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Eliasberg CD, Trinh PMP, Rodeo SA. Translational Research on Orthobiologics in the Treatment of Rotator Cuff Disease: From the Laboratory to the Operating Room. Sports Med Arthrosc Rev 2024; 32:33-37. [PMID: 38695501 DOI: 10.1097/jsa.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Rotator cuff disease is one of the most common human tendinopathies and can lead to significant shoulder dysfunction. Despite efforts to improve symptoms in patients with rotator cuff tears and healing rates after rotator cuff repair, high rates of failed healing and persistent shoulder morbidity exist. Increasing interest has been placed on the utilization of orthobiologics-scaffolds, cell-based augmentation, platelet right plasma (platelet-rich plasma), and small molecule-based strategies-in the management of rotator cuff disease and the augmentation of rotator cuff repairs. This is a complex topic that involves novel treatment strategies, including patches/scaffolds, small molecule-based, cellular-based, and tissue-derived augmentation techniques. Ultimately, translational research, with a particular focus on preclinical models, has allowed us to gain some insights into the utility of orthobiologics in the treatment of rotator cuff disease and will continue to be critical to our further understanding of the underlying cellular mechanisms moving forward.
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Affiliation(s)
- Claire D Eliasberg
- HSS Sports Medicine Institute, Hospital for Special Surgery
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery Research Institute
| | - Paula M P Trinh
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery Research Institute
- Weill Cornell Medical College, New York, NY
| | - Scott A Rodeo
- HSS Sports Medicine Institute, Hospital for Special Surgery
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery Research Institute
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Tashjian RZ, Zitnay J, Kazmers NH, Veerabhadraiah SR, Zelada AC, Honeggar M, Chalmers PN, Henninger HB, Jurynec MJ. Estrogen and testosterone supplementation improves tendon healing and functional recovery after rotator cuff repair. J Orthop Res 2024; 42:259-266. [PMID: 37756152 DOI: 10.1002/jor.25695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Failure of healing after rotator cuff repair (RCR) is common. The purpose of the current study was to evaluate the effect of systemic estrogen or testosterone supplementation on tendon healing after RCR. Seventy-two adult male mice were utilized for all experiments. The supraspinatus tendon was transected and repaired with 6-0 Prolene suture on the left shoulder of 51 animals. Mice were segregated into three groups postoperative: (1) vehicle group (VG; n = 18), (2) estrogen group (EST; n = 17), and (3) testosterone group (TST; n = 16). An unrepaired control group (unrepaired, n = 21) did not have surgery. Utilizing these animals, histological analysis, activity testing, biomechanical testing and RNA sequencing (RNA-seq) was performed. At 8 weeks post-RCR, TST, and EST supplementation improved the overall histologic structure of the repaired enthesis site. No differences in ultimate failure loads or stiffness were detected between VG, EST, and TST groups after biomechanical testing. RCR caused a reduction in wheel activity compared to unrepaired controls and supplementation with TST restored wheel activity. RNA-seq analysis indicated that estrogen and testosterone regulated different pathways associated with enthesis healing, including a suppression of inflammatory signaling. Supplementation with sex hormones improved the structure of the repaired tendon enthesis and significantly regulated expression of diverse pathways regulating multiple biological processes. Testosterone administration following RCR restored wheel activity without having a detrimental impact on biomechanical strength. Future human studies of sex hormone supplementation after RCR are warranted as supplementation in an animal model may improve tendon enthesis healing.
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Affiliation(s)
- Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jared Zitnay
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Antonio C Zelada
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew Honeggar
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael J Jurynec
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Kersten V, Seitz T, Sommer J, Thasler WE, Bosserhoff A, Hellerbrand C. Bone Morphogenetic Protein 13 Has Protumorigenic Effects on Hepatocellular Carcinoma Cells In Vitro. Int J Mol Sci 2023; 24:11059. [PMID: 37446238 DOI: 10.3390/ijms241311059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Activated hepatic stellate cells (HSCs) play a key role in hepatic fibrosis and, thus, build the "soil" for hepatocarcinogenesis. Furthermore, HSCs are known to promote the progression of hepatocellular carcinoma (HCC), but the molecular mechanisms are only incompletely understood. Recently, we newly described the expression of bone morphogenetic protein 13 (BMP13) by HSCs in fibrotic liver tissue. In addition, BMP13 has mostly been studied in the context of cartilage and bone repair, but not in liver disease or cancer. Thus, we aimed to analyze the expression and function of BMP13 in HCC. Expression analyses revealed high BMP13-expression in activated human HSCs, but not in human HCC-cell-lines. Furthermore, analysis of human HCC tissues showed a significant correlation between BMP13 and α-smooth muscle actin (α-SMA), and immunofluorescence staining confirmed the co-localization of BMP13 and α-SMA, indicating activated HSCs as the cellular source of BMP13 in HCC. Stimulation of HCC cells with recombinant BMP13 increased the expression of the inhibitors of differentiation 1 (ID1) and 2 (ID2), which are known targets of BMP-signaling and cell-cycle promotors. In line with this, BMP13-stimulation caused an induced SMAD 1/5/9 and extracellular signal-regulated kinase (ERK) phosphorylation, as well as reduced expression of cyclin-dependent kinase inhibitors 1A (CDKN1A) and 2A (CDKN2A). Furthermore, stimulation with recombinant BMP13 led to increased proliferation and colony size formation of HCC cells in clonogenicity assays. The protumorigenic effects of BMP13 on HCC cells were almost completely abrogated by the small molecule dorsomorphin 1 (DMH1), which selectively blocks the intracellular kinase domain of ALK2 and ALK3, indicating that BMP13 acts via these BMP type I receptors on HCC cells. In summary, this study newly identifies stroma-derived BMP13 as a potential new tumor promotor in HCC and indicates this secreted growth-factor as a possible novel therapeutic target in HCC.
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Affiliation(s)
- Vanessa Kersten
- Institute of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Tatjana Seitz
- Institute of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Judith Sommer
- Institute of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Wolfgang E Thasler
- Human Tissue and Cell Research-Services GmbH, Am Klopferspitz 19, D-82152 Planegg, Germany
| | - Anja Bosserhoff
- Institute of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany
- Comprehensive Cancer Center (CCC) Erlangen-EMN, D-91054 Erlangen, Germany
| | - Claus Hellerbrand
- Institute of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany
- Comprehensive Cancer Center (CCC) Erlangen-EMN, D-91054 Erlangen, Germany
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Ning C, Li P, Gao C, Fu L, Liao Z, Tian G, Yin H, Li M, Sui X, Yuan Z, Liu S, Guo Q. Recent advances in tendon tissue engineering strategy. Front Bioeng Biotechnol 2023; 11:1115312. [PMID: 36890920 PMCID: PMC9986339 DOI: 10.3389/fbioe.2023.1115312] [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: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Tendon injuries often result in significant pain and disability and impose severe clinical and financial burdens on our society. Despite considerable achievements in the field of regenerative medicine in the past several decades, effective treatments remain a challenge due to the limited natural healing capacity of tendons caused by poor cell density and vascularization. The development of tissue engineering has provided more promising results in regenerating tendon-like tissues with compositional, structural and functional characteristics comparable to those of native tendon tissues. Tissue engineering is the discipline of regenerative medicine that aims to restore the physiological functions of tissues by using a combination of cells and materials, as well as suitable biochemical and physicochemical factors. In this review, following a discussion of tendon structure, injury and healing, we aim to elucidate the current strategies (biomaterials, scaffold fabrication techniques, cells, biological adjuncts, mechanical loading and bioreactors, and the role of macrophage polarization in tendon regeneration), challenges and future directions in the field of tendon tissue engineering.
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Affiliation(s)
- Chao Ning
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Pinxue Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Cangjian Gao
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Liwei Fu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiyao Liao
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Guangzhao Tian
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Han Yin
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Muzhe Li
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiang Sui
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuyun Liu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Quanyi Guo
- Chinese PLA Medical School, Beijing, China.,Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Institute of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Oda H, Kaizawa Y, Franklin A, Rangel US, Min JG, Akerman J, Storaci H, Wang Z, Abrams GD, Chang J, Fox PM. Biomechanical, Histologic, and Micro-Computed Tomography Characterization of Partial-Width Full-Thickness Supraspinatus Tendon Injury in Rats. J Hand Surg Am 2022:S0363-5023(22)00510-X. [PMID: 36280554 DOI: 10.1016/j.jhsa.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/08/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Partial rotator cuff tears can cause shoulder pain and dysfunction and are more common than complete tears. However, few studies examine partial injuries in small animals and, therefore a robust, clinically relevant model may be lacking. This study aimed to fully characterize the established rat model of partial rotator cuff injury over time and determine if it models human partial rotator cuff tears. METHODS We created a full-thickness, partial-width injury at the supraspinatus tendon-bone interface bilaterally in 31 Sprague-Dawley rats. Rats were euthanized immediately, and at 2-, 3-, 4-, and 8-weeks after surgery. Fourteen intact shoulders were used as controls. Samples were assessed biomechanically, histologically, and morphologically. RESULTS Biomechanically, load to failure in controls and 8 weeks after injury was significantly greater than immediately and 3 weeks after injury. Load to failure at 8 weeks was comparable to control. However, the locations of failure were different between intact shoulders and partially injured samples. Bone mineral density at 8 weeks was significantly greater than that at 2 and 3 weeks. Although no animals demonstrated propagation to complete tear and the injury site remodeled histologically, the appearance at 8 weeks was not identical to that in the controls. CONCLUSIONS The biomechanical properties and bone quality decreased after the injury and was restored gradually over time with full restoration by 8 weeks after injury. However, the findings were not equivalent to the intact shoulder. This study demonstrated the limitations of the current model in its application to long-term outcome studies, and the need for better models that can be used to assess chronic partial rotator cuff injuries. CLINICAL RELEVANCE There is no small animal model that mimics human chronic partial rotator cuff tears, which limits our ability to improve care for this common condition.
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Affiliation(s)
- Hiroki Oda
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Yukitoshi Kaizawa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Austin Franklin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Uriel Sanchez Rangel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jung Gi Min
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jack Akerman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Hunter Storaci
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Zhen Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Geoffrey D Abrams
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, and Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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Gardner BB, He TC, Wu S, Liu W, Gutierrez-Sherman V, Mass DP. Growth Factor Expression During Healing in 3 Distinct Tendons. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:214-219. [PMID: 35880149 PMCID: PMC9308159 DOI: 10.1016/j.jhsg.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/09/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose We investigated unique tendon growth-factor expression profiles over time in response to simultaneous, similar injuries. Characterizing these genetic differences lays the foundation for creating targeted, tendon-specific therapies and provides insight into why current growth-factor treatments have success in some applications but not others. Methods The left fourth digital flexor, triceps, and supraspinatus tendons in 24 rats were cut to 50% of their transverse width at the midbelly under anesthesia. On postoperative days 1, 3, 5, 7, and 14, randomly selected rats were sacrificed, and the damaged tendons were excised and flash-frozen in liquid nitrogen. The expressional fibroblast growth factor 1, bone morphogenic protein 13, and transforming growth factor β-1 were measured at each time point and compared to their respective, uninjured levels with real-time polymerase chain reaction. Results The digital flexor tendon showed exponentially elevated expression of all 3 factors over the preinjury baseline values. Expression in the triceps and supraspinatus had more variation over time. The triceps tendon showed a considerable decrease of transforming growth factor β-1 and bone morphogenic protein 13 expression. The supraspinatus tendon had statistically significant increases of both transforming growth factor β-1 and bone morphogenic protein 13 expression relative to preoperative, uninjured levels, with a nonstatistically significant decrease of fibroblast growth factor 1. Conclusions Our study suggests different tendons express their own unique growth-factor profiles after similar, simultaneous injuries. The digital flexor showed particularly high, sustained levels of growth-factor expression in comparison to the supraspinatus and triceps, suggesting that variable dosing may be necessary for growth-factor therapies aimed at supplementing innate responses in these different tendon types. Clinical relevance These data show different tendons express unique trends of growth-factor expression over time in response to injury, suggesting each unique tendon may require specific dosing or knockdown therapies. These observations serve as a foundation for more tendon-specific questioning, experimentation, and therapeutic design.
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Peschl V, Seitz T, Sommer J, Thasler W, Bosserhoff A, Hellerbrand C. Bone morphogenetic protein 13 in hepatic stellate cells and hepatic fibrosis. J Cell Biochem 2022; 123:1544-1552. [PMID: 35442524 DOI: 10.1002/jcb.30248] [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: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/07/2022]
Abstract
Hepatic fibrosis can be considered as a deregulated wound healing process in response to chronic liver injury. Bone morphogenetic protein 13 (BMP13) has been described to promote bone and tendon repair. In this study, we aimed to analyze the expression and function of BMP13 in hepatic fibrosis. We found increased BMP13 expression during the activation of hepatic stellate cells (HSCs), which is known as the key event of hepatic fibrosis. Fitting to this, BMP13 was elevated in murine models of hepatic fibrosis, and immunofluorescence staining showed colocalization of BMP13 and α-smooth muscle actin (α-SMA), a marker for activated HSC, in cirrhotic human liver tissue. BMP13 depletion in activated human HSC reduced the phosphorylation of smad1/5/9 and the expression of the transcription factor inhibitor of differentiation 1 (ID1), a known BMP target gene and profibrogenic factor. Furthermore, BMP13-depletion led to reduced proliferation and downregulation of collagen I α1 (COL1A1) and α-SMA, and, interestingly, also reduced phosphorylation of extracellular signal-regulated kinases (ERK). Conversely, stimulation with recombinant BMP13 induced the phosphorylation of smad1/5/9 and ERK, as well as the proliferation and the expression of ID1, COL1A1, and α-SMA in HSCs. These stimulatory effects were inhibited by dorsomorphin 1, a small-molecule inhibitor of the BMP-type I receptors activin receptor-like kinase-2 and -3, which are both expressed by HSC. In summary, these data indicate increased BMP13 expression in hepatic fibrosis as a profibrogenic factor. Thus, this soluble growth factor might have the potential as a new fibrosis marker and antifibrogenic therapeutic target in patients with chronic liver disease.
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Affiliation(s)
- Vanessa Peschl
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tatjana Seitz
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Judith Sommer
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Anja Bosserhoff
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Claus Hellerbrand
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
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Li HS, Zhou M, Huang P, Liu J, Tang H, Zhang CK, Wang YJ, Shi YX, Liao YT, Jin BY, Tang KL, Zhou B. Histologic and biomechanical evaluation of the thoracolumbar fascia graft for massive rotator cuff tears in a rat model. J Shoulder Elbow Surg 2022; 31:699-710. [PMID: 34775038 DOI: 10.1016/j.jse.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fascial autografts, which are easily available grafts, have provided a promising option in patients with massive rotator cuff tears. However, no fascial autografts other than the fascia lata have been reported, and the exact healing process of the fascia-to-bone interface is not well understood. The objective of this study is to histologically and biomechanically evaluate the effect of the thoracolumbar fascia (TLF) on fascia-to-bone healing. METHODS A total of 88 rats were used in this study. Eight rats were killed at the beginning to form an intact control group, and the other rats were divided randomly into 2 groups (40 rats per group): the TLF augmentation group (TLF group) and the repair group (R group). The right supraspinatus was detached, and a 3 × 5 mm defect of the supraspinatus was created. The TLF was used to augment the torn supraspinatus in the TLF group, whereas in the R group, the torn supraspinatus was repaired in only a transosseous manner. Histology and biomechanics were assessed at 1, 2, 4, 8, and 16 weeks postoperatively. RESULTS The modified tendon maturation score of the TLF group was higher than that of the R group at 8 weeks (23.00 ± 0.71 vs. 24.40 ± 0.89, P = .025) and 16 weeks (24.60 ± 0.55 vs. 26.40 ± 0.55, P ≤ .001). The TLF group showed a rapid vascular reaction, and the peak value appeared at 1 week. Later, the capillary density decreased, and almost no angiogenesis was observed at 8 weeks postoperatively. Immunohistochemistry results demonstrated a significantly higher percentage of collagen I in the TLF group at 4, 8, and 16 weeks (24.78% ± 2.76% vs. 20.67% ± 2.11% at 4 weeks, P = .046; 25.46% ± 1.77% vs. 21.49% ± 2.33% at 8 weeks, P = .026; 34.77% ± 2.25% vs. 30.01% ± 3.17% at 16 weeks, P = .040) postoperatively. Biomechanical tests revealed that the ultimate failure force in the TLF group was significantly higher than that in the R group at the final evaluation (29.13 ± 2.49 N vs. 23.10 ± 3.47 N, P = .022). CONCLUSIONS The TLF autograft can promote a faster biological healing process and a better fixation strength. It could be used as an alternative reinforcement or bridging patch when the fascia lata is not appropriate or available for superior capsule reconstruction (SCR).
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Affiliation(s)
- Huai-Sheng Li
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Mei Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Pan Huang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Juan Liu
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Hong Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Chen-Ke Zhang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Yun-Jiao Wang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - You-Xing Shi
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Ya-Tao Liao
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Bao-Yong Jin
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Kang-Lai Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China.
| | - Binghua Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China.
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Zhu L, Liu Y, Wang A, Zhu Z, Li Y, Zhu C, Che Z, Liu T, Liu H, Huang L. Application of BMP in Bone Tissue Engineering. Front Bioeng Biotechnol 2022; 10:810880. [PMID: 35433652 PMCID: PMC9008764 DOI: 10.3389/fbioe.2022.810880] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/01/2022] [Indexed: 01/15/2023] Open
Abstract
At present, bone nonunion and delayed union are still difficult problems in orthopaedics. Since the discovery of bone morphogenetic protein (BMP), it has been widely used in various studies due to its powerful role in promoting osteogenesis and chondrogenesis. Current results show that BMPs can promote healing of bone defects and reduce the occurrence of complications. However, the mechanism of BMP in vivo still needs to be explored, and application of BMP alone to a bone defect site cannot achieve good therapeutic effects. It is particularly important to modify implants to carry BMP to achieve slow and sustained release effects by taking advantage of the nature of the implant. This review aims to explain the mechanism of BMP action in vivo, its biological function, and how BMP can be applied to orthopaedic implants to effectively stimulate bone healing in the long term. Notably, implantation of a system that allows sustained release of BMP can provide an effective method to treat bone nonunion and delayed bone healing in the clinic.
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Affiliation(s)
- Liwei Zhu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Yuzhe Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Ao Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhengqing Zhu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Youbin Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Chenyi Zhu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhenjia Che
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tengyue Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
- *Correspondence: He Liu, ; Lanfeng Huang,
| | - Lanfeng Huang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- *Correspondence: He Liu, ; Lanfeng Huang,
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Peng Y, Guanglan W, Jia S, Zheng C. Leukocyte-Rich and Leukocyte-Poor Platelet-Rich Plasma in Rotator Cuff Repair: A Meta-analysis. Int J Sports Med 2022; 43:921-930. [PMID: 35255508 DOI: 10.1055/a-1790-7982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To systematically review of randomized controlled trials(RCTs) to compared the effects of leukocyte-rich and leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair. Two independent reviewers comprehensively searched PubMed, Embase, and Cochrane library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparison of leukocyte-rich platelet-rich plasma or leukocyte-poor platelet-rich plasma in rotator cuff repair in a level I RCTs. Methodological quality assessment was carried out using Cochrane Review Manager 5.3 software. P<0.05 was considered statistically significant. Nine RCTs with 540 patients were included in this review. Meta-analysis showed that leukocyte-poor platelet-rich plasma in significantly reduced retear rate in rotator cuff repair [RR=0.56 95%CI (0.42,0.75); P<0.05), and in clinical results, the constant score [MD=3.67, 95%CI (1.62,5.73); P=0.0005], UCLA score [MD=1.60, 95%CI (0.79,2.42); P=0.0001], ASES score [MD=2.16, 95%CI(0.12,4.20);P=0.04] were significantly improved. There was a significant result in favor of PRP for the Constant score [MD=-1.24, 95%CI(-1.50,-0.99); P<0.00001], while SST scores were not significantly different among all groups [MD=0.21, 95%CI(-0.21,0.64); P=0.32]. In conclusion, leukocyte-poor platelet-rich plasma can improved the clinical function and reduced retear rate in arthroscopic rotator cuff repair. In contrast, the efficacy of leukocyte-rich platelet-rich plasma was not significantly improved with the exception of VAS score.
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Affiliation(s)
- Yundong Peng
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Wang Guanglan
- School of Health Sciences, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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11
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Feusi O, Karol A, Fleischmann T, von Rechenberg B, Bouaicha S, Werner CML, Jentzsch T. Platelet-rich plasma as a potential prophylactic measure against frozen shoulder in an in vivo shoulder contracture model. Arch Orthop Trauma Surg 2022; 142:363-372. [PMID: 33074367 PMCID: PMC8844181 DOI: 10.1007/s00402-020-03617-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/30/2020] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Frozen shoulder (adhesive capsulitis) is a common painful and functionally-limiting disease affecting around 2% of the population. So far, therapeutic options are limited and often unsatisfactory. Platelet-rich plasma (PRP) has been used as a treatment option in other orthopedic diseases since it contains growth factors that stimulate tissue repair. So far, the effect of PRP on frozen shoulder lacks evidence. We hypothesized that PRP may be valuable in the prophylaxis and treatment of secondary frozen shoulder due to capsular remodeling. MATERIALS AND METHODS An experimental study of an in vivo frozen shoulder model was conducted. Twenty Sprague-Dawley rats underwent surgery in which the body of the scapula was connected to the humerus with a high-strength suture. Two groups of 8 weeks survival time were allocated; a treatment group with one intraoperative injection of PRP into the glenohumeral joint (n = 10) and a control group without PRP (n = 10). The primary outcome was the structural change in the posterior synovial membrane of the posterior and inferior part of the glenohumeral joint using a semi-quantitative grading from 0 (lowest) to 3 (highest). RESULTS The posterior synovial membrane structural changes were significantly lower in the PRP group (median = 1 [interquartile range (IQR) = 0-1]) compared to controls (median = 2 [IQR = 1-3]) (p = 0.028). There were no differences for the remaining synovial membrane changes and fibrous capsule responses between groups. CONCLUSIONS In this in vivo shoulder contracture model, PRP injections seem to reduce the histological severity grade of some parts (i.e., posterior synovial membrane changes) of the secondary frozen shoulder without causing any side effects. It may be considered to investigate this effect further in future studies as a potential prophylaxis of secondary frozen shoulder (e.g., in operated or immobilized shoulders) or as a treatment option for patients with frozen shoulder in the early stage.
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Affiliation(s)
- Oscar Feusi
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Agnieszka Karol
- Musculoskeletal Research Unit (MSRU) Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, Centre for Clinical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU) Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Clément M. L. Werner
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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12
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Gandolfi M, Brandão C, Pellizon C, Hirota I, Barros R, Hussein A, Merlini N, Takahira R, Mesquita L. Allogenic platelet-rich plasma in induced ulcers in rat’s cornea. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The objective in this study was to evaluate the clinic effect of applying allogenic platelet-rich plasma (PRP) heated or not, for treating cornea ulcers, including the dosage of PDGF-BB in the cornea. The ulcers were induced, standardizing the left eye from 81 rats (Ratus norvegicus, albinus variety), assigned randomly into three groups (N=27): control group (CG) which did not receive any topic treatment; heated PRP group (GA) and PRP group (GP), which received topical treatment every eight hours for five days. Each group underwent evaluation at 24 hours (M1), three days (M3) and five days (M5). The clinical exam evaluated the opacity, vascularization and corneal repair. The corneal PDGF-BB was dosed through the ELISA method. The corneal opacity was decreased in PRP-treated animals (GA and GP) and corneal repair time reduced when compared to CG at M1 and M5. Furthermore, GP showed greater vascularization at M3 compared to M1. Applied allogenic PRP eye drops, heated or not, speed up corneal healing, and reduce corneal repair time. However, the corneal PDGF concentration was not altered in any of the treatments.
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Affiliation(s)
| | | | | | | | - R. Barros
- Universidade Estadual Paulista, Brazil
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13
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Wang D, Zhang X, Huang S, Liu Y, Fu BSC, Mak KKL, Blocki AM, Yung PSH, Tuan RS, Ker DFE. Engineering multi-tissue units for regenerative Medicine: Bone-tendon-muscle units of the rotator cuff. Biomaterials 2021; 272:120789. [PMID: 33845368 DOI: 10.1016/j.biomaterials.2021.120789] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022]
Abstract
Our body systems are comprised of numerous multi-tissue units. For the musculoskeletal system, one of the predominant functional units is comprised of bone, tendon/ligament, and muscle tissues working in tandem to facilitate locomotion. To successfully treat musculoskeletal injuries and diseases, critical consideration and thoughtful integration of clinical, biological, and engineering aspects are necessary to achieve translational bench-to-bedside research. In particular, identifying ideal biomaterial design specifications, understanding prior and recent tissue engineering advances, and judicious application of biomaterial and fabrication technologies will be crucial for addressing current clinical challenges in engineering multi-tissue units. Using rotator cuff tears as an example, insights relevant for engineering a bone-tendon-muscle multi-tissue unit are presented. This review highlights the tissue engineering strategies for musculoskeletal repair and regeneration with implications for other bone-tendon-muscle units, their derivatives, and analogous non-musculoskeletal tissue structures.
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Affiliation(s)
- Dan Wang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Shuting Huang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yang Liu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Bruma Sai-Chuen Fu
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Anna Maria Blocki
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Patrick Shu-Hang Yung
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Rocky S Tuan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Dai Fei Elmer Ker
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR; Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR.
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14
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Qi J, Liu Q, Reisdorf RL, Boroumand S, Behfar A, Moran SL, Amadio PC, Gingery A, Zhao C. Characterization of a purified exosome product and its effects on canine flexor tenocyte biology. J Orthop Res 2020; 38:1845-1855. [PMID: 31930553 DOI: 10.1002/jor.24587] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/21/2019] [Indexed: 02/04/2023]
Abstract
Flexor tendon injuries and tendinopathy are very common but remain challenging in clinical treatment. Exosomes-based cell-free therapy appears to be a promising strategy for tendon healing, while limited studies have evaluated its impacts on tenocyte biology. The objective of this study was to characterize a novel purified exosome product (PEP) derived from plasma, as well as to explore its cellular effects on canine tenocyte biology. The transmission electron microscope revealed that exosomes of PEP present cup-shaped structures with the diameters ranged from 80 to 141 nm, and the NanoSight report presented that their size mainly concentrated around 100 nm. The enzyme-linked immunosorbent assay kits analysis showed that PEP was positive for CD63 and AChE expression, and the cellular uptake of exosomes internalized into tenocyte cytoplasm was observed. The cell growth assays displayed that tenocyte proliferation ability was enhanced by PEP solution in a dose-dependent manner. Tenogenic phenotype was preserved as is evident by that tendon-related genes expression (SCX, COL1A, COL3A1, TNMD, DCN, and MKX) were expressed insistently in a high level, while tenocytes were treated with 5% PEP solution. Furthermore, migration capability was maintained and total collagen deposition was increased. More interesting, dexamethasone-induced cellular apoptosis was attenuated during the incubation of tenocytes with a 5% PEP solution. These findings will provide the basic understandings about the PEP, and support the potential use of this biological strategy for tendon healing.
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Affiliation(s)
- Jun Qi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Liu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Soulmaz Boroumand
- Division of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Atta Behfar
- Division of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anne Gingery
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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15
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Norelli JB, Plaza DP, Stal DN, Varghese AM, Liang H, Grande DA. Tenogenically differentiated adipose-derived stem cells are effective in Achilles tendon repair in vivo. J Tissue Eng 2018; 9:2041731418811183. [PMID: 30542597 PMCID: PMC6236638 DOI: 10.1177/2041731418811183] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to characterize rat adipose-derived stem cells,
induce adipose-derived stem cell tenogenesis, and analyze adipose-derived stem
cell effects on tendon repair in vivo. Adipose-derived stem cells demonstrated
an immunomodulatory, pro-angiogenic, and pro-proliferatory profile in vitro.
Tenogenesis was induced for 1, 7, 14, and 21 days with 24 combinations of growth
differentiation factor-5, 6, and 7 and platelet-derived growth factor–BB.
Adipose-derived stem cells expression of scleraxis and collagen type I increased
the most after 14 days of induction with growth differentiation factor-6 and
platelet-derived growth factor–BB. Achilles excision defects injected with
hydrogel alone (Gp2), with undifferentiated (Gp3) adipose-derived stem cells, or
tenogenically differentiated (Gp4) adipose-derived stem cells exhibited improved
tissue repair compared with untreated tendons (Gp1). Addition of adipose-derived
stem cells improved tissue cytoarchitecture and increased expression of collagen
type I and III, scleraxis, and tenomodulin. Adipose-derived stem cells
significantly improved biomechanical properties (ultimate load and elastic
toughness) over time more than hydrogel alone, while tenogenically
differentiated adipose-derived stem cells improved the mean histological score
and collagen fiber dispersion range closest to normal tendon. In addition,
tendon sections treated with GFP-adipose-derived stem cells exhibited green
fluorescence and positive GFP immunostaining on microscopy confirming the in
vivo survival of adipose-derived stem cells that were injected into tendon
defects to support the effects of adipose-derived stem cells on tissue up to
4.5 weeks post injury.
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Affiliation(s)
- Jolanta B Norelli
- Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Jolanta B Norelli, Orthopaedic Research
Laboratory, The Feinstein Institute for Medical Research, 350 Community Drive,
Manhasset, NY 11030, USA.
| | - Dawid P Plaza
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Drexel University College of Medicine,
Philadelphia, PA, USA
| | - Drew N Stal
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Orthopedic Surgery,
Northwell Health, Manhasset, NY, USA
| | - Anish M Varghese
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Haixiang Liang
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Orthopedic Surgery,
Northwell Health, Manhasset, NY, USA
| | - Daniel A Grande
- Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Orthopedic Surgery,
Northwell Health, Manhasset, NY, USA
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16
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Bianco ST, Moser HL, Galatz LM, Huang AH. Biologics and stem cell-based therapies for rotator cuff repair. Ann N Y Acad Sci 2018; 1442:35-47. [PMID: 30008172 DOI: 10.1111/nyas.13918] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022]
Abstract
The rotator cuff is composed of several distinct muscles and tendons that function in concert to coordinate shoulder motion. Injuries to these tendons frequently result in permanent dysfunction and persistent pain. Despite considerable advances in operation techniques, surgical repair alone still does not fully restore rotator cuff function. This review focuses on recent research in the use of biologics and stem cell-based therapies to augment repair, highlighting promising avenues for future work and remaining challenges. While a number of animal models are used for rotator cuff studies, the anatomy of the rotator cuff varies dramatically between species. Since the rodent rotator cuff shares the most anatomical features with the human, this review will focus primarily on rodent models to enable consistent interpretation of outcome measures.
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Affiliation(s)
- Spencer T Bianco
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Helen L Moser
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York.,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leesa M Galatz
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alice H Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
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17
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Ker DFE, Wang D, Behn AW, Wang ETH, Zhang X, Zhou BY, Mercado-Pagán ÁE, Kim S, Kleimeyer J, Gharaibeh B, Shanjani Y, Nelson D, Safran M, Cheung E, Campbell P, Yang YP. Functionally Graded, Bone- and Tendon-Like Polyurethane for Rotator Cuff Repair. ADVANCED FUNCTIONAL MATERIALS 2018; 28:1707107. [PMID: 29785178 PMCID: PMC5959293 DOI: 10.1002/adfm.201707107] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 05/25/2023]
Abstract
Critical considerations in engineering biomaterials for rotator cuff repair include bone-tendon-like mechanical properties to support physiological loading and biophysicochemical attributes that stabilize the repair site over the long-term. In this study, UV-crosslinkable polyurethane based on quadrol (Q), hexamethylene diisocyante (H), and methacrylic anhydride (M; QHM polymers), which are free of solvent, catalyst, and photoinitiator, is developed. Mechanical characterization studies demonstrate that QHM polymers possesses phototunable bone- and tendon-like tensile and compressive properties (12-74 MPa tensile strength, 0.6-2.7 GPa tensile modulus, 58-121 MPa compressive strength, and 1.5-3.0 GPa compressive modulus), including the capability to withstand 10 000 cycles of physiological tensile loading and reduce stress concentrations via stiffness gradients. Biophysicochemical studies demonstrate that QHM polymers have clinically favorable attributes vital to rotator cuff repair stability, including slow degradation profiles (5-30% mass loss after 8 weeks) with little-to-no cytotoxicity in vitro, exceptional suture retention ex vivo (2.79-3.56-fold less suture migration relative to a clinically available graft), and competent tensile properties (similar ultimate load but higher normalized tensile stiffness relative to a clinically available graft) as well as good biocompatibility for augmenting rat supraspinatus tendon repair in vivo. This work demonstrates functionally graded, bone-tendon-like biomaterials for interfacial tissue engineering.
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Affiliation(s)
- Dai Fei Elmer Ker
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Dan Wang
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Anthony William Behn
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Evelyna Tsi Hsin Wang
- Department of Material Science and Engineering Stanford University 496 Lomita Mall, Stanford, CA 94305, USA
| | - Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine The Chinese University of Hong Kong New Territories, Hong Kong SAR
| | - Benjamin Yamin Zhou
- Department of Mathematics Stanford University Building 380, Sloan Mathematical Center, Stanford, CA 94305, USA
| | | | - Sungwoo Kim
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - John Kleimeyer
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Burhan Gharaibeh
- Department of Biological Sciences University of Pittsburgh 4249 Fifth Avenue, Pittsburgh, PA 15260, USA
| | - Yaser Shanjani
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Drew Nelson
- Department of Mechanical Engineering Stanford University 440 Escondido Mall, Stanford, CA 94305, USA
| | - Marc Safran
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Emilie Cheung
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Phil Campbell
- Engineering Research Accelerator Carnegie Mellon University 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery Stanford University 300 Pasteur Drive, Stanford, CA 94305, USA
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18
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Zhang C, Liu YJ. Biomechanic and histologic analysis of fibroblastic effects of tendon-to-bone healing by transforming growth factor β1 (TGF-β1) in rotator cuff tears. Acta Cir Bras 2018; 32:1045-1055. [PMID: 29319733 DOI: 10.1590/s0102-865020170120000006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/19/2017] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the effect of transforming growth factor β1 (TGF-β1) on tendon-to-bone reconstruction of rotator cuff tears. METHODS Seventy-two rat supraspinatus tendons were transected and reconstructed in situ. At 8 and 16 weeks, specimens of three groups; that is control, L-dose (low dose), and H-dose (high dose) were harvested and underwent a biomechanical test to evaluate the maximum load and stiffness values. Histology sections of the tendon-to-bone interface were identified by hematoxylin-eosin or Masson trichrome stain. Collagen type III was observed by picric acid sirius red staining under polarized light. The level of insulin-like growth factor 1 (IGF-1) and vascular endothelial growth factor (VEGF) was measured by the enzyme-linked immunosorbent assay (ELISA) method. RESULTS Collagen type III of the H-dose group had a significant difference in histology structure compared with the L-dose group (P<0.05). The maximum load and stiffness decreased significantly in the control group compared with the values of the L-dose and H-dose groups. The stiffness among the three groups differed significantly at the same postoperative time (P<0.05). Interestingly, progressive reestablishment of collagen type III affected tendon-to-bone healing significantly in the later stages. CONCLUSION The H-dose was associated with an increased collagen type III morphology stimulated by TGF-β1.
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Affiliation(s)
- Chong Zhang
- Associated Professor, Department of Orthopaedic Surgery, Traditional Chinese Medicine Hospital, Hebei Province, China. Aquisition of data, manuscript writing
| | - Yu-Jie Liu
- MD, Professor, Department of Orthopaedic Surgery, Chinese PLA General Hospital, Beijing, China. Design, intellectual and scientific content of the study; critical revision
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A Comparative Study on the Clinical Results of Arthroscopic Rotator Cuff Repair and Open Repair Surgery. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2018. [DOI: 10.5812/rijm.60817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Growth factor delivery strategies for rotator cuff repair and regeneration. Int J Pharm 2018; 544:358-371. [PMID: 29317260 DOI: 10.1016/j.ijpharm.2018.01.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/21/2017] [Accepted: 01/01/2018] [Indexed: 12/21/2022]
Abstract
The high incidence of degenerative tears and prevalence of retears (20-95%) after surgical repair makes rotator cuff injuries a significant health problem. This high retear rate is attributed to the failure of the repaired tissue to regenerate the native tendon-to-bone insertion (enthesis). Biological augmentation of surgical repair such as autografts, allografts, and xenografts are confounded by donor site morbidity, immunogenicity, and disease transmission, respectively. In contrast, these risks may be alleviated via growth factor therapy, which can actively influence the healing environment to promote functional repair. Several challenges have to be overcome before growth factor delivery can translate into clinical practice such as the selection of optimal growth factor(s) or combination, identification of the most efficient stage and duration of delivery, and the design considerations for the delivery device. Emerging insight into the injury-repair microenvironment and our understanding of growth factor mechanisms in healing are informing the design of advanced delivery scaffolds to effectively treat rotator cuff tears. Here, we review potential growth factor candidates, design parameters and material selection for growth factor delivery, innovative and dynamic delivery scaffolds, and novel therapeutic targets from tendon and developmental biology for the structural and functional healing of rotator cuff repair.
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21
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Utilización del plasma rico en plaquetas en el tratamiento de la patología del manguito de los rotadores. ¿Qué hay demostrado científicamente? Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:249-258. [DOI: 10.1016/j.recot.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 02/16/2017] [Accepted: 03/14/2017] [Indexed: 01/07/2023] Open
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22
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Miranda I, Sánchez-Alepuz E, Lucas F, Carratalá V, González-Jofre C. Use of platelet-rich plasma in the treatment of rotator cuff pathology. What has been scientifically proven? Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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23
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Zhang J, Yuan T, Zheng N, Zhou Y, Hogan MV, Wang JHC. The combined use of kartogenin and platelet-rich plasma promotes fibrocartilage formation in the wounded rat Achilles tendon entheses. Bone Joint Res 2017; 6:231-244. [PMID: 28450316 PMCID: PMC5415905 DOI: 10.1302/2046-3758.64.bjr-2017-0268.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/10/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives After an injury, the biological reattachment of tendon to bone is a challenge because healing takes place between a soft (tendon) and a hard (bone) tissue. Even after healing, the transition zone in the enthesis is not completely regenerated, making it susceptible to re-injury. In this study, we aimed to regenerate Achilles tendon entheses (ATEs) in wounded rats using a combination of kartogenin (KGN) and platelet-rich plasma (PRP). Methods Wounds created in rat ATEs were given three different treatments: kartogenin platelet-rich plasma (KGN-PRP); PRP; or saline (control), followed by histological and immunochemical analyses, and mechanical testing of the rat ATEs after three months of healing. Results Histological analysis showed well organised arrangement of collagen fibres and proteoglycan formation in the wounded ATEs in the KGN-PRP group. Furthermore, immunohistochemical analysis revealed fibrocartilage formation in the KGN-PRP-treated ATEs, evidenced by the presence of both collagen I and II in the healed ATE. Larger positively stained collagen III areas were found in both PRP and saline groups than those in the KGN-PRP group. Chondrocyte-related genes, SOX9 and collagen II, and tenocyte-related genes, collagen I and scleraxis (SCX), were also upregulated by KGN-PRP. Moreover, mechanical testing results showed higher ultimate tensile strength in the KGN-PRP group than in the saline control group. In contrast, PRP treatment appeared to have healed the injured ATE but induced no apparent formation of fibrocartilage. The saline-treated group showed poor healing without fibrocartilage tissue formation in the ATEs. Conclusions Our results show that injection of KGN-PRP induces fibrocartilage formation in the wounded rat ATEs. Hence, KGN-PRP may be a clinically relevant, biological approach to regenerate injured enthesis effectively. Cite this article: J. Zhang, T. Yuan, N. Zheng, Y. Zhou, M. V. Hogan, J. H-C. Wang. The combined use of kartogenin and platelet-rich plasma promotes fibrocartilage formation in the wounded rat Achilles tendon entheses. Bone Joint Res 2017;6:231–244. DOI: 10.1302/2046-3758.64.BJR-2017-0268.R1.
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Affiliation(s)
- J Zhang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA
| | - T Yuan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA
| | - N Zheng
- Department of Mechanical Engineering, University of North Carolina, 9201 University City Blvd, Mechanical Engineering, Duke 201, Charlotte, North Carolina, USA
| | - Y Zhou
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA
| | - M V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA
| | - J H-C Wang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA
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Giotis D, Aryaei A, Vasilakakos T, Paschos NK. Effectiveness of Biologic Factors in Shoulder Disorders. Open Orthop J 2017; 11:163-182. [PMID: 28400884 PMCID: PMC5366381 DOI: 10.2174/1874325001711010163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 12/17/2022] Open
Abstract
Background: Shoulder pathology can cause significant pain, discomfort, and loss of function that all interfere with activities of daily living and may lead to poor quality of life. Primary osteoarthritis and rotator cuff diseases with its sequalae are the main culprits. Management of shoulder disorders using biological factors gained an increasing interest over the last years. This interest reveals the need of effective treatments for shoulder degenerative disorders, and highlights the importance of a comprehensive and detailed understanding of the rapidly increasing knowledge in the field. Methods: This study will describe most of the available biology-based strategies that have been recently developed, focusing on their effectiveness in animal and clinical studies. Results: Data from in vitro work will also be briefly presented; in order to further elucidate newly acquired knowledge regarding mechanisms of tissue degeneration and repair that would probably drive translational work in the next decade. The role of platelet rich-plasma, growth factors, stem cells and other alternative treatments will be described in an evidence-based approach, in an attempt to provide guidelines for their clinical application. Finally, certain challenges that biologic treatments face today will be described as an initiative for future strategies. Conclusion: The application of different growth factors and mesenchymal stem cells appears as promising approaches for enhancing biologic repair. However, data from clinical studies are still limited, and future studies need to improve understanding of the repair process in cellular and molecular level and evaluate the effectiveness of biologic factors in the management of shoulder disorders.
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Affiliation(s)
- Dimitrios Giotis
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Ashkan Aryaei
- Department of Biomedical Engineering, University of California, Davis, USA
| | - Theofanis Vasilakakos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Nikolaos K Paschos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, USA
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25
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Harada Y, Mifune Y, Inui A, Sakata R, Muto T, Takase F, Ueda Y, Kataoka T, Kokubu T, Kuroda R, Kurosaka M. Rotator cuff repair using cell sheets derived from human rotator cuff in a rat model. J Orthop Res 2017; 35:289-296. [PMID: 27171575 DOI: 10.1002/jor.23289] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/06/2016] [Indexed: 02/04/2023]
Abstract
To achieve biological regeneration of tendon-bone junctions, cell sheets of human rotator-cuff derived cells were used in a rat rotator cuff injury model. Human rotator-cuff derived cells were isolated, and cell sheets were made using temperature-responsive culture plates. Infraspinatus tendons in immunodeficient rats were resected bilaterally at the enthesis. In right shoulders, infraspinatus tendons were repaired by the transosseous method and covered with the cell sheet (sheet group), whereas the left infraspinatus tendons were repaired in the same way without the cell sheet (control group). Histological examinations (safranin-O and fast green staining, isolectin B4, type II collagen, and human-specific CD31) and mRNA expression (vascular endothelial growth factor; VEGF, type II collagen; Col2, and tenomodulin; TeM) were analyzed 4 weeks after surgery. Biomechanical tests were performed at 8 weeks. In the sheet group, proteoglycan at the enthesis with more type II collagen and isolectin B4 positive cells were seen compared with in the control group. Human specific CD31-positive cells were detected only in the sheet group. VEGF and Col2 gene expressions were higher and TeM gene expression was lower in the sheet group than in the control group. In mechanical testing, the sheet group showed a significantly higher ultimate failure load than the control group at 8 weeks. Our results indicated that the rotator-cuff derived cell sheet could promote cartilage regeneration and angiogenesis at the enthesis, with superior mechanical strength compared with the control. Treatment for rotator cuff injury using cell sheets could be a promising strategy for enthesis of tendon tissue engineering. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:289-296, 2017.
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Affiliation(s)
- Yoshifumi Harada
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yutaka Mifune
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Atsuyuki Inui
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ryosuke Sakata
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tomoyuki Muto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Fumiaki Takase
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yasuhiro Ueda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takeshi Kataoka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takeshi Kokubu
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masahiro Kurosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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26
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Zhou Y, Zhang J, Yang J, Narava M, Zhao G, Yuan T, Wu H, Zheng N, Hogan MV, Wang JHC. Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface. J Tissue Eng Regen Med 2017; 11:3445-3456. [DOI: 10.1002/term.2258] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/11/2016] [Accepted: 07/03/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Yiqin Zhou
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
- Joint Surgery and Sports Medicine Department; Shanghai Changzheng Hospital, Second Military Medical University; 415 Fengyang Road, Huangpu Shanghai 200003 China
| | - Jianying Zhang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Jinsong Yang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Manoj Narava
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Guangyi Zhao
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Ting Yuan
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Haishan Wu
- Joint Surgery and Sports Medicine Department; Shanghai Changzheng Hospital, Second Military Medical University; 415 Fengyang Road, Huangpu Shanghai 200003 China
| | - Nigel Zheng
- Department of Mechanical Engineering and Engineering Science, Center for Biomedical Engineering and Science; University of North Carolina at Charlotte; Charlotte NC USA
| | - MaCalus V. Hogan
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - James H.-C. Wang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
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27
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Kim SJ, Song DH, Park JW, Park S, Kim SJ. Effect of Bone Marrow Aspirate Concentrate-Platelet-Rich Plasma on Tendon-Derived Stem Cells and Rotator Cuff Tendon Tear. Cell Transplant 2017; 26:867-878. [PMID: 28105983 DOI: 10.3727/096368917x694705] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Bone marrow aspirate concentrates (BMACs) and platelet-rich plasma (PRP) are good sources to control the differentiation of tendon-derived stem cells (TDSCs), but there has been no study about the effect of the BMAC-PRP complex on TDSCs and tendinopathy. The aim of this study was to investigate the effect of BMAC-PRP on the TDSCs and to find the therapeutic effect of BMAC-PRP on the rotator cuff tendon tear. The chondrogenic and osteogenic potential of TDSCs decreased, but the adipogenic potential of TDSCs revealed no significant difference when they were cocultured with BMAC-PRP. Cell proliferation was significantly greater in TDSCs cocultured with BMAC-PRP than in TDSCs. The degree of wound closure (percentage) was different between TDSCs and TDSCs with BMAC-PRP. There was no significant difference in expression of collagen type I and type III in immunocytochemical staining in the presence of BMAC-PRP. Initial visual analog scale (VAS) score was 5.8 ± 1.9, which changed to 5.0 ± 2.3 at 3 weeks and 2.8 ± 2.3 at 3 months after the BMAC-PRP injection (p < 0.01). The American Shoulder Elbow Surgeon score changed from 39.4 ± 13.0 at baseline to 52.9 ± 22.9 at 3 weeks and 71.8 ± 19.7 at 3 months after the injection (p < 0.01). The initial torn area of the rotator cuff tendon was 30.2 ± 24.5 mm2, and this area was reduced to 22.5 ± 18.9 mm2 at 3 months, but the change was not significant (p > 0.05). The data indicate that BMAC-PRP enhances the proliferation and migration of TDSCs and prevents the aberrant chondrogenic and osteogenic differentiation of TDSCs, which might provide a mechanistic basis for the therapeutic benefits of BMAC-PRP for rotator cuff tendon tear.
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28
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Denduluri SK, Scott B, Lamplot JD, Yin L, Yan Z, Wang Z, Ye J, Wang J, Wei Q, Mohammed MK, Haydon RC, Kang RW, He TC, Athiviraham A, Ho SH, Shi LL. Immortalized Mouse Achilles Tenocytes Demonstrate Long-Term Proliferative Capacity While Retaining Tenogenic Properties. Tissue Eng Part C Methods 2016; 22:280-9. [PMID: 26959762 DOI: 10.1089/ten.tec.2015.0244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Investigating the cellular processes underlying tendon healing can allow researchers to improve long-term outcomes after injury. However, conducting meaningful studies to uncover the injury healing mechanism at cellular and molecular levels remains challenging. This is due to the inherent difficulty in isolating, culturing, and expanding sufficient primary tenocytes, due to their limited proliferative capacity and short lifespan. In this study, we sought to establish a novel line of immortalized mouse Achilles tenocytes (iMATs) with primary tenocyte properties, but increased proliferative capacity suitable for extensive in vitro experimentation. We show that isolated primary mouse Achilles tenocytes (pMATs) can be effectively immortalized using a piggyBac transposon expressing SV40 large T antigen flanked by FLP recombination target site (FRT). The resulting iMATs exhibit markedly greater proliferation and survival, which can be reversed with FLP recombinase. Furthermore, iMATs express the same set of tendon-specific markers as that of primary cells, although in lower levels, and respond similarly to exogenous stimulation with bone morphogenetic protein 13 (BMP13) as has been previously reported with pMATs. Taken together, our results suggest that iMATs acquire long-term proliferative capacity while maintaining tenogenic properties. We believe that iMATs are a suitable model for studying not only the native cellular processes involved in injury and healing, but also potential therapeutic agents that may augment the stability of tendon repair.
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Affiliation(s)
- Sahitya K Denduluri
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Bryan Scott
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Joseph D Lamplot
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Liangjun Yin
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois.,2 Ministry of Education Key Laboratory of Diagnostic Medicine, The Affiliated Hospitals of Chongqing Medical University , Chongqing, China
| | - Zhengjian Yan
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois.,2 Ministry of Education Key Laboratory of Diagnostic Medicine, The Affiliated Hospitals of Chongqing Medical University , Chongqing, China
| | - Zhongliang Wang
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois.,2 Ministry of Education Key Laboratory of Diagnostic Medicine, The Affiliated Hospitals of Chongqing Medical University , Chongqing, China
| | - Jixing Ye
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Jing Wang
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois.,2 Ministry of Education Key Laboratory of Diagnostic Medicine, The Affiliated Hospitals of Chongqing Medical University , Chongqing, China
| | - Qiang Wei
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois.,2 Ministry of Education Key Laboratory of Diagnostic Medicine, The Affiliated Hospitals of Chongqing Medical University , Chongqing, China
| | - Maryam K Mohammed
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Rex C Haydon
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Richard W Kang
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Tong-Chuan He
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Aravind Athiviraham
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Sherwin H Ho
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Lewis L Shi
- 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Pritzker School of Medicine , Chicago, Illinois
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29
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Deprés-Tremblay G, Chevrier A, Snow M, Hurtig MB, Rodeo S, Buschmann MD. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development. J Shoulder Elbow Surg 2016; 25:2078-2085. [PMID: 27554609 DOI: 10.1016/j.jse.2016.06.009] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Rotator cuff tears are the most common musculoskeletal injury occurring in the shoulder. Current surgical repair fails to heal in 20% to 95% of patients, depending on age, size of the tear, smoking, time of repair, tendon quality, muscle quality, healing response, and surgical treatments. These problems are worsened by the limited healing potential of injured tendons attributed to the presence of degenerative changes and relatively poor vascularity of the cuff tendons. Development of new techniques to treat rotator cuff tears requires testing in animal models to assess safety and efficacy before clinical testing. Hence, it is important to evaluate appropriate animal models for rotator cuff research with degeneration of tendons, muscular atrophy, and fatty infiltration similar to humans. This report reviews current clinical treatments and preclinical approaches for rotator cuff tear repair. The review will focus on current clinical surgical treatments, new repair strategies under clinical and preclinical development, and will also describe different animal models available for rotator cuff research. These findings and future directions for rotator cuff tear repair will be discussed.
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Affiliation(s)
| | - Anik Chevrier
- Chemical Engineering Department, Polytechnique Montréal, Montreal, QC, Canada
| | - Martyn Snow
- Department of Arthroscopy, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Mark B Hurtig
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Scott Rodeo
- Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA
| | - Michael D Buschmann
- Biomedical Engineering Institute, Polytechnique Montréal, Montreal, QC, Canada; Chemical Engineering Department, Polytechnique Montréal, Montreal, QC, Canada.
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30
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Gulati T, Chung SA, Wei AQ, Diwan AD. Localization of bone morphogenetic protein 13 in human intervertebral disc and its molecular and functional effects in vitro in 3D culture. J Orthop Res 2015; 33:1769-75. [PMID: 26134557 DOI: 10.1002/jor.22965] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/08/2015] [Indexed: 02/04/2023]
Abstract
Our laboratory has demonstrated that bone morphogenetic protein 13 prevented the effects of annular injury in an ovine model, maintaining intervertebral disc height, cell numbers and increasing extracellular matrix production compared to degenerated controls. The present study sought to examine the molecular effects of bone morphogenetic protein 13 on human degenerated disc cells and localize its expression in both human degenerate and scoliotic disc tissue. Effect of bone morphogenetic protein 13 on human derived nucleus pulposus, annulus fibrosus and endplate cells cultured in alginate beads was evaluated by changes in proteoglycan and collagen content. Migratory potential of disc cells towards bone morphogenetic protein 13 was also examined. Bone morphogenetic protein 13 induced significant proteoglycan accumulation in nucleus (18%), annulus (21%) and endplate (23%) cells cultured in alginate beads (p<0.05) compared to controls. Further bone morphogenetic protein 13 increased collagen I and II protein expression in nucleus and endplate cells. Nucleus cells displayed a significant chemotactic response towards bone morphogenetic protein 13. The endogenous expression of bone morphogenetic protein 13 in degenerate disc tissue was not different to scoliotic disc. Bone morphogenetic protein 13 has the potential to enhance extracellular matrix accumulation and induce cell migration in certain disc cells.
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Affiliation(s)
- Twishi Gulati
- Department of Orthopaedic Research, Orthopaedic Research Institute, St George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | - Sylvia A Chung
- Department of Orthopaedic Research, Orthopaedic Research Institute, St George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | - Ai-Qun Wei
- Department of Orthopaedic Research, Orthopaedic Research Institute, St George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | - Ashish D Diwan
- Department of Orthopaedic Research, Orthopaedic Research Institute, St George Hospital Clinical School, University of New South Wales, Sydney, Australia
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31
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Rubio-Azpeitia E, Sánchez P, Delgado D, Andia I. Three-Dimensional Platelet-Rich Plasma Hydrogel Model to Study Early Tendon Healing. Cells Tissues Organs 2015; 200:394-404. [PMID: 26562323 DOI: 10.1159/000441053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/19/2022] Open
Abstract
Since the experimental conditions of cell cultures may bias results, it is critical to use suitable models. This is also true in the context of tendon cell biology and the study of platelet-rich plasma (PRP) therapies and PRP-augmented cell-based therapies. We compared the culture of human tendon cells in 2 dimensions (2D) with PRP-supplemented media to culture in matching 3-dimensional (3D) PRP hydrogels. Cell proliferation, cell shape, and the pattern of gene and protein expression were examined. Our data revealed modifications in cell shape and enhanced expression of tenomodulin and scleraxis in 3D hydrogels. Additionally, protein secretion analysis using glass-based arrays specific for angiogenesis revealed differences in interleukin (IL)-6 and IL-8 protein expression between 2D cultures and 3D hydrogels, while the secretion of other angiogenic or inflammatory cytokines was unaffected. Our study suggests that 3D hydrogels are physiologically more relevant than 2D cultures in the study of tendon cells, based on cell shape, support of tenocyte proliferation, phenotype, and the pattern of gene and protein expression.
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Affiliation(s)
- Eva Rubio-Azpeitia
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
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32
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Affiliation(s)
- Aaron M Chamberlain
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, Saint Louis, MO 63110. E-mail address for J.D. Keener:
| | - Surena Namdari
- The Rothman Institute, Thomas Jefferson University, Shoulder and Elbow Service, 925 Chestnut Street, 5th floor, Philadelphia, PA 19107
| | - Jay D Keener
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, Saint Louis, MO 63110. E-mail address for J.D. Keener:
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33
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Jo CH, Shin JS, Shin WH, Lee SY, Yoon KS, Shin S. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med 2015; 43:2102-10. [PMID: 26015443 DOI: 10.1177/0363546515587081] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Two main questions about the use of platelet-rich plasma (PRP) for regeneration purposes are its effect on the speed of healing and the quality of healing. Despite recent numerous studies, evidence is still lacking in this area, especially in a representative patient population with medium to large rotator cuff tears. PURPOSE To assess the efficacy of PRP augmentation on the speed and quality of healing in patients undergoing arthroscopic repair for medium to large rotator cuff tears. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 74 patients scheduled for arthroscopic repair of medium to large rotator cuff tears were randomly assigned to undergo either PRP-augmented repair (PRP group) or conventional repair (conventional group). In the PRP group, 3 PRP gels (3 × 3 mL) were applied to each patient between the torn end and the greater tuberosity. The primary outcome was the Constant score at 3 months after surgery. Secondary outcome measures included the visual analog scale (VAS) for pain, range of motion (ROM), muscle strength, overall satisfaction and function, functional scores, retear rate, and change in the cross-sectional area (CSA) of the supraspinatus muscle. RESULTS There was no difference between the 2 groups in the Constant score at 3 months (P > .05). The 2 groups had similar results on the VAS for pain, ROM, muscle strength, overall satisfaction and function, and other functional scores (all P > .05) except for the VAS for worst pain (P = .043). The retear rate of the PRP group (3.0%) was significantly lower than that of the conventional group (20.0%) (P = .032). The change in 1-year postoperative and immediately postoperative CSAs was significantly different between the 2 groups: -36.76 ± 45.31 mm(2) in the PRP group versus -67.47 ± 47.26 mm(2) in the conventional group (P = .014). CONCLUSION Compared with repairs without PRP augmentation, the current PRP preparation and application methods for medium to large rotator cuff repairs significantly improved the quality, as evidenced by a decreased retear rate and increased CSA of the supraspinatus, but not the speed of healing. However, further studies may be needed to investigate the effects of PRP on the speed of healing without risking the quality.
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Affiliation(s)
- Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Ji Sun Shin
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Won Hyoung Shin
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Yeon Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sue Shin
- Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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