Impact of Porcine Pancreas Decellularization Conditions on the Quality of Obtained dECM

Due to the limited number of organ donors, 3D printing of organs is a promising technique. Tissue engineering is increasingly using xenogeneic material for this purpose. This study was aimed at assessing the safety of decellularized porcine pancreas, together with the analysis of the risk of an undesirable immune response. We tested eight variants of the decellularization process. We determined the following impacts: rinsing agents (PBS/NH₃·H₂O), temperature conditions (4 °C/24 °C), and the grinding method of native material (ground/cut). To assess the quality of the extracellular matrix after the completed decellularization process, analyses of the following were performed: DNA concentration, fat content, microscopic evaluation, proteolysis, material cytotoxicity, and most importantly, the Triton X-100 content. Our analyses showed that we obtained a product with an extremely low detergent content with negligible residual DNA content. The obtained results confirmed the performed histological and immuno-fluorescence staining. Moreover, the TEM microscopic analysis proved that the correct collagen structure was preserved after the decellularization process. Based on the obtained results, we chose the most favorable variant in terms of quality and biology. The method we chose is an effective and safe method that gives a chance for the development of transplant and regenerative medicine.

GMP compliant isolation of mucosal epithelial cells and fibroblasts from biopsy samples for clinical tissue engineering

Engineered epithelial cell sheets for clinical replacement of non-functional upper aerodigestive tract mucosa are regulated as medicinal products and should be manufactured to the standards of good manufacturing practice (GMP). The current gold standard for growth of epithelial cells for research utilises growth arrested murine 3T3 J2 feeder layers, which are not available for use as a GMP compliant raw material. Using porcine mucosal tissue, we demonstrate a new method for obtaining and growing non-keratinised squamous epithelial cells and fibroblast cells from a single biopsy, replacing the 3T3 J2 with a growth arrested primary fibroblast feeder layer and using pooled Human Platelet lysate (HPL) as the media serum supplement to replace foetal bovine serum (FBS). The initial isolation of the cells was semi-automated using an Octodissociator and the resultant cell suspension cryopreservation for future use. When compared to the gold standard of 3T3 J2 and FBS containing medium there was no reduction in growth, viability, stem cell population or ability to differentiate to mature epithelial cells. Furthermore, this method was replicated with Human buccal tissue, providing cells of sufficient quality and number to create a tissue engineered sheet.

[Effect of icariin/attapulgite/collagen type /polycaprolactone composite scaffold in repair of rabbit tibia defect]

OBJECTIVE

To investigate the effect of icarin/attapulgite/collagen type Ⅰ/polycaprolactone (ICA/ATP/Col Ⅰ/PCL) composite scaffold in repair of rabbit tibia defect.

METHODS

The ICA/20%ATP/Col Ⅰ/PCL (scaffold 1), ICA/30%ATP/Col Ⅰ/PCL (scaffold 2), 20%ATP/Col Ⅰ/PCL (scaffold 3), and 30%ATP/Col Ⅰ/PCL (scaffold 4) composite scaffolds were constructed by solution casting-particle filtration method. The structure characteristics of the scaffold 2 before and after cross-linking were observed by scanning electron microscopy, and the surface contact angles of the scaffold 2 and the scaffold 4 were used to evaluate the water absorption performance of the material. The in vitro degradation test was used to evaluate the sustained-release effect of the scaffold 2. Thirty male Japanese white rabbits, weighing (2.0±0.1) kg, were randomly divided into groups A, B, C, D, and E, 6 in each group. After making a 1 cm- diameter bilateral tibial defects model, group A was the defect control group without any material implanted. Groups B, C, D, and E were implanted with scaffolds 3, 4, 1, and 2 at the defect sites, respectively. At 4, 8, and 12 weeks after operation, the repairing effects of 4 scaffolds were observed by gross observation, histological observation of HE and Masson staining, and immunohistochemical staining of osteogenic specific transcription factor (runt-related transcription factor 2, RUNX2), osteogenic related transcription factor [Osterix (OSX), Col Ⅰ, osteopontin (OPN)].

RESULTS

Scanning electron microscopy observation showed that the scaffolds were all porous. The structure of the material was loose before and after cross-linking. The surface contact angle showed that the scaffold was hydrophobic, and the scaffold 2 was more hydrophobic than scaffold 4. The sustained-release effect in vitro showed that the drug could be released in a micro and long-term manner. In the animal implantation experiment, the gross observation showed that the defects were significantly smaller in groups D and E than in groups A, B, and C at 4 and 12 weeks after operation. HE and Masson staining showed that the defect of group A was full of connective tissue at 4 weeks after operation, a large number of fibers were seen in groups B and C, and the new bone formation was observed in groups D and E. The increase of new bone was observed in each group at 8 weeks after operation. The defect of group A was still dominated by connective tissue at 12 weeks after operation, and a small amount of new bone tissue was observed in groups B and C, and a large number of new bone tissue was observed in groups D and E, especially in group E, and most of the materials degraded. Immunohistochemical staining showed that the expressions of RUNX2 and OSX in the new tissues of groups D and E were significantly higher than those of the other groups at 4 weeks after operation. The expression of RUNX2 decreased at 8 and 12 weeks after operation. After 8 weeks and 12 weeks, the expressions of Col Ⅰand OPN increased than in 4 weeks. And the expressions of Col Ⅰ and OPN in the new tissues of groups D and E were significantly more than those of the other groups.

CONCLUSION

ICA/ATP/Col I/PCL composite scaffolds have good porosity and biocompatibility, can promote bone formation, and have good bone regeneration and repair effect.

3D printing of musculoskeletal tissues: impact on safety and health at work

Additive manufacturing (commonly referred to as 3D printing) created an attractive approach for regenerative medicine research in musculoskeletal tissue engineering. Given the high number of fabrication technologies available, characterized by different working and physical principles, there are several related risks that need to be managed to protect operators. Recently, an increasing number of studies demonstrated that several types of 3D printers are emitters of ultrafine particles and volatile organic compounds whose harmful effects through inhalation, ingestion and skin uptake are known. Confirmation of danger of these products is not yet final, but this provides a basis to adopt preventive measures in agreement with the precautionary principle. The purpose of this investigation was to provide a useful tool to the researcher for managing the risks related to the use of different kinds of three-dimensional printers (3D printers) in the lab, especiallyconcerning orthopedic applications, and to define appropriate control measures. Particular attention was given to new emerging risks and to developing response strategies for a comprehensive coverage of the health and safety of operators.

Engineering Human Tissue and Regulation: Confronting Biology and Law to Bridge the Gaps

There are a number of difficulties confronting the regulation of human tissue engineered products, from the scientific, ethical and legal perspectives. Many of these issues are international in scope and any responses must. consider the global implications of marketing and monitoring these products. The article argues that as tissue engineered products become more available regulatory authorities should not be I pressured into adopting possibly inappropriate measures, but must consider all the factors relevant to human health, including the need for innovative regulatory mechanisms as well as innovative tissue products themselves.

Clinical Translation of Cell Therapy, Tissue Engineering, and Regenerative Medicine Product in Malaysia and Its Regulatory Policy

With the worldwide growth of cell and tissue therapy (CTT) in treating diseases, the need of a standardized regulatory policy is of paramount concern. Research in CTT in Malaysia has reached stages of clinical trials and commercialization. In Malaysia, the regulation of CTT is under the purview of the National Pharmaceutical Control Bureau (NPCB), Ministry of Health (MOH). NPCB is given the task of regulating CTT, under a new Cell and Gene Therapy Products framework, and the guidelines are currently being formulated. Apart from the laboratory accreditation, researchers are advised to follow Guidelines for Stem Cell Research and Therapy from the Medical Development Division, MOH, published in 2009.

ASTM international workshop on standards and measurements for tissue engineering scaffolds

The "Workshop on Standards & Measurements for Tissue Engineering Scaffolds" was held on May 21, 2013 in Indianapolis, IN, and was sponsored by the ASTM International (ASTM). The purpose of the workshop was to identify the highest priority items for future standards work for scaffolds used in the development and manufacture of tissue engineered medical products (TEMPs). Eighteen speakers and 78 attendees met to assess current scaffold standards and to prioritize needs for future standards. A key finding was that the ASTM TEMPs subcommittees (F04.41-46) have many active "guide" documents for educational purposes, but few standard "test methods" or "practices." Overwhelmingly, the most clearly identified need was standards for measuring the structure of scaffolds, followed by standards for biological characterization, including in vitro testing, animal models and cell-material interactions. The third most pressing need was to develop standards for assessing the mechanical properties of scaffolds. Additional needs included standards for assessing scaffold degradation, clinical outcomes with scaffolds, effects of sterilization on scaffolds, scaffold composition, and drug release from scaffolds. Discussions highlighted the need for additional scaffold reference materials and the need to use them for measurement traceability. Workshop participants emphasized the need to promote the use of standards in scaffold fabrication, characterization, and commercialization. Finally, participants noted that standards would be more broadly accepted if their impact in the TEMPs community could be quantified. Many scaffold standard needs have been identified and focus is turning to generating these standards to support the use of scaffolds in TEMPs.

Preclinical good laboratory practice-compliant safety study to evaluate biodistribution and tumorigenicity of a cartilage advanced therapy medicinal product (ATMP)

BACKGROUND

The clinical development of advanced therapy medicinal products (ATMPs), a new class of drugs, requires initial safety studies that deviate from standard non-clinical safety protocols. The study provides a strategy to address the safety aspects of biodistribution and tumorigenicity of ATMPs under good laboratory practice (GLP) conditions avoiding cell product manipulation. Moreover, the strategy was applied on a human ATMP for cartilage repair.

METHODS

The testing strategy addresses biodistribution and tumorigenicity using a multi-step analysis without any cell manipulation to exclude changes of test item characteristics. As a safeguard measurement for meeting regulatory expectations, the project design and goals were discussed continuously with the regulatory authority using a staggered scientific advice concept. Subsequently, the strategy was applied to co.don chondrosphere® (huChon spheroid), a tissue-engineered matrix-free ATMP of human normal chondrocytes. In both the biodistribution and tumorigenicity studies, huChon spheroids were implanted subcutaneously into 40 immunodeficient mice. Biodistribution was studied 1 month after implantation. A skin disc containing the huChon spheroid, two surrounding skin rings and selected organs were analyzed by validated, gender-specific, highly-sensitive triplex qPCR and by immunohistochemistry (IHC).

RESULTS

No human DNA was detected in distant skin rings and analyzed organs. IHC revealed no direct or indirect indications of cell migration. Tumorigenicity was assessed 6 months after huChon spheroid implantation by palpation, macroscopic inspection, histology and IHC. No mice from the huChon spheroid group developed a tumor at the implantation site. In two mice, benign tumors were detected that were negative for HLA-ABC, suggesting that they were of spontaneous murine origin.

CONCLUSIONS

In summary, the presented strategy using a multi-step analysis was confirmed to be suitable for safety studies of ATMPs.

Concise review: tailoring bioengineered scaffolds for stem cell applications in tissue engineering and regenerative medicine

The potential for the clinical application of stem cells in tissue regeneration is clearly significant. However, this potential has remained largely unrealized owing to the persistent challenges in reproducibly, with tight quality criteria, and expanding and controlling the fate of stem cells in vitro and in vivo. Tissue engineering approaches that rely on reformatting traditional Food and Drug Administration-approved biomedical polymers from fixation devices to porous scaffolds have been shown to lack the complexity required for in vitro stem cell culture models or translation to in vivo applications with high efficacy. This realization has spurred the development of advanced mimetic biomaterials and scaffolds to increasingly enhance our ability to control the cellular microenvironment and, consequently, stem cell fate. New insights into the biology of stem cells are expected to eventuate from these advances in material science, in particular, from synthetic hydrogels that display physicochemical properties reminiscent of the natural cell microenvironment and that can be engineered to display or encode essential biological cues. Merging these advanced biomaterials with high-throughput methods to systematically, and in an unbiased manner, probe the role of scaffold biophysical and biochemical elements on stem cell fate will permit the identification of novel key stem cell behavioral effectors, allow improved in vitro replication of requisite in vivo niche functions, and, ultimately, have a profound impact on our understanding of stem cell biology and unlock their clinical potential in tissue engineering and regenerative medicine.

Regulatory biocompatibility requirements for biomaterials used in regenerative medicine

The biological safety of biomaterials used for implantable medical devices is usually determined by a series of standard tests that assess the effects that extractable substances have on cells in vitro and in simple short term animal studies. To use these tests to determine the suitability of materials for tissue engineering templates is inappropriate. This short essay discusses the issues that are involved.

Mechanical testing of hydrogels in cartilage tissue engineering: beyond the compressive modulus

Injuries to articular cartilage result in significant pain to patients and high medical costs. Unfortunately, cartilage repair strategies have been notoriously unreliable and/or complex. Biomaterial-based tissue-engineering strategies offer great promise, including the use of hydrogels to regenerate articular cartilage. Mechanical integrity is arguably the most important functional outcome of engineered cartilage, although mechanical testing of hydrogel-based constructs to date has focused primarily on deformation rather than failure properties. In addition to deformation testing, as the field of cartilage tissue engineering matures, this community will benefit from the addition of mechanical failure testing to outcome analyses, given the crucial clinical importance of the success of engineered constructs. However, there is a tremendous disparity in the methods used to evaluate mechanical failure of hydrogels and articular cartilage. In an effort to bridge the gap in mechanical testing methods of articular cartilage and hydrogels in cartilage regeneration, this review classifies the different toughness measurements for each. The urgency for identifying the common ground between these two disparate fields is high, as mechanical failure is ready to stand alongside stiffness as a functional design requirement. In comparing toughness measurement methods between hydrogels and cartilage, we recommend that the best option for evaluating mechanical failure of hydrogel-based constructs for cartilage tissue engineering may be tensile testing based on the single edge notch test, in part because specimen preparation is more straightforward and a related American Society for Testing and Materials (ASTM) standard can be adopted in a fracture mechanics context.

Synthesis and characterization of a laminated hydroxyapatite/gelatin nanocomposite scaffold with controlled pore structure for bone tissue engineering

In this study, a nanostructured scaffold was designed for bone repair using hydroxyapatite (HA) and gelatin (GEL) as its main components. Nanopowders of HA were synthesized, and together with GEL, used to engineer a 3-dimensional nanocomposite combining 3 techniques of layer solvent casting, freeze-drying, and lamination. The results show that the scaffold possesses a 3-dimensional interconnected homogenous porous structure with a porosity of 82% and pore sizes ranging from 300 to 500 mum. It has also been shown that mechanical indices are in the range of spongy bones. Cultured osteoblast-like cells (SaOS-2) have shown an excellent level of cell attachment, migration, and penetration into the porosities of the nanocomposite scaffold. Here, we have shown that by a combination of widely available methods with simple experimental operations, nano-HA powders can be synthesized and used to make 3-dimensional HA/GEL nanocomposites in any desired shape, with mechanical properties comparable to spongy bone.

Comparative study of different techniques for the sterilization of poly-L-lactide electrospun microfibers: effectiveness vs. material degradation

Electrospinning of biopolymeric scaffolds is a new and effective approach for creating replacement tissues to repair defects and/or damaged tissues with direct clinical application. However, many hurdles and technical concerns regarding biological issues, such as cell retention and the ability to grow, still need to be overcome to gain full access to the clinical arena. Interaction with the host human tissues, immunogenicity, pathogen transmission as well as production costs, technical expertise, and good manufacturing and laboratory practice requirements call for careful consideration when aiming at the production of a material that is available off-the-shelf, to be used immediately in operative settings. The issue of sterilization is one of the most important steps for the clinical application of these scaffolds. Nevertheless, relatively few studies have been performed to systematically investigate how sterilization treatments may affect the properties of electrospun polymers for tissue engineering. This paper presents the results of a comparative study of different sterilization techniques applied to an electrospun poly-L-lactide scaffold: soaking in absolute ethanol, dry oven and autoclave treatments, UV irradiation, and hydrogen peroxide gas plasma treatment. Morphological and chemical characterization was coupled with microbiological sterility assay to validate the examined sterilization techniques in terms of effectiveness and modifications to the scaffold. The results of this study reveal that UV irradiation and hydrogen peroxide gas plasma are the most effective sterilization techniques, as they ensure sterility of the electrospun scaffolds without affecting their chemical and morphological features.

Immunoarchitectural characterization of a human skin model reconstructed in vitro

CONTEXT AND OBJECTIVE

Over the last few years, different models for human skin equivalent reconstructed in vitro (HSERIV) have been reported for clinical usage and applications in research for the pharmaceutical industry. Before release for routine use as human skin replacements, HSERIV models need to be tested regarding their similarity with in vivo skin, using morphological (architectural) and immunohistochemical (functional) analyses. A model for HSERIV has been developed in our hospital, and our aim here was to further characterize its immunoarchitectural features by comparing them with human skin, before it can be tested for clinical use, e.g. for severe burns or wounds, whenever ancillary methods are not indicated.

DESIGN AND SETTING

Experimental laboratory study, in the Skin Cell Culture Laboratory, School of Medical Sciences, Universidade Estadual de Campinas.

METHODS

Histological sections were stained with hematoxylin-eosin, Masson's trichrome for collagen fibers, periodic acid-Schiff reagent for basement membrane and glycogen, Weigert-Van Gieson for elastic fibers and Fontana-Masson for melanocytes. Immunohistochemistry was used to localize cytokeratins (broad spectrum of molecular weight, AE1/AE3), high molecular weight cytokeratins (34betaE12), low molecular weight cytokeratins (35betaH11), cytokeratins 7 and 20, vimentin, S-100 protein (for melanocytic and dendritic cells), CD68 (KP1, histiocytes) and CD34 (QBend, endothelium).

RESULTS

Histology revealed satisfactory similarity between HSERIV and in vivo skin. Immunohistochemical analysis on HSERIV demonstrated that the marker pattern was similar to what is generally present in human skin in vivo.

CONCLUSION

HSERIV is morphologically and functionally compatible with human skin observed in vivo.

Clinical grade production of mesenchymal stem cells

Mesenchymal Stem Cells (MSCs) are multipotent adult stem cells having an immunosuppressive effect. These characteristics lead to an increasing use of MSC in graft process or for regenerative medicine. For the clinical uses of MSCs, standards are needed. The clinical grade production necessitates adhering to good manufacturing practices (GMP) to insure the delivery of a "cell drug" that is safe, reproducible and efficient. All parts of the process must be defined: the starting material (tissue origin, separation or enrichment procedures), cell density in culture, and medium (fetal calf serum (FCS) or human serum, cytokines with serum-free medium for target). But to reach the GMP goal, cells have to be cultured in as close to a closed system as possible. Analytical methods are needed to assay the active compound and impurities. At a minimum, quality control (QC) of cells must consider the phenotype, functional potential, microbiological safety, and ensure the cultured cells remain untransformed. Finally, quality assurance system (QA) procedures specific to the production of MSCs as a cell drug must be determined and implemented.

Cell therapy: a challenge in modern medicine

Cell therapies are unique in that the active component consists of living cells, which are difficult to define in their pharmacologic characteristics, and which produce variable and largely unknown amounts of bioactive molecules. Thus, the definition of the composition of a cellular product, mechanisms of action, pharmacokinetics, toxicity and efficacy assessment represent challenges never previously faced by traditional pharmacology. A pressing need for a routine use of cell therapies in the clinic is the development of quality controls for efficacy on the basis of clinically relevant potency assays, with prospective validation in human clinical trials. This review will focus on cell-based protocols for joint surface repair. In particular, we will present the case of autologous chondrocyte implantation as an example of advanced tissue engineering technology in the clinic, with the assumption that many issues discussed can be extrapolated to other cell-based approaches in regenerative medicine.

[Standards used in the regulation of medical device in USA]

OBJECTIVE

To study the USA government's administrative system about medical device standards as well as the standard making.

METHODS

The relevant documents, regulations, website that USA Food and Drug Administration announced were extensively reviewed, knowing the USA medical device standards synthetically.

RESULTS

The USA standards system of medical device included regulatory requirements and voluntary consensus standards. This article simply introduced the laws, regulations, performance standards and consensus standards.

CONCLUSION

The USA's administrative system about medical device standards as well as many standards can be referenced.

The role of fibroblasts in tissue engineering and regeneration

Fibroblasts are mesenchymal cells that can be readily cultured in the laboratory and play a significant role in epithelial-mesenchymal interactions, secreting various growth factors and cytokines that have a direct effect on epidermal proliferation, differentiation and formation of extracellular matrix. They have been incorporated into various tissue-engineered products such as Dermagraft (Advanced BioHealing, La Jolla, CA, U.S.A.) and Apligraf (Novartis, Basel, Switzerland) and used for a variety of clinical applications, including the treatment of burns, chronic venous ulcers and several other clinical applications in dermatology and plastic surgery. In this article we review the cell biology of dermal fibroblasts and discuss past and current experience of the clinical use of cultured fibroblasts.

A European regulatory pathway for tissue engineering--at last

After many years of scientific and political struggles, the European Union now appears to be heading for success in the development of a new regulatory pathway for innovative therapeutic products, including those of tissue engineering. This article summarises the main issues of those developments and some essentials of the proposed new regulation.

Directed engineering of umbilical cord blood stem cells to produce C-peptide and insulin

OBJECTIVES

In this study, we investigated the potential of umbilical cord blood stem cell lineages to produce C-peptide and insulin.

MATERIALS AND METHODS

Lineage negative, CD133+ and CD34+ cells were analyzed by flow cytometry to assess expression of cell division antigens. These lineages were expanded in culture and subjected to an established protocol to differentiate mouse embryonic stem cells (ESCs) toward the pancreatic phenotype. Phase contrast and fluorescence immunocytochemistry were used to characterize differentiation markers with particular emphasis on insulin and C-peptide.

RESULTS

All 3 lineages expressed SSEA-4, a marker previously reported to be restricted to the ESC compartment. Phase contrast microscopy showed all three lineages recapitulated the treatment-dependent morphological changes of ESCs as well as the temporally restricted expression of nestin and vimentin during differentiation. After engineering, each isolate contained both C-peptide and insulin, a result also obtained following a much shorter protocol for ESCs.

CONCLUSIONS

Since C-peptide can only be derived from de novo synthesis and processing of pre-proinsulin mRNA and protein, we conclude that these results are the first demonstration that human umbilical cord blood-derived stem cells can be engineered to engage in de novo synthesis of insulin.

Translation from Research to Applications

The article summarizes the collective views expressed at the fourth session of the workshop Tissue Engineering--the Next Generation, which was devoted to the translation of results of tissue engineering research into applications. Ernst Hunziker described the paradigm of a dual translational approach, and argued that tissue engineering should be guided by the dimensions and physiological setting of the bodily compartment to be repaired. Myron Spector discussed collagen-glycosaminoglycan (GAG) scaffolds for musculoskeletal tissue engineering. Jeanette Libera focused on the biological and clinical aspects of cartilage tissue engineering, and described a completely autologous procedure for engineering cartilage using the patient's own chondrocytes and blood serum. Arthur Gertzman reviewed the applications of allograft tissues in orthopedic surgery, and outlined the potential of allograft tissues as models for biological and medical studies. Savio Woo discussed a list of functional tissue engineering approaches designed to restore the biochemical and biomechanical properties of injured ligaments and tendons to be closer to that of the normal tissues. Specific examples of using biological scaffolds that have chemoattractants as well as growth factors with unique contact guidance properties to improve their healing process were shown. Anthony Ratcliffe discussed the translation of the results of research into products that are profitable and meet regulatory requirements. Michael Lysaght challenged the proposition that commercial and clinical failures of early tissue engineering products demonstrate a need for more focus on basic research. Arthur Coury described the evolution of tissue engineering products based on the example of Genzyme, and how various definitions of success and failure can affect perceptions and policies relative to the status and advancement of the field of tissue engineering.

Inherent Risks Associated With Manufacture of Bioengineered Ocular Surface Tissue

OBJECTIVE

To review the potential health risks associated with bioengineered ocular surface tissue, which serves as a bellwether for other tissues.

METHODS

All clinical trials using bioengineered ocular surface tissue published between July 1, 1996, and June 30, 2005, were reviewed with respect to materials used and statements of risk assessment, risk remediation, adverse events, manufacturing standards, and regulatory oversight.

RESULTS

Ninety-five percent of investigational protocols used 1 or more animal-derived products and an overlapping 95% used 1 or more donor human tissues. Consideration of risks reveals a very low probability of potential harm but a significant risk of disability or death if such an event were to occur. Details of ethics approval, patient consent, and donor serologic test results were not consistently provided. No references were made to risk assessment or to codes of manufacturing and clinical practice.

CONCLUSION

While a degree of risk is associated with bioengineered ocular surface tissue, investigational reports of this new technology have yet to address issues of risk management and regulatory oversight.

CLINICAL RELEVANCE

Attention to risk and codes of manufacturing and clinical practice will be required for advancement of the technology. We suggest the adoption of international standards to address these issues.

Regulation of tissue-engineered products in the European Union: where are we heading?

The emergence of tissue-engineered products (TEPs) raises a standard question for regulators: is the existing regulatory regime appropriate or is there a case for a new regulatory framework? In the USA, the FDA has developed a risk-based approach to TEPs, whereas in Europe, a common regulatory strategy for these products has not yet been implemented. In order to fill this perceived gap, member states have set up domestic rules, which has led to an unclear and patchy regulatory situation. The Regulation on Advanced Therapy Medicinal Products, voted on by the European Commission in November 2005, has been developed by European Union regulators to provide the necessary framework to regulate TEPs. As the text is still to be discussed and to be passed, many concerns have been raised regarding the appropriateness of the proposed framework.

The ABJS Nicolas Andry Award: Tissue engineering of bone and ligament: a 15-year perspective

Musculoskeletal repair is a major challenge for orthopaedic surgeons. The burden of repair is compounded by supply constraints and morbidity associated with autograft and allograft tissue. We report 15 years of research regarding tissue engineering and biological substitutes for bone and ligaments. Our approach has focused on biomaterial selection, scaffold development, cell selection, cell/material interaction, and growth factor delivery. We have extensively tested poly(ester), poly(anhydride), poly(phosphazene) derivatives, and composite materials using biocompatibility, degradation, and mechanical analyses for bone and ligament tissue engineering. We have developed novel three-dimensional matrices with a pore structure and mechanical properties similar to native tissue. We also have reported on the attachment, growth, proliferation, and differentiation of cells cultured on several scaffolds. Through extensive molecular analysis, in vitro culture condition analysis, and in vivo evaluation, our findings provide new methods of bone tissue regeneration using three-dimensional tissue engineered scaffolds, bioactive bone cement composite materials, and three-dimensional tissue engineered scaffolds for ligament regeneration.

Chemical characteristics and cytocompatibility of collagen-based scaffold reinforced by chitin fibers for bone tissue engineering

Chitin is a kind of seemly material to match PLLA for a scaffold, which may create an appropriate environment for the regeneration of tissues. In this study, we prepared and evaluated a new nano-hydroxyapatite/collagen/PLLA (nHACP) scaffold reinforced by chitin fibers for bone-tissue engineering. The chitin fibers were crosslinked with PLLA by dicyclohexylcarbodimide (DCC). The chemical characteristics were evaluated by Fourier transformed infrared (FTIR) spectroscopy and X-ray photoelectron spectroscopy (XPS). The mechanical strength was measured by compressive tests. The fibers, crosslinked with PLLA, could enhance the compressive strength of the scaffold about four times. Human marrow mesenchymal stem cells (MSCs) culture showed that the reinforced nHACP scaffolds were more cytocompatible than that without reinforcement. The crosslinks hardly affected the cytocompatibility of the reinforced scaffolds. The results suggested that the reinforced scaffolds (DCC crosslinked) might be a promising candidate for bone-tissue engineering.

Manufacturing, mechanical characterization, andin vitro performance of bioactive glass 13–93 fibers

Fibers were manufactured from the bioactive glass 13-93 by melt spinning. The fibers were further characterized by measuring their tensile and flexural strength, and their in vitro performance was characterized by immersing them in simulated body fluid, which analyzed changes in their mass, their flexural strength, and surface reactions. The strength of glass fibers is highly dependent on fiber diameter, test method, and possible surface flaws, for example, cracks due to abrasion. In this study, the thinnest fibers (diameter between 24 and 33 microm) possessed the highest average tensile strength of 861 MPa. The flexural strength was initially 1353.5 MPa and it remained at that level for 2 weeks. The Weibull modulus for both tensile and flexural strength values was initially about 2.1. The flexural strength started to decrease and was only approximately 20% of the initial strength after 5 weeks. During the weeks 5-40, only a slight decrease was detected. The flexural modulus decreased steadily from 68 to 40 GPa during this period. The weight of the samples initially decreased due to leaching of ions and further started to increase due to precipitation of calcium phosphate on the fiber surfaces. The mass change of the bioactive glass fibers was dependent on the surface area rather than initial weight of the sample. The compositional analysis of the fiber surface after 24 h and 5 weeks immersion did confirm the initial leaching of ions and later the precipitation of a calcium phosphate layer on the bioactive glass 13-93 fiber surface in vitro.

Cellular to tissue informatics: approaches to optimizing cellular function of engineered tissue

Tissue engineering is a rapidly expanding, multi-disciplinary field in biomedicine. It provides the ability to manipulate living cells and biomaterials for the purpose of restoring, maintaining, and enhancing tissue and organ function. Scientists have engineered various tissues in the body, from skin substitutes to artificial nerves to heart tissues, with varying degrees of success. Although the field of tissue engineering has come a long way since its first successful demonstration by Bisceglie in the 1930s, methods of coaxing them into functional tissues have been predominantly empirical to date. To successfully develop tissue-engineered organs, it is important to understand how to maintain the cells under conditions that maximize their ability to perform their physiological roles, regardless of their environment. In that context, a methodology that combines empirical data with mathematical and statistical techniques, such as metabolic engineering and cellular informatics, to systematically determine the optimal (1) type of cell to use, (2) scaffold properties and the corresponding processing conditions to achieve those properties, and (3) the required types and levels of environmental factors and the operating conditions needed in the bioreactor, will enable the design of viable and functional tissues tailored to the specific requirements of individual situations.

Symposium on Metrology and Standards for Cell Signaling: Impact on Tissue Engineering, National Institute for Standards and Technology, October 14-15, 2003

The Symposium on Metrology and Standards for Cell Signaling: Impact on Tissue Engineering, was cosponsored by the National Institute for Standards and Technology (NIST) and ASTM International, and was held at the NIST on October 14 and 15, 2003. The purpose of the symposium was to discuss the role of standards and quantitative measurements of cellular responses for the field of tissue engineering. Accurate and quantitative measurements, reference materials, and standards are needed to facilitate the understanding and control of cell responses to materials, culture media, and the in vivo environment. Speakers included government researchers from the NIST, the Food and Drug Administration, and the National Cancer Institute; vice presidents, chief executive officers, and directors of research from companies; and academic researchers in engineering, medicine, and cell biology. The metrology needs identified include quantitative assays of cell signaling pathways, bioinformatics that will allow consolidation of these complex data and permit correlative parameters to be identified, well-characterized standardized cell lines against which responses in other cells can be compared, and reference materials for use in control experiments.

Regulatory and microbiological safety issues surrounding cell and tissue-engineering products

Cell therapies and tissue‐engineered products that contain living cells are potentially some of the most exciting of the novel therapeutic products currently under development. These products, however, present a number of important safety issues, particularly with respect to the transmission of human viruses. In addition, the short shelf life of these products precludes the normally extensive characterization performed on other biotherapeutic products. Careful examination of the risks and extensive testing of the raw materials have been used in place of product testing to ensure safety.

[Indications and implementation of recommendations of the working group "Tissue Regeneration and Tissue Substitutes" for autologous chondrocyte transplantation (ACT)]

For the treatment of full-thickness articular cartilage lesions of the knee joint, as a result of trauma or osteochondritis dissecans, a variety of biological reconstruction techniques have been developed. Different studies, some of which were performed as randomised, prospective clinical studies, showed that the autologous chondrocyte transplantation (ACT) provides the most satisfying and reliable method of cartilage reconstruction in the adult when applied to defects exceeding 4 cm (2). Based on these results, ACT seems to be of economic benefit, as the risk of developing osteoarthritis correlates significantly with the size of the cartilage defect, when not treated properly and in time. Surveying the studies on basic scientific aspects of ACT, cartilage defect animal models and clinical studies, it can be concluded that clinical results of ACT depend on a variety of factors. In this review, published by the joined advisory board of the German Societies of Traumatology (DGU) and Orthopaedic Surgery (DGOOC), we summarize the current knowledge available and the state of the art concerning ACT. Especially we discuss the advantages of different procedures, methods for treating knee cartilage defects and factors that influence the outcome of the different treatment regimens, with the aim to develop guidelines for the correct indication and application of the ACT.

Three-dimensional tissue fabrication

In recent years, advances in fabrication technologies have brought a new dimension to the field of tissue engineering. Using manufacturing-based methods and hydrogel chemistries, researchers have been able to fabricate tissue engineering scaffolds with complex 3-D architectures and customized chemistries that mimic the in vivo tissue environment. These techniques may be useful in developing therapies for replacing lost tissue function, as in vitro models of living tissue, and also for further enabling fundamental studies of structure/function relationships in three dimensional contexts. Here, we present an overview of 3-D tissue fabrication techniques based on methods for: scaffold fabrication, cellular assembly, and hybrid hydrogel/cell methods and review their potential utility for tissue engineering.

Moral imagination in tissue engineering research on animal models

Animal experimentation is an integrated part of tissue engineering research. This paper investigates what scientists conducting such experimentation should reasonably take into consideration from an ethical point of view. It is argued that scientists should use their moral imagination in making fundamental ethical choices, in reflecting on legal regulation, in taking public opinion seriously, and in balancing human benefit and animal harm as expected outcomes of the experiments.

Quality evaluation analysis of bioengineered human skin

Our objective is to determine the quality of tissue engineered human skin via immunostaining, RT-PCR and electron microscopy (SEM and TEM). Culture-expanded human keratinocytes and fibroblasts were used to construct bilayer tissue-engineered skin. The in vitro skin construct was cultured for 5 days and implanted on the dorsum of athymic mice for 30 days. Immunostaining of the in vivo skin construct appeared positive for monoclonal mouse anti-human cytokeratin, anti-human involucrin and anti-human collagen type I. RT-PCR analysis revealed loss of the expression for keratin type 1, 10 and 5 and re-expression of keratin type 14, the marker for basal keratinocytes cells in normal skin. SEM showed fibroblasts proliferating in the 5 days in vitro skin. TEM of the in vivo skin construct showed an active fibrocyte cell secreting dense collagen fibrils. We have successfully constructed bilayer tissue engineered human skin that has similar features to normal human skin.

The fundamentals of tissue engineering: new scaffolds

The ability to regenerate new bone for skeletal use is a major clinical need. In this study, two novel porous calcium phosphate materials pure HA and biphasic HA/beta-Tricalcium phosphate (HA/beta -TCP) were evaluated as potential scaffolds for cell-seeded bone substitutes using human osteoblast-like cells (HOS) and primary human mesenchymal stem cells (hMSCs). A high rate of proliferation was observed on both scaffolds. A greater increase in alkaline phosphatase (ALP- an indicator of osteoblast differentiation) was observed on HA/beta -TCP compared to HA. This observation indicates that HA/TCP may play a role in inducing osteoblastic differentiation. Although further evaluation is required both materials show potential as innovative synthetic substitutes for tissue engineered scaffolds.

Effect of physiological temperature on the mechanical properties and network structure of biodegradable poly(propylene fumarate)-based networks

Poly(propylene fumarate) (PPF)-based networks have exhibited increases in mechanical properties during their initial stages of degradation. This study was designed to investigate whether physiological temperatures are the source of this reinforcing behavior by influencing the formation of additional crosslinks within the network. Utilizing a model PPF network formed with the crosslinking agent poly(propylene fumarate)-diacrylate (PPF-DA), cylindrical specimens were stored in an inert environment and conditioned at -20 and 37 degrees C while their mechanical properties and network structure were monitored over a six week period. The PPF/PPF-DA specimens exposed to physiological temperatures showed an increase in compressive modulus from 1674 +/- 88 to 2059 +/- 75 MPa. The double bond conversion improved as well, from 64 +/- 1 to 70 +/- 1%, indicating that crosslinks were being formed in the network. The additional reactivity occurred exclusively with unreacted fumarate bonds. PPF/PPF-DA networks stored at -20 degrees C showed no changes in mechanical properties; however, they increased when subsequently conditioned at 37 degrees C. The results were used to explain that PPF-based networks undergo a biphasic degradation behavior due to the competing hydrolytic degradation and thermal induced crosslinking. In addition, heat treating the networks at higher temperatures can be utilized as a means to further reinforce PPF-based materials.

Chemically-bound nerve growth factor for neural tissue engineering applications

In order to promote regeneration after spinal cord injury, growth factors have been applied in vivo to rescue ailing neurons and provide a path finding signal for regenerating neurites. We previously demonstrated that soluble growth factor concentration gradients can guide axons over long distances, but this model is inherently limited to in vitro applications. To translate the use of growth factor gradients to an implantible device for in vivo studies, we developed a photochemical method to bind nerve growth factor (NGF) to microporous poly(2-hydroxyethylmethacrylate) (PHEMA) gels and tested bioactivity in vitro. A cell adhesive photoreactive poly(allylamine) (PAA) was synthesized and characterized. This photoreactive PAA was applied to the surface of the PHEMA gels to provide both a cell adhesive layer and a photoreactive handle for further NGF immobilization. Using a direct ELISA technique, the amount of NGF immobilized on the surface of PHEMA after UV exposure was determined to be 5.65 +/- 0.82 ng/cm2 or 3.4% of the originally applied NGF. A cell-based assay was performed to determine the bioactivity of the immobilized NGF. Using pheochromocytoma (PC-12) cells, 30 +/- 7% of the cell population responded to bound NGF, a response statistically similar to that of cells cultured on collagen in the presence of 40 ng/ml soluble NGF of 39 +/- 12%. These results demonstrate that PHEMA with photochemically bound NGF is bioactive. This photochemical technique may be useful to spatially control the amount of NGF bound to PHEMA using light and thus build a stable concentration gradient.

European Animal Tissue Directive

In less than nine months, manufacturers of medical devices containing certain types of tissues of animal origin will need to ensure that their products comply with newly mandated specifications. They should not wait until the last minute to begin this work. This article discusses the important issues that will need to be addressed to ensure effective compliance with the requirements.

Stem Cells

Regenerative medicine and emerging biotechnologies stand to revolutionize the practice of medicine. Advancements in stem cell biology, including embryonic and postnatal somatic stem cells, have made the prospect of tissue regeneration a potential clinical reality. Short of reproductive cloning, these same technologies, properly used, could allow for the creation of replacement tissue for the deficient host. To provide a concise review for surgeons on the current science and biology of stem cells, we surveyed the scientific literature, MEDLINE, and relevant political headlines that illuminate the stem cell discussion; the issues are summarized in this review. Building on this conceptual framework, the related issues of clinical promise and the political debate enveloping this emerging technology are examined. A basic understanding of stem cell biology is paramount to stay informed of this emerging technology and the national debate.

[Supervision, administration and standard research related to tissue engineered medical products]

Tissue engineering advance in supplying the reparative and reconstructive medicine with promising tissue engineered medical products(TEMPs) and the new therapy alternative. The related supervision and administration of TEMPs is being developed and the standard research of TEMPs is also in progress. The Food and Drug Administration(FDA) of the United States has treated TEMPs as combined products and supervised them according to the level of risk to patients. Lately, FDA has determined that the Center for Devices and Radiological Health (CDRH) should take charge of examination and approval of TEMPs, with the cooperation of the Center for Biological Evaluations and Research(CBER). The regulatory controls have been established respectively in European Union and Japan. In China, TEMPs are identified as medical devices combined with cells. The Department of Medical Device of the State Food and Drug Administration (SFDA) is responsible for the examination and approval of TEMPs, and National Institute for the Control of Pharmaceutical & Biological Products(NICPBP) is responsible for evaluation tests. The standards of TEMPs are formulated mainly by the American Society of Testing Materials(ASTM) and International Standardization Organization(ISO).

Progress on regulations for human-derived therapeutic products

Several European work programmes are building a unified regulatory framework for therapeutic products that utilise material of human origin, that is, substances, derivatives or tissues of human origin or viable cells of human origin. This is a report on progress to date.

Human tissue-engineered products

Exciting developments are taking place that present a complex challenge for regulations and standards.

In vivo forces used to develop design parameters for tissue engineered implants for rabbit patellar tendon repair

Previous studies in tissue engineering have shown that suspending undifferentiated mesenchymal stem cells in collagen gels and wrapping them about a suture causes alignment of cells and contraction of constructs in culture in a form that is suitable for implantation for tendon repair. Little is known about the patterns of these in vivo signals that might improve tendon repair biomechanics. Three hypotheses were tested in this study using the rabbit patellar tendon (PT) model: (1) peak in vivo forces and the rates of rise and fall in these forces will increase significantly with increasing levels of activity; (2) the PTs safety factor for all activities will be in the range of values found for tendons (2.5-3); (3) rabbits will not "favor" the operated limb at the time of evaluation but maintain similar vertical ground reaction forces in both limbs during quiet standing (QS). In vivo rabbit PT forces were measured during QS and while the animal hopped on a treadmill whose speed (0.04 and 0.13 m/s) and inclination (0 degrees and 12 degrees) were controlled. Implantable force transducers were surgically placed in one PT and data collected three days post surgery in each of eight New Zealand White rabbits. Peak tensile forces increased significantly with inclination of the treadmill and the rates of rise and fall in tendon force increased significantly with both speed and inclination (p<0.001). Such design criteria should be useful in mechanically stimulating cell-gel constructs for tendon repair.

Vascularized three-dimensional skeletal muscle tissue-engineering

Medical science continues to battle against the loss or failure of organs or tissues. Since, skeletal muscle loss lead not only to the functional compromise of the affected site, but also a structural deformation; tissue engineering of skeletal muscle attempts to provide solutions to replace loss of tissue contour and function. In our study, myoblasts seeded onto polyglycolic acid (PGA) meshes were used to engineer skeletal muscle tissue in vivo. The cell-polymer constructs harvested after a period of 6-weeks were well vascularized three-dimensional structures with the ability to generate neo-muscle-like tissue. This is the first time that the ability of myoblasts to survive in vivo in the absence of mature skeletal muscle tissue was demonstrated. The successful ability to transplant myoblasts using biodegradable polymer strands without using the traditional transplantation buffer mediums as carriers was also employed for the first time.

Soft and hard tissue response to photocrosslinked poly(propylene fumarate) scaffolds in a rabbit model

The treatment of large cranial defects may be greatly improved by the development of precisely formed bone tissue engineering scaffolds. Such scaffolds could be constructed by using UV laser stereolithography to photocrosslink a linear, biodegradable polymer into a three-dimensional implant. We have previously presented a method to photocrosslink the biodegradable polyester, poly(propylene fumarate) (PPF). To ensure the safety and effectiveness of this technique, the soft and hard tissue response to photocrosslinked PPF scaffolds of different pore morphologies was investigated. Four classes of photocrosslinked PPF scaffolds, constructed with differing porosities (57-75%) and pore sizes (300-500 or 600-800 microm), were implanted both subcutaneously and in 6.3-mm-diameter cranial defects in a rabbit model. The rabbits were sacrificed at 2 and 8 weeks, and the implants were analyzed by light microscopy, histological scoring analysis, and histomorphometric analysis. Results showed the PPF scaffolds elicit a mild tissue response in both soft and hard tissues. Inflammatory cells, vascularization, and connective tissue were observed at 2 weeks; a decrease in inflammatory cell density and a more organized connective tissue were observed at 8 weeks. Scaffold porosity and scaffold pore size were not found to significantly affect the observed tissue response. Evidence of scaffold surface degradation was noted both by histology and histomorphometric analysis. Bone ingrowth in PPF scaffolds implanted into cranial defects was <3% of the defect area. The results indicate that photocrosslinked PPF scaffolds are biocompatible in both soft and hard tissues and thus may be an attractive platform for bone tissue engineering.