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Tan H, Kang W, Fan Q, Wang B, Yu Y, Yu N, Duan H, Yuan P, Wang S, Chen Q, Jin C. Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging Findings of Infrapatellar Fat Pad Signal Abnormalities: Comparison Between Symptomatic and Asymptomatic Knee Osteoarthritis. Acad Radiol 2023; 30:1374-1383. [PMID: 36609030 DOI: 10.1016/j.acra.2022.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 01/06/2023]
Abstract
RATIONALE AND OBJECTIVES Infrapatellar fat pad (IPFP) proton density-weighted images (PdWI) hyperintense regions on MRI are an important imaging feature of knee osteoarthritis (KOA) and are thought to represent inflammation which may induce knee pain. The aim of the study was to compare the intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) findings of PdWI hyperintense regions of IPFP between symptomatic and asymptomatic KOA and to determine whether IVIM-DWI parameters can be used as an objective biomarker for symptomatic KOA. MATERIALS AND METHODS In total, 84 patients with symptomatic KOA, 43 asymptomatic KOA persons, and 30 healthy controls with MRI were retrospectively reviewed. Demographic, IPFP-synovitis, Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain sub-score, IPFP volume and depth and quantitative parameters of IVIM-DWI were collected. The chi-square test, Binary logistic regression and receiver operating characteristic curve (ROC) analysis were used for diagnostic performance comparison. RESULTS The IPFP volume and depth were statistically significant differences between the non-KOA and sKOA groups (p<0.05). The IPFP PdWI hyperintense regions demonstrated significantly higher values of D and D* in the symptomatic KOA compared to those in the asymptomatic KOA (1.51±0.47 vs. 1.73±0.40 for D and 19.24±6.44 vs. 27.09±9.75 for D*) (both p<0.05). Multivariate logistic regression analyses showed that Higher D and D* values of IPFP hyperintense region were significantly associated with higher risks of knee pain (OR: 1.97; 95% CI: 1.21-3.19; p=0.006 for D and OR: 1.24; 95% CI: 1.09-1.41; p=0.001 for D*). Sensitivity and specificity of D value for symptomatic KOA were 80.28% and 83.33%, with an AUC of 0.78 (0.68-0.86). D* value had the sensitivity with 92.96% and a specificity of 58.33%, with an AUC of 0.82 (0.73-0.89) for symptomatic KOA. CONCLUSION IVIM-DWI can be used as an additional functional imaging technique to study IPFP with signal abnormalities on PdWI, and the D and D* values may have potential value to predict the symptom in mild-to-moderate KOA patients.
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Affiliation(s)
- Hui Tan
- From the department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China; Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Wulin Kang
- Department of Orthopedics, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Qiuju Fan
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Bin Wang
- Institute of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Yong Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Haifeng Duan
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Puwei Yuan
- Department of Orthopedics, The Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Shaoyu Wang
- MR senior scientific marketing specialist, Siemens Healthineers, Shanghai, People's Republic of China
| | - Qing Chen
- Institute of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People's Republic of China
| | - Chenwang Jin
- From the department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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O'Connell CD, Duchi S, Onofrillo C, Caballero-Aguilar LM, Trengove A, Doyle SE, Zywicki WJ, Pirogova E, Di Bella C. Within or Without You? A Perspective Comparing In Situ and Ex Situ Tissue Engineering Strategies for Articular Cartilage Repair. Adv Healthc Mater 2022; 11:e2201305. [PMID: 36541723 DOI: 10.1002/adhm.202201305] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/21/2022] [Indexed: 11/23/2022]
Abstract
Human articular cartilage has a poor ability to self-repair, meaning small injuries often lead to osteoarthritis, a painful and debilitating condition which is a major contributor to the global burden of disease. Existing clinical strategies generally do not regenerate hyaline type cartilage, motivating research toward tissue engineering solutions. Prospective cartilage tissue engineering therapies can be placed into two broad categories: i) Ex situ strategies, where cartilage tissue constructs are engineered in the lab prior to implantation and ii) in situ strategies, where cells and/or a bioscaffold are delivered to the defect site to stimulate chondral repair directly. While commonalities exist between these two approaches, the core point of distinction-whether chondrogenesis primarily occurs "within" or "without" (outside) the body-can dictate many aspects of the treatment. This difference influences decisions around cell selection, the biomaterials formulation and the surgical implantation procedure, the processes of tissue integration and maturation, as well as, the prospects for regulatory clearance and clinical translation. Here, ex situ and in situ cartilage engineering strategies are compared: Highlighting their respective challenges, opportunities, and prospects on their translational pathways toward long term human cartilage repair.
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Affiliation(s)
- Cathal D O'Connell
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Serena Duchi
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Carmine Onofrillo
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Lilith M Caballero-Aguilar
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Victoria, 3122, Australia
| | - Anna Trengove
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Stephanie E Doyle
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Wiktor J Zywicki
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Elena Pirogova
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia
| | - Claudia Di Bella
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
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Towards Clinical Translation of In Situ Cartilage Engineering Strategies: Optimizing the Critical Facets of a Cell-Laden Hydrogel Therapy. Tissue Eng Regen Med 2022; 20:25-47. [PMID: 36244053 PMCID: PMC9852400 DOI: 10.1007/s13770-022-00487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Articular cartilage repair using implantable photocrosslinkable hydrogels laden with chondrogenic cells, represents a promising in situ cartilage engineering approach for surgical treatment. The development of a surgical procedure requires a minimal viable product optimized for the clinical scenario. In our previous work we demonstrated how gelatin based photocrosslinkable hydrogels in combination with infrapatellar derived stem cells allow the production of neocartilage in vitro. In this study, we aim to optimize the critical facets of the in situ cartilage engineering therapy: the cell source, the cell isolation methodology, the cell expansion protocol, the cell number, and the delivery approach. METHODS We evaluated the impact of the critical facets of the cell-laden hydrogel therapy in vitro to define an optimized protocol that was then used in a rabbit model of cartilage repair. We performed cells counting and immunophenotype analyses, chondrogenic potential evaluation via immunostaining and gene expression, extrusion test analysis of the photocrosslinkable hydrogel, and clinical assessment of cartilage repair using macroscopic and microscopic scores. RESULTS We identified the adipose derived stem cells as the most chondrogenic cells source within the knee joint. We then devised a minimally manipulated stem cell isolation procedure that allows a chondrogenic population to be obtained in only 85 minutes. We found that cell expansion prior to chondrogenesis can be reduced to 5 days after the isolation procedure. We characterized that at least 5 million of cells/ml is needed in the photocrosslinkable hydrogel to successfully trigger the production of neocartilage. The maximum repairable defect was calculated based on the correlation between the number of cells retrievable with the rapid isolation followed by 5-day non-passaged expansion phase, and the minimum chondrogenic concentration in photocrosslinkable hydrogel. We next optimized the delivery parameters of the cell-laden hydrogel therapy. Finally, using the optimized procedure for in situ tissue engineering, we scored superior cartilage repair when compared to the gold standard microfracture approach. CONCLUSION This study demonstrates the possibility to repair a critical size articular cartilage defect by means of a surgical streamlined procedure with optimized conditions.
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Baek J, Lee KI, Ra HJ, Lotz MK, D'Lima DD. Collagen fibrous scaffolds for sustained delivery of growth factors for meniscal tissue engineering. Nanomedicine (Lond) 2022; 17:77-93. [PMID: 34991339 PMCID: PMC8765117 DOI: 10.2217/nnm-2021-0313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To mimic the ultrastructural morphology of the meniscus with nanofiber scaffolds coupled with controlled growth factor delivery to modulate cellular performance for tissue engineering of menisci. Methods: The authors functionalized collagen nanofibers by conjugating heparin to the following growth factors for sustained release: PDGF-BB, TGF-β1 and CTGF. Results: Incorporating growth factors increased human meniscal and synovial cell viability, proliferation and infiltration in vitro, ex vivo and in vivo; upregulated key genes involved in meniscal extracellular matrix synthesis and enhanced generation of meniscus-like tissue. Conclusion: The authors' results indicate that functionalizing collagen nanofibers can create a cell-favorable micro- and nanoenvironment and can serve as a system for sustained release of bioactive factors.
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Affiliation(s)
- Jihye Baek
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA 92037, USA,Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA
| | - Kwang Il Lee
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA
| | - Ho Jong Ra
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA 92037, USA,Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA
| | - Martin K Lotz
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA 92037, USA,Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MB-102, La Jolla, CA 92037, USA,Author for correspondence: Tel.: +1 858 784 7816;
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Messaoudi O, Henrionnet C, Bourge K, Loeuille D, Gillet P, Pinzano A. Stem Cells and Extrusion 3D Printing for Hyaline Cartilage Engineering. Cells 2020; 10:cells10010002. [PMID: 33374921 PMCID: PMC7821921 DOI: 10.3390/cells10010002] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023] Open
Abstract
Hyaline cartilage is deficient in self-healing properties. The early treatment of focal cartilage lesions is a public health challenge to prevent long-term degradation and the occurrence of osteoarthritis. Cartilage tissue engineering represents a promising alternative to the current insufficient surgical solutions. 3D printing is a thriving technology and offers new possibilities for personalized regenerative medicine. Extrusion-based processes permit the deposition of cell-seeded bioinks, in a layer-by-layer manner, allowing mimicry of the native zonal organization of hyaline cartilage. Mesenchymal stem cells (MSCs) are a promising cell source for cartilage tissue engineering. Originally isolated from bone marrow, they can now be derived from many different cell sources (e.g., synovium, dental pulp, Wharton’s jelly). Their proliferation and differentiation potential are well characterized, and they possess good chondrogenic potential, making them appropriate candidates for cartilage reconstruction. This review summarizes the different sources, origins, and densities of MSCs used in extrusion-based bioprinting (EBB) processes, as alternatives to chondrocytes. The different bioink constituents and their advantages for producing substitutes mimicking healthy hyaline cartilage is also discussed.
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Affiliation(s)
- Océane Messaoudi
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
| | - Christel Henrionnet
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
| | - Kevin Bourge
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
| | - Damien Loeuille
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
- Service de Rhumatologie, CHRU de Nancy, Hôpitaux de Brabois, Bâtiment des Spécialités Médicales, 5 rue du Morvan, F54511 Vandœuvre-Lès-Nancy, France
| | - Pierre Gillet
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
- Laboratoire de Pharmacologie, Toxicologie et Pharmacovigilance, Bâtiment de Biologie Médicale et de Biopathologie, CHRU de Nancy-Brabois, 5 Rue du Morvan, F54511 Vandœuvre-Lès-Nancy, France
| | - Astrid Pinzano
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
- Contrat d’Interface, Service de Rhumatologie, Hôpital de Brabois, Bâtiment Spécialités Médicales, F54511 Vandœuvre Lès Nancy, France
- Correspondence: ; Tel.: +33-(0)372-746-565
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Sriwatananukulkit O, Tawonsawatruk T, Rattanapinyopituk K, Luangwattanawilai T, Srikaew N, Hemstapat R. Scaffold-Free Cartilage Construct from Infrapatellar Fat Pad Stem Cells for Cartilage Restoration. Tissue Eng Part A 2020; 28:199-211. [PMID: 32972295 DOI: 10.1089/ten.tea.2020.0167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Once damaged, the articular cartilage has a very limited intrinsic capacity for self-renewal due to its avascular nature. If left untreated, damaged cartilage can lead to progressive degeneration of bone and eventually causes pain. Infrapatellar fat pad adipose-derived mesenchymal stromal cells (IPFP-ASCs) has a potential role for cartilage restoration. However, the therapeutic role for IPFP-ASCs remains to be evaluated in an appropriate osteochondral defect model. Thus, this study aimed to investigate the potential of using a three-dimensional (3D) cartilage construct of IPFP-ASCs as a promising source of cells to restore articular cartilage and to attenuate pain associated with the cartilage defect in an osteochondral defect model. The chondrogenic differentiation potential of the 3D cartilage construct derived from IPFP-ASCs was determined before implantation and postimplantation by gene expression and immunohistochemistry analysis. Pain-related behavior was also assessed by using a weight-bearing test. A significant pain-associated with the osteochondral defect was observed in this model in all groups postinduction; however, this pain can spontaneously resolve within 3 weeks postimplantation regardless of implantation of IPFP-ASCs constructs. The expression of SOX9 and COL2A1 genes in addition to protein expression were strongly expressed in 3D construct IPFP-ASCs. The existence of mature chondrocytes, along with significant (p < 0.05) positive immunostaining for type II collagen and aggrecan, were identified in the implanted site for up to 12 weeks compared with the untreated group, indicating hyaline cartilage regeneration. Taken together, this study demonstrated the successful outcome of osteochondral regeneration with scaffold-free IPFP-ASCs constructs in an osteochondral defect rat model. It provides novel and interesting insights into the current hypothesis that 3D construct IPFP-ASCs may offer potential benefits as an alternative approach to repair the cartilage defect. Impact statement This study provides evidence of using the human 3D scaffold-free infrapatellar fat pad adipose-derived mesenchymal stromal cells (IPFP-ASCs) construct to restore the full-thickness osteochondral defect in a rat model. This study showed that chondrogenic features of the construct could be retained for up to 12 weeks postimplantation. The results of this proof-of-concept study support that human 3D scaffold-free IPFP-ASCs construct has potential benefits in promoting the hyaline-like native cartilage restoration, which may be beneficial as a tissue-specific stem cell for cell-based cartilage therapy. There are several clinical advantages of IPFP-ASC including ease and minimal invasive harvesting, chondrogenic inducible property, and tissue-specific progenitors in the knee.
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Affiliation(s)
| | | | - Kasem Rattanapinyopituk
- Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | | | - Narongrit Srikaew
- Research Centre, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Ruedee Hemstapat
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
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Kunze KN, Burnett RA, Wright-Chisem J, Frank RM, Chahla J. Adipose-Derived Mesenchymal Stem Cell Treatments and Available Formulations. Curr Rev Musculoskelet Med 2020; 13:264-280. [PMID: 32328959 DOI: 10.1007/s12178-020-09624-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The use of human adipose-derived mesenchymal stem cells (ADSCs) has gained attention due to its potential to expedite healing and the ease of harvesting; however, clinical evidence is limited, and questions concerning optimal method of delivery and long-term outcomes remain unanswered. RECENT FINDINGS Administration of ADSCs in animal models has been reported to aid in improved healing benefits with enhanced repair biomechanics, superior gross histological appearance of injury sites, and higher concentrations of growth factors associated with healing compared to controls. Recently, an increasing body of research has sought to examine the effects of ADSCs in humans. Several available processing techniques and formulations for ADSCs exist with evidence to suggest benefits with the use of ADSCs, but the superiority of any one method is not clear. Evidence from the most recent clinical studies available demonstrates promising outcomes following treatment of select musculoskeletal pathologies with ADSCs despite reporting variability among ADSCs harvesting and processing; these include (1) healing benefits and pain improvement for rotator cuff and Achilles tendinopathies, (2) improvements in pain and function in those with knee and hip osteoarthritis, and (3) improved cartilage regeneration for osteochondral focal defects of the knee and talus. The limitation to most of this literature is the use of other therapeutic biologics in combination with ADSCs. Additionally, many studies lack control groups, making establishment of causation inappropriate. It is imperative to perform higher-quality studies using consistent, predictable control populations and to standardize formulations of ADSCs in these trials.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Joshua Wright-Chisem
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Colorado School of Medicine, Boulder, CO, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, IL, USA.
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Zhong YC, Wang SC, Han YH, Wen Y. Recent Advance in Source, Property, Differentiation, and Applications of Infrapatellar Fat Pad Adipose-Derived Stem Cells. Stem Cells Int 2020; 2020:2560174. [PMID: 32215015 PMCID: PMC7081037 DOI: 10.1155/2020/2560174] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022] Open
Abstract
Infrapatellar fat pad (IPFP) can be easily obtained during knee surgery, which avoids the damage to patients for obtaining IPFP. Infrapatellar fat pad adipose-derived stem cells (IPFP-ASCs) are also called infrapatellar fat pad mesenchymal stem cells (IPFP-MSCs) because the morphology of IPFP-ASCs is similar to that of bone marrow mesenchymal stem cells (BM-MSCs). IPFP-ASCs are attracting more and more attention due to their characteristics suitable to regenerative medicine such as strong proliferation and differentiation, anti-inflammation, antiaging, secreting cytokines, multipotential capacity, and 3D culture. IPFP-ASCs can repair articular cartilage and relieve the pain caused by osteoarthritis, so most of IPFP-related review articles focus on osteoarthritis. This article reviews the anatomy and function of IPFP, as well as the discovery, amplification, multipotential capacity, and application of IPFP-ASCs in order to explain why IPFP-ASC is a superior stem cell source in regenerative medicine.
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Affiliation(s)
- Yu-chen Zhong
- Department of Histology and Embryology, College of Basic Medical Sciences, China Medical University, Shenyang 110122, China
- Class 4, Phase 102, China Medical University, Shenyang 110122, China
| | - Shi-chun Wang
- Department of Histology and Embryology, College of Basic Medical Sciences, China Medical University, Shenyang 110122, China
- Class 4, Phase 102, China Medical University, Shenyang 110122, China
| | - Yin-he Han
- Department of Histology and Embryology, College of Basic Medical Sciences, China Medical University, Shenyang 110122, China
| | - Yu Wen
- Department of Histology and Embryology, College of Basic Medical Sciences, China Medical University, Shenyang 110122, China
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9
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Grogan SP, Dorthé EW, Glembotski NE, Gaul F, D'Lima DD. Cartilage tissue engineering combining microspheroid building blocks and microneedle arrays. Connect Tissue Res 2020; 61:229-243. [PMID: 31134817 DOI: 10.1080/03008207.2019.1617280] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Scaffold-free cartilage tissue engineering circumvents issues with scaffold seeding, potential toxicity response, and impaired host integration. However, precisely controlling and maintaining a scaffold-free construct shape have been challenging. We explored the feasibility of microneedle arrays to print tissue using cellular microspheroids as building blocks.Materials and Methods: Human embryonic-derived mesenchymal stem cells or infrapatellar fat pad mesenchymal stem cells were used to create microspheroids of 500 µm in diameter, which were assembled on microneedle arrays in a predefined arrangement using a robotic system under computer vision. Microspheroids on microneedles were cultured to permit fusion into a tissue construct. Infrapatellar fat pad mesenchymal stem cell constructs were either implanted into chondral defects created in human osteoarthritic cartilage explants or maintained on the microneedle array for 3 weeks. Embryonic-derived mesenchymal stem cell constructs were designed to be press-fit into 3 mm subchondral defects in New Zealand White rabbits and maintained for up to 8 weeks to assess retention, early tissue repair, and more mature cartilage regeneration.Results: Microspheroids of both cell types fused together in culture to form neotissues of predefined shape and size. Infrapatellar fat pad mesenchymal stem cell neotissues expressed high levels of chondrogenic genes and integrated with the surrounding osteoarthritic host cartilage. Embryonic-derived mesenchymal stem cell constructs generated chondrogenic neotissue in vivo as early as 2 weeks and more mature tissue by 8 weeks with increased glycosaminoglycan deposition.Conclusions: We constructed defined scaffold-free shapes by bioprinting and fusing microspheroids. Proof of concept was shown in the repair of ex vivo osteoarthritic human cartilage and in vivo rabbit osteochondral (OC) defects.
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Affiliation(s)
- Shawn P Grogan
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Erik W Dorthé
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Nicholas E Glembotski
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Florian Gaul
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA.,Department of Orthopedic, Trauma and Plastic Surgery, Spine Center, University Hospital Leipzig, Leipzig, Germany
| | - Darryl D D'Lima
- Scripps Health, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
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10
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Stocco E, Barbon S, Piccione M, Belluzzi E, Petrelli L, Pozzuoli A, Ramonda R, Rossato M, Favero M, Ruggieri P, Porzionato A, Di Liddo R, De Caro R, Macchi V. Infrapatellar Fat Pad Stem Cells Responsiveness to Microenvironment in Osteoarthritis: From Morphology to Function. Front Cell Dev Biol 2019; 7:323. [PMID: 31921840 PMCID: PMC6914674 DOI: 10.3389/fcell.2019.00323] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
Recently, infrapatellar fat pad (IFP) has been considered as a source of stem cells for cartilage regeneration in osteoarthritis (OA) due to their ability for differentiation into chondrocytes. However, stressful conditions, like that related to OA, may induce a pathogenic reprograming. The aim of this study was to characterize the structural and functional properties of a new population of stem cells isolated from osteoarthritic infrapatellar fat pad (OA-IFP). Nine OA patients undergoing total knee arthroplasty (TKA) were enrolled in this study [median age = 74 years, interquartile range (IQR) = 78.25-67.7; median body mass index = 29.4 Kg/m2, IQR = 31.7-27.4]. OA-IFP stem cells were isolated and characterized for morphology, stemness, metabolic profile and multi-differentiative potential by transmission electron microscopy, flow cytometric analysis, gene expression study and cytochemistry. OA-IFP stem cells displayed a spindle-like morphology, self-renewal potential and responsiveness (CD44, CD105, VEGFR2, FGFR2, IL1R, and IL6R) to microenvironmental stimuli. Characterized by high grade of stemness (STAT3, NOTCH1, c-Myc, OCT-4, KLF4, and NANOG), the cells showed peculiar immunophenotypic properties (CD73+/CD39+/CD90+/CD105+/CD44–/+/CD45–). The expression of HLA-DR, CD34, Fas and FasL was indicative of a possible phenotypic reprograming induced by inflammation. Moreover, the response to mechanical stimuli together with high expression level of COL1A1 gene, suggested their possible protective response against in vivo mechanical overloading. Conversely, the low expression of CD38/NADase was indicative of their inability to counteract NAD+-mediated OA inflammation. Based on the ultrastructural, immunophenotypic and functional characterization, OA-IFP stem cells were hypothesized to be primed by the pathological environment and to exert incomplete protective activity from OA inflammation.
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Affiliation(s)
- Elena Stocco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy.,LifeLab Program, Consorzio per la Ricerca Sanitaria (CORIS), Padua, Italy.,Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling ONLUS, Padua, Italy
| | - Silvia Barbon
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy.,LifeLab Program, Consorzio per la Ricerca Sanitaria (CORIS), Padua, Italy.,Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling ONLUS, Padua, Italy
| | - Monica Piccione
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Elisa Belluzzi
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padua, Italy.,Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, Italy
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Assunta Pozzuoli
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padua, Italy.,Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Padua, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, Padua, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy.,LifeLab Program, Consorzio per la Ricerca Sanitaria (CORIS), Padua, Italy
| | - Rosa Di Liddo
- Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling ONLUS, Padua, Italy.,Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy.,LifeLab Program, Consorzio per la Ricerca Sanitaria (CORIS), Padua, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy.,LifeLab Program, Consorzio per la Ricerca Sanitaria (CORIS), Padua, Italy
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11
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Sun Y, Chen S, Pei M. Comparative advantages of infrapatellar fat pad: an emerging stem cell source for regenerative medicine. Rheumatology (Oxford) 2018; 57:2072-2086. [PMID: 29373763 PMCID: PMC6256334 DOI: 10.1093/rheumatology/kex487] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/13/2017] [Indexed: 12/15/2022] Open
Abstract
Growing evidence indicates that infrapatellar fat pad (IPFP)-derived stem cells (IPFSCs) exert robust proliferation capacities and multilineage differentiation potentials. However, few papers summarize the advantages that the IPFP and IPFSCs have in regenerative medicine. In this review we delineate the development and anatomy of the IPFP by comparing it with an adjacent fibrous tissue, synovium, and a more frequently harvested fat depot, subcutaneous adipose tissue. Furthermore, we explore the similarities and differences of stem cells from these three tissues in terms of IPFSCs, synovium-derived stem cells and subcutaneous adipose tissue-derived stem cells in proliferation capacity and tri-lineage differentiation potentials, including chondrogenesis, osteogenesis and adipogenesis. Finally, we highlight the advantages of IPFSCs in regenerative medicine, such as the abundant accessibility and the ability to resist inflammation and senescence, two hurdles for cell-based tissue regeneration. Considering the comparative advantages of IPFSCs, the IPFP can serve as an excellent stem cell source for regenerative medicine, particularly for cartilage regeneration.
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Affiliation(s)
- Yu Sun
- Department of Orthopaedics, Orthopaedics Institute, Subei People’s Hospital of Jiangsu Province, Yangzhou, Jiangsu, China
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Song Chen
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
- Department of Orthopaedics, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - Ming Pei
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
- Exercise Physiology, West Virginia University, Morgantown, WV, USA
- Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA
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12
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Onofrillo C, Duchi S, O'Connell CD, Blanchard R, O'Connor AJ, Scott M, Wallace GG, Choong PFM, Di Bella C. Biofabrication of human articular cartilage: a path towards the development of a clinical treatment. Biofabrication 2018; 10:045006. [PMID: 30088479 DOI: 10.1088/1758-5090/aad8d9] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cartilage injuries cause pain and loss of function, and if severe may result in osteoarthritis (OA). 3D bioprinting is now a tangible option for the delivery of bioscaffolds capable of regenerating the deficient cartilage tissue. Our team has developed a handheld device, the Biopen, to allow in situ additive manufacturing during surgery. Given its ability to extrude in a core/shell manner, the Biopen can preserve cell viability during the biofabrication process, and it is currently the only biofabrication tool tested as a surgical instrument in a sheep model using homologous stem cells. As a necessary step toward the development of a clinically relevant protocol, we aimed to demonstrate that our handheld extrusion device can successfully be used for the biofabrication of human cartilage. Therefore, this study is a required step for the development of a surgical treatment in human patients. In this work we specifically used human adipose derived mesenchymal stem cells (hADSCs), harvested from the infra-patellar fat pad of donor patients affected by OA, to also prove that they can be utilized as the source of cells for the future clinical application. With the Biopen, we generated bioscaffolds made of hADSCs laden in gelatin methacrylate, hyaluronic acid methacrylate and cultured in the presence of chondrogenic stimuli for eight weeks in vitro. A comprehensive characterisation including gene and protein expression analyses, immunohistology, confocal microscopy, second harmonic generation, light sheet imaging, atomic force mycroscopy and mechanical unconfined compression demonstrated that our strategy resulted in human hyaline-like cartilage formation. Our in situ biofabrication approach represents an innovation with important implications for customizing cartilage repair in patients with cartilage injuries and OA.
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Affiliation(s)
- Carmine Onofrillo
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Clinical Sciences Building, 29 Regent Street, 3065 Fitzroy, VIC, Australia. ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, Innovation Campus, University of Wollongong, NSW, Australia. BioFab3D, Aikenhead Centre for Medical Discovery, St Vincent's Hospital, Melbourne, Australia
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13
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Ye K, Traianedes K, Robins SA, Choong PFM, Myers DE. Osteochondral repair using an acellular dermal matrix-pilot in vivo study in a rabbit osteochondral defect model. J Orthop Res 2018; 36:1919-1928. [PMID: 29244224 DOI: 10.1002/jor.23837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/04/2017] [Indexed: 02/04/2023]
Abstract
UNLABELLED The aim of this pilot project was to introduce a novel use of acellular dermal matrix (ADM) in combination with infrapatellar fat pad mesenchymal stromal cells (IPFP-MSCs) to effect repair in a rabbit osteochondral defect model. ADM, in a range of surgical procedures, has been shown to promote remodelling of tissue at the site of implantation. Rabbit-derived ADM (rabADM) was prepared from the skin of donor rabbits. Autologous IPFP-MSCs were obtained at the time of knee surgery. Osteochondral defects (4 mm cartilage outer/2 mm central bone defect) were drilled into distal femoral condyles of 12 New Zealand White rabbits. Treatments groups: (i) defect only; (ii) rabADM alone; (iii) IPFP-MSCs alone; and (iv) rabADM with IPFP-MSCs. Condyles were harvested at 12 weeks, and analyzed using histology, immunohistochemistry (types I and II collagen) and histomorphometry to evaluate osteochondral repair. The rabADM only group achieved the highest ratio of type II to non-type II collagen (77.3%) using areal measures (similar to normal cartilage), which indicated a higher quality of cartilage repair. The addition of IPFP-MSCs, with or without rabADM, formed a fibrous collagen cap above the lesion site not seen with rabADM alone. Macroscopically, there was no joint erosion, inflammation, swelling or deformity, and all animals maintained full range of motion. CONCLUSIONS RabADM alone resulted in neocartilage formation similar to native cartilage. IPFP-MSCs limited osteochondral repair and contributed to fibrosis, even in combination with the rabADM. Further studies using ADM for osteochondral repair are warranted in a more appropriate pre-clinical model of osteochondral repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1919-1928, 2018.
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Affiliation(s)
- Ken Ye
- Department of Surgery, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Kathy Traianedes
- Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, 3065, Australia.,Department of Medicine, University of Melbourne, St Vincent's Hospital, Fitzroy, Australia
| | - Shalley A Robins
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Fitzroy, Australia
| | - Peter F M Choong
- Department of Surgery, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Damian E Myers
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Fitzroy, Australia.,Victoria University, Sunshine Hospital, St Albans, Australia.,Australian Institute for Musculoskeletal Science, Victoria University and The University of Melbourne, Western Centre for Health and Research Education, Sunshine Hospital, St Albans, Australia
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14
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Adipose-Derived Mesenchymal Stem Cells in the Use of Cartilage Tissue Engineering: The Need for a Rapid Isolation Procedure. Stem Cells Int 2018; 2018:8947548. [PMID: 29765427 PMCID: PMC5903192 DOI: 10.1155/2018/8947548] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/01/2018] [Indexed: 01/09/2023] Open
Abstract
Mesenchymal stem cells (MSCs) have shown much promise with respect to their use in cartilage tissue engineering. MSCs can be obtained from many different tissue sources. Among these, adipose tissue can provide an abundant source of adipose-derived mesenchymal stem cells (ADMSCs). The infrapatellar fat pad (IFP) is a promising source of ADMSCs with respect to producing a cartilage lineage. Cell isolation protocols to date are time-consuming and follow conservative approaches that rely on a long incubation period of 24–48 hours. The different types of ADMSC isolation techniques used for cartilage repair will be reviewed and compared with the view of developing a rapid one-step isolation protocol that can be applied in the context of a surgical procedure.
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15
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Ude CC, Shamsul BS, Ng MH, Chen HC, Ohnmar H, Amaramalar SN, Rizal AR, Johan A, Norhamdan MY, Azizi M, Aminuddin BS, Ruszymah BHI. Long-term evaluation of osteoarthritis sheep knee, treated with TGF-β3 and BMP-6 induced multipotent stem cells. Exp Gerontol 2018; 104:43-51. [PMID: 29421350 DOI: 10.1016/j.exger.2018.01.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/09/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hyaline articular cartilage, which protects the bones of diarthrodial joints from forces associated with load bearing, frictions, and impacts has very limited capacities for self-repair. Over the years, the trend of treatments has shifted to regenerations and researchers have been on the quest for a lasting regeneration. We evaluated the treatment of osteoarthritis by chondrogenically induced ADSCs and BMSCs for a long time functional recovery. METHODS Osteoarthritis was induced at the right knee of sheep by complete resection of ACL and medial meniscus. Stem cells from sheep were induced to chondrogenic lineage. Test sheep received 5 mls single doses of 2 × 107 autologous PKH26-labelled ADSCs or BMSCs, while controls received basal medium. Functional recovery of the knees was evaluated via electromyography. RESULTS Induced ADSCs had 625, 255, 393, 908, 409, 157 and 1062 folds increases of collagen I, collagen II, aggrecan, SOX9, cartilage oligomeric protein, chondroadherin and fibromodullin compare to uninduced cells, while BMSCs had 702, 657, 321, 276, 337, 233 and 1163 respectively; p = .001. Immunocytochemistry was positive for these chondrogenic markers. 12 months post-treatment, controls scored 4 in most regions using ICRS, while the treated had 8; P = .001. Regenerated cartilages were positive to PKH26 and demonstrated the presence of condensing cartilages on haematoxylin and eosin; and Safranin O. OA degenerations caused significant amplitude shift from right to left hind limb. After treatments, controls persisted with significant decreases; while treated samples regained balance. CONCLUSIONS Both ADSCs and BMSCs had increased chondrogenic gene expressions using TGF-β3 and BMP-6. The treated knees had improved cartilage scores; PKH26 can provide elongated tracking, while EMG results revealed improved joint recoveries. These could be suitable therapies for osteoarthritis.
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Affiliation(s)
- C C Ude
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia; Bioartificial Organ and Regenerative Medicine Unit, National Defence University of Malaysia, Sungai Besi Camp 57000, K.L, Malaysia
| | - B S Shamsul
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia
| | - M H Ng
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia
| | - H C Chen
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Malaysia.
| | - Htwe Ohnmar
- Rehab Unit, Department of Orthopedic & Traumatology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia
| | - S N Amaramalar
- Rehab Unit, Department of Orthopedic & Traumatology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia
| | - A R Rizal
- Department of Orthopedic & Traumatology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia.
| | - A Johan
- Department of Orthopedic & Traumatology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia
| | - M Y Norhamdan
- Department of Orthopedic & Traumatology, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia
| | - M Azizi
- Bioartificial Organ and Regenerative Medicine Unit, National Defence University of Malaysia, Sungai Besi Camp 57000, K.L, Malaysia
| | - B S Aminuddin
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia; ENT Consultant Clinic, Ampang Putri Specialist Hospital, 68000 Ampang, Malaysia
| | - B H I Ruszymah
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, K.L, Malaysia; Department of Physiology, Medical Faculty, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif Bandar Tun Razak Muda Abdul Aziz, Campus, 56000 K.L, Malaysia..
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16
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Najar M, Dollé L, Crompot E, Verhulst S, van Grunsven LA, Busser H, Lagneaux L. Isolation and Characterization of Bone Marrow Mesenchymal Stromal Cell Subsets in Culture Based on Aldehyde Dehydrogenase Activity. Tissue Eng Part C Methods 2018; 24:89-98. [PMID: 29241418 DOI: 10.1089/ten.tec.2017.0312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mesenchymal stromal cells (MSCs) have particular properties that allow their use as therapeutic strategies for several cell-based applications. Historically, bone marrow (BM)-MSCs are isolated by culture adherence since specific cell surface markers are yet to be developed. This original work aimed to identify and characterize isolating expanded BM-MSCs based on their aldehyde dehydrogenase (ALDH) activity known to be a hallmark of stem cells and relevant for their isolation. We thus isolated by fluorescence-activated cell sorting technology two functionally different populations of BM-MSCs depending on their ALDH activity (ALDH+ and ALDH-). Transcriptome analysis and profiling clearly demonstrated that both populations of BM-MSCs present distinct pattern of genes related to the main properties of MSCs (proliferation, response to hypoxia, angiogenesis, phenotype, stemness, multilineage, hematopoiesis, immunomodulation) in an ALDH activity dependent manner. Both BM-MSC populations look to significantly differ in terms of biological responses and functionalities. More functional analyses are needed to understand and characterize the properties of these ALDH populations. Collectively, our results highlight ALDH activity as a potential feature for isolating and segregating functional and/or competent subset of BM-MSC populations, which may account for better and more efficient therapeutic issue.
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Affiliation(s)
- Mehdi Najar
- 1 Department of Haematology, Laboratory of Clinical Cell Therapy (LTCC), Jules Bordet Institute , Université Libre de Bruxelles (ULB), Campus Erasme, Bâtiment de Transfusion (Level +1), Brussels, Belgium
| | - Laurent Dollé
- 2 Department of Cell Biology (CYTO-VUB), Liver Cell Biology Laboratory, Vrije Universiteit Brussel , Brussels, Belgium
| | - Emerence Crompot
- 1 Department of Haematology, Laboratory of Clinical Cell Therapy (LTCC), Jules Bordet Institute , Université Libre de Bruxelles (ULB), Campus Erasme, Bâtiment de Transfusion (Level +1), Brussels, Belgium
| | - Stefaan Verhulst
- 2 Department of Cell Biology (CYTO-VUB), Liver Cell Biology Laboratory, Vrije Universiteit Brussel , Brussels, Belgium
| | - Leo A van Grunsven
- 2 Department of Cell Biology (CYTO-VUB), Liver Cell Biology Laboratory, Vrije Universiteit Brussel , Brussels, Belgium
| | - Hélène Busser
- 1 Department of Haematology, Laboratory of Clinical Cell Therapy (LTCC), Jules Bordet Institute , Université Libre de Bruxelles (ULB), Campus Erasme, Bâtiment de Transfusion (Level +1), Brussels, Belgium
| | - Laurence Lagneaux
- 1 Department of Haematology, Laboratory of Clinical Cell Therapy (LTCC), Jules Bordet Institute , Université Libre de Bruxelles (ULB), Campus Erasme, Bâtiment de Transfusion (Level +1), Brussels, Belgium
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17
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Neri S, Guidotti S, Lilli NL, Cattini L, Mariani E. Infrapatellar fat pad-derived mesenchymal stromal cells from osteoarthritis patients: In vitro genetic stability and replicative senescence. J Orthop Res 2017; 35:1029-1037. [PMID: 27334047 DOI: 10.1002/jor.23349] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/21/2016] [Indexed: 02/04/2023]
Abstract
Different sources of mesenchymal stromal cells can be considered for regenerative medicine applications. Here we analyzed human adipose-derived stromal cells from infrapatellar fat pad (IFPSC) of osteoarthritis patients, representing a very interesting candidate for cartilage regeneration. No data are available concerning IFPSC stability after in vitro expansion. Indeed, replicative potential and multipotency progressively decrease during culture passages while DNA damage and cell senescence increase, thus possibly affecting clinical applications. To investigate whether in vitro expansion influences the genetic stability and replicative senescence of IFPSC, we performed long-term cultures and comparatively analyzed cells at different culture passages. Stromal vascular fraction was harvested from infrapatellar fat pad of 11 osteoarthritis patients undergoing knee replacement surgery. Cell recovery, growth kinetics, surface marker profile, and differentiation ability in inductive culture conditions were recorded. Genetic integrity maintenance was estimated by microsatellite instability analysis and mismatch repair gene expression, whereas telomere length and telomerase activity were assessed to evaluate replicative senescence. Anchorage-dependent growth was tested by soft agar culture. IFPSC displayed a phenotype similar to mesenchymal stromal cells from subcutaneous fat and showed differentiation ability. No microsatellite instability was documented even at advanced culture times in accordance to a sustained expression of mismatch repair genes, thus highlighting stability of short repeated sequences in the genome. No significant telomere attrition nor telomerase activity were documented during culture and cells did not lose anchorage-dependent growth ability. The presented data support the suitability and safety of in vitro expanded IFPSC from osteoarthritis patients for applications in regenerative medicine approaches. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1029-1037, 2017.
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Affiliation(s)
- Simona Neri
- Immunorheumatology and Tissue Regeneration Laboratory, Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Serena Guidotti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nicoletta Libera Lilli
- Immunorheumatology and Tissue Regeneration Laboratory, Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Luca Cattini
- Immunorheumatology and Tissue Regeneration Laboratory, Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Erminia Mariani
- Immunorheumatology and Tissue Regeneration Laboratory, Rizzoli Orthopedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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18
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Zhu Y, Wu X, Liang Y, Gu H, Song K, Zou X, Zhou G. Repair of cartilage defects in osteoarthritis rats with induced pluripotent stem cell derived chondrocytes. BMC Biotechnol 2016; 16:78. [PMID: 27829414 PMCID: PMC5103600 DOI: 10.1186/s12896-016-0306-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 10/18/2016] [Indexed: 12/19/2022] Open
Abstract
Background The incapacity of articular cartilage (AC) for self-repair after damage ultimately leads to the development of osteoarthritis. Stem cell-based therapy has been proposed for the treatment of osteoarthritis (OA) and induced pluripotent stem cells (iPSCs) are becoming a promising stem cell source. Results Three steps were developed to differentiate human iPSCs into chondrocytes which were transplanted into rat OA models induced by monosodium iodoacetate (MIA). After 6 days embryonic body (EB) formation and 2 weeks differentiation, the gene and protein expression of Col2A1, GAG and Sox9 has significantly increased compare to undifferentiated hiPSCs. After 15 weeks transplantation, no immune responses were observed, micro-CT showed gradual engraftment and the improvement of subchondrol plate integrity, and histological examinations demonstrated articular cartilage matrix production. Conclusions hiPSC could be an efficient and clinically translatable approach for cartilage tissue regeneration in OA cartilages.
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Affiliation(s)
- Yanxia Zhu
- Shenzhen Key Laboratory for Anti-ageing and Regenerative Medicine, Health Science Center, Shenzhen University, Shenzhen, 518060, China.
| | - Xiaomin Wu
- Shenzhen Key Laboratory for Anti-ageing and Regenerative Medicine, Health Science Center, Shenzhen University, Shenzhen, 518060, China
| | - Yuhong Liang
- Shenzhen Key Laboratory for Anti-ageing and Regenerative Medicine, Health Science Center, Shenzhen University, Shenzhen, 518060, China
| | - Hongsheng Gu
- Department of Spinal Surgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518060, China
| | - Kedong Song
- State Key Laboratory of Fine Chemicals, Dalian R&D Center for Stem Cell and Tissue Engineering, Dalian University of Technology, Dalian, 116024, China
| | - Xuenong Zou
- Department of Spinal Surgery, Orthopaedic Research Institute, Huangpu Division, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Guangqian Zhou
- Shenzhen Key Laboratory for Anti-ageing and Regenerative Medicine, Health Science Center, Shenzhen University, Shenzhen, 518060, China.
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19
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Ye K, Traianedes K, Choong PFM, Myers DE. Chondrogenesis of Human Infrapatellar Fat Pad Stem Cells on Acellular Dermal Matrix. Front Surg 2016; 3:3. [PMID: 26858950 PMCID: PMC4726816 DOI: 10.3389/fsurg.2016.00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/12/2016] [Indexed: 11/25/2022] Open
Abstract
Acellular dermal matrix (ADM) has been in clinical use for decades in numerous surgical applications. The ability for ADM to promote cellular repopulation, revascularisation and tissue regeneration is well documented. Adipose stem cells have the ability to differentiate into mesenchymal tissue types, including bone and cartilage. The aim of this study was to investigate the potential interaction between ADM and adipose stem cells in vitro using TGFβ3 and BMP6. Human infrapatellar fat pad-derived adipose stem cells (IPFP-ASC) were cultured with ADM derived from rat dermis in chondrogenic (TGFβ3 and BMP6) medium in vitro for 2 and 4 weeks. Histology, qPCR, and immunohistochemistry were performed to assess for markers of chondrogenesis (collagen Type II, SOX9 and proteoglycans). At 4 weeks, cell-scaffold constructs displayed cellular changes consistent with chondrogenesis, with evidence of stratification of cell layers and development of a hyaline-like cartilage layer superficially, which stained positively for collagen Type II and proteoglycans. Significant cell–matrix interaction was seen between the cartilage layer and the ADM itself with seamless integration between each layer. Real time qPCR showed significantly increased COL2A1, SOX9, and ACAN gene expression over 4 weeks when compared to control. COL1A2 gene expression remained unchanged over 4 weeks. We believe that the principles that make ADM versatile and successful for tissue regeneration are applicable to cartilage regeneration. This study demonstrates in vitro the ability for IPFP-ASCs to undergo chondrogenesis, infiltrate, and interact with ADM. These outcomes serve as a platform for in vivo modelling of ADM for cartilage repair.
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Affiliation(s)
- Ken Ye
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Kathy Traianedes
- Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Damian E Myers
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne , Fitzroy, VIC , Australia
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Luo L, Thorpe SD, Buckley CT, Kelly DJ. The effects of dynamic compression on the development of cartilage grafts engineered using bone marrow and infrapatellar fat pad derived stem cells. ACTA ACUST UNITED AC 2015; 10:055011. [PMID: 26391756 DOI: 10.1088/1748-6041/10/5/055011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Bioreactors that subject cell seeded scaffolds or hydrogels to biophysical stimulation have been used to improve the functionality of tissue engineered cartilage and to explore how such constructs might respond to the application of joint specific mechanical loading. Whether a particular cell type responds appropriately to physiological levels of biophysical stimulation could be considered a key determinant of its suitability for cartilage tissue engineering applications. The objective of this study was to determine the effects of dynamic compression on chondrogenesis of stem cells isolated from different tissue sources. Porcine bone marrow (BM) and infrapatellar fat pad (FP) derived stem cells were encapsulated in agarose hydrogels and cultured in a chondrogenic medium in free swelling (FS) conditions for 21 d, after which samples were subjected to dynamic compression (DC) of 10% strain (1 Hz, 1 h d(-1)) for a further 21 d. Both BM derived stem cells (BMSCs) and FP derived stem cells (FPSCs) were capable of generating cartilaginous tissues with near native levels of sulfated glycosaminoglycan (sGAG) content, although the spatial development of the engineered grafts strongly depended on the stem cell source. The mechanical properties of cartilage grafts generated from both stem cell sources also approached that observed in skeletally immature animals. Depending on the stem cell source and the donor, the application of DC either enhanced or had no significant effect on the functional development of cartilaginous grafts engineered using either BMSCs or FPSCs. BMSC seeded constructs subjected to DC stained less intensely for collagen type I. Furthermore, histological and micro-computed tomography analysis showed mineral deposition within BMSC seeded constructs was suppressed by the application of DC. Therefore, while the application of DC in vitro may only lead to modest improvements in the mechanical functionality of cartilaginous grafts, it may play an important role in the development of phenotypically stable constructs.
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Affiliation(s)
- Lu Luo
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland. Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
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Solbak NM, Heard BJ, Achari Y, Chung M, Shrive NG, Frank CB, Hart DA. Alterations in Hoffa’s fat pad induced by an inflammatory response following idealized anterior cruciate ligament surgery. Inflamm Res 2015; 64:615-26. [DOI: 10.1007/s00011-015-0840-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 05/19/2015] [Accepted: 06/05/2015] [Indexed: 12/28/2022] Open
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Wang N, Zhao JY, Guan X, Dong Y, Liu Y, Zhou X, Wu R, Du Y, Zhao L, Zou W, Han C, Song L, Sun B, Liu Y, Liu J. Biological characteristics of adipose tissue-derived stem cells labeled with amine-surface-modified superparamagnetic iron oxide nanoparticles. Cell Biol Int 2015; 39:899-909. [PMID: 25759304 DOI: 10.1002/cbin.10457] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/25/2015] [Indexed: 12/20/2022]
Abstract
Cell labeling and tracking are becoming increasingly important areas within the field of stem cell transplantation. The ability to track the migration and distribution of implanted cells is critical to understanding the beneficial effects and mechanisms of stem cell therapy. The present study investigated the effects of amine-surface-modified superparamagnetic iron oxide (SPIO) nanoparticles on the biological properties of human adipose tissue-derived stem cells (hADSCs). Monodisperse hydrophobic magnetite (Fe3 O4 ) nanoparticles were prepared using silicon and surface-modified with amine coating. Cell viability, proliferation, differentiation potential, and surface marker expression were evaluated. The magnetic particles (10-18 nm) displayed high labeling efficiency and stability in hADSCs. SPIO-labeled cells produced a hypointense signal and were effectively visualized by MRI for up to 21 days. The results of MTT proliferation assays and flow cytometry analysis demonstrated that SPIOs were biocompatible, viz. the labeling process did not cause cell death or apoptosis and had no side effects on cell proliferation. In vivo experiments showed that the magnetic particles did not affect liver and kidney function. The successful and stable labeling of hADSCs combined with efficient magnetic tropism demonstrates that SPIOs are promising candidates for hADSC tracking in hADSC-based cell therapy applications.
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Affiliation(s)
- Nan Wang
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China.,Central Laboratory, Sixth People's Hospital of Dalian, Dalian 116031, P. R. China
| | - Jing-Yuan Zhao
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Xin Guan
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Yue Dong
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Yang Liu
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Xiang Zhou
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Ren'an Wu
- Dalian Institute of Chemical Physics, Dalian 116021, P. R. China
| | - Yue Du
- College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, P. R. China
| | - Liang Zhao
- Dalian Institute of Chemical Physics, Dalian 116021, P. R. China
| | - Wei Zou
- College of Life Sciences, Liaoning Normal University, Dalian 116011, P. R. China
| | - Chao Han
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Lin Song
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China.,School of Life Science and Biotechnology, Dalian University of Technology, Dalian 116024, P. R. China
| | - Bo Sun
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Yan Liu
- Department of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
| | - Jing Liu
- Regenerative Medicine Center, First Affiliated Hospital of Dalian Medical University, Dalian 116021, P. R. China
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Ye K, Felimban R, Traianedes K, Moulton SE, Wallace GG, Chung J, Quigley A, Choong PFM, Myers DE. Chondrogenesis of infrapatellar fat pad derived adipose stem cells in 3D printed chitosan scaffold. PLoS One 2014; 9:e99410. [PMID: 24918443 PMCID: PMC4053433 DOI: 10.1371/journal.pone.0099410] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/14/2014] [Indexed: 11/18/2022] Open
Abstract
Infrapatellar fat pad adipose stem cells (IPFP-ASCs) have been shown to harbor chondrogenic potential. When combined with 3D polymeric structures, the stem cells provide a source of stem cells to engineer 3D tissues for cartilage repair. In this study, we have shown human IPFP-ASCs seeded onto 3D printed chitosan scaffolds can undergo chondrogenesis using TGFβ3 and BMP6. By week 4, a pearlescent, cartilage-like matrix had formed that penetrated the top layers of the chitosan scaffold forming a 'cap' on the scaffold. Chondrocytic morphology showed typical cells encased in extracellular matrix which stained positively with toluidine blue. Immunohistochemistry demonstrated positive staining for collagen type II and cartilage proteoglycans, as well as collagen type I. Real time PCR analysis showed up-regulation of collagen type II, aggrecan and SOX9 genes when IPFP-ASCs were stimulated by TGFβ3 and BMP6. Thus, IPFP-ASCs can successfully undergo chondrogenesis using TGFβ3 and BMP6 and the cartilage-like tissue that forms on the surface of 3D-printed chitosan scaffold may prove useful as an osteochondral graft.
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Affiliation(s)
- Ken Ye
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Raed Felimban
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Kathy Traianedes
- Departments of Medicine and Clinical Neurosciences, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Simon E Moulton
- Intelligent Polymer Research Institute, University of Wollongong, ARC Centre of Excellence for Electromaterials Science (ACES), Squires Way, North Wollongong, New South Wales, Australia
| | - Gordon G Wallace
- Intelligent Polymer Research Institute, University of Wollongong, ARC Centre of Excellence for Electromaterials Science (ACES), Squires Way, North Wollongong, New South Wales, Australia
| | - Johnson Chung
- Intelligent Polymer Research Institute, University of Wollongong, ARC Centre of Excellence for Electromaterials Science (ACES), Squires Way, North Wollongong, New South Wales, Australia
| | - Anita Quigley
- Departments of Medicine and Clinical Neurosciences, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Damian E Myers
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St Vincent's Hospital, Fitzroy, Victoria, Australia
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