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Onodera T, Momma D, Matsuoka M, Kondo E, Suzuki K, Inoue M, Higano M, Iwasaki N. Single-step ultra-purified alginate gel implantation in patients with knee chondral defects. Bone Joint J 2023; 105-B:880-887. [PMID: 37524343 DOI: 10.1302/0301-620x.105b8.bjj-2022-1071.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Aims Implantation of ultra-purified alginate (UPAL) gel is safe and effective in animal osteochondral defect models. This study aimed to examine the applicability of UPAL gel implantation to acellular therapy in humans with cartilage injury. Methods A total of 12 patients (12 knees) with symptomatic, post-traumatic, full-thickness cartilage lesions (1.0 to 4.0 cm2) were included in this study. UPAL gel was implanted into chondral defects after performing bone marrow stimulation technique, and assessed for up to three years postoperatively. The primary outcomes were the feasibility and safety of the procedure. The secondary outcomes were self-assessed clinical scores, arthroscopic scores, tissue biopsies, and MRI-based estimations. Results No obvious adverse events related to UPAL gel implantation were observed. Self-assessed clinical scores, including pain, symptoms, activities of daily living, sports activity, and quality of life, were improved significantly at three years after surgery. Defect filling was confirmed using second-look arthroscopy at 72 weeks. Significantly improved MRI scores were observed from 12 to 144 weeks postoperatively. Histological examination of biopsy specimens obtained at 72 weeks after implantation revealed an extracellular matrix rich in glycosaminoglycan and type II collagen in the reparative tissue. Histological assessment yielded a mean overall International Cartilage Regeneration & Joint Preservation Society II score of 69.1 points (SD 10.4; 50 to 80). Conclusion This study provides evidence supporting the safety of acellular UPAL gel implantation in facilitating cartilage repair. Despite being a single-arm study, it demonstrated the efficacy of UPAL gel implantation, suggesting it is an easy-to-use, one-step method of cartilage tissue repair circumventing the need to harvest donor cells.
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Affiliation(s)
- Tomohiro Onodera
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Global Station of Soft Matter, Global Institution for Collaborative Research and Education, Sapporo, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masatake Matsuoka
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
- Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan
| | - Koji Suzuki
- Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan
| | | | | | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Global Station of Soft Matter, Global Institution for Collaborative Research and Education, Sapporo, Japan
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2
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Zann GJ, Jones SC, Selmic LS, Tinga S, Wanstrath AW, Howard J, Kieves NR. Long-term outcome of dogs treated by surgical debridement of proximal humeral osteochondrosis. Vet Surg 2023; 52:810-819. [PMID: 36086929 DOI: 10.1111/vsu.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 05/24/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate long-term clinical outcomes of dogs surgically treated for proximal humeral osteochondrosis (OC). STUDY DESIGN Cross-sectional study. SAMPLE POPULATION Twenty dogs (n = 26 shoulders). METHODS Dogs treated with surgical debridement of proximal humeral OC lesions >12 months prior were enrolled. Orthopedic examination (including limb circumference and shoulder goniometry), kinetic gait analysis, shoulder radiographs, shoulder computed tomography (CT), and shoulder arthroscopy were performed. All owners completed a dog mobility questionnaire. RESULTS Brachial circumference (P = .003) and maximum shoulder extension (P = .013) were decreased and maximum shoulder flexion (P = .008) was increased (ie less flexion) in the OC limb versus the contralateral limb in unilaterally affected dogs. There were no differences in peak vertical force and vertical impulse between affected and unaffected limbs. Dogs demonstrated a 4.4% decrease in load distributed to the operated limb. Osteoarthritis was present in all shoulders treated for OC lesions. The degree of osteoarthritis in OC-affected shoulders was increased compared to the contralateral limb as evaluated on CT (P = .005) and radiography (P = .0001) in unilaterally affected cases. Moderate-to-severe synovitis was seen in all OC-affected joints. Arthroscopically, all lesions were noted to have patchy, incomplete cartilaginous infilling. Median of aggregate Liverpool Osteoarthritis in Dogs (LOAD) scores was 6. CONCLUSION All dogs exhibited ipsilateral muscle atrophy and progressive osteoarthritis, with most dogs exhibiting subtle lameness on the subjective gait examination. Despite this, owner-perceived mobility was satisfactory. CLINICAL SIGNIFICANCE Progression of joint disease over time should be expected; however, the abnormalities detected on examination appear to be of questionable clinical relevance.
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Affiliation(s)
- Geoffrey J Zann
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - Stephen C Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
- Bark City Veterinary Specialists, Park City, Utah, USA
| | - Laura S Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - Selena Tinga
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - Audrey W Wanstrath
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - James Howard
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - Nina R Kieves
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
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3
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Recent Developments and Current Applications of Organic Nanomaterials in Cartilage Repair. Bioengineering (Basel) 2022; 9:bioengineering9080390. [PMID: 36004915 PMCID: PMC9405275 DOI: 10.3390/bioengineering9080390] [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: 06/26/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Regeneration of cartilage is difficult due to the unique microstructure, unique multizone organization, and avascular nature of cartilage tissue. The development of nanomaterials and nanofabrication technologies holds great promise for the repair and regeneration of injured or degenerated cartilage tissue. Nanomaterials have structural components smaller than 100 nm in at least one dimension and exhibit unique properties due to their nanoscale structure and high specific surface area. The unique properties of nanomaterials include, but are not limited to, increased chemical reactivity, mechanical strength, degradability, and biocompatibility. As an emerging nanomaterial, organic nanocomposites can mimic natural cartilage in terms of microstructure, physicochemical, mechanical, and biological properties. The integration of organic nanomaterials is expected to develop scaffolds that better mimic the extracellular matrix (ECM) environment of cartilage to enhance scaffold-cell interactions and improve the functionality of engineered tissue constructs. Next-generation hydrogel technology and bioprinting can be used not only for healing cartilage injury areas but also for extensive osteoarthritic degenerative changes within the joint. Although more challenges need to be solved before they can be translated into full-fledged commercial products, nano-organic composites remain very promising candidates for the future development of cartilage tissue engineering.
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4
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Rahman G, Frazier TP, Gimble JM, Mohiuddin OA. The Emerging Use of ASC/Scaffold Composites for the Regeneration of Osteochondral Defects. Front Bioeng Biotechnol 2022; 10:893992. [PMID: 35845419 PMCID: PMC9280640 DOI: 10.3389/fbioe.2022.893992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Articular cartilage is composed of chondrocytes surrounded by a porous permeable extracellular matrix. It has a limited spontaneous healing capability post-injury which, if left untreated, can result in severe osteochondral disease. Currently, osteochondral (OC) defects are treated by bone marrow stimulation, artificial joint replacement, or transplantation of bone, cartilage, and periosteum, while autologous osteochondral transplantation is also an option; it carries the risk of donor site damage and is limited only to the treatment of small defects. Allografts may be used for larger defects; however, they have the potential to elicit an immune response. A possible alternative solution to treat osteochondral diseases involves the use of stromal/stem cells. Human adipose-derived stromal/stem cells (ASCs) can differentiate into cartilage and bone cells. The ASC can be combined with both natural and synthetic scaffolds to support cell delivery, growth, proliferation, migration, and differentiation. Combinations of both types of scaffolds along with ASCs and/or growth factors have shown promising results for the treatment of OC defects based on in vitro and in vivo experiments. Indeed, these findings have translated to several active clinical trials testing the use of ASC-scaffold composites on human subjects. The current review critically examines the literature describing ASC-scaffold composites as a potential alternative to conventional therapies for OC tissue regeneration.
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Affiliation(s)
- Gohar Rahman
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | | | | | - Omair A. Mohiuddin
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
- *Correspondence: Omair A. Mohiuddin,
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Hede KTC, Christensen BB, Olesen ML, Thomsen JS, Foldager CB, Toh WS, Lim SK, Lind MC. Mesenchymal Stem Cell Extracellular Vesicles as Adjuvant to Bone Marrow Stimulation in Chondral Defect Repair in a Minipig Model. Cartilage 2021; 13:254S-266S. [PMID: 34308681 PMCID: PMC8804773 DOI: 10.1177/19476035211029707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study evaluated the effects of mesenchymal stem cell-extracellular vesicles (MSC-EVs) on chondrocyte proliferation in vitro and on cartilage repair in vivo following bone marrow stimulation (BMS) of focal chondral defects of the knee. METHODS Six adult Göttingen minipigs received 2 chondral defects in each knee. The pigs were randomized to treatment with either BMS combined with MSC-EVs or BMS combined with phosphate-buffered saline (PBS). Intraarticular injections MSC-EVs or PBS were performed immediately after closure of the surgical incisions, and at 2 and 4 weeks postoperatively. Repair was evaluated after 6 months with gross examination, histology, histomorphometry, immunohistochemistry, and micro-computed tomography (µCT) analysis of the trabecular bone beneath the defect. RESULTS Defects treated with MSC-EVs had more bone in the cartilage defect area than the PBS-treated defects (7.9% vs. 1.5%, P = 0.02). Less than 1% of the repair tissue in both groups was hyaline cartilage. International Cartilage and Joint Preservation Society II histological scoring showed that defects treated with MSC-EVs scored lower on "matrix staining" (20.8 vs. 50.0, P = 0.03), "cell morphology" (35.4 vs. 53.8, P = 0.04), and "overall assessment" (30.8 vs. 52.9, P = 0.03). Consistently, defects treated with MSC-EVs had lower collagen II and higher collagen I areal deposition. Defects treated with MSC-EVs had subchondral bone with significantly higher tissue mineral densities than PBS-treated defects (860 mg HA/cm3 vs. 838 mg HA/cm3, P = 0.02). CONCLUSION Intraarticular injections of MSC-EVs in conjunction with BMS led to osseous ingrowth that impaired optimal cartilage repair, while enhancing subchondral bone healing.
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Affiliation(s)
- Kris T. C. Hede
- Orthopedic Research Laboratory, Aarhus
University Hospital, Aarhus N, Denmark
| | | | - Morten L. Olesen
- Orthopedic Research Laboratory, Aarhus
University Hospital, Aarhus N, Denmark
| | | | - Casper B. Foldager
- Orthopedic Research Laboratory, Aarhus
University Hospital, Aarhus N, Denmark
| | - Wei Seong Toh
- Faculty of Dentistry, National
University of Singapore, Singapore
- Department of Orthopaedic Surgery, Yong
Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sai Kiang Lim
- Institute of Molecular and Cell
Biology, Agency for Science, Technology and Research, Singapore
| | - Martin C. Lind
- Orthopedic Research Laboratory, Aarhus
University Hospital, Aarhus N, Denmark
- Sports Trauma Clinic, Aarhus University
Hospital, Aarhus N, Denmark
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Xu L, Urita A, Onodera T, Hishimura R, Nonoyama T, Hamasaki M, Liang D, Homan K, Gong JP, Iwasaki N. Ultrapurified Alginate Gel Containing Bone Marrow Aspirate Concentrate Enhances Cartilage and Bone Regeneration on Osteochondral Defects in a Rabbit Model. Am J Sports Med 2021; 49:2199-2210. [PMID: 34061689 DOI: 10.1177/03635465211014186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ultrapurified alginate (UPAL) gel implantation has been demonstrated as effective in cartilage repair for osteochondral defects; however, cell transplantation within UPAL gels would be required to treat larger defects. HYPOTHESIS The combination of UPAL gel and bone marrow aspirate concentrate (BMAC) would enhance cartilage repair and subchondral bone repair for large osteochondral defects. STUDY DESIGN Controlled laboratory study. METHODS A total of 104 osteochondral defects (1 defect per knee) of 52 rabbits were randomly divided into 4 groups (26 defects per group): defects without any treatment (Defect group), defects treated using UPAL gel alone (UPAL group), defects treated using UPAL gel containing allogenic bone marrow mesenchymal stromal cells (UPAL-MSC group), and defects treated using UPAL gel containing BMAC (UPAL-BMAC group). At 4 and 16 weeks postoperatively, macroscopic and histologic evaluations and measurements of repaired subchondral bone volumes of reparative tissues were performed. Collagen orientation and mechanical properties of the reparative tissue were assessed at 16 weeks. RESULTS The defects in the UPAL-BMAC group were repaired with hyaline-like cartilage with well-organized collagen structures. The histologic scores at 4 weeks were significantly higher in the UPAL-BMAC group (16.9 ± 2.0) than in the Defect group (4.7 ± 1.9; P < .05), the UPAL group (10.0 ± 3.3; P < .05), and the UPAL-MSC group (12.2 ± 2.9; P < .05). At 16 weeks, the score in the UPAL-BMAC group (24.4 ± 1.7) was significantly higher than those in the Defect group (9.0 ± 3.7; P < .05), the UPAL group (14.2 ± 3.9; P < .05), and the UPAL-MSC group (16.3 ± 3.6; P < .05). At 4 and 16 weeks, the macroscopic evaluations were significantly superior in the UPAL-BMAC group compared with the other groups, and the values of repaired subchondral bone volumes in the UPAL-BMAC group were significantly higher than those in the Defect and UPAL groups. The mechanical properties of the reparative tissues were significantly better in the UPAL-BMAC group than in the other groups. CONCLUSION The implantation of UPAL gel containing BMAC-enhanced hyaline-like cartilage repair and subchondral bone repair of osteochondral defects in a rabbit knee model. CLINICAL RELEVANCE These data support the potential clinical application of 1-step treatment for large osteochondral defects using biomaterial implantation with cell transplantation.
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Affiliation(s)
- Liang Xu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Global Station of Soft Matter, Global Institution for Collaborative Research and Education (GSS, GI-CoRE), Sapporo, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Nonoyama
- Global Station of Soft Matter, Global Institution for Collaborative Research and Education (GSS, GI-CoRE), Sapporo, Japan
- Faculty of Advanced Life Science, Hokkaido University, Sapporo, Japan
| | - Masanari Hamasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Dawei Liang
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Homan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Jian Ping Gong
- Global Station of Soft Matter, Global Institution for Collaborative Research and Education (GSS, GI-CoRE), Sapporo, Japan
- Faculty of Advanced Life Science, Hokkaido University, Sapporo, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Global Station of Soft Matter, Global Institution for Collaborative Research and Education (GSS, GI-CoRE), Sapporo, Japan
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7
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Dwivedi G, Chevrier A, Alameh MG, Hoemann CD, Buschmann MD. Quality of Cartilage Repair from Marrow Stimulation Correlates with Cell Number, Clonogenic, Chondrogenic, and Matrix Production Potential of Underlying Bone Marrow Stromal Cells in a Rabbit Model. Cartilage 2021; 12:237-250. [PMID: 30569762 PMCID: PMC7970370 DOI: 10.1177/1947603518812555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Previous studies have shown that intrinsic behavior of subchondral bone marrow stem cells (BMSCs) is influenced by donors and locations. To understand the variability in cartilage repair outcomes following bone marrow stimulation, we tested the hypothesis that in vivo cartilage repair correlates with in vitro biological properties of BMSCs using a rabbit model. METHODS Full-thickness cartilage defects were created in the trochlea and condyle in one knee of skeletally mature New Zealand White rabbits (n = 8) followed by microdrilling. Three-week repair tissues were analyzed by macroscopic International Cartilage Repair Society (ICRS) scores, O'Driscoll histological scores, and Safranin-O (Saf-O) and type-II collagen (Coll-II) % stain. BMSCs isolated from contralateral knees were assessed for cell yield, surface marker expression, CFU-f, %Saf-O, and %Coll-II in pellet culture followed by correlation analyses with the above cartilage repair responses. RESULTS In vivo cartilage repair scores showed strong, positive correlation with cell number, clonogenic, chondrogenic, and matrix production (Coll-II, GAG) potential of in vitro TGF-βIII stimulated BMSC cultures. Trochlear repair showed clear evidence of donor dependency and strong correlation was observed for interdonor variation in repair and the above in vitro properties of trochlear BMSCs. Correlation analyses indicated that donor- and location-dependent variability observed in cartilage repair can be attributed to variation in the properties of BMSCs in underlying subchondral bone. CONCLUSION Variation in cell number, clonogenic, chondrogenic, and matrix production potential of BMSCs correlated with repair response observed in vivo and appear to be responsible for interanimal variability as well as location-dependent repair.
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Affiliation(s)
- Garima Dwivedi
- Chemical Engineering Department,
Polytechnique Montreal, Montreal, Quebec, Canada
| | - Anik Chevrier
- Chemical Engineering Department,
Polytechnique Montreal, Montreal, Quebec, Canada
| | | | - Caroline D. Hoemann
- Chemical Engineering Department,
Polytechnique Montreal, Montreal, Quebec, Canada,Biomedical Engineering Institute,
Polytechnique Montreal, Montreal, Quebec, Canada
| | - Michael D. Buschmann
- Chemical Engineering Department,
Polytechnique Montreal, Montreal, Quebec, Canada,Biomedical Engineering Institute,
Polytechnique Montreal, Montreal, Quebec, Canada,Michael D. Buschmann, Department of
Bioengineering, Volgenau School of Engineering, George Mason University, 4400
University Drive, MS 1J7, Fairfax, VA 22030, USA.
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8
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Momma D, Onodera T, Kawamura D, Urita A, Matsui Y, Baba R, Funakoshi T, Kondo M, Endo T, Kondo E, Iwasaki N. Acellular Cartilage Repair Technique Based on Ultrapurified Alginate Gel Implantation for Advanced Capitellar Osteochondritis Dissecans. Orthop J Sports Med 2021; 9:2325967121989676. [PMID: 34250159 PMCID: PMC8237226 DOI: 10.1177/2325967121989676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background: One of the most important limitations of osteochondral autograft transplant
is the adverse effect on donor sites in the knee. Ultrapurified alginate
(UPAL) gel is a novel biomaterial that enhances hyaline-like cartilage
repair for articular defects. To avoid the need for knee cartilage
autografting when treating osteochondritis dissecans (OCD) of the
capitellum, we developed a surgical procedure involving a bone marrow
stimulation technique (BMST) augmented by implantation of UPAL gel. Hypothesis: BMST augmented by UPAL gel implantation improves the cartilage repair
capacity and provides satisfactory clinical outcomes in OCD of the
capitellum. Study Design: Case series; Level of evidence, 4. Methods: A total of 5 athletes with advanced capitellar OCD in the dominant elbow
underwent BMST augmented by implantation of UPAL gel. The osteochondral
defects were filled with UPAL gel after BMST. At a mean follow-up of 97
weeks, all patients were evaluated clinically and radiographically. Results: At final follow-up, all 5 patients had returned to competitive-level sports,
and 4 patients were free from elbow pain. The mean Timmerman-Andrews score
significantly improved from 100 to 194 points. Radiographically, all
patients exhibited graft incorporation and a normal contour of the
subchondral cortex. Magnetic resonance imaging showed that the preoperative
heterogeneity of the lesion had disappeared, and the signal intensity had
returned to normal. Arthroscopic examinations consistently exhibited
improvement in the International Cartilage Regeneration and Joint
Preservation Society (ICRS) grade of lesions from 3 or 4 to 1 or 2 in 4
patients at 85 weeks postoperatively. Histologic analysis of biopsy
specimens revealed an average total ICRS Visual Assessment Scale II
histologic score of 1060. Conclusion: The acellular cartilage repair technique using UPAL gel for advanced
capitellar OCD provided satisfactory clinical and radiographic results. The
present results suggest that this novel technique is a useful, minimally
invasive approach for treating cartilaginous lesions in athletes.
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Affiliation(s)
- Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Tomohiro Onodera
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Daisuke Kawamura
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Atsushi Urita
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Yuichiro Matsui
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Rikiya Baba
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | | | - Makoto Kondo
- Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan
| | | | - Eiji Kondo
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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9
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Nelson M, Li S, Page SJ, Shi X, Lee PD, Stevens MM, Hanna JV, Jones JR. 3D printed silica-gelatin hybrid scaffolds of specific channel sizes promote collagen Type II, Sox9 and Aggrecan production from chondrocytes. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:111964. [PMID: 33812592 DOI: 10.1016/j.msec.2021.111964] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
Inorganic/organic hybrids have co-networks of inorganic and organic components, with the aim of obtaining synergy of the properties of those components. Here, a silica-gelatin sol-gel hybrid "ink" was directly 3D printed to produce 3D grid-like scaffolds, using a coupling agent, 3-glycidyloxypropyl)trimethoxysilane (GPTMS), to form covalent bonds between the silicate and gelatin co-networks. Scaffolds were printed with 1 mm strut separation, but the drying method affected the final architecture and properties. Freeze drying produced <40 μm struts and large ~700 μm channels. Critical point drying enabled strut consolidation, with ~160 μm struts and ~200 μm channels, which improved mechanical properties. This architecture was critical to cellular response: when chondrocytes were seeded on the scaffolds with 200 μm wide pore channels in vitro, collagen Type II matrix was preferentially produced (negligible amount of Type I or X were observed), indicative of hyaline-like cartilaginous matrix formation, but when pore channels were 700 μm wide, Type I collagen was prevalent. This was supported by Sox9 and Aggrecan expression. The scaffolds have potential for regeneration of articular cartilage regeneration, particularly in sports medicine cases.
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Affiliation(s)
- Maria Nelson
- Department of Materials, Imperial College London, London SW7 2AZ, UK
| | - Siwei Li
- Department of Materials, Imperial College London, London SW7 2AZ, UK
| | - Samuel J Page
- Department of Physics, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Xiaomeng Shi
- Department of Materials, Imperial College London, London SW7 2AZ, UK
| | - Peter D Lee
- Department of Mechanical Engineering, University College London, WC1E 7JE, UK
| | - Molly M Stevens
- Department of Materials, Imperial College London, London SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, London SW7 2AZ, UK; Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - John V Hanna
- Department of Physics, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Julian R Jones
- Department of Materials, Imperial College London, London SW7 2AZ, UK.
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10
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Davis S, Roldo M, Blunn G, Tozzi G, Roncada T. Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects. Front Bioeng Biotechnol 2021; 9:603408. [PMID: 33585430 PMCID: PMC7873466 DOI: 10.3389/fbioe.2021.603408] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022] Open
Abstract
Articular cartilage is a highly specialised connective tissue of diarthrodial joints which provides a smooth, lubricated surface for joint articulation and plays a crucial role in the transmission of loads. In vivo cartilage is subjected to mechanical stimuli that are essential for cartilage development and the maintenance of a chondrocytic phenotype. Cartilage damage caused by traumatic injuries, ageing, or degradative diseases leads to impaired loading resistance and progressive degeneration of both the articular cartilage and the underlying subchondral bone. Since the tissue has limited self-repairing capacity due its avascular nature, restoration of its mechanical properties is still a major challenge. Tissue engineering techniques have the potential to heal osteochondral defects using a combination of stem cells, growth factors, and biomaterials that could produce a biomechanically functional tissue, representative of native hyaline cartilage. However, current clinical approaches fail to repair full-thickness defects that include the underlying subchondral bone. Moreover, when tested in vivo, current tissue-engineered grafts show limited capacity to regenerate the damaged tissue due to poor integration with host cartilage and the failure to retain structural integrity after insertion, resulting in reduced mechanical function. The aim of this review is to examine the optimal characteristics of osteochondral scaffolds. Additionally, an overview on the latest biomaterials potentially able to replicate the natural mechanical environment of articular cartilage and their role in maintaining mechanical cues to drive chondrogenesis will be detailed, as well as the overall mechanical performance of grafts engineered using different technologies.
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Affiliation(s)
- Sarah Davis
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Marta Roldo
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, United Kingdom
| | - Tosca Roncada
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
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11
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Li S, Tallia F, Mohammed AA, Stevens MM, Jones JR. Scaffold channel size influences stem cell differentiation pathway in 3-D printed silica hybrid scaffolds for cartilage regeneration. Biomater Sci 2020; 8:4458-4466. [PMID: 32100748 DOI: 10.1039/c9bm01829h] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report that 3-D printed scaffold channel size can direct bone marrow derived stem cell differentiation. Treatment of articular cartilage trauma injuries, such as microfracture surgery, have limited success because durability is limited as fibrocartilage forms. A scaffold-assisted approach, combining microfracture with biomaterials has potential if the scaffold can promote articular cartilage production and share load with cartilage. Here, we investigated human bone marrow derived stromal cell (hBMSC) differentiation in vitro in 3-D printed silica/poly(tetrahydrofuran)/poly(ε-caprolactone) hybrid scaffolds with specific channel sizes. Channel widths of ∼230 μm (210 ± 22 μm mean strut size, 42.4 ± 3.9% porosity) provoked hBMSC differentiation down a chondrogenic path, with collagen Type II matrix prevalent, indicative of hyaline cartilage. When pores were larger (∼500 μm, 229 ± 29 μm mean strut size, 63.8 ± 1.6% porosity) collagen Type I was dominant, indicating fibrocartilage. There was less matrix and voids in smaller channels (∼100 μm, 218 ± 28 μm mean strut size, 31.2 ± 2.9% porosity). Our findings suggest that a 200-250 μm pore channel width, in combination with the surface chemistry and stiffness of the scaffold, is optimal for cell-cell interactions to promote chondrogenic differentiation and enable the chondrocytes to maintain their phenotype.
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Affiliation(s)
- Siwei Li
- Department of Materials, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Francesca Tallia
- Department of Materials, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Ali A Mohammed
- Department of Materials, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Molly M Stevens
- Department of Materials, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK. and Department of Bioengineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK and Institute of Biomedical Engineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Julian R Jones
- Department of Materials, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
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12
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Therapeutic effects and adaptive limits of an acellular technique by ultrapurified alginate (UPAL) gel implantation in canine osteochondral defect models. Regen Ther 2020; 14:154-159. [PMID: 32110684 PMCID: PMC7033291 DOI: 10.1016/j.reth.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/06/2019] [Accepted: 01/09/2020] [Indexed: 02/02/2023] Open
Abstract
Background The aim of this study was to clarify the objective therapeutic effects of an acellular technique by ultrapurified alginate (UPAL) gel implantation in canine osteochondral defect models. Methods Two osteochondral defects (diameters: 3.0 and 5.0 mm) were created on each patellar groove in both knees of 10 dogs. Defects were divided into four groups (n = 10 each): Group 1, untreated 3.0-mm defect; Group 2, 3.0-mm defect with UPAL gel; Group 3, untreated 5.0-mm defect; and Group 4, 5.0-mm defect with UPAL gel. All surgical procedures were performed by individuals unfamiliar with the technique at an independent institution. Articular surfaces were evaluated grossly and histologically at 27 weeks after operation. Results UPAL gel-treated osteochondral defects showed significantly improved gross appearance in Group 4 and histological appearance in Groups 2 and 4. Reparative tissues in the 3.0-mm defect with UPAL gel were replaced by hyaline-like cartilage tissue. The 5.0-mm defects with UPAL gel were mostly covered with fibrocartilaginous tissue, whereas UPAL gel-untreated defects mostly remained uncovered by any tissue. Conclusions Although an acellular technique using UPAL gel implantation significantly enhanced osteochondral repair in canines, reparative tissues of the large defect with alginate gel comprised of fibrocartilaginous tissue. This surgical technique is effective, especially for small cartilage injuries. Further improvements are required before clinical application in cases of severe osteochondral defects in humans.
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Maglio M, Brogini S, Pagani S, Giavaresi G, Tschon M. Current Trends in the Evaluation of Osteochondral Lesion Treatments: Histology, Histomorphometry, and Biomechanics in Preclinical Models. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4040236. [PMID: 31687388 PMCID: PMC6803751 DOI: 10.1155/2019/4040236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/23/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023]
Abstract
Osteochondral lesions (OCs) are typically of traumatic origins but are also caused by degenerative conditions, in primis osteoarthritis (OA). On the other side, OC lesions themselves, getting worse over time, can lead to OA, indicating that chondral and OC defects represent a risk factor for the onset of the pathology. Many animal models have been set up for years for the study of OC regeneration, being successfully employed to test different treatment strategies, from biomaterials and cells to physical and biological adjuvant therapies. These studies rely on a plethora of post-explant investigations ranging from histological and histomorphometric analyses to biomechanical ones. The present review aims to analyze the methods employed for the evaluation of OC treatments in each animal model by screening literature data within the last 10 years. According to the selected research criteria performed in two databases, 60 works were included. Data revealed that lapine (50% of studies) and ovine (23% of studies) models are predominant, and knee joints are the most used anatomical locations for creating OC defects. Analyses are mostly conducted on paraffin-embedded samples in order to perform histological/histomorphometric analyses by applying semiquantitative scoring systems and on fresh samples in order to perform biomechanical investigations by indentation tests on articular cartilage. Instead, a great heterogeneity is pointed out in terms of OC defect dimensions and animal's age. The choice of experimental times is generally adequate for the animal models adopted, although few studies adopt very long experimental times. Improvements in data reporting and in standardization of protocols would be desirable for a better comparison of results and for ethical reasons related to appropriate and successful animal experimentation.
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Affiliation(s)
- M. Maglio
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - S. Brogini
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - S. Pagani
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - G. Giavaresi
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
| | - M. Tschon
- IRCCS-Istituto Ortopedico Rizzoli, Laboratory of Preclinical and Surgical Studies, via di Barbiano 1/10, 40136 Bologna, Italy
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14
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Kim W, Onodera T, Kondo E, Kawaguchi Y, Terkawi MA, Baba R, Hontani K, Joutoku Z, Matsubara S, Homan K, Hishimura R, Iwasaki N. Effects of Ultra-Purified Alginate Gel Implantation on Meniscal Defects in Rabbits. Am J Sports Med 2019; 47:640-650. [PMID: 30597120 DOI: 10.1177/0363546518816690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many tissue-engineered methods for meniscal repair have been studied, but their utility remains unclear. HYPOTHESIS Implantation of low-endotoxin, ultra-purified alginate (UPAL) gel without cells could induce fibrocartilage regeneration on meniscal defects in rabbits. STUDY DESIGN Controlled laboratory study. METHODS Forty-two mature Japanese White rabbits were divided into 2 groups of 21 animals each. In each animal, a cylindrical defect measuring 2 mm in diameter was created with a biopsy punch on the anterior horn of the medial meniscus. In the control group, no treatment was applied on the left medial meniscal defect. In the UPAL gel group, the right medial meniscal defect was injected with the UPAL gel and gelated by a CaCl2 solution. Samples were evaluated at 3, 6, and 12 weeks postoperatively. For biomechanical evaluation, 6 additional samples from intact animals were used for comparison. RESULTS The macroscopic score was significantly greater in the UPAL gel group than in the control group at 3 weeks (mean ± SE: 5.6 ± 0.82 vs 3.4 ± 0.83, P = .010), 6 weeks (5.9 ± 0.72 vs 2.5 ± 0.75, P = .026), and 12 weeks (5.2 ± 1.21 vs 1.0 ± 0.63, P = .020). The histological score was significantly greater in the UPAL group than in the control group at 3 weeks (2.1 ± 0.31 vs 1.2 ± 0.25, P = .029) and 12 weeks (2.2 ± 0.55 vs 0.3 ± 0.21, P = .016). The mean stiffness of the reparative tissue in the UPAL gel group was significantly greater than that in the control group at 6 weeks (24.325 ± 3.920 N/mm vs 8.723 ± 1.190 N/mm, P = .006) and at 12 weeks (27.804 ± 6.169 N/mm vs not applicable [because of rupture]). CONCLUSION The UPAL gel enhanced the spontaneous repair of fibrocartilage tissues in a cylindrical meniscal defect in rabbits. CLINICAL RELEVANCE These results imply that the acellular UPAL gel may improve the repair of traumatic meniscal injuries.
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Affiliation(s)
- WooYoung Kim
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Global Station for Soft Matter, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Department of Advanced Therapeutic Research for Sports Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Mohamad Alaa Terkawi
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Global Station for Soft Matter, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Rikiya Baba
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazutoshi Hontani
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Zenta Joutoku
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinji Matsubara
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Homan
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryosuke Hishimura
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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