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Snider V, Homsi K, Kusnoto B, Atsawasuwan P, Viana G, Allareddy V, Gajendrareddy P, Elnagar MH. Clinical evaluation of Artificial Intelligence Driven Remote Monitoring technology for assessment of patient oral hygiene during orthodontic treatment. Am J Orthod Dentofacial Orthop 2024; 165:586-592. [PMID: 38363256 DOI: 10.1016/j.ajodo.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/01/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION This study aimed to clinically evaluate the accuracy of Dental Monitoring's (DM) artificial intelligence (AI) image analysis and oral hygiene notification algorithm in identifying oral hygiene and mucogingival conditions. METHODS Twenty-four patients seeking orthodontic therapy were monitored by DM oral hygiene protocol during their orthodontic treatment. During the bonding appointment and at each of 10 subsequent adjustment visits, a total of 232 clinical oral examinations were performed to assess the presence of the 3 oral hygiene parameters that DM monitors. In each clinical timepoint, the subjects took an oral DM scan and received a notification regarding their current oral status at that moment in time. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate AI and clinical assessment of plaque, gingivitis, and recession. RESULTS A total of 232 clinical time points have been evaluated clinically and by the DM AI algorithm. For DM's AI detection of plaque and calculus, gingivitis, and recession, the sensitivity was 0.53, 0.35, and 0.22; the specificity was 0.94, 0.96, and 0.99; and the accuracy was 0.60, 0.49, and 0.72, respectively. CONCLUSIONS DM's oral hygiene notification algorithm has low sensitivity, high specificity, and moderate accuracy. This indicates a tendency of DM to underreport the presence of plaque, gingivitis, and recession.
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Affiliation(s)
- Vivian Snider
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Karen Homsi
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Budi Kusnoto
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Phimon Atsawasuwan
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Grace Viana
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | | | - Praveen Gajendrareddy
- Department of Periodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Mohammed H Elnagar
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill.
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Gabriel A, Ravindran S, Cooper LF, Gajendrareddy P, Huang CC, Kang M, Thalji G. Comparative Osteogenesis of Three Clinical Bone Graft Materials: An In Vivo Study. Int J Oral Maxillofac Implants 2023; 38:1175-1181. [PMID: 38085749 DOI: 10.11607/jomi.9836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
PURPOSE To investigate bone regeneration among three different bone graft materials in a rat calvarum model. MATERIALS AND METHODS A total of 24 rats had two 5-mm defects placed per calvarial. Rats were divided into four groups: bovine xenograft (XG), demineralized bone matrix (DBM), mineralized bone graft (MBG), and collagen membrane control (CC). Within each group, samples were collected at two time points: 4 weeks (T4) and 8 weeks (T8). Bone regeneration was assessed by microcomputed tomography (micro-CT) imaging and was analyzed using MATLAB software. Additionally, the fixed samples were subsequently demineralized for immunohistochemistry and histomorphometry. Slides were mounted and stained with hematoxylin and eosin (H&E) stain as well as bone morphogenetic protein 2 (BMP-2) and runt-related transcription factor 2 (RUNX2) markers. The numbers of positive cells/area were calculated for each group and analyzed. RESULTS At 4 weeks, DBM showed low mineral density (7.7%) compared to the control (25.2%), but increased dramatically at 8 weeks (DBM, T8 = 27.6%; CC, T8 = 27.2%). Xenograft material showed an increase in mineral desnity between T4 and T8 (XG, T4 = 25.0%; XG, T8 = 32.3%). MBG remained consistent over the 8-week trial period (MBG, T4 = 30.4%; MBG, T8 = 30.4%). BMP-2 expression was present in cells adherent to all graft materials. RUNX2 expression was also observed in cells adherent to all graft materials, indicating that during the 4- to 8-week healing period, all materials supported osteogenesis. CONCLUSIONS Compared to other materials, the DBM had high osteoinductive properties during the 4- to 8-week time period based on increased mineral content. All materials were associated with immunohistologic evidence of osteogenesis in the rat calvarial defect model.
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Snider V, Homsi K, Kusnoto B, Atsawasuwan P, Viana G, Allareddy V, Gajendrareddy P, Elnagar MH. Effectiveness of AI-driven remote monitoring technology in improving oral hygiene during orthodontic treatment. Orthod Craniofac Res 2023; 26 Suppl 1:102-110. [PMID: 37113065 DOI: 10.1111/ocr.12666] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of Dental Monitoring™ (DM™) Artificial Intelligence Driven Remote Monitoring Technology (AIDRM) technology in improving the patient's oral hygiene during orthodontic treatment through AI-based personalized active notifications. METHODS A prospective clinical study was conducted on two groups of orthodontic patients. DM Group: (n = 24) monitored by DM weekly scans and received personalized notifications on the DM smartphone application regarding their oral hygiene status. Control Group (n = 25) not monitored by DM. Both groups were clinically assessed using Plaque Index (OPI) and the Modified Gingival Index (MGI). DM Group was followed for 13 months and the Control Group was followed for 5 months. Student-independent t test and paired t tests were used to investigate the mean differences between study groups and between time points for each group respectively. RESULTS At all time points, the mean differences indicated that the DM group had lower OPI and MGI values than the control group. The mean value for OPI and MGI were statistically significantly lower in the DM group (OPI = 1.96, MGI = 1.56) than in the control group (OPI = 2.41, MGI = 2.17) after 5 months. A rapid increase in mean OPI and MGI values was found between T0 and T1 for both study groups. A plateau effect for OPI scores appeared to occur from T1 to T5 for both study groups, but the plateau effect seemed to be more pronounced for the DM group than the study group. The MGI values for both study groups also increased dramatically from baseline to T5, however, a plateau effect was not observed. CONCLUSIONS The oral hygiene of orthodontic patients rapidly worsens over the first 3 months and plateaus after about 5 months of treatment. AIDRM by weekly DM scans and personalized active notifications may improve oral hygiene over time in orthodontic patients.
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Affiliation(s)
- Vivian Snider
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Karen Homsi
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Budi Kusnoto
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Phimon Atsawasuwan
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Grace Viana
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Praveen Gajendrareddy
- Department of Periodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mohammed H Elnagar
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, USA
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Homsi K, Snider V, Kusnoto B, Atsawasuwan P, Viana G, Allareddy V, Gajendrareddy P, Elnagar MH. In-vivo evaluation of Artificial Intelligence Driven Remote Monitoring technology for tracking tooth movement and reconstruction of 3-dimensional digital models during orthodontic treatment. Am J Orthod Dentofacial Orthop 2023; 164:690-699. [PMID: 37341668 DOI: 10.1016/j.ajodo.2023.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION An in-vivo evaluation of the Dental Monitoring (DM; Paris, France) Artificial Intelligence Driven Remote Monitoring technology was conducted in an active clinical setting. Our objectives were to compare the accuracy and validity of the 3-dimensional (3D) digital models remotely generated from the DM application to 3D Digital Models generated from the iTero Element 5D intraoral scanner (Align Technologies, San Jose, Calif) of patients' dentition during in-vivo fixed orthodontic treatment. METHODS The orthodontic treatment of 24 patients (aged 14-55 years) was tracked across an average of 13.4 months. Scans of the maxillary and mandibular arches of each patient were taken by an iTero intraoral scanner and with the DM application before treatment initiation without (T0) and with (T1) the fixed orthodontic appliances and at every in-person adjustment appointment (T2-T10). The global deviation between the reconstructed digital models from the DM and iTero scans was compared at each time point using Geomagic Control-X 2020 (3D Systems, Rock Hill, SC). Descriptive analysis was conducted to determine the mean deviation at each time point for the maxillary and mandibular arches, to compare the maxilla and mandible mean deviations at each time point to the null hypothesis mean of 0 mm and the paired mean of the average at each time point between the maxilla and mandible. RESULTS The findings revealed no clinically significant difference between the reconstructed digital models generated by the iTero IOS and the remotely reconstructed digital dental models generated by the DM application. CONCLUSION DM artificial intelligence tracking algorithm can track tooth movement and reconstruct 3D digital models to a clinically acceptable degree for orthodontic application.
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Affiliation(s)
- Karen Homsi
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Vivian Snider
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Budi Kusnoto
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Phimon Atsawasuwan
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Grace Viana
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | | | - Praveen Gajendrareddy
- Department of Periodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill
| | - Mohammed H Elnagar
- Department of Orthodontics, College of Dentistry, University of Illinois Chicago, Chicago, Ill.
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Huang CC, Kang M, Leung K, Lu Y, Shirazi S, Gajendrareddy P, Ravindran S. Micro RNA based MSC EV engineering: Targeting the BMP2 cascade for bone repair. Front Cell Dev Biol 2023; 11:1127594. [PMID: 36846585 PMCID: PMC9945088 DOI: 10.3389/fcell.2023.1127594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Mesenchymal stem cell derived extracellular vesicles (MSC EVs) possess excellent immunomodulatory and therapeutic properties. While beneficial, from a translational perspective, extracellular vesicles with consistent functionality and target specificity are required to achieve the goals of precision medicine and tissue engineering. Prior research has identified that the miRNA composition of mesenchymal stem cell derived extracellular vesicles contributes significantly towards extracellular vesicles functionality. In this study, we hypothesized that mesenchymal stem cell derived extracellular vesicle functionality can be rendered pathway-specific using a miRNA-based extracellular vesicles engineering approach. To test this hypothesis, we utilized bone repair as a model system and the BMP2 signaling cascade as the targeted pathway. We engineered mesenchymal stem cell extracellular vesicles to possess increased levels of miR-424, a potentiator of the BMP2 signaling cascade. We evaluated the physical and functional characteristics of these extracellular vesicles and their enhanced ability to trigger the osteogenic differentiation of naïve mesenchymal stem cell in vitro and facilitate bone repair in vivo. Results indicated that the engineered extracellular vesicles retained their extracellular vesicles characteristics and endocytic functionality and demonstrated enhanced osteoinductive function by activating SMAD1/5/8 phosphorylation and mesenchymal stem cell differentiation in vitro and enhanced bone repair in vivo. Furthermore, the inherent immunomodulatory properties of the mesenchymal stem cell derived extracellular vesicles remained unaltered. These results serve as a proof-of-concept for miRNA-based extracellular vesicles engineering approaches for regenerative medicine applications.
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Affiliation(s)
- Chun-Chieh Huang
- Department of Oral Biology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Miya Kang
- Department of Oral Biology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Kasey Leung
- Department of Oral Biology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Yu Lu
- Department of Oral Biology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Sajjad Shirazi
- Department of Oral Biology, University of Illinois Chicago, Chicago, Illinois, United States
| | - Praveen Gajendrareddy
- Department of Periodontics, College of Dentistry, University of Illinois Chicago, Chicago, Illinois, United States,*Correspondence: Praveen Gajendrareddy, ; Sriram Ravindran,
| | - Sriram Ravindran
- Department of Oral Biology, University of Illinois Chicago, Chicago, Illinois, United States,*Correspondence: Praveen Gajendrareddy, ; Sriram Ravindran,
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Kang M, Huang CC, Gajendrareddy P, Lu Y, Shirazi S, Ravindran S, Cooper LF. Extracellular Vesicles From TNFα Preconditioned MSCs: Effects on Immunomodulation and Bone Regeneration. Front Immunol 2022; 13:878194. [PMID: 35585987 PMCID: PMC9108364 DOI: 10.3389/fimmu.2022.878194] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/17/2022] [Accepted: 04/07/2022] [Indexed: 01/08/2023] Open
Abstract
Mesenchymal stem cells show remarkable versatility and respond to extracellular and micro environmental cues by altering their phenotype and behavior. In this regard, the MSC’s immunomodulatory properties in tissue repair are well documented. The paracrine effects of MSCs in immunomodulation are, in part, attributable to their secreted extracellular vesicles (EVs). When MSCs migrate to the wound bed, they are exposed to a myriad of inflammatory signals. To understand their response to an inflammatory environment from an EV perspective, we sought to evaluate the effects of the inflammatory cytokine TNFα on MSC EV mediated immunomodulation. Our results indicate that while the physical characteristics of the EVs remain unchanged, the TNFα preconditioned MSC EVs possess enhanced immunomodulatory properties. In vitro experiments using polarized (M1 and M2) primary mouse macrophages indicated that the preconditioned MSC EVs suppressed pro-inflammatory (M1) markers such as IL-1β and iNOS and elevated reparatory (M2) markers such as Arg1 and CD206. When evaluated in vivo in a rat calvarial defect model, the TNFα preconditioned MSC EVs reduced inflammation at 1-, 3- and 7-days post wounding resulting in the subsequent enhanced bone formation at 4- and 8-weeks post wounding possibly by modulation of oncostatin M (OSM) expression. An analysis of EV miRNA composition revealed significant changes to anti-inflammatory miRNAs in the preconditioned MSC EVs hinting at a possible role for EV derived miRNA in the enhanced immunomodulatory activity. Overall, these results indicate that MSC exposure to inflammatory signals influence the MSC EV’s immunomodulatory function in the context of tissue repair. The specific function of TNFα preconditioned MSC EV miRNAs in immunomodulatory control of bone regeneration merits further investigation.
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Affiliation(s)
- Miya Kang
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States
| | - Chun-Chieh Huang
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States
| | - Praveen Gajendrareddy
- Department of Periodontics, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States
| | - Yu Lu
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States
| | - Sajjad Shirazi
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States
| | - Sriram Ravindran
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States
- *Correspondence: Lyndon F. Cooper, ; Sriram Ravindran,
| | - Lyndon F. Cooper
- Department of Oral Biology, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States
- *Correspondence: Lyndon F. Cooper, ; Sriram Ravindran,
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Rajendiran M, Trivedi HM, Chen D, Gajendrareddy P, Chen L. Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases. Molecules 2021; 26:molecules26072001. [PMID: 33916013 PMCID: PMC8037529 DOI: 10.3390/molecules26072001] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 01/01/2023] Open
Abstract
Periodontal diseases like gingivitis and periodontitis are primarily caused by dental plaque. Several antiplaque and anti-microbial agents have been successfully incorporated into toothpastes and mouthwashes to control plaque biofilms and to prevent and treat gingivitis and periodontitis. The aim of this article was to review recent developments in the antiplaque, anti-gingivitis, and anti-periodontitis properties of some common compounds in toothpastes and mouthwashes by evaluating basic and clinical studies, especially the ones published in the past five years. The common active ingredients in toothpastes and mouthwashes included in this review are chlorhexidine, cetylpyridinium chloride, sodium fluoride, stannous fluoride, stannous chloride, zinc oxide, zinc chloride, and two herbs—licorice and curcumin. We believe this comprehensive review will provide useful up-to-date information for dental care professionals and the general public regarding the major oral care products on the market that are in daily use.
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Affiliation(s)
- Meenakshi Rajendiran
- The Center for Wound Healing and Tissue Regeneration, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Harsh M Trivedi
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (H.M.T.); (D.C.)
| | - Dandan Chen
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (H.M.T.); (D.C.)
| | - Praveen Gajendrareddy
- The Center for Wound Healing and Tissue Regeneration, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (P.G.); (L.C.); Tel.: +1-312-413-8405 (P.G.); +1-312-413-5387 (L.C.)
| | - Lin Chen
- The Center for Wound Healing and Tissue Regeneration, Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (P.G.); (L.C.); Tel.: +1-312-413-8405 (P.G.); +1-312-413-5387 (L.C.)
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Kang M, Huang CC, Lu Y, Shirazi S, Gajendrareddy P, Ravindran S, Cooper LF. Bone regeneration is mediated by macrophage extracellular vesicles. Bone 2020; 141:115627. [PMID: 32891867 PMCID: PMC8107826 DOI: 10.1016/j.bone.2020.115627] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 12/24/2022]
Abstract
Multiple local and systemic factors including inflammation influence bone regeneration. Several lines of evidence demonstrate that macrophages contribute to the immunological regulation of MSC and osteoblast function during bone regeneration. Recent studies demonstrate that macrophage polarization influences this regulatory process. In this manuscript, we investigated the paracrine functional role of naïve (M0), M1 and M2 polarized macrophage derived EVs in bone repair. Treatment of rat calvaria defects with no EVs, M0 EVs, M1 EVs, or M2 EVs revealed polarization-specific control of bone regeneration by macrophage EVs at 3 and 6 weeks. M0 and M2 EVs promoted repair/regeneration and M1 EVs inhibited bone repair. Pathway-specific studies conducted in cell culture showed that M1 EVs negatively regulated the BMP signaling pathway, specifically BMP2 and BMP9. In parallel, miRNA sequencing studies showed similar miRNA cargo in M0 and M2 EVs and different miRNA cargo in M1 EVs. Functional examination of M1 macrophage EV-enriched miR-155 demonstrated that miR-155 mimic treatment reduced MSC osteogenic differentiation as measured by reduced BMP2, BMP9 and RUNX2 expression when compared to controls. Conversely, treatment of MSCs with the M2 macrophage EV-enriched miR-378a mimic increased MSC osteoinductive gene expression when compared to controls. These functional studies implicate polarized macrophage EV miRNAs in the positive or negative regulation of bone regeneration that was observed in vivo. Overall, the results presented in this study indicate that macrophage polarization influences EV cargo and related EV function in the paracrine regulation of bone regeneration.
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Affiliation(s)
- Miya Kang
- Departments of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, United States of America
| | - Chun-Chieh Huang
- Departments of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, United States of America
| | - Yu Lu
- Departments of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, United States of America
| | - Sajjad Shirazi
- Departments of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, United States of America
| | - Praveen Gajendrareddy
- Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, United States of America
| | - Sriram Ravindran
- Departments of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, United States of America
| | - Lyndon F Cooper
- Departments of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, United States of America.
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Abstract
In orthopedics and dentistry there is an increasing need for novel biomaterials and clinical strategies to achieve predictable bone regeneration. These novel molecular strategies have the potential to eliminate the limitations of currently available approaches. Specifically, they have the potential to reduce or eliminate the need to harvest autogenous bone, and the overall complexity of the clinical procedures. In this review, emerging tissue engineering strategies that have been, or are currently being, developed based on the current understanding of bone biology, development and wound healing will be discussed. In particular, protein/peptide based approaches, DNA/RNA therapeutics, cell therapy, and the use of exosomes will be briefly covered. The review ends with a summary of the current status of these approaches, their clinical translational potentials and their challenges.
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Affiliation(s)
- Satheesh Elangovan
- Department of Periodontics, The University of Iowa College of Dentistry, Iowa City, IA 52242, United States of America
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Huang CC, Kang M, Lu Y, Shirazi S, Diaz JI, Cooper LF, Gajendrareddy P, Ravindran S. Functionally engineered extracellular vesicles improve bone regeneration. Acta Biomater 2020; 109:182-194. [PMID: 32305445 DOI: 10.1016/j.actbio.2020.04.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 02/08/2023]
Abstract
Lineage specific differentiation of host mesenchymal stem cells (MSCs) is a necessary step for bone repair/regeneration. Clinically, growth factors such as bone morphogenetic protein 2 (BMP2) are used to enhance/hasten this process to heal critical sized defects. However, the clinical application of such growth factors is fraught with dosage challenges as well as immunological and ectopic complications. The identification of extracellular vesicles (EVs) as active components of the MSC secretome suggest alternative approaches to enhancing bone regeneration. Based on our earlier studies on the properties of EVs from lineage specified MSCs, this study sought to engineer EVs to enhance osteogenic differentiation. To generate MSC EVs with enhanced osteoinductive abilities, genetically modified human bone marrow derived MSCs (HMSCs) were generated by constitutively expressing BMP2. We hypothesized that these cells would generate functionally engineered EVs (FEEs) with enhanced osteoinductive properties. Our results show that these FEEs maintained the general physical and biochemical characteristics of naïve HMSC EVs in the form of size distribution, EV marker expression and endocytic properties but show increased bone regenerative potential compared to MSC EVs in a rat calvarial defect model in vivo. Mechanistic studies revealed that although BMP2 was constitutively expressed in the parental cells, the corresponding EVs (FEEs) do not contain BMP2 protein as an EV constituent. Further investigations revealed that the FEEs potentiate the BMP2 signaling cascade possibly due to an altered miRNA composition. Collectively, these studies indicate that EVs' functionality may be engineered by genetic modification of the parental MSCs to induce osteoinduction and bone regeneration. SIGNIFICANCE STATEMENT: With mounting evidence for the potential of MSC EVs in treatment of diseases and regeneration of tissues, it is imperative to evaluate if they can be modified for application specificity. The results presented here indicate the possibility for generating Functionally Engineered EVs (FEEs) from MSC sources. As a proof of concept approach, we have shown that EVs derived from genetically modified MSCs (BMP2 overexpression) can be effective as biomimetic substitutes for growth factors for enhanced tissue-specific regeneration (bone regeneration) in vivo. Mechanistic studies highlight the role of EV miRNAs in inducing pathway-specific changes. We believe that this study will be useful to researchers evaluating EVs for regenerative medicine applications.
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Huang CC, Kang M, Narayanan R, DiPietro LA, Cooper LF, Gajendrareddy P, Ravindran S. Evaluating the Endocytosis and Lineage-Specification Properties of Mesenchymal Stem Cell Derived Extracellular Vesicles for Targeted Therapeutic Applications. Front Pharmacol 2020; 11:163. [PMID: 32194405 PMCID: PMC7063066 DOI: 10.3389/fphar.2020.00163] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/07/2020] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stem cells (MSCs) are multipotent cells with regenerative and immunomodulatory properties. Several aspects of MSC function have been attributed to the paracrine effects of MSC derived extracellular vesicles (EVs). Although MSC EVs show great promise for regenerative medicine applications, insights into their uptake mechanisms by different target cells and the ability to control MSC EV properties for defined function in vivo have remained elusive knowledge gaps. The primary goal of this study is to elucidate how the basic properties of MSC derived EVs can be exploited for function-specific activity in regenerative medicine. Our first important observation is that, MSC EVs possess a common mechanism of endocytosis across multiple cell types. Second, altering the MSC state by inducing differentiation into multiple lineages did not affect the exosomal properties or endocytosis but triggered the expression of lineage-specific genes and proteins in vitro and in vivo respectively. Overall, the results presented in this study show a common mechanism of endocytosis for MSC EVs across different cell types and the feasibility to generate functionally enhanced EVs by modifications to parental MSCs.
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Affiliation(s)
- Chun-Chieh Huang
- Department of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Miya Kang
- Department of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Raghuvaran Narayanan
- Department of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Luisa A DiPietro
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Lyndon F Cooper
- Department of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Praveen Gajendrareddy
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Sriram Ravindran
- Department of Oral Biology, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
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Elangovan S, Prakasam S, Gajendrareddy P, Allareddy V. A Risk of Bias Assessment of Randomized Controlled Trials (RCTs) on Periodontal Regeneration Published in 2013. J Evid Based Dent Pract 2016; 16:30-40. [DOI: 10.1016/j.jebdp.2015.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 11/26/2022]
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Ravindran S, Huang CC, Gajendrareddy P, Narayanan R. Biomimetically enhanced demineralized bone matrix for bone regenerative applications. Front Physiol 2015; 6:292. [PMID: 26557093 PMCID: PMC4617051 DOI: 10.3389/fphys.2015.00292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/02/2015] [Indexed: 01/12/2023] Open
Abstract
Demineralized bone matrix (DBM) is one of the most widely used bone graft materials in dentistry. However, the ability of DBM to reliably and predictably induce bone regeneration has always been a cause for concern. The quality of DBM varies greatly depending on several donor dependent factors and also manufacturing techniques. In order to standardize the quality and to enable reliable and predictable bone regeneration, we have generated a biomimetically-enhanced version of DBM (BE-DBM) using clinical grade commercial DBM as a control. We have generated the BE-DBM by incorporating a cell-derived pro-osteogenic extracellular matrix (ECM) within clinical grade DBM. In the present study, we have characterized the BE-DBM and evaluated its ability to induce osteogenic differentiation of human marrow derived stromal cells (HMSCs) with respect to clinical grade commercial DBM. Our results indicate that the BE-DBM contains significantly more pro-osteogenic factors than DBM and enhances HMSC differentiation and mineralized matrix formation in vitro and in vivo. Based on our results, we envision that the BE-DBM has the potential to replace DBM as the bone graft material of choice.
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Affiliation(s)
- Sriram Ravindran
- Departments of Oral Biology, University of Illinois at Chicago Chicago, IL, USA
| | - Chun-Chieh Huang
- Departments of Oral Biology, University of Illinois at Chicago Chicago, IL, USA
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