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Mohd Isa IL, Zulkiflee I, Ogaili RH, Mohd Yusoff NH, Sahruddin NN, Sapri SR, Mohd Ramli ES, Fauzi MB, Mokhtar SA. Three-dimensional hydrogel with human Wharton jelly-derived mesenchymal stem cells towards nucleus pulposus niche. Front Bioeng Biotechnol 2023; 11:1296531. [PMID: 38149172 PMCID: PMC10749916 DOI: 10.3389/fbioe.2023.1296531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction: A regenerative strategy employing extracellular matrix (ECM)-based biomaterials and stem cells provide a better approach to mimicking the three-dimensional (3D) microenvironment of intervertebral disc for endogenous tissue regeneration. However, there is currently limited understanding regarding the human Wharton Jelly derived-mesenchymal stem cells (hWJ-MSCs) towards nucleus pulposus (NP)-like cells. Our study focused on the development of 3D bioengineered hydrogel based on the predominant ECM of native NP, including type II collagen (COLII) and hyaluronic acid (HA), which aims to tailor the needs of the microenvironment in NP. Methods: We have fabricated a 3D hydrogel using from COLII enriched with HA by varying the biomacromolecule concentration and characterised it for degradation, stability and swelling properties. The WJ-MSC was then encapsulated in the hydrogel system to guide the cell differentiation into NP-like cells. Results: We successfully fabricated COLII hydrogel (2 mg/ml) and HA 10 mg/ml at a weight ratio of HA and COLII at 1:9 and 4.5:9, and both hydrogels physically maintained their 3D sphere-shaped structure after complete gelation. The higher composition of HA in the hydrogel system indicated a higher water intake capacity in the hydrogel with a higher amount of HA. All hydrogels showed over 60% hydrolytic stability over a month. The hydrogel showed an increase in degradation on day 14. The hWJ-MSCs encapsulated in hydrogel showed a round morphology shape that was homogenously distributed within the hydrogel of both groups. The viability study indicated a higher cell growth of hWJ-MSCs encapsulated in all hydrogel groups until day 14. Discussion: Overall, our findings demonstrate that HA/COLII hydrogel provides an optimal swelling capacity, stability, degradability, and non-cytotoxic, thus mimics the NP microenvironment in guiding hWJ-MSCs towards NP phenotype, which is potentially used as an advanced cell delivery system for intervertebral disc regeneration.
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Affiliation(s)
- Isma Liza Mohd Isa
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Izzat Zulkiflee
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Raed H. Ogaili
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Huda Mohd Yusoff
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Natasya Nadia Sahruddin
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shaiful Ridzwan Sapri
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Elvy Suhana Mohd Ramli
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sabarul Afian Mokhtar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Mohd Isa IL, Teoh SL, Mohd Nor NH, Mokhtar SA. Discogenic Low Back Pain: Anatomy, Pathophysiology and Treatments of Intervertebral Disc Degeneration. Int J Mol Sci 2022; 24:208. [PMID: 36613651 PMCID: PMC9820240 DOI: 10.3390/ijms24010208] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is a major contributing factor for discogenic low back pain (LBP), causing a significant global disability. The IVD consists of an inner core proteoglycan-rich nucleus pulposus (NP) and outer lamellae collagen-rich annulus fibrosus (AF) and is confined by a cartilage end plate (CEP), providing structural support and shock absorption against mechanical loads. Changes to degenerative cascades in the IVD cause dysfunction and instability in the lumbar spine. Various treatments include pharmacological, rehabilitation or surgical interventions that aim to relieve pain; however, these modalities do not halt the pathologic events of disc degeneration or promote tissue regeneration. Loss of stem and progenitor markers, imbalance of the extracellular matrix (ECM), increase of inflammation, sensory hyperinnervation and vascularization, and associated signaling pathways have been identified as the onset and progression of disc degeneration. To better understand the pain originating from IVD, our review focuses on the anatomy of IVD and the pathophysiology of disc degeneration that contribute to the development of discogenic pain. We highlight the key mechanisms and associated signaling pathways underlying disc degeneration causing discogenic back pain, current clinical treatments, clinical perspective and directions of future therapies. Our review comprehensively provides a better understanding of healthy IVD and degenerative events of the IVD associated with discogenic pain, which helps to model painful disc degeneration as a therapeutic platform and to identify signaling pathways as therapeutic targets for the future treatment of discogenic pain.
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Affiliation(s)
- Isma Liza Mohd Isa
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- SFI Research Centre for Medical Devices, University of Galway, H91W2TY Galway, Ireland
| | - Seong Lin Teoh
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nurul Huda Mohd Nor
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia
| | - Sabarul Afian Mokhtar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Mohd Isa IL, Mokhtar SA, Abbah SA, Fauzi MB, Devitt A, Pandit A. Intervertebral Disc Degeneration: Biomaterials and Tissue Engineering Strategies toward Precision Medicine. Adv Healthc Mater 2022; 11:e2102530. [PMID: 35373924 DOI: 10.1002/adhm.202102530] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/01/2022] [Indexed: 12/22/2022]
Abstract
Intervertebral disc degeneration is a common cause of discogenic low back pain resulting in significant disability. Current conservative or surgical intervention treatments do not reverse the underlying disc degeneration or regenerate the disc. Biomaterial-based tissue engineering strategies exhibit the potential to regenerate the disc due to their capacity to modulate local tissue responses, maintain the disc phenotype, attain biochemical homeostasis, promote anatomical tissue repair, and provide functional mechanical support. Despite preliminary positive results in preclinical models, these approaches have limited success in clinical trials as they fail to address discogenic pain. This review gives insights into the understanding of intervertebral disc pathology, the emerging concept of precision medicine, and the rationale of personalized biomaterial-based tissue engineering tailored to the severity of the disease targeting early, mild, or severe degeneration, thereby enhancing the efficacy of the treatment for disc regeneration and ultimately to alleviate discogenic pain. Further research is required to assess the relationship between disc degeneration and lower back pain for developing future clinically relevant therapeutic interventions targeted towards the subgroup of degenerative disc disease patients.
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Affiliation(s)
- Isma Liza Mohd Isa
- Department of Anatomy Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur 56000 Malaysia
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
| | - Sabarul Afian Mokhtar
- Department of Orthopaedics and Traumatology Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur 56000 Malaysia
| | - Sunny A. Abbah
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur 56000 Malaysia
| | - Aiden Devitt
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
- Department of Orthopedic Surgery University Hospital Galway Galway H91YR71 Ireland
| | - Abhay Pandit
- CÚRAM SFI Research Centre for Medical Devices National University of Ireland Galway H91W2TY Ireland
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Inoue M, Isa ILM, Orita S, Suzuki-Narita M, Inage K, Shiga Y, Norimoto M, Umimura T, Sakai T, Eguchi Y, Watanabe A, Aoki Y, Pandit A, Ohtori S. An Injectable Hyaluronic Acid Hydrogel Promotes Intervertebral Disc Repair in a Rabbit Model. Spine (Phila Pa 1976) 2021; 46:E810-E816. [PMID: 34228691 DOI: 10.1097/brs.0000000000003921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo model to study the effect of an injectable hyaluronic acid (HA) hydrogel following puncture-induced lumbar disc injury in rabbits. OBJECTIVES The aim of this study was to determine the efficacy of an injectable HA hydrogel to maintain disc height and tissue hydration, promote structural repair, and attenuate inflammation and innervation in the lumbar discs. SUMMARY OF BACKGROUND DATA Previously, we have demonstrated that HA hydrogel alleviated inflammation, innervation, and pain to promote disc repair. Nevertheless, the effect of an injectable HA hydrogel in the lumbar disc in a weight-bearing animal model was not performed. METHODS We have adopted a surgically puncture-induced disc injury at lumbar levels in a rabbit model. The discs were grouped into sham, puncture with water injection, and puncture with HA hydrogel injection. Postoperatively, we measured changes in disc height using x-ray. We used magnetic resonance imaging to assess disc degeneration on tissue hydration after euthanasia. Post-mortem, we determined histological changes, innervation (PGP9.5) and inflammation (interleukin [IL]-6, IL-1β, and tumor necrosis factor [TNF]-α) in the discs. RESULTS We have demonstrated a significant reduction of disc height and T2/T1ρ mapping with histological evidence of degenerative discs, increase of innervation and inflammation in puncture-induced disc injury over time. In the HA hydrogel group, disc height was increased at weeks four and eight. A slight increase of T2 mapping, but significantly in T1ρ mapping, was observed in the HA hydrogel group at week 8. We observed homogenous NP distribution and organised AF lamellae at week eight and a slight reduced innervation score in the treatment group. HA hydrogel significantly downregulated IL-6 expression at day 1. This, however, was only slightly reduced for IL-1β and TNF-α. CONCLUSION An injectable HA hydrogel had the protective effects in suppressing the loss of disc height, promoting tissue hydration for structural repair, and attenuating inflammation and innervation to prevent further disc degeneration.Level of Evidence: N/A.
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Affiliation(s)
- Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Isma Liza Mohd Isa
- SFI Research Center for Medical Devices, National University of Ireland Galway, Ireland.,Department of Orthopedic and Traumatology, The National University of Malaysia, Malaysia
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Miyako Suzuki-Narita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Masaki Norimoto
- Department of Orthopedic Surgery, Toho University of Sakura Hospital, Sakura, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic surgery, Sanmu medical center, Sanmu, Chiba, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Abhay Pandit
- SFI Research Center for Medical Devices, National University of Ireland Galway, Ireland
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chuo-ku, Japan
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Anindyajati A, Boughton P, Ruys AJ. Mechanical and Cytocompatibility Evaluation of UHMWPE/PCL/Bioglass ® Fibrous Composite for Acetabular Labrum Implant. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E916. [PMID: 30893909 PMCID: PMC6470684 DOI: 10.3390/ma12060916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 11/16/2022]
Abstract
In this study, a fibrous composite was developed as synthetic graft for labral reconstruction treatment, comprised of ultra-high molecular weight polyethylene (UHMWPE) fabric, ultrafine fibre of polycaprolactone (PCL), and 45S5 Bioglass®. This experiment aimed to examine the mechanical performance and cytocompatibility of the composite. Electrospinning and a slurry dipping technique were applied for composite fabrication. To assess the mechanical performance of UHMWPE, tensile cyclic loading test was carried out. Meanwhile, cytocompatibility of the composite on fibroblastic cells was examined through a viability assay, as well as SEM images to observe cell attachment and proliferation. The mechanical test showed that the UHMWPE fabric had a mean displacement of 1.038 mm after 600 cycles, approximately 4.5 times greater resistance compared to that of natural labrum, based on data obtained from literature. A viability assay demonstrated the predominant occupation of live cells on the material surface, suggesting that the composite was able to provide a viable environment for cell growth. Meanwhile, SEM images exhibited cell adhesion and the formation of cell colonies on the material surface. These results indicated that the UHMWPE/PCL/Bioglass® composite could be a promising material for labrum implants.
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Affiliation(s)
- Adhi Anindyajati
- School of Aerospace, Mechanical and Mechatronic Engineering, University of Sydney, NSW 2006, Australia.
| | - Philip Boughton
- School of Aerospace, Mechanical and Mechatronic Engineering, University of Sydney, NSW 2006, Australia.
| | - Andrew J Ruys
- School of Aerospace, Mechanical and Mechatronic Engineering, University of Sydney, NSW 2006, Australia.
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