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Pan X, Li R, Li W, Sun W, Yan Y, Xiang X, Fang J, Liao Y, Xie C, Wang X, Cai Y, Yao X, Ouyang H. Silk fibroin hydrogel adhesive enables sealed-tight reconstruction of meniscus tears. Nat Commun 2024; 15:2651. [PMID: 38531881 DOI: 10.1038/s41467-024-47029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
Despite orientationally variant tears of the meniscus, suture repair is the current clinical gold treatment. However, inaccessible tears in company with re-tears susceptibility remain unresolved. To extend meniscal repair tools from the perspective of adhesion and regeneration, we design a dual functional biologic-released bioadhesive (S-PIL10) comprised of methacrylated silk fibroin crosslinked with phenylboronic acid-ionic liquid loading with growth factor TGF-β1, which integrates chemo-mechanical restoration with inner meniscal regeneration. Supramolecular interactions of β-sheets and hydrogen bonds richened by phenylboronic acid-ionic liquid (PIL) result in enhanced wet adhesion, swelling resistance, and anti-fatigue capabilities, compared to neat silk fibroin gel. Besides, elimination of reactive oxygen species (ROS) by S-PIL10 further fortifies localized meniscus tear repair by affecting inflammatory microenvironment with dynamic borate ester bonds, and S-PIL10 continuously releases TGF-β1 for cell recruitment and bridging of defect edge. In vivo rabbit models functionally evidence the seamless and dense reconstruction of torn meniscus, verifying that the concept of meniscus adhesive is feasible and providing a promising revolutionary strategy for preclinical research to repair meniscus tears.
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Affiliation(s)
- Xihao Pan
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China
| | - Rui Li
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Wenyue Li
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Wei Sun
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiyang Yan
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Xiaochen Xiang
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Jinghua Fang
- Orthopedics Research Institute, Zhejiang University, Hangzhou, 310009, China
| | - Youguo Liao
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Chang Xie
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaozhao Wang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China
| | - Youzhi Cai
- Sports Medical Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Xudong Yao
- The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China
| | - Hongwei Ouyang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China.
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China.
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China.
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Mazy D, Chung-Tze-Cheong C, Ma Z, Huo R, Lamer S, Li J, Nault ML. Tough gel adhesive is an effective method for meniscal repair in a bovine cadaveric study. J Exp Orthop 2023; 10:139. [PMID: 38095758 PMCID: PMC10721589 DOI: 10.1186/s40634-023-00691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE To test tough gel adhesives to repair meniscus tears under relevant loading conditions and determine if they have adequate biomechanical properties to repair meniscus tears in a bovine cadaveric study. METHODS Cyclic compression tests on 24 dissected bovine knees were performed. The tough gel adhesive was used either as an adhesive patch or as a coating bonded onto commercially available surgical sutures. Forty-eight menisci were tested in this study; 24 complete radial tears and 24 bucket-handle tears. After preconditioning, the specimens underwent 100 cycles of compression, (800 N/0.5 Hz) on an Instron© machine and the size of the gaps measured. One third of the menisci were repaired with pristine sutures, one third with adhesive patches, and one third with sutures coated in adhesive gel. The size of the gaps was compared after 100 and 500 cycles of compression. RESULTS The mean gap measured at the tear site without treatment was 6.46 mm (± 1.41 mm) for radial tears and 1.92 mm (± 0.65 mm) for bucket-handle tears. After treatment and 500 cycles of compression, the mean gap was 1.63 mm (± 1.41 mm) for pristine sutures, 1.50 mm (± 1.16 mm) for adhesive sutures and 2.06 mm (± 1.53 mm) for adhesive gel patches. There was no significant difference between treatments regardless of the type of tear. Also, the gaps for radial tears increased significantly with the number of compression cycles applied (p > 0.001). CONCLUSION From a biomechanical standpoint, the tough adhesive gel patch is as effective as suturing. In addition, it would allow the repair of non-suturable tears and thus broaden the indications for meniscus repair. LEVEL OF EVIDENCE Controlled laboratory study.
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Affiliation(s)
- David Mazy
- University of Montreal, 2900 Boul. Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- CHU Sainte-Justine, 3175 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Christopher Chung-Tze-Cheong
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West Montreal, Quebec, H3A 0C3, Canada
| | - Zhenwei Ma
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West Montreal, Quebec, H3A 0C3, Canada
| | - Ran Huo
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West Montreal, Quebec, H3A 0C3, Canada
| | - Stephanie Lamer
- University of Montreal, 2900 Boul. Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
| | - Jianyu Li
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West Montreal, Quebec, H3A 0C3, Canada.
- Department of Biomedical Engineering, McGill University, 3775 Rue University Montréal, Montreal, QC, H3A 2B4, Canada.
- Department of Surgery, McGill University, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada.
| | - Marie-Lyne Nault
- University of Montreal, 2900 Boul. Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada.
- CHU Sainte-Justine, 3175 Chemin de La Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
- Department of Orthopedic Surgery, CIUSSS Hôpital du Sacré-Coeur de Montréal (HSCM), 5400 Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
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Tarafder S, Ghataure J, Langford D, Brooke R, Kim R, Eyen SL, Bensadoun J, Felix JT, Cook JL, Lee CH. Advanced bioactive glue tethering Lubricin/PRG4 to promote integrated healing of avascular meniscus tears. Bioact Mater 2023; 28:61-73. [PMID: 37214259 PMCID: PMC10199165 DOI: 10.1016/j.bioactmat.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
Meniscus injuries are extremely common with approximately one million patients undergoing surgical treatment annually in the U.S. alone, but no regenerative therapy exist. Previously, we showed that controlled applications of connective tissue growth factor (CTGF) and transforming growth factor beta 3 (TGFβ3) via fibrin-based bio-glue facilitate meniscus healing by inducing recruitment and stepwise differentiation of synovial mesenchymal stem/progenitor cells. Here, we first explored the potential of genipin, a natural crosslinker, to enhance fibrin-based glue's mechanical and degradation properties. In parallel, we identified the harmful effects of lubricin on meniscus healing and investigated the mechanism of lubricin deposition on the injured meniscus surface. We found that the pre-deposition of hyaluronic acid (HA) on the torn meniscus surface mediates lubricin deposition. Then we implemented chemical modifications with heparin conjugation and CD44 on our bioactive glue to achieve strong initial bonding and integration of lubricin pre-coated meniscal tissues. Our data suggested that heparin conjugation significantly enhances lubricin-coated meniscal tissues. Similarly, CD44, exhibiting a strong binding affinity to lubricin and hyaluronic acid (HA), further improved the integrated healing of HA/lubricin pre-coated meniscus injuries. These findings may represent an important foundation for developing a translational bio-active glue guiding the regenerative healing of meniscus injuries.
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Affiliation(s)
- Solaiman Tarafder
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - Jaskirti Ghataure
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - David Langford
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - Rachel Brooke
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - Ryunhyung Kim
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - Samantha Lewis Eyen
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - Julian Bensadoun
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - Jeffrey T. Felix
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
| | - James L. Cook
- Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopedic Institute, University of Missouri, 1100 Virginia Avenue, Columbia, MO, 65212, USA
| | - Chang H. Lee
- Regenerative Engineering Laboratory, Columbia University Medical Center, 630 W. 168 St. – VC12-212, New York, NY, 10032, USA
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Bansal S, Floyd ER, Kowalski MA, Aikman E, Elrod P, Burkey K, Chahla J, LaPrade RF, Maher SA, Robinson JL, Patel JM. Meniscal repair: The current state and recent advances in augmentation. J Orthop Res 2021; 39:1368-1382. [PMID: 33751642 PMCID: PMC8249336 DOI: 10.1002/jor.25021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
Meniscal injuries represent one of the most common orthopedic injuries. The most frequent treatment is partial resection of the meniscus, or meniscectomy, which can affect joint mechanics and health. For this reason, the field has shifted gradually towards suture repair, with the intent of preservation of the tissue. "Save the Meniscus" is now a prolific theme in the field; however, meniscal repair can be challenging and ineffective in many scenarios. The objectives of this review are to present the current state of surgical management of meniscal injuries and to explore current approaches being developed to enhance meniscal repair. Through a systematic literature review, we identified meniscal tear classifications and prevalence, approaches being used to improve meniscal repair, and biological- and material-based systems being developed to promote meniscal healing. We found that biologic augmentation typically aims to improve cellular incorporation to the wound site, vascularization in the inner zones, matrix deposition, and inflammatory relief. Furthermore, materials can be used, both with and without contained biologics, to further support matrix deposition and tear integration, and novel tissue adhesives may provide the mechanical integrity that the meniscus requires. Altogether, evaluation of these approaches in relevant in vitro and in vivo models provides new insights into the mechanisms needed to salvage meniscal tissue, and along with regulatory considerations, may justify translation to the clinic. With the need to restore long-term function to injured menisci, biologists, engineers, and clinicians are developing novel approaches to enhance the future of robust and consistent meniscal reparative techniques.
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Affiliation(s)
- Sonia Bansal
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Kyley Burkey
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | | | | | - Jay M. Patel
- Emory University, Atlanta, Georgia, USA
- Atlanta VA Medical Center, Decatur, Georgia, USA
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Tarafder S, Park G, Lee CH. Explant models for meniscus metabolism, injury, repair, and healing. Connect Tissue Res 2020; 61:292-303. [PMID: 31842590 PMCID: PMC7190414 DOI: 10.1080/03008207.2019.1702031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/03/2019] [Indexed: 02/03/2023]
Abstract
Purpose/Aim: Knee meniscus is a wedge-shaped fibrocartilaginous tissue, playing important roles in maintaining joint stability and function. Injuries to the meniscus, particularly with the avascular inner third zone, hardly heal and frequently progress into structural breakdown, followed by the initiation of osteoarthritis. As the importance of meniscus in joint function and diseases is being recognized, the field of meniscus research is growing. Not only development, biology, and metabolism but also injury, repair, and healing of meniscus are being actively investigated. As meniscus functions as an integrated unit of a knee joint, in vivo models with various species have been the predominant method for studying meniscus pathophysiology and for testing healing/regeneration strategies. However, in vivo models for meniscus studies suffer from low reproducibility and high cost. To complement the limitations of in vivo animal models, several types of meniscus explants have been applied as highly controlled, standardized in vitro models to investigate meniscus metabolism, pathophysiology, and repair or regeneration process. This review summarizes and compares the existing meniscus explant models. We also discuss the advantages and disadvantages of each explant model.Conclusion: Despite few outstanding challenges, meniscus explant models have potential to serve as an effective tool for investigations of meniscus metabolism, injury, repair and healing.
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Affiliation(s)
- Solaiman Tarafder
- Regenerative Engineering Laboratory, Center for Advanced Regenerative Technologies (cART), Columbia University Irving Medical Center, 630 West 168 Street, VC12-211, New York, NY 10032
| | - Gayoung Park
- Regenerative Engineering Laboratory, Center for Advanced Regenerative Technologies (cART), Columbia University Irving Medical Center, 630 West 168 Street, VC12-211, New York, NY 10032
| | - Chang H. Lee
- Regenerative Engineering Laboratory, Center for Advanced Regenerative Technologies (cART), Columbia University Irving Medical Center, 630 West 168 Street, VC12-211, New York, NY 10032
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Tarafder S, Gulko J, Sim KH, Yang J, Cook JL, Lee CH. Engineered Healing of Avascular Meniscus Tears by Stem Cell Recruitment. Sci Rep 2018; 8:8150. [PMID: 29802356 PMCID: PMC5970239 DOI: 10.1038/s41598-018-26545-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/09/2018] [Indexed: 12/29/2022] Open
Abstract
Meniscus injuries are extremely common with approximately one million patients undergoing surgical treatment annually in the U.S. alone. Upon injury, the outer zone of the meniscus can be repaired and expected to functionally heal but tears in the inner avascular region are unlikely to heal. To date, no regenerative therapy has been proven successful for consistently promoting healing in inner-zone meniscus tears. Here, we show that controlled applications of connective tissue growth factor (CTGF) and transforming growth factor beta 3 (TGFβ3) can induce seamless healing of avascular meniscus tears by inducing recruitment and step-wise differentiation of synovial mesenchymal stem/progenitor cells (syMSCs). A short-term release of CTGF, a selected chemotactic and profibrogenic cue, successfully recruited syMSCs into the incision site and formed an integrated fibrous matrix. Sustain-released TGFβ3 then led to a remodeling of the intermediate fibrous matrix into fibrocartilaginous matrix, fully integrating incised meniscal tissues with improved functional properties. Our data may represent a novel clinically relevant strategy to improve healing of avascular meniscus tears by recruiting endogenous stem/progenitor cells.
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Affiliation(s)
- Solaiman Tarafder
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA
| | - Joseph Gulko
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA
| | - Kun Hee Sim
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA
| | - Jian Yang
- Department of Biomedical Engineering, The Pennsylvania State University, 205 Hallowell Building, University Park, Pennsylvania, PA, 16802-4400, USA
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics Missouri Orthopaedic institute, University of Missouri, 1100 Virginia Avenue, Columbia, Missouri, 65212, USA
| | - Chang H Lee
- Regenerative Engineering Laboratory Columbia University Medical Center, 630W. 168 St. - VC12-230, New York, NY, 10032, USA.
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Bhagat V, Becker ML. Degradable Adhesives for Surgery and Tissue Engineering. Biomacromolecules 2017; 18:3009-3039. [DOI: 10.1021/acs.biomac.7b00969] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Vrushali Bhagat
- Department
of Polymer Science and ‡Department of Biomedical Engineering, The University of Akron, Akron, Ohio 44325, United States
| | - Matthew L. Becker
- Department
of Polymer Science and ‡Department of Biomedical Engineering, The University of Akron, Akron, Ohio 44325, United States
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