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Khader A, Alquran H. Automated Prediction of Osteoarthritis Level in Human Osteochondral Tissue Using Histopathological Images. Bioengineering (Basel) 2023; 10:764. [PMID: 37508791 PMCID: PMC10376879 DOI: 10.3390/bioengineering10070764] [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: 05/24/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
Osteoarthritis (OA) is the most common arthritis and the leading cause of lower extremity disability in older adults. Understanding OA progression is important in the development of patient-specific therapeutic techniques at the early stage of OA rather than at the end stage. Histopathology scoring systems are usually used to evaluate OA progress and the mechanisms involved in the development of OA. This study aims to classify the histopathological images of cartilage specimens automatically, using artificial intelligence algorithms. Hematoxylin and eosin (HE)- and safranin O and fast green (SafO)-stained images of human cartilage specimens were divided into early, mild, moderate, and severe OA. Five pre-trained convolutional networks (DarkNet-19, MobileNet, ResNet-101, NasNet) were utilized to extract the twenty features from the last fully connected layers for both scenarios of SafO and HE. Principal component analysis (PCA) and ant lion optimization (ALO) were utilized to obtain the best-weighted features. The support vector machine classifier was trained and tested based on the selected descriptors to achieve the highest accuracies of 98.04% and 97.03% in HE and SafO, respectively. Using the ALO algorithm, the F1 scores were 0.97, 0.991, 1, and 1 for the HE images and 1, 0.991, 0.97, and 1 for the SafO images for the early, mild, moderate, and severe classes, respectively. This algorithm may be a useful tool for researchers to evaluate the histopathological images of OA without the need for experts in histopathology scoring systems or the need to train new experts. Incorporating automated deep features could help to improve the characterization and understanding of OA progression and development.
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Affiliation(s)
- Ateka Khader
- Department of Biomedical Systems and Informatics Engineering, Hijjawi Faculty for Engineering Technology, Yarmouk University, Irbid 21163, Jordan
| | - Hiam Alquran
- Department of Biomedical Systems and Informatics Engineering, Hijjawi Faculty for Engineering Technology, Yarmouk University, Irbid 21163, Jordan
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Mantripragada VP, Muschler GF. Improved biological performance of human cartilage-derived progenitors in platelet lysate xenofree media in comparison to fetal bovine serum media. Curr Res Transl Med 2022; 70:103353. [PMID: 35940083 DOI: 10.1016/j.retram.2022.103353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/08/2022] [Accepted: 05/17/2022] [Indexed: 01/31/2023]
Abstract
Primary articular cartilage-derived cells are among the preferred contenders for cell-based therapy approaches for cartilage repair. Limited access to primary human cartilage tissue necessitates the process of in vitro cell expansion to obtain sufficient cells for therapeutic purposes. Therapeutic outcomes of such cell-based approaches become highly dependent on the quality of the in vitro culture-expanded cells. The objective of this study was to determine the differential biological effects of human platelet lysate (hPL) xeno-free defined media vs FBS containing traditional media on primary human cartilage-derived cells. Our goal in pursuing this work was to identify a preferred xenofree media alternative, that can be used as a platform for expansion of cells intended for clinical applications. Primary cartilage-derived cells obtained from five patients were simultaneously cultured in two expansion media's: (1) traditional (DMEM+10%FBS+1%P/S) and (2) defined xenofree (Nutristem® complete media+0.5%hPL). Connective tissue progenitors (CTPs) were assayed by standard colony forming unit assay, morphology, proliferation in early and late passages, expression of MSC associated cell-surface markers (CD73, CD90 and CD105) and trilineage differentiation (adipogenesis, osteogenesis and chondrogenesis) were considered for comparison of biological performance. Early biological performance of primary cartilage-derived cells was significantly improved in Nutristem® expansion media in comparison to traditional expansion media with respect to (1) Colony forming efficiency tended to be higher (p = 0.058) and (2) CTPs formed larger colonies with respect to total cells per colony and colony area (p < 0.01). In the culture expanded cell population, Nutristem® expansion media was superior to traditional expansion media with respect to: (1) overall proliferation rate through passages 1-4 (p = 0.027), (2) total cells harvested at end of passage 4 (p = 0.028) and (3) total positive stain area of CD73 (p = 0.006), CD90 (p = 0.001) and CD105 (p = 0.049). Nutristem®-hPL expanded cells when differentiated in respective xenofree serum-free defined MSCgo™ differentiated media's, also showed significant improvement in adipogenic, osteogenic and chondrogenic marker expression. Overall, we convincingly demonstrated that a low concentration of hPL in combination with defined xenofree media is an effective and economic growth supplement to culture expand primary cartilage-derived cells. It can be manufactured under cGMP conditions to improve clinical-grade cell products' quality for therapeutic applications.
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Affiliation(s)
- Venkata P Mantripragada
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - George F Muschler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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Kaspiris A, Chronopoulos E, Vasiliadis E, Khaldi L, Melissaridou D, Iliopoulos ID, Savvidou OD. Sex, but not age and bone mass index positively impact on the development of osteochondral micro‐defects and the accompanying cellular alterations during osteoarthritis progression. Chronic Dis Transl Med 2022; 8:41-50. [PMID: 35620158 PMCID: PMC9128565 DOI: 10.1002/cdt3.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Osteoarthritis (ΟΑ) is characterized by cartilage breakdown and subchondral sclerosis. Micro‐fractures of the calcified tissues have been, also, detected, but their exact role has not been elucidated yet. This study was to examine the frequency of cracks during OA progression and to correlate them with the underlying cellular modifications and matrix metalloproteinase‐2 (MMP‐2) expression using histological/immunohistological methods. Methods Overall, 20 patients and 3 controls (9 specimens per patient), aged 60–89 years, diagnosed with hip/knee OA were included. The development of cracks was examined in 138 sections, whereas the expression of MMP‐2 was examined in 69 additional sections. Results Based on Mankin score, three groups of OA severity were analyzed: Group I (mild) was constituted of sections with score 1–5 while Groups II (moderate) and III (severe) with score 6–7 and greater or equal to 8, respectively. Demographic characteristics did not reveal any association between the number of microdefects and age or body mass index (BMI). Cartilage micro‐cracks were increased during moderate and severe OA, while bone cracks were increased during mild and severe OA. In knee OA, cartilage cracks were not correlated with Mankin score, whereas in hip OA they appeared association with severity score. Bone cracks were positively correlated with matrix apoptotic osteocytes and osteoblastic cells, but not with osteoclasts. MMP‐2 immunostaining was increasing by OA severity in the osteochondral unit. Similarly, MMP‐2 was expressed on the microcracks’ wall mainly in Group III. Conclusion Our data displayed that bone cracks during primary OA stages, represent an early adaptative mechanism aiming to maintain cartilage integrity. Accumulation of bone defects and concomitant increase of apoptotic osteocytes activated an abnormal remodeling due to osteoblastic activity, in which MMP‐2 played a pivotal role, leading to subchondral sclerosis promoting further osteochondral deformities.
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Affiliation(s)
- Angelos Kaspiris
- Laboratory of Molecular Pharmacology, Division for Orthopaedic Research, School of Health Sciences University of Patras Patras Greece
| | - Efstathios Chronopoulos
- Second Department of Orthopaedic Surgery, School of Medicine National and Kapodistrian University of Athens, “Konstantopoulio” General Hospital Athens Greece
| | - Elias Vasiliadis
- Third Department of Orthopaedic Surgery “KAT” General Hospital and Medical School University of Athens Athens Greece
| | - Lubna Khaldi
- Department of Pathology “Agios Savvas” Athens Cancer Hospital–NHS Athens Greece
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, School of Medicine National and Kapodistrian University of Athens, “ATTIKON” University General Hospital Athens Greece
| | - Ilias D. Iliopoulos
- Department of Orthopaedic Surgery, “Rion” University Hospital and Medical School, School of Health Sciences University of Patras Patras Greece
| | - Olga D. Savvidou
- First Department of Orthopaedic Surgery, School of Medicine National and Kapodistrian University of Athens, “ATTIKON” University General Hospital Athens Greece
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Mantripragada VP, Csorba A, Bova W, Boehm C, Piuzzi NS, Bullen J, Midura RJ, Muschler GF. Assessment of Clinical, Tissue, and Cell-Level Metrics Identify Four Biologically Distinct Knee Osteoarthritis Patient Phenotypes. Cartilage 2022; 13:19476035221074003. [PMID: 35109693 PMCID: PMC9137310 DOI: 10.1177/19476035221074003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Clinical heterogeneity of primary osteoarthritis (OA) is a major challenge in understanding pathogenesis and development of targeted therapeutic strategies. This study aims to (1) identify OA patient subgroups phenotypes and (2) determine predictors of OA severity and cartilage-derived stem/progenitor concentration using clinical-, tissue-, and cell- level metrics. DESIGN Cartilage, synovium (SYN) and infrapatellar fatpad (IPFP) were collected from 90 total knee arthroplasty patients. Clinical metrics (patient demographics, radiograph-based joint space width (JSW), Kellgren and Lawrence score (KL)), tissue metrics (cartilage histopathology grade, glycosaminoglycans (GAGs)) and cell-based metrics (cartilage-, SYN-, and IPFP-derived cell concentration ([Cell], cells/mg), connective tissue progenitor (CTP) prevalence (PCTP, CTPs/million cells plated), CTP concentration, [CTP], CTPs/mg)) were assessed using k-mean clustering and linear regression model. RESULTS Four patient subgroups were identified. Clusters 1 and 2 comprised of younger, high body mass index (BMI) patients with healthier cartilage, where Cluster 1 had high CTP in cartilage, SYN, and IPFP, and Cluster 2 had low [CTP] in cartilage, SYN, and IPFP. Clusters 3 and 4 comprised of older, low BMI patients with diseased cartilage where Cluster 3 had low [CTP] in SYN, IPFP but high [CTP] in cartilage, and Cluster 4 had high [CTP] in SYN, IPFP but low [CTP] in cartilage. Age (r = 0.23, P = 0.026), JSW (r = 0.28, P = 0.007), KL (r = 0.26, P = 0.012), GAG/mg cartilage tissue (r = -0.31, P = 0.007), and SYN-derived [Cell] (r = 0.25, P = 0.049) were weak but significant predictors of OA severity. Cartilage-derived [Cell] (r = 0.38, P < 0.001) and PCTP (r = 0.9, P < 0.001) were moderate/strong predictors of cartilage-derived [CTP]. CONCLUSION Initial findings suggests the presence of OA patient subgroups that could define opportunities for more targeted patient-specific approaches to prevention and treatment.
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Affiliation(s)
- Venkata P. Mantripragada
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Csorba
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Wesley Bova
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Cynthia Boehm
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas S. Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald J. Midura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - George F. Muschler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Mantripragada V, Gao W, Piuzzi N, Hoemann C, Muschler G, Midura R. Comparative Assessment of Primary Osteoarthritis Progression Using Conventional Histopathology, Polarized Light Microscopy, and Immunohistochemistry. Cartilage 2021; 13:1494S-1510S. [PMID: 32659115 PMCID: PMC8808935 DOI: 10.1177/1947603520938455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Evaluation of collagen orientation and arrangement in articular cartilage can improve our understanding of primary osteoarthritis (OA) progression and targeted therapies. Our goal was to determine if polarized light microscopy (PLM) for collagen organization is useful in identifying early primary OA features in comparison to current standard histopathological methods. DESIGN Osteochondral specimens from 90 total knee arthroplasty patients with relatively preserved lateral femoral condyle were scored using (1) histological-histochemical grading system (HHGS); (2) Osteoarthritis Research Society International (OARSI); (3) PLM-Changoor system for repair cartilage, scores ranging between 0 (totally disorganized cartilage) and 5 (healthy adult cartilage); and (4) new PLM system for primary OA cartilage with superficial zone PLM (PLM-SZ) and deep zone PLM (PLM-DZ) scores, each ranging between 0 (healthy adult SZ and DZ collagen organization) and 4 (total loss of collagen organization). Serial sections were stained for collagen I and II antibodies. Spearman correlation coefficients (rs) were determined. RESULTS The associations between: (1) PLM-Changoor and HHGS or OARSI were weak (rs = -0.36) or moderate (rs = -0.56); (2) PLM-SZ and HHGS or OARSI were moderate (rs = 0.46 or rs = 0.53); and (3) PLM-DZ and HHGS or OARSI were poor (rs = 0.31 or rs = 0.21), respectively. Specimens exhibiting early and mild OA (HHGS < 5 and OARSI < 8.6) had PLM-SZ and PLM-DZ scores between 0 and 4 and between 0 and 3, respectively, and indicated new histopathological features not currently considered by HHGS/OARSI. CONCLUSIONS PLM was effective at identifying early SZ and DZ collagen alterations that were not evident in the traditional scoring systems. Incorporating PLM scores and/or additional HHGS/OARSI features can help improve characterization of early primary OA cartilage.
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Affiliation(s)
- V.P. Mantripragada
- Department of Biomedical Engineering,
Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA,V.P. Mantripragada, Department of Biomedical
Engineering, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH
44195, USA.
| | - W. Gao
- Department of Biomedical Engineering,
Cornell University, Ithaca, NY, USA
| | - N.S. Piuzzi
- Department of Biomedical Engineering,
Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA,Department of Orthopedic Surgery,
Cleveland Clinic, Cleveland, OH, USA
| | - C.D. Hoemann
- Department of Bioengineering, George
Mason University, Manassas, VA, USA
| | - G.F. Muschler
- Department of Biomedical Engineering,
Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA,Department of Orthopedic Surgery,
Cleveland Clinic, Cleveland, OH, USA
| | - R.J. Midura
- Department of Biomedical Engineering,
Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Rauwolf M, Turyanskaya A, Wobrauschek P, Sawhney K, Roschger A, Roschger P, Streli C, Hofstaetter J. Thickness determination of the tidemark of human articular cartilage using high-resolution micro-XRF imaging of zinc and lead. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100182. [DOI: 10.1016/j.ocarto.2021.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
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Haberkamp S, Oláh T, Orth P, Cucchiarini M, Madry H. Analysis of spatial osteochondral heterogeneity in advanced knee osteoarthritis exposes influence of joint alignment. Sci Transl Med 2021; 12:12/562/eaba9481. [PMID: 32967975 DOI: 10.1126/scitranslmed.aba9481] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Osteoarthritis (OA) is considerably affected by joint alignment. Here, we investigate the patterns of spatial osteochondral heterogeneity in patients with advanced varus knee OA together with clinical data. We report strong correlations of osteochondral parameters within individual topographical patterns, highlighting their fundamental and location-dependent interactions in OA. We further identify site-specific effects of varus malalignment on the lesser loaded compartment and, conversely, an unresponsive overloaded compartment. Last, we trace compensatory mechanisms to the overloaded subarticular spongiosa in patients with additional high body weight. We therefore propose to consider and to determine axial alignment in clinical trials when selecting the location to assess structural changes in OA. Together, these findings broaden the scientific basis of therapeutic load redistribution and weight loss in varus knee OA.
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Affiliation(s)
- Sophie Haberkamp
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Patrick Orth
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, 66421 Homburg, Germany.
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A comprehensive dataset of histopathology images, grades and patient demographics for human Osteoarthritis Cartilage. Data Brief 2021; 37:107129. [PMID: 34113698 PMCID: PMC8170068 DOI: 10.1016/j.dib.2021.107129] [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: 02/25/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Osteoarthritis (OA) is a leading cause of disability in older adults and takes substantial toll at personal, economic and societal levels. There is inadequate comprehension of OA disease progression specifically during the early phases of OA. This knowledge is critical to understanding the heterogeneity in OA progression as well as enable development of targeted therapeutics at the start of the disease rather than end-stage. Histopathology of cartilage is a common method used to assess in situ state of cartilage tissue. The data presented in this article assesses the histopathological status of human cartilage specimens collected from 90 patients (n = 180). Each specimen was processed for histology and stained with hematoxylin and eosin (HE) and safranin O fast-green (SafO) for acquiring brightfield images to visualize changes in cartilage structure, cells, gycosaminoglycan content and tidemark integrity. The unstained sections were imaged using polarized light microscopy (PLM) to visualize changes in collagen organization and composition within the cartilage specimen. All the specimens were systematically graded by three scorers using established primary OA cartilage grading systems including Histological–Histochemical Grading System (HHGS), advanced Osteoarthritis Research Society International (OARSI) system and Polarized Light Microscopy (PLM) scoring system. These data can be used by the OA community as an educational resource to train new reviewers (scorers), it serves as a comprehensive image database for experienced OA community to review the wide spectrum of histopathological features presented by these mild to moderate OA specimens, to define different OA-subtypes, and to generate hypothesis on OA progression mechanisms. Finally, the high quality images can be used to develop machine learning algorithms for classification of OA, automated detection and segmentation of existing or new OA features that can serve as early OA histopathological indicators.
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Characterization of heterogeneous primary human cartilage-derived cell population using non-invasive live-cell phase-contrast time-lapse imaging. Cytotherapy 2020; 23:488-499. [PMID: 33092987 DOI: 10.1016/j.jcyt.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 01/14/2023]
Abstract
Reliable and reproducible cell therapy strategies to treat osteoarthritis demand an improved characterization of the cell and heterogeneous cell population resident in native cartilage tissue. Using live-cell phase-contrast time-lapse imaging (PC-TLI), this study investigates the morphological attributes and biological performance of the three primary biological objects enzymatically isolated from primary human cartilage: connective tissue progenitors (CTPs), non-progenitors (NPs) and multi-cellular structures (MCSs). The authors' results demonstrated that CTPs were smaller in size in comparison to NPs (P < 0.001). NPs remained part of the adhered cell population throughout the cell culture period. Both NPs and CTP progeny on day 8 increased in size and decreased in circularity in comparison to their counterparts on day 1, although the percent change was considerably less in CTP progeny (P < 0.001). PC-TLI analyses indicated three colony types: single-CTP-derived (29%), multiple-CTP-derived (26%) and MCS-derived (45%), with large heterogeneity with respect to cell morphology, proliferation rate and cell density. On average, clonal (CL) (P = 0.009) and MCS (P = 0.001) colonies exhibited higher cell density (cells per colony area) than multi-clonal (MC) colonies; however, it is interesting to note that the behavior of CL (less cells per colony and less colony area) and MCS (high cells per colony and high colony area) colonies was quite different. Overall effective proliferation rate (EPR) of the CTPs that formed CL colonies was higher than the EPR of CTPs that formed MC colonies (P = 0.02), most likely due to CTPs with varying EPR that formed the MC colonies. Finally, the authors demonstrated that lag time before first cell division of a CTP (early attribute) could potentially help predict its proliferation rate long-term. Quantitative morphological characterization using non-invasive PC-TLI serves as a reliable and reproducible technique to understand cell heterogeneity. Size and circularity parameters can be used to distinguish CTP from NP populations. Morphological cell and colony features can also be used to reliably and reproducibly identify CTP subpopulations with preferred proliferation and differentiation potentials in an effort to improve cell manufacturing and therapeutic outcomes.
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A novel RGB-trichrome staining method for routine histological analysis of musculoskeletal tissues. Sci Rep 2020; 10:16659. [PMID: 33028938 PMCID: PMC7541469 DOI: 10.1038/s41598-020-74031-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 09/18/2020] [Indexed: 12/23/2022] Open
Abstract
Morphometry and histology are essential approaches for investigation and diagnosis of musculo-skeletal disorders. Despite the advent of revolutionary methods of image analysis and high resolution three-dimensional imaging technology, basic conventional light microscopy still provides an incisive overview of the structure and tissue dynamics of the musculoskeletal system. This is crucial to both preclinical and clinical research, since several clinically relevant processes, such as bone repair, osteoarthritis, and metabolic bone diseases, display distinct, if not pathognomonic, histological features. Due to the particular characteristics of the skeletal tissues (i.e., the existence of mineralized extracellular matrices), a large number of staining methods applicable to either decalcified or undecalcified tissues are available. However, it is usually the case that several staining methods need to be sequentially applied in order to achieve the different endpoints required to fully assess skeletal tissue structure and dynamics, and to allow morphometric quantification. We describe herein a novel staining method, the RGB trichrome, amenable for application to decalcified, paraffin embedded human musculoskeletal tissues. The acronym RGB corresponds to the three primary dyes used: picrosirius Red, fast Green, and alcian Blue. Although these individual pigments are commonly used either isolated, in binary combinations, or as part of more complex polychrome staining methods, when merged in the RGB trichrome staining produce high-quality/high-contrast images, permitting not only clear identification of different tissues (i.e., the different types of cartilage, bone and fibrous connective tissue), but also discrimination between calcified and uncalcified bone and cartilage, as well as an unexpected diversity of shades of color, while displaying singular properties among polychrome staining methods, such as the unveiling of the bone osteocyte dendritic/canalicular network. Hence, we propose the RGB trichrome as simple but highly-reliable tool for the preclinical and clinical study of the musculoskeletal system.
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Bone marrow concentrate injections for the treatment of osteoarthritis: evidence from preclinical findings to the clinical application. INTERNATIONAL ORTHOPAEDICS 2020; 45:525-538. [PMID: 32661635 PMCID: PMC7843474 DOI: 10.1007/s00264-020-04703-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023]
Abstract
Purpose To investigate the available literature on the use of bone marrow aspirate concentrate (BMAC) and summarize the current evidence supporting its potential for the injective treatment of joints affected by osteoarthritis (OA). Methods A systematic literature search was conducted on three electronic databases (PubMed, Embase, and Cochrane Library) in April 2020, using the following string: “((bone marrow concentrate) OR (BMC) OR (bone marrow aspirate concentrate) OR (BMAC)) AND (osteoarthritis)”, and inclusion criteria: clinical and preclinical (animal) studies of any level of evidence, written in English language, and evaluating the intra-articular or subchondral use of BMAC for the injective treatment of OA joints. Results The publication trend remarkably increased over time. A total of 22 studies were included in the qualitative data synthesis: four preclinical studies and 18 clinical studies, for a total number of 4626 patients. Safety was documented by all studies, with a low number of adverse events. An overall improvement in pain and function was documented in most of the studies, but the clinical studies present significant heterogeneity, few patients, short-term follow-up, and overall poor methodology. Conclusion There is a growing interest in the field of BMAC injections for the treatment of OA, with promising results in preclinical and clinical studies in terms of safety and effectiveness. Nevertheless, the current knowledge is still preliminary. Preclinical research is still needed to optimize BMAC use, as well as high-level large controlled trials to better understand the real potential of BMAC injections for the treatment of patients affected by OA.
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12
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Mantripragada VP, Piuzzi NS, Bova WA, Boehm C, Obuchowski NA, Lefebvre V, Midura RJ, Muschler GF. Donor-matched comparison of chondrogenic progenitors resident in human infrapatellar fat pad, synovium, and periosteum - implications for cartilage repair. Connect Tissue Res 2019; 60:597-610. [PMID: 31020864 DOI: 10.1080/03008207.2019.1611795] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: There is a clinical need to better characterize tissue sources being used for stem cell therapies. This study focuses on comparison of cells and connective tissue progenitors (CTPs) derived from native human infrapatellar fatpad (IPFP), synovium (SYN), and periosteum (PERI). Materials and Methods: IPFP, SYN, PERI were harvested from twenty-eight patients undergoing arthroplasty. CTPs were quantitatively characterized using automated colony-forming-unit assay to compare total nucleated cell concentration-[Cell], cells/mg; prevalence-(PCTP), CTPs/million nucleated cells; CTP concentration-[CTP], CTPs/mg; proliferation and differentiation potential; and correlate outcomes with patient's age and gender. Results: [Cell] did not differ between IPFP, SYN, and PERI. PCTP was influenced by age and gender: patients >60 years, IPFP and SYN had higher PCTP than PERI (p < 0.001) and females had higher PCTP in IPFP (p < 0.001) and SYN (p = 0.001) than PERI. [CTP] was influenced by age: patients <50 years, SYN (p = 0.0165) and PERI (p < 0.001) had higher [CTP] than IPFP; patients between 60 and 69 years, SYN (p < 0.001) had higher [CTP] than PERI; patients >70 years, IPFP (p = 0.006) had higher [CTP] than PERI. In patients >60 years, proliferation potential of CTPs differed significantly (SYN>IPFP>PERI); however, differentiation potentials were comparable between all three tissue sources. Conclusion: SYN and IPFP may serve as a preferred tissue source for patients >60 years, and PERI along with SYN and IPFP may serve as a preferred tissue source for patients <60 years for cartilage repair. However, the heterogeneity among the CTPs in any given tissue source suggests performance-based selection might be useful to optimize cell-sourcing strategies to improve efficacy of cellular therapies for cartilage repair.
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Affiliation(s)
- V P Mantripragada
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - N S Piuzzi
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA.,Department of Orthopedic Surgery, Cleveland Clinic , Cleveland , OH , USA.,Department of Orthopaedic Surgery, Instituto Universitario del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - W A Bova
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - C Boehm
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - N A Obuchowski
- Department of Quantitative Health Science, Cleveland Clinic , Cleveland , OH , USA
| | - V Lefebvre
- Department of Cellular and Molecular Medicine, Cleveland Clinic , Cleveland , OH , USA
| | - R J Midura
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - G F Muschler
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA.,Department of Orthopedic Surgery, Cleveland Clinic , Cleveland , OH , USA
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13
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Mantripragada V, Bova W, Boehm C, Piuzzi N, Obuchowski N, Midura R, Muschler G. Primary Cells Isolated from Human Knee Cartilage Reveal Decreased Prevalence of Progenitor Cells but Comparable Biological Potential During Osteoarthritic Disease Progression. J Bone Joint Surg Am 2018; 100:1771-1780. [PMID: 30334888 PMCID: PMC6636794 DOI: 10.2106/jbjs.18.00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current decisions on cellular therapies for osteoarthritis are based primarily on clinical experience or on assumptions about preferred cell sourcing. They have not been informed by rigorous standardized measurements of the chondrogenic connective-tissue progenitors (CTP-Cs) or their intrinsic diversity of chondrogenic potential. The goal of this study was to quantitatively define the CTP-Cs resident in cartilage of different grades of osteoarthritis and to compare their concentration, prevalence, and biological potential. METHODS Twenty-three patients who had varus malalignment of the knee and were scheduled to undergo elective total knee arthroplasty for idiopathic osteoarthritis and who had grade 1-2 osteoarthritis on the lateral femoral condyle and grade 3-4 osteoarthritis on the medial femoral condyle were recruited for study of the cartilage removed during surgery. CTP-Cs were assayed by a standardized colony-forming-unit assay using automated image-analysis software based on ASTM standard test method F2944-12. RESULTS Cell concentration was significantly greater (p < 0.001) in grade 3-4 cartilage than in grade 1-2 cartilage. The prevalence of CTP-Cs varied widely, but it trended lower in grade 3-4 cartilage than in grade 1-2 samples (p = 0.078). The biological performance of CTP-Cs from grade 1-2 and grade 3-4 cartilage was comparable. Increased cell concentration was a significant predictor of decreased CTP-C prevalence (p = 0.002). CONCLUSIONS Although grade 3-4 cartilage showed fewer CTP-Cs than grade 1-2 cartilage, the range of biological performance was comparable, which suggests that either may be used as a source for potent CTP-Cs. However, the biological reason for the heterogeneity of CTP-Cs in cartilage and the biological implications of that heterogeneity are not well understood and require further study. CLINICAL RELEVANCE In order to improve the efficacy of cartilage cell therapy procedures, it is key to characterize the quality and quantity of the cells and progenitors being administered. Additionally, understanding the heterogeneity in order to select appropriate subsets of populations will improve the rigor of decisions concerning cell sourcing and targeting for pharmacological and cellular therapies.
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Affiliation(s)
- V.P. Mantripragada
- Department of Biomedical Engineering, Lerner Research Institute (V.P.M., W.A.B., C.B., N.S.P., R.J.M., and G.F.M.), and Departments of Orthopedic Surgery (N.S.P. and G.F.M.) and Quantitative Health Science (N.A.O.), Cleveland Clinic, Cleveland, Ohio
| | - W.A. Bova
- Department of Biomedical Engineering, Lerner Research Institute (V.P.M., W.A.B., C.B., N.S.P., R.J.M., and G.F.M.), and Departments of Orthopedic Surgery (N.S.P. and G.F.M.) and Quantitative Health Science (N.A.O.), Cleveland Clinic, Cleveland, Ohio
| | - C. Boehm
- Department of Biomedical Engineering, Lerner Research Institute (V.P.M., W.A.B., C.B., N.S.P., R.J.M., and G.F.M.), and Departments of Orthopedic Surgery (N.S.P. and G.F.M.) and Quantitative Health Science (N.A.O.), Cleveland Clinic, Cleveland, Ohio
| | - N.S. Piuzzi
- Department of Biomedical Engineering, Lerner Research Institute (V.P.M., W.A.B., C.B., N.S.P., R.J.M., and G.F.M.), and Departments of Orthopedic Surgery (N.S.P. and G.F.M.) and Quantitative Health Science (N.A.O.), Cleveland Clinic, Cleveland, Ohio,Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - N.A. Obuchowski
- Department of Biomedical Engineering, Lerner Research Institute (V.P.M., W.A.B., C.B., N.S.P., R.J.M., and G.F.M.), and Departments of Orthopedic Surgery (N.S.P. and G.F.M.) and Quantitative Health Science (N.A.O.), Cleveland Clinic, Cleveland, Ohio
| | - R.J. Midura
- Department of Biomedical Engineering, Lerner Research Institute (V.P.M., W.A.B., C.B., N.S.P., R.J.M., and G.F.M.), and Departments of Orthopedic Surgery (N.S.P. and G.F.M.) and Quantitative Health Science (N.A.O.), Cleveland Clinic, Cleveland, Ohio
| | - G.F. Muschler
- Department of Biomedical Engineering, Lerner Research Institute (V.P.M., W.A.B., C.B., N.S.P., R.J.M., and G.F.M.), and Departments of Orthopedic Surgery (N.S.P. and G.F.M.) and Quantitative Health Science (N.A.O.), Cleveland Clinic, Cleveland, Ohio
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14
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Piuzzi NS, Midura RJ, Muschler GF, Hascall VC. Intra-articular hyaluronan injections for the treatment of osteoarthritis: perspective for the mechanism of action. Ther Adv Musculoskelet Dis 2018; 10:55-57. [PMID: 29387178 DOI: 10.1177/1759720x17752038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedic Surgery and Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA and Instituto Universitario del Hospital Italiano de Buenos Aires, Bs. As., Argentina
| | - Ronald J Midura
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - George F Muschler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Vincent C Hascall
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
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