Mesenchymal stem cells as therapeutic target of biophysical stimulation for the treatment of musculoskeletal disorders

BACKGROUND

Musculoskeletal disorders are regarded as a major cause of worldwide morbidity and disability, and they result in huge costs for national health care systems. Traditional therapies frequently turned out to be poorly effective in treating bone, cartilage, and tendon disorders or joint degeneration. As a consequence, the development of novel biological therapies that can treat more effectively these conditions should be the highest priority in regenerative medicine. Mesenchymal stem cells (MSCs) represent one of the most promising tools in musculoskeletal tissue regenerative medicine, thanks to their proliferation and differentiation potential and their immunomodulatory and trophic ability. Indeed, MSC-based approaches have been proposed for the treatment of almost all orthopedic conditions, starting from different cell sources, alone or in combination with scaffolds and growth factors, and in one-step or two-step procedures. While all these approaches would require cell harvesting and transplantation, the possibility to stimulate the endogenous MSCs to enhance their tissue homeostasis activity represents a less-invasive and cost-effective therapeutic strategy. Nowadays, the role of tissue-specific resident stem cells as possible therapeutic target in degenerative pathologies is underinvestigated. Biophysical stimulations, and in particular extracorporeal shock waves treatment and pulsed electromagnetic fields, are able to induce proliferation and support differentiation of MSCs from different origins and affect their paracrine production of growth factors and cytokines.

SHORT CONCLUSIONS

The present review reports the attempts to exploit the resident stem cell potential in musculoskeletal pathologies, highlighting the role of MSCs as therapeutic target of currently applied biophysical treatments.

Hyaluronan size and concentration: Effect on key biophysical and biochemical features

The effect of hyaluronan (HA) molecular weight (MW) and concentration (c) on key features of HA-formulations was systematically studied, in vitro, exploring the widest range/number of MW/c to date. Nine pharmaceutical grade HA samples (60-2500 kDa) were hydrodynamically characterized using Size Exclusion Chromatography-Triple Detector Array (SEC-TDA) also providing conformational data. HAs aqueous solutions (thirteen concentrations in the range 0.1-32 g/L) were tested for dynamic viscosity (η). η dependence on MW/c was analyzed providing mathematical correlations not only for the specific zero-shear viscosity, but also for the critical shear rate and the shear-thinning-extent. Besides confirming the dilute and semi-dilute c-regimes for the HAs, a third concentrated regime was evidenced for the 220-2500 kDa samples. Data on how MW affects the dependence of viscosity parameters on c and vice-versa were provided. The 60-90 kDa HAs proved stable to thermal sterilization and enzymatically catalyzed hydrolysis, while the 220-2500 kDa samples depolymerized to an extent depending, beyond concentration, on MW. HA size did not significantly affect fibroblasts behavior: under the conditions here tested, the HAs similarly sustained human dermal fibroblasts growth and wound healing also showing comparable effect on collagen-I, elastin and hyaluronan synthase-1 expression. Overall, results valuably contribute to the understanding of the HA MW/c impact on the rheological, stability and biochemical features of the final formulations, also providing mathematical correlations allowing for their optimization towards specific performance.