Kunze
- Department of Surgery, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering,
Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Adetola B Adesida
- Department of Surgery, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Ma Z, Li DX, Chee RKW, Kunze M, Mulet-Sierra A, Sommerfeldt M, Westover L, Graf D, Adesida AB. Mechanical Unloading of Engineered Human Meniscus Models Under Simulated Microgravity: A Transcriptomic Study. Sci Data 2022; 9:736. [PMID: 36450785 PMCID: PMC9712603 DOI: 10.1038/s41597-022-01837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Osteoarthritis (OA) primarily affects mechanical load-bearing joints, with the knee being the most common. The prevalence, burden and severity of knee osteoarthritis (KOA) are disproportionately higher in females, but hormonal differences alone do not explain the disproportionate incidence of KOA in females. Mechanical unloading by spaceflight microgravity has been implicated in OA development in cartilaginous tissues. However, the mechanisms and sex-dependent differences in OA-like development are not well explored. In this study, engineered meniscus constructs were generated from healthy human meniscus fibrochondrocytes (MFC) seeded onto type I collagen scaffolds and cultured under normal gravity and simulated microgravity conditions. We report the whole-genome sequences of constructs from 4 female and 4 male donors, along with the evaluation of their phenotypic characteristics. The collected data could be used as valuable resources to further explore the mechanism of KOA development in response to mechanical unloading, and to investigate the molecular basis of the observed sex differences in KOA.
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Affiliation(s)
- Zhiyao Ma
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2E1 Canada
| | - David Xinzheyang Li
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2E1 Canada ,grid.17089.370000 0001 2190 316XDepartment of Civil & Environmental Engineering, University of Alberta, Edmonton, AB Canada
| | - Ryan K. W. Chee
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2E1 Canada
| | - Melanie Kunze
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2E1 Canada
| | - Aillette Mulet-Sierra
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2E1 Canada
| | - Mark Sommerfeldt
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2E1 Canada
| | - Lindsey Westover
- grid.17089.370000 0001 2190 316XDepartment of Mechanical Engineering, University of Alberta, Edmonton, AB Canada
| | - Daniel Graf
- grid.17089.370000 0001 2190 316XSchool of Dentistry, University of Alberta, Edmonton, AB Canada
| | - Adetola B. Adesida
- grid.17089.370000 0001 2190 316XDepartment of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2E1 Canada
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Spielberger B, Pfeil J, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Hufnagel M. Infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine. Monatsschr Kinderheilkd 2022; 170:1103-1112. [PMID: 36188233 PMCID: PMC9510227 DOI: 10.1007/s00112-022-01607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Hintergrund Bis Anfang Juni 2022 sind ca. 300.000 Kinder und Jugendliche aus der Ukraine im deutschen Ausländerzentralregister registriert worden. Die vorliegenden Handlungsempfehlungen sollen die Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine schaffen. Ziele Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge aus der Ukraine unterstützen, um 1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen; 2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln; 3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren. Material und Methoden Die Handlungsempfehlungen wurden als durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) koordinierte Leitlinie der Stufe 1 verfasst und an die Situation Flucht aus der Ukraine angepasst. Die Empfehlungen wurden durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet. Ergebnisse Es werden Empfehlungen für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge, angepasst an die Situation Flucht aus der Ukraine, ausgesprochen. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbilds sowie Untersuchungen auf Tuberkulose, Hepatitis B und C sowie eine Human-Immunodeficiency-Virus(HIV)-Infektion empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und Indikationsbezogene Priorisierung einzelner Impfungen vorgenommen. Diskussion Angesichts anhaltend hoher Flüchtlingszahlen nicht nur aus der Ukraine ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.
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Affiliation(s)
- B. Spielberger
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - J. Pfeil
- Praxis für Kinder- und Jugendmedizin, Schwaigern, Deutschland
| | - K. Assaad
- Gesundheitsamt Rhein-Neckar-Kreis, Heidelberg, Deutschland
| | - U. von Both
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, München, Deutschland
| | - A. Janda
- Universitätsklinik für Kinder- und Jugendmedizin, Ulm, Deutschland
| | - C. Kitz
- Praxis für Kinder- und Jugendmedizin, Veitshöchheim, Deutschland
| | - R. Kobbe
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M. Kunze
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J. Lindert
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - N. Ritz
- Kinderspital, Luzerner Kantonsspital, Luzern, Schweiz
| | - S. Trapp
- Praxis für Kinder- und Jugendmedizin, Bremen, Deutschland
| | - M. Hufnagel
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
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Kunze M, Schäfer B, Andrijevska V, Al Machot F, Fischer U, Lotz J, Wienbeck S. Interpretierbares maschinelles Lernen in der Diagnostik von Verkalkungen in der Brust in der Cone-beam Brust CT und digitalen Vollfeldmammographie. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M Kunze
- Universitätsmedizin Göttingen, Institut für Diagnostische und Interventionelle Radiologie, Göttingen
| | - B Schäfer
- Faculty of Science and Technology, Norwegian University of Life Sciences, 1432 Ås, Norwegen
| | | | - F Al Machot
- Faculty of Science and Technology, Norwegian University of Life Sciences, 1432 Ås, Norwegen
| | - U Fischer
- Diagnostisches Brustzentrum Göttingen, Göttingen
| | - J Lotz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen
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Lan X, Liang Y, Vyhlidal M, Erkut EJN, Kunze M, Mulet-Sierra A, Osswald M, Ansari K, Seikaly H, Boluk Y, Adesida AB. In vitro maturation and in vivo stability of bioprinted human nasal cartilage. J Tissue Eng 2022; 13:20417314221086368. [PMID: 35599742 PMCID: PMC9122109 DOI: 10.1177/20417314221086368] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
The removal of skin cancer lesions on the nose often results in the loss of nasal
cartilage. The cartilage loss is either surgically replaced with autologous
cartilage or synthetic grafts. However, these replacement options come with
donor-site morbidity and resorption issues. 3-dimensional (3D) bioprinting
technology offers the opportunity to engineer anatomical-shaped autologous nasal
cartilage grafts. The 3D bioprinted cartilage grafts need to embody a
mechanically competent extracellular matrix (ECM) to allow for surgical suturing
and resistance to contraction during scar tissue formation. We investigated the
effect of culture period on ECM formation and mechanical properties of 3D
bioprinted constructs of human nasal chondrocytes (hNC)-laden type I collagen
hydrogel in vitro and in vivo. Tissue-engineered nasal cartilage constructs
developed from hNC culture in clinically approved collagen type I and type III
semi-permeable membrane scaffold served as control. The resulting 3D bioprinted
engineered nasal cartilage constructs were comparable or better than the
controls both in vitro and in vivo. This study demonstrates that 3D bioprinted
constructs of engineered nasal cartilage are feasible options in nasal cartilage
reconstructive surgeries.
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Affiliation(s)
- Xiaoyi Lan
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Yan Liang
- Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Margaret Vyhlidal
- Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Esra JN Erkut
- Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Martin Osswald
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, AB, Canada
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Khalid Ansari
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Yaman Boluk
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Adetola B Adesida
- Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Ma Z, Li DX, Kunze M, Mulet-Sierra A, Westover L, Adesida AB. Engineered Human Meniscus in Modeling Sex Differences of Knee Osteoarthritis in Vitro. Front Bioeng Biotechnol 2022; 10:823679. [PMID: 35284415 PMCID: PMC8904202 DOI: 10.3389/fbioe.2022.823679] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/21/2022] [Indexed: 12/30/2022] Open
Abstract
Background: Osteoarthritis (OA) primarily affects mechanical load-bearing joints. The knee joint is the most impacted by OA. Knee OA (KOA) occurs in almost all demographic groups, but the prevalence and severity are disproportionately higher in females. The molecular mechanism underlying the pathogenesis and progression of KOA is unknown. The molecular basis of biological sex matters of KOA is not fully understood. Mechanical stimulation plays a vital role in modulating OA-related responses of load-bearing tissues. Mechanical unloading by simulated microgravity (SMG) induced OA-like gene expression in engineered cartilage, while mechanical loading by cyclic hydrostatic pressure (CHP), on the other hand, exerted a pro-chondrogenic effect. This study aimed to evaluate the effects of mechanical loading and unloading via CHP and SMG, respectively, on the OA-related profile changes of engineered meniscus tissues and explore biological sex-related differences.Methods: Tissue-engineered menisci were made from female and male meniscus fibrochondrocytes (MFCs) under static conditions of normal gravity in chondrogenic media and subjected to SMG and CHP culture. Constructs were assayed via histology, immunofluorescence, GAG/DNA assays, RNA sequencing, and testing of mechanical properties.Results: The mRNA expression of ACAN and COL2A1, was upregulated by CHP but downregulated by SMG. COL10A1, a marker for chondrocyte hypertrophy, was downregulated by CHP compared to SMG. Furthermore, CHP increased GAG/DNA levels and wet weight in both female and male donors, but only significantly in females. From the transcriptomics, CHP and SMG significantly modulated genes related to the ossification, regulation of ossification, extracellular matrix, and angiogenesis Gene Ontology (GO) terms. A clear difference in fold-change magnitude and direction was seen between the two treatments for many of the genes. Furthermore, differences in fold-change magnitudes were seen between male and female donors within each treatment. SMG and CHP also significantly modulated genes in OA-related KEGG pathways, such as mineral absorption, Wnt signalling pathway, and HIF-1 signalling pathway.Conclusion: Engineered menisci responded to CHP and SMG in a sex-dependent manner. SMG may induce an OA-like profile, while CHP promotes chondrogenesis. The combination of SMG and CHP could serve as a model to study the early molecular events of KOA and potential drug-targetable pathways.
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Affiliation(s)
- Zhiyao Ma
- Department of Surgery, Divisions of Orthopaedic Surgery, Surgical Research and Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David Xinzheyang Li
- Department of Surgery, Divisions of Orthopaedic Surgery, Surgical Research and Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopaedic Surgery, Surgical Research and Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopaedic Surgery, Surgical Research and Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Adetola B. Adesida
- Department of Surgery, Divisions of Orthopaedic Surgery, Surgical Research and Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Adetola B. Adesida,
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Szojka ARA, Liang Y, Marqueti RDC, Moore CN, Erkut EJN, Kunze M, Mulet-Sierra A, Jomha NM, Adesida AB. Time course of 3D fibrocartilage formation by expanded human meniscus fibrochondrocytes in hypoxia. J Orthop Res 2022; 40:495-503. [PMID: 33788325 DOI: 10.1002/jor.25046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Adult human meniscus fibrocartilage is avascular and nonhealing after injury. Meniscus tissue engineering aims to replace injured meniscus with lab-grown fibrocartilage. Dynamic culture systems may be necessary to generate fibrocartilage of sufficient mechanical properties for implantation; however, the optimal static preculture conditions before initiation of dynamic culture are unknown. This study thus investigated the time course of fibrocartilage formation by human meniscus fibrochondrocytes on a three-dimensional biomaterial scaffold under various static conditions. Human meniscus fibrochondrocytes from partial meniscectomy were expanded to passage 1 (P1) or P2 (3.0 ± 0.4 and 6.5 ± 0.6 population doublings), seeded onto type I collagen scaffolds, and grown in hypoxia (HYP, 3% O2 ) or normoxia (NRX, 20% O2 ) for 3, 6, and 9 weeks. Mechanical properties were not different between P1 and P2 cell-based constructs. Mechanical properties were lower in HYP, increased continually in NRX only, and were positively correlated with glycosaminoglycan content and accumulation of hyaline cartilage-like matrix components. The most mechanically competent tissues (NRX/9 weeks) reached 1/5 of the native meniscus instantaneous compression modulus but had an increasingly hypertrophic matrix-forming phenotype. HYP consistently suppressed the hypertrophic phenotype. The results provide baselines of engineered meniscus fibrocartilage properties under static conditions, which can be used to select a preculture strategy for dynamic culture depending on the desired combination of mechanical properties, hyaline cartilage-like matrix abundance, and hypertrophic phenotype.
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Affiliation(s)
- Alexander R A Szojka
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Yan Liang
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Rita de Cássia Marqueti
- Graduate Program of Rehabilitation Sciences, University of Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Colleen N Moore
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Esra J N Erkut
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M Jomha
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopedic Surgery and Surgical Research, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
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Lan X, Ma Z, Szojka ARA, Kunze M, Mulet-Sierra A, Vyhlidal MJ, Boluk Y, Adesida AB. TEMPO-Oxidized Cellulose Nanofiber-Alginate Hydrogel as a Bioink for Human Meniscus Tissue Engineering. Front Bioeng Biotechnol 2021; 9:766399. [PMID: 34805119 PMCID: PMC8602093 DOI: 10.3389/fbioe.2021.766399] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: The avascular inner regions of the knee menisci cannot self-heal. As a prospective treatment, functional replacements can be generated by cell-based 3D bioprinting with an appropriate cell source and biomaterial. To that end, human meniscus fibrochondrocytes (hMFC) from surgical castoffs of partial meniscectomies as well as cellulose nanofiber-alginate based hydrogels have emerged as a promising cell source and biomaterial combination. The objectives of the study were to first find the optimal formulations of TEMPO (2,2,6,6-tetramethylpiperidine-1-oxyl)-oxidized cellulose nanofiber/alginate (TCNF/ALG) precursors for bioprinting, and then to use them to investigate redifferentiation and synthesis of functional inner meniscus-like extracellular matrix (ECM) components by expanded hMFCs. Methods: The rheological properties including shear viscosity, thixotropic behavior recovery, and loss tangent of selected TCNF/ALG precursors were measured to find the optimum formulations for 3D bioprinting. hMFCs were mixed with TCNF/ALG precursors with suitable formulations and 3D bioprinted into cylindrical disc constructs and crosslinked with CaCl2 after printing. The bioprinted constructs then underwent 6 weeks of in vitro chondrogenesis in hypoxia prior to analysis with biomechanical, biochemical, molecular, and histological assays. hMFCs mixed with a collagen I gel were used as a control. Results: The TCNF/ALG and collagen-based constructs had similar compression moduli. The expression of COL2A1 was significantly higher in TCNF/ALG. The TCNF/ALG constructs showed more of an inner meniscus-like phenotype while the collagen I-based construct was consistent with a more outer meniscus-like phenotype. The expression of COL10A1 and MMP13 were lower in the TCNF/ALG constructs. In addition, the immunofluorescence of human type I and II collagens were evident in the TCNF/ALG, while the bovine type I collagen constructs lacked type II collagen deposition but did contain newly synthesized human type I collagen.
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Affiliation(s)
- Xiaoyi Lan
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
- Divisions of Orthopaedic Surgery and Surgical Research, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Zhiyao Ma
- Divisions of Orthopaedic Surgery and Surgical Research, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Alexander R. A. Szojka
- Divisions of Orthopaedic Surgery and Surgical Research, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Divisions of Orthopaedic Surgery and Surgical Research, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Divisions of Orthopaedic Surgery and Surgical Research, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Margaret J. Vyhlidal
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
| | - Yaman Boluk
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
| | - Adetola B. Adesida
- Divisions of Orthopaedic Surgery and Surgical Research, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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11
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Szojka ARA, Li DX, Sopcak MEJ, Ma Z, Kunze M, Mulet-Sierra A, Adeeb SM, Westover L, Jomha NM, Adesida AB. Mechano-Hypoxia Conditioning of Engineered Human Meniscus. Front Bioeng Biotechnol 2021; 9:739438. [PMID: 34540817 PMCID: PMC8446439 DOI: 10.3389/fbioe.2021.739438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
Meniscus fibrochondrocytes (MFCs) experience simultaneous hypoxia and mechanical loading in the knee joint. Experimental conditions based on these aspects of the native MFC environment may have promising applications in human meniscus tissue engineering. We hypothesized that in vitro “mechano-hypoxia conditioning” with mechanical loading such as dynamic compression (DC) and cyclic hydrostatic pressure (CHP) would enhance development of human meniscus fibrocartilage extracellular matrix in vitro. MFCs from inner human meniscus surgical discards were pre-cultured on porous type I collagen scaffolds with TGF-β3 supplementation to form baseline tissues with newly formed matrix that were used in a series of experiments. First, baseline tissues were treated with DC or CHP under hypoxia (HYP, 3% O2) for 5 days. DC was the more effective load regime in inducing gene expression changes, and combined HYP/DC enhanced gene expression of fibrocartilage precursors. The individual treatments of DC and HYP regulated thousands of genes, such as chondrogenic markers SOX5/6, in an overwhelmingly additive rather than synergistic manner. Similar baseline tissues were then treated with a short course of DC (5 vs 60 min, 10–20% vs 30–40% strain) with different pre-culture duration (3 vs 6 weeks). The longer course of loading (60 min) had diminishing returns in regulating mechano-sensitive and inflammatory genes such as c-FOS and PTGS2, suggesting that as few as 5 min of DC was adequate. There was a dose-effect in gene regulation by higher DC strains, whereas outcomes were inconsistent for different MFC donors in pre-culture durations. A final set of baseline tissues was then cultured for 3 weeks with mechano-hypoxia conditioning to assess mechanical and protein-level outcomes. There were 1.8–5.1-fold gains in the dynamic modulus relative to baseline in HYP/DC, but matrix outcomes were equal or inferior to static controls. Long-term mechano-hypoxia conditioning was effective in suppressing hypertrophic markers (e.g., COL10A1 10-fold suppression vs static/normoxia). Taken together, these results indicate that appropriately applied mechano-hypoxia conditioning can support meniscus fibrocartilage development in vitro and may be useful as a strategy for developing non-hypertrophic articular cartilage using mesenchymal stem cells.
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Affiliation(s)
- Alexander R A Szojka
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David Xinzheyang Li
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Malou E J Sopcak
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Zhiyao Ma
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Samer M Adeeb
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Nadr M Jomha
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adetola B Adesida
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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12
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Rahman S, Szojka ARA, Liang Y, Kunze M, Goncalves V, Mulet-Sierra A, Jomha NM, Adesida AB. Inability of Low Oxygen Tension to Induce Chondrogenesis in Human Infrapatellar Fat Pad Mesenchymal Stem Cells. Front Cell Dev Biol 2021; 9:703038. [PMID: 34381784 PMCID: PMC8350173 DOI: 10.3389/fcell.2021.703038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Articular cartilage of the knee joint is avascular, exists under a low oxygen tension microenvironment, and does not self-heal when injured. Human infrapatellar fat pad-sourced mesenchymal stem cells (IFP-MSC) are an arthroscopically accessible source of mesenchymal stem cells (MSC) for the repair of articular cartilage defects. Human IFP-MSC exists physiologically under a low oxygen tension (i.e., 1-5%) microenvironment. Human bone marrow mesenchymal stem cells (BM-MSC) exist physiologically within a similar range of oxygen tension. A low oxygen tension of 2% spontaneously induced chondrogenesis in micromass pellets of human BM-MSC. However, this is yet to be demonstrated in human IFP-MSC or other adipose tissue-sourced MSC. In this study, we explored the potential of low oxygen tension at 2% to drive the in vitro chondrogenesis of IFP-MSC. We hypothesized that 2% O2 will induce stable chondrogenesis in human IFP-MSC without the risk of undergoing endochondral ossification at ectopic sites of implantation. METHODS Micromass pellets of human IFP-MSC were cultured under 2% O2 or 21% O2 (normal atmosphere O2) in the presence or absence of chondrogenic medium with transforming growth factor-β3 (TGFβ3) for 3 weeks. Following in vitro chondrogenesis, the resulting pellets were implanted in immunodeficient athymic nude mice for 3 weeks. RESULTS A low oxygen tension of 2% was unable to induce chondrogenesis in human IFP-MSC. In contrast, chondrogenic medium with TGFβ3 induced in vitro chondrogenesis. All pellets were devoid of any evidence of undergoing endochondral ossification after subcutaneous implantation in athymic mice.
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Affiliation(s)
- Samia Rahman
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Alexander R. A. Szojka
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Yan Liang
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Victoria Goncalves
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nadr M. Jomha
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Adetola B. Adesida
- Laboratory of Stem Cell Biology and Orthopedic Tissue Engineering, Division of Orthopedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
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13
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Lan X, Liang Y, Erkut EJN, Kunze M, Mulet-Sierra A, Gong T, Osswald M, Ansari K, Seikaly H, Boluk Y, Adesida AB. Bioprinting of human nasoseptal chondrocytes-laden collagen hydrogel for cartilage tissue engineering. FASEB J 2021; 35:e21191. [PMID: 33595884 DOI: 10.1096/fj.202002081r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
Skin cancer patients often have tumorigenic lesions on their noses. Surgical resection of the lesions often results in nasal cartilage removal. Cartilage grafts taken from other anatomical sites are used for the surgical reconstruction of the nasal cartilage, but donor-site morbidity is a common problem. Autologous tissue-engineered nasal cartilage grafts can mitigate the problem, but commercially available scaffolds define the shape and sizes of the engineered grafts during tissue fabrication. Moreover, the engineered grafts suffer from the inhomogeneous distribution of the functional matrix of cartilage. Advances in 3D bioprinting technology offer the opportunity to engineer cartilages with customizable dimensions and anatomically shaped configurations without the inhomogeneous distribution of cartilage matrix. Here, we report the fidelity of Freeform Reversible Embedding of Suspended Hydrogel (FRESH) bioprinting as a strategy to generate customizable and homogenously distributed functional cartilage matrix engineered nasal cartilage. Using FRESH and in vitro chondrogenesis, we have fabricated tissue-engineered nasal cartilage from combining bovine type I collagen hydrogel and human nasoseptal chondrocytes. The engineered nasal cartilage constructs displayed molecular, biochemical and histological characteristics akin to native human nasal cartilage.
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Affiliation(s)
- Xiaoyi Lan
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Yan Liang
- Department of Surgery, Divisions of Orthopedic Surgery & Surgical Research, University of Alberta, Edmonton, AB, Canada
| | - Esra J N Erkut
- Department of Surgery, Divisions of Orthopedic Surgery & Surgical Research, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopedic Surgery & Surgical Research, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopedic Surgery & Surgical Research, University of Alberta, Edmonton, AB, Canada
| | - Tianxing Gong
- Department of Surgery, Divisions of Orthopedic Surgery & Surgical Research, University of Alberta, Edmonton, AB, Canada
| | - Martin Osswald
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Department of Surgery, Division of Otolaryngology, University of Alberta, Edmonton, AB, Canada
| | - Khalid Ansari
- Department of Surgery, Division of Otolaryngology, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology, University of Alberta, Edmonton, AB, Canada
| | - Yaman Boluk
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopedic Surgery & Surgical Research, University of Alberta, Edmonton, AB, Canada.,Department of Surgery, Division of Otolaryngology, University of Alberta, Edmonton, AB, Canada
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14
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Szojka ARA, Moore CN, Liang Y, Andrews SHJ, Kunze M, Mulet-Sierra A, Jomha NM, Adesida AB. Correction: Engineered human meniscus' matrix-forming phenotype is unaffected by low strain dynamic compression under hypoxic conditions. PLoS One 2021; 16:e0249513. [PMID: 33780501 PMCID: PMC8006994 DOI: 10.1371/journal.pone.0249513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Szojka AR, Marqueti RDC, Li DX, Molter CW, Liang Y, Kunze M, Mulet-Sierra A, Jomha NM, Adesida AB. Human engineered meniscus transcriptome after short-term combined hypoxia and dynamic compression. J Tissue Eng 2021; 12:2041731421990842. [PMID: 33613959 PMCID: PMC7874349 DOI: 10.1177/2041731421990842] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/10/2021] [Indexed: 12/30/2022] Open
Abstract
This study investigates the transcriptome response of meniscus fibrochondrocytes (MFCs) to the low oxygen and mechanical loading signals experienced in the knee joint using a model system. We hypothesized that short term exposure to the combined treatment would promote a matrix-forming phenotype supportive of inner meniscus tissue formation. Human MFCs on a collagen scaffold were stimulated to form fibrocartilage over 6 weeks under normoxic (NRX, 20% O2) conditions with supplemented TGF-β3. Tissues experienced a delayed 24h hypoxia treatment (HYP, 3% O2) and then 5 min of dynamic compression (DC) between 30 and 40% strain. Delayed HYP induced an anabolic and anti-catabolic expression profile for hyaline cartilage matrix markers, while DC induced an inflammatory matrix remodeling response along with upregulation of both SOX9 and COL1A1. There were 41 genes regulated by both HYP and DC. Overall, the combined treatment supported a unique gene expression profile favouring the hyaline cartilage aspect of inner meniscus matrix and matrix remodeling.
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Affiliation(s)
- Alexander Ra Szojka
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Rita de Cássia Marqueti
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.,Graduate Program of Rehabilitation Sciences, University of Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - David Xinzheyang Li
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.,Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Clayton W Molter
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Yan Liang
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Nadr M Jomha
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
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16
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Anderson-Baron M, Liang Y, Kunze M, Mulet-Sierra A, Osswald M, Ansari K, Seikaly H, Adesida AB. Suppression of Hypertrophy During in vitro Chondrogenesis of Cocultures of Human Mesenchymal Stem Cells and Nasal Chondrocytes Correlates With Lack of in vivo Calcification and Vascular Invasion. Front Bioeng Biotechnol 2021; 8:572356. [PMID: 33469528 PMCID: PMC7813892 DOI: 10.3389/fbioe.2020.572356] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023] Open
Abstract
Objective Human nasal septal chondrocytes (NC) are a promising minimally invasive derivable chondrogenic cell source for cartilage repair. However, the quality of NC-derived cartilage is variable between donors. Coculture of NC with mesenchymal stem cells (MSCs) mitigates the variability but with undesirable markers of chondrocyte hypertrophy, such as type X collagen, and the formation of unstable calcifying cartilage at ectopic sites. In contrast, monoculture NC forms non-calcifying stable cartilage. Formation of a stable NC-MSC coculture cartilage is crucial for clinical application. The aim of this study was to explore the utility of parathyroid hormone-related peptide (PTHrP) hormone to suppress chondrocyte hypertrophy in NC-MSC cocultures and form stable non-calcifying cartilage at ectopic sites. Methods Human NC and bone marrow MSCs, and cocultures of NC and MSC (1:3 ratio) were aggregated in pellet form and subjected to in vitro chondrogenesis for 3 weeks in chondrogenic medium in the presence and absence of PTHrP. Following in vitro chondrogenesis, the resulting pellets were implanted in immunodeficient athymic nude mice for 3 weeks. Results Coculture of NC and MSC resulted in synergistic cartilage matrix production. PTHrP suppressed the expression of hypertrophy marker, type X collagen (COL10A1), in a dose-dependent fashion without affecting the synergism in cartilage matrix synthesis, and in vivo calcification was eradicated with PTHrP. In contrast, cocultured control (CC) pellets without PTHrP treatment expressed COL10A1, calcified, and became vascularized in vivo.
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Affiliation(s)
- Matthew Anderson-Baron
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada.,Division of Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada
| | - Yan Liang
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada.,Division of Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada
| | - Melanie Kunze
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada.,Division of Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada.,Division of Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada
| | - Martin Osswald
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada.,Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, AB, Canada
| | - Khalid Ansari
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Adetola B Adesida
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada.,Division of Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, University of Alberta, Edmonton, AB, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
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17
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Elkhenany HA, Szojka ARA, Mulet-Sierra A, Liang Y, Kunze M, Lan X, Sommerfeldt M, Jomha NM, Adesida AB. Bone Marrow Mesenchymal Stem Cell-Derived Tissues are Mechanically Superior to Meniscus Cells. Tissue Eng Part A 2020; 27:914-928. [PMID: 32940137 DOI: 10.1089/ten.tea.2020.0183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bone marrow-derived mesenchymal stem cells (BMSCs) have the potential to form the mechanically responsive matrices of joint tissues, including the menisci of the knee joint. The purpose of this study is to assess BMSC's potential to engineer meniscus-like tissue relative to meniscus fibrochondrocytes (MFCs). MFCs were isolated from castoffs of partial meniscectomy from nonosteoarthritic knees. BMSCs were developed from bone marrow aspirates of the iliac crest. All cells were of human origin. Cells were cultured in type I collagen scaffolds under normoxia (21% O2) for 2 weeks followed by hypoxia (3% O2) for 3 weeks. The structural and functional assessment of the generated meniscus constructs were based on glycosaminoglycan (GAG) content, histological appearance, gene expression, and mechanical properties. The tissues formed by both cell types were histologically positive for Safranin O stain and appeared more intense in the BMSC constructs. This observation was confirmed by a 2.7-fold higher GAG content. However, there was no significant difference in collagen I (COL1A2) expression in BMSC- and MFC-based constructs (p = 0.17). The expression of collagen II (COL2A1) and aggrecan (ACAN) were significantly higher in BMSCs than MFC (p ≤ 0.05). Also, the gene expression of the hypertrophic marker collagen X (COL10A1) was 199-fold higher in BMSCs than MFC (p < 0.001). Moreover, relaxation moduli were significantly higher in BMSC-based constructs at 10-20% strain step than MFC-based constructs. BMSC-based constructs expressed higher COL2A1, ACAN, COL10A1, contained higher GAG content, and exhibited higher relaxation moduli at 10-20% strain than MFC-based construct. Impact statement Cell-based tissue engineering (TE) has the potential to produce functional tissue replacements for irreparably damaged knee meniscus. But the source of cells for the fabrication of the tissue replacements is currently unknown and of research interest in orthopedic TE. In this study, we fabricated tissue-engineered constructs using type I collagen scaffolds and two candidate cell sources in meniscus TE. We compared the mechanical properties of the tissues formed from human meniscus fibrochondrocytes and bone marrow-derived mesenchymal stem cells (BMSCs). Our data show that the tissues engineered from the BMSC are mechanically superior in relaxation modulus.
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Affiliation(s)
- Hoda A Elkhenany
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Surgery, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt
| | - Alexander R A Szojka
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aillette Mulet-Sierra
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Yan Liang
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Kunze
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Xiaoyi Lan
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Mark Sommerfeldt
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
| | - Nadr M Jomha
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Adetola B Adesida
- Divisions of Orthopedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Makarevic A, Markfeld-Erol F, Prömpeler H, Kunze M, Juhasz-Böss I. Zwei akute Blutungsereignisse in der Frühschwangerschaft. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | - H Prömpeler
- Universitätsfrauenklinik Freiburg, Pränataldiagnostik
| | - M Kunze
- Universitätsfrauenklinik Freiburg
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19
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Meschede J, Bertz H, Kunze M, Juhasz-Böss I, Markfeld-Erol F. Progredientes metastasiertes Colonkarzinom in der Schwangerschaft- eine interdisziplinäre Herausforderung. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Meschede
- Universitätsklinik Freiburg, Frauenklinik
| | - H Bertz
- Universitätsklinik Freiburg, Innere Medizin 1
| | - M Kunze
- Universitätsklinik Freiburg, Frauenklinik
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20
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Medl M, Kunze M, Juhasz-Böss I, Markfeld-Erol F. Management einer großen Ovarialzyste in einer fortgeschrittenen Schwangerschaftswoche. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Snoeck V, Kunze M, Juhasz-Böss I, Markfeld-Erol F. Fulminantes postpartales HELLP-Syndrom. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- V Snoeck
- Uniklinik Freiburg, Klinik für Frauenheilkunde
| | - M Kunze
- Uniklinik Freiburg, Klinik für Frauenheilkunde
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22
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Zavala G, González F, Hidalgo C, Kunze M, Khoury M, Acevedo J. Injectable functionalized-gelatin derived from cold-adapted species balances between arthroscopic extrudability prerequisite, chondrocompatibility and biomechanical requirements for precise arthroscopic restoration. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Anderson-Baron M, Kunze M, Mulet-Sierra A, Osswald M, Ansari K, Seikaly H, Adesida AB. Nasal Chondrocyte-Derived Soluble Factors Affect Chondrogenesis of Cocultured Mesenchymal Stem Cells. Tissue Eng Part A 2020; 27:37-49. [PMID: 32122264 DOI: 10.1089/ten.tea.2019.0306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To investigate the effect of soluble factors released from human nasal chondrocytes (NCs) on cocultured human bone marrow mesenchymal stem cells (MSCs) and NC tissue-engineered constructs. Cartilage engineered from pure NCs on a three-dimensional (3D) porous collagen scaffold was cultured indirectly in a Transwell system with cartilage engineered from a direct coculture of human bone marrow-derived MSCs and NCs on a 3D porous collagen scaffold. The soluble factors were measured in the conditioned media from the different chambers of the Transwell system. Engineered cartilage from cocultures exposed to the pure NC construct exhibited reduced chondrogenic potential relative to control constructs, shown by reduced extracellular matrix deposition and increased expression of hypertrophic markers. Analysis of the soluble factors within the conditioned media showed an increase in inflammatory cytokines in the coculture chamber exposed to the pure NC construct. Principal component analysis revealed that the majority of the data variance could be explained by proinflammatory factors and hypertrophic chondrogenesis. In conclusion, our data suggest that inflammatory cytokines derived from NCs reduce the chondrogenic potential of coculture engineered cartilage through the induction of hypertrophic chondrogenesis. Impact statement The use of engineered cartilage from cocultured nasal chondrocytes (NCs) and mesenchymal stem cells for nasal cartilage reconstruction may be problematic. Our data suggest that the soluble factors from surrounding native NCs in the cartilage to be fixed can compromise the quality of the engineered cartilage if used in reconstructive surgery.
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Affiliation(s)
- Matthew Anderson-Baron
- Division of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, Canada
| | - Melanie Kunze
- Division of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, Canada
| | - Aillette Mulet-Sierra
- Division of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, Canada
| | - Martin Osswald
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, Canada.,Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Canada
| | - Khalid Ansari
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, Canada
| | - Adetola B Adesida
- Division of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, Canada
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24
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Liang Y, Szojka ARA, Idrees E, Kunze M, Mulet-Sierra A, Adesida AB. Re-Differentiation of Human Meniscus Fibrochondrocytes Differs in Three-Dimensional Cell Aggregates and Decellularized Human Meniscus Matrix Scaffolds. Ann Biomed Eng 2020; 48:968-979. [PMID: 31147805 DOI: 10.1007/s10439-019-02272-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023]
Abstract
Decellularized matrix (DCM) derived from native tissues may be a promising supporting material to induce cellular differentiation by sequestered bioactive factors. However, no previous study has investigated the use of human meniscus-derived DCM to re-differentiate human meniscus fibrochondrocytes (MFCs) to form meniscus-like extracellular matrix (ECM). We expanded human MFCs and seeded them upon a cadaveric meniscus-derived DCM prepared by physical homogenization under hypoxia. To assess the bioactivity of the DCM, we used conditions with and without chondrogenic factor TGF-β3 and set up a cell pellet culture model as a biomaterial-free control. We found that the DCM supported chondrogenic re-differentiation and ECM formation of MFCs only in the presence of exogenous TGF-β3. Chondrogenic re-differentiation was more robust at the protein level in the pellet model as MFCs on the DCM appeared to favour a more proliferative phenotype. Interestingly, without growth factors, the DCM tended to promote expression of hypertrophic differentiation markers relative to the pellet model. Therefore, the human meniscus-derived DCM prepared by physical homogenization contained insufficient bioactive factors to induce appreciable ECM formation by human MFCs.
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Affiliation(s)
- Yan Liang
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Li Ka Shing Centre for Health Research Innovation (3.002E), Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, T6G 2E1, Canada
- Division of Burn and Reconstructive Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Alexander R A Szojka
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Li Ka Shing Centre for Health Research Innovation (3.002E), Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, T6G 2E1, Canada
| | - Enaam Idrees
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Li Ka Shing Centre for Health Research Innovation (3.002E), Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, T6G 2E1, Canada
| | - Melanie Kunze
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Li Ka Shing Centre for Health Research Innovation (3.002E), Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, T6G 2E1, Canada
| | - Aillette Mulet-Sierra
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Li Ka Shing Centre for Health Research Innovation (3.002E), Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, T6G 2E1, Canada
| | - Adetola B Adesida
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Li Ka Shing Centre for Health Research Innovation (3.002E), Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Edmonton, T6G 2E1, Canada.
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25
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Anderson-Baron M, Kunze M, Mulet-Sierra A, Adesida AB. Effect of cell seeding density on matrix-forming capacity of meniscus fibrochondrocytes and nasal chondrocytes in meniscus tissue engineering. FASEB J 2020; 34:5538-5551. [PMID: 32090374 DOI: 10.1096/fj.201902559r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022]
Abstract
The presence of intact menisci is imperative for the proper function of the knee joint. Meniscus injuries are often treated by the surgical removal of the damaged tissue, which increases the likelihood of post-traumatic osteoarthritis. Tissue engineering holds great promise in producing viable engineered meniscal tissue for implantation using the patient's own cells; however, the cell source for producing the engineered tissue is unclear. Nasal chondrocytes (NC) possess many attractive features for engineering meniscus. However, in order to validate the use of NC for engineering meniscus fibrocartilage, a thorough comparison of NC and meniscus fibrochondrocytes (MFC) must be considered. Our study presents an analysis of the relative features of NC and MFC and their respective chondrogenic potential in a pellet culture model. We showed considerable differences in the cartilage tissue formed by the two different cell types. Our data showed that NC were more proliferative in culture, deposited more extracellular matrix, and showed higher expression of chondrogenic genes than MFC. Overall, our data suggest that NC produce superior cartilage tissue to MFC in a pellet culture model. In addition, NCs produce higher quality cartilage tissue at higher cell seeding densities during cell expansion.
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Affiliation(s)
- Matthew Anderson-Baron
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Melanie Kunze
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Adetola B Adesida
- Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, 3-021 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
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26
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Stavropoulou D, Hentschel R, Rädecke J, Kunze M, Niemeyer C, Uhl M, Grohmann J. Preoperative selective embolization with vascular coiling of giant sacrococcygeal teratoma. J Neonatal Perinatal Med 2020; 12:345-349. [PMID: 30932896 DOI: 10.3233/npm-180066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sacrococcygeal teratoma is one of the most common congenital tumors. Its optimal management requires interdisciplinary care by obstetricians, radiologists, pediatric surgeons, and neonatologists. Early surgery entailing complete tumor excision is the main therapy aim, but a substantial risk of life-threatening complications remains, especially uncontrollable intraoperative hemorrhage. To reduce the risk of bleeding in a female neonate with a giant sacrococcygeal teratoma, we successfully coil-embolized the tumor's main feeding arteries. Her subsequent complete surgical resection was uneventful, and the child is well with favorable reconstructive and functional status of all involved and adjacent organ systems.
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Affiliation(s)
- D Stavropoulou
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Hentschel
- Department of General Pediatrics, Adolescent Medicine, Division of Neonatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Rädecke
- Department of Pediatric Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kunze
- Department of Obstetrics and Gynecology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Niemeyer
- Department of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Uhl
- Department of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Grohmann
- Department of Congenital Heart Defects and Pediatric Cardiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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27
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Andrews SHJ, Kunze M, Mulet-Sierra A, Williams L, Ansari K, Osswald M, Adesida AB. Author Correction: Strategies to Mitigate Variability in Engineering Human Nasal Cartilage. Sci Rep 2019; 9:17115. [PMID: 31723212 PMCID: PMC6853904 DOI: 10.1038/s41598-019-53740-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stephen H J Andrews
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Melanie Kunze
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Aillette Mulet-Sierra
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Lynn Williams
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada
| | - Khalid Ansari
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Martin Osswald
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada.,Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada
| | - Adetola B Adesida
- Laboratory of Stem Cell Biology and Orthopaedic Tissue Engineering, Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, University of Alberta, Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada.
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28
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Szojka ARA, Lyons BD, Moore CN, Liang Y, Kunze M, Idrees E, Mulet-Sierra A, Jomha NM, Adesida AB. Hypoxia and TGF-β3 Synergistically Mediate Inner Meniscus-Like Matrix Formation by Fibrochondrocytes. Tissue Eng Part A 2019; 25:446-456. [PMID: 30343640 DOI: 10.1089/ten.tea.2018.0211] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The interactions of hypoxia and TGF-β3 in aggregates of human meniscus fibrochondrocytes are synergistic in nature, suggesting combinatorial strategies using these factors are promising for tissue engineering the inner meniscus regions. Hypoxia alone in the absence of TGF-β supplementation may be insufficient to initiate an inner meniscus-like extracellular matrix-forming response in this model.
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Affiliation(s)
- Alexander R A Szojka
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Brayden D Lyons
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Colleen N Moore
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Yan Liang
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- 2 Division of Burn and Reconstructive Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China
| | - Melanie Kunze
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Enaam Idrees
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Aillette Mulet-Sierra
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Nadr M Jomha
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Adetola B Adesida
- 1 Divisions of Orthopaedic Surgery and Surgical Research, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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29
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Liang Y, Idrees E, Szojka ARA, Andrews SHJ, Kunze M, Mulet-Sierra A, Jomha NM, Adesida AB. Chondrogenic differentiation of synovial fluid mesenchymal stem cells on human meniscus-derived decellularized matrix requires exogenous growth factors. Acta Biomater 2018; 80:131-143. [PMID: 30267878 DOI: 10.1016/j.actbio.2018.09.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
The objective of this study was to investigate whether meniscus-derived decellularized matrix (DCM) has the capacity to induce differentiation of synovial fluid-derived mesenchymal stem cells (SF-MSCs) towards a meniscus fibrochondrocyte (MFC) phenotype. The potential roles of transforming growth factor beta-3 (TGF-β3) and insulin-like growth factor 1 (IGF-1) in the differentiation of SF-MSCs towards an MFC phenotype were also investigated. SF-MSCs were isolated via plastic adherence cell culture from the synovial fluid of five donors (5 male, average age 34 years). Porous DCM was generated by homogenizing and freeze-drying fresh normal human cadaveric meniscus tissue. SF-MSCs were seeded and cultured on the DCM scaffold in a defined serum-free media (SFM) supplemented with or without the combination of TGF-β3 and IGF-1. Cell pellets of SF-MSCs were cultured in SFM with either TGF-β3 or IGF-1 or their combination as controls. The duration of culture was 3 weeks for both experimental configurations. We assessed newly-formed tissues by biochemical assays, scanning electron microscopy (SEM), immunofluorescence and quantitative real-time PCR (qPCR). The combination of TGF-β3 and IGF-1 induced production of the cartilaginous matrix in DCM and upregulated the expression of aggrecan, collagens I and II. Moreover, the SF-MSCs exhibited a round morphology in the DCM scaffolds in the presence of the growth factors. In pellets, combined TGF-β3 and IGF-1 synergistically enhanced cartilaginous matrix production. In contrast to bone marrow mesenchymal stem cells (BM-MSCs), the differentiated SF-MSCs showed little evidence of the expression of the hypertrophic differentiation marker, collagen X. In conclusion, meniscus-derived DCM appears to require exogenous growth factor supplementation to direct differentiation of SF-MSCs. STATEMENT OF SIGNIFICANCE: Meniscus tears are the most common injury of the knee joint. These tears pose a major risk factor for the early development of knee osteoarthritis. Unfortunately, the majority of these tears occur in the inner region of the meniscus and lacks blood supply with no reparative or regenerative capacity. The goal of this study was to determine if the native extracellular matrix (ECM) of human meniscus has the capacity to differentiate human knee synovial fluid resident mesenchymal stem cells (SF-MSCs) towards a meniscus phenotype as a potential strategy to repair avascular meniscal tears. Our findings show that the human meniscus-derived ECM without supplementation with growth factors (TGF-β3 and IGF-1) cannot differentiate SF-MSCs towards a meniscus phenotype. The use of meniscus-derived scaffolds as a material to stimulate endogenous repair of meniscus tears via differentiation of SF-MSCs may require supplementation with TGF-β3 and IGF-1.
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Affiliation(s)
- Yan Liang
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada; Division of Burn and Reconstructive Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Enaam Idrees
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada
| | - Alexander R A Szojka
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada
| | - Stephen H J Andrews
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada
| | - Melanie Kunze
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada
| | - Aillette Mulet-Sierra
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada
| | - Nadr M Jomha
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada
| | - Adetola B Adesida
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, Alberta T6G 2E1, Canada.
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Hagenah HP, Dudenhausen JW, Schild RL, Stein W, Kunze M, Voigt M. Zur Beurteilung der fetalen Gewichtschätzung unter Berücksichtigung von Korrekturwerten für Körperhöhe und Körpergewicht der Mutter und daraus resultierenden Konsequenzen in der täglich klinischen Praxis. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- HP Hagenah
- Agaplesion Diakonieklinikum Rotenburg, Frauenklinik, Rotenburg, Deutschland
| | - JW Dudenhausen
- Dept. of Obstetrics and Gynecology, Weill Cornell Medicine, New York, Vereinigte Staaten von Amerika
- Charité Universitätsmedizin, Berlin, Deutschland
| | - RL Schild
- DIAKOVERE Henriettenstift und Friederikenstift, Hannover, Deutschland
| | - W Stein
- Agaplesion Diakonieklinikum Rotenburg, Frauenklinik, Rotenburg, Deutschland
| | - M Kunze
- Universitätsklinikum Freiburg, Frauenklinik, Abt. Geburtshilfe, Freiburg, Deutschland
| | - M Voigt
- Center for Medicine and Society, University of Freiburg, Freiburg, Deutschland
- Medizinische Fakultät der Universität Freiburg, Freiburg, Deutschland
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Winkler K, Contini C, König B, Krumrey B, Pütz G, Zschiedrich S, Pecks U, Stavropoulou D, Prömpeler H, Kunze M, Markfeld-Erol F. Treatment of very preterm preeclampsia via heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.) apheresis: The Freiburg preeclampsia H.E.L.P.-Apheresis study. Pregnancy Hypertens 2018; 12:136-143. [PMID: 29858106 DOI: 10.1016/j.preghy.2018.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/02/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Soluble Fms-like tyrosine kinase-1 (sFlt-1) is thought to be causative in the pathogenesis of preeclampsia (PE) and specific removal of sFlt-1 via dextran sulfate cellulose (DSC)-apheresis was suggested as cure to allow prolongation of pregnancy in preterm PE. However, in addition a deranged lipoprotein metabolism may impact endothelial and placental function in PE. Lipoprotein-apheresis by heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.) was previously applied and has been shown to alleviate symptoms in PE. This clinical trial reevaluates the clinical efficacy of H.E.L.P.-apheresis in PE considering sFlt-1. STUDY DESIGN Open pilot study assessing the prolongation by H.E.L.P.-apheresis in 6 women (30-41 years) with very preterm PE (24+4 to 27+0 gestational weeks (GW)) (NCT01967355) compared to a historic control-group matched for GW at admission (<28 GW; n = 6). Clinical outcome of mothers and babies, and pre- and post H.E.L.P.-apheresis levels of sFlt-1 and PlGF were monitored. MAIN OUTCOME MEASURES In apheresis patients (2-6 treatments), average time from admission to birth was 15.0 days (6.3 days in controls; p = 0.027). Lung maturation was induced in all treated cases, and all children were released in healthy condition. Apheresis reduced triglycerides and LDL-cholesterol by more than 40%. Although H.E.L.P.-apheresis induced a transient peak baseline levels did not change and rather stabilized sFlt-1 levels at pre-apheresis levels throughout treatments, with sFlt-1/PLGF ratio remaining unaffected. CONCLUSIONS H.E.L.P.-apheresis proved again to be safe and prolongs pregnancies in PE. However, without changing sFlt-1 levels below baseline lowering lipids or other yet undefined factors appear to be of more relevance than reducing sFlt-1.
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Affiliation(s)
- K Winkler
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany.
| | - C Contini
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - B König
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - B Krumrey
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - G Pütz
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - S Zschiedrich
- Renal Division, Department of Medicine, University Hospital Freiburg, Germany
| | - U Pecks
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus, Kiel, Germany
| | - D Stavropoulou
- Department of Neonatology, Children's Hospital, University of Freiburg, Germany
| | - H Prömpeler
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Germany
| | - M Kunze
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Germany
| | - F Markfeld-Erol
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Germany
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Liang Y, Idrees E, Andrews SHJ, Labib K, Szojka A, Kunze M, Burbank AD, Mulet-Sierra A, Jomha NM, Adesida AB. Plasticity of Human Meniscus Fibrochondrocytes: A Study on Effects of Mitotic Divisions and Oxygen Tension. Sci Rep 2017; 7:12148. [PMID: 28939894 PMCID: PMC5610182 DOI: 10.1038/s41598-017-12096-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/04/2017] [Indexed: 02/07/2023] Open
Abstract
Meniscus fibrochondrocytes (MFCs) may be the optimal cell source to repair non-healing meniscus injuries using tissue engineering strategies. In this study, we investigated the effects of mitotic divisions and oxygen tension on the plasticity of adult human MFCs. Our assessment techniques included gene expression, biochemical, histological, and immunofluorescence assays. MFCs were expanded in monolayer culture with combined growth factors TGFβ1 and FGF-2 (T1F2) under normoxia (21% O2). Trilineage (adipogenesis, chondrogenesis and osteogenesis) differentiation was performed under both normoxic (21% O2) and hypoxic (3% O2) conditions. The data demonstrated that MFCs with a mean total population doubling of 10 can undergo adipogenesis and chondrogenesis. This capability was enhanced under hypoxic conditions. The MFCs did not undergo osteogenesis. In conclusion, our findings suggest that extensively expanded human MFCs have the capacity to generate tissues with the functional matrix characteristics of avascular meniscus. To this end, expanded MFCs may be an ideal cell source for engineering functional constructs for the replacement or repair of avascular meniscus.
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Affiliation(s)
- Yan Liang
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
- Division of Burn and Reconstructive Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Enaam Idrees
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Stephen H J Andrews
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Kirollos Labib
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Alexander Szojka
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Melanie Kunze
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Andrea D Burbank
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Aillette Mulet-Sierra
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Nadr M Jomha
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada
| | - Adetola B Adesida
- University of Alberta, Department of Surgery, Divisions of Orthopaedic Surgery and Surgical Research, Edmonton, T6G 2E1, Canada.
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Kranz J, Schmidt S, Lebert C, Schneidewind L, Vahlensieck W, Sester U, Fünfstück R, Helbig S, Hofmann W, Hummers E, Kunze M, Kniehl E, Naber K, Mandraka F, Mündner-Hensen B, Schmiemann G, Wagenlehner FME. Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Urologe A 2017; 56:746-758. [DOI: 10.1007/s00120-017-0389-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Winkler K, Markfeld-Erol F, Kunze M, Christine C, König B, Krumrey B, Pütz G, Zschiedrich S, Pecks U, Hentschel R, Prömpeler H. Verlängerung der Schwangerschaft mittels Heparin-induzierter, extrakorporaler LDL-Präzipitation (H.E.L.P.-Apherese) bei Präeklampsie: Die Freiburg Preeclampsia H.E.L.P.-Apheresis Study. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1600080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- K Winkler
- Universitätsklinikum Freiburg, Institut für Klinische Chemie und Laboratoriumsmedizin, Freiburg, Deutschland
| | - F Markfeld-Erol
- Universitätsklinikum Freiburg, Klinik für Frauenheilkunde, Freiburg, Deutschland
| | - M Kunze
- Universitätsklinikum Freiburg, Klinik für Frauenheilkunde, Freiburg, Deutschland
| | - C Christine
- Universitätsklinikum Freiburg, Institut für Klinische Chemie und Laboratoriumsmedizin, Freiburg, Deutschland
| | - B König
- Universitätsklinikum Freiburg, Institut für Klinische Chemie und Laboratoriumsmedizin, Freiburg, Deutschland
| | - B Krumrey
- Universitätsklinikum Freiburg, Institut für Klinische Chemie und Laboratoriumsmedizin, Freiburg, Deutschland
| | - G Pütz
- Universitätsklinikum Freiburg, Institut für Klinische Chemie und Laboratoriumsmedizin, Freiburg, Deutschland
| | - S Zschiedrich
- Universitätsklinikum Freiburg, Klinik für Innere Medizin IV, Schwerpunkt Nephrologie und Allgemeinmedizin, Freiburg, Deutschland
| | - U Pecks
- Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Kiel, Deutschland
| | - R Hentschel
- Universitätsklinikum Freiburg, Klinik für Allgemeine Kinder- und Jugendmedizin, Freiburg, Deutschland
| | - H Prömpeler
- Universitätsklinikum Freiburg, Klinik für Frauenheilkunde, Freiburg, Deutschland
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Voigt M, Hentschel R, Kunze M, Nikischin W, Olbertz D, Hagenah HP, Wittwer-Backofen U, Strauss A. Vergleich der Perzentilkurven von Körpermaßen neugeborener Einlinge, Zwillinge und Drillinge. Z Geburtshilfe Neonatol 2017; 221:43-44. [PMID: 28363233 DOI: 10.1055/s-0043-101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Voigt
- Zentrum für Medizin und Gesellschaft, Universität Freiburg, Freiburg
| | - R Hentschel
- Klinik für Allgemeine Kinder- und Jugendmedizin Funktionsbereich Neonatologie/Intensivmedizin, Universitätsklinikum Freiburg, Freiburg
| | - M Kunze
- Frauenklinik, Abteilung Geburtshilfe, Universität Freiburg, Freiburg
| | - W Nikischin
- Kinderklinik, Abteilung Neonatologie, Universität Kiel, Kiel
| | - D Olbertz
- Abteilung Neonatologie und Neonatologische Intensivmedizin, Klinikum Südstadt, Rostock
| | - H P Hagenah
- Frauenklinik, Abteilung Geburtshilfe, Agaplesion-Klinikum, Rotenburg
| | | | - A Strauss
- Christian-Albrechts-Universität, Kiel
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Hug C, Markfeld-Erol F, Kunze M, Prömpeler H. Schwangerschaft bei dialysepflichtiger schwerer Nierenerkrankung oder nach erfolgreicher Nierentransplantation. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Westermann C, Markfeld-Erol F, Kunze M, Kalbhenn J, Prömpeler H. Maternale Bradykardie unter der Geburt – Die peripartale Kardiomyopathie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dany N, Markfeld-Erol F, Kunze M, Frankenschmidt A, Stenzel M, Pohl M, Kurz P, Prömpeler H. Rapide wachsendes mesoblastisches Nephrom in der Schwangerschaft. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Huhn EA, Fischer T, Göbl CS, Todesco Bernasconi M, Kreft M, Kunze M, Schoetzau A, Dölzlmüller E, Eppel W, Husslein P, Ochsenbein-Koelble N, Zimmermann R, Bäz E, Prömpeler H, Bruder E, Hahn S, Hoesli I. Screening of gestational diabetes mellitus in early pregnancy by oral glucose tolerance test and glycosylated fibronectin: study protocol for an international, prospective, multicentre cohort trial. BMJ Open 2016; 6:e012115. [PMID: 27733413 PMCID: PMC5073542 DOI: 10.1136/bmjopen-2016-012115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION As the accurate diagnosis and treatment of gestational diabetes mellitus (GDM) is of increasing importance; new diagnostic approaches for the assessment of GDM in early pregnancy were recently suggested. We evaluate the diagnostic power of an 'early' oral glucose tolerance test (OGTT) 75 g and glycosylated fibronectin (glyFn) for GDM screening in a normal cohort. METHODS AND ANALYSIS In a prospective cohort study, 748 singleton pregnancies are recruited in 6 centres in Switzerland, Austria and Germany. Women are screened for pre-existing diabetes mellitus and GDM by an 'early' OGTT 75 g and/or the new biomarker, glyFn, at 12-15 weeks of gestation. Different screening strategies are compared to evaluate the impact on detection of GDM by an OGTT 75 g at 24-28 weeks of gestation as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). A new screening algorithm is created by using multivariable risk estimation based on 'early' OGTT 75 g and/or glyFn results, incorporating maternal risk factors. Recruitment began in May 2014. ETHICS AND DISSEMINATION This study received ethical approval from the ethics committees in Basel, Zurich, Vienna, Salzburg and Freiburg. It was registered under http://www.ClinicalTrials.gov (NCT02035059) on 12 January 2014. Data will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02035059.
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Affiliation(s)
- E A Huhn
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - T Fischer
- Department of Obstetrics and Gynaecology, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - C S Göbl
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - M Todesco Bernasconi
- Department of Obstetrics and Gynaecology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - M Kreft
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - M Kunze
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - A Schoetzau
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
| | - E Dölzlmüller
- Department of Obstetrics and Gynaecology, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - W Eppel
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - P Husslein
- Division of Obstetrics and Feto-maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - N Ochsenbein-Koelble
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - R Zimmermann
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - E Bäz
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - H Prömpeler
- Department of Obstetrics and Gynaecology, University Hospital Freiburg, Freiburg, Germany
| | - E Bruder
- Department of Pathology, University Hospital Basel, Basel, Switzerland
| | - S Hahn
- Department of Biomedicine, Laboratory of Perinatology, University Basel, Basel, Switzerland
| | - I Hoesli
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland
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Voigt M, Olbertz D, Hentschel R, Kunze M, Hagenah HP, Scholz R, Wittwer-Backofen U, Hesse V, Straube S. Percentile Values for the Anthropometric Dimensions of Triplet Neonates - Analysis of German Perinatal Survey Data of 2007-2011 from all States of Germany. Z Geburtshilfe Neonatol 2016; 220:185. [PMID: 27392283 DOI: 10.1055/s-0042-111604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Voigt
- Zentrum für Medizin und Gesellschaft, Universität Freiburg, Freiburg
| | - D Olbertz
- Abteilung Neonatologie und Neonatologische Intensivmedizin, Klinikum Südstadt, Rostock
| | - R Hentschel
- Klinik für Allgemeine Kinder- und Jugendmedizin, Funktionsbereich Neonatologie/Intensivmedizin, Universitätsklinikum Freiburg, Freiburg
| | - M Kunze
- Frauenklinik, Universitätsklinikum Freiburg, Freiburg
| | - H-P Hagenah
- Abteilung Geburtshilfe, Agaplesion Klinikum Rotenburg, Rotenburg (Wümme)
| | - R Scholz
- Max-Planck-Institut für Demografische Forschung, Arbeitsbereich Demografische Daten, Rostock
| | | | - V Hesse
- Deutsches Zentrum für Wachstum, Entwicklung und Gesundheitsförderung im Kindes- und Jugendalter, Berlin
| | - S Straube
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
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Afreen S, Bohler S, Kunze M, Weiss JM, Erlacher M. The role of the anti-apoptotic protein Bcl-xL for the maintenance of human hematopoiesis. Klin Padiatr 2016. [DOI: 10.1055/s-0036-1582503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Voigt M, Olbertz D, Hentschel R, Kunze M, Hagenah HP, Scholz R, Wittwer-Backofen U, Hesse V, Straube S. [Percentile Values for the Anthropometric Dimensions of Triplet Neonates - Analysis of German Perinatal Survey Data of 2007-2011 from all States of Germany]. Z Geburtshilfe Neonatol 2016; 220:66-73. [PMID: 27111593 DOI: 10.1055/s-0035-1564090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM We aimed to develop national reference values for birth weight, length, head circumference, and weight for length for newborn triplets based on data from the German perinatal survey of 2007-2011. MATERIAL AND METHODS Perinatal survey data of 3,690 newborn triplets from all the states of Germany were kindly provided to us by the AQUA Institute in Göttingen, Germany. Data of 3,567 newborn triplets were included in the analyses. Sex-specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for 21-36 completed weeks of gestation. RESULTS AND CONCLUSIONS We present the first German reference values (tables and curves) for the anthropometric dimensions of triplet neonates and compare selected birth weight and length percentiles of triplets (after 32 and 34 completed weeks of gestation) to those of singletons and twins. The differences in the 50th birth weight percentiles between singletons and triplets after 32 completed weeks of gestation were 180 g for girls and 210 g for boys; after 34 weeks of gestation the differences were 320 and 325 g, respectively. The differences between twins and triplets after 32 weeks of gestation were 100 g for girls and 120 g for boys; after 34 weeks of gestation they were 130 and 135 g, respectively. The data presented here enable the classification of newborn triplets according to somatic parameters making reference to German perinatal data.
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Affiliation(s)
- M Voigt
- Zentrum für Medizin und Gesellschaft, Universität Freiburg, Freiburg
| | - D Olbertz
- Abteilung Neonatologie und Neonatologische Intensivmedizin, Klinikum Südstadt, Rostock
| | - R Hentschel
- Klinik für Allgemeine Kinder- und Jugendmedizin, Funktionsbereich Neonatologie/Intensivmedizin, Universitätsklinikum Freiburg, Freiburg
| | - M Kunze
- Frauenklinik, Universitätsklinikum Freiburg, Freiburg
| | - H-P Hagenah
- Abteilung Geburtshilfe, Agaplesion Klinikum Rotenburg, Rotenburg (Wümme)
| | - R Scholz
- Max-Planck-Institut für Demografische Forschung, Arbeitsbereich Demografische Daten, Rostock
| | | | - V Hesse
- Deutsches Zentrum für Wachstum, Entwicklung und Gesundheitsförderung im Kindes- und Jugendalter, Berlin
| | - S Straube
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
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Hug C, Markfeld-Erol F, Kunze M, Prömpeler H. Uterusruptur nach B-Lynch-Nähten und Massentransfusion. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Voigt M, Kunze M, Strauss A, Hagenah HP, Wittwer-Backofen U, Straube S. Beziehungen zwischen Körperhöhe der Mütter, Schwangerschaftsdauer und dem Geburtsgewicht der Neugeborenen. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kunze M, Markfeld-Erol F, Balafoutas D, Hasenburg A, Prömpeler H. Erfolgreiche Schwangerschaftsverlängerung nach Uterusruptur bei Plazenta increta und Geminigravidität in der 16. SSW. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Contini C, König B, Markfeld-Erol F, Kunze M, Krumrey B, Zschiedrich S, Prömpeler H, Pütz G, Winkler K. The Freiburg Preeclampsia H.E.L.P.-Apheresis Study: rationale for lipid-apheresis in preeclampsia. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rasenack R, Baez E, Kunze M, Proempeler H. 40 Jahre Blutgruppen-Inkompatibilität am Perinatalzentrum. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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48
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Dany N, Neumann-Haefelin E, Siebers F, Kunze M, Prömpeler H. Reaktivierung eines hämolytisch-urämischen Syndroms in der Schwangerschaft und erfolgreiche Therapie mit dem monoklonalen Antikörper Eculizumab. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Markfeld-Erol F, Kunze M, Contini C, König B, Krumrey B, Zschiedrich S, Pütz G, Prömpeler H, Winkler K. Die „Freiburg Preeclampsia H.E.L.P. Apheresis Study“: Klinischer Verlauf. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Fendl D, Gerdes T, Weber K, Waletzky A, Kunze M, Stiller S, Leoni AL. Evaluation of a mouse model for scrotal heat stress. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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