1
|
Zhang J, Ruan D, Xuan A, He Q, Zhang C, Xu C, Zhu C, Zhou Q. Comparative study of outcomes between allograft intervertebral disc transplantation and anterior cervical discectomy and fusion: a retrospective cohort study at least 5 years of follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3561-3574. [PMID: 37330937 DOI: 10.1007/s00586-023-07799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE Adjacent segment degeneration (ASDeg) after anterior cervical discectomy and fusion (ACDF) seriously affects the long-term efficacy of the operation. Therefore, our team has done a lot of research on allograft intervertebral disc transplantation (AIDT) to prove its feasibility and safety. This study will compare the efficacy between AIDT and ACDF in the treatment of cervical spondylosis. METHODS All patients who received ACDF or AIDT in our hospital from 2000 to 2016 and followed up for at least 5 years were recruited and divided into ACDF and AIDT groups. The clinical outcomes including functional scores and radiological data of both groups were collected and compared preoperatively and postoperatively at 1 week, 3 months, 6 months, 12 months, 24 months, 60 months and last follow-up. Functional scores included Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), Visual Analog Scale of Neck (N-VAS) and Arms (A-VAS) pain, the Short Form Health Survey-36 (SF-36) and imaging dates including digital radiographs in the lateral, hyperextension and flexion positions to assess the stability, sagittal balance and mobility of the cervical spine and magnetic resonance imaging (MRI) scans to assess the degeneration of adjacent segment. RESULTS There were 68 patients with 25 in AIDT group and 43 in ACDF group. Satisfactory clinical results were obtained in both groups, but the long-term NDI score and N-VAS score in the AIDT group were better. The AIDT obtained the same stability and sagittal balance of the cervical spine as fusion surgery. The range of motion of adjacent segments can be restored to the preoperative level after transplantation, but this increases significantly after ACDF. There were significant differences in the superior adjacent segment range of motion (SROM) between two groups at 12 months (P = 0.039), 24 months (P = 0.035), 60 months (P = 0.039) and the last follow-up (P = 0.011). The inferior adjacent segment range of motion (IROM) and SROM had a similar trend in the two groups. The ratio value of the greyscale (RVG) of adjacent segments showed a downward trend. At the last follow-up, the RVG decreased more significantly in the ACDF group. At the last follow-up, there was a significant difference in the incidence of ASDeg between the two groups (P = 0.000). And the incidence of adjacent segment disease (ASDis) is 22.86% in the ACDF group. CONCLUSION The allograft intervertebral disc transplantation may be as an alternative technique to traditional anterior cervical discectomy and fusion for the management of cervical degenerative diseases. For the more, the results showed it would improve cervical kinematics and reduce the incidence of adjacent segment degeneration.
Collapse
Affiliation(s)
- Junyou Zhang
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China.
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
| | - Anwu Xuan
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qing He
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Chao Zhang
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Cheng Xu
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Chao Zhu
- The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Qing Zhou
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, 230032, Anhui Province, China
| |
Collapse
|
2
|
Li Y, Wu H, Li Z, Li B, Zhu M, Chen D, Ye F, Yu B, Huang Y. Species variation in the cartilaginous endplate of the lumbar intervertebral disc. JOR Spine 2022; 5:e1218. [PMID: 36203863 PMCID: PMC9520767 DOI: 10.1002/jsp2.1218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022] Open
Abstract
Backgrounds Cartilaginous endplate (CEP) plays an essential role in intervertebral disc (IVD) health and disease. The aim was to compare the CEP structure of lumbar IVD and to reveal the detailed pattern of integration between the CEP and bony endplate (BEP) from different species. Methods A total of 34 IVDs (5 human, 5 goat, 8 pig, 8 rabbit, and 8 rat IVDs) were collected, fixed and midsagittally cut; in each IVD, one‐half was used for histological staining to observe the CEP morphology, and the other half was used for scanning electron microscopy (SEM) analysis to measure the diameters and distributions of collagen fibers in the central and peripheral CEP areas and to observe the pattern of CEP‐BEP integration from different species. Results The human, pig, goat, and rabbit IVDs had the typical BEP‐CEP structure, but the rat CEP was directly connected with the growth plate. Human CEP was the thickest (896.95 ± 87.71 μm) among these species, followed by pig, goat, rat, and rabbit CEPs. Additionally, the mean cellular density of the rabbit CEP was the highest, which was 930 ± 202 per mm2, followed by the rat, goat, pig, and human CEPs. In all the species, the collagen fiber diameter in the peripheral area was much bigger than that in the central area. The collagen fiber diameters of CEP from the human, pig, goat, and rat were distributed between 35 nm and 65 nm. The BEP and CEP were connected by the collagen from the CEP, aggregating into bundles or cross links with each other to form a network, and anchored to BEP. Conclusions Significant differences in the thickness, cellular density, and collagen characterization of CEPs from different species were demonstrated; the integration of BEP‐CEP in humans, pigs, goats, and rabbits was mainly achieved by the collagen bundles anchoring system, while the typical BEP‐CEP interface did not exist in rats.
Collapse
Affiliation(s)
- Yun‐He Li
- Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery Peking University Shenzhen Hospital Shenzhen China
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials Peking University Shenzhen Hospital Shenzhen China
| | - Hai‐Long Wu
- Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery Peking University Shenzhen Hospital Shenzhen China
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials Peking University Shenzhen Hospital Shenzhen China
| | - Zhen Li
- AO Research Institute Davos Davos Switzerland
| | - Bin‐Bin Li
- Department of Human Anatomy & Histoembryology Hangzhou Normal University Hangzhou China
| | - Man Zhu
- Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery Peking University Shenzhen Hospital Shenzhen China
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials Peking University Shenzhen Hospital Shenzhen China
| | - Di Chen
- Research Center for Computer‐aided Drug Discovery, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences Shenzhen China
| | - Fei‐Hong Ye
- Hangzhou Zhigu Research Center for Tissue Engineering and Regenerative Medicine Hangzhou China
| | - Bin‐Sheng Yu
- Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery Peking University Shenzhen Hospital Shenzhen China
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials Peking University Shenzhen Hospital Shenzhen China
- Institute of Orthopaedics, Peking University Shenzhen Hospital Shenzhen Peking University‐The Hong Kong University of Science and Technology Medical Center Shenzhen China
| | - Yong‐Can Huang
- Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery Peking University Shenzhen Hospital Shenzhen China
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials Peking University Shenzhen Hospital Shenzhen China
- Institute of Orthopaedics, Peking University Shenzhen Hospital Shenzhen Peking University‐The Hong Kong University of Science and Technology Medical Center Shenzhen China
| |
Collapse
|
3
|
Hickman TT, Rathan-Kumar S, Peck SH. Development, Pathogenesis, and Regeneration of the Intervertebral Disc: Current and Future Insights Spanning Traditional to Omics Methods. Front Cell Dev Biol 2022; 10:841831. [PMID: 35359439 PMCID: PMC8963184 DOI: 10.3389/fcell.2022.841831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
The intervertebral disc (IVD) is the fibrocartilaginous joint located between each vertebral body that confers flexibility and weight bearing capabilities to the spine. The IVD plays an important role in absorbing shock and stress applied to the spine, which helps to protect not only the vertebral bones, but also the brain and the rest of the central nervous system. Degeneration of the IVD is correlated with back pain, which can be debilitating and severely affects quality of life. Indeed, back pain results in substantial socioeconomic losses and healthcare costs globally each year, with about 85% of the world population experiencing back pain at some point in their lifetimes. Currently, therapeutic strategies for treating IVD degeneration are limited, and as such, there is great interest in advancing treatments for back pain. Ideally, treatments for back pain would restore native structure and thereby function to the degenerated IVD. However, the complex developmental origin and tissue composition of the IVD along with the avascular nature of the mature disc makes regeneration of the IVD a uniquely challenging task. Investigators across the field of IVD research have been working to elucidate the mechanisms behind the formation of this multifaceted structure, which may identify new therapeutic targets and inform development of novel regenerative strategies. This review summarizes current knowledge base on IVD development, degeneration, and regenerative strategies taken from traditional genetic approaches and omics studies and discusses the future landscape of investigations in IVD research and advancement of clinical therapies.
Collapse
Affiliation(s)
- Tara T. Hickman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sudiksha Rathan-Kumar
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sun H. Peck
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
- *Correspondence: Sun H. Peck,
| |
Collapse
|
4
|
Mern DS, Walsen T, Beierfuß A, Thomé C. Animal models of regenerative medicine for biological treatment approaches of degenerative disc diseases. Exp Biol Med (Maywood) 2020; 246:483-512. [PMID: 33175609 DOI: 10.1177/1535370220969123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Degenerative disc disease (DDD) is a painful, chronic and progressive disease, which is characterized by inflammation, structural and biological deterioration of the intervertebral disc (IVD) tissues. DDD is specified as cell-, age-, and genetic-dependent degenerative process that can be accelerated by environmental factors. It is one of the major causes of chronic back pain and disability affecting millions of people globally. Current treatment options, such as physical rehabilitation, pain management, and surgical intervention, can provide only temporary pain relief. Different animal models have been used to study the process of IVD degeneration and develop therapeutic options that may restore the structure and function of degenerative discs. Several research works have depicted considerable progress in understanding the biological basis of disc degeneration and the therapeutic potentials of cell transplantation, gene therapy, applications of supporting biomaterials and bioactive factors, or a combination thereof. Since animal models play increasingly significant roles in treatment approaches of DDD, we conducted an electronic database search on Medline through June 2020 to identify, compare, and discuss publications regarding biological therapeutic approaches of DDD that based on intradiscal treatment strategies. We provide an up-to-date overview of biological treatment strategies in animal models including mouse, rat, rabbit, porcine, bovine, ovine, caprine, canine, and primate models. Although no animal model could profoundly reproduce the clinical conditions in humans; animal models have played important roles in specifying our knowledge about the pathophysiology of DDD. They are crucial for developing new therapy approaches for clinical applications.
Collapse
Affiliation(s)
| | - Tanja Walsen
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Anja Beierfuß
- Laboratory Animal Facility, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck A-6020, Austria
| |
Collapse
|
5
|
Chamoli U, Umali J, Kleuskens MWA, Chepurin D, Diwan AD. Morphological characteristics of the kangaroo lumbar intervertebral discs and comparison with other animal models used in spine research. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:652-662. [PMID: 31240440 DOI: 10.1007/s00586-019-06044-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Animal models are frequently used to elucidate pathomechanism and pathophysiology of various disorders of the human intervertebral disc (IVD) and also to develop therapeutic approaches. Here we report morphological characteristics of the kangaroo lumbar IVDs and compare them with other animal models used in spine research. METHODS Twenty-five fresh-frozen cadaveric lumbar spines (T12-S1) derived from kangaroo carcases (Macropus giganteus) of undetermined age were first scanned in a C-Arm X-ray machine. A photograph of the axial section of the disc including a calibrated metric scale was also acquired. The digital radiographs and photographs were processed in ImageJ to determine the axial and sagittal plane dimensions for the whole disc (WD) and the nucleus pulposus (NP) and the mid-sagittal disc height for all the lumbar levels. RESULTS Our results suggest that the L6-S1 IVD in kangaroos is distinctly large compared with the upper lumbar IVDs. Based on previously published data, human lumbar IVDs are the largest of all the animal IVDs used in spine research, with camelid cervical IVDs being the closest relative in absolute dimensions (llamas: 78% in disc height, 40% in WD volume, and 38% in NP volume). Kangaroo L6-S1 IVD was approximately 51% in height, 20% in WD volume, and 20% in NP volume of the human lumbar IVD. CONCLUSIONS We conclude that morphological similarities exist between a kangaroo and human lumbar IVD, especially with the lima bean shape in the axial plane, wedge shape in the sagittal plane, convexity at the cephalad endplates, and percentage volume occupied by the NP in the IVD. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Uphar Chamoli
- Spine Service, Department of Orthopaedic Surgery, St. George and Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, NSW, 2217, Australia.
- Faculty of Engineering and Information Technology, School of Biomedical Engineering, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
| | - Jose Umali
- Spine Service, Department of Orthopaedic Surgery, St. George and Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, NSW, 2217, Australia
| | - Meike W A Kleuskens
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Daniel Chepurin
- Spine Service, Department of Orthopaedic Surgery, St. George and Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, NSW, 2217, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Melbourne, VIC, 3168, Australia
| | - Ashish D Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George and Sutherland Clinical School, University of New South Wales Australia, Kogarah, Sydney, NSW, 2217, Australia
| |
Collapse
|
6
|
Huang YC, Hu Y, Li Z, Luk KDK. Biomaterials for intervertebral disc regeneration: Current status and looming challenges. J Tissue Eng Regen Med 2018; 12:2188-2202. [PMID: 30095863 DOI: 10.1002/term.2750] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/21/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
A biomaterial-based strategy is employed to regenerate the degenerated intervertebral disc, which is considered a major generator of neck and back pain. Although encouraging enhancements in the anatomy and kinematics of the degenerative disc have been gained by biomaterials with various formulations in animals, the number of biomaterials tested in humans is rare. At present, most studies that involve the use of newly developed biomaterials focus on regeneration of the degenerative disc, but not pain relief. In this review, we summarise the current state of the art in the field of biomaterial-based regeneration or repair for the nucleus pulposus, annulus fibrosus, and total disc transplantation in animals and humans, and we then provide essential suggestions for the development and clinical translation of biomaterials for disc regeneration. It is important for researchers to consider the commonly neglected issues instead of concentrating solely on biomaterial development and fabrication.
Collapse
Affiliation(s)
- Yong-Can Huang
- Shenzhen Engineering Laboratory of Orthopaedic Regenerative Technologies, Orthopaedic Research Center, Peking University Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.,Shenzhen Key Laboratory of Spine Surgery, Department of Spine Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Zhen Li
- AO Research Institute Davos, Davos, Switzerland
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
7
|
Hensley A, Rames J, Casler V, Rood C, Walters J, Fernandez C, Gill S, Mercuri JJ. Decellularization and characterization of a whole intervertebral disk xenograft scaffold. J Biomed Mater Res A 2018; 106:2412-2423. [PMID: 29673061 PMCID: PMC6158084 DOI: 10.1002/jbm.a.36434] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 02/06/2023]
Abstract
Intervertebral disk (IVD) degeneration is a multifactor process that results in the physical destruction of the nucleus pulposus (NP) and annulus fibrosus (AF). This compromises IVD function and causes significant disability and economic burden. Strategies to replace the entire composite structure of the IVD are limited and most approaches do not recapitulate the heterogenous biochemical composition, microarchitecture or mechanical properties of the native tissue. Our central hypothesis was that donor IVDs which resemble the size and biochemistry of human lumbar IVDs could be successfully decellularized while retaining the tissue's structure and function with the long-term goal of creating a composite scaffold for tissue engineering the human IVD. Accordingly, we optimized a procedure to decellularize bovine tail IVDs using a combination of detergents, ultrasonication, freeze-thaw cycles, and nucleases. The resultant decellularized whole IVD xenografts retained distinct AF and NP regions which contained no visible intact cell nuclei and minimal residual bovine deoxyribose nucleic acid (DNA; 65.98 ± 4.07 and 47.12 ± 13.22 ng/mg, respectively). Moreover, the NP region of decellularized IVDs contained 313.40 ± 50.67 µg/mg glycosaminoglycan. The presence of collagen type II was confirmed via immunohistochemistry. Additionally, histological analysis of the AF region of decellularized IVDs demonstrated retention of the native angle-ply collagen microarchitecture. Unconfined compression testing demonstrated no significant differences in swelling pressure and toe-region modulus between fresh and decellularized IVDs. However, linear region moduli, peak stress and equilibrium moduli were all significantly reduced. Together, this research demonstrates a successful initial step in developing a biomimetic acellular whole IVD xenograft scaffold for use in IVD tissue engineering. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A:2412-2423, 2018.
Collapse
Affiliation(s)
- Austin Hensley
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Jess Rames
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Victor Casler
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Christopher Rood
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Joshua Walters
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Christopher Fernandez
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina
| | - Sanjitpal Gill
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina.,Department of Orthopaedic Surgery, Medical Group of the Carolinas-Pelham, Spartanburg Regional Healthcare System, Greer, South Carolina
| | - Jeremy J Mercuri
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina
| |
Collapse
|
8
|
Huang YC, Xiao J, Leung VY, Lu WW, Hu Y, Luk KDK. Lumbar intervertebral disc allograft transplantation: the revascularisation pattern. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:728-736. [DOI: 10.1007/s00586-017-5419-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/24/2017] [Accepted: 11/30/2017] [Indexed: 12/31/2022]
|
9
|
Imaging Evaluation and Relative Significance in Cases of Cervical Disk Allografting: Radiographic Character After Total Disk Transplantation. Clin Spine Surg 2016; 29:E488-E495. [PMID: 27755207 DOI: 10.1097/bsd.0b013e318290fc41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY DESIGN The clinical and radiologic data of total disk allografting (TDA) cases were collected and analyzed to explore the correlation between neurological function improvements and imaging changes. OBJECTIVE The aim of the study was to assess the medium-term and long-term outcome and radiographic character after TDA, and, furthermore, to explore the significance of the changes of imaging signs after the transplantation. SUMMARY OF BACKGROUND DATA Spinal fusion may result in the adjacent segment degeneration. The anxiousness urged the necessity for the development of TDA to reduce the risk of adjacent segment degeneration. Both animal studies and recent clinical trials have shown promising results to support the use of intervertebral disk allograft as a natural mobile disk replacement. METHODS The conditions of 13 cases that underwent TDA after cervical discectomy were recorded in detail. Axial symptoms and neurological function in various periods were assessed, and, meanwhile, radiologic examination was performed for the comprehensive evaluation of the relevant indicators before and after surgery. RESULTS (1) There was significant improvement in the neurological function after TDA. Postoperatively, the Visual Analog Score of axial symptoms did not increase significantly. (2) Both the entire and local segment maintained a satisfactory curve after allografting. There was no obvious correlation between the neurological function recovery and the cervical curve. Besides, the motion of the cervical spine did not change postoperatively. (3) Postoperatively, the spinal cord area at the index level increased significantly, whereas the signal value of the transplanted disk decreased sharply. CONCLUSIONS (1) Disk allografting is one of the effective and safe methods in treating the diseases of cervical disk herniation. (2) Although some degeneration occurs in the transplanted disk, the allograft can still be alive and can successfully maintain and improve the biological characters of the cervical spine in both radiologic and practical aspects.
Collapse
|
10
|
A Review of Animal Models of Intervertebral Disc Degeneration: Pathophysiology, Regeneration, and Translation to the Clinic. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5952165. [PMID: 27314030 PMCID: PMC4893450 DOI: 10.1155/2016/5952165] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/03/2016] [Indexed: 12/19/2022]
Abstract
Lower back pain is the leading cause of disability worldwide. Discogenic pain secondary to intervertebral disc degeneration is a significant cause of low back pain. Disc degeneration is a complex multifactorial process. Animal models are essential to furthering understanding of the degenerative process and testing potential therapies. The adult human lumbar intervertebral disc is characterized by the loss of notochordal cells, relatively large size, essentially avascular nature, and exposure to biomechanical stresses influenced by bipedalism. Animal models are compared with regard to the above characteristics. Numerous methods of inducing disc degeneration are reported. Broadly these can be considered under the categories of spontaneous degeneration, mechanical and structural models. The purpose of such animal models is to further our understanding and, ultimately, improve treatment of disc degeneration. The role of animal models of disc degeneration in translational research leading to clinical trials of novel cellular therapies is explored.
Collapse
|
11
|
Lumbar intervertebral disc allograft transplantation: long-term mobility and impact on the adjacent segments. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:799-805. [DOI: 10.1007/s00586-016-4535-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 11/26/2022]
|
12
|
Stich S, Stolk M, Girod PP, Thomé C, Sittinger M, Ringe J, Seifert M, Hegewald AA. Regenerative and immunogenic characteristics of cultured nucleus pulposus cells from human cervical intervertebral discs. PLoS One 2015; 10:e0126954. [PMID: 25993467 PMCID: PMC4438063 DOI: 10.1371/journal.pone.0126954] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 04/09/2015] [Indexed: 12/24/2022] Open
Abstract
Cell-based regenerative approaches have been suggested as primary or adjuvant procedures for the treatment of degenerated intervertebral disc (IVD) diseases. Our aim was to evaluate the regenerative and immunogenic properties of mildly and severely degenerated cervical nucleus pulposus (NP) cells with regard to cell isolation, proliferation and differentiation, as well as to cell surface markers and co-cultures with autologous or allogeneic peripheral blood mononuclear cells (PBMC) including changes in their immunogenic properties after 3-dimensional (3D)-culture. Tissue from the NP compartment of 10 patients with mild or severe grades of IVD degeneration was collected. Cells were isolated, expanded with and without basic fibroblast growth factor and cultured in 3D fibrin/poly (lactic-co-glycolic) acid transplants for 21 days. Real-time reverse-transcription polymerase chain reaction (RT-PCR) showed the expression of characteristic NP markers ACAN, COL1A1 and COL2A1 in 2D- and 3D-culture with degeneration- and culture-dependent differences. In a 5,6-carboxyfluorescein diacetate N-succinimidyl ester-based proliferation assay, NP cells in monolayer, regardless of their grade of degeneration, did not provoke a significant proliferation response in T cells, natural killer (NK) cells or B cells, not only with donor PBMC, but also with allogeneic PBMC. In conjunction with low inflammatory cytokine expression, analyzed by Cytometric Bead Array and fluorescence-activated cell sorting (FACS), a low immunogenicity can be assumed, facilitating possible therapeutic approaches. In 3D-culture, however, we found elevated immune cell proliferation levels, and there was a general trend to higher responses for NP cells from severely degenerated IVD tissue. This emphasizes the importance of considering the specific immunological alterations when including biomaterials in a therapeutic concept. The overall expression of Fas receptor, found on cultured NP cells, could have disadvantageous implications on their potential therapeutic applications because they could be the targets of cytotoxic T-cell activity acting by Fas ligand-induced apoptosis.
Collapse
Affiliation(s)
- Stefan Stich
- Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Meaghan Stolk
- Institute of Medical Immunology and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pierre Pascal Girod
- Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Sittinger
- Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen Ringe
- Tissue Engineering Laboratory and Berlin-Brandenburg Center for Regenerative Therapies, Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martina Seifert
- Institute of Medical Immunology and Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aldemar Andres Hegewald
- Department of Neurosurgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
- * E-mail:
| |
Collapse
|
13
|
Cell-Based Therapies Used to Treat Lumbar Degenerative Disc Disease: A Systematic Review of Animal Studies and Human Clinical Trials. Stem Cells Int 2015; 2015:946031. [PMID: 26074979 PMCID: PMC4446495 DOI: 10.1155/2015/946031] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/08/2015] [Accepted: 04/15/2015] [Indexed: 01/07/2023] Open
Abstract
Low back pain and degenerative disc disease are a significant cause of pain and disability worldwide. Advances in regenerative medicine and cell-based therapies, particularly the transplantation of mesenchymal stem cells and intervertebral disc chondrocytes, have led to the publication of numerous studies and clinical trials utilising these biological therapies to treat degenerative spinal conditions, often reporting favourable outcomes. Stem cell mediated disc regeneration may bridge the gap between the two current alternatives for patients with low back pain, often inadequate pain management at one end and invasive surgery at the other. Through cartilage formation and disc regeneration or via modification of pain pathways stem cells are well suited to enhance spinal surgery practice. This paper will systematically review the current status of basic science studies, preclinical and clinical trials utilising cell-based therapies to repair the degenerate intervertebral disc. The mechanism of action of transplanted cells, as well as the limitations of published studies, will be discussed.
Collapse
|
14
|
Surgical technique for lumbar intervertebral disc transplantation in a goat model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1951-8. [PMID: 25344092 DOI: 10.1007/s00586-014-3631-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 10/17/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Fresh-frozen intervertebral disc transplantation was determined to be an effective treatment for degenerative disc diseases in rhesus monkeys and in humans. Further research in improving different aspects of disc allografts transplantation is needed and will be investigated in large animal models. This study reports the detailed surgical technique of intervertebral disc transplantation without internal fixation and the important notes to ensure success in goats. METHODS Fifty-one male goats were used in this study. Ten goats were used as intervertebral disc allograft donors; the remaining forty-one goats were used to develop the surgical technique for intervertebral disc allograft transplantation. Radiographs, ex vivo MRI and gross observation were used to monitor the stability and healing of the disc allografts at 3 months, postoperatively. RESULTS Size matching of the disc allograft, preservation of the anterior longitudinal ligament and an appropriate portion of the annulus fibrosus at the recipient site were crucial for stable graft retention. Additionally, a slightly reduced height of the disc allograft compared to that of the recipient slot may avoid graft endplate fracture. CONCLUSIONS Lumbar intervertebral disc transplantation without internal fixation can be successfully performed in goats.
Collapse
|
15
|
Chaofeng W, Chao Z, Deli W, Jianhong W, Yan Z, Cheng X, Hongkui X, Qing H, Dike R. Nucleus pulposus cells expressing hBMP7 can prevent the degeneration of allogenic IVD in a canine transplantation model. J Orthop Res 2013; 31:1366-73. [PMID: 23580474 DOI: 10.1002/jor.22369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 03/13/2013] [Indexed: 02/04/2023]
Abstract
We have previously explored the possibilities of allogenic intervertebral disc (IVD) curing disc degeneration disease in clinical practice. The results showed that the motion and stability of the spinal unit was preserved after transplantation of allogenic IVD in human beings at 5-year follow-up. However, mild degeneration was observed in the allogenic transplanted IVD cases. In this study, we construct the biological tissue engineering IVD by injecting the nucleus pulposus cells (NPCs) expressing human bone morphogenetic protein 7 (hBMP7) into cryopreserved IVD, and transplant the biological tissue engineering IVD into a beagle dog to investigate whether NPCs expressing hBMP7 could prevent the degeneration of the transplanted allogenic IVDs. At 24 weeks after transplantation, MRI scan showed that IVD allografts injected NPCs expressing hBMP7 have a slighter signs of degeneration than IVD allografts with NPCs or without NPCs. The range of motion of left-right rotation in the group without NPCs was bigger than that of two cells injection group. PKH-26-labeled cells were identified at IVD allograft. The study demonstrated that NPCs expressing hBMP7 could survive at least 24 weeks and prevent the degeneration of the transplanted IVD. This solution might have a potential role in preventing the IVD allograft degeneration in long time follow-up.
Collapse
Affiliation(s)
- Wang Chaofeng
- Department of Orthopedic Surgery, Navy General Hospital, Fucheng Road No. 6, Haidian District, Beijing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Tanaka M, Sakai D, Hiyama A, Arai F, Nakajima D, Nukaga T, Nakai T, Mochida J. Effect of cryopreservation on canine and human activated nucleus pulposus cells: a feasibility study for cell therapy of the intervertebral disc. Biores Open Access 2013; 2:273-82. [PMID: 23914334 PMCID: PMC3731681 DOI: 10.1089/biores.2013.0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
It has been shown that coculture of bone marrow–derived stromal cells (BMSCs) with intervertebral disc (IVD) nucleus pulposus (NP) cells significantly activates the biological characteristics of NP cells in animal models and in humans. We therefore predicted that activated NP cells would be a useful graft source for cellular transplantation therapy in the treatment of degenerative IVDs. However, the activation protocol is based on fresh isolation and activation of NP cells, which limits the timing of clinical application. Cell transplantation therapy could be offered to more patients than is now possible if activated NP cells could be transplanted as and when required by the condition of the patient. No study has investigated the effect of cryopreservation on NP cells after enzymatic isolation. We investigated the effects of cryopreservation of canine and human NP cells in both cell and tissue form before coculture with autologous BMSCs. Cell viability, proliferation, glycosaminoglycan production, aggrecan transcriptional activity, colony generation, and gene expression profile of the cells after cryopreservation and subsequent coculture were analyzed. The influence of cryopreservation on cell chromosomal abnormalities and tumorigenesis was also studied. The results showed that there were no clear differences between the noncryopreserved and cryopreserved cells in terms of cell viability, proliferation capacity, and capacity to synthesize extracellular matrix. Furthermore, the cells showed no apparent chromosomal abnormalities or tumorigenic ability and exhibited similar patterns of gene expression. These findings suggest that by using cryopreservation, it may be possible to transplant activated NP cells upon request for patients' needs.
Collapse
Affiliation(s)
- Masahiro Tanaka
- Departments of Orthopedic Surgery and Surgical Science, and the Research Center for Regenerative Medicine, Tokai University School of Medicine , Isehara, Kanagawa, Japan
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Iatridis JC, Nicoll SB, Michalek AJ, Walter BA, Gupta MS. Role of biomechanics in intervertebral disc degeneration and regenerative therapies: what needs repairing in the disc and what are promising biomaterials for its repair? Spine J 2013; 13:243-62. [PMID: 23369494 PMCID: PMC3612376 DOI: 10.1016/j.spinee.2012.12.002] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 07/26/2012] [Accepted: 12/09/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Degeneration and injuries of the intervertebral disc (IVD) result in large alterations in biomechanical behaviors. Repair strategies using biomaterials can be optimized based on the biomechanical and biological requirements of the IVD. PURPOSE To review the present literature on the effects of degeneration, simulated degeneration, and injury on biomechanics of the IVD, with special attention paid to needle puncture injuries, which are a pathway for diagnostics and regenerative therapies and the promising biomaterials for disc repair with a focus on how those biomaterials may promote biomechanical repair. STUDY DESIGN A narrative review to evaluate the role of biomechanics on disc degeneration and regenerative therapies with a focus on what biomechanical properties need to be repaired and how to evaluate and accomplish such repairs using biomaterials. Model systems for the screening of such repair strategies are also briefly described. METHODS Articles were selected from two main PubMed searches using keywords: intervertebral AND biomechanics (1,823 articles) and intervertebral AND biomaterials (361 articles). Additional keywords (injury, needle puncture, nucleus pressurization, biomaterials, hydrogel, sealant, tissue engineering) were used to narrow the articles down to the topics most relevant to this review. RESULTS Degeneration and acute disc injuries have the capacity to influence nucleus pulposus (NP) pressurization and annulus fibrosus (AF) integrity, which are necessary for an effective disc function and, therefore, require repair. Needle injection injuries are of particular clinical relevance with the potential to influence disc biomechanics, cellularity, and metabolism, yet these effects are localized or small and more research is required to evaluate and reduce the potential clinical morbidity using such techniques. NP replacement strategies, such as hydrogels, are required to restore the NP pressurization or the lost volume. AF repair strategies including cross-linked hydrogels, fibrous composites, and sealants offer promise for regenerative therapies to restore AF integrity. Tissue engineered IVD structures, as a single implantable construct, may promote greater tissue integration due to the improved repair capacity of the vertebral bone. CONCLUSIONS IVD height, neutral zone characteristics, and torsional biomechanics are sensitive to specific alterations in the NP pressurization and AF integrity and must be addressed for an effective functional repair. Synthetic and natural biomaterials offer promise for NP replacement, AF repair, as an AF sealant, or whole disc replacement. Meeting mechanical and biological compatibilities are necessary for the efficacy and longevity of the repair.
Collapse
Affiliation(s)
- James C. Iatridis
- Leni and Peter W. May Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY
| | - Steven B. Nicoll
- Department of Biomedical Engineering, The City College of New York, New York, NY
| | - Arthur J. Michalek
- Department of Molecular Physiology and Biophysics, University of Vermont, Burlington, VT
| | - Benjamin A. Walter
- Leni and Peter W. May Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY,Department of Biomedical Engineering, The City College of New York, New York, NY
| | - Michelle S. Gupta
- Department of Biomedical Engineering, The City College of New York, New York, NY
| |
Collapse
|
18
|
Leung VYL, Tam V, Chan D, Chan BP, Cheung KMC. Tissue engineering for intervertebral disk degeneration. Orthop Clin North Am 2011; 42:575-83, ix. [PMID: 21944593 DOI: 10.1016/j.ocl.2011.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Many challenges confront intervertebral disk engineering owing to complexity and the presence of extraordinary stresses. Rebuilding a disk of native function could be useful for removal of the symptoms and correction of altered spine kinematics. Improvement in understanding of disk properties and techniques for disk engineering brings promise to the fabrication of a functional motion segment for the treatment of disk degeneration. Increasing sophistication of techniques available in biomedical sciences will bring its application into clinics. This review provides an account of current progress and challenges of intervertebral disk bioengineering and discusses means to move forward and toward bedside translation.
Collapse
Affiliation(s)
- Victor Y L Leung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | | | | | | | | |
Collapse
|
19
|
Chan SCW, Gantenbein-Ritter B, Leung VYL, Chan D, Cheung KMC, Ito K. Cryopreserved intervertebral disc with injected bone marrow-derived stromal cells: a feasibility study using organ culture. Spine J 2010; 10:486-96. [PMID: 20171933 DOI: 10.1016/j.spinee.2009.12.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 11/07/2009] [Accepted: 12/25/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A recent clinical study demonstrated that cryopreserved allogeneic intervertebral disc transplantation relieved pain and preserved motion, thus opening up a new treatment option for degenerative disc disease. However, these transplanted discs continued to degenerate, possibly due to a lack of viable cells. Bone marrow-derived stromal cell (BMSC) implantation has been shown to delay disc degeneration. PURPOSE This study examined the viability over time of endogenous and injected BMSCs in cryopreserved disc under simulated-physiological loading conditions. STUDY DESIGN/ SETTING: An in vitro study of BMSCs injected into cryopreserved bovine caudal discs. METHODS Bovine caudal discs were harvested and cryopreserved at -196 degrees C. After thawing, PKH-26-labeled BMSCs embedded in peptide hydrogel carrier were injected into the nucleus pulposus. Two BMSC injection quantities, that is, 1x10(5) and 2.5x10(5) were examined. Discs with injected cells were maintained in a bioreactor for 7 days under simulated-physiological loading. Cell viability (staining), gene expression (reverse transcription-polymerase chain reaction) profile, and proteoglycan content (histologically) were evaluated. RESULTS Forty percent of endogenous cell viability was maintained after freeze thawing. Over the 7-day culture, this did not change further. However, there was upregulation of Col1a2 and Mmp-13 and downregulation of Col2a1gene expression. Sixty percent of BMSCs survived the initial injection procedure, and only 20% remained alive after 7 days of culture. Bone marrow-derived stromal cell implantation did not alter the viability of the endogenous cells, but discs injected with 1x105 BMSCs showed significantly higher ACAN expression than sham discs. CONCLUSIONS Although only 40% of cells survived cryopreservation, these endogeneous cells continued to survive over 7 days if maintained under simulated-physiological loading conditions. Although only a small portion of injected BMSCs survived, they did have some effect on the matrix protein gene expression profile. Their influence on native cells requires long-term evaluation.
Collapse
|
20
|
Nerurkar NL, Elliott DM, Mauck RL. Mechanical design criteria for intervertebral disc tissue engineering. J Biomech 2010; 43:1017-30. [PMID: 20080239 PMCID: PMC2849875 DOI: 10.1016/j.jbiomech.2009.12.001] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
Due to the inability of current clinical practices to restore function to degenerated intervertebral discs, the arena of disc tissue engineering has received substantial attention in recent years. Despite tremendous growth and progress in this field, translation to clinical implementation has been hindered by a lack of well-defined functional benchmarks. Because successful replacement of the disc is contingent upon replication of some or all of its complex mechanical behaviors, it is critically important that disc mechanics be well characterized in order to establish discrete functional goals for tissue engineering. In this review, the key functional signatures of the intervertebral disc are discussed and used to propose a series of native tissue benchmarks to guide the development of engineered replacement tissues. These benchmarks include measures of mechanical function under tensile, compressive, and shear deformations for the disc and its substructures. In some cases, important functional measures are identified that have yet to be measured in the native tissue. Ultimately, native tissue benchmark values are compared to measurements that have been made on engineered disc tissues, identifying where functional equivalence was achieved, and where there remain opportunities for advancement. Several excellent reviews exist regarding disc composition and structure, as well as recent tissue engineering strategies; therefore this review will remain focused on the functional aspects of disc tissue engineering.
Collapse
Affiliation(s)
- Nandan L. Nerurkar
- McKay Orthopaedic Research Laboratory University of Pennsylvania, Philadelphia, PA 19104
| | - Dawn M. Elliott
- McKay Orthopaedic Research Laboratory University of Pennsylvania, Philadelphia, PA 19104
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory University of Pennsylvania, Philadelphia, PA 19104
| |
Collapse
|
21
|
Huang B, Li CQ, Zhou Y, Luo G, Zhang CZ. Collagen II/hyaluronan/chondroitin-6-sulfate tri-copolymer scaffold for nucleus pulposus tissue engineering. J Biomed Mater Res B Appl Biomater 2010; 92:322-31. [PMID: 19802835 DOI: 10.1002/jbm.b.31518] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study aims to investigate the bioactivity of collagen II/hyaluronan/chondroitin-6-sulfate tri-copolymer as bionic scaffold for nucleus pulposus (NP) tissue engineering. Collagen II (C II) (pH 1-2) was mixed with hyaluronan (HyA) and lyophilized to prepare C II/HyA matrices. Chondroitin 6-sulfate (6-CS) was covalently attached to the C II/HyA matrices using 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS). Then, cells were expanded from rabbit NP and seeded in the tri-copolymer scaffold. Cell-scaffold hybrids were maintained for up to 28 days in culture. Cell viability/proliferation, extracellular matrix (ECM)-related gene expression, and the content of sulfated glycosaminoglycans (s-GAG) were evaluated. Our results are as following: when cultured for 28 days, the cell-scaffold hybrids maintained active cell viability/proliferation and exhibited a significantly increased s-GAG content. In addition, rabbit NP cells cultured in the scaffold demonstrated a significantly higher level of C II and aggrecan gene expression and a significantly lower level of Collagen I (C I) gene expression when compared with that of monolayer cells. Histological studies and scanning electron microscopy (SEM) further indicated newly secreted ECM deposits in the scaffolds. In conclusion, the C II/HyA-CS scaffold may be an alternative material for NP tissue engineering due to its satisfactory bioactivity, and it deserves further in vivo investigation.
Collapse
Affiliation(s)
- Bo Huang
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, People's Republic of China
| | | | | | | | | |
Collapse
|
22
|
Luk KDK, Ruan DK. Intervertebral disc transplantation: a biological approach to motion preservation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17 Suppl 4:504-10. [PMID: 19005699 DOI: 10.1007/s00586-008-0748-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 07/05/2008] [Accepted: 07/05/2008] [Indexed: 12/01/2022]
Abstract
Intervertebral disc transplantation was developed in a bipedal animal model through the stages of autograft, fresh allograft and fresh frozen allograft. Results showed that the allografts were able to survive through a deep freezing protocol and maintain cell viability after transplantation without significant immunoreaction. Although degeneration of the allograft appeared to be inevitable, it was able to maintain stability and mobility of the functional spinal unit. These findings were similarly reproduced in the human clinical trial with excellent mid-term clinical results at 5 years. The process of evolution and findings were summarized in this review.
Collapse
Affiliation(s)
- Keith D K Luk
- The Department of Orthopedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | | |
Collapse
|
23
|
Chan BP, Leong KW. Scaffolding in tissue engineering: general approaches and tissue-specific considerations. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17 Suppl 4:467-79. [PMID: 19005702 DOI: 10.1007/s00586-008-0745-3] [Citation(s) in RCA: 815] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 07/09/2008] [Accepted: 07/09/2008] [Indexed: 12/19/2022]
Abstract
Scaffolds represent important components for tissue engineering. However, researchers often encounter an enormous variety of choices when selecting scaffolds for tissue engineering. This paper aims to review the functions of scaffolds and the major scaffolding approaches as important guidelines for selecting scaffolds and discuss the tissue-specific considerations for scaffolding, using intervertebral disc as an example.
Collapse
Affiliation(s)
- B P Chan
- Medical Engineering Program, Department of Mechanical Engineering, The University of Hong Kong, Room 711, Haking Wong Building, Pokfulam Road, Hong Kong SAR, China.
| | | |
Collapse
|
24
|
Luk KDK. Non-fusion surgeries of the cervical spine. J Orthop Surg (Hong Kong) 2008; 16:1-2. [PMID: 18453648 DOI: 10.1177/230949900801600101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- KDK Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
25
|
Plasencia-Arriba M, Maestre-García C. New Horizons in the Treatment of Lumbar Disc Disease. Rev Esp Cir Ortop Traumatol (Engl Ed) 2007. [DOI: 10.1016/s1988-8856(07)70048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
26
|
Ruan D, He Q, Ding Y, Hou L, Li J, Luk KDK. Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study. Lancet 2007; 369:993-9. [PMID: 17382826 DOI: 10.1016/s0140-6736(07)60496-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spinal fusion can be complicated by accelerated degeneration of the adjacent segments. Artificial disc replacements have been developed, but results are variable. Successful transplantations of intervertebral disc autografts, fresh allografts, and fresh-frozen allografts-ie, a non-fusion strategy-in which the mobility and stability of the spinal segment were preserved have been done in a primate model. Our aim was to determine the feasibility, safety, and long-term clinical results of disc transplantation in human beings. METHODS Five patients, average age 47 years, with cervical disc herniation underwent transplantation of fresh-frozen composite disc allografts after disc excision. Serial MRI and static and dynamic radiographs were used to monitor the status of the grafts and the sagittal stability and mobility of the segment. FINDINGS Good union of the graft endplates was seen by the end of 3 months after surgery in all patients. At a minimum follow-up of 5 years, the neurological symptoms of all patients had improved from before surgery levels. No immunoreaction was encountered. There was no olisthesis and only mild degenerative changes of the transplanted discs. All except one of the discs showed preservation of 7.0-11.3 degrees of sagittal motion at the final follow-up. MRI at 5 years showed preservation of hydration in at least two discs. INTERPRETATION Despite signs of mild disc degeneration, the motion and stability of the spinal unit was preserved after transplantation of fresh-frozen allogenic intervertebral discs in our patients. With further refinements, such transplantations could be an effective treatment for degenerative disc disease.
Collapse
Affiliation(s)
- Dike Ruan
- Department of Orthopedic Surgery, The Navy General Hospital, Beijing, China
| | | | | | | | | | | |
Collapse
|
27
|
Yoon ST, Patel NM. Molecular therapy of the intervertebral disc. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15 Suppl 3:S379-88. [PMID: 16835736 PMCID: PMC2335383 DOI: 10.1007/s00586-006-0155-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Accepted: 06/06/2006] [Indexed: 01/07/2023]
Abstract
Disc degeneration is the loss of the normal nucleus pulposus disc matrix to a more fibrotic and less cartilaginous structure. This change in disc micro-anatomy can be associated with pain and deformity, however, prevention and treatment options of disc degeneration are currently limited. Much research is going on to understand intervertebral discs at a molecular/ cellular level in hopes of creating clinically applicable options for treating disc degeneration. This review article will give insight into the current and developing status of treating intervertebral disc degeneration from a molecular standpoint.
Collapse
Affiliation(s)
- S Tim Yoon
- Department of Orthopaedic Surgery, Emory Spine Center, Emory University, 59 Executive Park S. STE 3000, Atlanta, GA 30029, USA.
| | | |
Collapse
|
28
|
Mizuno H, Roy AK, Zaporojan V, Vacanti CA, Ueda M, Bonassar LJ. Biomechanical and biochemical characterization of composite tissue-engineered intervertebral discs. Biomaterials 2006; 27:362-70. [PMID: 16165204 DOI: 10.1016/j.biomaterials.2005.06.042] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Accepted: 06/30/2005] [Indexed: 11/28/2022]
Abstract
Composite tissue-engineered intervertebral tissue was assembled in the shape of cylindrical disks composed of an outer shell of PGA mesh seeded with annulus fibrosus cells with an inner core of nucleus pulposus cells seeded into an alginate gel. Samples were implanted subcutaneously in athymic mice and retrieved at time points up to 16 weeks. At all retrieval times, samples maintained shape and contained regions of distinct tissue formation. Histology revealed progressive tissue formation with distinct morphological differences in tissue formation in regions seeded with annulus fibrosus and nucleus pulposus cells. Biochemical analysis indicated that DNA, proteoglycan, and collagen content in tissue-engineered discs increased with time, reaching >50% of the levels of native tissue by 16 weeks. The exception to this was the collagen content of the nucleus pulposus portion of the implants with were approximately 15% of native values. The equilibrium modulus of tissue-engineered discs was 49.0+/-13.2 kPa at 16 weeks, which was between the measured values for the modulus of annulus fibrosus and nucleus pulposus. The hydraulic permeability of tissue-engineered discs was 5.1+/-1.7x10(-14) m2/Pa at 16 weeks, which was between the measured values for the hydraulic permeability of annulus fibrosus and nucleus pulposus. These studies document the feasibility of creating composite tissue-engineered intevertebral disc implants with similar composition and mechanical properties to native tissue.
Collapse
Affiliation(s)
- Hirokazu Mizuno
- Center for Tissue Engineering, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | | |
Collapse
|
29
|
Longo G, Ripalda P, Denaro V, Forriol F. Morphologic comparison of cervical, thoracic, lumbar intervertebral discs of cynomolgus monkey (Macaca fascicularis). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 15:1845-51. [PMID: 16374650 PMCID: PMC2276588 DOI: 10.1007/s00586-005-0035-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 06/15/2005] [Accepted: 11/30/2005] [Indexed: 10/25/2022]
Abstract
The aim was to analyze the morphological differences of the intervertebral disc and endplates at different levels. Forty-five vertebral motion segments were obtained from the spine of nine 3 to 4-year-old cynomolgus monkeys (Macaca fascicularis). From every spine, five discs were sectioned (C5-C6, T3-T4, T9-T10, L2-L3, L4-L5). In all the groups, tissue samples were collected and sections were stained with Masson's trichrome, Safranine-O and van Gieson's connective tissue stain to analyze the intervertebral discs. Immunohistochemistry was performed, using specific antibodies to detect collagens I and II. The intervertebral disc height, the maximum nucleus pulposus height, the superior and inferior endplate heights were histomorphometrically measured and different indexes were calculated to compare the differences between specimens of the same animal and between discs of the same level, and finally the differences between groups of discs of different levels. There were no differences existing in annular fibers anchoring on the endplate between discs of different levels. A positive immune reaction for type I collagen was observed in the longitudinal ligaments and in the annular region adjacent to them. Collagen II immune reactivity was found in the annulus close to the nucleus pulposus, in the endplates and in the nucleus. There were no differences between discs of different levels in the collagen I and II localization. The height of the discs varied along the spine. The smallest value was measured in T3-T4, with a larger increase caudally than cranially. The highest value was measured in L2-L3. A cervical disc was 55% the height of a lumbar one. The endplate height increased along the length of the spine. The inferior EP was always higher than the superior. The study provides a detailed structural characterization of the intervertebral disc and may be useful for further investigations on the disc degeneration process.
Collapse
Affiliation(s)
- Giuseppe Longo
- Orthopaedic Department, Universita Campus BioMedico, Rome, Italy
| | - Purificacion Ripalda
- Orthopaedic Surgery and Traumatology, University of Navarra, Pamplona, Navarra, Spain
| | - Vicenzo Denaro
- Orthopaedic Department, Universita Campus BioMedico, Rome, Italy
| | - Francisco Forriol
- Orthopaedic Surgery and Traumatology, University of Navarra, Pamplona, Navarra, Spain
| |
Collapse
|
30
|
Abstract
BACKGROUND CONTEXT Currently, no biologic treatment is available for disc degeneration. However, many different molecules of potential therapeutic benefit are being investigated. PURPOSE Review and categorize the molecules under investigation for potential therapy in preventing or reversing disc degeneration. STUDY DESIGN Review article. METHODS Review of published articles on molecules that may be useful in biologic therapy of the intervertebral disc. RESULTS The list of molecules under investigation for potential benefit in biologic therapy of the intervertebral disc repair continues to grow. These molecules are so diverse that they no longer all fall into the classic terminology of "growth factor." Some of these molecules are not growth factors at all and some are not even cytokines. At least four different classes of molecules may be effective in disc repair. These include anticatabolics (eg, tissue inhibitors of metalloproteinase [TIMPs]), mitogens (eg, insulin-like growth factor-1 [IGF-1], platelet-derived growth factor [PDGF]), chondrogenic morphogens (transforming growth factor beta [TGF-beta] and bone morphogenetic proteins [BMPs]), and intracellular regulators (LIM mineralization protein-1 [LMP-1] and Sox9). Although some in vitro data are available on all of these molecules, few of these molecules have been tested in vivo with an animal model of disc degeneration. CONCLUSIONS As the current screening experiments are concluded, more definitive in vivo systems involving a more realistic degeneration model will be a necessary step before attempting human studies.
Collapse
Affiliation(s)
- S Tim Yoon
- Department of Orthopaedic Surgery, Emory University, 59 Executive Park South, Suite 3000, Atlanta, GA 30029, USA.
| |
Collapse
|
31
|
Abstract
BACKGROUND CONTEXT One of the most promising therapies for symptomatic disc degeneration involves the implantation of therapeutic cells into the degenerative disc. PURPOSE In this article, the rationale and approaches for cell-based tissue engineering of the intervertebral disc are discussed. STUDY DESIGN The scientific literature related to cell-based tissue engineering of the intervertebral disc is reviewed. METHODS A variety of cell types have been used in various research models to affect matrix repair of the intervertebral disc. The use of cellular scaffolds and growth factors or genes also appears promising for achieving meaningful tissue repair of the intervertebral disc. RESULTS Disc tissue engineering is a promising approach for achieving repair of the intervertebral disc. Using cell-based approaches, various research models suggest that improvements in the complex matrix of the disc may be achieved. CONCLUSION A cell-based approach to repair of the intervertebral disc appears promising. More research is needed to define the optimal cell type, cellular scaffold and mixture of growth factors that may allow meaningful repair of the human symptomatic degenerative disc.
Collapse
Affiliation(s)
- D Greg Anderson
- Graduate Program in Tissue Engineering and Regenerative Medicine and Department of Orthopaedic Surgery, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
| | | | | | | | | |
Collapse
|