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Application of Stem Cell Therapy for ACL Graft Regeneration. Stem Cells Int 2021; 2021:6641818. [PMID: 34381504 PMCID: PMC8352687 DOI: 10.1155/2021/6641818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/19/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023] Open
Abstract
Graft regeneration after anterior cruciate ligament (ACL) reconstruction surgery is a complex three-stage process, which usually takes a long duration and often results in fibrous scar tissue formation that exerts a detrimental impact on the patients' prognosis. Hence, as a regeneration technique, stem cell transplantation has attracted increasing attention. Several different stem cell types have been utilized in animal experiments, and almost all of these have shown good capacity in improving tendon-bone regeneration. Various differentiation inducers have been widely applied together with stem cells to enhance specific lineage differentiation, such as recombinant gene transfection, growth factors, and biomaterials. Among the various different types of stem cells, bone marrow-derived mesenchymal stem cells (BMSCs) have been investigated the most, while ligament stem progenitor cells (LDSCs) have demonstrated the best potential in generating tendon/ligament lineage cells. In the clinic, 4 relevant completed trials have been reported, but only one trial with BMSCs showed improved outcomes, while 5 relevant trials are still in progress. This review describes the process of ACL graft regeneration after implantation and summarizes the current application of stem cells from bench to bedside, as well as discusses future perspectives in this field.
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van Vijven M, van Groningen B, Kimenai JN, van der Steen MC, van Doeselaar M, Janssen RPA, Ito K, Foolen J. Identifying potential patient-specific predictors for anterior cruciate ligament reconstruction outcome - a diagnostic in vitro tissue remodeling platform. J Exp Orthop 2020; 7:48. [PMID: 32623555 PMCID: PMC7335379 DOI: 10.1186/s40634-020-00266-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Upon anterior cruciate ligament (ACL) rupture, reconstruction is often required, with the hamstring tendon autograft as most widely used treatment. Post-operative autograft remodeling enhances graft rupture risk, which occurs in up to 10% of the patient population, increasing up to 30% of patients aged under 20 years. Therefore, this research aimed to identify potential biological predictors for graft rupture, derived from patient-specific tissue remodeling-related cell properties in an in vitro micro-tissue platform. Methods Hamstring tendon-derived cells were obtained from remnant autograft tissue after ACL reconstructions (36 patients, aged 12–55 years), and seeded in collagen I gels on a micro-tissue platform. Micro-tissue compaction over time – induced by altering the boundary constraints – was monitored. Pro-collagen I expression was assessed using ELISA, and protein expression of tenomodulin and α-smooth muscle actin were measured using Western blot. Expression and activity of matrix metalloproteinase 2 were determined using gelatin zymography. Results Only micro-tissues corresponding to younger patients occasionally released themselves from the constraining posts. Pro-collagen I expression was significantly higher in younger patients. Differences in α-smooth muscle actin and tenomodulin expression between patients were found, but these were age-independent. Active matrix metalloproteinase 2 expression was slightly more abundant in younger patients. Conclusions The presented micro-tissue platform exposed patient-specific remodeling-related differences between tendon-derived cells, with the micro-tissues that released from constraining posts and pro-collagen I expression best reflecting the clinical age-dependency of graft rupture. These properties can be the starting point in the quest for potential predictors for identifying individual patients at risk for graft rupture.
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Affiliation(s)
- Marc van Vijven
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Building 15, Groene Loper, Gemini-Zuid 4.12, PO Box 513, 5600MB, Eindhoven, The Netherlands. .,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Bart van Groningen
- Department of Orthopaedic Surgery, Máxima MC, Eindhoven, the Netherlands
| | - Joyce N Kimenai
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Building 15, Groene Loper, Gemini-Zuid 4.12, PO Box 513, 5600MB, Eindhoven, The Netherlands
| | - Maria C van der Steen
- Department of Orthopaedic Surgery, Máxima MC, Eindhoven, the Netherlands.,Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Marina van Doeselaar
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Building 15, Groene Loper, Gemini-Zuid 4.12, PO Box 513, 5600MB, Eindhoven, The Netherlands
| | - Rob P A Janssen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Building 15, Groene Loper, Gemini-Zuid 4.12, PO Box 513, 5600MB, Eindhoven, The Netherlands.,Department of Orthopaedic Surgery, Máxima MC, Eindhoven, the Netherlands.,Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Building 15, Groene Loper, Gemini-Zuid 4.12, PO Box 513, 5600MB, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jasper Foolen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Building 15, Groene Loper, Gemini-Zuid 4.12, PO Box 513, 5600MB, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
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Rosa S, Pitrez P, Fernandes H, Ferreira L. A High-Throughput Screening Method to Identify Compounds Displaying Human Vascular Embryonic Toxicity. ACTA ACUST UNITED AC 2019; 50:e93. [PMID: 31479593 DOI: 10.1002/cpsc.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article describes a screening platform to identify compounds that affect human embryonic vascular development. The procedure comprises the generation of human embryonic-like endothelial cells (ECs) from human pluripotent stem cells (hPSCs) and subsequent maturation under arterial flow conditions; the use of these cells for the high-throughput screening of small molecules that specifically inhibit the survival of embryonic-like ECs; the confirmation of the hits in embryonic-like ECs cultured under flow shear stress; and final validation in mouse embryonic ECs. The embryonic-like ECs express embryonic genes including DLL1, EPHB2, LYN, TEK, ID1, NRP2, CAST, FLT1, IGF1, DKK3, NIN, LEF1, and SORBS3. The entire screening procedure (without the validation step) can be completed within 1 month. This platform is an alternative/complement to standard animal protocols for assessing the effects of chemicals on embryonic vascular development. © 2019 by John Wiley & Sons, Inc.
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Affiliation(s)
- Susana Rosa
- CNC-Center for Neurosciences and Cell Biology, University of Coimbra, Rua Larga, Coimbra, Portugal
| | - Patrícia Pitrez
- Faculty of Medicine, University of Coimbra, Health Sciences Campus, Pólo III, Central Unit, Coimbra, Portugal
| | - Hugo Fernandes
- Faculty of Medicine, University of Coimbra, Health Sciences Campus, Pólo III, Central Unit, Coimbra, Portugal
| | - Lino Ferreira
- CNC-Center for Neurosciences and Cell Biology, University of Coimbra, Rua Larga, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Health Sciences Campus, Pólo III, Central Unit, Coimbra, Portugal
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Liu Z, Li Y, Ren Y, Jin Y, Yang J, Wang S, Zhu X, Xiong H, Zou G, Liu Y, Huang W. Enhancement of in vitro proliferation and bioactivity of human anterior cruciate ligament fibroblasts using an in situ tissue isolation method and basic fibroblast growth factor culture conditions: A pilot analysis. Medicine (Baltimore) 2019; 98:e15907. [PMID: 31145353 PMCID: PMC6708876 DOI: 10.1097/md.0000000000015907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have reported poor proliferation and bioactivity of human anterior cruciate ligament fibroblasts (hACLFs) after injury. As hACLFs are one of the most significant and indispensable source of seed cells in constructing tissue-engineered ligament, enhancing hACLF proliferation would offer favorable cellular-biological ability and induce the extracellular matrix secretion of hACLFs after loading on multiple types of scaffolds. Enhancing the bioactivity of hACLFs would improve tissue repair and functional recovery after tissue-engineered ligament transplantation. This study compared cells prepared by collagenase digestion and the in situ culture of tissue pieces and investigated the effect of basic fibroblast growth factor (bFGF) on hACLFs. METHODS Six adult patients participated in this study. Of these patients, tissues from three were compared after culture establishment through collagenase digestion or in situ tissue isolation. hACLF phenotypic characteristics were assessed, and the effect of bFGF on hACLF cultures was observed. hACLFs cultured with and without bFGF served as the experimental and control groups, respectively. Cell Counting Kit-8 was used to detect proliferation. The expression of ligament-related genes and proteins was evaluated by immunofluorescence staining, real-time polymerase chain reaction (PCR) assays, and Western blot assays. RESULTS The morphology of hACLFs isolated using the two methods differed after the 2nd passage. The proliferation of cells obtained by in situ culture was higher than that of cells obtained by collagenase digestion. hACLFs cultured with bFGF after the 3rd passage exhibited a higher proliferation rate than the controls. Immunofluorescence staining, real-time PCR, and Western blot analysis showed a significant increase in ligament-related gene and protein expression in the hACLFs cultured with bFGF. CONCLUSIONS The in situ isolation of tissue pieces enhanced hACLF proliferation in vitro, and the hACLFs exhibited phenotypic characteristics of fibroblasts. hACLFs cultured with bFGF exhibited increased hACLF bioactivity.
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Affiliation(s)
- Ziming Liu
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University
| | - Yuwan Li
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University
| | - Youliang Ren
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Ying Jin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Jibin Yang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Shengmin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Xizhong Zhu
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Huazhang Xiong
- Department of Orthopaedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Gang Zou
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Yi Liu
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Wei Huang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University
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Ogata Y, Mabuchi Y, Shinoda K, Horiike Y, Mizuno M, Otabe K, Suto EG, Suzuki N, Sekiya I, Akazawa C. Anterior cruciate ligament-derived mesenchymal stromal cells have a propensity to differentiate into the ligament lineage. Regen Ther 2018; 8:20-28. [PMID: 30271862 PMCID: PMC6149186 DOI: 10.1016/j.reth.2017.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction The anterior cruciate ligament (ACL) consists of various components, such as collagen, elastin fibres, and fibroblasts. Because ACL has a poor regenerative ability, ACL reconstruction need require the use of autologous tendons. In recent years, tissue-resident stem cells have been studied to promote ACL regeneration as an alternatively method. However, the existence of stem cells in ligaments has not been clearly defined. Here, we prospectively isolated stem cells from ACLs and characterized their properties. Methods ACLs from 11 donors and bone marrows (BM) from 8 donors were obtained with total knee arthroplasty. We used flow cytometry to screen the cell surface markers on ACL cells. Frozen sections were prepared from patient ACL tissues and stained with specific antibodies. Cultured ACL-derived and BM-derived cells at passage 3 were differentiated into adipocytes, osteoblasts and tendon/ligament cells. Results ACL-derived mesenchymal stem/stromal cells (ACL-MSCs) expressed high levels of CD73 and CD90. Immunohistochemical analyses revealed that ACL-MSCs were located on the inner surface of ACL sinusoids. Furthermore, the expression of cell surface antigens was clearly different between ACL-MSCs and bone marrow (BM)-derived MSCs (BM-MSCs) at the time of isolation, but the two cell populations became indistinguishable after long-term culture. Interestingly, ACL-MSCs are markedly different from BM-MSCs in their differentiation ability and have a high propensity to differentiate into ligament-committed cells. Conclusions Our findings suggest that ACL-MSCs express CD90 and CD73 markers, and their differentiation capacity is maintained even through culture. The cell population having tissue-specific properties is an important research target for investigating the ligament therapies. CD73+/90+ cell population in ACL have the highest colony forming ability and can differentiate into mesenchymal lineages. The expression pattern of cell surface antigen in CD73+/90+ ACL-MSCs become similar to that of BM-MSCs during culture. CD73+/90+ ACL-MSCs may be important for ligament regeneration therapies. CD73+/90+ ACL-MSCs may be important for ligament regeneration therapies.
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Affiliation(s)
- Yusuke Ogata
- Department of Biochemistry and Biophysics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yo Mabuchi
- Department of Biochemistry and Biophysics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kosuke Shinoda
- Department of Biochemistry and Biophysics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuta Horiike
- Department of Biochemistry and Biophysics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuru Mizuno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Otabe
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriko Grace Suto
- Department of Biochemistry and Biophysics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuharu Suzuki
- Department of Biochemistry and Biophysics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chihiro Akazawa
- Department of Biochemistry and Biophysics, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Ghebes CA, Groen N, Cheuk YC, Fu SC, Fernandes HM, Saris DBF. Muscle-Secreted Factors Improve Anterior Cruciate Ligament Graft Healing: An In Vitro and In Vivo Analysis. Tissue Eng Part A 2017; 24:322-334. [PMID: 28530157 DOI: 10.1089/ten.tea.2016.0546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
One of the ligaments most often damaged during sports-the anterior cruciate ligament (ACL)-has poor healing capacity. On damage, reconstructive surgery is performed to restore the mechanical stability of the knee and to reduce the inflammatory milieu otherwise present in the joint. A return to normal activities, however, takes between 9 and 12 months. Thus, strategies capable of improving ACL graft healing are needed. Embryonic development of tendon and ligament (T/L) is regulated by a crosstalk between different cell types. We hypothesized that terminally differentiated skeletal-derived cells such as osteoblasts, chondrocytes, and myoblasts modulate T/L healing. Using an indirect coculture system, we discovered that myoblast-secreted signals-but not osteoblasts, chondrocytes, or stromal-secreted signals-are capable of upregulating classical T/L markers such as scleraxis and tenomodulin on human hamstring tendon-derived cells (hTC), which contribute to ACL graft healing. Transcriptome analysis showed that coculturing hTC with myoblasts led to an upregulation of extracellular matrix (ECM) genes and resulted in enhanced ECM deposition. In vivo, using a rat model of ACL reconstruction showed that conditioned media derived from human muscle tissue accelerated femoral tunnel closure, a key step for autograft integration. Collectively, these results indicate that muscle-secreted signals can be used to improve ACL graft healing in a clinical setting where muscle remnants are often discarded.
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Affiliation(s)
- Corina Adriana Ghebes
- 1 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede, The Netherlands
| | - Nathalie Groen
- 2 Department of Nephrology, Leiden University Medical Center , ZA Leiden, The Netherlands
| | - Yau Chuk Cheuk
- 3 Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong , Prince of Wales of Hospital, Shatin, New Territories, Hong Kong, SAR, China .,4 Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong , Prince of Wales of Hospital, Shatin, New Territories, Hong Kong, SAR, China
| | - Sai Chuen Fu
- 3 Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong , Prince of Wales of Hospital, Shatin, New Territories, Hong Kong, SAR, China .,4 Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong , Prince of Wales of Hospital, Shatin, New Territories, Hong Kong, SAR, China
| | - Hugo Machado Fernandes
- 1 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede, The Netherlands .,5 Stem Cells and Drug Screening Lab, Center for Neuroscience and Cell Biology (CNC), University of Coimbra , Coimbra, Portugal
| | - Daniel B F Saris
- 1 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede, The Netherlands .,6 Department of Orthopaedics, University Medical Center Utrecht , Utrecht, The Netherlands
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Abstract
Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.
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Affiliation(s)
| | - Emily Naclerio
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA,Address for correspondence: Dr. Seth L Sherman, Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Ave., Columbia, MO 65212, USA. E-mail:
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Hao ZC, Wang SZ, Zhang XJ, Lu J. Stem cell therapy: a promising biological strategy for tendon-bone healing after anterior cruciate ligament reconstruction. Cell Prolif 2016; 49:154-62. [PMID: 26929145 DOI: 10.1111/cpr.12242] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
Tendon-bone healing after anterior cruciate ligament (ACL) reconstruction is a complex process, impacting significantly on patients' prognosis. Natural tendon-bone healing usually results in fibrous scar tissue, which is of inferior quality compared to native attachment. In addition, the early formed fibrous attachment after surgery is often not reliable to support functional rehabilitation, which may lead to graft failure or unsatisfied function of the knee joint. Thus, strategies to promote tendon-bone healing are crucial for prompt and satisfactory functional recovery. Recently, a variety of biological approaches, including active substances, gene transfer, tissue engineering and stem cells, have been proposed and applied to enhance tendon-bone healing. Among these, stem cell therapy has been shown to have promising prospects and draws increasing attention. From commonly investigated bone marrow-derived mesenchymal stem cells (bMSCs) to emerging ACL-derived CD34+ stem cells, multiple stem cell types have been proven to be effective in accelerating tendon-bone healing. This review describes the current understanding of tendon-bone healing and summarizes the current status of related stem cell therapy. Future limitations and perspectives are also discussed.
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Affiliation(s)
- Zi-Chen Hao
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Shan-Zheng Wang
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Xue-Jun Zhang
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China
| | - Jun Lu
- Department of Orthopaedics, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009, China.,Surgical Research Center, Medical School of Southeast University, Nanjing, 210009, China
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