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Böl M, Leichsenring K, Kohn S, Ehret AE. The anisotropic and region-dependent mechanical response of wrap-around tendons under tensile, compressive and combined multiaxial loads. Acta Biomater 2024; 183:157-172. [PMID: 38838908 DOI: 10.1016/j.actbio.2024.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
The present work reports on the multiaxial region and orientation-dependent mechanical properties of two porcine wrap-around tendons under tensile, compressive and combined loads based on an extensive study with n=175 samples. The results provide a detailed dataset of the anisotropic tensile and compressive longitudinal properties and document a pronounced tension-compression asymmetry. Motivated by the physiological loading conditions of these tendons, which include transversal compression at bony abutments in addition to longitudinal tension, we systematically investigated the change in axial tension when the tendon is compressed transversally along one or both perpendicular directions. The results reveal that the transversal compression can increase axial tension (proximal-distal direction) in both cases to orders of 30%, yet by a larger amount in the first case (transversal compression in anterior-posterior direction), which seems to be more relevant for wrap-around tendons in-vivo. These quantitative measurements are in line with earlier findings on auxetic properties of tendon tissue, but show for the first time the influence of this property on the stress response of the tendon, and may thus reveal an important functional principle within these essential elements of force transmission in the body. STATEMENT OF SIGNIFICANCE: The work reports for the first time on multiaxial region and orientation-dependent mechanical properties of wrap-around tendons under various loads. The results indicate that differences in the mechanical properties exist between zones that are predominantly in a uniaxial tensile state and those that experience complex load states. The observed counterintuitive increase of the axial tension upon lateral compression points at auxetic properties of the tendon tissue which may be pivotal for the function of the tendon as an element of the musculoskeletal system. It suggests that the tendon's performance in transmitting forces is not diminished but enhanced when the action line is deflected by a bony pulley around which the tendon wraps, representing an important functional principle of tendon tissue.
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Affiliation(s)
- Markus Böl
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany.
| | - Kay Leichsenring
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Stephan Kohn
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Alexander E Ehret
- Empa, Swiss Federal Laboratories for Materials Science and Technology, CH-8600 Dübendorf, Switzerland; Institute for Mechanical Systems, ETH Zurich, Zürich, CH-8092, Switzerland
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Smit TH. On growth and scoliosis. 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 2024; 33:2439-2450. [PMID: 38705903 DOI: 10.1007/s00586-024-08276-9] [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: 11/01/2023] [Revised: 03/15/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To describe the physiology of spinal growth in patients with adolescent idiopathic scoliosis (AIS). METHODS Narrative review of the literature with a focus on mechanisms of growth. RESULTS In his landmark publication On Growth and Form, D'Arcy Thompson wrote that the anatomy of an organism reflects the forces it is subjected to. This means that mechanical forces underlie the shape of tissues, organs and organisms, whether healthy or diseased. AIS is called idiopathic because the underlying cause of the deformation is unknown, although many factors are associated. Eventually, however, any deformity is due to mechanical forces. It has long been shown that the typical curvature and rotation of the scoliotic spine could result from vertebrae and intervertebral discs growing faster than the ligaments attached to them. This raises the question why in AIS the ligaments do not keep up with the speed of spinal growth. The spine of an AIS patient deviates from healthy spines in various ways. Growth is later but faster, resulting in higher vertebrae and intervertebral discs. Vertebral bone density is lower, which suggests less spinal compression. This also preserves the notochordal cells and the swelling pressure in the nucleus pulposus. Less spinal compression is due to limited muscular activity, and low muscle mass indeed underlies the lower body mass index (BMI) in AIS patients. Thus, AIS spines grow faster because there is less spinal compression that counteracts the force of growth (Hueter-Volkmann Law). Ligaments consist of collagen fibres that grow by tension, fibrillar sliding and the remodelling of cross-links. Growth and remodelling are enhanced by dynamic loading and by hormones like estrogen. However, they are opposed by static loading. CONCLUSION Increased spinal elongation and reduced ligamental growth result in differential strain and a vicious circle of scoliotic deformation. Recognising the physical and biological cues that contribute to differential growth allows earlier diagnosis of AIS and prevention in children at risk.
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Affiliation(s)
- Theodoor H Smit
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam University Medical Centres, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Department of Medical Biology, Amsterdam University Medical Centres, Meibergdreef 9, Room K2-140, 1105 AZ, Amsterdam, The Netherlands.
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Li H, Li Y, Xiang L, Luo S, Zhang Y, Li S. Therapeutic potential of GDF-5 for enhancing tendon regenerative healing. Regen Ther 2024; 26:290-298. [PMID: 39022600 PMCID: PMC11252783 DOI: 10.1016/j.reth.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 07/20/2024] Open
Abstract
Tendon injury is a common disorder of the musculoskeletal system, with a higher possibility of occurrence in elderly individuals and athletes. After a tendon injury, the tendon suffers from inadequate and slow healing, resulting in the formation of fibrotic scar tissue, ending up with inferior functional properties. Therapeutic strategies involving the application of growth factors have been advocated to promote tendon healing. Growth and differentiation-5 (GDF-5) represents one such factor that has shown promising effect on tendon healing in animal models and in vitro cultures. Although promising, these studies are limited as the molecular mechanisms by which GDF-5 exerts its effect remain incompletely understood. Starting from broadly introducing essential elements of current understanding about GDF-5, the present review aims to define the effect of GDF-5 and its possible mechanisms of action in tendon healing. Nevertheless, we still need more in vivo studies to explore dosage, application time and delivery strategy of GDF-5, so as to pave the way for future clinical translation.
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Affiliation(s)
- Hanyue Li
- School of Physical Education, Southwest Medical University, PR China
| | - Yini Li
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Sichuan, PR China
| | - Linmei Xiang
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China
| | - Shengyu Luo
- School of Physical Education, Southwest Medical University, PR China
| | - Yan Zhang
- Luzhou Vocational and Technical College, PR China
| | - Sen Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, PR China
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Lal L P MR, Agrawal DK. Hyperlipidemia Induced Pathological Changes with no Effect in Biomechanical Properties in the Achilles Tendon of Young Swine. JOURNAL OF ORTHOPAEDICS AND SPORTS MEDICINE 2024; 6:67-72. [PMID: 38784690 PMCID: PMC11113011 DOI: 10.26502/josm.511500144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Hyperlipidemia is linked to atherosclerosis and various diseases. Its strong association with Achilles tendinopathies and xanthomas affects tendon properties through lipid deposition in tendon tissue. We examined the impact of hyperlipidemia on the biomechanical properties of the swine Achilles tendons. Swines were fed a high-cholesterol-high-fat diet to induce hyperlipidemia, and their Achilles tendons were collected and examined for biomechanical properties. The ultimate tensile strength, modulus of elasticity and viscoelastic properties did not exhibit significant differences between hyperlipidemic and control swines. H&E and pentachrome staining revealed extracellular matrix (ECM) disorganization and cellular infiltration in the hyperlipidemic swines, highlighting a marked difference between the control and hyperlipidemic groups. These results suggest hyperlipidemia in young swines alters the tendon composition and may contribute to weak biomechanical properties with time.
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Affiliation(s)
- Merlin Rajesh Lal L P
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California USA
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California USA
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Squier K, Mousavizadeh R, Damji F, Beck C, Hunt M, Scott A. In vitro collagen biomarkers in mechanically stimulated human tendon cells: a systematic review. Connect Tissue Res 2024; 65:89-101. [PMID: 38375562 DOI: 10.1080/03008207.2024.2313582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE The aim of this study was to comprehensively examine and summarize the available in vitro evidence regarding the relationship between mechanical stimulation and biomarkers of collagen synthesis in human-derived tendon cells. METHODS Systematic review with narrative analyses and risk of bias assessment guided by the Health Assessment and Translation tool. The electronic databases MEDLINE (Ovid), EMBASE (Ovid), CENTRAL (Ovid) and COMPENDEX (Engineering Village) were systematically searched from inception to 3 August 2023. Inclusion criteria encompassed English language, original experimental, or quasi-experimental in vitro publications that subjected human tendon cells to mechanical stimulation, with collagen synthesis (total collagen, type I, III, V, XI, XII, and XIV) and related biomarkers (matrix metalloproteinases, transforming growth factor β, scleraxis, basic fibroblast growth factor) as outcomes. RESULTS Twenty-one publications were included. A pervasive definite high risk of bias was evident in all included studies. Owing to incomplete outcome reporting and heterogeneity in mechanical stimulation protocols, planned meta-analyses were unfeasible. Reviewed data suggested that human tendon cells respond to mechanical stimulation with increased synthesis of collagen (e.g., COL1A1, procollagen, total soluble collagen, etc.), scleraxis and several matrix metalloproteinases. Results also indicate that mechanical stimulation dose magnitude may influence synthesis in several biomarkers. CONCLUSIONS A limited number of studies, unfortunately characterized by a definite high risk of bias, suggest that in vitro mechanical stimulation primarily increases type I collagen synthesis by human tendon cells. Findings from this systematic review provide researchers and clinicians with biological evidence concerning the possible beneficial influence of exercise and loading on cellular-level tendon adaptation.
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Affiliation(s)
- Kipling Squier
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at VCH, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rouhollah Mousavizadeh
- Centre for Aging SMART at VCH, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Faraz Damji
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Charlotte Beck
- Woodward Library, University of British Columbia, Vancouver, Canada
| | - Michael Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at VCH, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alexander Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at VCH, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Huang S, Rao Y, Ju AL, Ker DFE, Blocki AM, Wang DM, Tuan RS. Non-collagenous proteins, rather than the collagens, are key biochemical factors that mediate tenogenic bioactivity of tendon extracellular matrix. Acta Biomater 2024; 176:99-115. [PMID: 38142795 DOI: 10.1016/j.actbio.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
Despite the growing clinical use of extracellular matrix (ECM)-based biomaterials for tendon repair, undesired healing outcomes or complications have frequently been reported. A major scientific challenge has been the limited understanding of their functional compositions and mechanisms of action due to the complex nature of tendon ECM. Previously, we have reported a soluble ECM fraction from bovine tendons (tECM) by urea extraction, which exhibited strong, pro-tenogenic bioactivity on human adipose-derived stem cells (hASCs). In this study, to advance our previous findings and gain insights into the biochemical nature of its pro-tenogenesis activity, tECM was fractionated using (i) an enzymatic digestion approach (pepsin, hyaluronidase, and chondroitinase) to yield various enzyme-digested tECM fractions; and (ii) a gelation-based approach to yield collagen matrix-enriched (CM) and non-collagenous matrix-enriched (NCM) fractions. Their tenogenic bioactivity on hASCs was assessed. Our results collectively indicated that non-collagenous tECM proteins, rather than collagens, are likely the important biochemical factors responsible for tECM pro-tenogenesis bioactivity. Mechanistically, RNA-seq analysis revealed that tECM and its non-collagenous portion induced similar transcriptional profiles of hASCs, particularly genes associated with cell proliferation, collagen synthesis, and tenogenic differentiation, which were distinct from transcriptome induced by its collagenous portion. From an application perspective, the enhanced solubility of the non-collagenous tECM, compared to tECM, should facilitate its combination with various water-soluble biomaterials for tissue engineering protocols. Our work provides insight into the molecular characterization of native tendon ECM, which will help to effectively translate their functional components into the design of well-defined, ECM biomaterials for tendon regeneration. STATEMENT OF SIGNIFICANCE: Significant progress has been made in extracellular matrix (ECM)-based biomaterials for tendon repair. However, their effectiveness remains debated, with conflicting research and clinical findings. Understanding the functional composition and mechanisms of action of ECM is crucial for developing safe and effective bioengineered scaffolds. Expanding on our previous work with bovine tendon ECM extracts (tECM) exhibiting strong pro-tenogenesis activity, we fractionated tECM to evaluate its bioactive moieties. Our findings indicate that the non-collagenous matrix within tECM, rather than the collagenous portions, plays a major role in the pro-tenogenesis bioactivity on human adipose-derived stem cells. These insights will drive further optimization of ECM-based biomaterials, including our advanced method for preparing highly soluble, non-collagenous matrix-enriched tendon ECM for effective tendon repair.
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Affiliation(s)
- Shuting Huang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Science Park, Hong Kong SAR, China.
| | - Ying Rao
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Adler Leigh Ju
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dai Fei Elmer Ker
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Ministry of Education Key Laboratory for Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Science Park, Hong Kong SAR, China
| | - Anna M Blocki
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Science Park, Hong Kong SAR, China
| | - Dan Michelle Wang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Ministry of Education Key Laboratory for Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Science Park, Hong Kong SAR, China.
| | - Rocky S Tuan
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromusculoskeletal Restorative Medicine, Science Park, Hong Kong SAR, China.
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Park SH, Kim DY, Lee WJ, Jang M, Jeong SM, Ku SK, Kwon YS, Yun S. Effect of platelet-rich plasma in Achilles tendon allograft in rabbits. J Vet Sci 2024; 25:e22. [PMID: 38568824 PMCID: PMC10990913 DOI: 10.4142/jvs.23281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Achilles tendon is composed of dense connective tissue and is one of the largest tendons in the body. In veterinary medicine, acute ruptures are associated with impact injury or sharp trauma. Healing of the ruptured tendon is challenging because of poor blood and nerve supply as well as the residual cell population. Platelet-rich plasma (PRP) contains numerous bioactive agents and growth factors and has been utilized to promote healing in bone, soft tissue, and tendons. OBJECTIVE The purpose of this study was to evaluate the healing effect of PRP injected into the surrounding fascia of the Achilles tendon after allograft in rabbits. METHODS Donor rabbits (n = 8) were anesthetized and 16 lateral gastrocnemius tendons were fully transected bilaterally. Transected tendons were decellularized and stored at -80°C prior to allograft. The allograft was placed on the partially transected medial gastrocnemius tendon in the left hindlimb of 16 rabbits. The allograft PRP group (n = 8) had 0.3 mL of PRP administered in the tendon and the allograft control group (n = 8) did not receive any treatment. After 8 weeks, rabbits were euthanatized and allograft tendons were transected for macroscopic, biomechanical, and histological assessment. RESULTS The allograft PRP group exhibited superior macroscopic assessment scores, greater tensile strength, and a histologically enhanced healing process compared to those in the allograft control group. CONCLUSIONS Our results suggest administration of PRP on an allograft tendon has a positive effect on the healing process in a ruptured Achilles tendon.
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Affiliation(s)
- Seok-Hong Park
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Dong-Yub Kim
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Won-Jae Lee
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Min Jang
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Seong Mok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Sae-Kwang Ku
- Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Korea
| | - Young-Sam Kwon
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea
| | - Sungho Yun
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea.
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Dwivedi J, Wal P, Dash B, Ovais M, Sachan P, Verma V. Diabetic Pneumopathy- A Novel Diabetes-associated Complication: Pathophysiology, the Underlying Mechanism and Combination Medication. Endocr Metab Immune Disord Drug Targets 2024; 24:1027-1052. [PMID: 37817659 DOI: 10.2174/0118715303265960230926113201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The "diabetic lung" has been identified as a possible target organ in diabetes, with abnormalities in ventilation control, bronchomotor tone, lung volume, pulmonary diffusing capacity, and neuroadrenergic bronchial innervation. OBJECTIVE This review summarizes studies related to diabetic pneumopathy, pathophysiology and a number of pulmonary disorders including type 1 and type 2 diabetes. METHODS Electronic searches were conducted on databases such as Pub Med, Wiley Online Library (WOL), Scopus, Elsevier, ScienceDirect, and Google Scholar using standard keywords "diabetes," "diabetes Pneumopathy," "Pathophysiology," "Lung diseases," "lung infection" for review articles published between 1978 to 2023 very few previous review articles based their focus on diabetic pneumopathy and its pathophysiology. RESULTS Globally, the incidence of diabetes mellitus has been rising. It is a chronic, progressive metabolic disease. The "diabetic lung" may serve as a model of accelerated ageing since diabetics' rate of respiratory function deterioration is two to three-times higher than that of normal, non-smoking people. CONCLUSION Diabetes-induced pulmonary dysfunction has not gained the attention it deserves due to a lack of proven causality and changes in cellular properties. The mechanism underlying a particular lung illness can still only be partially activated by diabetes but there is evidence that hyperglycemia is linked to pulmonary fibrosis in diabetic people.
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Affiliation(s)
- Jyotsana Dwivedi
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Pranay Wal
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Biswajit Dash
- Department of Pharmaceutical Technology, ADAMAS University, West Bengal, India
| | | | - Pranjal Sachan
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
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Tu T, Shi Y, Zhou B, Wang X, Zhang W, Zhou G, Mo X, Wang W, Wu J, Liu W. Type I collagen and fibromodulin enhance the tenogenic phenotype of hASCs and their potential for tendon regeneration. NPJ Regen Med 2023; 8:67. [PMID: 38092758 PMCID: PMC10719373 DOI: 10.1038/s41536-023-00341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Our previous work demonstrated the tendon-derived extracellular matrix (ECM) extracts as vital niches to specifically direct mesenchymal stem cells towards tenogenic differentiation. This study aims to further define the effective ECM molecules capable of teno-lineage induction on human adipose-derived stem cells (hASCs) and test their function for tendon engineering. By detecting the teno-markers expression levels in hASCs exposed to various substrate coatings, collagen I (COL1) and fibromodulin (FMOD) were identified to be the key molecules as a combination and further employed to the modification of poly(L-lactide-co-ε-caprolactone) electrospun nanoyarns, which showed advantages in inducting seeded hASCs for teno-lineage specific differentiation. Under dynamic mechanical loading, modified scaffold seeded with hASCs formed neo-tendon in vitro at the histological level and formed better tendon tissue in vivo with mature histology and enhanced mechanical properties. Primary mechanistic investigation with RNA sequencing demonstrated that the inductive mechanism of these two molecules for hASCs tenogenic differentiation was directly correlated with positive regulation of peptidase activity, regulation of cell-substrate adhesion and regulation of cytoskeletal organization. These biological processes were potentially affected by LOC101929398/has-miR-197-3p/TENM4 ceRNA regulation axis. In summary, COL1 and FMOD in combination are the major bioactive molecules in tendon ECM for likely directing tenogenic phenotype of hASCs and certainly valuable for hASCs-based tendon engineering.
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Affiliation(s)
- Tian Tu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Plastic and Aesthetic Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310003, China
| | - Yuan Shi
- Department of Burn and Plastic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215000, China
| | - Boya Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiaoyu Wang
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, P. R. China
| | - Wenjie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- National Tissue Engineering Center of China, Shanghai, 200241, China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- National Tissue Engineering Center of China, Shanghai, 200241, China
| | - Xiumei Mo
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, P. R. China
| | - Wenbo Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, 201620, P. R. China.
| | - Wei Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- National Tissue Engineering Center of China, Shanghai, 200241, China.
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Klahr B, Lanzendorf JZ, Thiesen JLM, Pinto OT, Müller LG, Carniel TA, Fancello EA. On the contribution of solid and fluid behavior to the modeling of the time-dependent mechanics of tendons under semi-confined compression. J Mech Behav Biomed Mater 2023; 148:106220. [PMID: 37944227 DOI: 10.1016/j.jmbbm.2023.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
The present work aims to investigate whether it is possible to identify and quantify the contributions of the interstitial fluid and the solid skeleton to the overall time-dependent behavior of tendons based on a single mechanical test. For this purpose, the capabilities of three different time-dependent models (a viscoelastic, a poroelastic and a poroviscoelastic) were investigated in the modeling of the experimental behavior obtained from semi-confined compression with stress relaxation tests transverse to collagen fibers. The main achieved result points out that the poroviscoelastic model was the only one capable to characterize both the experimental responses of the force and volume changes of the tissue samples. Moreover, further analysis of this model shows that while the kinematics of the sample are mainly governed by the fluid flow (pore pressure contribution of the model), the behavior intrinsically associated with the viscoelastic solid skeleton makes a significant contribution to the experimental force response. This study reinforces the importance of taking both the experimental kinematics and kinetics of tendon tissues into account during the constitutive characterization procedure.
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Affiliation(s)
- Bruno Klahr
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jonas Zin Lanzendorf
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - José Luís Medeiros Thiesen
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Otávio Teixeira Pinto
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Liz Girardi Müller
- Graduate Program in Environmental Sciences, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil
| | - Thiago André Carniel
- Graduate Program in Health Sciences, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil; Polytechnic School, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil.
| | - Eduardo Alberto Fancello
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Lal MRLP, Agrawal DK. Hyperlipidemia Lowers the Biomechanical Properties of Rotator Cuff Tendon. JOURNAL OF ORTHOPAEDICS AND SPORTS MEDICINE 2023; 5:391-397. [PMID: 37982013 PMCID: PMC10655854 DOI: 10.26502/josm.511500126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Infraspinatus tendon is the most affected tendon of the rotator cuff, being an important posterior component of the shoulder joint. Hyperlipidemia is a predisposing factor in the progression of rotator cuff tears and retear. We studied the effect of hyperlipidemia on the biomechanical properties of rotator cuff tendons. The infraspinatus tendon of the rotator cuff from hyperlipidemic swine were collected and tested for ultimate tensile strength (UTS) and modulus of elasticity. Dynamic mechanical analysis was performed to examine viscoelastic properties. The findings revealed no significant difference in UTS but had significantly lower modulus of elasticity in the infraspinatus tendon of the hyperlipidemic group compared to the control group. Moreover, differences in the dynamic modulus, storage modulus, and loss modulus were not statistically significant between the hyperlipidemic and control swine. There was no difference in water content between the groups but the hyperlipidemic group had fatty infiltration aiding the initial decrease in mechanical properties. These findings suggest an association between fat deposition and early changes in the biomechanical properties of the tendons in the shoulder rotator cuff in hyperlipidemic state.
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Affiliation(s)
- Merlin Rajesh L P Lal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California USA
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California USA
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12
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Kwan KYC, Ng KWK, Rao Y, Zhu C, Qi S, Tuan RS, Ker DFE, Wang DM. Effect of Aging on Tendon Biology, Biomechanics and Implications for Treatment Approaches. Int J Mol Sci 2023; 24:15183. [PMID: 37894875 PMCID: PMC10607611 DOI: 10.3390/ijms242015183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Tendon aging is associated with an increasing prevalence of tendon injuries and/or chronic tendon diseases, such as tendinopathy, which affects approximately 25% of the adult population. Aged tendons are often characterized by a reduction in the number and functionality of tendon stem/progenitor cells (TSPCs), fragmented or disorganized collagen bundles, and an increased deposition of glycosaminoglycans (GAGs), leading to pain, inflammation, and impaired mobility. Although the exact pathology is unknown, overuse and microtrauma from aging are thought to be major causative factors. Due to the hypovascular and hypocellular nature of the tendon microenvironment, healing of aged tendons and related injuries is difficult using current pain/inflammation and surgical management techniques. Therefore, there is a need for novel therapies, specifically cellular therapy such as cell rejuvenation, due to the decreased regenerative capacity during aging. To augment the therapeutic strategies for treating tendon-aging-associated diseases and injuries, a comprehensive understanding of tendon aging pathology is needed. This review summarizes age-related tendon changes, including cell behaviors, extracellular matrix (ECM) composition, biomechanical properties and healing capacity. Additionally, the impact of conventional treatments (diet, exercise, and surgery) is discussed, and recent advanced strategies (cell rejuvenation) are highlighted to address aged tendon healing. This review underscores the molecular and cellular linkages between aged tendon biomechanical properties and the healing response, and provides an overview of current and novel strategies for treating aged tendons. Understanding the underlying rationale for future basic and translational studies of tendon aging is crucial to the development of advanced therapeutics for tendon regeneration.
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Affiliation(s)
- Ka Yu Carissa Kwan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kerry Ng
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ying Rao
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chenxian Zhu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shengcai Qi
- Department of Prosthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai 200040, China;
| | - Rocky S. Tuan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dai Fei Elmer Ker
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dan Michelle Wang
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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13
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Shojaee A. Equine tendon mechanical behaviour: Prospects for repair and regeneration applications. Vet Med Sci 2023; 9:2053-2069. [PMID: 37471573 PMCID: PMC10508504 DOI: 10.1002/vms3.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/03/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
Tendons are dense connective tissues that play an important role in the biomechanical function of the musculoskeletal system. The mechanical forces have been implicated in every aspect of tendon biology. Tendon injuries are frequently occurring and their response to treatments is often unsatisfactory. A better understanding of tendon biomechanics and mechanobiology can help develop treatment options to improve clinical outcomes. Recently, tendon tissue engineering has gained more attention as an alternative treatment due to its potential to overcome the limitations of current treatments. This review first provides a summary of tendon mechanical properties, focusing on recent findings of tendon mechanobiological responses. In the next step, we highlight the biomechanical parameters of equine energy-storing and positional tendons. The final section is devoted to how mechanical loading contributes to tenogenic differentiation using bioreactor systems. This study may help develop novel strategies for tendon injury prevention or accelerate and improve tendon healing.
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Affiliation(s)
- Asiyeh Shojaee
- Division of PhysiologyDepartment of Basic SciencesFaculty of Veterinary MedicineFerdowsi University of MashhadMashhadIran
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14
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Rana D, Desai N, Salave S, Karunakaran B, Giri J, Benival D, Gorantla S, Kommineni N. Collagen-Based Hydrogels for the Eye: A Comprehensive Review. Gels 2023; 9:643. [PMID: 37623098 PMCID: PMC10454301 DOI: 10.3390/gels9080643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
Collagen-based hydrogels have emerged as a highly promising platform for diverse applications in ophthalmology, spanning from drug delivery systems to biomedical interventions. This review explores the diverse sources of collagen, which give rise to different types of collagen protein. The critical isolation and purification steps are discussed, emphasizing their pivotal role in preparing collagen for biomedical use. To ensure collagen quality and purity, and the suitability of collagen for targeted applications, a comprehensive characterization and quality control are essential, encompassing assessments of its physical, chemical, and biological properties. Also, various cross-linking collagen methods have been examined for providing insight into this crucial process. This comprehensive review delves into every facet of collagen and explores the wide-ranging applications of collagen-based hydrogels, with a particular emphasis on their use in drug delivery systems and their potential in diverse biomedical interventions. By consolidating current knowledge and advancements in the field, this review aims to provide a detailed overview of the utilization of engineered collagen-based hydrogels in ocular therapeutics.
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Affiliation(s)
- Dhwani Rana
- National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad 382355, Gujarat, India; (D.R.); (S.S.); (B.K.); (D.B.)
| | - Nimeet Desai
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi 502285, Telangana, India; (N.D.); (J.G.)
| | - Sagar Salave
- National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad 382355, Gujarat, India; (D.R.); (S.S.); (B.K.); (D.B.)
| | - Bharathi Karunakaran
- National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad 382355, Gujarat, India; (D.R.); (S.S.); (B.K.); (D.B.)
| | - Jyotsnendu Giri
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi 502285, Telangana, India; (N.D.); (J.G.)
| | - Derajram Benival
- National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad 382355, Gujarat, India; (D.R.); (S.S.); (B.K.); (D.B.)
| | - Srividya Gorantla
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA;
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15
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Dabrowska S, Ekiert-Radecka M, Karbowniczek J, Weglarz WP, Heljak M, Lojkowski M, Obuchowicz R, Swieszkowski W, Mlyniec A. Calcification alters the viscoelastic properties of tendon fascicle bundles depending on matrix content. Acta Biomater 2023; 166:360-374. [PMID: 37172636 DOI: 10.1016/j.actbio.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Tendon fascicle bundles are often used as biological grafts and thus must meet certain quality requirements, such as excluding calcification, which alters the biomechanical properties of soft tissues. In this work, we investigate the influence of early-stage calcification on the mechanical and structural properties of tendon fascicle bundles with varying matrix content. The calcification process was modeled using sample incubation in concentrated simulated body fluid. Mechanical and structural properties were investigated using uniaxial tests with relaxation periods, dynamic mechanical analysis, as well as magnetic resonance imaging and atomic force microscopy. Mechanical tests showed that the initial phase of calcification causes an increase in the elasticity, storage, and loss modulus, as well as a drop in the normalized value of hysteresis. Further calcification of the samples results in decreased modulus of elasticity and a slight increase in the normalized value of hysteresis. Analysis via MRI and scanning electron microscopy showed that incubation alters fibrillar relationships within the tendon structure and the flow of body fluids. In the initial stage of calcification, calcium phosphate crystals are barely visible; however, extending the incubation time for the next 14 days results in the appearance of calcium phosphate crystals within the tendon structure and leads to damage in its structure. Our results show that the calcification process modifies the collagen-matrix relationships and leads to a change in their mechanical properties. These findings will help to understand the pathogenesis of clinical conditions caused by calcification process, leading to the development of effective treatments for these conditions. STATEMENT OF SIGNIFICANCE: This study investigates how calcium mineral deposition in tendons affects their mechanical response and which processes are responsible for this phenomenon. By analyzing the elastic and viscoelastic properties of animal fascicle bundles affected by calcification induced via incubation in concentrated simulated body fluid, the study sheds light on the relationship between structural and biochemical changes in tendons and their altered mechanical response. This understanding is crucial for optimizing tendinopathy treatment and preventing tendon injury. The findings provide insights into the calcification pathway and its resulting changes in the biomechanical behaviors of affected tendons, which have been previously unclear.
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Affiliation(s)
- Sylwia Dabrowska
- AGH University of Science and Technology, Faculty of Mechanical Engineering and Robotics, Krakow, Poland.
| | - Martyna Ekiert-Radecka
- AGH University of Science and Technology, Faculty of Mechanical Engineering and Robotics, Krakow, Poland.
| | - Joanna Karbowniczek
- AGH University of Science and Technology, Faculty of Metals Engineering and Industrial Computer Science, Krakow, Poland.
| | | | - Marcin Heljak
- Warsaw University of Technology, Faculty of Materials Science and Engineering, Warsaw, Poland.
| | - Maciej Lojkowski
- Warsaw University of Technology, Faculty of Materials Science and Engineering, Warsaw, Poland; Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, Warsaw, Poland.
| | - Rafal Obuchowicz
- Jagiellonian University Collegium Medicum, Department of Radiology, Krakow, Poland.
| | - Wojciech Swieszkowski
- Warsaw University of Technology, Faculty of Materials Science and Engineering, Warsaw, Poland.
| | - Andrzej Mlyniec
- AGH University of Science and Technology, Faculty of Mechanical Engineering and Robotics, Krakow, Poland.
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16
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Lu J, Li H, Zhang Z, Xu R, Wang J, Jin H. Platelet-rich plasma in the pathologic processes of tendinopathy: a review of basic science studies. Front Bioeng Biotechnol 2023; 11:1187974. [PMID: 37545895 PMCID: PMC10401606 DOI: 10.3389/fbioe.2023.1187974] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Tendinopathy is a medical condition that includes a spectrum of inflammatory and degenerative tendon changes caused by traumatic or overuse injuries. The pathological mechanism of tendinopathy has not been well defined, and no ideal treatment is currently available. Platelet-rich plasma (PRP) is an autologous whole blood derivative containing a variety of cytokines and other protein components. Various basic studies have found that PRP has the therapeutic potential to promote cell proliferation and differentiation, regulate angiogenesis, increase extracellular matrix synthesis, and modulate inflammation in degenerative tendons. Therefore, PRP has been widely used as a promising therapeutic agent for tendinopathy. However, controversies exist over the optimal treatment regimen and efficacy of PRP for tendinopathy. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. This article has also pointed out the future direction of basic research and clinical application of PRP in the treatment of tendinopathy, which will play a guiding role in the design of PRP treatment protocols for tendinopathy.
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Affiliation(s)
- Jialin Lu
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Han Li
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Ziyu Zhang
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Rui Xu
- Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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17
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Shivapatham G, Richards S, Bamber J, Screen H, Morrissey D. Ultrasound Measurement of Local Deformation in the Human Free Achilles Tendon Produced by Dynamic Muscle-Induced Loading: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1499-1509. [PMID: 37149429 DOI: 10.1016/j.ultrasmedbio.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/28/2023] [Accepted: 03/18/2023] [Indexed: 05/08/2023]
Abstract
Achilles tendinopathy is the most prevalent lower limb tendinopathy, yet it remains poorly understood, with mismatches between observed structure and reported function. Recent studies have hypothesised that Achilles tendon (AT) healthy function is associated with variable deformation across the tendon width during use, focusing on quantifying sub-tendon deformation. Here, the aim of this work was to synthesise recent advances exploring human free AT tissue-level deformation during use. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, Scopus and Web of Science were systematically searched. Study quality and risk of bias were assessed. Thirteen articles were retained, yielding data on free AT deformation patterns. Seven were categorised as high-quality and six as medium-quality studies. Evidence consistently reports that healthy and young tendons deform non-uniformly, with the deeper layer displacing 18%-80% more than the superficial layer. Non-uniformity decreased by 12%-85% with increasing age and by 42%-91% in the presence of injury. There is limited evidence of large effect that AT deformation patterns during dynamic loading are non-uniform and may act as a biomarker of tendon health, risk of injury and rehabilitation impact. Better considered participant recruitment and improved measurement procedures would particularly improve study quality, to explore links between tendon structure, function, aging and disease in distinct populations.
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Affiliation(s)
| | - Samuel Richards
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Jeffrey Bamber
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Hazel Screen
- School of Engineering and Material Science, Queen Mary University of London, London, UK
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK
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18
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Waugh CM, Mousavizadeh R, Lee J, Screen HRC, Scott A. Mild hypercholesterolemia impacts achilles sub-tendon mechanical properties in young rats. BMC Musculoskelet Disord 2023; 24:282. [PMID: 37046262 PMCID: PMC10091839 DOI: 10.1186/s12891-023-06375-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Hypercholesterolemia is associated with tendon pathology, but the reasons underpinning this relationship are not well understood. Cholesterol can accumulate in the tendon non-collagenous matrix which may affect both global and local tissue mechanics. Changes to the local strain environment within tendon may have significant implications for mechanosensitive tenocytes. Here, we investigated the association between elevated blood cholesterol and presence of tendon lipids in the Achilles tendon. We expected lipids to be localised in the proteoglycan-rich inter-sub-tendon matrix (ISTM), therefore we also sought to examine the impact of this on the biomechanical and viscoelastic properties of the ISTM. METHODS The Achilles tendons of 32 young wild-type (SD) and 32 apolipoprotein E knock-out rats (ApoE-/-) were harvested at 15.6 ± 2.3 weeks of age. 32 specimens underwent histological examination to assess the distribution of lipids throughout sub-tendons and ISTM. The remaining specimens were prepared for biomechanical testing, where the ISTM between the gastrocnemius and soleus sub-tendons was subjected to shear load mechanical testing. A sub-set of tests were video recorded to enable a strain analysis. RESULTS ApoE-/- serum cholesterol was double that of SD rats (mean 2.25 vs. 1.10 mg/ml, p < 0.001) indicating a relatively mild hypercholesterolemia phenotype. Nonetheless, we found histological evidence of esterified lipids in the ISTM and unesterified lipids in the sub-tendons, although the location or intensity of staining was not appreciably different between rat strains. Despite a lack of observable histological differences in lipid content between groups, there were significant differences in the mechanical and viscoelastic behaviour of the Achilles sub-tendon matrix. CONCLUSION Even slightly elevated cholesterol may result in subtle changes to tendon biomechanical properties and hence injury risk. The young age of our cohort and the mild phenotype of our ApoE-/- rats are likely to have limited our findings and so we also conclude that the ApoE-/- rat model is not well suited for investigating the biomechanical impact of tendon xanthomas on Achilles sub-tendon function.
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Affiliation(s)
- Charlie M Waugh
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada.
- School of Engineering and Materials Science, Queen Mary, University of London, London, U.K..
| | - Rouhollah Mousavizadeh
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Jenny Lee
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Hazel R C Screen
- School of Engineering and Materials Science, Queen Mary, University of London, London, U.K
| | - Alexander Scott
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada
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19
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Muljadi PM, Andarawis-Puri N. Glycosaminoglycans modulate microscale mechanics and viscoelasticity in fatigue injured tendons. J Biomech 2023; 152:111584. [PMID: 37080079 DOI: 10.1016/j.jbiomech.2023.111584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Tendinopathies are common injuries that typically occur from overuse and fatigue. Treatments target late-stage symptoms with limited success, leading to high rates of reinjury. Early intervention could halt tendinopathy progression to rupture but requires a better understanding of the biomechanical environment associated with early-stage disease. While fatigue injured tendons are further damaged by exercise that is initiated immediately after onset of injury, exercise that is initiated after a brief delay promotes repair. Similar macroscale mechanical properties and collagen damage throughout this delay period suggests that microscale, non-collagenous matrix changes after fatigue injury modulate tendon mechanotransduction and shifts the exercise response from detrimental to reparative. Glycosaminoglycans (GAGs) and proteoglycans (PGs) are increased during chronic tendinopathy, but their role in early-stage disease is unknown. We hypothesized that increased GAGs from fatigue injury modulate viscoelasticity and microscale strains to enable repair from exercise. Various GAG types were increased in the weeks after onset of fatigue injury in the extracellular and pericellular matrices of rat patellar tendons. Enzymatic removal of GAGs from these fatigued tendons increased microscale shear strain, suggesting that GAGs modulate the cell microenvironment after fatigue injury. GAG removal decreased dynamic modulus in the toe region and decreased loss tangent in the linear region of the stress-strain curve in fatigued tendons, suggesting the GAG increase modulates tendon multiscale mechanics and viscoelasticity during fiber uncrimping and fibril sliding and strain transfer. GAGs may influence repair in response to exercise and could serve as a therapeutic target for tendinopathy.
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Affiliation(s)
- Patrick M Muljadi
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA; Hospital for Special Surgery, New York, NY, USA.
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20
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Jones CL, Penney BT, Theodossiou SK. Engineering Cell-ECM-Material Interactions for Musculoskeletal Regeneration. Bioengineering (Basel) 2023; 10:bioengineering10040453. [PMID: 37106640 PMCID: PMC10135874 DOI: 10.3390/bioengineering10040453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
The extracellular microenvironment regulates many of the mechanical and biochemical cues that direct musculoskeletal development and are involved in musculoskeletal disease. The extracellular matrix (ECM) is a main component of this microenvironment. Tissue engineered approaches towards regenerating muscle, cartilage, tendon, and bone target the ECM because it supplies critical signals for regenerating musculoskeletal tissues. Engineered ECM-material scaffolds that mimic key mechanical and biochemical components of the ECM are of particular interest in musculoskeletal tissue engineering. Such materials are biocompatible, can be fabricated to have desirable mechanical and biochemical properties, and can be further chemically or genetically modified to support cell differentiation or halt degenerative disease progression. In this review, we survey how engineered approaches using natural and ECM-derived materials and scaffold systems can harness the unique characteristics of the ECM to support musculoskeletal tissue regeneration, with a focus on skeletal muscle, cartilage, tendon, and bone. We summarize the strengths of current approaches and look towards a future of materials and culture systems with engineered and highly tailored cell-ECM-material interactions to drive musculoskeletal tissue restoration. The works highlighted in this review strongly support the continued exploration of ECM and other engineered materials as tools to control cell fate and make large-scale musculoskeletal regeneration a reality.
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Affiliation(s)
- Calvin L Jones
- Department of Mechanical and Biomedical Engineering, Boise State University, 1910 University Dr MS2085, Boise, ID 83725, USA
| | - Brian T Penney
- Department of Mechanical and Biomedical Engineering, Boise State University, 1910 University Dr MS2085, Boise, ID 83725, USA
| | - Sophia K Theodossiou
- Department of Mechanical and Biomedical Engineering, Boise State University, 1910 University Dr MS2085, Boise, ID 83725, USA
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21
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Steinberg N, Funk S, Zeev A, Waddington G, Svorai-Litvak S, Pantanowitz M. Achilles Tendon and Patellar Tendon Structure in Combat Soldiers Following Prevention Exercises. Mil Med 2023; 188:678-688. [PMID: 35134964 DOI: 10.1093/milmed/usac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Military training that increases physical stress on musculoskeletal morphology also increases the risk of orthopedic injuries. Somatosensory prevention programs that reduce stress and improve functionality could be beneficial for better organization of tendon structure. The aim of this study was to investigate the impact of a somatosensory prevention exercise on the tendon structure (percentage of echo-type fibers; A-P and M-L diameters and cross-sectional area) of the Achilles tendon and patellar tendon among combat soldiers. MATERIALS AND METHODS These tendons of male Infantry soldiers aged 18-21 were screened before and after a 14-week training course. The intervention group, who performed preventative exercises, included 108 soldiers (BMI = 23.85 ± 2.76), while the control group, who participated in the same military course without these exercises, included 98 soldiers (BMI = 24.26 ± 4.03). Ultrasound scanning for tendon structure included percent of echo-type I-IV fibers, A-P diameter, M-L diameter, and cross-sectional area parameters. RESULTS Time by group interaction was found for echo-type I and II in both tendons. No significant differences were found between the two groups in the pretesting percentage of echo-type IV fibers of the Achilles tendon (P = .522), in echo-type III fibers of the Achilles tendon (P = .833), and echo-type IV fibers of the patellar tendon (P = .162). Greater pre-post differences in echo-type III and IV fibers were found in the control group compared with the intervention group for both the Achilles tendon (P = .021, P = .002) and the patellar tendon (P < .001, P < .001). CONCLUSION Increased damaged fibers (echo-type III and IV) of both tendons were found among the control group, yet not among soldiers who performed prevention exercises.
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Affiliation(s)
- Nili Steinberg
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
| | - Shani Funk
- Combat Fitness Department, Doctrine and Research Branch, IDF, Netanya 01443, Israel
| | - Aviva Zeev
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
| | - Gordon Waddington
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | | | - Michal Pantanowitz
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
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22
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Hecht JT, Chiu F, Veerisetty A, Hossain M, Posey KL. Matrix in Medicine: Health Consequences of Mutant Cartilage Oligomeric Matrix Protein and its relationship to abnormal growth and to joint degeneration. Matrix Biol 2023; 119:101-111. [PMID: 37001593 DOI: 10.1016/j.matbio.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
Cartilage oligomeric matrix protein (COMP), an extracellular matrix protein, has been shown to enhance proliferation and mechanical integrity in the matrix, supporting functions of the growth plate and articular cartilage. Mutations in COMP cause pseudoachondroplasia (PSACH), a severe dwarfing condition associated with premature joint degeneration and significant lifelong joint pain. The MT (mutant)-COMP mouse mimics PSACH with decreased limb growth, early joint degeneration and pain. Ablation of endoplasmic reticulum stress CHOP signaling eliminated pain and prevented joint degeneration. The health effects of mutant COMP are discussed in relation to cellular/chondrocyte stress in the growth plate, articular cartilage and nearby tissues, and the implications for therapeutic approaches. There are many similarities between osteoarthritis and mutant-COMP protein-induced joint degeneration, suggesting that the relevance of findings in the joints may extend beyond PSACH to idiopathic primary OA.
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23
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The mechanical behavior of silk-fibroin reinforced alginate hydrogel biocomposites - Toward functional tissue biomimetics. J Mech Behav Biomed Mater 2023; 138:105598. [PMID: 36455380 DOI: 10.1016/j.jmbbm.2022.105598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Soft tissues are constructed as fiber-reinforced composites consisting of structural mechanisms and unique mechanical behavior. Biomimetics of their mechanical behavior is currently a significant bioengineering challenge, emphasizing the need to replicate structural and mechanical mechanisms into novel biocomposite designs. Here we present a novel silk-based biocomposite laminate constructed from long natural silk and fibroin fibers embedded in an alginate hydrogel matrix. Controlling the mechanical features of these laminates were studied for different fiber volume fractions (VF) and orientations using unidirectional tensile tests. Three material systems were investigated having different fiber orientations: longitudinal (0°), transverse (90°), and cross-plied (0/90°). The general behavior of the biocomposite laminates was anisotropic hyperelastic with large deformations. Longitudinal fibroin laminates have shown a tensile modulus of 178.55 ± 14.46 MPa and tensile strength of 18.47 ± 2.01 MPa for 0.48 VF. With similar VF, cross-plied fibroin laminates demonstrated structural shielding ability, having a tensile modulus and tensile strength of 101.73 ± 8.04 MPa and 8.29 ± 1.63 MPa for only a third of the VF directed in the stretching direction. The stress-strain behavior was in a similar range to highly stiff native human soft tissues such as ligament and meniscus. These findings demonstrate the potential of the fibroin fiber-reinforced biocomposites to mimic the mechanics of tissues with a quantitatively controlled amount of fibers and designed spatial arrangement. This can lead to new solutions for the repair and replacement of damaged functional and highly stiff soft tissues.
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24
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Chalidis B, Givissis P, Papadopoulos P, Pitsilos C. Molecular and Biologic Effects of Platelet-Rich Plasma (PRP) in Ligament and Tendon Healing and Regeneration: A Systematic Review. Int J Mol Sci 2023; 24:2744. [PMID: 36769065 PMCID: PMC9917492 DOI: 10.3390/ijms24032744] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Platelet-rich plasma (PRP) has been introduced and applied to a wide spectrum of acute and chronic ligament and tendon pathologic conditions. Although the biological effect of PRP has been studied thoroughly in both animal and human studies, there is no consensus so far on the exact mechanism of its action as well as the optimal timing and dosage of its application. Therefore, we conducted a systematic review aiming to evaluate the molecular effect of the administration of PRP in tendoligamentous injuries and degenerative diseases. The literature search revealed 36 in vitro and in vivo studies examining the healing and remodeling response of animal and human ligament or tendon tissues to PRP. Platelet-rich plasma added in the culture media was highly associated with increased cell proliferation, migration, viability and total collagen production of both ligament- and tendon-derived cells in in vitro studies, which was further confirmed by the upregulation of collagen gene expression. In vivo studies correlated the PRP with higher fibroblastic anabolic activity, including increased cellularity, collagen production and vascularity of ligament tissue. Similarly, greater metabolic response of tenocytes along with the acceleration of the healing process in the setting of a tendon tear were noticed after PRP application, particularly between the third and fourth week after treatment. However, some studies demonstrated that PRP had no or even negative effect on tendon and ligament regeneration. This controversy is mainly related to the variable processes and methodologies of preparation of PRP, necessitating standardized protocols for both investigation and ap-plication.
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Affiliation(s)
- Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece
| | - Charalampos Pitsilos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece
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25
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Spinal Manual Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7928429. [PMID: 36644168 PMCID: PMC9833903 DOI: 10.1155/2023/7928429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Abstract
Objective We conducted this meta-analysis to provide better evidence of the efficacy of manual therapy (MT) on adolescent idiopathic scoliosis (AIS). Methods All RCTs of MT for the management of patients with AIS were included in the present study. The treatment difference between the experimental and control group was mainly MT. The outcomes consisted of the total effective rate, the Cobb angle, and Scoliosis Research Society-22 (SRS-22) questionnaire score. Electronic database searches were conducted from database inception to July 2022, including the Cochrane Library, PubMed, Web of Science, Embase, Wanfang Data, CNKI, and VIP. The pooled data were analyzed using RevMan 5.4 software. Results Four RCTs with 213 patients in the experimental group were finally included. There are 2 studies of standalone MT in the experimental group and 3 studies of MT with identical conservative treatments in the control group. Three trials reported total effective rate, and a statistically significant difference was found (P = 0.004). Three trials reported Cobb angle, and a statistical difference was found (P = 0.01). Then, sensitivity analysis showed that there was a significant difference in the additional MT subgroup (P < 0.00001) while not in the standalone MT subgroup (P = 0.41). Three trials reported SRS-22 scores (P = 0.55) without significant differences. Conclusion There is insufficient data to determine the effectiveness of spinal manipulation limited by the very low quality of included studies. High-quality studies with appropriate design and follow-up periods are warranted to determine if MT may be beneficial as an adjunct therapy for AIS. Currently, there is no evidence to support spinal manipulation.
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26
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Steinberg N, Pantanowitz M, Zeev A, Svorai Band S, Funk S, Nemet D. Achilles and patellar tendon structure following a prevention program in male combat soldiers. PHYSICIAN SPORTSMED 2022; 50:531-540. [PMID: 34488525 DOI: 10.1080/00913847.2021.1976601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of the study were to compare the prevalence of soldiers with musculoskeletal symptoms between soldiers that participated in a prevention program (INT) and a control group (CONT); and, to assess whether 'high risk' for a symptom indicator [participants with patellar tendon (PT) echo-type III+IV >10% or Achilles tendon (AT) echo-type III >8.5%] applies when a prevention intervention is used. METHODS Soldiers from two consecutive infantry commanders courses (year 1-CONT, n = 165; year 2-INT, n = 196) were examined pre-course for AT and PT structure using ultrasound tissue characterization (UTC), and their musculoskeletal overuse symptoms were assessed and recorded by military physicians throughout the course. A prevention program was provided to the INT group (year 2) during the 14-week course. RESULTS No significant differences were found in the prevalence of soldiers with symptoms between the two groups [INT: 39 (19.9%), CONT: 40 (24.2%); p = .32]. Using the indicator at baseline, 20 soldiers (10.2%) were suggested to be at 'high risk.' Of those 20 soldiers, 17 actually had symptoms during the course (positive predictive value-85%). The prevalence of soldiers with a suggested 'high risk' according to our indicator who had no symptoms during the course was low (3/20, 15%). Twenty-two soldiers who had symptoms during the course had not been suggested to be at 'high risk' by our indicator. CONCLUSION Our intervention did not reduce the prevalence of soldiers with symptoms. Our 'high risk' pre-course, AT and PT structure indicator is valid and can be used as a screening tool to reduce the prevalence of symptoms in combat soldiers; with the caution that soldiers that were not identified by the indicator, might also have symptoms along the course.
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Affiliation(s)
- Nili Steinberg
- Life science, Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | - Michal Pantanowitz
- Life science, Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | - Aviva Zeev
- Life science, Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | | | - Shany Funk
- Combat Fitness Department, Doctrine and Research Branch, Israel
| | - Dan Nemet
- Child Health and Sport Center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
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27
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Disser NP, Piacentini AN, De Micheli AJ, Schonk MM, Yao VJH, Deng XH, Oliver DJ, Rodeo SA. Achilles Tendons Display Region-Specific Transcriptomic Signatures Associated With Distinct Mechanical Properties. Am J Sports Med 2022; 50:3866-3874. [PMID: 36305762 DOI: 10.1177/03635465221128589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have examined the transcriptomes and mechanical properties of whole tendons in different regions of the body. However, less is known about these characteristics within a single tendon. PURPOSE To develop a regional transcriptomic atlas and evaluate the region-specific mechanical properties of Achilles tendons. STUDY DESIGN Descriptive laboratory study. METHODS Achilles tendons from 2-month-old male Sprague Dawley rats were used. Tendons were isolated and divided into proximal, middle, and distal thirds for RNA sequencing (n = 5). For mechanical testing, the Achilles muscle-tendon-calcaneus unit was mounted in a custom-designed materials testing system with the unit clamped over the musculotendinous junction (MTJ) and the calcaneus secured at 90° of dorsiflexion (n = 9). Tendons were stretched to 20 N at a constant speed of 0.0167 mm/s. Cross-sectional area, strain, stress, and Young modulus were determined in each tendon region. RESULTS An open-access, interactive transcriptional atlas was generated that revealed distinct gene expression signatures in each tendon region. The proximal and distal regions had the largest differences in gene expression, with 2596 genes significantly differentially regulated at least 1.5-fold (q < .01). The proximal tendon displayed increased expression of genes resembling a tendon phenotype and increased expression of nerve cell markers. The distal region displayed increases in genes involved in extracellular matrix synthesis and remodeling, immune cell regulation, and a phenotype similar to cartilage and bone. There was a 3.72-fold increase in Young modulus from the proximal to middle region (P < .01) and an additional 1.34-fold increase from the middle to distal region (P = .027). CONCLUSION Within a single tendon, there are region-specific transcriptomic signatures and mechanical properties, and there is likely a gradient in the biological and functional phenotype from the proximal origin at the MTJ to the distal insertion at the enthesis. CLINICAL RELEVANCE These findings improve our understanding of the underlying biological heterogeneity of tendon tissue and will help inform the future targeted use of regenerative medicine and tissue engineering strategies for patients with tendon disorders.
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Affiliation(s)
- Nathaniel P Disser
- Hospital for Special Surgery, New York, New York, USA.,McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Andrea J De Micheli
- Hospital for Special Surgery, New York, New York, USA.,Department of Oncology of the Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland
| | | | - Vincent J H Yao
- Hospital for Special Surgery, New York, New York, USA.,Sophie Davis Biomedical Education Program at CUNY School of Medicine, New York, New York, USA
| | | | - David J Oliver
- Hospital for Special Surgery, New York, New York, USA.,The David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
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28
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Camy C, Brioche T, Senni K, Bertaud A, Genovesio C, Lamy E, Fovet T, Chopard A, Pithioux M, Roffino S. Effects of hindlimb unloading and subsequent reloading on the structure and mechanical properties of Achilles tendon-to-bone attachment. FASEB J 2022; 36:e22548. [PMID: 36121701 DOI: 10.1096/fj.202200713r] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022]
Abstract
While muscle and bone adaptations to deconditioning have been widely described, few studies have focused on the tendon enthesis. Our study examined the effects of mechanical loading on the structure and mechanical properties of the Achilles tendon enthesis. We assessed the fibrocartilage surface area, the organization of collagen, the expression of collagen II, the presence of osteoclasts, and the tensile properties of the mouse enthesis both after 14 days of hindlimb suspension (HU) and after a subsequent 6 days of reloading. Although soleus atrophy was severe after HU, calcified fibrocartilage (CFc) was a little affected. In contrast, we observed a decrease in non-calcified fibrocartilage (UFc) surface area, collagen fiber disorganization, modification of morphological characteristics of the fibrocartilage cells, and altered collagen II distribution. Compared to the control group, restoring normal loads increased both UFc surface area and expression of collagen II, and led to a crimp pattern in collagen. Reloading induced an increase in CFc surface area, probably due to the mineralization front advancing toward the tendon. Functionally, unloading resulted in decreased enthesis stiffness and a shift in site of failure from the osteochondral interface to the bone, whereas 6 days of reloading restored the original elastic properties and site of failure. In the context of spaceflight, our results suggest that care must be taken when performing countermeasure exercises both during missions and during the return to Earth.
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Affiliation(s)
- Claire Camy
- Aix Marseille University, CNRS, ISM, Institute of Movement Sciences, Marseille, France
| | - Thomas Brioche
- DMEM, Montpellier University, INRAE, UMR 866, Montpellier, France
| | - Karim Senni
- Laboratoire EBInnov, Ecole de Biologie Industrielle-EBI, Cergy, France
| | - Alexandrine Bertaud
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.,Laboratoire de Biochimie, Faculté de Pharmacie, Marseille, France
| | - Cécile Genovesio
- Laboratoire de Biochimie, Faculté de Pharmacie, Marseille, France
| | - Edouard Lamy
- Aix Marseille University, CNRS, ISM, Institute of Movement Sciences, Marseille, France.,Laboratoire de Biochimie, Faculté de Pharmacie, Marseille, France
| | - Théo Fovet
- DMEM, Montpellier University, INRAE, UMR 866, Montpellier, France
| | - Angèle Chopard
- DMEM, Montpellier University, INRAE, UMR 866, Montpellier, France
| | - Martine Pithioux
- Aix Marseille University, CNRS, ISM, Institute of Movement Sciences, Marseille, France.,Department of Orthopaedics and Traumatology, Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France.,Aix Marseille Univ, APHM, CNRS, Centrale Marseille, ISM, Mecabio Platform, Anatomy Laboratory, Timone, Marseille, France
| | - Sandrine Roffino
- Aix Marseille University, CNRS, ISM, Institute of Movement Sciences, Marseille, France.,Aix Marseille Univ, APHM, CNRS, Centrale Marseille, ISM, Mecabio Platform, Anatomy Laboratory, Timone, Marseille, France
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29
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Nakamichi R, Ma S, Nonoyama T, Chiba T, Kurimoto R, Ohzono H, Olmer M, Shukunami C, Fuku N, Wang G, Morrison E, Pitsiladis YP, Ozaki T, D'Lima D, Lotz M, Patapoutian A, Asahara H. The mechanosensitive ion channel PIEZO1 is expressed in tendons and regulates physical performance. Sci Transl Med 2022; 14:eabj5557. [PMID: 35648809 DOI: 10.1126/scitranslmed.abj5557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
How mechanical stress affects physical performance via tendons is not fully understood. Piezo1 is a mechanosensitive ion channel, and E756del PIEZO1 was recently found as a gain-of-function variant that is common in individuals of African descent. We generated tendon-specific knock-in mice using R2482H Piezo1, a mouse gain-of-function variant, and found that they had higher jumping abilities and faster running speeds than wild-type or muscle-specific knock-in mice. These phenotypes were associated with enhanced tendon anabolism via an increase in tendon-specific transcription factors, Mohawk and Scleraxis, but there was no evidence of changes in muscle. Biomechanical analysis showed that the tendons of R2482H Piezo1 mice were more compliant and stored more elastic energy, consistent with the enhancement of jumping ability. These phenotypes were replicated in mice with tendon-specific R2482H Piezo1 replacement after tendon maturation, indicating that PIEZO1 could be a target for promoting physical performance by enhancing function in mature tendon. The frequency of E756del PIEZO1 was higher in sprinters than in population-matched nonathletic controls in a small Jamaican cohort, suggesting a similar function in humans. Together, this human and mouse genetic and physiological evidence revealed a critical function of tendons in physical performance, which is tightly and robustly regulated by PIEZO1 in tenocytes.
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Affiliation(s)
- Ryo Nakamichi
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MBB-102, La Jolla, CA 92037, USA.,Department of Systems BioMedicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shang Ma
- Howard Hughes Medical Institute, Department of Neuroscience, Dorris Neuroscience Center, Scripps Research, La Jolla, CA, 92037, USA.,Howard Hughes Medical Institute, Chevy Chase, MD 20815-6789, USA
| | - Takayuki Nonoyama
- Faculty of Advanced Life Science and Global Station for Soft Matter, Global Institution for Collaborative Research and Education (GSS, GI-CoRE), Hokkaido University, Sapporo 001-0021, Japan
| | - Tomoki Chiba
- Department of Systems BioMedicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Ryota Kurimoto
- Department of Systems BioMedicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Hiroki Ohzono
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MBB-102, La Jolla, CA 92037, USA
| | - Merissa Olmer
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MBB-102, La Jolla, CA 92037, USA
| | - Chisa Shukunami
- Department of Molecular Biology and Biochemistry and Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Noriyuki Fuku
- Graduate School of Health and Sports Science, Juntendo University, Chiba 270-1965, Japan
| | - Guan Wang
- School of Sport and Health Sciences, University of Brighton, Brighton BN2 4AT, UK.,Centre for Regenerative Medicine and Devices, University of Brighton, Brighton BN2 4AT, UK
| | - Errol Morrison
- National Commission on Science and Technology, PCJ Building, 36 Trafalgar Road, Kingston 10, Jamaica
| | - Yannis P Pitsiladis
- School of Sport and Health Sciences, University of Brighton, Brighton BN2 4AT, UK.,Centre of Stress and Age-related Disease, University of Brighton, Brighton BN2 4AT, UK
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Darryl D'Lima
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MBB-102, La Jolla, CA 92037, USA
| | - Martin Lotz
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MBB-102, La Jolla, CA 92037, USA
| | - Ardem Patapoutian
- Howard Hughes Medical Institute, Department of Neuroscience, Dorris Neuroscience Center, Scripps Research, La Jolla, CA, 92037, USA.,Howard Hughes Medical Institute, Chevy Chase, MD 20815-6789, USA
| | - Hiroshi Asahara
- Department of Molecular Medicine, Scripps Research, 10550 North Torrey Pines Road, MBB-102, La Jolla, CA 92037, USA.,Department of Systems BioMedicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
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30
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Gomez-Florit M, Labrador-Rached CJ, Domingues RM, Gomes ME. The tendon microenvironment: Engineered in vitro models to study cellular crosstalk. Adv Drug Deliv Rev 2022; 185:114299. [PMID: 35436570 DOI: 10.1016/j.addr.2022.114299] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022]
Abstract
Tendinopathy is a multi-faceted pathology characterized by alterations in tendon microstructure, cellularity and collagen composition. Challenged by the possibility of regenerating pathological or ruptured tendons, the healing mechanisms of this tissue have been widely researched over the past decades. However, so far, most of the cellular players and processes influencing tendon repair remain unknown, which emphasizes the need for developing relevant in vitro models enabling to study the complex multicellular crosstalk occurring in tendon microenvironments. In this review, we critically discuss the insights on the interaction between tenocytes and the other tendon resident cells that have been devised through different types of existing in vitro models. Building on the generated knowledge, we stress the need for advanced models able to mimic the hierarchical architecture, cellularity and physiological signaling of tendon niche under dynamic culture conditions, along with the recreation of the integrated gradients of its tissue interfaces. In a forward-looking vision of the field, we discuss how the convergence of multiple bioengineering technologies can be leveraged as potential platforms to develop the next generation of relevant in vitro models that can contribute for a deeper fundamental knowledge to develop more effective treatments.
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31
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Pien N, Van de Maele Y, Parmentier L, Meeremans M, Mignon A, De Schauwer C, Peeters I, De Wilde L, Martens A, Mantovani D, Van Vlierberghe S, Dubruel P. Design of an electrospun tubular construct combining a mechanical and biological approach to improve tendon repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:51. [PMID: 35639212 PMCID: PMC9156498 DOI: 10.1007/s10856-022-06673-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Hand tendon injuries represent a major clinical problem and might dramatically diminish a patient's life quality. In this study, a targeted solution for flexor tendon repair was developed by combining a mechanical and biological approach. To this end, a novel acrylate-endcapped urethane-based polymer (AUP) was synthesized and its physico-chemical properties were characterized. Next, tubular repair constructs were developed using electrospinning of the AUP material with incorporated naproxen and hyaluronic acid (i.e. anti-inflammatory and anti-adhesion compounds, respectively), and with a tubular braid as mechanical reinforcement. Tensile testing of the repair constructs using ex vivo sheep tendons showed that the developed repair constructs fulfilled the required mechanical properties for tendon repair (i.e. minimal ultimate stress of 4 MPa), with an ultimate stress of 6.4 ± 0.6 MPa. Moreover, in vitro biological assays showed that the developed repair tubes and the incorporated bioactive components were non-cytotoxic. In addition, when equine tenocytes and mesenchymal stem cells were co-cultured with the repair tubes, an increased production of collagen and non-collagenous proteins was observed. In conclusion, this novel construct in which a mechanical approach (fulfilling the required mechanical properties) was combined with a biological approach (incorporation of bioactive compounds), shows potential as flexor tendon repair application. Graphical abstract.
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Affiliation(s)
- N Pien
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Krijgslaan 281 S4-bis, 9000, Ghent, Belgium
- Laboratory for Biomaterials and Bioengineering, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, 2325 Rue de l'Universite, Quebec, QC, G1V 0A6, Canada
| | - Y Van de Maele
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Krijgslaan 281 S4-bis, 9000, Ghent, Belgium
| | - L Parmentier
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Krijgslaan 281 S4-bis, 9000, Ghent, Belgium
| | - M Meeremans
- Faculty of Veterinary Medicine, Department of Translational Physiology, Infectiology and Public Health, Ghent University, Salisburylaan 133, 9280, Merelbeke, Belgium
| | - A Mignon
- Smart Polymeric Biomaterials, Surface and Interface Engineered Materials, KU Leuven, Andreas Vesaliusstraat 13 - box 2600, 3000, Leuven, Belgium
| | - C De Schauwer
- Faculty of Veterinary Medicine, Department of Translational Physiology, Infectiology and Public Health, Ghent University, Salisburylaan 133, 9280, Merelbeke, Belgium
| | - I Peeters
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University Hospital, C. Heymanslaan 10, ingang 46, 9000, Gent, Belgium
| | - L De Wilde
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University Hospital, C. Heymanslaan 10, ingang 46, 9000, Gent, Belgium
| | - A Martens
- Faculty of Veterinary Medicine, Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Salisburylaan 133, 9280, Merelbeke, Belgium
| | - D Mantovani
- Laboratory for Biomaterials and Bioengineering, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, 2325 Rue de l'Universite, Quebec, QC, G1V 0A6, Canada
| | - S Van Vlierberghe
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Krijgslaan 281 S4-bis, 9000, Ghent, Belgium
| | - P Dubruel
- Polymer Chemistry & Biomaterials Research Group, Centre of Macromolecular Chemistry (CMaC), Ghent University, Krijgslaan 281 S4-bis, 9000, Ghent, Belgium.
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Calejo I, Labrador‐Rached CJ, Gomez‐Florit M, Docheva D, Reis RL, Domingues RMA, Gomes ME. Bioengineered 3D Living Fibers as In Vitro Human Tissue Models of Tendon Physiology and Pathology. Adv Healthc Mater 2022; 11:e2102863. [PMID: 35596614 DOI: 10.1002/adhm.202102863] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Clinically relevant in vitro models of human tissue's health and disease are urgently needed for a better understanding of biological mechanisms essential for the development of novel therapies. Herein, physiological (healthy) and pathological (disease) tendon states are bioengineered by coupling the biological signaling of platelet lysate components with controlled 3D architectures of electrospun microfibers to drive the fate of human tendon cells in different composite living fibers (CLFs). In the CLFs-healthy model, tendon cells adopt a high cytoskeleton alignment and elongation, express tendon-related markers (scleraxis, tenomodulin, and mohawk) and deposit a dense tenogenic matrix. In contrast, cell crowding with low preferential orientation, high matrix deposition, and phenotypic drift leading to increased expression of nontendon related and fibrotic markers, are characteristics of the CLFs-diseased model. This diseased-like profile, also reflected in the increase of COL3/COL1 ratio, is further evident by the imbalance between matrix remodeling and degradation effectors, characteristic of tendinopathy. In summary, microengineered 3D in vitro models of human tendon healthy and diseased states are successfully fabricated. Most importantly, these innovative and versatile microphysiological models offer major advantages over currently used systems, holding promise for drugs screening and development of new therapies.
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Affiliation(s)
- Isabel Calejo
- 3B's Research Group i3Bs—Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho 4805‐017 Barco Guimarães Portugal
| | - Claudia J. Labrador‐Rached
- 3B's Research Group i3Bs—Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho 4805‐017 Barco Guimarães Portugal
| | - Manuel Gomez‐Florit
- 3B's Research Group i3Bs—Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho 4805‐017 Barco Guimarães Portugal
| | - Denitsa Docheva
- Experimental Trauma Surgery Department of Trauma Surgery University Hospital Regensburg Franz‐Josef Strauss‐Allee 11 93053 Regensburg Germany
| | - Rui L. Reis
- 3B's Research Group i3Bs—Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho 4805‐017 Barco Guimarães Portugal
| | - Rui M. A. Domingues
- 3B's Research Group i3Bs—Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho 4805‐017 Barco Guimarães Portugal
| | - Manuela E. Gomes
- 3B's Research Group i3Bs—Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho 4805‐017 Barco Guimarães Portugal
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Eisner LE, Rosario R, Andarawis-Puri N, Arruda EM. The Role of the Non-Collagenous Extracellular Matrix in Tendon and Ligament Mechanical Behavior: A Review. J Biomech Eng 2022; 144:1128818. [PMID: 34802057 PMCID: PMC8719050 DOI: 10.1115/1.4053086] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 12/26/2022]
Abstract
Tendon is a connective tissue that transmits loads from muscle to bone, while ligament is a similar tissue that stabilizes joint articulation by connecting bone to bone. The 70-90% of tendon and ligament's extracellular matrix (ECM) is composed of a hierarchical collagen structure that provides resistance to deformation primarily in the fiber direction, and the remaining fraction consists of a variety of non-collagenous proteins, proteoglycans, and glycosaminoglycans (GAGs) whose mechanical roles are not well characterized. ECM constituents such as elastin, the proteoglycans decorin, biglycan, lumican, fibromodulin, lubricin, and aggrecan and their associated GAGs, and cartilage oligomeric matrix protein (COMP) have been suggested to contribute to tendon and ligament's characteristic quasi-static and viscoelastic mechanical behavior in tension, shear, and compression. The purpose of this review is to summarize existing literature regarding the contribution of the non-collagenous ECM to tendon and ligament mechanics, and to highlight key gaps in knowledge that future studies may address. Using insights from theoretical mechanics and biology, we discuss the role of the non-collagenous ECM in quasi-static and viscoelastic tensile, compressive, and shear behavior in the fiber direction and orthogonal to the fiber direction. We also address the efficacy of tools that are commonly used to assess these relationships, including enzymatic degradation, mouse knockout models, and computational models. Further work in this field will foster a better understanding of tendon and ligament damage and healing as well as inform strategies for tissue repair and regeneration.
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Affiliation(s)
- Lainie E Eisner
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109; Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853
| | - Ryan Rosario
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853
| | - Ellen M Arruda
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109; Professor Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109; Professor Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109
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Preparation and optimization of polyurethane/crosslinked poly acrylic acid semi-IPNs containing multi wall carbon nanotube applicable for artificial tendon. Colloids Surf A Physicochem Eng Asp 2022. [DOI: 10.1016/j.colsurfa.2022.128415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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35
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Mechanical activation drives tenogenic differentiation of human mesenchymal stem cells in aligned dense collagen hydrogels. Biomaterials 2022; 286:121606. [DOI: 10.1016/j.biomaterials.2022.121606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 01/13/2023]
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Advances in Microscopic Studies of Tendinopathy: Literature Review and Current Trends, with Special Reference to Neovascularization Process. J Clin Med 2022; 11:jcm11061572. [PMID: 35329898 PMCID: PMC8949578 DOI: 10.3390/jcm11061572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 01/05/2023] Open
Abstract
Tendinopathy is a process of chaotic extracellular matrix remodeling followed by increased secretion of enzymes and mediators of inflammation. The histopathological assessment of tendinous tissue is crucial to formulate the diagnosis and establish the severity of tendon degeneration. Nevertheless, the microscopic analysis of tendinous tissue features is often challenging. In this review, we aimed to compare the most popular scales used in tendon pathology assessment and reevaluate the role of the neovascularization process. The following scores were evaluated: the Bonar score, the Movin score, the Astrom and Rausing Score, and the Soslowsky score. Moreover, the role of neovascularization in tendon degeneration was reassessed. The Bonar system is the most commonly used in tendon pathology. According to the literature, hematoxylin and eosin with additional Alcian Blue staining seems to provide satisfactory results. Furthermore, two observers experienced in musculoskeletal pathology are sufficient for tendinopathy microscopic evaluation. The control, due to similar and typical alterations in tendinous tissue, is not necessary. Neovascularization plays an ambiguous role in tendon disorders. The neovascularization process is crucial in the tendon healing process. On the other hand, it is also an important component of the degeneration of tendinous tissue when the regeneration is incomplete and insufficient. The microscopic analysis of tendinous tissue features is often challenging. The assessment of tendinous tissue using the Bonar system is the most universal. The neovascularization variable in tendinopathy scoring systems should be reconsidered due to discrepancies in studies.
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Hager B, Schreiner MM, Walzer SM, Hirtler L, Mlynarik V, Berg A, Deligianni X, Bieri O, Windhager R, Trattnig S, Juras V. Transverse Relaxation Anisotropy of the Achilles and Patellar Tendon Studied by MR Microscopy. J Magn Reson Imaging 2022; 56:1091-1103. [PMID: 35122454 PMCID: PMC9545006 DOI: 10.1002/jmri.28095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/20/2023] Open
Abstract
Background T2* anisotropy affects the clinical assessment of tendons (magic‐angle artifact) and may be a source of T2*‐misinterpretation. Purpose To analyze T2*‐anisotropy and T2*‐decay of Achilles and patellar tendons in vitro at microscopic resolution using a variable‐echo‐time (vTE) sequence. Study Type Prospective. Specimen Four human Achilles and four patellar tendons. Field Strength/Sequence A 7 T MR‐microscopy; 3D‐vTE spoiled‐gradient‐echo‐sequence (T2*‐mapping). Assessment All tendons were measured at 0° and 55° relative to B0. Additional angles were measured for one Achilles and one patellar tendon for a total of 11 angles ranging from 0° to 90°. T2*‐decay was analyzed with mono‐ and bi‐exponential signal fitting. Mono‐exponential T2*‐values (T2*m), short and long T2*‐components (T2*s, T2*l), and the fraction of the short component Fs of the bi‐exponential T2*‐fit were calculated. T2*‐decay characteristics were compared with morphological MRI and histologic findings based on a region‐of‐interest analysis. Statistical Tests Akaike information criterion (AICC), F‐test, and paired t‐test. A P value smaller than the α‐level of 0.05 was considered statistically significant. Results T2*m‐values between fiber‐to‐field angles of 0° and 55° were increased on average from T2*m (0°) = 1.92 msec to T2*m (55°) = 29.86 msec (15.5‐fold) in the Achilles and T2*m (0°) = 1.46 msec to T2*m (55°) = 23.33 msec (16.0‐fold) in the patellar tendons. The changes in T2*m‐values were statistically significant. For the whole tendon, according to F‐test and AICC, a bi‐exponential model was preferred for angles close to 0°, while the mono‐exponential model tended to be preferred at angles close to 55°. Conclusion MR‐microscopy provides a deeper insight into the relationship between T2*‐decay (mono‐ vs. bi‐exponential model) and tendon heterogeneity. Changes in fiber‐to‐field angle result in significant changes in T2*‐values. Thus, we conclude that awareness of T2*‐anisotropy should be noted in quantitative T2*‐mapping of tendons to avoid T2*‐misinterpretation such as a false positive detection of degeneration due to large fiber‐to‐field angles. Evidence Level 2 Technical Efficacy Stage 2
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Affiliation(s)
- Benedikt Hager
- Institute for Clinical Molecular MRI in the Musculoskeletal System, Karl Landsteiner Society, Vienna, Austria
| | - Markus M Schreiner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Austria
| | - Sonja M Walzer
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Austria
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, Austria
| | - Vladimir Mlynarik
- Institute for Clinical Molecular MRI in the Musculoskeletal System, Karl Landsteiner Society, Vienna, Austria
| | - Andreas Berg
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Xeni Deligianni
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Basel Muscle MRI, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Reinhard Windhager
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Austria
| | - Siegfried Trattnig
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.,CD Laboratory for Clinical Molecular MR Imaging, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Vladimir Juras
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.,CD Laboratory for Clinical Molecular MR Imaging, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Russo V, El Khatib M, Prencipe G, Cerveró-Varona A, Citeroni MR, Mauro A, Berardinelli P, Faydaver M, Haidar-Montes AA, Turriani M, Di Giacinto O, Raspa M, Scavizzi F, Bonaventura F, Liverani L, Boccaccini AR, Barboni B. Scaffold-Mediated Immunoengineering as Innovative Strategy for Tendon Regeneration. Cells 2022; 11:cells11020266. [PMID: 35053383 PMCID: PMC8773518 DOI: 10.3390/cells11020266] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Tendon injuries are at the frontier of innovative approaches to public health concerns and sectoral policy objectives. Indeed, these injuries remain difficult to manage due to tendon’s poor healing ability ascribable to a hypo-cellularity and low vascularity, leading to the formation of a fibrotic tissue affecting its functionality. Tissue engineering represents a promising solution for the regeneration of damaged tendons with the aim to stimulate tissue regeneration or to produce functional implantable biomaterials. However, any technological advancement must take into consideration the role of the immune system in tissue regeneration and the potential of biomaterial scaffolds to control the immune signaling, creating a pro-regenerative environment. In this context, immunoengineering has emerged as a new discipline, developing innovative strategies for tendon injuries. It aims at designing scaffolds, in combination with engineered bioactive molecules and/or stem cells, able to modulate the interaction between the transplanted biomaterial-scaffold and the host tissue allowing a pro-regenerative immune response, therefore hindering fibrosis occurrence at the injury site and guiding tendon regeneration. Thus, this review is aimed at giving an overview on the role exerted from different tissue engineering actors in leading immunoregeneration by crosstalking with stem and immune cells to generate new paradigms in designing regenerative medicine approaches for tendon injuries.
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Affiliation(s)
- Valentina Russo
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Mohammad El Khatib
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Giuseppe Prencipe
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
- Correspondence:
| | - Adrián Cerveró-Varona
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Maria Rita Citeroni
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Annunziata Mauro
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Paolo Berardinelli
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Melisa Faydaver
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Arlette A. Haidar-Montes
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Maura Turriani
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Oriana Di Giacinto
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
| | - Marcello Raspa
- Institute of Biochemistry and Cellular Biology (IBBC), Council of National Research (CNR), Campus International Development (EMMA-INFRAFRONTIER-IMPC), 00015 Monterotondo Scalo, Italy; (M.R.); (F.S.); (F.B.)
| | - Ferdinando Scavizzi
- Institute of Biochemistry and Cellular Biology (IBBC), Council of National Research (CNR), Campus International Development (EMMA-INFRAFRONTIER-IMPC), 00015 Monterotondo Scalo, Italy; (M.R.); (F.S.); (F.B.)
| | - Fabrizio Bonaventura
- Institute of Biochemistry and Cellular Biology (IBBC), Council of National Research (CNR), Campus International Development (EMMA-INFRAFRONTIER-IMPC), 00015 Monterotondo Scalo, Italy; (M.R.); (F.S.); (F.B.)
| | - Liliana Liverani
- Department of Materials Science and Engineering, Institute of Biomaterials, University of Erlangen-Nuremberg, 91058 Erlangen, Germany; (L.L.); (A.R.B.)
| | - Aldo R. Boccaccini
- Department of Materials Science and Engineering, Institute of Biomaterials, University of Erlangen-Nuremberg, 91058 Erlangen, Germany; (L.L.); (A.R.B.)
| | - Barbara Barboni
- Unit of Basic and Applied Sciences, Faculty of Biosciences and Agro-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy; (V.R.); (M.E.K.); (A.C.-V.); (M.R.C.); (A.M.); (P.B.); (M.F.); (A.A.H.-M.); (M.T.); (O.D.G.); (B.B.)
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Golman M, Birman V, Thomopoulos S, Genin GM. Enthesis strength, toughness and stiffness: an image-based model comparing tendon insertions with varying bony attachment geometries. J R Soc Interface 2021; 18:20210421. [PMID: 34932930 PMCID: PMC8692040 DOI: 10.1098/rsif.2021.0421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/25/2021] [Indexed: 12/24/2022] Open
Abstract
Tendons of the body differ dramatically in their function, mechanics and range of motion, but all connect to bone via an enthesis. Effective force transfer at the enthesis enables joint stability and mobility, with strength and stiffness arising from a fibrous architecture. However, how enthesis toughness arises across tendons with diverse loading orientations remains unclear. To study this, we performed simultaneous imaging of the bone and tendon in entheses that represent the range of tendon-to-bone insertions and extended a mathematical model to account for variations in insertion and bone geometry. We tested the hypothesis that toughness, across a range of tendon entheses, could be explained by differences observed in interactions between fibre architecture and bone architecture. In the model, toughness arose from fibre reorientation, recruitment and rupture, mediated by interactions between fibres at the enthesis and the bony ridge abutting it. When applied to tendons sometimes characterized as either energy-storing or positional, the model predicted that entheses of the former prioritize toughness over strength, while those of the latter prioritize consistent stiffness across loading directions. Results provide insight into techniques for surgical repair of tendon-to-bone attachments, and more broadly into mechanisms for the attachment of highly dissimilar materials.
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Affiliation(s)
- Mikhail Golman
- Columbia University, Black Building, Room 1408, 650 W 168 ST, New York, NY 10032-3702, USA
| | - Victor Birman
- Missouri University of Science and Technology, Rolla, MO 65409, USA
| | - Stavros Thomopoulos
- Columbia University, Black Building, Room 1408, 650 W 168 ST, New York, NY 10032-3702, USA
| | - Guy M. Genin
- Washington University, Jubel Hall, Room 103F, 1 Brookings Drive, St Louis, MO 63130, USA
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40
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Atta G, Tempfer H, Kaser-Eichberger A, Traweger A, Heindl LM, Schroedl F. Is the human sclera a tendon-like tissue? A structural and functional comparison. Ann Anat 2021; 240:151858. [PMID: 34798297 DOI: 10.1016/j.aanat.2021.151858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/22/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022]
Abstract
Collagen rich connective tissues fulfill a variety of important functions throughout the human body, most of which having to resist mechanical challenges. This review aims to compare structural and functional aspects of tendons and sclera, two tissues with distinct location and function, but with striking similarities regarding their cellular content, their extracellular matrix and their low degree of vascularization. The description of these similarities meant to provide potential novel insight for both the fields of orthopedic research and ophthalmology.
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Affiliation(s)
- Ghada Atta
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Institute for Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Herbert Tempfer
- Institute for Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Alexandra Kaser-Eichberger
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology - Salzburg, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Andreas Traweger
- Institute for Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Center for Integrated Oncology (CIO) Aachen - Bonn - Cologne - Düsseldorf, Cologne, Germany
| | - Falk Schroedl
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology - Salzburg, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
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Al Makhzoomi AK, Kirk TB, Allison GT. An AFM study of the nanostructural response of New Zealand white rabbit Achilles tendons to cyclic loading. Microsc Res Tech 2021; 85:728-737. [PMID: 34632676 DOI: 10.1002/jemt.23944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/14/2021] [Accepted: 09/09/2021] [Indexed: 01/21/2023]
Abstract
The nanostructural response of New Zealand white rabbit Achilles tendons to a fatigue damage model was assessed quantitatively and qualitatively using the endpoint of dose assessments of each tendon from our previous study. The change in mechanical properties was assessed concurrently with nanostructural change in the same non-viable intact tendon. Atomic force microscopy was used to study the elongation of D-periodicities, and the changes were compared both within the same fibril bundle and between fibril bundles. D-periodicities increased due to both increased strain and increasing numbers of fatigue cycles. Although no significant difference in D-periodicity lengthening was found between fibril bundles, the lengthening of D-periodicity correlated strongly with the overall tendon mechanical changes. The accurate quantification of fibril elongation in response to macroscopic applied strain assisted in assessing the complex structure-function relationship in Achilles tendons.
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Affiliation(s)
- Anas K Al Makhzoomi
- School of Allied Health, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Thomas B Kirk
- School of Science, Engineering and Technology, RMIT University Vietnam, Ho Chi Minh City, Vietnam
| | - Garry T Allison
- Associate Deputy Vice-Chancellor, Research Excellence, Curtin University, Perth, Western Australia, Australia
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Zhang S, Ju W, Chen X, Zhao Y, Feng L, Yin Z, Chen X. Hierarchical ultrastructure: An overview of what is known about tendons and future perspective for tendon engineering. Bioact Mater 2021; 8:124-139. [PMID: 34541391 PMCID: PMC8424392 DOI: 10.1016/j.bioactmat.2021.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022] Open
Abstract
Abnormal tendons are rarely ever repaired to the natural structure and morphology of normal tendons. To better guide the repair and regeneration of injured tendons through a tissue engineering method, it is necessary to have insights into the internal morphology, organization, and composition of natural tendons. This review summarized recent researches on the structure and function of the extracellular matrix (ECM) components of tendons and highlight the application of multiple detection methodologies concerning the structure of ECMs. In addition, we look forward to the future of multi-dimensional biomaterial design methods and the potential of structural repair for tendon ECM components. In addition, focus is placed on the macro to micro detection methods for tendons, and current techniques for evaluating the extracellular matrix of tendons at the micro level are introduced in detail. Finally, emphasis is given to future extracellular matrix detection methods, as well as to how future efforts could concentrate on fabricating the biomimetic tendons. Summarize recent research on the structure and function of the extracellular matrix (ECM) components of tendons. Comments on current research methods concerning the structure of ECMs. Perspective on the future of multi-dimensional detection techniques and structural repair of tendon ECM components.
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Affiliation(s)
- Shichen Zhang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine and Department of Orthopedic Surgery of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310052, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Wei Ju
- Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Xiaoyi Chen
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi-ASEAN Collaborative Innovation Center for Major Disease Prevention and Treatment, Guangxi Medical University, Guangxi, 530021, China
| | - Yanyan Zhao
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine and Department of Orthopedic Surgery of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310052, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Lingchong Feng
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, 310058, Zhejiang, China
| | - Zi Yin
- Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, 310058, China.,Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine and Regenerative Medicine and Department of Orthopedic Surgery of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, China.,Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, 310058, China.,China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, 310058, China
| | - Xiao Chen
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine and Department of Orthopedic Surgery of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310052, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, 310058, China.,Guangxi Key Laboratory of Regenerative Medicine, Guangxi-ASEAN Collaborative Innovation Center for Major Disease Prevention and Treatment, Guangxi Medical University, Guangxi, 530021, China.,Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, 310058, China.,China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, 310058, China
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Al Makhzoomi AK, Kirk TB, Dye DE, Allison GT. The influence of glycosaminoglycan proteoglycan side chains on tensile force transmission and the nanostructural properties of Achilles tendons. Microsc Res Tech 2021; 85:233-243. [PMID: 34390286 DOI: 10.1002/jemt.23899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 01/13/2023]
Abstract
This study investigates the nanostructural mechanisms that lie behind load transmission in tendons and the role of glycosaminoglycans (GAGs) in the transmission of force in the tendon extracellular matrix. The GAGs in white New Zealand rabbit Achilles tendons were enzymatically depleted, and the tendons subjected to cyclic loading at 6% strain for up to 2 hr. A nanoscale morphometric assessment of fibril deformation under strain was linked with the decline in the tendon macroscale mechanical properties. An atomic force microscope (AFM) was employed to characterize the D-periodicity within and between fibril bundles (WFB and BFB, respectively). By the end of the second hour of the applied strain, the WFB and BFB D-periodicities had significantly increased in the GAG-depleted group (29% increase compared with 15% for the control, p < .0001). No statistically significant differences were found between WFB and BFB D-periodicities in either the control or GAG-depleted groups, suggesting that mechanical load in Achilles tendons is uniformly distributed and fairly homogenous among the WFB and BFB networks. The results of this study have provided evidence of a cycle-dependent mechanism of damage accumulation. The accurate quantification of fibril elongation (measured as the WFB and BFB D-periodicity lengths) in response to macroscopic applied strain has assisted in assessing the complex structure-function relationship in Achilles tendon.
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Affiliation(s)
- Anas K Al Makhzoomi
- School of Allied Health, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Thomas B Kirk
- Dean, School of Science, Engineering and Technology, RMIT University Vietnam, Ho Chi Minh City, Vietnam
| | - Danielle E Dye
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Garry T Allison
- Associate Deputy Vice-Chancellor -Research Excellence - Curtin University, Perth, Western Australia, Australia, Member Board of Directors; Sports Medicine Australia, Perth
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Sugita S, Suzumura T, Nakamura A, Tsukiji S, Ujihara Y, Nakamura M. Second harmonic generation light quantifies the ratio of type III to total (I + III) collagen in a bundle of collagen fiber. Sci Rep 2021; 11:11874. [PMID: 34088955 PMCID: PMC8178339 DOI: 10.1038/s41598-021-91302-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
The ratio of type III to type I collagen is important for properly maintaining functions of organs and cells. We propose a method to quantify the ratio of type III to total (type I + III) collagen (λIII) in a given collagen fiber bundle using second harmonic generation (SHG) light. First, the relationship between SHG light intensity and the λIII of collagen gels was examined, and the slope (k1) and SHG light intensity at 0% type III collagen (k2) were determined. Second, the SHG light intensity of a 100% type I collagen fiber bundle and its diameter (D) were measured, and the slope (k3) of the relationship was determined. The λIII in a collagen fiber bundle was estimated from these constants (k1-3) and SHG light intensity. We applied this method to collagen fiber bundles isolated from the media and adventitia of porcine thoracic aortas, and obtained λIII = 84.7% ± 13.8% and λIII = 17.5% ± 15.2%, respectively. These values concurred with those obtained with a typical quantification method using sodium dodecyl sulfate–polyacrylamide gel electrophoresis. The findings demonstrated that the method proposed is useful to quantify the ratio of type III to total collagen in a collagen fiber bundle.
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Affiliation(s)
- Shukei Sugita
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya, 466-8555, Japan. .,Center of Biomedical Physics and Information Technology, Nagoya Institute of Technology, Nagoya, Japan.
| | - Takuya Suzumura
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya, 466-8555, Japan
| | - Akinobu Nakamura
- Department of Life Science and Applied Chemistry, Nagoya Institute of Technology, Nagoya, Japan
| | - Shinya Tsukiji
- Department of Life Science and Applied Chemistry, Nagoya Institute of Technology, Nagoya, Japan.,Department of Nanopharmaceutical Sciences, Nagoya Institute of Technology, Nagoya, Japan
| | - Yoshihiro Ujihara
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya, 466-8555, Japan
| | - Masanori Nakamura
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya, 466-8555, Japan.,Center of Biomedical Physics and Information Technology, Nagoya Institute of Technology, Nagoya, Japan.,Department of Nanopharmaceutical Sciences, Nagoya Institute of Technology, Nagoya, Japan
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45
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Ustriyana P, Schulte F, Gombedza F, Gil-Bona A, Paruchuri S, Bidlack FB, Hardt M, Landis WJ, Sahai N. Spatial survey of non-collagenous proteins in mineralizing and non-mineralizing vertebrate tissues ex vivo. Bone Rep 2021; 14:100754. [PMID: 33665237 PMCID: PMC7900015 DOI: 10.1016/j.bonr.2021.100754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022] Open
Abstract
Bone biomineralization is a complex process in which type I collagen and associated non-collagenous proteins (NCPs), including glycoproteins and proteoglycans, interact closely with inorganic calcium and phosphate ions to control the precipitation of nanosized, non-stoichiometric hydroxyapatite (HAP, idealized stoichiometry Ca10(PO4)6(OH)2) within the organic matrix of a tissue. The ability of certain vertebrate tissues to mineralize is critically related to several aspects of their function. The goal of this study was to identify specific NCPs in mineralizing and non-mineralizing tissues of two animal models, rat and turkey, and to determine whether some NCPs are unique to each type of tissue. The tissues investigated were rat femur (mineralizing) and tail tendon (non-mineralizing) and turkey leg tendon (having both mineralizing and non-mineralizing regions in the same individual specimen). An experimental approach ex vivo was designed for this investigation by combining sequential protein extraction with comprehensive protein mapping using proteomics and Western blotting. The extraction method enabled separation of various NCPs based on their association with either the extracellular organic collagenous matrix phases or the inorganic mineral phases of the tissues. The proteomics work generated a complete picture of NCPs in different tissues and animal species. Subsequently, Western blotting provided validation for some of the proteomics findings. The survey then yielded generalized results relevant to various protein families, rather than only individual NCPs. This study focused primarily on the NCPs belonging to the small leucine-rich proteoglycan (SLRP) family and the small integrin-binding ligand N-linked glycoproteins (SIBLINGs). SLRPs were found to be associated only with the collagenous matrix, a result suggesting that they are mainly involved in structural matrix organization and not in mineralization. SIBLINGs as well as matrix Gla (γ-carboxyglutamate) protein were strictly localized within the inorganic mineral phase of mineralizing tissues, a finding suggesting that their roles are limited to mineralization. The results from this study indicated that osteocalcin was closely involved in mineralization but did not preclude possible additional roles as a hormone. This report provides for the first time a spatial survey and comparison of NCPs from mineralizing and non-mineralizing tissues ex vivo and defines the proteome of turkey leg tendons as a model for vertebrate mineralization.
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Key Words
- B, rat bone
- BSP, bone sialoprotein
- DCN, decorin
- E, EDTA extract
- ECM, extracellular matrix
- G, guanidine-HCl-only extract (for non-mineralizing tissues)
- G1, first guanidine-HCl extract
- G2, second guanidine-HCl extract
- Gla, gamma-carboxylated glutamic acid
- MGP, matrix Gla protein
- MT, turkey mineralizing tendon
- Mineralization
- NCP, non-collagenous protein
- NMT, turkey never-mineralizing tendon
- NT, turkey not-yet-mineralized tendon
- Non-collagenous protein
- OCN, osteocalcin
- OPN, osteopontin
- Proteomics
- SIBLING, small integrin-binding ligand N-linked glycoprotein
- SLRP, small leucine-rich proteoglycan
- T, rat tail tendon
- TLT, turkey leg tendon (gastrocnemius)
- TNAP, tissue-nonspecific alkaline phosphatase
- Type I collagen
- Vertebrate
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Affiliation(s)
- Putu Ustriyana
- School of Polymer Science and Polymer Engineering, The University of Akron, Akron, OH 44325, USA
| | - Fabian Schulte
- The Forsyth Institute, Cambridge, MA 02142, USA
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Farai Gombedza
- Department of Chemistry, The University of Akron, Akron, OH 44325, USA
| | - Ana Gil-Bona
- The Forsyth Institute, Cambridge, MA 02142, USA
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Sailaja Paruchuri
- Department of Chemistry, The University of Akron, Akron, OH 44325, USA
| | - Felicitas B. Bidlack
- The Forsyth Institute, Cambridge, MA 02142, USA
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Markus Hardt
- The Forsyth Institute, Cambridge, MA 02142, USA
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - William J. Landis
- School of Polymer Science and Polymer Engineering, The University of Akron, Akron, OH 44325, USA
| | - Nita Sahai
- School of Polymer Science and Polymer Engineering, The University of Akron, Akron, OH 44325, USA
- Department of Geosciences, The University of Akron, Akron, OH 44325, USA
- Integrated Bioscience Program, The University of Akron, Akron, OH 44325, USA
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46
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Ekiert M, Karbowniczek J, Stachewicz U, Mlyniec A. The effect of multiple freeze-thaw cycles on the viscoelastic properties and microstructure of bovine superficial digital flexor tendon. J Mech Behav Biomed Mater 2021; 120:104582. [PMID: 34090220 DOI: 10.1016/j.jmbbm.2021.104582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/15/2021] [Accepted: 05/08/2021] [Indexed: 11/19/2022]
Abstract
The most common injuries of the human musculoskeletal system are related to soft tissue structures such as tendons or ligaments. To repair torn structures, surgical intervention and application of a biological or synthetic graft may be required. A typical procedure for the processing, storage, and distribution of soft tissue grafts involves at least two freezing/thawing (F/T) cycles. Even though repeated F/T cycles decrease the mechanical performance and change the structure of tendons, it is unclear whether there exists a maximum number of F/T cycles above which tendons should not be approved for use as a tissue allograft. To fill this research gap, we present an ex vivo study on the effects of repetitive F/T cycles on the biomechanical stability of bovine superficial digital flexor tendon tissue. Using mechanical testing supported with scanning electron microscopy imaging, we show that multiple F/T cycles affect the viscoelastic and structural properties of tissue by significantly reducing its tensile modulus after the 3rd or 4th F/T cycle (depending on the strain range), stress drop during relaxation after the 8th F/T cycle (regardless the strain values), mechanical hysteresis after the 10th F/T cycle, and by causing a significant decrease in collagen fibril diameter. Our results provide a deeper insight into understanding the mechanisms responsible for tissue damage during multiple F/T cycles, and thus, may be useful for the future optimization of tissue storage protocols.
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Affiliation(s)
- Martyna Ekiert
- AGH University of Science and Technology, Faculty of Mechanics and Robotics, Krakow, Poland.
| | - Joanna Karbowniczek
- AGH University of Science and Technology, Faculty of Metals Engineering and Industrial Computer Science, Krakow, Poland
| | - Urszula Stachewicz
- AGH University of Science and Technology, Faculty of Metals Engineering and Industrial Computer Science, Krakow, Poland
| | - Andrzej Mlyniec
- AGH University of Science and Technology, Faculty of Mechanics and Robotics, Krakow, Poland
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47
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Zahn I, Stöbener DD, Weinhart M, Gögele C, Breier A, Hahn J, Schröpfer M, Meyer M, Schulze-Tanzil G. Cruciate Ligament Cell Sheets Can Be Rapidly Produced on Thermoresponsive poly(glycidyl ether) Coating and Successfully Used for Colonization of Embroidered Scaffolds. Cells 2021; 10:cells10040877. [PMID: 33921450 PMCID: PMC8069541 DOI: 10.3390/cells10040877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 01/14/2023] Open
Abstract
Anterior cruciate ligament (ACL) cell sheets combined with biomechanically competent scaffolds might facilitate ACL tissue engineering. Since thermoresponsive polymers allow a rapid enzyme-free detachment of cell sheets, we evaluated the applicability of a thermoresponsive poly(glycidyl ether) (PGE) coating for cruciate ligamentocyte sheet formation and its influence on ligamentocyte phenotype during sheet-mediated colonization of embroidered scaffolds. Ligamentocytes were seeded on surfaces either coated with PGE or without coating. Detached ligamentocyte sheets were cultured separately or wrapped around an embroidered scaffold made of polylactide acid (PLA) and poly(lactic-co-ε-caprolactone) (P(LA-CL)) threads functionalized by gas-phase fluorination and with collagen foam. Ligamentocyte viability, protein and gene expression were determined in sheets detached from surfaces with or without PGE coating, scaffolds seeded with sheets from PGE-coated plates and the respective monolayers. Stable and vital ligamentocyte sheets could be produced within 24 h with both surfaces, but more rapidly with PGE coating. PGE did not affect ligamentocyte phenotype. Scaffolds could be colonized with sheets associated with high cell survival, stable gene expression of ligament-related type I collagen, decorin, tenascin C and Mohawk after 14 d and extracellular matrix (ECM) deposition. PGE coating facilitates ligamentocyte sheet formation, and sheets colonizing the scaffolds displayed a ligament-related phenotype.
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Affiliation(s)
- Ingrid Zahn
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany; (I.Z.); (C.G.)
- Department of Applied Chemistry, Nuremberg Institute of Technology Georg Simon Ohm, Keßlerplatz 12, 90489 Nuremberg, Germany
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University, Erlangen-Nuremberg, Universitätsstr. 19, 91054 Erlangen, Germany
| | - Daniel David Stöbener
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 3, 14195 Berlin, Germany; (D.D.S.); (M.W.)
- Institute of Physical Chemistry and Electrochemistry, Leibniz Universität Hannover, Callinstr. 3A, 30167 Hannover, Germany
| | - Marie Weinhart
- Institute of Chemistry and Biochemistry, Freie Universität Berlin, Takustrasse 3, 14195 Berlin, Germany; (D.D.S.); (M.W.)
- Institute of Physical Chemistry and Electrochemistry, Leibniz Universität Hannover, Callinstr. 3A, 30167 Hannover, Germany
| | - Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany; (I.Z.); (C.G.)
- Department of Biosciences, Paris Lodron University Salzburg, Hellbrunnerstraße 34, 5020 Salzburg, Austria
| | - Annette Breier
- Leibniz-Institut für Polymerforschung Dresden e. V. (IPF), Hohe Straße 6, 01069 Dresden, Germany; (A.B.); (J.H.)
| | - Judith Hahn
- Leibniz-Institut für Polymerforschung Dresden e. V. (IPF), Hohe Straße 6, 01069 Dresden, Germany; (A.B.); (J.H.)
| | - Michaela Schröpfer
- FILK Freiberg Institute (FILK), Meißner Ring 1-5, 09599 Freiberg, Germany; (M.S.); (M.M.)
| | - Michael Meyer
- FILK Freiberg Institute (FILK), Meißner Ring 1-5, 09599 Freiberg, Germany; (M.S.); (M.M.)
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str. 1, 90419 Nuremberg, Germany; (I.Z.); (C.G.)
- Correspondence: ; Tel.: +49-911-398-(11)-6772
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Comparative Analysis of Tenogenic Gene Expression in Tenocyte-Derived Induced Pluripotent Stem Cells and Bone Marrow-Derived Mesenchymal Stem Cells in Response to Biochemical and Biomechanical Stimuli. Stem Cells Int 2021; 2021:8835576. [PMID: 33510795 PMCID: PMC7825360 DOI: 10.1155/2021/8835576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
The tendon is highly prone to injury, overuse, or age-related degeneration in both humans and horses. Natural healing of injured tendon is poor, and cell-based therapeutic treatment is still a significant clinical challenge. In this study, we extensively investigated the expression of tenogenic genes in equine bone marrow mesenchymal stem cells (BMSCs) and tenocyte-derived induced pluripotent stem cells (teno-iPSCs) stimulated by growth factors (TGF-β3 and BMP12) combined with ectopic expression of tenogenic transcription factor MKX or cyclic uniaxial mechanical stretch. Western blotting revealed that TGF-β3 and BMP12 increased the expression of transcription factors SCX and MKX in both cells, but the tenocyte marker tenomodulin (TNMD) was detected only in BMSCs and upregulated by either inducer. On the other hand, quantitative real-time PCR showed that TGF-β3 increased the expression of EGR1, COL1A2, FMOD, and TNC in BMSCs and SCX, COL1A2, DCN, FMOD, and TNC in teno-iPSCs. BMP12 treatment elevated SCX, MKX, DCN, FMOD, and TNC in teno-iPSCs. Overexpression of MKX increased SCX, DCN, FMOD, and TNC in BMSCs and EGR1, COL1A2, DCN, FMOD, and TNC in teno-iPSCs; TGF-β3 further enhanced TNC in BMSCs. Moreover, mechanical stretch increased SCX, EGR1, DCN, ELN, and TNC in BMSCs and SCX, MKX, EGR1, COL1A2, DCN, FMOD, and TNC in teno-iPSCs; TGF-β3 tended to further elevate SCX, ELN, and TNC in BMSCs and SCX, MKX, COL1A2, DCN, and TNC in teno-iPSCs, while BMP12 further uptrended the expression of SCX and DCN in BMSCs and DCN in teno-iPSCs. Additionally, the aforementioned tenogenic inducers also affected the expression of signaling regulators SMAD7, ETV4, and SIRT1 in BMSCs and teno-iPSCs. Taken together, our data demonstrate that, in respect to the tenocyte-lineage-specific gene expression, BMSCs and teno-iPSCs respond differently to the tenogenic stimuli, which may affect the outcome of their application in tendon repair or regeneration.
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49
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Bianchi E, Ruggeri M, Rossi S, Vigani B, Miele D, Bonferoni MC, Sandri G, Ferrari F. Innovative Strategies in Tendon Tissue Engineering. Pharmaceutics 2021; 13:89. [PMID: 33440840 PMCID: PMC7827834 DOI: 10.3390/pharmaceutics13010089] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
The tendon is a highly aligned connective tissue that transmits force from muscle to bone. Each year, more than 32 million tendon injuries have been reported, in fact, tendinopathies represent at least 50% of all sports injuries, and their incidence rates have increased in recent decades due to the aging population. Current clinical grafts used in tendon treatment are subject to several restrictions and there is a significant demand for alternative engineered tissue. For this reason, innovative strategies need to be explored. Tendon replacement and regeneration are complex since scaffolds need to guarantee an adequate hierarchical structured morphology and mechanical properties to stand the load. Moreover, to guide cell proliferation and growth, scaffolds should provide a fibrous network that mimics the collagen arrangement of the extracellular matrix in the tendons. This review focuses on tendon repair and regeneration. Particular attention has been devoted to the innovative approaches in tissue engineering. Advanced manufacturing techniques, such as electrospinning, soft lithography, and three-dimensional (3D) printing, have been described. Furthermore, biological augmentation has been considered, as an emerging strategy with great therapeutic potential.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppina Sandri
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (E.B.); (M.R.); (S.R.); (B.V.); (D.M.); (M.C.B.); (F.F.)
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50
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Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers 2021; 7:1. [PMID: 33414454 DOI: 10.1038/s41572-020-00234-1] [Citation(s) in RCA: 293] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
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Affiliation(s)
- Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | | | - Kristian Thorborg
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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