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Alini M, Diwan AD, Erwin WM, Little CB, Melrose J. An update on animal models of intervertebral disc degeneration and low back pain: Exploring the potential of artificial intelligence to improve research analysis and development of prospective therapeutics. JOR Spine 2023; 6:e1230. [PMID: 36994457 PMCID: PMC10041392 DOI: 10.1002/jsp2.1230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 02/03/2023] Open
Abstract
Animal models have been invaluable in the identification of molecular events occurring in and contributing to intervertebral disc (IVD) degeneration and important therapeutic targets have been identified. Some outstanding animal models (murine, ovine, chondrodystrophoid canine) have been identified with their own strengths and weaknesses. The llama/alpaca, horse and kangaroo have emerged as new large species for IVD studies, and only time will tell if they will surpass the utility of existing models. The complexity of IVD degeneration poses difficulties in the selection of the most appropriate molecular target of many potential candidates, to focus on in the formulation of strategies to effect disc repair and regeneration. It may well be that many therapeutic objectives should be targeted simultaneously to effect a favorable outcome in human IVD degeneration. Use of animal models in isolation will not allow resolution of this complex issue and a paradigm shift and adoption of new methodologies is required to provide the next step forward in the determination of an effective repairative strategy for the IVD. AI has improved the accuracy and assessment of spinal imaging supporting clinical diagnostics and research efforts to better understand IVD degeneration and its treatment. Implementation of AI in the evaluation of histology data has improved the usefulness of a popular murine IVD model and could also be used in an ovine histopathological grading scheme that has been used to quantify degenerative IVD changes and stem cell mediated regeneration. These models are also attractive candidates for the evaluation of novel anti-oxidant compounds that counter inflammatory conditions in degenerate IVDs and promote IVD regeneration. Some of these compounds also have pain-relieving properties. AI has facilitated development of facial recognition pain assessment in animal IVD models offering the possibility of correlating the potential pain alleviating properties of some of these compounds with IVD regeneration.
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Affiliation(s)
- Mauro Alini
- AO Research Institute Davos Platz Switzerland
| | - Ashish D. Diwan
- Spine Service, Department of Orthopedic Surgery, St. George & Sutherland Campus, Clinical School University of New South Wales Sydney New South Wales Australia
| | - W. Mark Erwin
- Department of Surgery University of Toronto Ontario Canada
| | - Chirstopher B. Little
- Raymond Purves Bone and Joint Research Laboratory Kolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore Hospital St. Leonards New South Wales Australia
| | - James Melrose
- Raymond Purves Bone and Joint Research Laboratory Kolling Institute, Sydney University Faculty of Medicine and Health, Northern Sydney Area Health District, Royal North Shore Hospital St. Leonards New South Wales Australia
- Graduate School of Biomedical Engineering The University of New South Wales Sydney New South Wales Australia
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A Biodegradable Polymeric Matrix for the Repair of Annulus Fibrosus Defects in Intervertebral Discs. Tissue Eng Regen Med 2022; 19:1311-1320. [PMID: 35816226 PMCID: PMC9679066 DOI: 10.1007/s13770-022-00466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Tissue defects in the annulus fibrosus (AF) due to intervertebral disc (IVD) degeneration or after nucleodiscectomy have little self-healing capacity. To prevent progressive degeneration of the IVD, the AF must be repaired. Biological closure has not yet been achieved and is a challenge for the research community. In this study, a scaffold made of absorbable poly (glycolic acid) (PGA) and hyaluronan (HA) that exhibit excellent biocompatibility and cell colonization properties was used to repair AF defects in an ovine model. METHODS A partial resection was performed in AF in L3/4 or L4/5 of 10 sheep and PGA-HA scaffolds were implanted on the defects (n = 5), while defects in the control group were left untreated (n = 5). Three months post-operation, the lumbar discs were sectioned and stained with hematoxylin and eosin and safranin-O/fast-green. Histological features including proteoglycan content, annular structure, cellular morphology, blood vessel ingrowth and tear/cleft formation were scored using a modified scoring scheme by 3 investigators and evaluated by a pathologist independently. RESULTS The treated AF exhibited significantly enhanced repair tissue structure with signs of proteoglycan formation compared to the untreated group. The median scores were 4.3 for the treated and 9.8 for the untreated group. Cystic degeneration, perivascular infiltration, inflammation and necrosis were only present in the untreated group. Blood vessel ingrowth and tear/cleft formation were increased, though not significant, in the untreated group while cell morphology was comparable in both groups. CONCLUSION PGA-HA scaffolds used for AF closure support repair tissue formation in an ovine lumbar disc defect model.
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Yamada K, Iwasaki N, Sudo H. Biomaterials and Cell-Based Regenerative Therapies for Intervertebral Disc Degeneration with a Focus on Biological and Biomechanical Functional Repair: Targeting Treatments for Disc Herniation. Cells 2022; 11:cells11040602. [PMID: 35203253 PMCID: PMC8870062 DOI: 10.3390/cells11040602] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is a common cause of low back pain and most spinal disorders. As IVD degeneration is a major obstacle to the healthy life of so many individuals, it is a major issue that needs to be overcome. Currently, there is no clinical treatment for the regeneration of degenerated IVDs. However, recent advances in regenerative medicine and tissue engineering suggest the potential of cell-based and/or biomaterial-based IVD regeneration therapies. These treatments may be indicated for patients with IVDs in the intermediate degenerative stage, a point where the number of viable cells decreases, and the structural integrity of the disc begins to collapse. However, there are many biological, biomechanical, and clinical challenges that must be overcome before the clinical application of these IVD regeneration therapies can be realized. This review summarizes the basic research and clinical trials literature on cell-based and biomaterial-based IVD regenerative therapies and outlines the important role of these strategies in regenerative treatment for IVD degenerative diseases, especially disc herniation.
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Affiliation(s)
- Katsuhisa Yamada
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (K.Y.); (N.I.)
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (K.Y.); (N.I.)
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
- Correspondence:
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Peng Y, Li J, Lin H, Tian S, Liu S, Pu F, Zhao L, Ma K, Qing X, Shao Z, Yp, Zs, Xq, Yp, Yp, Xq, Jl, St, Yp, Xq, Jl, St, Sl, Fp, Lz, Km, Xq, Yp, Xq, Hs, St, Yp, Jl, Hl, St, Lz, Fp, Sl, Zs, Xq. Endogenous repair theory enriches construction strategies for orthopaedic biomaterials: a narrative review. BIOMATERIALS TRANSLATIONAL 2021; 2:343-360. [PMID: 35837417 PMCID: PMC9255795 DOI: 10.12336/biomatertransl.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/19/2021] [Indexed: 02/06/2023]
Abstract
The development of tissue engineering has led to new strategies for mitigating clinical problems; however, the design of the tissue engineering materials remains a challenge. The limited sources and inadequate function, potential risk of microbial or pathogen contamination, and high cost of cell expansion impair the efficacy and limit the application of exogenous cells in tissue engineering. However, endogenous cells in native tissues have been reported to be capable of spontaneous repair of the damaged tissue. These cells exhibit remarkable plasticity, and thus can differentiate or be reprogrammed to alter their phenotype and function after stimulation. After a comprehensive review, we found that the plasticity of these cells plays a major role in establishing the cell source in the mechanism involved in tissue regeneration. Tissue engineering materials that focus on assisting and promoting the natural self-repair function of endogenous cells may break through the limitations of exogenous seed cells and further expand the applications of tissue engineering materials in tissue repair. This review discusses the effects of endogenous cells, especially stem cells, on injured tissue repairing, and highlights the potential utilisation of endogenous repair in orthopaedic biomaterial constructions for bone, cartilage, and intervertebral disc regeneration.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Zengwu Shao
- Corresponding authors: Zengwu Shao, ; Xiangcheng Qing,
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5
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Integrin and syndecan binding peptide-conjugated alginate hydrogel for modulation of nucleus pulposus cell phenotype. Biomaterials 2021; 277:121113. [PMID: 34492582 DOI: 10.1016/j.biomaterials.2021.121113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 01/05/2023]
Abstract
Biomaterial based strategies have been widely explored to preserve and restore the juvenile phenotype of cells of the nucleus pulposus (NP) in degenerated intervertebral discs (IVD). With aging and maturation, NP cells lose their ability to produce necessary extracellular matrix and proteoglycans, accelerating disc degeneration. Previous studies have shown that integrin or syndecan binding peptide motifs from laminin can induce NP cells from degenerative human discs to re-express juvenile NP-specific cell phenotype and biosynthetic activity. Here, we engineered alginate hydrogels to present integrin- and syndecan-binding peptides alone or in combination (cyclic RGD and AG73, respectively) to introduce bioactive features into the alginate gels. We demonstrated human NP cells cultured upon and within alginate hydrogels presented with cRGD and AG73 peptides exhibited higher cell viability, biosynthetic activity, and NP-specific protein expression over alginate alone. Moreover, the combination of the two peptide motifs elicited markers of the NP-specific cell phenotype, including N-Cadherin, despite differences in cell morphology and multicellular cluster formation between 2D and 3D cultures. These results represent a promising step toward understanding how distinct adhesive peptides can be combined to guide NP cell fate. In the future, these insights may be useful to rationally design hydrogels for NP cell-transplantation based therapies for IVD degeneration.
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Barcellona MN, Speer JE, Jing L, Patil DS, Gupta MC, Buchowski JM, Setton LA. Bioactive in situ crosslinkable polymer-peptide hydrogel for cell delivery to the intervertebral disc in a rat model. Acta Biomater 2021; 131:117-127. [PMID: 34229105 PMCID: PMC9157564 DOI: 10.1016/j.actbio.2021.06.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Abstract
Degeneration of the intervertebral disc (IVD) is associated with
significant biochemical and morphological changes that include a loss of disc
height, decreased water content and decreased cellularity. Cell delivery has
been widely explored as a strategy to supplement the nucleus pulposus (NP)
region of the degenerated IVD in both pre-clinical and clinical trials, using
progenitor or primary cell sources. We previously demonstrated an ability for a
polymer-peptide hydrogel, serving as a culture substrate, to promote adult NP
cells to undergo a shift from a degenerative fibroblast-like state to a
juvenile-like NP phenotype. In the current study, we evaluate the ability for
this peptide-functionalized hydrogel to serve as a bioactive system for cell
delivery, retention and preservation of a biosynthetic phenotype for primary IVD
cells delivered to the rat caudal disc in an anular puncture degeneration model.
Our data suggest that encapsulation of adult degenerative human NP cells in a
stiff formulation of the hydrogel functionalized with laminin-mimetic peptides
IKVAV and AG73 can promote cell viability and increased biosynthetic activity
for this population in 3D culture in vitro. Delivery of the
peptide-functionalized biomaterial with primary rat cells to the degenerated IVD
supported NP cell retention and NP-specific protein expression in
vivo, and promoted improved disc height index (DHI) values and
endplate organization compared to untreated degenerated controls. The results of
this study suggest the physical cues of this peptide-functionalized hydrogel can
serve as a supportive carrier for cell delivery to the IVD.
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Affiliation(s)
- Marcos N Barcellona
- Department of Biomedical Engineering, Washington University in St. Louis, United States
| | - Julie E Speer
- Department of Biomedical Engineering, Washington University in St. Louis, United States
| | - Liufang Jing
- Department of Biomedical Engineering, Washington University in St. Louis, United States
| | - Deepanjali S Patil
- Department of Biomedical Engineering, Washington University in St. Louis, United States
| | - Munish C Gupta
- Department of Orthopedic Surgery, Washington University School of Medicine, United States
| | - Jacob M Buchowski
- Department of Orthopedic Surgery, Washington University School of Medicine, United States
| | - Lori A Setton
- Department of Biomedical Engineering, Washington University in St. Louis, United States; Department of Orthopedic Surgery, Washington University School of Medicine, United States.
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Yamada K, Kenichiro M, Ito YM, Inage F, Isoe T, Yokota N, Sugita O, Sato N, Tha KK, Iwasaki N, Arato T, Sudo H. Exploratory clinical trial on the safety and capability of dMD-001 in lumbar disc herniation: Study protocol for a first-in-human pilot study. Contemp Clin Trials Commun 2021; 23:100805. [PMID: 34278043 PMCID: PMC8261539 DOI: 10.1016/j.conctc.2021.100805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 01/08/2023] Open
Abstract
Herniated nucleus pulposus (NP), one of the most common diseases of the spine, is surgically treated by removing the sequestered NP. However, intervertebral disc (IVD) defects may remain after discectomy, leading to inadequate tissue healing and predisposing patients to IVD degeneration. An acellular, bioresorbable, ultra-purified alginate (UPAL) gel (dMD-001) implantation system can be used to fill any IVD defects in order to prevent IVD degeneration after discectomy. This first-in-human pilot study aims to determine the feasibility, safety, and perceived patient response to a combined treatment involving discectomy and UPAL gel implantation for herniated NP. We designed a one-arm, double-centre, open-label, pilot trial. The study started in November 2018 and will run until a sample of 40 suitable participants is established. Patients aged 20-49 years, diagnosed with isolated lumbar IVD herniation and scheduled for discectomy represent suitable candidates. All eligible participants who provide informed consent undergo standard discectomy followed by UPAL gel implantation. The primary outcomes of the trial will be the feasibility and safety of the procedure. Secondary outcomes will include self-assessed clinical scores and magnetic resonance imaging-based measures of morphological and compositional quality of the IVD tissue. Initial outcomes will be published at 24 weeks. Analysis of feasibility and safety will be performed using descriptive statistics. Both intention-to-treat and per-protocol analyses of treatment trends of effectiveness will be conducted.
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Affiliation(s)
- Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, and Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Maeda Kenichiro
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, N14W5, Sapporo, Hokkaido, Japan
| | - Fujio Inage
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Toshiyuki Isoe
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Nozomi Yokota
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Osamu Sugita
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Khin Khin Tha
- Department of Diagnostic Imaging, Hokkaido University Hospital, N14W5, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, and Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido, 060-8638, Japan
| | - Teruyo Arato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, N14W5, Sapporo, Japan
| | - Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14W5, Sapporo, Japan.,Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Rahman M, Peng XL, Zhao XH, Gong HL, Sun XD, Wu Q, Wei DX. 3D bioactive cell-free-scaffolds for in-vitro/in-vivo capture and directed osteoinduction of stem cells for bone tissue regeneration. Bioact Mater 2021; 6:4083-4095. [PMID: 33997495 PMCID: PMC8091180 DOI: 10.1016/j.bioactmat.2021.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 12/24/2022] Open
Abstract
Hydrophilic bone morphogenetic protein 2 (BMP2) is easily degraded and difficult to load onto hydrophobic carrier materials, which limits the application of polyester materials in bone tissue engineering. Based on soybean-lecithin as an adjuvant biosurfactant, we designed a novel cell-free-scaffold of polymer of poly(ε-caprolactone) and poly(lactide-co-glycolide)-co-polyetherimide with abundant entrapped and continuously released BMP2 for in vivo stem cell-capture and in situ osteogenic induction, avoiding the use of exogenous cells. The optimized bioactive osteo-polyester scaffold (BOPSC), i.e. SBMP-10SC, had a high BMP2 entrapment efficiency of 95.35%. Due to its higher porosity of 83.42%, higher water uptake ratio of 850%, and sustained BMP2 release with polymer degradation, BOPSCs were demonstrated to support excellent in vitro capture, proliferation, migration and osteogenic differentiation of mouse adipose derived mesenchymal stem cells (mADSCs), and performed much better than traditional BMP-10SCs with unmodified BMP2 and single polyester scaffolds (10SCs). Furthermore, in vivo capture and migration of stem cells and differentiation into osteoblasts was observed in mice implanted with BOPSCs without exogenous cells, which enabled allogeneic bone formation with a high bone mineral density and ratios of new bone volume to existing tissue volume after 6 months. The BOPSC is an advanced 3D cell-free platform with sustained BMP2 supply for in situ stem cell capture and osteoinduction in bone tissue engineering with potential for clinical translation.
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Affiliation(s)
- Mamatali Rahman
- MOE Key Laboratory of Bioinformatics, Center for Synthetic and System Biology, Tsinghua University, Beijing, 100084, China.,School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Xue-Liang Peng
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
| | - Xiao-Hong Zhao
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
| | - Hai-Lun Gong
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
| | - Xiao-Dan Sun
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China.,Key Laboratory of Advanced Materials of Ministry of Education of China, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - Qiong Wu
- MOE Key Laboratory of Bioinformatics, Center for Synthetic and System Biology, Tsinghua University, Beijing, 100084, China.,School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Dai-Xu Wei
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Department of Life Sciences and Medicine, Northwest University, Xi'an, 710069, China
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Schmitz TC, Salzer E, Crispim JF, Fabra GT, LeVisage C, Pandit A, Tryfonidou M, Maitre CL, Ito K. Characterization of biomaterials intended for use in the nucleus pulposus of degenerated intervertebral discs. Acta Biomater 2020; 114:1-15. [PMID: 32771592 DOI: 10.1016/j.actbio.2020.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/06/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Abstract
Biomaterials for regeneration of the intervertebral disc must meet complex requirements conforming to biological, mechanical and clinical demands. Currently no consensus on their characterization exists. It is crucial to identify parameters and their method of characterization for accurate assessment of their potential efficacy, keeping in mind the translation towards clinical application. This review systematically analyses the characterization techniques of biomaterial systems that have been used for nucleus pulposus (NP) restoration and regeneration. Substantial differences in the approach towards assessment became evident, hindering comparisons between different materials with respect to their suitability for NP restoration and regeneration. We have analysed the current approaches and identified parameters necessary for adequate biomaterial characterization, with the clinical goal of functional restoration and biological regeneration of the NP in mind. Further, we provide guidelines and goals for their measurement. STATEMENT OF SIGNIFICANCE: Biomaterials intended for restoration of regeneration of the nucleus pulposus within the intervertebral disc must meet biological, biomechanical and clinical demands. Many materials have been investigated, but a lack of consensus on which parameters to evaluate leads to difficulties in comparing materials as well as mostly partial characterization of the materials in question. A gap between current methodology and clinically relevant and meaningful characterization is prevalent. In this article, we identify necessary methods and their implementation for complete biomaterial characterization in the context of clinical applicability. This will allow for a more unified approach to NP-biomaterials research within the field as a whole and enable comparative analysis of novel materials yet to be developed.
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Affiliation(s)
- Tara C Schmitz
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
| | - Elias Salzer
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
| | - João F Crispim
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
| | - Georgina Targa Fabra
- Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, 7WQJ+8F Galway, Ireland.
| | - Catherine LeVisage
- Université de Nantes, INSERM UMR 1229, Regenerative Medicine and Skeleton, RMeS School of Dental Surgery, University of Nantes, 1 Place Ricordeau, 44300 Nantes, France.
| | - Abhay Pandit
- Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, 7WQJ+8F Galway, Ireland.
| | - Marianna Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, Netherlands.
| | - Christine Le Maitre
- Biomolecular Sciences Research Centre Sheffield Hallam University, City Campus, Howard Street, S1 1WB Sheffield, United Kingdom.
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, Netherlands.
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10
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Barakat AH, Elwell VA, Lam KS. Stem cell therapy in discogenic back pain. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:561-583. [PMID: 32043007 PMCID: PMC6989932 DOI: 10.21037/jss.2019.09.22] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Chronic low back pain has both substantial social and economic impacts on patients and healthcare budgets. Adding to the magnitude of the problem is the difficulty in identifying the exact causes of disc degeneration with modern day diagnostic and imaging techniques. With that said, current non-operative and surgical treatment modalities for discogenic low back pain fails to meet the expectations in many patients and hence the challenge. The objective for newly emerging stem cell regenerative therapy is to treat degenerative disc disease (DDD) by restoring the disc's cellularity and modulating the inflammatory response. Appropriate patient selection is crucial for the success of stem cell therapy. Regenerative modalities for discogenic pain currently focus on the use of either primary cells harvested from the intervertebral discs or stem cells from other sources whether autogenic or allogenic. The microenvironment in which stem cells are being cultured has been recognized to play a crucial role in directing or maintaining the production of the desired phenotypes and may enhance their regenerative potential. This has led to a more specific focus on innovating more effective culturing techniques, delivery vehicles and scaffolds for stem cell application. Although stem cell therapy might offer an attractive alternative treatment option, more clinical studies are still needed to establish on the safety and feasibility of such therapy. In this literature review, we aim to present the most recent in vivo and in vitro studies related to the use of stem cell therapy in the treatment of discogenic low back pain.
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Affiliation(s)
- Ahmed H. Barakat
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Vivian A. Elwell
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Zhao R, Liu W, Xia T, Yang L. Disordered Mechanical Stress and Tissue Engineering Therapies in Intervertebral Disc Degeneration. Polymers (Basel) 2019; 11:polym11071151. [PMID: 31284436 PMCID: PMC6680713 DOI: 10.3390/polym11071151] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022] Open
Abstract
Low back pain (LBP), commonly induced by intervertebral disc degeneration, is a lumbar disease with worldwide prevalence. However, the mechanism of degeneration remains unclear. The intervertebral disc is a nonvascular organ consisting of three components: Nucleus pulposus, annulus fibrosus, and endplate cartilages. The disc is structured to support our body motion and endure persistent external mechanical pressure. Thus, there is a close connection between force and intervertebral discs in LBP. It is well established that with aging, disordered mechanical stress profoundly influences the fate of nucleus pulposus and the alignment of collagen fibers in the annulus fibrosus. These support a new understanding that disordered mechanical stress plays an important role in the degeneration of the intervertebral discs. Tissue-engineered regenerative and reparative therapies are being developed for relieving disc degeneration and symptoms of lower back pain. In this paper, we will review the current literature available on the role of disordered mechanical stress in intervertebral disc degeneration, and evaluate the existing tissue engineering treatment strategies of the current therapies.
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Affiliation(s)
- Runze Zhao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Wanqian Liu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Tingting Xia
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China.
| | - Li Yang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China.
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12
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Tsujimoto T, Sudo H, Todoh M, Yamada K, Iwasaki K, Ohnishi T, Hirohama N, Nonoyama T, Ukeba D, Ura K, Ito YM, Iwasaki N. An acellular bioresorbable ultra-purified alginate gel promotes intervertebral disc repair: A preclinical proof-of-concept study. EBioMedicine 2018; 37:521-534. [PMID: 30389504 PMCID: PMC6286260 DOI: 10.1016/j.ebiom.2018.10.055] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/14/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background The current surgical procedure of choice for lumbar intervertebral disc (IVD) herniation is discectomy. However, defects within IVD produced upon discectomy may impair tissue healing and predispose patients to subsequent IVD degeneration. This study aimed to investigate whether the use of an acellular bioresorbable ultra-purified alginate (UPAL) gel implantation system is safe and effective as a reparative therapeutic strategy after lumbar discectomy. Methods Human IVD cells were cultured in a three-dimensional system in UPAL gel. In addition, lumbar spines of sheep were used for mechanical analysis. Finally, the gel was implanted into IVD after discectomy in rabbits and sheep in vivo. Findings The UPAL gel was biocompatible with human IVD cells and promoted extracellular matrix production after discectomy, demonstrating sufficient biomechanical characteristics without material protrusion. Interpretation The present results indicate the safety and efficacy of UPAL gels in a large animal model and suggest that these gels represent a novel therapeutic strategy after discectomy in cases of lumbar IVD herniation. Fund Grant-in-Aid for the Ministry of Education, Culture, Sports, Science, and Technology of Japan, Japan Agency for Medical Research and Development, and the Mochida Pharmaceutical Co., Ltd.
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Affiliation(s)
- Takeru Tsujimoto
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Hideki Sudo
- Faculty of Medicine and Graduate of Medicine, Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University, N15W7, Sapporo 060-8638, Hokkaido, Japan.
| | - Masahiro Todoh
- Faculty of Engineering, Division of Human Mechanical Systems and Design, Hokkaido University, N13W8, Sapporo, Hokkaido 060-8628, Japan
| | - Katsuhisa Yamada
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Koji Iwasaki
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Takashi Ohnishi
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Naoki Hirohama
- Faculty of Engineering, Division of Human Mechanical Systems and Design, Hokkaido University, N13W8, Sapporo, Hokkaido 060-8628, Japan
| | - Takayuki Nonoyama
- Faculty of Advanced Life Science, Division of Advanced Transdisciplinary Sciences, Hokkaido University, N21W11, Sapporo, Hokkaido 001-0021, Japan
| | - Daisuke Ukeba
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Katsuro Ura
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Yoichi M Ito
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate of Medicine, Department of Orthopedic Surgery, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
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13
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Huang YC, Hu Y, Li Z, Luk KDK. Biomaterials for intervertebral disc regeneration: Current status and looming challenges. J Tissue Eng Regen Med 2018; 12:2188-2202. [PMID: 30095863 DOI: 10.1002/term.2750] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/21/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
A biomaterial-based strategy is employed to regenerate the degenerated intervertebral disc, which is considered a major generator of neck and back pain. Although encouraging enhancements in the anatomy and kinematics of the degenerative disc have been gained by biomaterials with various formulations in animals, the number of biomaterials tested in humans is rare. At present, most studies that involve the use of newly developed biomaterials focus on regeneration of the degenerative disc, but not pain relief. In this review, we summarise the current state of the art in the field of biomaterial-based regeneration or repair for the nucleus pulposus, annulus fibrosus, and total disc transplantation in animals and humans, and we then provide essential suggestions for the development and clinical translation of biomaterials for disc regeneration. It is important for researchers to consider the commonly neglected issues instead of concentrating solely on biomaterial development and fabrication.
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Affiliation(s)
- Yong-Can Huang
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, Orthopaedic Research Center, Peking University Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.,Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Zhen Li
- AO Research Institute Davos, Davos, Switzerland
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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14
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Fernandez-Moure J, Moore CA, Kim K, Karim A, Smith K, Barbosa Z, Van Eps J, Rameshwar P, Weiner B. Novel therapeutic strategies for degenerative disc disease: Review of cell biology and intervertebral disc cell therapy. SAGE Open Med 2018; 6:2050312118761674. [PMID: 29568524 PMCID: PMC5858682 DOI: 10.1177/2050312118761674] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/05/2018] [Indexed: 12/17/2022] Open
Abstract
Intervertebral disc degeneration is a disease of the discs connecting adjoining vertebrae in which structural damage leads to loss of disc integrity. Degeneration of the disc can be a normal process of ageing, but can also be precipitated by other factors. Literature has made substantial progress in understanding the biological basis of intervertebral disc, which is reviewed here. Current medical and surgical management strategies have shortcomings that do not lend promise to be effective solutions in the coming years. With advances in understanding the cell biology and characteristics of the intervertebral disc at the molecular and cellular level that have been made, alternative strategies for addressing disc pathology can be discovered. A brief overview of the anatomic, cellular, and molecular structure of the intervertebral disc is provided as well as cellular and molecular pathophysiology surrounding intervertebral disc degeneration. Potential therapeutic strategies involving stem cell, protein, and genetic therapy for intervertebral disc degeneration are further discussed.
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Affiliation(s)
- Joseph Fernandez-Moure
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Regenerative and Biomimetic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Caitlyn A Moore
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Azim Karim
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Kevin Smith
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Zonia Barbosa
- Department of Regenerative and Biomimetic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Jeffrey Van Eps
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.,Department of Regenerative and Biomimetic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Pranela Rameshwar
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Bradley Weiner
- Department of Regenerative and Biomimetic Medicine, Houston Methodist Research Institute, Houston, TX, USA.,Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
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15
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Casaroli G, Villa T, Bassani T, Berger-Roscher N, Wilke HJ, Galbusera F. Numerical Prediction of the Mechanical Failure of the Intervertebral Disc under Complex Loading Conditions. MATERIALS (BASEL, SWITZERLAND) 2017; 10:E31. [PMID: 28772392 PMCID: PMC5344546 DOI: 10.3390/ma10010031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/06/2016] [Accepted: 12/20/2016] [Indexed: 11/16/2022]
Abstract
Finite element modeling has been widely used to simulate the mechanical behavior of the intervertebral disc. Previous models have been generally limited to the prediction of the disc behavior under simple loading conditions, thus neglecting its response to complex loads, which may induce its failure. The aim of this study was to generate a finite element model of the ovine lumbar intervertebral disc, in which the annulus was characterized by an anisotropic hyperelastic formulation, and to use it to define which mechanical condition was unsafe for the disc. Based on published in vitro results, numerical analyses under combined flexion, lateral bending, and axial rotation with a magnitude double that of the physiological ones were performed. The simulations showed that flexion was the most unsafe load and an axial tensile stress greater than 10 MPa can cause disc failure. The numerical model here presented can be used to predict the failure of the disc under all loading conditions, which may support indications about the degree of safety of specific motions and daily activities, such as weight lifting.
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Affiliation(s)
- Gloria Casaroli
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, 20133 Milan, Italy.
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, 20133 Milan, Italy.
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy.
| | - Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy.
| | - Nikolaus Berger-Roscher
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University, D-89081 Ulm, Germany.
| | - Hans-Joachim Wilke
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University, D-89081 Ulm, Germany.
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16
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Fernandez C, Marionneaux A, Gill S, Mercuri J. Biomimetic nucleus pulposus scaffold created from bovine caudal intervertebral disc tissue utilizing an optimal decellularization procedure. J Biomed Mater Res A 2016; 104:3093-3106. [PMID: 27507100 PMCID: PMC5832047 DOI: 10.1002/jbm.a.35858] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/14/2016] [Accepted: 08/05/2016] [Indexed: 11/07/2022]
Abstract
Intervertebral disc (IVD) degeneration (IDD) and herniation (IDH) can result in low back pain and impart significant socioeconomic burden. These pathologies involve detrimental alteration to the nucleus pulposus (NP) either via biochemical degradation or extrusion from the IVD, respectively. Thus, engineering living NP tissue utilizing biomaterial scaffolds that recapitulate native NP microarchitecture, biochemistry, mechanical properties, and which support cell viability represents an approach to aiding patients with IDD and IDH. To date, an ideal biomaterial to support NP regeneration has yet to be developed; however, one promising approach to generating biomimetic materials is to employ the decellularization (decell) of xenogeneic NP tissue to remove host DNA while maintaining critical native extracellular matrix (ECM) components. Herein, 13 different procedures were evaluated in an attempt to decell bovine caudal IVD NP tissue. An optimal method was identified which was confirmed to effectively remove bovine DNA, while maintaining physiologically relevant amounts of glycosaminoglycan (GAG) and type II collagen. Unconfined static and dynamic compressive mechanical properties of scaffolds approached values reported for human NP and viability of human amniotic stem cells (hAMSCs) was maintained on noncrosslinked and EDC/NHS treated scaffolds for up to 14 days in culture. Taken together, NP tissue obtained from bovine caudal IVDs can be successfully decelled in order to generate a biomimetic scaffold for NP tissue regeneration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 3093-3106, 2016.
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Affiliation(s)
- Christopher Fernandez
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina
| | - Alan Marionneaux
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina
| | - Sanjitpal Gill
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina
- Department of Orthopaedic Surgery, Spartanburg Regional Healthcare System, Greer, South Carolina
| | - Jeremy Mercuri
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina.
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17
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Development of a Three-Dimensional (3D) Printed Biodegradable Cage to Convert Morselized Corticocancellous Bone Chips into a Structured Cortical Bone Graft. Int J Mol Sci 2016; 17:ijms17040595. [PMID: 27104525 PMCID: PMC4849049 DOI: 10.3390/ijms17040595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022] Open
Abstract
This study aimed to develop a new biodegradable polymeric cage to convert corticocancellous bone chips into a structured strut graft for treating segmental bone defects. A total of 24 adult New Zealand white rabbits underwent a left femoral segmental bone defect creation. Twelve rabbits in group A underwent three-dimensional (3D) printed cage insertion, corticocancellous chips implantation, and Kirschner-wire (K-wire) fixation, while the other 12 rabbits in group B received bone chips implantation and K-wire fixation only. All rabbits received a one-week activity assessment and the initial image study at postoperative 1 week. The final image study was repeated at postoperative 12 or 24 weeks before the rabbit scarification procedure on schedule. After the animals were sacrificed, both femurs of all the rabbits were prepared for leg length ratios and 3-point bending tests. The rabbits in group A showed an increase of activities during the first week postoperatively and decreased anterior cortical disruptions in the postoperative image assessments. Additionally, higher leg length ratios and 3-point bending strengths demonstrated improved final bony ingrowths within the bone defects for rabbits in group A. In conclusion, through this bone graft converting technique, orthopedic surgeons can treat segmental bone defects by using bone chips but with imitate characters of structured cortical bone graft.
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18
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Priyadarshani P, Li Y, Yao L. Advances in biological therapy for nucleus pulposus regeneration. Osteoarthritis Cartilage 2016; 24:206-12. [PMID: 26342641 DOI: 10.1016/j.joca.2015.08.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 07/29/2015] [Accepted: 08/18/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The intervertebral disc (IVD) is composed of the external annulus fibrosus (AF) and the inner gel-like center, the nucleus pulposus (NP). The elastic NP can function to relieve stress and maintain IVD function by distributing hydraulic pressure evenly to annulus and endplate. Degeneration of the NP, which leads to increased death of NP cells, the loss of proteoglycan (PG), and aberrant gene expression, may result in an overall alteration of the biomechanics of the spinal column and cause low back pain. Recent advances in biological therapy strategies that target therapy at the regeneration of degenerated and damaged NP have been investigated in in vitro and in vivo studies and demonstrated promising outcomes. In this article, we review recent studies of biological approaches for NP regeneration. METHOD The articles regarding NP regeneration using biomaterials, stem cells, and gene vectors were identified in PubMed databases. RESULTS Stem cell-mediated cell therapy demonstrates the potential to restore the function and structure of the NP. The viral or non-viral vectors encoding functional genes may generate a therapeutic effect when they are introduced into grafted cells or native cells in the NP. Biomaterial scaffolds generate an initial permissive environment for cell growth and allow the remodeling of scaffolds in the regeneration process. Biomaterial scaffolds provide structural support for NP regeneration and serve as a carrier for stem cell and gene vector delivery. CONCLUSION Though recent studies advance the body of knowledge needed to treat degenerated discs, many challenges need to be overcome before the application of these approaches can be successful clinically.
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Affiliation(s)
- P Priyadarshani
- Department of Biological Sciences, Wichita State University, Wichita, KS 67260, USA.
| | - Y Li
- Department of Biological Sciences, Wichita State University, Wichita, KS 67260, USA.
| | - L Yao
- Department of Biological Sciences, Wichita State University, Wichita, KS 67260, USA.
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19
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Edmunds KJ, Gargiulo P. Imaging Approaches in Functional Assessment of Implantable Myogenic Biomaterials and Engineered Muscle Tissue. Eur J Transl Myol 2015; 25:4847. [PMID: 26913149 PMCID: PMC4749010 DOI: 10.4081/ejtm.2015.4847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/21/2015] [Indexed: 12/13/2022] Open
Abstract
The fields of tissue engineering and regenerative medicine utilize implantable biomaterials and engineered tissues to regenerate damaged cells or replace lost tissues. There are distinct challenges in all facets of this research, but functional assessments and monitoring of such complex environments as muscle tissues present the current strategic priority. Many extant methods for addressing these questions result in the destruction or alteration of tissues or cell populations under investigation. Modern advances in non-invasive imaging modalities present opportunities to rethink some of the anachronistic methods, however, their standard employment may not be optimal when considering advancements in myology. New image analysis protocols and/or combinations of established modalities need to be addressed. This review focuses on efficacies and limitations of available imaging modalities to the functional assessment of implantable myogenic biomaterials and engineered muscle tissues.
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Affiliation(s)
- Kyle J. Edmunds
- Institute for Biomedical and Neural Engineering, University of Reykjavík
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, University of Reykjavík
- University Hospital Landspítali, Reykjavík, Iceland
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20
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Tao Y, Zhou X, Liang C, Li H, Han B, Li F, Chen Q. TGF-β3 and IGF-1 synergy ameliorates nucleus pulposus mesenchymal stem cell differentiation towards the nucleus pulposus cell type through MAPK/ERK signaling. Growth Factors 2015; 33:326-36. [PMID: 26431359 DOI: 10.3109/08977194.2015.1088532] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aimed to investigate the synergy between transforming growth factor beta 3 (TGF-β3) and insulin-like growth factor 1 (IGF-1) on nucleus pulposus-derived mesenchymal stem cells (NP-MSCs) and the underlying mechanism using a serum-free culture system. NP-MSC proliferation and viability were measured using a CCK-8 assay and annexin V-FITC/propidium iodide, respectively. NP-MSCs in micromasses were investigated for differentiation towards nucleus pulposus cells (NPCs). SOX-9, collagen-I, collagen-II, aggrecan and decorin expressions were detected by RT-PCR and immunoblotting. Matrix deposition was assessed by sulfated glycosaminoglycan (sGAG) analysis. Novel chondrogenic and nucleus pulposus (NP) genes were detected to distinguish differentiated cell types. MAPK/ERK and TGF/Smad signaling pathways were also examined. As a result, the synergy between TGF-β3 and IGF-1 enhanced NP-MSC viability, extracellular matrix (ECM) biosynthesis and differentiation towards NPCs, partly through the activation of the MAPK/ERK signaling pathway. Therefore, the synergy between TGF-β3 and IGF-1 ameliorates NP-MSC viability, differentiation and promotes intervertebral disc regeneration.
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Affiliation(s)
- Yiqing Tao
- a Department of Orthopedics , 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Xiaopeng Zhou
- a Department of Orthopedics , 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Chengzhen Liang
- a Department of Orthopedics , 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Hao Li
- a Department of Orthopedics , 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Bin Han
- a Department of Orthopedics , 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Fangcai Li
- a Department of Orthopedics , 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Qixin Chen
- a Department of Orthopedics , 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
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21
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Showalter BL, Malhotra NR, Vresilovic EJ, Elliott DM. Nucleotomy reduces the effects of cyclic compressive loading with unloaded recovery on human intervertebral discs. J Biomech 2014; 47:2633-40. [PMID: 24957922 DOI: 10.1016/j.jbiomech.2014.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/29/2014] [Accepted: 05/24/2014] [Indexed: 01/06/2023]
Abstract
The first objective of this study was to determine the effects of physiological cyclic loading followed by unloaded recovery on the mechanical response of human intervertebral discs. The second objective was to examine how nucleotomy alters the disc's mechanical response to cyclic loading. To complete these objectives, 15 human L5-S1 discs were tested while intact and subsequent to nucleotomy. The testing consisted of 10,000 cycles of physiological compressive loads followed by unloaded hydrated recovery. Cyclic loading increased compression modulus (3%) and strain (33%), decreased neutral zone modulus (52%), and increased neutral zone strain (31%). Degeneration was not correlated with the effect of cyclic loading in intact discs, but was correlated with cyclic loading effects after nucleotomy, with more degenerate samples experiencing greater increases in both compressive and neutral zone strain following cyclic loading. Partial removal of the nucleus pulposus decreased the compression and neutral zone modulus while increasing strain. These changes correspond to hypermobility, which will alter overall spinal mechanics and may impact low back pain via altered motion throughout the spinal column. Nucleotomy also reduced the effects of cyclic loading on mechanical properties, likely due to altered fluid flow, which may impact cellular mechanotransduction and transport of disc nutrients and waste. Degeneration was not correlated with the acute changes of nucleotomy. Results of this study provide an ideal protocol and control data for evaluating the effectiveness of a mechanically-based disc degeneration treatment, such as a nucleus replacement.
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Affiliation(s)
- Brent L Showalter
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Neil R Malhotra
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Edward J Vresilovic
- Hershey Department of Orthopaedics and Rehabilitation, Penn State University, Hershey, PA, United States
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, 125 East Delaware Ave, Newark, DE, United States.
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22
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McHenry CL, Wu J, Shields RK. Potential regenerative rehabilitation technology: implications of mechanical stimuli to tissue health. BMC Res Notes 2014; 7:334. [PMID: 24894666 PMCID: PMC4055276 DOI: 10.1186/1756-0500-7-334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/21/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Mechanical loads induced through muscle contraction, vibration, or compressive forces are thought to modulate tissue plasticity. With the emergence of regenerative medicine, there is a need to understand the optimal mechanical environment (vibration, load, or muscle force) that promotes cellular health. To our knowledge no mechanical system has been proposed to deliver these isolated mechanical stimuli in human tissue. We present the design, performance, and utilization of a new technology that may be used to study localized mechanical stimuli on human tissues. A servo-controlled vibration and limb loading system were developed and integrated into a single instrument to deliver vibration, compression, or muscle contractile loads to a single limb (tibia) in humans. The accuracy, repeatability, transmissibility, and safety of the mechanical delivery system were evaluated on eight individuals with spinal cord injury (SCI). FINDINGS The limb loading system was linear, repeatable, and accurate to less than 5, 1, and 1 percent of full scale, respectively, and transmissibility was excellent. The between session tests on individuals with spinal cord injury (SCI) showed high intra-class correlations (>0.9). CONCLUSIONS All tests supported that therapeutic loads can be delivered to a lower limb (tibia) in a safe, accurate, and measureable manner. Future collaborations between engineers and cellular physiologists will be important as research programs strive to determine the optimal mechanical environment for developing cells and tissues in humans.
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Affiliation(s)
- Colleen L McHenry
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, 1-252 Medical Education Building, Iowa City, IA 52242-1190, USA
| | - Jason Wu
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, 1-252 Medical Education Building, Iowa City, IA 52242-1190, USA
| | - Richard K Shields
- Department of Physical Therapy & Rehabilitation Science, Carver College of Medicine, University of Iowa, 1-252 Medical Education Building, Iowa City, IA 52242-1190, USA
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Reitmaier S, Schmidt H, Ihler R, Kocak T, Graf N, Ignatius A, Wilke HJ. Preliminary investigations on intradiscal pressures during daily activities: an in vivo study using the merino sheep. PLoS One 2013; 8:e69610. [PMID: 23894509 PMCID: PMC3722231 DOI: 10.1371/journal.pone.0069610] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose Currently, no studies exist, which attest the suitability of the ovine intervertebral disc as a biomechanical in vivo model for preclinical tests of new therapeutic strategies of the human disc. By measuring the intradiscal pressure in vivo, the current study attempts to characterize an essential biomechanical parameter to provide a more comprehensive physiological understanding of the ovine intervertebral disc. Methods Intradiscal pressure (IDP) was measured for 24 hours within the discs L2-L3 and L4-L5 via a piezo-resistive pressure sensor in one merino sheep. The data were divided into an activity and a recovery phase and the corresponding average pressures for both phases were determined. Additionally, IDPs for different static and dynamic activities were analyzed and juxtaposed to human data published previously. After sacrificing the sheep, the forces corresponding to the measured IDPs were examined ex vivo in an axial compression test. Results The temporal patterns of IDP where pressure decreased during activity and increased during rest were comparable between humans and sheep. However, large differences were observed for different dynamic activities such as standing up or walking. Here, IDPs averaged 3.73 MPa and 1.60 MPa respectively, approximately two to four times higher in the ovine disc compared to human. These IDPs correspond to lower ex vivo derived axial compressive forces for the ovine disc in comparison to the human disc. For activity and rest, average ovine forces were 130 N and 58 N, compared to human forces of 400-600 N and 100 N, respectively. Conclusions In vivo IDPs were found to be higher in the ovine than in the human disc. In contrast, axial forces derived ex vivo were markedly lower in comparison to humans. Both should be considered in future preclinical tests of intradiscal therapies using the sheep. The techniques used in the current study may serve as a protocol for measuring IDP in a variety of large animal models.
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Affiliation(s)
- Sandra Reitmaier
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm, Germany.
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Vielreicher M, Schürmann S, Detsch R, Schmidt MA, Buttgereit A, Boccaccini A, Friedrich O. Taking a deep look: modern microscopy technologies to optimize the design and functionality of biocompatible scaffolds for tissue engineering in regenerative medicine. J R Soc Interface 2013; 10:20130263. [PMID: 23864499 DOI: 10.1098/rsif.2013.0263] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This review focuses on modern nonlinear optical microscopy (NLOM) methods that are increasingly being used in the field of tissue engineering (TE) to image tissue non-invasively and without labelling in depths unreached by conventional microscopy techniques. With NLOM techniques, biomaterial matrices, cultured cells and their produced extracellular matrix may be visualized with high resolution. After introducing classical imaging methodologies such as µCT, MRI, optical coherence tomography, electron microscopy and conventional microscopy two-photon fluorescence (2-PF) and second harmonic generation (SHG) imaging are described in detail (principle, power, limitations) together with their most widely used TE applications. Besides our own cell encapsulation, cell printing and collagen scaffolding systems and their NLOM imaging the most current research articles will be reviewed. These cover imaging of autofluorescence and fluorescence-labelled tissue and biomaterial structures, SHG-based quantitative morphometry of collagen I and other proteins, imaging of vascularization and online monitoring techniques in TE. Finally, some insight is given into state-of-the-art three-photon-based imaging methods (e.g. coherent anti-Stokes Raman scattering, third harmonic generation). This review provides an overview of the powerful and constantly evolving field of multiphoton microscopy, which is a powerful and indispensable tool for the development of artificial tissues in regenerative medicine and which is likely to gain importance also as a means for general diagnostic medical imaging.
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Affiliation(s)
- M Vielreicher
- Department of Chemical and Biological Engineering, Institute of Medical Biotechnology, Friedrich-Alexander-University Erlangen-Nuremberg, Paul-Gordan-Strasse 3, 91052 Erlangen, Germany.
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The challenge and advancement of annulus fibrosus tissue engineering. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1090-100. [PMID: 23361531 DOI: 10.1007/s00586-013-2663-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 12/26/2012] [Accepted: 01/07/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intervertebral disc degeneration, a main cause of back pain, is an endemic problem and a big economic burden for the health care system. Current treatments are symptom relieving but do not address underlying problems-biological and structural deterioration of the disc. Tissue engineering is an emerging approach for the treatment of intervertebral disc degeneration since it restores the functionality of native tissues. Although numerous studies have focused on the nucleus pulposus tissue engineering and achieved successes in laboratory settings, disc tissue engineering without annulus fibrosus for the end stage of disc degeneration is deemed to fail. The purpose of this article is to review the advancement of annulus fibrosus tissue engineering. MATERIAL AND METHODS Relevant articles regarding annulus fibrosus tissue engineering were identified in PubMed and Medline databases. RESULTS The ideal strategy for disc regeneration is to restore the function and integrity of the disc by using biomaterials, native matrices, growth factors, and cells that producing matrices. In the past decades there are tremendous advancement in annulus fibrosus tissue engineering including cell biology, biomaterials, and whole disc replacement. The recent promising results on whole disc tissue engineering-a composite of annulus fibrosus and nucleus pulposus-make the tissue engineering approach more appealing. CONCLUSION Despite the promising results in disc tissue engineering, there is still much work to be done regarding the clinical application.
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