1
|
Fossum V, Hansen AK, Wilsgaard T, Knutsen G. Collagen-Covered Autologous Chondrocyte Implantation Versus Autologous Matrix-Induced Chondrogenesis: A Randomized Trial Comparing 2 Methods for Repair of Cartilage Defects of the Knee. Orthop J Sports Med 2019; 7:2325967119868212. [PMID: 31555714 PMCID: PMC6749791 DOI: 10.1177/2325967119868212] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Autologous matrix-induced chondrogenesis (AMIC) is a single-stage alternative to autologous chondrocyte implantation for treatment of localized cartilage defects of the knee. To our knowledge, no randomized controlled trial exists comparing the 2 methods. Purpose: To evaluate any difference in the outcome of AMIC as compared with collagen-covered autologous chondrocyte implantation (ACI-C). Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A prospective randomized controlled clinical trial was designed to assess any differences in the outcomes between ACI-C and AMIC for the treatment of ≥1 chondral or osteochondral defects of the distal femur and/or patella. The inclusion period was set to 3 years, and the aim was to include 80 patients (40 in each group). Patient inclusion was broad, with few exclusion criteria. The primary outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 years as compared with baseline. The secondary outcomes were the number of failures in each group at 2 years and the change in KOOS subscale, Lysholm, and pain visual analog scale (VAS) scores at 2 years as compared with baseline. A 2-sample t test with a significance level of P < .05 was used to compare the change in score from baseline between groups. Results: A total of 41 patients over 3 years were included in the study: 21 in the ACI-C group and 20 in the AMIC group. All the patients had prior surgery to the index knee. At 2-year follow-up, the clinical scores for both groups improved significantly from baseline. No significant differences between groups were seen in the change from baseline for KOOS (AMIC, 18.1; ACI-C, 10.3), any of the KOOS subscales, the Lysholm score (AMIC, 19.7; ACI-C, 17.0), or the VAS pain score (AMIC, 30.6; ACI-C, 19.6). Two patients in the AMIC group had progressed to a total knee replacement by the 2-year follow-up as compared with none in the ACI-C group. Conclusion: At 2-year follow-up, no significant differences were found regarding outcomes between ACI-C and AMIC. Mid- and long-term results will be important. Registration: NCT01458782 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Vegard Fossum
- Department of Orthopaedic Surgery, The University Hospital of North Norway, Tromsø, Norway
| | - Ann Kristin Hansen
- Department of Orthopaedic Surgery, The University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Centre for Quality Improvement and Development, The University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Gunnar Knutsen
- Department of Orthopaedic Surgery, The University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
2
|
Islam A, Fossum V, Hansen AK, Urbarova I, Knutsen G, Martinez-Zubiaurre I. In vitro chondrogenic potency of surplus chondrocytes from autologous transplantation procedures does not predict short-term clinical outcomes. BMC Musculoskelet Disord 2019; 20:19. [PMID: 30630436 PMCID: PMC6329094 DOI: 10.1186/s12891-018-2380-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 12/12/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) has been used over the last two decades to treat focal cartilage lesions aiming to delay or prevent the onset of osteoarthritis; however, some patients do not respond adequately to the procedure. A number of biomarkers that can forecast the clinical potency of the cells have been proposed, but evidence for the relationship between in vitro chondrogenic potential and clinical outcomes is missing. In this study, we explored if the ability of cells to make cartilage in vitro correlates with ACI clinical outcomes. Additionally, we evaluated previously proposed chondrogenic biomarkers and searched for new biomarkers in the chondrocyte proteome capable of predicting clinical success or failure after ACI. METHODS The chondrogenic capacity of chondrocytes derived from 14 different donors was defined based on proteoglycans staining and visual histological grading of tissues generated using the pellet culture system. A Lysholm score of 65 two years post-ACI was used as a cut-off to categorise "success" and "failure" clinical groups. A set of predefined biomarkers were investigated in the chondrogenic and clinical outcomes groups using flow cytometry and qPCR. High-throughput proteomics of cell lysates was used to search for putative biomarkers to predict chondrogenesis and clinical outcomes. RESULTS Visual histological grading of pellets categorised donors into "high" and "low" chondrogenic groups. Direct comparison between donor-matched in vitro chondrogenic potential and clinical outcomes revealed no significant associations. Comparative analyses of selected biomarkers revealed that expression of CD106 and TGF-β-receptor-3 was enhanced in the low chondrogenic group, while expression of integrin-α1 and integrin-β1 was significantly upregulated in the high chondrogenic group. Additionally, increased surface expression of CD166 was observed in the clinical success group, while the gene expression of cartilage oligomeric matrix protein was downregulated. High throughput proteomics revealed no differentially expressed proteins from success and failure clinical groups, whereas seven proteins including prolyl-4-hydroxylase 1 were differentially expressed when comparing chondrogenic groups. CONCLUSION In our limited material, we found no correlation between in vitro cartilage-forming capacity and clinical outcomes, and argue on the limitations of using the chondrogenic potential of cells or markers for chondrogenesis as predictors of clinical outcomes.
Collapse
Affiliation(s)
- Ashraful Islam
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Vegard Fossum
- Department of Orthopaedic Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Ann Kristin Hansen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Orthopaedic Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Ilona Urbarova
- Department of Medical Biology, Tromsø University Proteomics Platform, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunnar Knutsen
- Department of Orthopaedic Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | | |
Collapse
|
3
|
Mizuno S, Takada E, Fukai N. Spheroidal Organoids Reproduce Characteristics of Longitudinal Depth Zones in Bovine Articular Cartilage. Cells Tissues Organs 2016; 202:382-392. [PMID: 27654347 DOI: 10.1159/000447532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 11/19/2022] Open
Abstract
Articular cartilage has multiple histologically distinct longitudinal depth zones. Development and pathogenesis occur throughout these zones. Cartilage explants, monolayer cell culture and reconstituted 3-dimensional cell constructs have been used for investigating mechanisms of pathophysiology in articular cartilage. Such models have been insufficient to reproduce zone-dependent cellular characteristics and extracellular matrix (ECM) upon investigation into cartilage development and pathogenesis. Therefore, we defined a chondrocyte spheroid model consistently formed with isolated chondrocytes from longitudinal depth zones without extrinsic materials. This spheroid showed zone-dependent characteristics of size, cartilage-specific ECM (collagen types I and II, aggrecan and keratan sulfate) and gene expressions of anabolic and catabolic molecules (matrix molecules and matrix metalloproteinase-13). In addition, the spheroid model is small enough to maintain the viability of cells and point symmetry to analyze the gradient of diffusive molecules. This spheroid organoid model will be useful to elucidate the mechanism of histogenesis and pathogenesis in articular cartilage.
Collapse
|
4
|
Shoji T, Yasunaga Y, Yamasaki T, Nakamae A, Mori R, Hamanishi M, Ochi M. Transtrochanteric rotational osteotomy combined with intra-articular procedures for pigmented villonodular synovitis of the hip. J Orthop Sci 2015; 20:943-50. [PMID: 24687213 DOI: 10.1007/s00776-014-0563-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Yuji Yasunaga
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ryo Mori
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Michio Hamanishi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| |
Collapse
|
5
|
Millan C, Cavalli E, Groth T, Maniura-Weber K, Zenobi-Wong M. Engineered Microtissues Formed by Schiff Base Crosslinking Restore the Chondrogenic Potential of Aged Mesenchymal Stem Cells. Adv Healthc Mater 2015; 4:1348-58. [PMID: 25866187 DOI: 10.1002/adhm.201500102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/12/2015] [Indexed: 01/09/2023]
Abstract
A universal method for reproducibly directing stem cell differentiation remains a major challenge for clinical applications involving cell-based therapies. The standard approach for chondrogenic induction by micromass pellet culture is highly susceptible to interdonor variability. A novel method for the fabrication of condensation-like engineered microtissues (EMTs) that utilizes hydrophilic polysaccharides to induce cell aggregation is reported here. Chondrogenesis of mesenchymal stem cells (MSCs) in EMTs is significantly enhanced compared to micromass pellets made by centrifugation measured by type II collagen gene expression, dimethylmethylene blue assay, and histology. MSCs from aged donors that fail to differentiate in pellet culture are successfully induced to synthesize cartilage-specific matrix in EMTs under identical media conditions. Furthermore, the EMT polysaccharides support the loading and release of the chondroinduction factor transforming growth factor β3 (TGF-β3). TGF-β-loaded EMTs (EMT(+TGF) ) facilitate cartilaginous tissue formation during culture in media not supplemented with the growth factor. The clinical potential of this approach is demonstrated in an explant defect model where EMT(+TGF) from aged MSCs synthesize de novo tissue containing sulfated glycosaminoglycans and type II collagen in situ.
Collapse
Affiliation(s)
- Christopher Millan
- Cartilage Engineering + Regeneration Laboratory; ETH Zürich; Otto-Stern-Weg 7 8093 Zürich Switzerland
| | - Emma Cavalli
- Cartilage Engineering + Regeneration Laboratory; ETH Zürich; Otto-Stern-Weg 7 8093 Zürich Switzerland
| | - Thomas Groth
- Biomedical Materials Group; Martin Luther University Halle-Wittenberg; Heinrich-Damerow-Strasse 4 06120 Halle (Saale) Germany
| | - Katharina Maniura-Weber
- Laboratory for Biointerfaces, Empa; Swiss Federal Laboratories for Materials Science and Technology; Lerchenfeldstrasse 5 9014 St. Gallen Switzerland
| | - Marcy Zenobi-Wong
- Cartilage Engineering + Regeneration Laboratory; ETH Zürich; Otto-Stern-Weg 7 8093 Zürich Switzerland
| |
Collapse
|
6
|
Wang M, Shen J, Jin H, Im HJ, Sandy J, Chen D. Recent progress in understanding molecular mechanisms of cartilage degeneration during osteoarthritis. Ann N Y Acad Sci 2012; 1240:61-9. [PMID: 22172041 DOI: 10.1111/j.1749-6632.2011.06258.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteoarthritis (OA) is a highly prevalent disease affecting more than 20% of American adults. Predispositions include joint injury, heredity, obesity, and aging. Biomechanical alterations are commonly involved. However, the molecular mechanisms of this disease are complex, and there is currently no effective disease-modifying treatment. The initiation and progression of OA subtypes is a complex process that at the molecular level probably involves many cell types, signaling pathways, and changes in extracellular matrix. Ex vivo studies with tissue derived from OA patients and in vivo studies with mutant mice have suggested that pathways involving receptor ligands such as TGF-β1, WNT3a, and Indian hedgehog; signaling molecules such as Smads, β-catenin, and HIF-2a; and peptidases such as MMP13 and ADAMTS4/5 are probably involved to some degree. This review focuses on molecular mechanisms of OA development related to recent findings.
Collapse
Affiliation(s)
- Meina Wang
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | | | | | | |
Collapse
|
7
|
Wu X, Liu X, Wang S. Implantation of biomaterial as an efficient method to harvest mesenchymal stem cells. Exp Biol Med (Maywood) 2011; 236:1477-84. [DOI: 10.1258/ebm.2011.011061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Autologous mesenchymal stem cell (MSC) transplants have been used successfully to treat a number of diseases, and patients undergoing cell transplantation must have stem cells collected before transplantation. In this study, we developed a new method to harvest MSCs. Biomaterials were implanted into the spatium intermuscular of mice hind limbs, and a large number of migrating cells (MCs) were isolated from the transplanted biomaterials. The adherent cells in MCs showed the characteristics of MSCs. Further comparative study demonstrated that the characteristics of MC-MSCs were similar to that of bone marrow (BM)-MSCs, including morphology, phenotype, proliferation potential, multilineage differentiation capacity and hematopoiesis-supportive function. The colony-forming unit-fibroblast frequency of the MCs was equivalent to approximately 20-fold of that of the BM. In addition, a BM transplantation experiment demonstrated that MC-MSCs were derived from the peripheral blood. In conclusion, we successfully establish an efficient method to harvest MSCs, and together with the distinct advantages of this method, such as accessibility and possibility for autologous cell therapy, we conclude that our efficient method may be a promising alternative for clinical application.
Collapse
Affiliation(s)
- Xiaoyun Wu
- Shandong Medicinal Biotechnology Center
- Provincial Laboratory for Modern Medicine and Technology of Shandong
| | - Xiaoshuai Liu
- Shandong Medicinal Biotechnology Center
- Provincial Laboratory for Modern Medicine and Technology of Shandong
| | - Shili Wang
- Provincial Laboratory for Modern Medicine and Technology of Shandong
- Laboratory for Bio-Drugs of Ministry of Health, Shandong Academy of Medical Sciences, Jingshi Road 18877, Jinan, Shandong 250062, China
| |
Collapse
|
8
|
Shuang-zhi H, Ping S, Xi-ning P. Culture and identification of human amniotic mesenchymal stem cells. ACTA ACUST UNITED AC 2011; 25:211-4. [PMID: 21232180 DOI: 10.1016/s1001-9294(11)60004-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To establish the method of isolation, purification, and identification of human amniotic mesenchymal stem cells (hAMSCs). METHODS hAMSCs were isolated from human amniotic membrane by trypsin-collagenase digestion, and cultured in Dulbecco's modified Eagle's medium/F12 medium supplemented with 10% fetal bovine serum. Phenotypic characteristics of these cells were analyzed by means of immunocytochemistry and flow cytometry. RESULTS The cells successfully isolated from human amniotic membrane expressed representative mesenchymal cell surface markers CD44, CD90, and vimentin, but not CD45. CONCLUSIONS This study establishes a potential method for isolation of hAMSCs from human amnion,in vitro culture, and identification. The isolated cells show phenotypic characteristics of mesenchymal stem cells.
Collapse
Affiliation(s)
- Huo Shuang-zhi
- Department of Stem Cells and Regenerative Medicine, China Medical University, Shenyang 110001, China
| | | | | |
Collapse
|
9
|
Haleem AM, Chu CR. Advances in Tissue Engineering Techniques for Articular Cartilage Repair. ACTA ACUST UNITED AC 2010; 20:76-89. [PMID: 29430164 DOI: 10.1053/j.oto.2009.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The limited repair potential of human articular cartilage contributes to development of debilitating osteoarthritis and remains a great clinical challenge. This has led to evolution of cartilage treatment strategies from palliative to either reconstructive or reparative methods in an attempt to delay or "bridge the gap" to joint replacement. Further development of tissue engineering-based cartilage repair methods have been pursued to provide a more functional biological tissue. Currently, tissue engineering of articular cartilage has three cornerstones; a cell population capable of proliferation and differentiation into mature chondrocytes, a scaffold that can host these cells, provide a suitable environment for cellular functioning and serve as a sustained-release delivery vehicle of chondrogenic growth factors and thirdly, signaling molecules and growth factors that stimulate the cellular response and the production of a hyaline extracellular matrix (ECM). The aim of this review is to summarize advances in each of these three fields of tissue engineering with specific relevance to surgical techniques and technical notes.
Collapse
Affiliation(s)
- A M Haleem
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - C R Chu
- Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
10
|
Min BH, Lee HJ, Kim YJ. Cartilage Repair Using Mesenchymal Stem Cells. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.11.1077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Byoung-Hyun Min
- Department of Orthopedic Surgery, Ajou University College of Medicine, Korea.
| | - Hyun Jung Lee
- Cell Therapy Center, Ajou University Medical Center, Korea
| | - Young Jick Kim
- Cell Therapy Center, Ajou University Medical Center, Korea
| |
Collapse
|