1
|
Lintz M, Walk RE, Tang SY, Bonassar LJ. The degenerative impact of hyperglycemia on the structure and mechanics of developing murine intervertebral discs. JOR Spine 2022; 5:e1191. [PMID: 35386755 PMCID: PMC8966876 DOI: 10.1002/jsp2.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Diabetes has long been implicated as a major risk factor for intervertebral disc (IVD) degeneration, interfering with molecular signaling and matrix biochemistry, which ultimately aggravates the progression of the disease. Glucose content has been previously shown to influence structural and compositional changes in engineered discs in vitro, impeding fiber formation and mechanical stability. Methods In this study, we investigated the impact of diabetic hyperglycemia on young IVDs by assessing biochemical composition, collagen fiber architecture, and mechanical behavior of discs harvested from 3‐ to 4‐month‐old db/db mouse caudal spines. Results We found that discs taken from diabetic mice with elevated blood glucose levels demonstrated an increase in total glycosaminoglycan and collagen content, but comparable advanced glycation end products (AGE) levels to wild‐type discs. Diabetic discs also contained ill‐defined boundaries between the nucleus pulposus and annulus fibrosus, with the latter showing a disorganized and unaligned collagen fiber network at this same boundary. Conclusions These compositional and structural changes had a detrimental effect on function, as the diabetic discs were twice as stiff as their wild‐type counterparts and demonstrated a significant resistance to deformation. These results indicate that diabetes may predispose the young disc to DDD later in life by altering patterns of extracellular matrix deposition, fiber formation, and motion segment mechanics independently of AGE accumulation.
Collapse
Affiliation(s)
- Marianne Lintz
- Meinig School of Biomedical Engineering Cornell University Ithaca New York USA
| | - Remy E. Walk
- Department of Biomedical Engineering Washington University in St. Louis St. Louis Missouri USA
| | - Simon Y. Tang
- Department of Biomedical Engineering Washington University in St. Louis St. Louis Missouri USA
- Department of Mechanical Engineering and Materials Science Washington University in St. Louis St. Louis Missouri USA
- Department of Orthopaedic Surgery Washington University in St. Louis St. Louis Missouri USA
| | - Lawrence J. Bonassar
- Meinig School of Biomedical Engineering Cornell University Ithaca New York USA
- Sibley School of Mechanical and Aerospace Engineering Cornell University Ithaca New York USA
| |
Collapse
|
2
|
Gullbrand SE, Kim DH, Ashinsky BG, Bonnevie ED, Smith HE, Mauck RL. Restoration of physiologic loading modulates engineered intervertebral disc structure and function in an in vivo model. JOR Spine 2020; 3:e1086. [PMID: 32613161 PMCID: PMC7323465 DOI: 10.1002/jsp2.1086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022] Open
Abstract
Tissue-engineered whole disc replacements are an emerging treatment strategy for advanced intervertebral disc degeneration. A challenge facing the translation of tissue-engineered disc replacement to clinical use are the opposing needs of initial immobilization to advantage integration contrasted with physiologic loading and its anabolic effects. Here, we utilize our established rat tail model of tissue engineered disc replacement with external fixation to study the effects of remobilization at two time points postimplantation on engineered disc structure, composition, and function. Our results suggest that the restoration of mechanical loading following immobilization enhanced collagen and proteoglycan content within the nucleus pulposus and annulus fibrosus of the engineered discs, in addition to improving the integration of the endplate region of the construct with native bone. Despite these benefits, angulation of the vertebral bodies at the implanted level occurred following remobilization at both early and late time points, reducing tensile failure properties in the remobilized groups compared to the fixed group. These results demonstrate the necessity of restoring physiologic mechanical loading to engineered disc implants in vivo, and the need to transition toward their evaluation in larger animal models with more human-like anatomy and motion compared to the rat tail.
Collapse
Affiliation(s)
- Sarah E. Gullbrand
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dong Hwa Kim
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Beth G. Ashinsky
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- School of Biomedical Engineering, Science and Health SystemsDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Edward D. Bonnevie
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Harvey E. Smith
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
3
|
Chong JE, Santerre JP, Kandel RA. Generation of an in vitro model of the outer annulus fibrosus-cartilage interface. JOR Spine 2020; 3:e1089. [PMID: 32613164 PMCID: PMC7323466 DOI: 10.1002/jsp2.1089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/06/2020] [Accepted: 03/22/2020] [Indexed: 12/19/2022] Open
Abstract
Current treatments for degenerative disc disease do not restore full biological functionality of the intervertebral disc (IVD). As a result, regenerative medicine approaches are being developed to generate a biological replacement that when implanted will restore form and function of the degenerated IVD. Tissue-engineered models to date have focused on the generation of nucleus pulposus and annulus fibrosus IVD components. However, these tissues need to be integrated with a cartilage endplate in order for successful implantation to occur. The purpose of this study was to generate an in vitro annulus fibrosus-cartilage interface model which would enable us to better understand the biological and biomechanical implications of such interfaces. It was hypothesized that in vitro-formed outer annulus fibrosus (OAF) and cartilage tissues would integrate in direct-contact coculture to yield an interface containing extracellular matrix with aspects resembling the native OAF-CEP interface. In vitro-formed tissues were generated using bovine OAF cell-seeded angle-ply, multi-lamellated polycarbonate urethane scaffolds and articular chondrocytes, which were then placed in direct-contact coculture. 2-week old OAF tissues integrated with 3-day old cartilage by 1 week of coculture. Immunohistochemical staining of 2-week interfaces showed that distributions of collagen type I, collagen type II, and aggrecan were similar to the native bovine interface. The apparent tensile strength of the in vitro interface increased significantly between 2 and 4 weeks of coculture. In summary, an annulus fibrosus-cartilage interface model can be formed in vitro which will facilitate the identification of conditions required to generate an entire tissue-engineered disc replacement suitable for clinical use.
Collapse
Affiliation(s)
- Jasmine E. Chong
- Lunenfeld‐Tanenbaum Research Institute, Mount Sinai HospitalTorontoOntarioCanada
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoOntarioCanada
| | - J. Paul Santerre
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoOntarioCanada
- Translational Biology and Engineering Program and Faculty of DentistryUniversity of TorontoTorontoOntarioCanada
| | - Rita A. Kandel
- Lunenfeld‐Tanenbaum Research Institute, Mount Sinai HospitalTorontoOntarioCanada
- Institute of Biomaterials and Biomedical EngineeringUniversity of TorontoTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
4
|
Gloria A, Russo T, D'Amora U, Santin M, De Santis R, Ambrosio L. Customised multiphasic nucleus/annulus scaffold for intervertebral disc repair/regeneration. Connect Tissue Res 2020; 61:152-162. [PMID: 31398999 DOI: 10.1080/03008207.2019.1650037] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: In the case of a degenerated intervertebral disc (IVD), even though spinal fusion has provided good short-term clinical results, an alteration of the spine stability has been demonstrated by long-term studies. In this context, different designs of IVD prostheses have been proposed as alternative to spinal fusion. However, over the past few years, much of the recent research has been devoted to IVD tissue engineering, even if several limitations related to the complex structure of IVD are still presented.Purpose/Aim: Accordingly, the aim of the current paper was to develop a strategy in designing customised multiphasic nucleus/annulus scaffolds for IVD tissue engineering, benefiting from the great potential of reverse engineering, additive manufacturing and gels technology.Materials and Methods: The device consisted of a customised additive-manufactured poly(ε-caprolactone) scaffold with tailored architectural features as annulus and a cell-laden collagen-low molecular weight hyaluronic acid-based material as nucleus with specific rheological and functional properties. To this aim, injectability and viscoelastic properties of the hydrogel were analyzed. Furthermore, a mechanical and biological characterization of cell-laden multiphasic nucleus/annulus scaffold was performed.Results and Conclusions: Analyses on the developed devices demonstrated appropriate viscoelastic and mechanical properties. As evidenced by rheological tests, the hydrogel showed a shear-thinning behaviour, supporting the possibility to inject the material. The mechanical characterization highlighted a compressive modulus which falls in the range of lumbar discs, with the typical initial J-shaped stress-strain curve of natural IVDs. Furthermore, preliminary biological tests showed that human mesenchymal stem cells were viable over the culture period.
Collapse
Affiliation(s)
- A Gloria
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - T Russo
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - U D'Amora
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - M Santin
- Centre for Regenerative Medicine and Devices, School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - R De Santis
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| | - L Ambrosio
- Institute of Polymers, Composites and Biomaterials, National Research Council, Naples, Italy
| |
Collapse
|
5
|
Frost BA, Camarero-Espinosa S, Foster EJ. Materials for the Spine: Anatomy, Problems, and Solutions. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E253. [PMID: 30646556 PMCID: PMC6356370 DOI: 10.3390/ma12020253] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/28/2018] [Accepted: 01/05/2019] [Indexed: 12/24/2022]
Abstract
Disc degeneration affects 12% to 35% of a given population, based on genetics, age, gender, and other environmental factors, and usually occurs in the lumbar spine due to heavier loads and more strenuous motions. Degeneration of the extracellular matrix (ECM) within reduces mechanical integrity, shock absorption, and swelling capabilities of the intervertebral disc. When severe enough, the disc can bulge and eventually herniate, leading to pressure build up on the spinal cord. This can cause immense lower back pain in individuals, leading to total medical costs exceeding $100 billion. Current treatment options include both invasive and noninvasive methods, with spinal fusion surgery and total disc replacement (TDR) being the most common invasive procedures. Although these treatments cause pain relief for the majority of patients, multiple challenges arise for each. Therefore, newer tissue engineering methods are being researched to solve the ever-growing problem. This review spans the anatomy of the spine, with an emphasis on the functions and biological aspects of the intervertebral discs, as well as the problems, associated solutions, and future research in the field.
Collapse
Affiliation(s)
- Brody A Frost
- Department of Materials Science and Engineering, Macromolecules Innovation Institute, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Sandra Camarero-Espinosa
- Complex Tissue Regeneration Department, MERLN Institute for Technology-inspired Regenerative Medicine, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands.
| | - E Johan Foster
- Department of Materials Science and Engineering, Macromolecules Innovation Institute, Virginia Tech, Blacksburg, VA 24061, USA.
| |
Collapse
|
6
|
Yang J, Yang X, Wang L, Zhang W, Yu W, Wang N, Peng B, Zheng W, Yang G, Jiang X. Biomimetic nanofibers can construct effective tissue-engineered intervertebral discs for therapeutic implantation. NANOSCALE 2018; 9:13095-13103. [PMID: 28848971 DOI: 10.1039/c7nr03944a] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present a total tissue engineered (TE) intervertebral disc (IVD) to address IVD degradation, which is a major cause of chronic neck and back pain. The TE IVD is comprised of an alginate hydrogel-based nucleus pulposus (NP) and hierarchically organized, concentric ring-aligned electrospun (ES) polycaprolactone (PCL)/poly (d,l-lactide-co-glycolide) (PLGA)/Collagen type I (PPC)-based annulus fibrosus (AF). The TE IVD exhibits excellent hydrophilicity to simulate highly hydrated native IVD. Long-term in vivo implantation assays demonstrate the excellent structural (shape maintenance, hydration, and integration with surrounding tissues) and functional (mechanical supporting and flexibility) performances of the TE IVD. Our study provides a novel approach for treating IVD degeneration.
Collapse
Affiliation(s)
- Junchuan Yang
- National Engineering Research Center for Nano-Medicine, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Gullbrand SE, Ashinsky BG, Bonnevie ED, Kim DH, Engiles JB, Smith LJ, Elliott DM, Schaer TP, Smith HE, Mauck RL. Long-term mechanical function and integration of an implanted tissue-engineered intervertebral disc. Sci Transl Med 2018; 10:eaau0670. [PMID: 30463917 PMCID: PMC7380504 DOI: 10.1126/scitranslmed.aau0670] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023]
Abstract
Tissue engineering holds great promise for the treatment of advanced intervertebral disc degeneration. However, assessment of in vivo integration and mechanical function of tissue-engineered disc replacements over the long term, in large animal models, will be necessary to advance clinical translation. To that end, we developed tissue-engineered, endplate-modified disc-like angle ply structures (eDAPS) sized for the rat caudal and goat cervical spines that recapitulate the hierarchical structure of the native disc. Here, we demonstrate functional maturation and integration of these eDAPS in a rat caudal disc replacement model, with compressive mechanical properties reaching native values after 20 weeks in vivo and evidence of functional integration under physiological loads. To further this therapy toward clinical translation, we implanted eDAPS sized for the human cervical disc space in a goat cervical disc replacement model. Our results demonstrate maintenance of eDAPS composition and structure up to 8 weeks in vivo in the goat cervical disc space and maturation of compressive mechanical properties to match native levels. These results demonstrate the translational feasibility of disc replacement with a tissue-engineered construct for the treatment of advanced disc degeneration.
Collapse
Affiliation(s)
- Sarah E Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beth G Ashinsky
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- School of Biomedical Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Edward D Bonnevie
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dong Hwa Kim
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Julie B Engiles
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19348, USA
| | - Lachlan J Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716, USA
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19348, USA
| | - Harvey E Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA.
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert L Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA.
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
8
|
Doench I, Torres-Ramos MEW, Montembault A, Nunes de Oliveira P, Halimi C, Viguier E, Heux L, Siadous R, Thiré RMSM, Osorio-Madrazo A. Injectable and Gellable Chitosan Formulations Filled with Cellulose Nanofibers for Intervertebral Disc Tissue Engineering. Polymers (Basel) 2018; 10:E1202. [PMID: 30961127 PMCID: PMC6290636 DOI: 10.3390/polym10111202] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022] Open
Abstract
The development of non-cellularized injectable suspensions of viscous chitosan (CHI) solutions (1.7⁻3.3% (w/w)), filled with cellulose nanofibers (CNF) (0.02⁻0.6% (w/w)) of the type nanofibrillated cellulose, was proposed for viscosupplementation of the intervertebral disc nucleus pulposus tissue. The achievement of CNF/CHI formulations which can gel in situ at the disc injection site constitutes a minimally-invasive approach to restore damaged/degenerated discs. We studied physico-chemical aspects of the sol and gel states of the CNF/CHI formulations, including the rheological behavior in relation to injectability (sol state) and fiber mechanical reinforcement (gel state). CNF-CHI interactions could be evidenced by a double flow behavior due to the relaxation of the CHI polymer chains and those interacting with the CNFs. At high shear rates resembling the injection conditions with needles commonly used in surgical treatments, both the reference CHI viscous solutions and those filled with CNFs exhibited similar rheological behavior. The neutralization of the flowing and weakly acidic CNF/CHI suspensions yielded composite hydrogels in which the nanofibers reinforced the CHI matrix. We performed evaluations in relation to the biomedical application, such as the effect of the intradiscal injection of the CNF/CHI formulation in pig and rabbit spine models on disc biomechanics. We showed that the injectable formulations became hydrogels in situ after intradiscal gelation, due to CHI neutralization occurring in contact with the body fluids. No leakage of the injectate through the injection canal was observed and the gelled formulation restored the disc height and loss of mechanical properties, which is commonly related to disc degeneration.
Collapse
Affiliation(s)
- Ingo Doench
- Institute of Microsystems Engineering IMTEK, Laboratory for Sensors, University of Freiburg, 79110 Freiburg, Germany.
- Freiburg Materials Research Center FMF, University of Freiburg, 79104 Freiburg, Germany.
| | - Maria E W Torres-Ramos
- Institute of Microsystems Engineering IMTEK, Laboratory for Sensors, University of Freiburg, 79110 Freiburg, Germany.
- Freiburg Materials Research Center FMF, University of Freiburg, 79104 Freiburg, Germany.
| | - Alexandra Montembault
- Ingénierie des Matériaux Polymères (IMP), CNRS UMR 5223, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne Cedex, France.
| | - Paula Nunes de Oliveira
- Ingénierie des Matériaux Polymères (IMP), CNRS UMR 5223, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne Cedex, France.
| | - Celia Halimi
- Ingénierie des Matériaux Polymères (IMP), CNRS UMR 5223, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne Cedex, France.
| | - Eric Viguier
- VetAgro Sup, Veterinary School, University of Lyon, 69280 Marcy l'Etoile, France.
| | - Laurent Heux
- Centre de Recherches sur les Macromolécules Végétales (CERMAV)-CNRS UPR 5301 Université Grenoble-Alpes, 38041 Grenoble, France.
| | - Robin Siadous
- INSERM U1026 Bioingénierie tissulaire, Université Bordeaux, 33000 Bordeaux, France.
| | - Rossana M S M Thiré
- COPPE/Program of Metallurgical and Materials Engineering, Federal University of Rio de Janeiro, P.O. Box 68505, 21941-972 Rio de Janeiro, Brazil.
| | - Anayancy Osorio-Madrazo
- Institute of Microsystems Engineering IMTEK, Laboratory for Sensors, University of Freiburg, 79110 Freiburg, Germany.
- Freiburg Materials Research Center FMF, University of Freiburg, 79104 Freiburg, Germany.
| |
Collapse
|
9
|
Gullbrand SE, Smith LJ, Smith HE, Mauck RL. Promise, progress, and problems in whole disc tissue engineering. JOR Spine 2018; 1:e1015. [PMID: 31463442 PMCID: PMC6686799 DOI: 10.1002/jsp2.1015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/28/2018] [Accepted: 04/29/2018] [Indexed: 12/19/2022] Open
Abstract
Intervertebral disc degeneration is frequently implicated as a cause of back and neck pain, which are pervasive musculoskeletal complaints in modern society. For the treatment of end stage disc degeneration, replacement of the disc with a viable, tissue-engineered construct that mimics native disc structure and function is a promising alternative to fusion or mechanical arthroplasty techniques. Substantial progress has been made in the field of whole disc tissue engineering over the past decade, with a variety of innovative designs characterized both in vitro and in vivo in animal models. However, significant barriers to clinical translation remain, including construct size, cell source, culture technique, and the identification of appropriate animal models for preclinical evaluation. Here we review the clinical need for disc tissue engineering, the current state of the field, and the outstanding challenges that will need to be addressed by future work in this area.
Collapse
Affiliation(s)
- Sarah E. Gullbrand
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Lachlan J. Smith
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Harvey E. Smith
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Robert L. Mauck
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvania
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvania
| |
Collapse
|
10
|
Gullbrand SE, Kim DH, Bonnevie E, Ashinsky BG, Smith LJ, Elliott DM, Mauck RL, Smith HE. Towards the scale up of tissue engineered intervertebral discs for clinical application. Acta Biomater 2018; 70:154-164. [PMID: 29427744 PMCID: PMC7593900 DOI: 10.1016/j.actbio.2018.01.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 12/21/2022]
Abstract
Replacement of the intervertebral disc with a viable, tissue-engineered construct that mimics native tissue structure and function is an attractive alternative to fusion or mechanical arthroplasty for the treatment of disc pathology. While a number of engineered discs have been developed, the average size of these constructs remains a fraction of the size of human intervertebral discs. In this study, we fabricated medium (3 mm height × 10 mm diameter) and large (6 mm height × 20 mm diameter) sized disc-like angle ply structures (DAPS), encompassing size scales from the rabbit lumbar spine to the human cervical spine. Maturation of these engineered discs was evaluated over 15 weeks in culture by quantifying cell viability and metabolic activity, construct biochemical content, MRI T2 values, and mechanical properties. To assess the performance of the DAPS in the in vivo space, pre-cultured DAPS were implanted subcutaneously in athymic rats for 5 weeks. Our findings show that both sized DAPS matured functionally and compositionally during in vitro culture, as evidenced by increases in mechanical properties and biochemical content over time, yet large DAPS under-performed compared to medium DAPS. Subcutaneous implantation resulted in reductions in NP cell viability and GAG content at both size scales, with little effect on AF biochemistry or metabolic activity. These findings demonstrate that engineered discs at large size scales will mature during in vitro culture, however, future work will need to address the challenges of reduced cell viability and heterogeneous matrix distribution throughout the construct. STATEMENT OF SIGNIFICANCE This work establishes, for the first time, tissue-engineered intervertebral discs for total disc replacement at large, clinically relevant length scales. Clinical translation of tissue-engineered discs will offer an alternative to mechanical disc arthroplasty and fusion procedures, and may contribute to a paradigm shift in the clinical care for patients with disc pathology and associated axial spine and neurogenic extremity pain.
Collapse
Affiliation(s)
- Sarah E Gullbrand
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Dong Hwa Kim
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Edward Bonnevie
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Beth G Ashinsky
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; School of Biomedical Engineering, Drexel Univeristy, Philadelphia, PA, United States
| | - Lachlan J Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Robert L Mauck
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
| | - Harvey E Smith
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States.
| |
Collapse
|
11
|
In Vitro Maturation and In Vivo Integration and Function of an Engineered Cell-Seeded Disc-like Angle Ply Structure (DAPS) for Total Disc Arthroplasty. Sci Rep 2017; 7:15765. [PMID: 29150639 PMCID: PMC5693867 DOI: 10.1038/s41598-017-15887-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/30/2017] [Indexed: 12/15/2022] Open
Abstract
Total disc replacement with an engineered substitute is a promising avenue for treating advanced intervertebral disc disease. Toward this goal, we developed cell-seeded disc-like angle ply structures (DAPS) and showed through in vitro studies that these constructs mature to match native disc composition, structure, and function with long-term culture. We then evaluated DAPS performance in an in vivo rat model of total disc replacement; over 5 weeks in vivo, DAPS maintained their structure, prevented intervertebral bony fusion, and matched native disc mechanical function at physiologic loads in situ. However, DAPS rapidly lost proteoglycan post-implantation and did not integrate into adjacent vertebrae. To address this, we modified the design to include polymer endplates to interface the DAPS with adjacent vertebrae, and showed that this modification mitigated in vivo proteoglycan loss while maintaining mechanical function and promoting integration. Together, these data demonstrate that cell-seeded engineered discs can replicate many characteristics of the native disc and are a viable option for total disc arthroplasty.
Collapse
|
12
|
Hudson KD, Bonassar LJ. Hypoxic Expansion of Human Mesenchymal Stem Cells Enhances Three-Dimensional Maturation of Tissue-Engineered Intervertebral Discs. Tissue Eng Part A 2017; 23:293-300. [PMID: 27903131 DOI: 10.1089/ten.tea.2016.0270] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Culture of three-dimensional (3D) constructs in hypoxic conditions (1-5% O2) has been shown to increase production of extracellular matrix components in primary intervertebral disc (IVD) cells and drive chondrogenesis of human mesenchymal stem cells (hMSCs). Growing evidence suggests that two-dimensional (2D) expansion under hypoxic conditions may have an even greater influence on chondrogenesis in MSCs. This study aims to determine the effects of hypoxia during 2D expansion and subsequent 3D culture on the in vitro maturation of tissue-engineered IVDs (TE-IVDs) made with hMSCs, using a previously developed TE-IVD system. hMSCs were expanded in either hypoxic (5% O2) or normoxic (21% O2) conditions before construction of TE-IVDs. Discs were cultured in 3D in either hypoxic or normoxic conditions to create four experimental groups. Discs made from MSCs expanded in hypoxia were up to 141% stiffer than those made with normoxia-expanded MSCs. Similar patterns were seen in all mechanical properties. Increases in glycosaminoglycan content and collagen content in the nucleus pulposus (NP) were associated with 3D hypoxic culture. A boundary region between the manufactured fibrosus and NP regions developed by 2 weeks and mimicked the organization of the native disc. Hypoxic conditions in both 2D expansion and subsequent 3D culture improved the maturation of TE-IVDs made with hMSCs.
Collapse
Affiliation(s)
- Katherine D Hudson
- Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University , Ithaca, New York
| |
Collapse
|