1
|
Gantenbein B, Oswald KAC, Erbach GF, Croft AS, Bermudez-Lekerika P, Strunz F, Bigdon SF, Albers CE. The bone morphogenetic protein 2 analogue L51P enhances spinal fusion in combination with BMP2 in an in vivo rat tail model. Acta Biomater 2024; 177:148-156. [PMID: 38325708 DOI: 10.1016/j.actbio.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/31/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
Bone morphogenic protein 2 (BMP2) is known to induce osteogenesis and is applied clinically to enhance spinal fusion despite adverse effects. BMP2 needs to be used in high doses to be effective due to the presence of BMP2 inhibitors. L51P is a BMP2 analogue that acts by inhibition of BMP2 inhibitors. Here, we hypothesized that mixtures of BMP2 and L51P could achieve better spinal fusion outcomes regarding ossification. To test whether mixtures of both cytokines are sufficient to improve ossification, 45 elderly Wistar rats (of which 21 were males) were assigned to seven experimental groups, all which received spinal fusion surgery, including discectomy at the caudal 4-5 level using an external fixator and a porous β-tricalcium phosphate (βTCP) carrier. These βTCP carriers were coated with varying concentrations of BMP2 and L51P. X-rays were taken immediately after surgery and again six and twelve weeks post-operatively. Histological sections and µCT were analyzed after twelve weeks. Spinal fusion was assessed using X-ray, µCT and histology according to the Bridwell scale by voxel-based quantification and a semi-quantitative histological score, respectively. The results were congruent across modalities and revealed high ossification for high-dose BMP2 (10 µg), while PBS induced no ossification. Low-dose BMP2 (1 µg) or 10 µg L51P alone did not induce relevant bone formation. However, all combinations of low-dose BMP2 with L51P (1 µg + 1/5/10 µg) were able to induce similar ossificationas high-dose BMP2. These results are of high clinical relevance, as they indicate L51P is sufficient to increase the efficacy of BMP2 and thus lower the required dose for spinal fusion. STATEMENT OF SIGNIFICANCE: Spinal fusion surgery is frequently applied to treat spinal pathologies. Bone Morphogenic Protein-2 (BMP2) has been approved by the U .S. Food and Drug Administration (FDA-) and by the "Conformité Européenne" (CE)-label. However, its application is expensive and high concentrations cause side-effects. This research targets the improvement of the efficacy of BMP2 in spinal fusion surgery.
Collapse
Affiliation(s)
- Benjamin Gantenbein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland; Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, Bern, Switzerland.
| | - Katharina A C Oswald
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland
| | - Georg F Erbach
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland
| | - Andreas S Croft
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | - Paola Bermudez-Lekerika
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | - Franziska Strunz
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | - Sebastian F Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Medical Faculty, University of Bern, Bern, Switzerland
| |
Collapse
|
2
|
Goldberg JL, Garton A, Singh S, Kirnaz S, Sommer F, Carnevale JA, Atalay B, Medary B, McGrath LB, Härtl R. Challenges in the Development of Biological Approaches for the Treatment of Degenerative Disc Disease. World Neurosurg 2021; 157:274-281. [PMID: 34929785 DOI: 10.1016/j.wneu.2021.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
There are numerous innovative and promising approaches aimed at slowing, reversing, or healing degenerative disc disease. However, multiple treatment-specific impediments slow progress toward realizing the benefits of these therapies. First, the exact pathophysiology underlying degenerative disc disease remains complicated and challenging to study. In addition, the study of the spine and intervertebral disc in animal models is difficult to translate to humans, hindering the utility of preclinical research. Biological treatments are subject to the complex biomechanical environment in which native discs degenerate. The regulatory approval environment for these therapeutics will likely involve a high degree of scrutiny. Finally, patient selection and assessment of outcomes are a particular challenge in this clinical setting.
Collapse
Affiliation(s)
- Jacob L Goldberg
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Andrew Garton
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Sunidhi Singh
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Basar Atalay
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Lynn B McGrath
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
| |
Collapse
|
3
|
Zhu M, Tan J, Liu L, Tian J, Li L, Luo B, Zhou C, Lu L. Construction of biomimetic artificial intervertebral disc scaffold via 3D printing and electrospinning. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 128:112310. [PMID: 34474861 DOI: 10.1016/j.msec.2021.112310] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022]
Abstract
Intervertebral disc (IVD) degeneration is a clinically disease that seriously endangers people's health. Tissue engineering provides a promising method to repair and regenerate the damaged IVD physiological function. Successfully tissue-engineered IVD scaffold should mimic the native IVD histological and macro structures. Here, 3D printing and electrospinning were combined to construct an artificial IVD composite scaffold. Poly lactide (PLA) was used to print the IVD frame structure, the oriented porous poly(l-lactide)/octa-armed polyhedral oligomeric silsesquioxanes (PLLA/POSS-(PLLA)8) fiber bundles simulated the annulus fibrosus (AF), and the gellan gum/poly (ethylene glycol) diacrylate (GG/PEGDA) double network hydrogel loaded with bone marrow mesenchymal stem cells (BMSCs) simulated the nucleus pulposus (NP) structure. Morphological and mechanical tests showed that the structure and mechanical properties of the IVD scaffold were similar to that of the natural IVD. The compression modulus of the scaffold is about 10 MPa, which is comparable to natural IVD and provides good mechanical support for tissue repair and regeneration. At the same time, the porosity and mechanical properties of the scaffold can be regulated through the 3D model design. In the AF structure, the fiber bundles are oriented concentrically with each subsequent layer oriented 60° to the spinal column, and can withstand the tension generated during the deformation of the NP. In the NP structure, BMSCs were evenly distributed in the hydrogel and could maintain high cell viability. Animal experiment results demonstrated that the biomimetic artificial IVD scaffold could maintain the disc space and produce the new extracellular matrix. This engineered biomimetic IVD scaffold is a promising biomaterial for individualized IVD repair and regeneration.
Collapse
Affiliation(s)
- Meiling Zhu
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China
| | - Jianwang Tan
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China
| | - Lu Liu
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China
| | - Jinhuan Tian
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China
| | - Lihua Li
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China
| | - Binghong Luo
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China
| | - Changren Zhou
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China
| | - Lu Lu
- Department of Materials Science and Engineering, Jinan University, Guangzhou 510632, China.
| |
Collapse
|
4
|
Moriguchi Y, Mojica-Santiago J, Grunert P, Pennicooke B, Berlin C, Khair T, Navarro-Ramirez R, Ricart Arbona RJ, Nguyen J, Härtl R, Bonassar LJ. Total disc replacement using tissue-engineered intervertebral discs in the canine cervical spine. PLoS One 2017; 12:e0185716. [PMID: 29053719 PMCID: PMC5650136 DOI: 10.1371/journal.pone.0185716] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/18/2017] [Indexed: 01/07/2023] Open
Abstract
The most common reason that adults in the United States see their physician is lower back or neck pain secondary to degenerative disc disease. To date, approaches to treat degenerative disc disease are confined to purely mechanical devices designed to either eliminate or enable flexibility of the diseased motion segment. Tissue engineered intervertebral discs (TE-IVDs) have been proposed as an alternative approach and have shown promise in replacing native IVD in the rodent tail spine. Here we demonstrate the efficacy of our TE-IVDs in the canine cervical spine. TE-IVD components were constructed using adult canine annulus fibrosis and nucleus pulposus cells seeded into collagen and alginate hydrogels, respectively. Seeded gels were formed into a single disc unit using molds designed from the geometry of the canine spine. Skeletally mature beagles underwent discectomy with whole IVD resection at levels between C3/4 and C6/7, and were then divided into two groups that received only discectomy or discectomy followed by implantation of TE-IVD. Stably implanted TE-IVDs demonstrated significant retention of disc height and physiological hydration compared to discectomy control. Both 4-week and 16-week histological assessments demonstrated chondrocytic cells surrounded by proteoglycan-rich matrices in the NP and by fibrocartilaginous matrices in the AF portions of implanted TE-IVDs. Integration into host tissue was confirmed over 16 weeks without any signs of immune reaction. Despite the significant biomechanical demands of the beagle cervical spine, our stably implanted TE-IVDs maintained their position, structure and hydration as well as disc height over 16 weeks in vivo.
Collapse
Affiliation(s)
- Yu Moriguchi
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Jorge Mojica-Santiago
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America
| | - Peter Grunert
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Brenton Pennicooke
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Connor Berlin
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Thamina Khair
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Rodolfo J. Ricart Arbona
- Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center & Weill Cornell Medicine, New York, NY, United States of America
| | - Joseph Nguyen
- Healthcare Research Institute, Hospital for Special Surgery, Hospital for Special Surgery, New York, NY, United States of America
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States of America
| | - Lawrence J. Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States of America
- * E-mail:
| |
Collapse
|
5
|
Martin JT, Milby AH, Chiaro JA, Kim DH, Hebela NM, Smith LJ, Elliott DM, Mauck RL. Translation of an engineered nanofibrous disc-like angle-ply structure for intervertebral disc replacement in a small animal model. Acta Biomater 2014; 10:2473-81. [PMID: 24560621 DOI: 10.1016/j.actbio.2014.02.024] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/13/2014] [Accepted: 02/11/2014] [Indexed: 12/29/2022]
Abstract
Intervertebral disc degeneration has been implicated in the etiology of low back pain; however, the current surgical strategies for treating symptomatic disc disease are limited. A variety of materials have been developed to replace disc components, including the nucleus pulposus (NP), the annulus fibrosus (AF) and their combination into disc-like engineered constructs. We have previously shown that layers of electrospun poly(ε-caprolactone) scaffold, mimicking the hierarchical organization of the native AF, can achieve functional parity with native tissue. Likewise, we have combined these structures with cell-seeded hydrogels (as an NP replacement) to form disc-like angle-ply structures (DAPS). The objective of this study was to develop a model for the evaluation of DAPS in vivo. Through a series of studies, we developed a surgical approach to replace the rat caudal disc with an acellular DAPS and then stabilized the motion segment via external fixation. We then optimized cell infiltration into DAPS by including sacrificial poly(ethylene oxide) layers interspersed throughout the angle-ply structure. Our findings illustrate that DAPS are stable in the caudal spine, are infiltrated by cells from the peri-implant space and that infiltration is expedited by providing additional routes for cell migration. These findings establish a new in vivo platform in which to evaluate and optimize the design of functional disc replacements.
Collapse
Affiliation(s)
- John T Martin
- Department of Orthopaedic Surgery, University of Pennsylvania, McKay Orthopaedic Research Laboratory, 36th Street and Hamilton Walk, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA; Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, 220 South 33rd Street, 229 Towne Building, Philadelphia, PA 19104-6315, USA; Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, 3900 Woodland Avenue, Building 21, Room A200, Philadelphia, PA 19104, USA
| | - Andrew H Milby
- Department of Orthopaedic Surgery, University of Pennsylvania, McKay Orthopaedic Research Laboratory, 36th Street and Hamilton Walk, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA; Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, 3900 Woodland Avenue, Building 21, Room A200, Philadelphia, PA 19104, USA
| | - Joseph A Chiaro
- Department of Orthopaedic Surgery, University of Pennsylvania, McKay Orthopaedic Research Laboratory, 36th Street and Hamilton Walk, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA; Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, 3900 Woodland Avenue, Building 21, Room A200, Philadelphia, PA 19104, USA
| | - Dong Hwa Kim
- Department of Orthopaedic Surgery, University of Pennsylvania, McKay Orthopaedic Research Laboratory, 36th Street and Hamilton Walk, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA
| | - Nader M Hebela
- Department of Orthopaedic Surgery, University of Pennsylvania, McKay Orthopaedic Research Laboratory, 36th Street and Hamilton Walk, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA; Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, 3900 Woodland Avenue, Building 21, Room A200, Philadelphia, PA 19104, USA
| | - Lachlan J Smith
- Department of Orthopaedic Surgery, University of Pennsylvania, McKay Orthopaedic Research Laboratory, 36th Street and Hamilton Walk, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA; Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, 3900 Woodland Avenue, Building 21, Room A200, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, 3rd Floor, Silverstein Pavilion, Philadelphia, PA 19104, USA
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, 125 E. Delaware Avenue, Newark, DE 19716, USA
| | - Robert L Mauck
- Department of Orthopaedic Surgery, University of Pennsylvania, McKay Orthopaedic Research Laboratory, 36th Street and Hamilton Walk, 424 Stemmler Hall, Philadelphia, PA 19104-6081, USA; Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, 220 South 33rd Street, 229 Towne Building, Philadelphia, PA 19104-6315, USA; Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, Suite 240, Skirkanich Hall, Philadelphia, PA 19104-6321, USA; Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, 3900 Woodland Avenue, Building 21, Room A200, Philadelphia, PA 19104, USA.
| |
Collapse
|
6
|
Grunert P, Gebhard HH, Bowles RD, James AR, Potter HG, Macielak M, Hudson KD, Alimi M, Ballon DJ, Aronowitz E, Tsiouris AJ, Bonassar LJ, Härtl R. Tissue-engineered intervertebral discs: MRI results and histology in the rodent spine. J Neurosurg Spine 2014; 20:443-51. [DOI: 10.3171/2013.12.spine13112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Tissue-engineered intervertebral discs (TE-IVDs) represent a new experimental approach for the treatment of degenerative disc disease. Compared with mechanical implants, TE-IVDs may better mimic the properties of native discs. The authors conducted a study to evaluate the outcome of TE-IVDs implanted into the rat-tail spine using radiological parameters and histology.
Methods
Tissue-engineered intervertebral discs consist of a distinct nucleus pulposus (NP) and anulus fibrosus (AF) that are engineered in vitro from sheep IVD chondrocytes. In 10 athymic rats a discectomy in the caudal spine was performed. The discs were replaced with TE-IVDs. Animals were kept alive for 8 months and were killed for histological evaluation. At 1, 5, and 8 months, MR images were obtained; T1-weighted sequences were used for disc height measurements, and T2-weighted sequences were used for morphological analysis. Quantitative T2 relaxation time analysis was used to assess the water content and T1ρ-relaxation time to assess the proteoglycan content of TE-IVDs.
Results
Disc height of the transplanted segments remained constant between 68% and 74% of healthy discs. Examination of TE-IVDs on MR images revealed morphology similar to that of native discs. T2-relaxation time did not differ between implanted and healthy discs, indicating similar water content of the NP tissue. The size of the NP decreased in TE-IVDs. Proteoglycan content in the NP was lower than it was in control discs. Ossification of the implanted segment was not observed. Histological examination revealed an AF consisting of an organized parallel-aligned fiber structure. The NP matrix appeared amorphous and contained cells that resembled chondrocytes.
Conclusions
The TE-IVDs remained viable over 8 months in vivo and maintained a structure similar to that of native discs. Tissue-engineered intervertebral discs should be explored further as an option for the potential treatment of degenerative disc disease.
Collapse
Affiliation(s)
- Peter Grunert
- 1Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York
| | - Harry H. Gebhard
- 1Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York
| | - Robby D. Bowles
- 2Department of Biomedical Engineering, Cornell University, Ithaca
| | - Andrew R. James
- 1Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York
| | - Hollis G. Potter
- 3Department of Radiology, Hospital for Special Surgery, New York
| | - Michael Macielak
- 1Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York
| | | | - Marjan Alimi
- 1Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York
| | - Douglas J. Ballon
- 4Department of Radiology, Weill Cornell Medical College, New York; and
| | - Eric Aronowitz
- 4Department of Radiology, Weill Cornell Medical College, New York; and
| | | | - Lawrence J. Bonassar
- 2Department of Biomedical Engineering, Cornell University, Ithaca
- 5Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York
| | - Roger Härtl
- 1Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York
| |
Collapse
|