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Weißenberger M, Wagenbrenner M, Nickel J, Ahlbrecht R, Blunk T, Steinert AF, Gilbert F. Comparative in vitro treatment of mesenchymal stromal cells with GDF-5 and R57A induces chondrogenic differentiation while limiting chondrogenic hypertrophy. J Exp Orthop 2023; 10:29. [PMID: 36943593 PMCID: PMC10030724 DOI: 10.1186/s40634-023-00594-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Hypertrophic cartilage is an important characteristic of osteoarthritis and can often be found in patients suffering from osteoarthritis. Although the exact pathomechanism remains poorly understood, hypertrophic de-differentiation of chondrocytes also poses a major challenge in the cell-based repair of hyaline cartilage using mesenchymal stromal cells (MSCs). While different members of the transforming growth factor beta (TGF-β) family have been shown to promote chondrogenesis in MSCs, the transition into a hypertrophic phenotype remains a problem. To further examine this topic we compared the effects of the transcription growth and differentiation factor 5 (GDF-5) and the mutant R57A on in vitro chondrogenesis in MSCs. METHODS Bone marrow-derived MSCs (BMSCs) were placed in pellet culture and in-cubated in chondrogenic differentiation medium containing R57A, GDF-5 and TGF-ß1 for 21 days. Chondrogenesis was examined histologically, immunohistochemically, through biochemical assays and by RT-qPCR regarding the expression of chondrogenic marker genes. RESULTS Treatment of BMSCs with R57A led to a dose dependent induction of chondrogenesis in BMSCs. Biochemical assays also showed an elevated glycosaminoglycan (GAG) content and expression of chondrogenic marker genes in corresponding pellets. While treatment with R57A led to superior chondrogenic differentiation compared to treatment with the GDF-5 wild type and similar levels compared to incubation with TGF-ß1, levels of chondrogenic hypertrophy were lower after induction with R57A and the GDF-5 wild type. CONCLUSIONS R57A is a stronger inducer of chondrogenesis in BMSCs than the GDF-5 wild type while leading to lower levels of chondrogenic hypertrophy in comparison with TGF-ß1.
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Affiliation(s)
- Manuel Weißenberger
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany.
- Department of Orthopedic Surgery, University of Wuerzburg, König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg, Germany.
| | - Mike Wagenbrenner
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Joachim Nickel
- Department of Tissue Engineering and Regenerative Medicine, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
| | - Rasmus Ahlbrecht
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
| | - Torsten Blunk
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, König-Ludwig-Haus, Würzburg, Germany
- Current address:, Department of Orthopaedic, Trauma, Shoulder and Arthroplasty Surgery, Rhön-Klinikum, Campus Bad Neustadt, Bad Neustadt, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, Julius-Maximilians-University Würzburg, University Hospital, Würzburg, Germany
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von Hertzberg-Boelch SP, Luedemann M, Rudert M, Steinert AF. PMMA Bone Cement: Antibiotic Elution and Mechanical Properties in the Context of Clinical Use. Biomedicines 2022; 10:biomedicines10081830. [PMID: 36009376 PMCID: PMC9404960 DOI: 10.3390/biomedicines10081830] [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] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 12/04/2022] Open
Abstract
This literature review discusses the use of antibiotic loaded polymethylmethacrylate bone cements in arthroplasty. The clinically relevant differences that have to be considered when antibiotic loaded bone cements (ALBC) are used either for long-term implant fixation or as spacers for the treatment of periprosthetic joint infections are outlined. In this context, in vitro findings for antibiotic elution and material properties are summarized and transferred to clinical use.
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Affiliation(s)
- Sebastian Philipp von Hertzberg-Boelch
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, 11 Brettreichstrasse, 97074 Würzburg, Germany; (M.L.); (M.R.); (A.F.S.)
- Correspondence:
| | - Martin Luedemann
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, 11 Brettreichstrasse, 97074 Würzburg, Germany; (M.L.); (M.R.); (A.F.S.)
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, 11 Brettreichstrasse, 97074 Würzburg, Germany; (M.L.); (M.R.); (A.F.S.)
| | - Andre F. Steinert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, 11 Brettreichstrasse, 97074 Würzburg, Germany; (M.L.); (M.R.); (A.F.S.)
- Rhön Klinikum, Campus Bad Neustadt, EndoRhoen Center for Joint Replacement, Teaching Hospital of the Phillipps University Marburg, Von Guttenberg Str. 11, 97616 Bad Neustadt, Germany
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Steinert AF, Sefrin L, Jansen B, Schröder L, Holzapfel BM, Arnholdt J, Rudert M. Patient-specific cruciate-retaining total knee replacement with individualized implants and instruments (iTotal™ CR G2). Oper Orthop Traumatol 2020; 33:170-180. [PMID: 33289871 DOI: 10.1007/s00064-020-00690-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/02/2019] [Accepted: 06/11/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Treatment of tricompartimental osteoarthritis (OA) using customized instruments and implants for cruciate-retaining total knee arthroplasty. Use of patient-specific instruments and implants (ConforMIS iTotalTM CR G2) together with a 3D-planning protocol (iView®). Retropatellar resurfacing is optional. INDICATIONS Symptomatic tricompartmental OA of the knee (Kellgren-Lawrence stage IV) with preserved posterior cruciate ligament (PCL) after unsuccessful conservative or joint-preserving surgical treatment. CONTRAINDICATIONS Knee ligament instabilities of the posterior cruciate or collateral ligaments. Infection. Relative contraindication: knee deformities >15° (varus, valgus, flexion); prior partial knee replacement. SURGICAL TECHNIQUE Midline or parapatellar medial skin incision, medial arthrotomy; distal femoral resection with patient-specific cutting block; tibial resection using either a cutting jig for the anatomic slope or a fixed 5° slope. Balancing the knee in extension and flexion gap using patient-specific spacer. The final tibial preparation achieved with gap-balanced placement of the femoral cutting jigs. Kinematic testing using anatomic trial components. Final implant components are cemented in extension. Wound layers are sutured. Drainage is optional. POSTOPERATIVE MANAGEMENT Sterile wound dressing; compressive bandage. No limitation of the active and passive range of motion. Optional partial weight bearing during the first 2 weeks, then transition to full weight bearing. Follow-up directly after surgery, at 12 and 52 weeks, then every 1-2 years. RESULTS Overall 60 patients with tricompartmental knee OA and preserved PCL were treated. Mean age was 66 (range 45-76) years. Minimum follow-up was 12 months. There was 1 septic revision after a low-grade infection, 1 reoperation to replace the patellar due to patellar osteoarthritis and 3 manipulations under anesthesia (MUAs) to increase range of motion. Radiographic analyses demonstrated an ideal implant fit with less than 2 mm subsidence or overhang. The WOMAC score improved from 154.8 points preoperatively to 83.5 points at 1 year and 59.3 points at 2 years postoperatively. The EuroQol-5D Score also improved from 11.1 points preoperatively to 7.7 points at 1 year postoperatively.
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Affiliation(s)
- Andre F Steinert
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany. .,Campus Bad Neustadt, Klinik für Orthopädie, Unfallchirurgie, Schulterchirurgie und Endoprothetik, Rhön Klinikum, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany.
| | | | - Björn Jansen
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Lennart Schröder
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Boris M Holzapfel
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Jörg Arnholdt
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
| | - Maximilian Rudert
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany
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Arnholdt J, Kamawal Y, Horas K, Holzapfel BM, Gilbert F, Ripp A, Rudert M, Steinert AF. Accurate implant fit and leg alignment after cruciate-retaining patient-specific total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:699. [PMID: 33092567 PMCID: PMC7583183 DOI: 10.1186/s12891-020-03707-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/09/2020] [Indexed: 01/18/2023] Open
Abstract
Background For improved outcomes in total knee arthroplasty (TKA) correct implant fitting and positioning are crucial. In order to facilitate a best possible implant fitting and positioning patient-specific systems have been developed. However, whether or not these systems allow for better implant fitting and positioning has yet to be elucidated. For this reason, the aim was to analyse the novel patient-specific cruciate retaining knee replacement system iTotal™ CR G2 that utilizes custom-made implants and instruments for its ability to facilitate accurate implant fitting and positioning including correction of the hip-knee-ankle angle (HKA). Methods We assessed radiographic results of 106 patients who were treated with the second generation of a patient-specific cruciate retaining knee arthroplasty using iTotal™ CR G2 (ConforMIS Inc.) for tricompartmental knee osteoarthritis (OA) using custom-made implants and instruments. The implant fit and positioning as well as the correction of the mechanical axis (hip-knee-ankle angle, HKA) and restoration of the joint line were determined using pre- and postoperative radiographic analyses. Results On average, HKA was corrected from 174.4° ± 4.6° preoperatively to 178.8° ± 2.2° postoperatively and the coronal femoro-tibial angle was adjusted on average 4.4°. The measured preoperative tibial slope was 5.3° ± 2.2° (mean +/− SD) and the average postoperative tibial slope was 4.7° ± 1.1° on lateral views. The joint line was well preserved with an average modified Insall-Salvati index of 1.66 ± 0.16 pre- and 1.67 ± 0.16 postoperatively. The overall accuracy of fit of implant components was decent with a measured medial overhang of more than 1 mm (1.33 mm ± 0.32 mm) in 4 cases only. Further, a lateral overhang of more than 1 mm (1.8 mm ± 0.63) (measured in the anterior-posterior radiographs) was observed in 11 cases, with none of the 106 patients showing femoral notching. Conclusion The patient-specific iTotal™ CR G2 total knee replacement system facilitated a proper fitting and positioning of the implant components. Moreover, a good restoration of the leg axis towards neutral alignment was achieved as planned. Nonetheless, further clinical follow-up studies are necessary to validate our findings and to determine the long-term impact of using this patient- specific system.
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Affiliation(s)
- Jörg Arnholdt
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.
| | - Yama Kamawal
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany
| | - Konstantin Horas
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany
| | - Boris M Holzapfel
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.,Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, 4059, Australia
| | - Fabian Gilbert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University Würzburg, D-97080, Würzburg, Germany
| | - Axel Ripp
- Department of Trauma and Orthopaedic Surgery, Elblandklinikum Radebeul, Heinrich-Zille-Straße 13, D-01445, Radebeul, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, D-97074, Würzburg, Germany.,Rhön-Klinikum Campus Bad Neustadt, Department of Orthopaedic, Trauma, Shoulder and Arthroplasty Surgery, Von-Guttenberg-Straße 11, D-97616, Bad Neustadt a. d. Saale, Germany
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Weißenberger M, Weißenberger MH, Wagenbrenner M, Heinz T, Reboredo J, Holzapfel BM, Rudert M, Groll J, Evans CH, Steinert AF. Different types of cartilage neotissue fabricated from collagen hydrogels and mesenchymal stromal cells via SOX9, TGFB1 or BMP2 gene transfer. PLoS One 2020; 15:e0237479. [PMID: 32790806 PMCID: PMC7425924 DOI: 10.1371/journal.pone.0237479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/27/2020] [Indexed: 11/18/2022] Open
Abstract
Objective As native cartilage consists of different phenotypical zones, this study aims to fabricate different types of neocartilage constructs from collagen hydrogels and human mesenchymal stromal cells (MSCs) genetically modified to express different chondrogenic factors. Design Human MSCs derived from bone-marrow of osteoarthritis (OA) hips were genetically modified using adenoviral vectors encoding sex-determining region Y-type high-mobility-group-box (SOX) 9, transforming growth factor beta (TGFB) 1 or bone morphogenetic protein (BMP) 2 cDNA, placed in type I collagen hydrogels and maintained in serum-free chondrogenic media for three weeks. Control constructs contained unmodified MSCs or MSCs expressing GFP. The respective constructs were analyzed histologically, immunohistochemically, biochemically, and by qRT-PCR for chondrogenesis and hypertrophy. Results Chondrogenesis in MSCs was consistently and strongly induced in collagen I hydrogels by the transgenes SOX9, TGFB1 and BMP2 as evidenced by positive staining for proteoglycans, chondroitin-4-sulfate (CS4) and collagen (COL) type II, increased levels of glycosaminoglycan (GAG) synthesis, and expression of mRNAs associated with chondrogenesis. The control groups were entirely non-chondrogenic. The levels of hypertrophy, as judged by expression of alkaline phosphatase (ALP) and COL X on both the protein and mRNA levels revealed different stages of hypertrophy within the chondrogenic groups (BMP2>TGFB1>SOX9). Conclusions Different types of neocartilage with varying levels of hypertrophy could be generated from human MSCs in collagen hydrogels by transfer of genes encoding the chondrogenic factors SOX9, TGFB1 and BMP2. This technology may be harnessed for regeneration of specific zones of native cartilage upon damage.
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Affiliation(s)
- Manuel Weißenberger
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research (OCMR), Julius-Maximilians-University Würzburg, Würzburg, Germany
- * E-mail:
| | - Manuela H. Weißenberger
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research (OCMR), Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Mike Wagenbrenner
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research (OCMR), Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Tizian Heinz
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research (OCMR), Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Jenny Reboredo
- Department of Tissue Engineering and Regenerative Medicine, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Boris M. Holzapfel
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research (OCMR), Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research (OCMR), Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Jürgen Groll
- Department of Functional Materials in Medicine and Dentistry, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Christopher H. Evans
- Department of Physical Medicine and Rehabilitation, Musculoskeletal Gene Therapy Research Laboratory, Mayo Clinic, Rochester, MN, United States of America
| | - Andre F. Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research (OCMR), Julius-Maximilians-University Würzburg, Würzburg, Germany
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Beckmann J, Steinert AF, Huber B, Rudert M, Köck FX, Buhs M, Rolston L. Customised bi-compartmental knee arthroplasty shows encouraging 3-year results: findings of a prospective, multicenter study. Knee Surg Sports Traumatol Arthrosc 2020; 28:1742-1749. [PMID: 31254031 DOI: 10.1007/s00167-019-05595-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess the clinical and patient-reported outcomes of a customised, individually made (CIM) bi-compartmental knee arthroplasty (BKA). METHODS A prospectively recruited cohort of 79 patients was implanted with a CIM-BKA (patello-femoral plus either medial or lateral tibio-femoral, iDuo G2 system, Conformis, Billerica MA) at eight centres in the US and Germany. Patients were assessed for the 2011 KSS, KOOS, and ROM pre-operatively and at 2 weeks, 6 weeks, 12 weeks, 1 year, and 2 years post-operatively. RESULTS The objective KSS score significantly improved from 69 at the pre-operative visit, to 94 at the 2-year post-operative time-point. Similar improvements were observed for the KSS function and satisfaction domains. Significant improvements from pre-operative levels were observed across all five domains of the KOOS. Two patients have undergone surgery to revise their CIM-BKA implant to total knees, resulting in a survivorship rate of 97.5% at an average follow-up of 2.6 years. CONCLUSIONS CIM-BKA compares favourably to published scores as well as revision rates for previously available monolithic OTS-BKA implants. CIM-BKA implants provide surgeons with a viable and patient-specific monolithic implant solution as an option for patients presenting with bi-compartmental disease, who might, otherwise, be treated by performing uni-condylar + patello-femoral joint or bicruciate sparing TKA surgeries. Longer follow-up and higher numbers have to be awaited for further validation of these encouraging early results. LEVEL OF EVIDENCE 3b (individual case-controlled study).
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Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany.
| | - A F Steinert
- König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
| | - B Huber
- Copley Hospital, 555 Washington Highway, Morrisville, VT, USA
| | - M Rudert
- König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
| | - F X Köck
- MedArtes Orthopaedic Surgery, 93073, Regensburg, Neutraubling, Germany
| | - M Buhs
- COVZ, Bahnhofstraße 92, 25451, Quickborn, Germany
| | - L Rolston
- Henry County Center for Orthopedics Surgery and Sports Medicine, New Castle, IN, USA
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Wagenbrenner M, Heinz T, Horas K, Jakuscheit A, Arnholdt J, Herrmann M, Rudert M, Holzapfel BM, Steinert AF, Weißenberger M. The human arthritic hip joint is a source of mesenchymal stromal cells (MSCs) with extensive multipotent differentiation potential. BMC Musculoskelet Disord 2020; 21:297. [PMID: 32404085 PMCID: PMC7222515 DOI: 10.1186/s12891-020-03340-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/08/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND While multiple in vitro studies examined mesenchymal stromal cells (MSCs) derived from bone marrow or hyaline cartilage, there is little to no data about the presence of MSCs in the joint capsule or the ligamentum capitis femoris (LCF) of the hip joint. Therefore, this in vitro study examined the presence and differentiation potential of MSCs isolated from the bone marrow, arthritic hyaline cartilage, the LCF and full-thickness samples of the anterior joint capsule of the hip joint. METHODS MSCs were isolated and multiplied in adherent monolayer cell cultures. Osteogenesis and adipogenesis were induced in monolayer cell cultures for 21 days using a differentiation medium containing specific growth factors, while chondrogenesis in the presence of TGF-ß1 was performed using pellet-culture for 27 days. Control cultures were maintained for comparison over the same duration of time. The differentiation process was analyzed using histological and immunohistochemical stainings as well as semiquantitative RT-PCR for measuring the mean expression levels of tissue-specific genes. RESULTS This in vitro research showed that the isolated cells from all four donor tissues grew plastic-adherent and showed similar adipogenic and osteogenic differentiation capacity as proven by the histological detection of lipid droplets or deposits of extracellular calcium and collagen type I. After 27 days of chondrogenesis proteoglycans accumulated in the differentiated MSC-pellets from all donor tissues. Immunohistochemical staining revealed vast amounts of collagen type II in all differentiated MSC-pellets, except for those from the LCF. Interestingly, all differentiated MSCs still showed a clear increase in mean expression of adipogenic, osteogenic and chondrogenic marker genes. In addition, the examination of an exemplary selected donor sample revealed that cells from all four donor tissues were clearly positive for the surface markers CD44, CD73, CD90 and CD105 by flow cytometric analysis. CONCLUSIONS This study proved the presence of MSC-like cells in all four examined donor tissues of the hip joint. No significant differences were observed during osteogenic or adipogenic differentiation depending on the source of MSCs used. Further research is necessary to fully determine the tripotent differentiation potential of cells isolated from the LCF and capsule tissue of the hip joint.
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Affiliation(s)
- Mike Wagenbrenner
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Tizian Heinz
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Konstantin Horas
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Joerg Arnholdt
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Marietta Herrmann
- Bernhard-Heine-Center for Locomotion Research, University of Wuerzburg, Wuerzburg, Germany.,IZKF Research Group Tissue Regeneration in Musculoskeletal Disease, University Clinics Wuerzburg, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Boris M Holzapfel
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic, Trauma, Shoulder and Arthroplasty Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt, Germany
| | - Manuel Weißenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany.
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Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U, Jakob F, Ebert R, Steinert AF. The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis. J Orthop Surg (Hong Kong) 2020; 27:2309499018820349. [PMID: 30739571 DOI: 10.1177/2309499018820349] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The long head of the biceps (LHB) is often resected in shoulder surgery. However, its contribution to inflammatory processes in the shoulder remains unclear. In the present study, inflamed and noninflamed human LHBs were comparatively characterized for features of inflammation. MATERIALS AND METHODS Twenty-two resected LHB tendons were classified into inflamed ( n = 11) and noninflamed ( n = 11) samples. For histological examination, samples were stained with hematoxylin eosin, Azan, van Gieson, and Masson Goldner trichrome. Neuronal tissue was immunohistochemically visualized. In addition, specific inflammatory marker gene expression of primary LHB-derived cell cultures were analyzed. RESULTS Features of tendinopathy, such as collagen disorganization, infiltration by inflammatory cells, neovascularization, and extensive neuronal innervation were found in the tendinitis group. Compared to noninflamed samples, inflamed LHBs showed a significantly increased inflammatory marker gene expression. CONCLUSION Structural and biomolecular differences of both groups suggest that the LHB tendon acts as an important pain generator in the shoulder joint. These findings can, on the one hand, contribute to the understanding of the biomolecular genesis of LHB tendinitis and, on the other hand, provide possibilities for new therapeutic approaches.
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Affiliation(s)
- J Schmalzl
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,2 Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Suedendstraße Karlsruhe, Germany
| | - P Plumhoff
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - F Gilbert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,3 Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - F Gohlke
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,4 Clinic for Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt/Saale, Germany
| | - C Konrads
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - U Brunner
- 5 Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel-Platz, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - F Jakob
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - R Ebert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - A F Steinert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,5 Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel-Platz, Krankenhaus Agatharied GmbH, Hausham, Germany
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9
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Weissenberger M, Weissenberger MH, Gilbert F, Groll J, Evans CH, Steinert AF. Reduced hypertrophy in vitro after chondrogenic differentiation of adult human mesenchymal stem cells following adenoviral SOX9 gene delivery. BMC Musculoskelet Disord 2020; 21:109. [PMID: 32066427 PMCID: PMC7026978 DOI: 10.1186/s12891-020-3137-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/12/2020] [Indexed: 01/03/2023] Open
Abstract
Background Mesenchymal stem cell (MSC) based-treatments of cartilage injury are promising but impaired by high levels of hypertrophy after chondrogenic induction with several bone morphogenetic protein superfamily members (BMPs). As an alternative, this study investigates the chondrogenic induction of MSCs via adenoviral gene-delivery of the transcription factor SOX9 alone or in combination with other inducers, and comparatively explores the levels of hypertrophy and end stage differentiation in a pellet culture system in vitro. Methods First generation adenoviral vectors encoding SOX9, TGFB1 or IGF1 were used alone or in combination to transduce human bone marrow-derived MSCs at 5 × 102 infectious particles/cell. Thereafter cells were placed in aggregates and maintained for three weeks in chondrogenic medium. Transgene expression was determined at the protein level (ELISA/Western blot), and aggregates were analysed histologically, immunohistochemically, biochemically and by RT-PCR for chondrogenesis and hypertrophy. Results SOX9 cDNA was superior to that encoding TGFB1, the typical gold standard, as an inducer of chondrogenesis in primary MSCs as evidenced by improved lacuna formation, proteoglycan and collagen type II staining, increased levels of GAG synthesis, and expression of mRNAs associated with chondrogenesis. Moreover, SOX9 modified aggregates showed a markedly lower tendency to progress towards hypertrophy, as judged by expression of the hypertrophy markers alkaline phosphatase, and collagen type X at the mRNA and protein levels. Conclusion Adenoviral SOX9 gene transfer induces chondrogenic differentiation of human primary MSCs in pellet culture more effectively than TGFB1 gene transfer with lower levels of chondrocyte hypertrophy after 3 weeks of in vitro culture. Such technology might enable the formation of more stable hyaline cartilage repair tissues in vivo.
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Affiliation(s)
- M Weissenberger
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.
| | - M H Weissenberger
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.,Department of Pathology, Caritas-Hospital, Bad Mergentheim, Germany
| | - F Gilbert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.,Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
| | - J Groll
- Department of Functional Materials in Medicine and Dentistry, Julius-Maximilians-University, Würzburg, Germany
| | - C H Evans
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - A F Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstrasse 11, D-97074, Würzburg, Germany.,Present address: Department of Orthopaedic, Trauma, Shoulder and Arthroplasty Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt a.d. Saale, Germany
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Steinert AF, Gohlke F. Editorial Commentary: Subacromial Bursa-Friend or Foe Within The Shoulder? An Old Debate With New Insights. Arthroscopy 2019; 35:2989-2991. [PMID: 31699249 DOI: 10.1016/j.arthro.2019.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023]
Abstract
There is an ongoing debate about whether to resect or preserve the subacromial bursa during surgical treatment of rotator cuff tears. Neer was the first to systematically describe bursitis as a component of subacromial impingement syndrome that may extend to rotator cuff disease, often discussed as a point of controversy with Uhthoff who first identified the bursa as a contributor to rotator cuff healing, both experimentally and clinically. Because the subacromial bursa provides the gliding mechanism of the shoulder and regenerates itself after surgical removal, interest evolved on the role of the bursa in the healing of rotator cuff tears for evolution of regenerative therapies as a support of arthroscopic repair techniques. In vitro work could identify human subacromial bursa as a source of mesenchymal stem cells, which revealed lineage-specific differentiation capacity, including the tendon and a marker profile that was highly similar to, although in some aspects distinct from, marrow-derived mesenchymal stem cells. Only recently, this knowledge was used in controlled experimental work in vivo to demonstrate superior engraftment of bursal cells within tendon tissue. These findings shed new light on the biology of the subacromial space and provides novel prospects for the clinical use of local stem cells in rotator cuff repair.
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11
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Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U, Jakob F, Ebert R, Steinert AF. Tendon-derived stem cells from the long head of the biceps tendon: Inflammation does not affect the regenerative potential. Bone Joint Res 2019; 8:414-424. [PMID: 31588358 PMCID: PMC6775540 DOI: 10.1302/2046-3758.89.bjr-2018-0214.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives The long head of the biceps (LHB) is often resected in shoulder surgery and could therefore serve as a cell source for tissue engineering approaches in the shoulder. However, whether it represents a suitable cell source for regenerative approaches, both in the inflamed and non-inflamed states, remains unclear. In the present study, inflamed and native human LHBs were comparatively characterized for features of regeneration. Methods In total, 22 resected LHB tendons were classified into inflamed samples (n = 11) and non-inflamed samples (n = 11). Proliferation potential and specific marker gene expression of primary LHB-derived cell cultures were analyzed. Multipotentiality, including osteogenic, adipogenic, chondrogenic, and tenogenic differentiation potential of both groups were compared under respective lineage-specific culture conditions. Results Inflammation does not seem to affect the proliferation rate of the isolated tendon-derived stem cells (TDSCs) and the tenogenic marker gene expression. Cells from both groups showed an equivalent osteogenic, adipogenic, chondrogenic and tenogenic differentiation potential in histology and real-time polymerase chain reaction (RT-PCR) analysis. Conclusion These results suggest that the LHB tendon might be a suitable cell source for regenerative approaches, both in inflamed and non-inflamed states. The LHB with and without tendinitis has been characterized as a novel source of TDSCs, which might facilitate treatment of degeneration and induction of regeneration in shoulder surgery. Cite this article: J. Schmalzl, P. Plumhoff, F. Gilbert, F. Gohlke, C. Konrads, U. Brunner, F. Jakob, R. Ebert, A. F. Steinert. Tendon-derived stem cells from the long head of the biceps tendon: Inflammation does not affect the regenerative potential. Bone Joint Res 2019;8:414–424. DOI: 10.1302/2046-3758.89.BJR-2018-0214.R2.
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Affiliation(s)
- Jonas Schmalzl
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinis, Teaching Hospital Albert-Ludwigs University Freiburg, Karlsruhe, Germany
| | - Piet Plumhoff
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Wuerzburg, Germany
| | - Frank Gohlke
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Clinic for Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt an der Saale, Germany
| | - Christian Konrads
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Ulrich Brunner
- Department of Orthopaedic and Trauma Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - Franz Jakob
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Regina Ebert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Orthopaedic and Trauma Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
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12
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Boelch SP, Jordan MC, Arnholdt J, Steinert AF, Rudert M, Luedemann M. Antibiotic elution and compressive strength of gentamicin/vancomycin loaded bone cements are considerably influenced by immersion fluid volume. J Mater Sci Mater Med 2019; 30:29. [PMID: 30762118 DOI: 10.1007/s10856-019-6229-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
The effect of doubling the immersion fluid (eluate) volume on antibiotic concentrations and on mechanical stability from vancomycin and gentamicin loaded bone cements was investigated in vitro. Antibiotic loaded bone cements containing premixed 1.34% gentamicin antibiotic concentration in the cement powder (wt), premixed 1.19% gentamicin wt and 4.76% vancomycin wt and premixed 1.17% wt gentamicin additionally manually blended with 4.68% wt vancomycin were tested. Six specimens per group were immersed in 4 ml and 8 ml for 6 weeks while the eluate was exchanged every 24 h. The antibiotic concentrations were repeatedly measured. Then the specimens were tested for compressive strength. Doubling the eluate volume significantly decreased gentamicin and vancomycin concentrations from 6 h and 24 h on, except for the gentamicin concentration of the additionally manually blended formulation after 3 weeks. The additionally manually blended vancomycin formulation produced significantly higher gentamicin concentrations in 8 ml compared to the other formulations. The reduction ratios of the vancomycin concentrations were significantly smaller than the reduction ratios of the gentamicin concentrations for the manually blended vancomycin formulation. Vancomycin containing formulations showed significantly lower compressive strengths than the vancomycin free formulation after immersion. Doubling the eluate volume lead to significant compressive strength reduction of the vancomycin containing formulations. Eluate volume change influences antibiotic elution dependent on the antibiotic combination and loading technique. The reducing effect is higher on vancomycin than on gentamicin elution. Compressive strength of gentamicin/vancomycin loaded bone cements after immersion is eluate volume dependent.
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Affiliation(s)
- Sebastian P Boelch
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany.
| | - Martin C Jordan
- Julius-Maximilians University Wuerzburg, Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, 6 Oberduerrbacher Strasse, D-97080, Wuerzburg, Germany
| | - Joerg Arnholdt
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
| | - Andre F Steinert
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
- Hospital Agatharied, Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel Platz, 83734, Hausham, Germany
| | - Maximilian Rudert
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
| | - Martin Luedemann
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
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13
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Böck T, Schill V, Krähnke M, Steinert AF, Tessmar J, Blunk T, Groll J. TGF-β1-Modified Hyaluronic Acid/Poly(glycidol) Hydrogels for Chondrogenic Differentiation of Human Mesenchymal Stromal Cells. Macromol Biosci 2018; 18:e1700390. [DOI: 10.1002/mabi.201700390] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/20/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Thomas Böck
- Department of Trauma, Hand, Plastic and Reconstructive Surgery; University of Würzburg; Oberdürrbacher Str. 6 97080 Würzburg Germany
| | - Verena Schill
- Department of Functional Materials for Medicine and Dentistry and Bavarian Polymer Institute; University of Würzburg; Pleicherwall 2 97070 Würzburg Germany
| | - Martin Krähnke
- Department of Trauma, Hand, Plastic and Reconstructive Surgery; University of Würzburg; Oberdürrbacher Str. 6 97080 Würzburg Germany
| | - Andre F. Steinert
- Orthopedic Center for Musculoskeletal Research; University of Würzburg; Brettreichstr. 11 97074 Würzburg Germany
| | - Jörg Tessmar
- Department of Functional Materials for Medicine and Dentistry and Bavarian Polymer Institute; University of Würzburg; Pleicherwall 2 97070 Würzburg Germany
| | - Torsten Blunk
- Department of Trauma, Hand, Plastic and Reconstructive Surgery; University of Würzburg; Oberdürrbacher Str. 6 97080 Würzburg Germany
| | - Jürgen Groll
- Department of Functional Materials for Medicine and Dentistry and Bavarian Polymer Institute; University of Würzburg; Pleicherwall 2 97070 Würzburg Germany
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14
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Hoberg M, Holzapfel BM, Steinert AF, Kratzer F, Walcher M, Rudert M. [Treatment of acetabular bone defects in revision hip arthroplasty using the Revisio-System]. Orthopade 2017; 46:126-132. [PMID: 28012061 DOI: 10.1007/s00132-016-3375-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many different systems for the management of primary and secondary acetabular defects are available, each with its inherent advantages and disadvantages. The Revisio-System is a press-fit oval mono-block implant that makes a defect-oriented reconstruction and restoration of the center of rotation possible. MATERIAL AND METHODS In this study, we retrospectively reviewed the outcome of 92 consecutive patients treated with this oval press-fit cup due to periacetabular bone loss. The average follow-up was 58.2 months. Defects were classified according to D'Antonio. There were 39 type II, 38 Type III, and 15 type IV defects. After an average of 4.9 years, the implant survival rate was 94.6% with cup revision as the end point and 89.1% with revision for any reason as the end point. The Harris Hip Score increased from 41.1 preoperatively to 62.3 postoperatively. The mean level of pain measured with the Visual Analogue Scale (VSA) was reduced from 6.9 preoperatively to 3.8 postoperatively. RESULTS The Revisio-System represents a promising toolbox for defect-orientated reconstruction of acetabular bone loss in revision hip arthroplasty. Our results demonstrate that the implantation of the Revisio-System can result in a good mid-term clinical outcome.
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Affiliation(s)
- M Hoberg
- Orthopädische Klinik König-Ludwig Haus, Lehrstuhl der Julius-Maximilians Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland.
| | - B M Holzapfel
- Orthopädische Klinik König-Ludwig Haus, Lehrstuhl der Julius-Maximilians Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland.,Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4049, Brisbane, Australien
| | - A F Steinert
- Orthopädische Klinik König-Ludwig Haus, Lehrstuhl der Julius-Maximilians Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | - F Kratzer
- Endogap Klinik für Gelenkersatz, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - M Walcher
- Orthopädische Klinik König-Ludwig Haus, Lehrstuhl der Julius-Maximilians Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | - M Rudert
- Orthopädische Klinik König-Ludwig Haus, Lehrstuhl der Julius-Maximilians Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland
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15
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Boelch SP, Jordan MC, Arnholdt J, Rudert M, Luedemann M, Steinert AF. Loading with vancomycin does not decrease gentamicin elution in gentamicin premixed bone cement. J Mater Sci Mater Med 2017; 28:104. [PMID: 28534287 DOI: 10.1007/s10856-017-5915-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
Antibiotic loaded bone cements are used as drug delivery systems for the treatment of periprosthetic joint infections. They can be loaded with antibiotics during industrial component production (premixing) and during cement preparation (manually blending). Although double premixed antibiotic loaded bone cements are available, manually blending of a gentamicin premixed antibiotic loaded bone cement with vancomycin is still popular. We compared in vitro antibiotic elution and compressive strength of 0.5 g gentamicin premixed bone cement (PALACOS® R + G), 0.5 g gentamicin premixed bone cement (PALACOS® R + G) manually blended with 2.0 g vancomycin, 0.5 g gentamicin and 2.0 g vancomycin premixed bone cement (COPAL® G + V), 1 g gentamicin and clindamycin premixed bone cement (COPAL® G + C) and bone cement without an antibiotic (PALACOS® R) as control. Antibiotic concentration measurements were performed for 6 weeks and then compression strength was tested. Concentrations of gentamicin showed no significant differences between PALACOS® R + G, PALACOS® R + G with vancomycin and COPAL G® + V. After 48 h COPAL G® + C produced significantly higher gentamicin concentrations than the other formulations. After 12 h PALACOS® R + G with vancomycin produced significantly higher vancomycin concentrations, but had the lowest compression strength. We found no influence of vancomycin addition on gentamicin elution, irrespectively of the loading method. However, the manually vancomycin blended ALBC produced higher vancomycin concentrations. Compression strength after aging is reduced by loading with vancomycin.
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Affiliation(s)
- Sebastian P Boelch
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany.
| | - Martin C Jordan
- Julius-Maximilians University Wuerzburg, Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, 6 Oberduerrbacher Strasse, D-97080, Wuerzburg, Germany
| | - Joerg Arnholdt
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
| | - Maximilian Rudert
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
| | - Martin Luedemann
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
| | - Andre F Steinert
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, 11 Brettreichstrasse, D-97074, Wuerzburg, Germany
- Hospital Agatharied, Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel Platz, 83734, Hausham, Germany
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Armbruster N, Krieg J, Weißenberger M, Scheller C, Steinert AF. Rescued Chondrogenesis of Mesenchymal Stem Cells under Interleukin 1 Challenge by Foamyviral Interleukin 1 Receptor Antagonist Gene Transfer. Front Pharmacol 2017; 8:255. [PMID: 28536528 PMCID: PMC5422547 DOI: 10.3389/fphar.2017.00255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 12/05/2016] [Accepted: 04/24/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Mesenchymal stem cells (MSCs) and their chondrogenic differentiation have been extensively investigated in vitro as MSCs provide an attractive source besides chondrocytes for cartilage repair therapies. Here we established prototype foamyviral vectors (FVV) that are derived from apathogenic parent viruses and are characterized by a broad host range and a favorable integration pattern into the cellular genome. As the inflammatory cytokine interleukin 1 beta (IL1β) is frequently present in diseased joints, the protective effects of FVV expressing the human interleukin 1 receptor antagonist protein (IL1RA) were studied in an established in vitro model (aggregate culture system) of chondrogenesis in the presence of IL1β. Materials and Methods: We generated different recombinant FVVs encoding enhanced green fluorescent protein (EGFP) or IL1RA and examined their transduction efficiencies and transgene expression profiles using different cell lines and human primary MSCs derived from bone marrow-aspirates. Transgene expression was evaluated by fluorescence microscopy (EGFP), flow cytometry (EGFP), and ELISA (IL1RA). For evaluation of the functionality of the IL1RA transgene to block the inhibitory effects of IL1β on chondrogenesis of primary MSCs and an immortalized MSC cell line (TERT4 cells), the cells were maintained following transduction as aggregate cultures in standard chondrogenic media in the presence or absence of IL1β. After 3 weeks of culture, pellets were harvested and analyzed by histology and immunohistochemistry for chondrogenic phenotypes. Results: The different FVV efficiently transduced cell lines as well as primary MSCs, thereby reaching high transgene expression levels in 6-well plates with levels of around 100 ng/ml IL1RA. MSC aggregate cultures which were maintained in chondrogenic media without IL1β supplementation revealed a chondrogenic phenotype by means of strong positive staining for collagen type II and matrix proteoglycan (Alcian blue). Addition of IL1β was inhibitory to chondrogenesis in untreated control pellets. In contrast, foamyviral mediated IL1RA expression rescued the chondrogenesis in pellets cultured in the presence of IL1β. Transduced MSC pellets reached thereby very high IL1RA transgene expression levels with a peak of 1087 ng/ml after day 7, followed by a decrease to 194 ng/ml after day 21, while IL1RA concentrations of controls were permanently below 200 pg/ml. Conclusion: Our results indicate that FVV are capable of efficient gene transfer to MSCs, while reaching IL1RA transgene expression levels, that were able to efficiently block the impacts of IL1β in vitro. FVV merit further investigation as a means to study the potential as a gene transfer tool for MSC based therapies for cartilage repair.
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Affiliation(s)
- Nicole Armbruster
- Institute for Virology and Immunobiology, University of WuerzburgWuerzburg, Germany.,Department of Orthopaedic Surgery, Klinik König-Ludwig-Haus Würzburg - Center for Musculoskeletal Research, University of WuerzburgWuerzburg, Germany
| | - Jennifer Krieg
- Institute for Virology and Immunobiology, University of WuerzburgWuerzburg, Germany.,Department of Orthopaedic Surgery, Klinik König-Ludwig-Haus Würzburg - Center for Musculoskeletal Research, University of WuerzburgWuerzburg, Germany
| | - Manuel Weißenberger
- Department of Orthopaedic Surgery, Klinik König-Ludwig-Haus Würzburg - Center for Musculoskeletal Research, University of WuerzburgWuerzburg, Germany
| | - Carsten Scheller
- Institute for Virology and Immunobiology, University of WuerzburgWuerzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, Klinik König-Ludwig-Haus Würzburg - Center for Musculoskeletal Research, University of WuerzburgWuerzburg, Germany
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Kamawal Y, Steinert AF, Holzapfel BM, Rudert M, Barthel T. Case report - calcification of the medial collateral ligament of the knee with simultaneous calcifying tendinitis of the rotator cuff. BMC Musculoskelet Disord 2016; 17:283. [PMID: 27411380 PMCID: PMC4944491 DOI: 10.1186/s12891-016-1147-z] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/29/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Calcification of the medial collateral ligament (MCL) of the knee is a very rare disease. We report on a case of a patient with a calcifying lesion within the MCL and simultaneous calcifying tendinitis of the rotator cuff in both shoulders. CASE PRESENTATION Calcification of the MCL was diagnosed both via x-ray and magnetic resonance imaging (MRI) and was successfully treated surgically. Calcifying tendinitis of the rotator cuff was successfully treated applying conservative methods. CONCLUSION This is the first case report of a patient suffering from both a calcifying lesion within the medial collateral ligament and calcifying tendinitis of the rotator cuff in both shoulders. Clinical symptoms, radio-morphological characteristics and macroscopic features were very similar and therefore it can be postulated that the underlying pathophysiology is the same in both diseases. Our experience suggests that magnetic resonance imaging and x-ray are invaluable tools for the diagnosis of this inflammatory calcifying disease of the ligament, and that surgical repair provides a good outcome if conservative treatment fails. It seems that calcification of the MCL is more likely to require surgery than calcifying tendinitis of the rotator cuff. However, the exact reason for this remains unclear to date.
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Affiliation(s)
- Yama Kamawal
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Julius-Maximilians-University Wuerzburg, Brettreichstraße 11, D- 97074, Wuerzburg, Germany.
| | - Andre F Steinert
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Julius-Maximilians-University Wuerzburg, Brettreichstraße 11, D- 97074, Wuerzburg, Germany
| | - Boris M Holzapfel
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Julius-Maximilians-University Wuerzburg, Brettreichstraße 11, D- 97074, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Julius-Maximilians-University Wuerzburg, Brettreichstraße 11, D- 97074, Wuerzburg, Germany
| | - Thomas Barthel
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Julius-Maximilians-University Wuerzburg, Brettreichstraße 11, D- 97074, Wuerzburg, Germany
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Steinert AF, Rudert M. [Individualized knee joint endoprosthetics: Patient-specific intrumentation and implant systems]. Orthopade 2016; 45:279. [PMID: 27000382 DOI: 10.1007/s00132-016-3244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A F Steinert
- Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland.
| | - M Rudert
- Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland.
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Steinert AF, Kunz M, Prager P, Göbel S, Klein-Hitpass L, Ebert R, Nöth U, Jakob F, Gohlke F. Characterization of bursa subacromialis-derived mesenchymal stem cells. Stem Cell Res Ther 2015; 6:114. [PMID: 26036250 PMCID: PMC4479225 DOI: 10.1186/s13287-015-0104-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 08/15/2014] [Revised: 08/15/2014] [Accepted: 05/21/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction The bursa subacromialis (BS) provides the gliding mechanism of the shoulder and regenerates itself after surgical removal. Therefore, we explored the presence of mesenchymal stem cells (MSCs) within the human adult BS tissue and characterized the BS cells compared to MSCs from bone marrow (BMSCs) on a molecular level. Methods BS cells were isolated by collagenase digest from BS tissues derived from patients with degenerative rotator cuff tears, and BMSCs were recovered by adherent culture from bone-marrow of patients with osteoarthritis of the hip. BS cells and BMSCs were compared upon their potential to proliferate and differentiate along chondrogenic, osteogenic and adipogenic lineages under specific culture conditions. Expression profiles of markers associated with mesenchymal phenotypes were comparatively evaluated by flow cytometry, immunohistochemistry, and whole genome array analyses. Results BS cells and BMSCs appeared mainly fibroblastic and revealed almost similar surface antigen expression profiles, which was CD44+, CD73+, CD90+, CD105+, CD106+, STRO-1+, CD14−, CD31−, CD34−, CD45−, CD144−. Array analyses revealed 1969 genes upregulated and 1184 genes downregulated in BS cells vs. BMSCs, indicating a high level of transcriptome similarity. After 3 weeks of differentiation culture, BS cells and BMSCs showed a similar strong chondrogenic, adipogenic and osteogenic potential, as shown by histological, immunohistochemical and RT-PCR analyses in contrast to the respective negative controls. Conclusions Our in vitro characterizations show that BS cells fulfill all characteristics of mesenchymal stem cells, and therefore merit further attention for the development of improved therapies for various shoulder pathologies.
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Affiliation(s)
- Andre F Steinert
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany.
| | - Manuela Kunz
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany.
| | - Patrick Prager
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany.
| | - Sascha Göbel
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany.
| | - Ludger Klein-Hitpass
- University of Duisburg-Essen, Center for Medical Biotechnology, BioChip Laboratory, Essen, Germany.
| | - Regina Ebert
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany.
| | - Ulrich Nöth
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany.
| | - Franz Jakob
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany.
| | - Frank Gohlke
- Julius-Maximilians-University Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University Würzburg, Brettreichstr. 11, D - 97074, Würzburg, Germany. .,Present address: Klinik für Schulterchirurgie, Rhön Klinikum AG, Bad Neustadt/Saale, Germany.
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Armbruster N, Weber C, Wictorowicz T, Rethwilm A, Scheller C, Steinert AF. Ex vivo gene delivery to synovium using foamy viral vectors. J Gene Med 2015; 16:166-78. [PMID: 25044583 DOI: 10.1002/jgm.2774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/13/2013] [Revised: 04/21/2014] [Accepted: 07/14/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Gene transfer technologies have the potential to fundamentally improve current therapies for arthritic conditions, although this is essentially dependent on safe and efficient vector systems. The foamy virus (FV)-based vectors have many safety features that favour their use in the treatment of arthritis. In the present study, we investigated the use of safe prototype foamy viral vectors (FVV) for indirect gene delivery to articular tissues. METHODS We generated recombinant FVV encoding enhanced green fluorescent protein (EGFP) or human interleukin 1 receptor antagonist protein (IL1RA) cDNA under the control of the spleen focus forming virus U3 promoter and explored their transgene expression profile following ex vivo gene delivery to knee joints of Wistar and athymic nude rats. RESULTS FVV efficiently transduced primary rat synovial fibroblasts using the EGFP and the IL1RA transgene in vitro. FVV-mediated IL1RA expression was functional in blocking IL1 effects in vitro. After the transplantation of FVV transduced synovial fibroblasts, the intra-articular transgene expression in Wistar rats was initially high and declined after approximately 3 weeks for both transgenes. By contrast, FVV-mediated expression of EGFP and IL1RA persisted for at least 12 weeks at high levels in immunocompromised nude rats. FVV-meditated gene delivery was well tolerated by all animals without extra-articular transgene expression, arguing for the safety of this approach. CONCLUSIONS Our results indicate that FVV are capable of efficient ex vivo gene transfer to synovium and merit further investigation as a means to provide long-term intra-articular transgene expression for arthritis treatment.
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Affiliation(s)
- Nicole Armbruster
- Julius-Maximilians-University of Würzburg, Institute for Virology and Immunobiology, Würzburg, Germany; Julius-Maximilians-University of Würzburg, Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Würzburg, Germany
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Sieker JT, Kunz M, Weißenberger M, Gilbert F, Frey S, Rudert M, Steinert AF. Direct bone morphogenetic protein 2 and Indian hedgehog gene transfer for articular cartilage repair using bone marrow coagulates. Osteoarthritis Cartilage 2015; 23:433-42. [PMID: 25463442 DOI: 10.1016/j.joca.2014.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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] [Received: 05/20/2014] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Bone morphogenetic protein 2 (BMP-2, encoded by BMP2) and Indian hedgehog protein (IHH, encoded by IHH) are well known regulators of chondrogenesis and chondrogenic hypertrophy. Despite being a potent chondrogenic factor BMP-2 was observed to induce chondrocyte hypertrophy in osteoarthritis (OA), growth plate cartilage and adult mesenchymal stem cells (MSCs). IHH might induce chondrogenic differentiation through different intracellular signalling pathways without inducing subsequent chondrocyte hypertrophy. The primary objective of this study is to test the efficacy of direct BMP2 and IHH gene delivery via bone marrow coagulates to influence histological repair cartilage quality in vivo. METHOD Vector-laden autologous bone marrow coagulates with 10(11) adenoviral vector particles encoding BMP2, IHH or the Green fluorescent protein (GFP) were delivered to 3.2 mm osteochondral defects in the trochlea of rabbit knees. After 13 weeks the histological repair cartilage quality was assessed using the ICRS II scoring system and the type II collagen positive area. RESULTS IHH treatment resulted in superior histological repair cartilage quality than GFP controls in all of the assessed parameters (with P < 0.05 in five of 14 assessed parameters). Results of BMP2 treatment varied substantially, including severe intralesional bone formation in two of six joints after 13 weeks. CONCLUSION IHH gene transfer is effective to improve repair cartilage quality in vivo, whereas BMP2 treatment, carried the risk intralesional bone formation. Therefore IHH protein can be considered as an attractive alternative candidate growth factor for further preclinical research and development towards improved treatments for articular cartilage defects.
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Affiliation(s)
- J T Sieker
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University of Würzburg, Germany.
| | - M Kunz
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University of Würzburg, Germany.
| | - M Weißenberger
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University of Würzburg, Germany.
| | - F Gilbert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University of Würzburg, Germany; Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Germany.
| | - S Frey
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Würzburg, Germany.
| | - M Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University of Würzburg, Germany.
| | - A F Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University of Würzburg, Germany.
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Nöth U, Rackwitz L, Steinert AF, Tuan RS. Principles of tissue engineering and cell- and gene-based therapy. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00021-8] [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: 11/15/2022] Open
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Sieker JT, Rudert M, Steinert AF. Symptomatic loosening of a total knee arthroplasty caused by a tibial chondrosarcoma - a case report. Springerplus 2014; 3:308. [PMID: 24995155 PMCID: PMC4079896 DOI: 10.1186/2193-1801-3-308] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 06/16/2014] [Indexed: 11/23/2022]
Abstract
Premature implant loosening following total knee arthroplasty (TKA) can have several causes. In this article we report on a rare case of a 74 year old male patient suffering tibial component loosening 14 month after primary TKA. The patient did neither have any malignancies nor joint arthroplasty before. Upon clinical examination the range of motion in the diseased knee was painfully restricted to 80° of knee flexion, with the patient increasingly suffering sleeping and resting pain, and also at weight bearing. In standard radiographs, loosening of the TKA due to a large osteolysis at the tibial component was evident. Local computed tomography (CT) of the right knee revealed loosening of the tibial component due to a presumably malign bone tumor. For determination of the final diagnosis a representative biopsy of the tumor was taken by open surgery prior to the tumor resection. Histopathologic evaluation of the biopsy revealed a periprosthetic myxoid chondrosarcoma of the proximal tibia. Pre-operative staging examination included CT scans of lung and abdomen, as well as a bone scintigraphy which revealed no signs of tumor metastasis in the body. Surgical management comprised wide tumor resection and implantation of a hinged tumor knee arthroplasty with replacements of the distal femur and proximal tibia, as well as a patella tendon replacement using a synthetic ligament. Revision surgery was necessary twice due to impaired wound healing and critical soft tissue coverage, and treatment included a gastrocnemius muscle flap with skin mesh graft covering. Unfortunately long-term follow-up examinations could not be obtained, as the patient deceased due to an alveolitis during rehabilitation. In summary, the specifics of this rare case of aseptic TKA loosening, and the unusual circumstances of chondrosarcoma diagnosis and treatment are informative for those providing surgical treatment of similar cases.
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Affiliation(s)
- Jakob T Sieker
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstr. 11, Würzburg, D-97074 Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstr. 11, Würzburg, D-97074 Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstr. 11, Würzburg, D-97074 Germany
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Weber C, Armbruster N, Scheller C, Kreppel F, Kochanek S, Rethwilm A, Steinert AF. Foamy virus-adenovirus hybrid vectors for gene therapy of the arthritides. J Gene Med 2013; 15:155-67. [PMID: 23554302 DOI: 10.1002/jgm.2705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/24/2013] [Accepted: 03/25/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Genetic treatments of chronic arthritic conditions are essentially dependent on safe and efficient vector systems. To combine features of the efficient transduction of adenovirus vectors with the advantage of stable integration into the host cell genome of apathogenic prototype foamy virus vectors, hybrid vectors (FAD) have been established. In the present study, we have generated and investigated the use of safe FAD vectors for direct gene delivery to joints. METHODS We generated recombinant FAD encoding enhanced green fluorescent protein (EGFP) or human interleukin 1 receptor antagonist protein (IL1RA) cDNA, and explored their transgene expression profile, as well as the bioactivity of the IL1RA transgene in vitro. The feasibility of IL1RA gene delivery to articular tissues was investigated in a pilot study employing direct FAD injections to the knee joints of Wistar rats. RESULTS FAD vectors efficiently transduced human or rat fibroblasts with EGFP or IL1RA transgene in vitro. Levels of IL1RA transgene expression were high, stable and functional in vitro. Transduced synovial fibroblasts and high levels of IL1RA protein (10-35 ng/ml) could be detected in vivo in the synovium of Wistar rats 3-5 days after injection of FAD vectors to the knee joints. CONCLUSIONS Our results indicate that FAD vectors are capable of efficient in vivo gene transfer to synovium and merit further investigation as a means of providing efficient and long-term intra-articular transgene expression for treatment of the arthritides.
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Affiliation(s)
- Conrad Weber
- University of Würzburg, Department of Virology and Immunobiology, Würzburg, Germany
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Steinert AF, Weissenberger M, Kunz M, Gilbert F, Ghivizzani SC, Göbel S, Jakob F, Nöth U, Rudert M. Indian hedgehog gene transfer is a chondrogenic inducer of human mesenchymal stem cells. Arthritis Res Ther 2012; 14:R168. [PMID: 22817660 PMCID: PMC3580562 DOI: 10.1186/ar3921] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 07/20/2012] [Indexed: 02/07/2023] Open
Abstract
Introduction To date, no single most-appropriate factor or delivery method has been identified for the purpose of mesenchymal stem cell (MSC)-based treatment of cartilage injury. Therefore, in this study we tested whether gene delivery of the growth factor Indian hedgehog (IHH) was able to induce chondrogenesis in human primary MSCs, and whether it was possible by such an approach to modulate the appearance of chondrogenic hypertrophy in pellet cultures in vitro. Methods First-generation adenoviral vectors encoding the cDNA of the human IHH gene were created by cre-lox recombination and used alone or in combination with adenoviral vectors, bone morphogenetic protein-2 (Ad.BMP-2), or transforming growth factor beta-1 (Ad.TGF-β1) to transduce human bone-marrow derived MSCs at 5 × 102 infectious particles/cell. Thereafter, 3 × 105 cells were seeded into aggregates and cultured for 3 weeks in serum-free medium, with untransduced or marker gene transduced cultures as controls. Transgene expressions were determined by ELISA, and aggregates were analysed histologically, immunohistochemically, biochemically and by RT-PCR for chondrogenesis and hypertrophy. Results IHH, TGF-β1 and BMP-2 genes were equipotent inducers of chondrogenesis in primary MSCs, as evidenced by strong staining for proteoglycans, collagen type II, increased levels of glycosaminoglycan synthesis, and expression of mRNAs associated with chondrogenesis. IHH-modified aggregates, alone or in combination, also showed a tendency to progress towards hypertrophy, as judged by the expression of alkaline phosphatase and stainings for collagen type X and Annexin 5. Conclusion As this study provides evidence for chondrogenic induction of MSC aggregates in vitro via IHH gene delivery, this technology may be efficiently employed for generating cartilaginous repair tissues in vivo.
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Steinert AF, Middleton KK, Araujo PH, Fu FH. Platelet-Rich Plasma in Orthopaedic Surgery and Sports Medicine: Pearls, Pitfalls, and New Trends in Research. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.oto.2011.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Steinert AF, Rackwitz L, Gilbert F, Nöth U, Tuan RS. Concise review: the clinical application of mesenchymal stem cells for musculoskeletal regeneration: current status and perspectives. Stem Cells Transl Med 2012; 1:237-47. [PMID: 23197783 PMCID: PMC3659848 DOI: 10.5966/sctm.2011-0036] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [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: 10/05/2011] [Accepted: 01/12/2012] [Indexed: 12/12/2022] Open
Abstract
Regenerative therapies in the musculoskeletal system are based on the suitable application of cells, biomaterials, and/or factors. For an effective approach, numerous aspects have to be taken into consideration, including age, disease, target tissue, and several environmental factors. Significant research efforts have been undertaken in the last decade to develop specific cell-based therapies, and in particular adult multipotent mesenchymal stem cells hold great promise for such regenerative strategies. Clinical translation of such therapies, however, remains a work in progress. In the clinical arena, autologous cells have been harvested, processed, and readministered according to protocols distinct for the target application. As outlined in this review, such applications range from simple single-step approaches, such as direct injection of unprocessed or concentrated blood or bone marrow aspirates, to fabrication of engineered constructs by seeding of natural or synthetic scaffolds with cells, which were released from autologous tissues and propagated under good manufacturing practice conditions (for example, autologous chondrocyte implantation). However, only relatively few of these cell-based approaches have entered the clinic, and none of these treatments has become a "standard of care" treatment for an orthopaedic disease to date. The multifaceted reasons for the current status from the medical, research, and regulatory perspectives are discussed here. In summary, this review presents the scientific background, current state, and implications of clinical mesenchymal stem cell application in the musculoskeletal system and provides perspectives for future developments.
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Affiliation(s)
- Andre F. Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University, Würzburg, Germany
| | - Lars Rackwitz
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University, Würzburg, Germany
| | - Fabian Gilbert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University, Würzburg, Germany
| | - Ulrich Nöth
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University, Würzburg, Germany
| | - Rocky S. Tuan
- Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Steinert AF, Reppenhagen S, Baumann B, Rudert M, Nöth U. Total knee arthroplasty in a patient with Erdheim-Chester disease with massive joint destruction: a case report. J Bone Joint Surg Am 2011; 93:e29. [PMID: 21471409 DOI: 10.2106/jbjs.j.00025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Andre F Steinert
- Department of Orthopaedic Surgery, Julius-Maximilians-University Würzburg, Würzburg, Germany.
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Steinert AF, Kunz M, Prager P, Barthel T, Jakob F, Nöth U, Murray MM, Evans CH, Porter RM. Mesenchymal stem cell characteristics of human anterior cruciate ligament outgrowth cells. Tissue Eng Part A 2011; 17:1375-88. [PMID: 21247268 DOI: 10.1089/ten.tea.2010.0413] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
When ruptured, the anterior cruciate ligament (ACL) of the human knee has limited regenerative potential. However, the goal of this report was to show that the cells that migrate out of the human ACL constitute a rich population of progenitor cells and we hypothesize that they display mesenchymal stem cell (MSC) characteristics when compared with adherent cells derived from bone marrow or collagenase digests from ACL. We show that ACL outgrowth cells are adherent, fibroblastic cells with a surface immunophenotype strongly positive for cluster of differentiation (CD)29, CD44, CD49c, CD73, CD90, CD97, CD105, CD146, and CD166, weakly positive for CD106 and CD14, but negative for CD11c, CD31, CD34, CD40, CD45, CD53, CD74, CD133, CD144, and CD163. Staining for STRO-1 was seen by immunohistochemistry but not flow cytometry. Under suitable culture conditions, the ACL outgrowth-derived MSCs differentiated into chondrocytes, osteoblasts, and adipocytes and showed capacity to self-renew in an in vitro assay of ligamentogenesis. MSCs derived from collagenase digests of ACL tissue and human bone marrow were analyzed in parallel and displayed similar, but not identical, properties. In situ staining of the ACL suggests that the MSCs reside both aligned with the collagenous matrix of the ligament and adjacent to small blood vessels. We conclude that the cells that emigrate from damaged ACLs are MSCs and that they have the potential to provide the basis for a superior, biological repair of this ligament.
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Affiliation(s)
- Andre F Steinert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Orthopaedic Center for Musculoskeletal Research, Julius-Maximilians-University, Würzburg, Germany.
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Haddad-Weber M, Prager P, Kunz M, Seefried L, Jakob F, Murray MM, Evans CH, Nöth U, Steinert AF. BMP12 and BMP13 gene transfer induce ligamentogenic differentiation in mesenchymal progenitor and anterior cruciate ligament cells. Cytotherapy 2011; 12:505-13. [PMID: 20334610 DOI: 10.3109/14653241003709652] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AIMS To date there are only very few data available on the ligamentogenic differentiation capacity of mesenchymal stromal/progenitor cells (MSC) and anterior cruciate ligament (ACL) fibroblasts. METHODS We describe the in vitro potential of MSC and ACL cells to undergo ligamentogenic differentiation upon transduction with adenoviral vectors encoding the human cDNA for bone morphogenetic protein (BMP) 12 and BMP13, also known as growth and differentiation factors (GDF) 6 and 7, respectively. RESULTS Transgene expression for at least 14 days was confirmed by Western blot analyzes. After 21 days of cell culture within collagen type I hydrogels, histochemical (hematoxylin/eosin (H&E), Azan and van Gieson), immunohistochemical and polymerase chain reaction (PCR) analyzes of the genetically modified constructs of both cell types revealed elongated, viable fibroblast-like cells embedded in a ligament-like matrix rich in collagens, vimentin, fibronectin, decorin, elastin, scleraxis, tenascin, and tenomodulin. CONCLUSIONS It appears that both MSC and ACL fibroblasts are capable of ligamentogenic differentiation with these factors. This information may aid in the development of biologic approaches to repair and restore ACL after injury.
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Affiliation(s)
- Meike Haddad-Weber
- Orthopedic Center for Musculoskeletal Research, Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany.
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Nöth U, Rackwitz L, Steinert AF, Tuan RS. Cell delivery therapeutics for musculoskeletal regeneration. Adv Drug Deliv Rev 2010; 62:765-83. [PMID: 20398712 DOI: 10.1016/j.addr.2010.04.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 04/02/2010] [Accepted: 04/08/2010] [Indexed: 02/07/2023]
Abstract
The last decade has witnessed the development of cell-based therapy as a major biomedical research area, including the treatment of musculoskeletal diseases. Both differentiated and undifferentiated stem cells have been used as starting cell sources. In particular, the use of multipotent adult mesenchymal stem cells holds great promise for future therapeutic strategies. In addition to the cell type used, the cell delivery system is also of critical importance in cell-based therapy. Cell delivery may be achieved by direct cell injection or by grafting engineered constructs derived by cell seeding into natural or synthetic biomaterial scaffolds. While direct injection is the most direct and convenient means of cell delivery, the latter approach is capable of producing three-dimensional engineered tissues with mechanical properties compatible with those of various musculoskeletal tissues. This review will focus on the functional approach of using biomaterial scaffold materials as cell carriers for musculoskeletal applications, as well as the use of cell-based gene therapy for tissue engineering and regeneration.
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Affiliation(s)
- Ulrich Nöth
- Orthopaedic Center for Musculoskeletal Research, Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
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Steinert AF, Goebel S, Rucker A, Barthel T. Snapping elbow caused by hypertrophic synovial plica in the radiohumeral joint: a report of three cases and review of literature. Arch Orthop Trauma Surg 2010; 130:347-51. [PMID: 19089437 DOI: 10.1007/s00402-008-0798-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Indexed: 12/12/2022]
Abstract
The snapping elbow caused by hypertrophic synovial radiohumeral plica is a rare form of lateral elbow impingement. In this article we report on hypertrophic radiohumeral synovial folds in three male patients, aged 54, 65 and 27 years. All three patients suffered isolated lateral elbow pain, painful snapping and unsuccessful conservative treatment over at least 5 months (range 5-9 months, mean 7.7 months) prior to surgical treatment. None of the patients had lateral epicondylitis, instability, osteochondrosis dissecans, loose bodies, arthritis or neurological disorders. Upon clinical examination the range of motion in the respective painful elbows was found to be normal in all three cases, but a painful snapping occurred between 80 degrees and 100 degrees of flexion with the forearm in pronation. While there were no pathologic findings in standard radiographs, magnetic resonance imaging (MRI) revealed hypertrophic synovial plicae in the radiohumeral joints associated with effusion in each of the diseased elbows. Arthroscopic examinations confirmed the presence of a hypertrophic synovial plica in all three radiocapitellar joints, and revealed a transient interposition and compression of the folds in the articulation from extension until 90 degrees -100 degrees elbow flexion, with replacement beyond 90 degrees elbow flexion with a visible jump. Surgical management in all three cases comprised arthroscopic diagnosis confirmation and removal of the synovial plicae, leading to excellent outcomes at 6-12 months follow-up.
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Affiliation(s)
- Andre F Steinert
- Division of Sports Medicine and Arthroscopy, Orthopaedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstrasse 11, Würzburg, Germany.
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Steinert AF, Proffen B, Kunz M, Hendrich C, Ghivizzani SC, Nöth U, Rethwilm A, Eulert J, Evans CH. Hypertrophy is induced during the in vitro chondrogenic differentiation of human mesenchymal stem cells by bone morphogenetic protein-2 and bone morphogenetic protein-4 gene transfer. Arthritis Res Ther 2009; 11:R148. [PMID: 19799789 PMCID: PMC2787261 DOI: 10.1186/ar2822] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [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: 05/01/2009] [Revised: 09/15/2009] [Accepted: 10/02/2009] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The present study compares bone morphogenetic protein (BMP)-4 and BMP-2 gene transfer as agents of chondrogenesis and hypertrophy in human primary mesenchymal stem cells (MSCs) maintained as pellet cultures. METHODS Adenoviral vectors carrying cDNA encoding human BMP-4 (Ad.BMP-4) were constructed by cre-lox combination and compared to previously generated adenoviral vectors for BMP-2 (Ad.BMP-2), green fluorescent protein (Ad.GFP), or firefly luciferase (Ad.Luc). Cultures of human bone-marrow derived MSCs were infected with 5 x 10(2) viral particles/cell of Ad.BMP-2, or Ad.BMP-4, seeded into aggregates and cultured for three weeks in a defined, serum-free medium. Untransduced cells or cultures transduced with marker genes served as controls. Expression of BMP-2 and BMP-4 was determined by ELISA, and aggregates were analyzed histologically, immunohistochemically, biochemically and by RT-PCR for chondrogenesis and hypertrophy. RESULTS Levels of BMP-2 and BMP-4 in the media were initially 30 to 60 ng/mL and declined thereafter. BMP-4 and BMP-2 genes were equipotent inducers of chondrogenesis in primary MSCs as judged by lacuna formation, strong staining for proteoglycans and collagen type II, increased levels of GAG synthesis, and expression of mRNAs associated with the chondrocyte phenotype. However, BMP-4 modified aggregates showed a lower tendency to progress towards hypertrophy, as judged by expression of alkaline phosphatase, annexin 5, immunohistochemical staining for type X collagen protein, and lacunar size. CONCLUSIONS BMP-2 and BMP-4 were equally effective in provoking chondrogenesis by primary human MSCs in pellet culture. However, chondrogenesis triggered by BMP-2 and BMP-4 gene transfer showed considerable evidence of hypertrophic differentiation, with, the cells resembling growth plate chondrocytes both morphologically and functionally. This suggests caution when using these candidate genes in cartilage repair.
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Affiliation(s)
- Andre F Steinert
- Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstrasse 11, 97074 Würzburg, Germany
- Center for Molecular Orthopaedics, Harvard Medical School, 221 Longwood Avenue, BLI 152, Boston, MA 02115, USA
| | - Benedikt Proffen
- Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstrasse 11, 97074 Würzburg, Germany
| | - Manuela Kunz
- Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstrasse 11, 97074 Würzburg, Germany
| | - Christian Hendrich
- Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstrasse 11, 97074 Würzburg, Germany
| | - Steven C Ghivizzani
- Center for Molecular Orthopaedics, Harvard Medical School, 221 Longwood Avenue, BLI 152, Boston, MA 02115, USA
- Department of Orthopaedics and Rehabilitation, University of Florida, 3450 Hull Road, Gainesville, FL 32607, USA
| | - Ulrich Nöth
- Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstrasse 11, 97074 Würzburg, Germany
| | - Axel Rethwilm
- Institut für Virologie und Immunbiologie, Julius-Maximilians-University, Versbacherstrasse 7, 97078 Würzburg, Germany
| | - Jochen Eulert
- Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstrasse 11, 97074 Würzburg, Germany
| | - Christopher H Evans
- Center for Molecular Orthopaedics, Harvard Medical School, 221 Longwood Avenue, BLI 152, Boston, MA 02115, USA
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Steinert AF, Palmer GD, Pilapil C, Nöth U, Evans CH, Ghivizzani SC. Enhanced in vitro chondrogenesis of primary mesenchymal stem cells by combined gene transfer. Tissue Eng Part A 2009; 15:1127-39. [PMID: 18826340 DOI: 10.1089/ten.tea.2007.0252] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Because articular cartilage has a poor regeneration capacity, numerous cell-based approaches to therapy are currently being explored. The present study involved the use of gene transfer as a means to provide sustained delivery of chondrogenic proteins to primary mesenchymal stem cells (MSCs). In previous work, we found that adenoviral-mediated gene transfer of transforming growth factor-beta1 (TGF-beta1) and bone morphogenetic protein 2 (BMP-2), but not insulin-like growth factor 1 (IGF-1), could be used to induce chondrogenic differentiation of MSCs in an aggregate culture system. In the present study, we examined the effects on chondrogenesis of these transgenes when delivered in combination. Cultures of bone marrow-derived MSCs were infected with 2.5 x 10(2) or 2.5 x 10(3) viral particles/cell of each adenoviral vector individually, or in combination, seeded into aggregates, and cultured for 3 weeks in a defined serum-free medium. Levels of transgene product in the medium were initially high, approximately 100 ng/mL TGF-beta1, 120 ng/mL BMP-2, and 80 ng/mL IGF-1 at day 3, and declined thereafter. We found that co-expression of IGF-1 and TGF-beta1, BMP-2, or both at low doses resulted in larger aggregates, higher levels of glycosaminoglycan synthesis, stronger staining for proteoglycans and collagen type II and X, and greater expression of cartilage-specific marker genes than with either transgene alone. Gene-induced chondrogenesis of MSCs using multiple genes that act synergistically may enable the administration of reduced viral doses in vivo and could be of considerable benefit for the development of cell-based therapies for cartilage repair.
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Affiliation(s)
- Andre F Steinert
- Harvard Medical School, Center for Molecular Orthopaedics, Boston, Massachusetts, USA.
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Wiktorowicz T, Peters K, Armbruster N, Steinert AF, Rethwilm A. Generation of an improved foamy virus vector by dissection of cis-acting sequences. J Gen Virol 2009; 90:481-487. [PMID: 19141459 DOI: 10.1099/vir.0.006312-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In contrast to other retroviruses, foamy viruses (FVs) generate their Pol protein precursor independently of the Gag protein from a spliced mRNA. The exact mechanism of Pol protein incorporation into the viral capsid is poorly understood. Previously, we showed that Pol encapsidation critically depends on the packaging of (pre-) genomic RNA and identified two distinct signals within the cis-acting sequences (CASI and CASII), Pol encapsidation sequences (PESI and PESII), which are required for Pol capsid incorporation. Here, we investigated whether the presence of PESI and PESII in an FV vector is sufficient for Pol encapsidation and whether the rather extended CASII element can be shortened without loss of functionality. Our results indicate that (i) the presence of PESI and II are not sufficient for Pol encapsidation, (ii) prototype FV vectors with a shortened CASII element retain Pol incorporation and full functionality, in particular upon transducing fibroblasts and primary human mesenchymal stem cells, (iii) the presence of the central poly purine tract significantly increased the transduction rates of FV vectors and (iv) Pol encapsidation and RNA packaging can be clearly separated. In essence, we designed a new FV vector that bears approximately 850 bp less of CAS than previously established vectors and is fully functional when analysed to transduce cell lines and primary human cells.
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Affiliation(s)
- Tatiana Wiktorowicz
- Universität Würzburg, Institut für Virologie und Immunbiologie, Würzburg, Germany
| | - Katrin Peters
- University of California, International Laboratory of Molecular Biology for Tropical Disease Agents, School of Veterinary Medicine, Davis, USA.,Universität Würzburg, Institut für Virologie und Immunbiologie, Würzburg, Germany
| | - Nicole Armbruster
- Universität Würzburg, Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic König-Ludwig-Haus, Würzburg, Germany.,Universität Würzburg, Institut für Virologie und Immunbiologie, Würzburg, Germany
| | - Andre F Steinert
- Universität Würzburg, Orthopaedic Center for Musculoskeletal Research, Orthopaedic Clinic König-Ludwig-Haus, Würzburg, Germany
| | - Axel Rethwilm
- Universität Würzburg, Institut für Virologie und Immunbiologie, Würzburg, Germany
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Abstract
Once articular cartilage is injured, it has a very limited capacity for self repair. Although current surgical therapeutic procedures for cartilage repair are clinically useful, they cannot restore a normal articular surface. Current research offers a growing number of bioactive reagents, including proteins and nucleic acids, that may be used to augment various aspects of the repair process. As these agents are difficult to administer effectively, gene-transfer approaches are being developed to provide their sustained synthesis at sites of repair. To augment regeneration of articular cartilage, therapeutic genes can be delivered to the synovium or directly to the cartilage lesion. Gene delivery to the cells of the synovial lining is generally considered more suitable for chondroprotective approaches, based on the expression of anti-inflammatory mediators. Gene transfer targeted at cartilage defects can be achieved by either direct vector administration to cells located at or surrounding the defects, or by transplantation of genetically modified chondrogenic cells into the defect. Several studies have shown that exogenous cDNAs encoding growth factors can be delivered locally to sites of cartilage damage, where they are expressed at therapeutically relevant levels. Furthermore, data is beginning to emerge indicating that efficient delivery and expression of these genes is capable of influencing a repair response toward the synthesis of a more hyaline cartilage repair tissue in vivo. This review presents the current status of gene therapy for cartilage healing and highlights some of the remaining challenges.
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Affiliation(s)
- Andre F. Steinert
- Orthopaedic Center for Musculoskeletal Research König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
| | - Ulrich Nöth
- Orthopaedic Center for Musculoskeletal Research König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
| | - Rocky S. Tuan
- Cartilage Biology and Orthopaedics Branch National Institute of Arthritis, and Musculoskeletal and Skin Diseases National Institutes of Health, Department of Health and Human Services Bethesda, MD, U.S.A
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Steinert AF, Ghivizzani SC, Rethwilm A, Tuan RS, Evans CH, Nöth U. Major biological obstacles for persistent cell-based regeneration of articular cartilage. Arthritis Res Ther 2008; 9:213. [PMID: 17561986 PMCID: PMC2206353 DOI: 10.1186/ar2195] [Citation(s) in RCA: 225] [Impact Index Per Article: 14.1] [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] [Indexed: 02/08/2023] Open
Abstract
Hyaline articular cartilage, the load-bearing tissue of the joint, has very limited repair and regeneration capacities. The lack of efficient treatment modalities for large chondral defects has motivated attempts to engineer cartilage constructs in vitro by combining cells, scaffold materials and environmental factors, including growth factors, signaling molecules, and physical influences. Despite promising experimental approaches, however, none of the current cartilage repair strategies has generated long lasting hyaline cartilage replacement tissue that meets the functional demands placed upon this tissue in vivo. The reasons for this are diverse and can ultimately result in matrix degradation, differentiation or integration insufficiencies, or loss of the transplanted cells and tissues. This article aims to systematically review the different causes that lead to these impairments, including the lack of appropriate differentiation factors, hypertrophy, senescence, apoptosis, necrosis, inflammation, and mechanical stress. The current conceptual basis of the major biological obstacles for persistent cell-based regeneration of articular cartilage is discussed, as well as future trends to overcome these limitations.
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Affiliation(s)
- Andre F Steinert
- Orthopaedic Center for Musculoskeletal Research, König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
| | - Steven C Ghivizzani
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Axel Rethwilm
- Institut für Virologie und Immunbiologie, Julius-Maximilians-University, Würzburg, Germany
| | - Rocky S Tuan
- Cartilage Biology and Orthopaedics Branch, National Institute of Arthritis, and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | | | - Ulrich Nöth
- Orthopaedic Center for Musculoskeletal Research, König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
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Steinert AF, Weber M, Kunz M, Palmer GD, Nöth U, Evans CH, Murray MM. In situ IGF-1 gene delivery to cells emerging from the injured anterior cruciate ligament. Biomaterials 2007; 29:904-16. [PMID: 18045683 DOI: 10.1016/j.biomaterials.2007.10.054] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 10/19/2007] [Indexed: 11/28/2022]
Abstract
Ruptures of the anterior cruciate ligament (ACL) are common knee injuries that do not heal, even with surgical repair. Our research is directed towards developing novel, biological approaches that enable suture repair of this ligament. One promising strategy involves the insertion of a collagen hydrogel between the severed ends of the ACL. Cells migrate from the damaged ligament into the hydrogel and produce repair tissue. Here we have investigated the potential for augmenting this process by the transfer of insulin like growth factor (IGF) 1 cDNA to the repair cells using an adenovirus vector. The goal is to achieve direct, in situ gene delivery by loading the hydrogel with vector prior to its insertion into the defect. In a step-wise approach towards evaluating this process, we confirmed that monolayers of ACL fibroblasts were efficiently transduced by adenovirus vectors and continued to express transgenes when subsequently incorporated into the hydrogel; indeed, transgene expression persisted longer within collagen gels than in monolayer culture. Transfer of IGF-1 cDNA increased the cellularity of the gels and led to the synthesis and deposition of increased amounts of types I and III collagen, elastin, tenascin, and vimentin. The cells remained viable, even when subjected to high viral loads. Similar results were obtained when collagen hydrogels were preloaded with adenovirus prior to insertion into an experimental ACL lesion in vitro. These data confirm the promise of using vector-laden hydrogels for the in situ delivery of genes to cells within damaged ligaments and suggest novel possibilities for the biological repair of the ACL.
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Affiliation(s)
- Andre F Steinert
- Division of Gene Therapy, Orthopedic Center for Musculoskeletal Research, Orthopedic Clinic, König-Ludwig-Haus, Julius-Maximilians-University, Brettreichstrasse 11, D-97074 Würzburg, Germany.
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Steinert AF, Palmer GD, Capito R, Hofstaetter JG, Pilapil C, Ghivizzani SC, Spector M, Evans CH. Genetically enhanced engineering of meniscus tissue using ex vivo delivery of transforming growth factor-beta 1 complementary deoxyribonucleic acid. ACTA ACUST UNITED AC 2007; 13:2227-37. [PMID: 17561802 DOI: 10.1089/ten.2006.0270] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To investigate the use of a scaffold seeded with genetically modified meniscal cells or mesenchymal stem cells (MSCs) for the healing of meniscal lesions, primary meniscus cells and bone marrow-derived MSCs were isolated from bovine calves and transduced with first-generation adenoviral vectors encoding green fluorescent protein, luciferase, or transforming growth factor (TGF)-beta1 complementary deoxyribonucleic acid (cDNA). The genetically modified cells were seeded in type I collagen-glycosaminoglycan (GAG) matrices and transplanted into tears of the avascular zone of bovine menisci. After 3 weeks of in vitro culture, constructs and repair tissues were analyzed histologically, biochemically, and using reverse transcriptase polymerase chain reaction. Recombinant adenovirus readily transduced meniscal cells and MSCs, and transgene expression remained high after the cells were incorporated into collagen-GAG matrices. Transfer of TGF-beta1 cDNA increased cellularitiy and the synthesis of GAG/DNA [microg/microg]. It also led to stronger staining for proteoglycans and type II collagen and enhanced expression of meniscal genes. Transplantation of the TGF-beta1 transduced constructs into meniscal lesions of the avascular zone resulted in filling of the lesions with repair tissue after 3 weeks of in vitro culture. These results indicate that TGF-beta1 cDNA delivery may affect cell-based meniscus repair approaches in vivo.
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Affiliation(s)
- Andre F Steinert
- Center for Molecular Orthopedics, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Pascher A, Steinert AF, Palmer GD, Betz O, Gouze JN, Gouze E, Pilapil C, Ghivizzani SC, Evans CH, Murray MM. Enhanced repair of the anterior cruciate ligament by in situ gene transfer: evaluation in an in vitro model. Mol Ther 2005; 10:327-36. [PMID: 15294179 DOI: 10.1016/j.ymthe.2004.03.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Accepted: 03/15/2004] [Indexed: 01/13/2023] Open
Abstract
The inability of the ruptured anterior cruciate ligament (ACL) of the knee joint to heal spontaneously presents numerous clinical problems. Here we describe a novel, gene-based approach to augment ACL healing. It is based upon the migration of cells from the ruptured ends of the ligament into a collagen hydrogel laden with recombinant adenovirus. Cells entering the gel become transduced by the vector, which provides a basis for the local synthesis of gene products that aid repair. Monolayers of bovine ACL cells were readily transduced by first-generation, recombinant adenovirus, and transgene expression remained high after the cells were incorporated into collagen hydrogels. Using an in vitro model of ligament repair, cells migrated from the cut ends of the ACL into the hydrogel and were readily transduced by recombinant adenovirus contained within it. The results of experiments in which GFP was used as the transgene suggest highly efficient transduction of ACL cells in this manner. Moreover, during a 21-day period GFP+ cells were observed more than 6 mm from the severed ligament. This distance is ample for the projected clinical application of this technology. In response to TGF-beta1 as the transgene, greater numbers of ACL cells accumulated in the hydrogels, where they deposited larger amounts of type III collagen. These data confirm that it is possible to transduce ACL cells efficiently in situ as they migrate from the ruptured ACL, that transduction does not interfere with the cells' ability to migrate distances necessary for successful repair, and that ACL cells will respond in a suitable manner to the products of the transgenes they express. This permits optimism over a possible clinical use for this technology.
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Affiliation(s)
- Arnulf Pascher
- Center of Molecular Orthopaedics, Harvard Medical School, Boston, MA 02115, USA
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Steinert AF, Hendrich C, Zimmermann U. [Tissue engineering of cartilage replacement tissue in an improved alginate matrix]. Z Orthop Ihre Grenzgeb 2001; 139:M94-5. [PMID: 11605307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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