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Bian Y, Wang H, Zhao X, Weng X. Meniscus repair: up-to-date advances in stem cell-based therapy. Stem Cell Res Ther 2022; 13:207. [PMID: 35578310 PMCID: PMC9109379 DOI: 10.1186/s13287-022-02863-7] [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] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/26/2022] [Indexed: 12/24/2022] Open
Abstract
The meniscus is a semilunar fibrocartilage between the tibia and femur that is essential for the structural and functional integrity of the keen joint. In addition to pain and knee joint dysfunction, meniscus injuries can also lead to degenerative changes of the knee joint such as osteoarthritis, which further affect patient productivity and quality of life. However, with intrinsic avascular property, the tearing meniscus tends to be nonunion and the augmentation of post-injury meniscus repair has long time been a challenge. Stem cell-based therapy with potent regenerative properties has recently attracted much attention in repairing meniscus injuries, among which mesenchymal stem cells were most explored for their easy availability, trilineage differentiation potential, and immunomodulatory properties. Here, we summarize the advances and achievements in stem cell-based therapy for meniscus repair in the last 5 years. We also highlight the obstacles before their successful clinical translation and propose some perspectives for stem cell-based therapy in meniscus repair.
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Affiliation(s)
- Yixin Bian
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Han Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiuli Zhao
- Department of Medical Genetics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China.
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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Degenerative Meniscus in Knee Osteoarthritis: From Pathology to Treatment. Life (Basel) 2022; 12:life12040603. [PMID: 35455094 PMCID: PMC9032096 DOI: 10.3390/life12040603] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
Knee osteoarthritis is a common degenerative joint disease characterized by chronic knee pain and disability in daily living. The lesion can involve the cartilage as well as the synovium, bone, ligaments, and meniscus, indicating a complicated pathology for knee osteoarthritis. The association with the meniscus has recently attracted much attention. Meniscal tears can initiate and progress knee osteoarthritis, with deleterious effects on the important roles of the meniscus in load distribution, shock absorption, and stability of the knee joint. Degenerative meniscus lesions are commonly observed in elderly people, but they have less impact on the prognosis of osteoarthritis. However, they are often accompanied by meniscal extrusion, which substantially decreases the hoop function of the meniscus and increases the risk of knee osteoarthritis. When surgical treatment is necessary, meniscal tears should be repaired to the greatest extent possible to preserve meniscus function. Long-term studies show better clinical outcomes and less degenerative osteoarthritis changes following meniscal repair than following partial meniscectomy. For meniscal extrusion repair, centralization techniques have been proposed that involve suturing the meniscus-capsule complex to the edge of the tibial plateau. Advancements in orthobiologics, such as platelet-rich plasma or stem cell therapy, have the potential to prevent the initiation or progression of osteoarthritis.
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Trivedi J, Betensky D, Desai S, Jayasuriya CT. Post-Traumatic Osteoarthritis Assessment in Emerging and Advanced Pre-Clinical Meniscus Repair Strategies: A Review. Front Bioeng Biotechnol 2021; 9:787330. [PMID: 35004646 PMCID: PMC8733822 DOI: 10.3389/fbioe.2021.787330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Surgical repair of meniscus injury is intended to help alleviate pain, prevent further exacerbation of the injury, restore normal knee function, and inhibit the accelerated development of post-traumatic osteoarthritis (PTOA). Meniscus injuries that are treated poorly or left untreated are reported to significantly increase the risk of PTOA in patients. Current surgical approaches for the treatment of meniscus injuries do not eliminate the risk of accelerated PTOA development. Through recent efforts by scientists to develop innovative and more effective meniscus repair strategies, the use of biologics, allografts, and scaffolds have come into the forefront in pre-clinical investigations. However, gauging the extent to which these (and other) approaches inhibit the development of PTOA in the knee joint is often overlooked, yet an important consideration for determining the overall efficacy of potential treatments. In this review, we catalog recent advancements in pre-clinical therapies for meniscus injuries and discuss the assessment methodologies that are used for gauging the success of these treatments based on their effect on PTOA severity. Methodologies include histopathological evaluation of cartilage, radiographic evaluation of the knee, analysis of knee function, and quantification of OA predictive biomarkers. Lastly, we analyze the prevalence of these methodologies using a systemic PubMed® search for original scientific journal articles published in the last 3-years. We indexed 37 meniscus repair/replacement studies conducted in live animal models. Overall, our findings show that approximately 75% of these studies have performed at least one assessment for PTOA following meniscus injury repair. Out of this, 84% studies have reported an improvement in PTOA resulting from treatment.
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Affiliation(s)
| | | | | | - Chathuraka T. Jayasuriya
- Department of Orthopaedics, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, United States
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Rhim HC, Jeon OH, Han SB, Bae JH, Suh DW, Jang KM. Mesenchymal stem cells for enhancing biological healing after meniscal injuries. World J Stem Cells 2021; 13:1005-1029. [PMID: 34567422 PMCID: PMC8422933 DOI: 10.4252/wjsc.v13.i8.1005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/02/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
The meniscus is a semilunar fibrocartilage structure that plays important roles in maintaining normal knee biomechanics and function. The roles of the meniscus, including load distribution, force transmission, shock absorption, joint stability, lubrication, and proprioception, have been well established. Injury to the meniscus can disrupt overall joint stability and cause various symptoms including pain, swelling, giving-way, and locking. Unless treated properly, it can lead to early degeneration of the knee joint. Because meniscal injuries remain a significant challenge due to its low intrinsic healing potential, most notably in avascular and aneural inner two-thirds of the area, more efficient repair methods are needed. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential in vitro and in vivo. Thus far, the application of MSCs, including bone marrow-derived, synovium-derived, and adipose-derived MSCs, has shown promising results in preclinical studies in different animal models. These preclinical studies could be categorized into intra-articular injection and tissue-engineered construct application according to delivery method. Despite promising results in preclinical studies, there is still a lack of clinical evidence. This review describes the basic knowledge, current treatment, and recent studies regarding the application of MSCs in treating meniscal injuries. Future directions for MSC-based approaches to enhance meniscal healing are suggested.
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Affiliation(s)
- Hye Chang Rhim
- T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, United States
| | - Ok Hee Jeon
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul 08308, Seoul, South Korea
| | - Dong Won Suh
- Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam 13497, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Seoul, South Korea
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Korpershoek JV, Rikkers M, de Windt TS, Tryfonidou MA, Saris DBF, Vonk LA. Selection of Highly Proliferative and Multipotent Meniscus Progenitors through Differential Adhesion to Fibronectin: A Novel Approach in Meniscus Tissue Engineering. Int J Mol Sci 2021; 22:ijms22168614. [PMID: 34445320 PMCID: PMC8395239 DOI: 10.3390/ijms22168614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 12/26/2022] Open
Abstract
Meniscus injuries can be highly debilitating and lead to knee osteoarthritis. Progenitor cells from the meniscus could be a superior cell type for meniscus repair and tissue-engineering. The purpose of this study is to characterize meniscus progenitor cells isolated by differential adhesion to fibronectin (FN-prog). Human osteoarthritic menisci were digested, and FN-prog were selected by differential adhesion to fibronectin. Multilineage differentiation, population doubling time, colony formation, and MSC surface markers were assessed in the FN-prog and the total meniscus population (Men). Colony formation was compared between outer and inner zone meniscus digest. Chondrogenic pellet cultures were performed for redifferentiation. FN-prog demonstrated multipotency. The outer zone FN-prog formed more colonies than the inner zone FN-prog. FN-prog displayed more colony formation and a higher proliferation rate than Men. FN-prog redifferentiated in pellet culture and mostly adhered to the MSC surface marker profile, except for HLA-DR receptor expression. This is the first study that demonstrates differential adhesion to fibronectin for the isolation of a progenitor-like population from the meniscus. The high proliferation rates and ability to form meniscus extracellular matrix upon redifferentiation, together with the broad availability of osteoarthritis meniscus tissue, make FN-prog a promising cell type for clinical translation in meniscus tissue-engineering.
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Affiliation(s)
- Jasmijn V. Korpershoek
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.V.K.); (M.R.); (T.S.d.W.); (D.B.F.S.)
| | - Margot Rikkers
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.V.K.); (M.R.); (T.S.d.W.); (D.B.F.S.)
| | - Tommy S. de Windt
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.V.K.); (M.R.); (T.S.d.W.); (D.B.F.S.)
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands;
| | - Daniel B. F. Saris
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.V.K.); (M.R.); (T.S.d.W.); (D.B.F.S.)
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Reconstructive medicine, University of Twente, 7522 NB Enschede, The Netherlands
| | - Lucienne A. Vonk
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.V.K.); (M.R.); (T.S.d.W.); (D.B.F.S.)
- Correspondence: ; Tel.: +49-0-3328-4346-25
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6
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Hagmeijer MH, Korpershoek JV, Crispim JF, Chen LT, Jonkheijm P, Krych AJ, Saris DBF, Vonk LA. The regenerative effect of different growth factors and platelet lysate on meniscus cells and mesenchymal stromal cells and proof of concept with a functionalized meniscus implant. J Tissue Eng Regen Med 2021; 15:648-659. [PMID: 33982442 PMCID: PMC8362003 DOI: 10.1002/term.3218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/04/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022]
Abstract
Meniscus regeneration could be enhanced by targeting meniscus cells and mesenchymal stromal cells (MSCs) with the right growth factors. Combining these growth factors with the Collagen Meniscus Implant (CMI®) could accelerate cell ingrowth and tissue formation in the implant and thereby improve clinical outcomes. Using a transwell migration assay and a micro-wound assay, the effect of insulin-like growth factor-1, platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor beta 1 (TGF-β1), fibroblast growth factor, and platelet lysate (PL) on migration and proliferation of meniscus cells and MSCs was assessed. The formation of extracellular matrix under influence of the above-mentioned growth factors was assessed after 28 days of culture of both MSCs and meniscus cells. As a proof of concept, the CMI® was functionalized with a VEGF binding peptide and coated with platelet-rich plasma (PRP) for clinical application. Our results demonstrate that PDGF, TGF-β1, and PL stimulate migration, proliferation, and/or extracellular matrix production of meniscus cells and MSCs. Additionally, the CMI® was successfully functionalized with a VEGF binding peptide and PRP which increased migration of meniscus cell and MSC into the implant. This study demonstrates proof of concept of functionalizing the CMI® with growth factor binding peptides. A CMI® functionalized with the right growth factors holds great potential for meniscus replacement after partial meniscectomy.
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Affiliation(s)
- Michella H Hagmeijer
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jasmijn V Korpershoek
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - João F Crispim
- Developmental Bioengineering, University of Twente, Enschede, The Netherlands.,Department of Molecules and Materials, MESA+ Institute for Nanotechnology, University of Twente, Enschede, The Netherlands
| | - Li-Ting Chen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pascal Jonkheijm
- Department of Molecules and Materials, MESA+ Institute for Nanotechnology, University of Twente, Enschede, The Netherlands
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.,Developmental Bioengineering, University of Twente, Enschede, The Netherlands.,Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lucienne A Vonk
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Wang Z, Kapadia W, Li C, Lin F, Pereira RF, Granja PL, Sarmento B, Cui W. Tissue-specific engineering: 3D bioprinting in regenerative medicine. J Control Release 2021; 329:237-256. [DOI: 10.1016/j.jconrel.2020.11.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
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Takata Y, Nakase J, Shimozaki K, Asai K, Tsuchiya H. Autologous Adipose-Derived Stem Cell Sheet Has Meniscus Regeneration-Promoting Effects in a Rabbit Model. Arthroscopy 2020; 36:2698-2707. [PMID: 32554078 DOI: 10.1016/j.arthro.2020.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This study investigated meniscal regeneration-promoting effects of adipose-derived stem cell (ADSC) sheets in a rabbit meniscal defect models. METHODS ADSCs were extracted from the interscapular fat pad adipose tissue of 42 mature female Japanese white rabbits. Once cells reached confluence at the third passage, the culture medium was supplemented with ascorbic acid. Within a week, the cells in culture formed removable sheets, which were used as ADSC sheets. Cell death (CD) sheets were created by killing ADSCs by freezing to investigate the need for viable ADSCs in ADSC sheets. The anterior half of the medial meniscus from the anterior root to the posterior edge of the medial collateral ligament was removed from both limbs. An autologous ADSC or CD sheet was transplanted to one knee (ADSC sheet or CD sheet group). The contralateral limb was closed without transplantation following meniscal removal (control group). Rabbits were euthanized 4 and 12 weeks after transplantation to harvest the entire medial menisci. The meniscal tissue area, transverse diameter on the inside of the medial collateral ligament, and histologic score were compared between the 3 groups. RESULTS The area and transverse diameter of regenerated tissues were larger in the ADSC sheet group than in the control group at 4 and 12 weeks. Further, the histologic score in the ADSC sheet group (8) was significantly greater than that in the control group (4.5) at 4 weeks (P = .02) and greater than that in the CD sheet group (9) (ADSC = 12.5, P = .009) and control group (6) (ADSC = 12.5, P = .0003) at 12 weeks. CONCLUSIONS Transplantation of the ADSC sheet into the meniscal defect increased the volume and improved the histologic score of the regenerated meniscal tissue. ADSC sheets may have meniscal regeneration-promoting effects in a rabbit model with meniscal defects. CLINICAL RELEVANCE ADSC sheets do not require a scaffold for implantation in the rabbit model, and this evidence suggests that some tissue regeneration occurs at the site of a surgically created meniscal defect.
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Affiliation(s)
- Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan.
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan
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9
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Smoak JB, Matthews JR, Vinod AV, Kluczynski MA, Bisson LJ. An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses. Orthop J Sports Med 2020; 8:2325967120950306. [PMID: 32953923 PMCID: PMC7485005 DOI: 10.1177/2325967120950306] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: A large number of systematic reviews and meta-analyses regarding the meniscus
have been published. Purpose: To provide a qualitative summary of the published systematic reviews and
meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the
meniscus and published between July 2009 and July 2019 was performed with
PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts,
narrative reviews, articles not written in English, commentaries, study
protocols, and topics that were not focused on the meniscus were excluded.
The most pertinent results were extracted and summarized from each
study. Results: A total of 332 articles were found, of which 142 were included. Included
articles were summarized and divided into 16 topics: epidemiology,
diagnosis, histology, biomechanics, comorbid pathology, animal models,
arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root
repairs, meniscal allograft transplantation (MAT), meniscal implants and
scaffolds, mesenchymal stem cells and growth factors, postoperative
rehabilitation, postoperative imaging assessment, patient-reported outcome
measures, and cost-effectiveness. The majority of articles focused on APM
(20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a
single source of the current evidence regarding the meniscus.
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Affiliation(s)
- Jason B Smoak
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - John R Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Amrit V Vinod
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, New York, USA
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10
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Van Genechten W, Verdonk P, Krych AJ, Saris DB. Biologic Adjuvants in Meniscus Repair: A Review of Current Translational and Clinical Evidence. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Carlson Strother CR, Saris DBF, Verdonk P, Nakamura N, Krych AJ. Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Twomey-Kozak J, Jayasuriya CT. Meniscus Repair and Regeneration: A Systematic Review from a Basic and Translational Science Perspective. Clin Sports Med 2020; 39:125-163. [PMID: 31767102 DOI: 10.1016/j.csm.2019.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Meniscus injuries are among the most common athletic injuries and result in functional impairment in the knee. Repair is crucial for pain relief and prevention of degenerative joint diseases like osteoarthritis. Current treatments, however, do not produce long-term improvements. Thus, recent research has been investigating new therapeutic options for regenerating injured meniscal tissue. This review comprehensively details the current methodologies being explored in the basic sciences to stimulate better meniscus injury repair. Furthermore, it describes how these preclinical strategies may improve current paradigms of how meniscal injuries are clinically treated through a unique and alternative perspective to traditional clinical methodology.
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Affiliation(s)
- John Twomey-Kozak
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA
| | - Chathuraka T Jayasuriya
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA.
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13
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Stammzelltherapie am Kniegelenk. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Newberry J, Desai S, Adler C, Li N, Karamchedu NP, Fleming BC, Jayasuriya CT. SDF-1 preconditioned HPC scaffolds mobilize cartilage-derived progenitors and stimulate meniscal fibrocartilage repair in human explant tissue culture. Connect Tissue Res 2020; 61:338-348. [PMID: 31744353 PMCID: PMC7190451 DOI: 10.1080/03008207.2019.1689966] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: The purpose of this study was to characterize the influence of SDF-1 on cell migration/adhesion and temporal gene expression of human cartilage mesenchymal progenitor cells (C-PCs); and to utilize SDF-1 conditioned mesenchymal progenitors to stimulate reintegration of human meniscus fibrocartilage breaks.Materials and Methods: Characterization of SDF-1-induced cell migration was achieved using hydroxypropyl cellulose (HPC) scaffolds pretreated with SDF-1. Fluorescence microscopy and cell counting were used to visualize and quantify the extent of cell migration into scaffolds, respectively. Relative mRNA expression analysis was used to characterize the temporal effects of SDF-1 on C-PCs. Tissue reintegration experiments were conducted using cylindrical human meniscal tissue punches, which were then placed back together with an HPC scaffold embedded with C-PCs. Tensile testing was used to evaluate the extent of tissue reintegration stimulated by human mesenchymal progenitors.Results: C-PCs migrate into scaffolds in response to SDF-1 with the same efficiency as mesenchymal progenitors from human marrow (BM-MSCs). SDF-1 treatment of C-PCs did not significantly alter the expression of early and late stage chondrogenic differentiation genes. Scaffolds containing SDF-1 pre-conditioned C-PCs successfully adhered to fibrocartilage breaks and migrated from the scaffold into the tissue. Tensile testing demonstrated that SDF-1 preconditioned C-PCs stimulate reintegration of fibrocartilage tears.Conclusion: C-PCs migrate in response to SDF-1. Exposure to SDF-1 does not significantly alter the unique mRNA profile of C-PCs that make them desirable for cartilaginous tissue repair applications. SDF-1 pretreated mesenchymal progenitors successfully disperse into injured tissues to help facilitate tissue reintegration.
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15
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Hidalgo Perea S, Lyons LP, Nishimuta JF, Weinberg JB, McNulty AL. Evaluation of culture conditions for in vitro meniscus repair model systems using bone marrow-derived mesenchymal stem cells. Connect Tissue Res 2020; 61:322-337. [PMID: 31661326 PMCID: PMC7188595 DOI: 10.1080/03008207.2019.1680656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Meniscal injury and loss of meniscus tissue lead to osteoarthritis development. Therefore, novel biologic strategies are needed to enhance meniscus tissue repair. The purpose of this study was to identify a favorable culture medium for both bone marrow-derived mesenchymal stem cells (MSCs) and meniscal tissue, and to establish a novel meniscus tissue defect model that could be utilized for in vitro screening of biologics to promote meniscus repair.Materials and Methods: In parallel, we analyzed the biochemical properties of MSC - seeded meniscus-derived matrix (MDM) scaffolds and meniscus repair model explants cultured in different combinations of serum, dexamethasone (Dex), and TGF-β. Next, we combined meniscus tissue and MSC-seeded MDM scaffolds into a novel meniscus tissue defect model to evaluate the effects of chondrogenic and meniscal media on the tissue biochemical properties and repair strength.Results: Serum-free medium containing TGF-β and Dex was the most promising formulation for experiments with MSC-seeded scaffolds, whereas serum-containing medium was the most effective for meniscus tissue composition and integrative repair. When meniscus tissue and MSC-seeded MDM scaffolds were combined into a defect model, the chondrogenic medium (serum-free with TGF-β and Dex) enhanced the production of proteoglycans and promoted integrative repair of meniscus tissue. As well, cross-linked scaffolds improved repair over the MDM slurry.Conclusions: The meniscal tissue defect model established in this paper can be used to perform in vitro screening to identify and optimize biological treatments to enhance meniscus tissue repair prior to conducting preclinical animal studies.
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Affiliation(s)
- Sofia Hidalgo Perea
- Department of Biology, Duke University, Durham, North
Carolina, USA,Department of Orthopaedic Surgery, Duke University School
of Medicine, Durham, North Carolina, USA
| | - Lucas P. Lyons
- Department of Orthopaedic Surgery, Duke University School
of Medicine, Durham, North Carolina, USA
| | - James F. Nishimuta
- Department of Orthopaedic Surgery, Duke University School
of Medicine, Durham, North Carolina, USA
| | - J. Brice Weinberg
- Department of Medicine, Duke University School of Medicine,
Durham, North Carolina, USA,VA Medical Center, Durham, NC, USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School
of Medicine, Durham, North Carolina, USA,Department of Pathology, Duke University School of
Medicine, Durham, North Carolina, USA,Corresponding Author: Amy L. McNulty,
PhD, Duke University School of Medicine, 355A Medical Sciences Research Building
1, DUMC Box 3093, Durham, NC 27710, Phone: 919-684-6882,
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Rothrauff BB, Sasaki H, Kihara S, Overholt KJ, Gottardi R, Lin H, Fu FH, Tuan RS, Alexander PG. Point-of-Care Procedure for Enhancement of Meniscal Healing in a Goat Model Utilizing Infrapatellar Fat Pad-Derived Stromal Vascular Fraction Cells Seeded in Photocrosslinkable Hydrogel. Am J Sports Med 2019; 47:3396-3405. [PMID: 31644307 DOI: 10.1177/0363546519880468] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large radial tears of the meniscus involving the avascular region can compromise meniscal function and result in poor healing and subsequent osteochondral degeneration. Augmentation of surgical repairs with adipose-derived stromal vascular fraction (SVF), which contains mesenchymal stromal cells, may improve meniscal healing and preserve function (ie, chondroprotection). PURPOSES (1) To develop a goat model of a radial meniscal tear with resulting osteoarthritis and (2) to explore the efficacy of a 1-step procedure utilizing infrapatellar fat pad-derived SVF cells seeded in a photocrosslinkable hydrogel to enhance meniscal healing and mitigate osteochondral degeneration. STUDY DESIGN Controlled laboratory study. METHODS A full-thickness radial tear spanning 90% of the medial meniscal width was made at the junction of the anterior and middle bodies of the goat stifle joint. Tears received 1 of 3 interventions (n = 4 per group): untreated, repair, or repair augmented with photocrosslinkable methacrylated gelatin hydrogel containing 2.0 × 106 SVF cells/mL and 2.0 µg/mL of transforming growth factor β3. The contralateral (left) joint served as a healthy control. At 6 months, meniscal healing and joint health were evaluated by magnetic resonance imaging (MRI) and assessed by histological and macroscopic scoring. The Whole-Organ Magnetic Resonance Imaging Score and the presence of a residual tear, as evaluated with T2 MRI sequences, were determined by a single blinded orthopaedic surgeon. RESULTS When compared with tears left untreated or repaired with suture alone, augmented repairs demonstrated increased tissue formation in the meniscal tear site, as seen on MRI and macroscopically. Likewise, the neotissue of augmented repairs possessed a histological appearance more similar, although still inferior, to healthy meniscus. Osteochondral degeneration in the medial compartment, as evaluated by the Whole-Organ Magnetic Resonance Imaging Score and Inoue (macroscopic) scale, revealed increased degeneration in the untreated and repair groups, which was mitigated in the augmented repair group. Histological evaluation with a modified Mankin score showed a similar trend. In all measures of osteochondral degeneration, the augmented repair group did not differ significantly from the uninjured control. CONCLUSION A radial tear spanning 90% of the medial meniscal width in a goat stifle joint showed poor healing potential and resulted in osteochondral degeneration by 6 months, even if suture repair was performed. Augmentation of the repair with a photocrosslinkable hydrogel containing transforming growth factor β3 and SVF cells, isolated intraoperatively by rapid enzymatic digestion, improved meniscal healing and mitigated osteoarthritic changes. CLINICAL RELEVANCE Repair augmentation with an SVF cell-seeded hydrogel may support successful repair of meniscal tears previously considered irreparable.
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Affiliation(s)
- Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hiroshi Sasaki
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shinsuke Kihara
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kalon J Overholt
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Riccardo Gottardi
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Dzobo K, Motaung KSCM, Adesida A. Recent Trends in Decellularized Extracellular Matrix Bioinks for 3D Printing: An Updated Review. Int J Mol Sci 2019; 20:E4628. [PMID: 31540457 PMCID: PMC6788195 DOI: 10.3390/ijms20184628] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/01/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023] Open
Abstract
The promise of regenerative medicine and tissue engineering is founded on the ability to regenerate diseased or damaged tissues and organs into functional tissues and organs or the creation of new tissues and organs altogether. In theory, damaged and diseased tissues and organs can be regenerated or created using different configurations and combinations of extracellular matrix (ECM), cells, and inductive biomolecules. Regenerative medicine and tissue engineering can allow the improvement of patients' quality of life through availing novel treatment options. The coupling of regenerative medicine and tissue engineering with 3D printing, big data, and computational algorithms is revolutionizing the treatment of patients in a huge way. 3D bioprinting allows the proper placement of cells and ECMs, allowing the recapitulation of native microenvironments of tissues and organs. 3D bioprinting utilizes different bioinks made up of different formulations of ECM/biomaterials, biomolecules, and even cells. The choice of the bioink used during 3D bioprinting is very important as properties such as printability, compatibility, and physical strength influence the final construct printed. The extracellular matrix (ECM) provides both physical and mechanical microenvironment needed by cells to survive and proliferate. Decellularized ECM bioink contains biochemical cues from the original native ECM and also the right proportions of ECM proteins. Different techniques and characterization methods are used to derive bioinks from several tissues and organs and to evaluate their quality. This review discusses the uses of decellularized ECM bioinks and argues that they represent the most biomimetic bioinks available. In addition, we briefly discuss some polymer-based bioinks utilized in 3D bioprinting.
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Affiliation(s)
- Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Wernher and Beit Building (South), UCT Medical Campus, Anzio Road, Observatory, Cape Town 7925, South Africa.
- Division of Medical Biochemistry and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
| | | | - Adetola Adesida
- Department of Surgery, Faculty of Medicine and Dentistry, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada.
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De Moor L, Beyls E, Declercq H. Scaffold Free Microtissue Formation for Enhanced Cartilage Repair. Ann Biomed Eng 2019; 48:298-311. [DOI: 10.1007/s10439-019-02348-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/17/2019] [Indexed: 12/12/2022]
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19
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Hayes AJ, Melrose J. Glycosaminoglycan and Proteoglycan Biotherapeutics in Articular Cartilage Protection and Repair Strategies: Novel Approaches to Visco‐supplementation in Orthobiologics. ADVANCED THERAPEUTICS 2019. [DOI: 10.1002/adtp.201900034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anthony J. Hayes
- Bioimaging Research HubCardiff School of BiosciencesCardiff University Cardiff CF10 3AX Wales UK
| | - James Melrose
- Graduate School of Biomedical EngineeringUNSW Sydney Sydney NSW 2052 Australia
- Raymond Purves Bone and Joint Research LaboratoriesKolling Institute of Medical ResearchRoyal North Shore Hospital and The Faculty of Medicine and HealthUniversity of Sydney St. Leonards NSW 2065 Australia
- Sydney Medical SchoolNorthernRoyal North Shore HospitalSydney University St. Leonards NSW 2065 Australia
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20
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Zhang Z, Wu Q, Zeng L, Wang S. Modeling-Based Assessment of 3D Printing-Enabled Meniscus Transplantation. Healthcare (Basel) 2019; 7:E69. [PMID: 31083361 PMCID: PMC6627735 DOI: 10.3390/healthcare7020069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023] Open
Abstract
3D printing technology is able to produce personalized artificial substitutes for patients with damaged menisci. However, there is a lack of thorough understanding of 3D printing-enabled (3DP-enabled) meniscus transplantation and its long-term advantages over traditional transplantation. To help health care stakeholders and patients assess the value of 3DP-enabled meniscus transplantation, this study compares the long-term cost and risk of this new paradigm with traditional transplantation by simulation. Pathway models are developed to simulate patients' treatment process during a 20-year period, and a Markov process is used to model the state transitions of patients after transplantation. A sensitivity analysis is also conducted to show the effect of quality of 3D-printed meniscus on model outputs. The simulation results suggest that the performance of 3DP-enabled meniscus transplantation depends on quality of 3D-printed meniscus. The conclusion of this study is that 3DP-enabled meniscus transplantation has many advantages over traditional meniscus transplantation, including a minimal waiting time, perfect size and shape match, and potentially lower cost and risk in the long term.
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Affiliation(s)
- Zimeng Zhang
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - Qian Wu
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - Li Zeng
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - Shiren Wang
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX 77843, USA.
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The Importance of the Knee Joint Meniscal Fibrocartilages as Stabilizing Weight Bearing Structures Providing Global Protection to Human Knee-Joint Tissues. Cells 2019; 8:cells8040324. [PMID: 30959928 PMCID: PMC6523218 DOI: 10.3390/cells8040324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to review aspects of the pathobiology of the meniscus in health and disease and show how degeneration of the meniscus can contribute to deleterious changes in other knee joint components. The menisci, distinctive semilunar weight bearing fibrocartilages, provide knee joint stability, co-ordinating functional contributions from articular cartilage, ligaments/tendons, synovium, subchondral bone and infra-patellar fat pad during knee joint articulation. The meniscus contains metabolically active cell populations responsive to growth factors, chemokines and inflammatory cytokines such as interleukin-1 and tumour necrosis factor-alpha, resulting in the synthesis of matrix metalloproteases and A Disintegrin and Metalloprotease with ThromboSpondin type 1 repeats (ADAMTS)-4 and 5 which can degrade structural glycoproteins and proteoglycans leading to function-limiting changes in meniscal and other knee joint tissues. Such degradative changes are hall-marks of osteoarthritis (OA). No drugs are currently approved that change the natural course of OA and translate to long-term, clinically relevant benefits. For any pharmaceutical therapeutic intervention in OA to be effective, disease modifying drugs will have to be developed which actively modulate the many different cell types present in the knee to provide a global therapeutic. Many individual and combinatorial approaches are being developed to treat or replace degenerate menisci using 3D printing, bioscaffolds and hydrogel delivery systems for therapeutic drugs, growth factors and replacement progenitor cell populations recognising the central role the menisci play in knee joint health.
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22
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Koch M, Hammer S, Fuellerer J, Lang S, Pfeifer CG, Pattappa G, Weber J, Loibl M, Nerlich M, Angele P, Zellner J. Bone Marrow Aspirate Concentrate for the Treatment of Avascular Meniscus Tears in a One-Step Procedure-Evaluation of an In Vivo Model. Int J Mol Sci 2019; 20:ijms20051120. [PMID: 30841560 PMCID: PMC6429139 DOI: 10.3390/ijms20051120] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/11/2022] Open
Abstract
Avascular meniscus tears show poor intrinsic regenerative potential. Thus, lesions within this area predispose the patient to developing knee osteoarthritis. Current research focuses on regenerative approaches using growth factors or mesenchymal stem cells (MSCs) to enhance healing capacity within the avascular meniscus zone. The use of MSCs especially as progenitor cells and a source of growth factors has shown promising results. However, present studies use bone-marrow-derived BMSCs in a two-step procedure, which is limiting the transfer in clinical praxis. So, the aim of this study was to evaluate a one-step procedure using bone marrow aspirate concentrate (BMAC), containing BMSCs, for inducing the regeneration of avascular meniscus lesions. Longitudinal meniscus tears of 4 mm in size of the lateral New Zealand White rabbit meniscus were treated with clotted autologous PRP (platelet-rich plasma) or BMAC and a meniscus suture or a meniscus suture alone. Menisci were harvested at 6 and 12 weeks after initial surgery. Macroscopical and histological evaluation was performed according to an established Meniscus Scoring System. BMAC significantly enhanced regeneration of the meniscus lesions in a time-dependent manner and in comparison to the PRP and control groups, where no healing could be observed. Treatment of avascular meniscus lesions with BMAC and meniscus suturing seems to be a promising approach to promote meniscus regeneration in the avascular zone using a one-step procedure.
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Affiliation(s)
- Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Selma Hammer
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Julian Fuellerer
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Siegmund Lang
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Christian G Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Girish Pattappa
- Laboratory of Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Markus Loibl
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Peter Angele
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
- Sporthopaedicum Regensburg/Straubing, Hildegard-von-Bingen-Str. 1, 93053, Regensburg, Germany.
| | - Johannes Zellner
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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Sooriyaarachchi D, Wu J, Feng A, Islam M, Tan GZ. Hybrid Fabrication of Biomimetic Meniscus Scaffold by 3D Printing and Parallel Electrospinning. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.promfg.2019.06.216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Tissue-Engineered Grafts from Human Decellularized Extracellular Matrices: A Systematic Review and Future Perspectives. Int J Mol Sci 2018; 19:ijms19124117. [PMID: 30567407 PMCID: PMC6321114 DOI: 10.3390/ijms19124117] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022] Open
Abstract
Tissue engineering and regenerative medicine involve many different artificial and biologic materials, frequently integrated in composite scaffolds, which can be repopulated with various cell types. One of the most promising scaffolds is decellularized allogeneic extracellular matrix (ECM) then recellularized by autologous or stem cells, in order to develop fully personalized clinical approaches. Decellularization protocols have to efficiently remove immunogenic cellular materials, maintaining the nonimmunogenic ECM, which is endowed with specific inductive/differentiating actions due to its architecture and bioactive factors. In the present paper, we review the available literature about the development of grafts from decellularized human tissues/organs. Human tissues may be obtained not only from surgery but also from cadavers, suggesting possible development of Human Tissue BioBanks from body donation programs. Many human tissues/organs have been decellularized for tissue engineering purposes, such as cartilage, bone, skeletal muscle, tendons, adipose tissue, heart, vessels, lung, dental pulp, intestine, liver, pancreas, kidney, gonads, uterus, childbirth products, cornea, and peripheral nerves. In vitro recellularizations have been reported with various cell types and procedures (seeding, injection, and perfusion). Conversely, studies about in vivo behaviour are poorly represented. Actually, the future challenge will be the development of human grafts to be implanted fully restored in all their structural/functional aspects.
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25
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Garcia JP, Stein J, Cai Y, Riemers F, Wexselblatt E, Wengel J, Tryfonidou M, Yayon A, Howard KA, Creemers LB. Fibrin-hyaluronic acid hydrogel-based delivery of antisense oligonucleotides for ADAMTS5 inhibition in co-delivered and resident joint cells in osteoarthritis. J Control Release 2018; 294:247-258. [PMID: 30572032 DOI: 10.1016/j.jconrel.2018.12.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/16/2018] [Indexed: 02/06/2023]
Abstract
To date no disease-modifying drugs for osteoarthritis (OA) are available, with treatment limited to the use of pain killers and prosthetic replacement. The ADAMTS (A Disintegrin and Metallo Proteinase with Thrombospondin Motifs) enzyme family is thought to be instrumental in the loss of proteoglycans during cartilage degeneration in OA, and their inhibition was shown to reverse osteoarthritic cartilage degeneration. Locked Nucleic Acid (LNA)-modified antisense oligonucleotides (gapmers) released from biomaterial scaffolds for specific and prolonged ADAMTS inhibition in co-delivered and resident chondrocytes, is an attractive therapeutic strategy. Here, a gapmer sequence identified from a gapmer screen showed 90% ADAMTS5 silencing in a monolayer culture of human OA chondrocytes. Incorporation of the gapmer in a fibrin-hyaluronic acid hydrogel exhibited a sustained release profile up to 14 days. Gapmers loaded in hydrogels were able to transfect both co-embedded chondrocytes and chondrocytes in a neighboring gapmer-free hydrogel, as demonstrated by flow cytometry and confocal microscopy. Efficient knockdown of ADAMTS5 was shown up to 14 days in both cell populations, i.e. the gapmer-loaded and gapmer-free hydrogel. This work demonstrates the use applicability of a hydrogel as a platform for combined local delivery of chondrocytes and an ADAMTS-targeting gapmer for catabolic gene modulation in OA.
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Affiliation(s)
- João Pedro Garcia
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands
| | - Jeroen Stein
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands
| | - Yunpeng Cai
- Interdisciplinary Nanoscience Center (iNANO), Department of Molecular Biology and Genetics, Aarhus University, Denmark
| | - Frank Riemers
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | | | - Jesper Wengel
- Nucleic Acid Center, University of Southern Denmark, Denmark
| | - Marianna Tryfonidou
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | | | - Kenneth A Howard
- Interdisciplinary Nanoscience Center (iNANO), Department of Molecular Biology and Genetics, Aarhus University, Denmark
| | - Laura B Creemers
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands.
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Hagmeijer MH, Vonk LA, Kouwenhoven JW, Custers RJ, Bleys RL, Krych AJ, Saris DB. Surgical Feasibility of a One-Stage Cell-Based Arthroscopic Procedure for Meniscus Regeneration: A Cadaveric Study. Tissue Eng Part C Methods 2018; 24:688-696. [PMID: 30398399 PMCID: PMC7615694 DOI: 10.1089/ten.tec.2018.0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPACT STATEMENT Meniscus injury remains the most common indication for orthopedic surgery, but loss of functioning meniscus tissue is strongly correlated with development of early osteoarthritis. However, current clinical options for tissue engineering of the meniscus are limited. This study demonstrates the feasibility of combining human meniscus cells with mesenchymal stromal cells to enhance a meniscus scaffold for meniscus regeneration in a one-stage solution for partial meniscal deficiency.
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Affiliation(s)
- Michella H. Hagmeijer
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lucienne A. Vonk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan-Willem Kouwenhoven
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald L. Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aaron J. Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel B.F. Saris
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
- MIRA Institute for Technical Medicine, University Twente, Enschede, The Netherlands. Investigation performed at the University Medical Center Utrecht, Utrecht, The Netherlands
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Shimomura K, Rothrauff BB, Hart DA, Hamamoto S, Kobayashi M, Yoshikawa H, Tuan RS, Nakamura N. Enhanced repair of meniscal hoop structure injuries using an aligned electrospun nanofibrous scaffold combined with a mesenchymal stem cell-derived tissue engineered construct. Biomaterials 2018; 192:346-354. [PMID: 30471629 DOI: 10.1016/j.biomaterials.2018.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
Damage to the meniscal hoop structure results in loss of biomechanical function, which potentially leads to the extrusion of the meniscus from the weight bearing area. However, there have been no established, effective treatments for such injuries. The purpose of this study was to investigate the applicability of cell-seeded nanofibrous scaffolds to repair the damaged meniscal hoop structure along with the prevention of subsequent cartilage degeneration using a rabbit model. Meniscal radial defects (5 mm width) in the medial meniscus were treated by wrapping and suturing with either an aligned electrospun nanofibrous scaffold alone or a scaffold combined with a tissue engineered construct (TEC) derived from synovial mesenchymal stem cells (MSCs), with the scaffold fiber direction matching that of the meniscal circumferential fibers. The MSC-based TEC-combined nanofibrous scaffolds contributed significantly to the prevention of meniscal extrusion and exerted a chondroprotective effect, compared with either scaffold alone or the untreated control groups. Also, meniscal defects treated with such TEC-combined nanofibrous scaffolds were consistently repaired with a fibrocartilaginous tissue. In this study, we have demonstrated the feasibility of a combined TEC-nanofibrous scaffold to repair the meniscal hoop structure, and prevent the progression to cartilage degeneration, as a potential tissue engineering method.
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Affiliation(s)
- Kazunori Shimomura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 221, Pittsburgh, PA, 15219-3143, USA.
| | - David A Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta, T2N 4N1, Canada.
| | - Shuichi Hamamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Masato Kobayashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 221, Pittsburgh, PA, 15219-3143, USA.
| | - Norimasa Nakamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan; Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27 Tenma, Kita-ku, Osaka City, Osaka, 530-0043, Japan; Center for Advanced Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
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Jayasuriya CT, Twomey-Kozak J, Newberry J, Desai S, Feltman P, Franco JR, Li N, Terek R, Ehrlich MG, Owens BD. Human Cartilage-Derived Progenitors Resist Terminal Differentiation and Require CXCR4 Activation to Successfully Bridge Meniscus Tissue Tears. Stem Cells 2018; 37:102-114. [PMID: 30358021 PMCID: PMC6312732 DOI: 10.1002/stem.2923] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/21/2018] [Accepted: 09/05/2018] [Indexed: 12/14/2022]
Abstract
Meniscus injuries are among the most common orthopedic injuries. Tears in the inner one‐third of the meniscus heal poorly and present a significant clinical challenge. In this study, we hypothesized that progenitor cells from healthy human articular cartilage (chondroprogenitor cells [C‐PCs]) may be more suitable than bone‐marrow mesenchymal stem cells (BM‐MSCs) to mediate bridging and reintegration of fibrocartilage tissue tears in meniscus. C‐PCs were isolated from healthy human articular cartilage based on their expression of mesenchymal stem/progenitor marker activated leukocyte cell adhesion molecule (ALCAM) (CD166). Our findings revealed that healthy human C‐PCs are CD166+, CD90+, CD54+, CD106‐ cells with multilineage differentiation potential, and elevated basal expression of chondrogenesis marker SOX‐9. We show that, similar to BM‐MSCs, C‐PCs are responsive to the chemokine stromal cell‐derived factor‐1 (SDF‐1) and they can successfully migrate to the area of meniscal tissue damage promoting collagen bridging across inner meniscal tears. In contrast to BM‐MSCs, C‐PCs maintained reduced expression of cellular hypertrophy marker collagen X in monolayer culture and in an explant organ culture model of meniscus repair. Treatment of C‐PCs with SDF‐1/CXCR4 pathway inhibitor AMD3100 disrupted cell localization to area of injury and prevented meniscus tissue bridging thereby indicating that the SDF‐1/CXCR4 axis is an important mediator of this repair process. This study suggests that C‐PCs from healthy human cartilage may potentially be a useful tool for fibrocartilage tissue repair/regeneration because they resist cellular hypertrophy and mobilize in response to chemokine signaling. stem cells2019;37:102–114
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Affiliation(s)
- Chathuraka T Jayasuriya
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - John Twomey-Kozak
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jake Newberry
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Salomi Desai
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Peter Feltman
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jonathan R Franco
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Neill Li
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Richard Terek
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Michael G Ehrlich
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
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Cell-Free Strategies for Repair and Regeneration of Meniscus Injuries through the Recruitment of Endogenous Stem/Progenitor Cells. Stem Cells Int 2018; 2018:5310471. [PMID: 30123286 PMCID: PMC6079391 DOI: 10.1155/2018/5310471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022] Open
Abstract
The meniscus plays a vital role in protecting the articular cartilage of the knee joint. The inner two-thirds of the meniscus are avascular, and injuries to this region often fail to heal without intervention. The use of tissue engineering and regenerative medicine techniques may offer novel and effective approaches to repairing meniscal injuries. Meniscal tissue engineering and regenerative medicine typically use one of two techniques, cell-based or cell-free. While numerous cell-based strategies have been applied to repair and regenerate meniscal defects, these techniques possess certain limitations including cellular contamination and an increased risk of disease transmission. Cell-free strategies attempt to repair and regenerate the injured tissues by recruiting endogenous stem/progenitor cells. Cell-free strategies avoid several of the disadvantages of cell-based techniques and, therefore, may have a wider clinical application. This review first compares cell-based to cell-free techniques. Next, it summarizes potential sources for endogenous stem/progenitor cells. Finally, it discusses important recruitment factors for meniscal repair and regeneration. In conclusion, cell-free techniques, which focus on the recruitment of endogenous stem and progenitor cells, are growing in efficacy and may play a critical role in the future of meniscal repair and regeneration.
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Abstract
The complex ultrastructure of the meniscus determines its vital functions for the knee, the lower extremity, and the body. The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue. It is the orthopaedic surgeon’s responsibility to combine clinical information, radiological images, and clinical experience in an effort to individualize management of meniscal tears, taking into account factors related to the patient and lesion. Surgeons should strive not to operate in most cases, but to protect, repair or reconstruct, in order to prevent early development of osteoarthritis by restoring the native structure, function, and biomechanics of the meniscus. Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. Meniscus surgery has come a long way from the old slogan, “If it is torn, take it out!” to the currently accepted slogan, “Save the meniscus!” which has guided evolving modern treatment methods for meniscal tears. This last slogan will probably constitute the basis for newer alternative biological treatment methods in the future.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170067.
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Affiliation(s)
- Mahmut Nedim Doral
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Ankara, Turkey
| | - Onur Bilge
- Konya N.E. University, Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Konya, Turkey
| | - Gazi Huri
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Egemen Turhan
- Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - René Verdonk
- Ghent University, Faculty of Medicine, Department of Orthopaedics and Traumatology, De Pintelaan, Ghent, Belgium
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Chew E, Prakash R, Khan W. Mesenchymal stem cells in human meniscal regeneration: A systematic review. Ann Med Surg (Lond) 2017; 24:3-7. [PMID: 29062478 PMCID: PMC5644998 DOI: 10.1016/j.amsu.2017.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stem cell regeneration is the holy grail of meniscal tissue repair. Currently, the best treatment is to preserve the original meniscus but if it fails, a partial meniscectomy is indicated to delay the onset of osteoarthritis. MATERIALS AND METHODS The authors present a systematic review to determine the up-to-date evidence underlying the use of mesenchymal stem cells for meniscal regeneration in humans. A search was conducted using the electronic databases of MEDLINE/Pubmed, Google scholar, and the Cochrane Collaboration. Search keywords included human, meniscus, stem cells and regeneration. RESULTS After screening 10 non-duplicate studies, 5 were identified based on title and abstract. 4 were included in the analysis. There were marked differences in the method of stem cell harvest techniques. 3 studies administered stem cells through percutaneous injection into the knee and 1 study used a collagen scaffold. MRI analysis, functional scores and safety were assessed and the longest follow-up period was 2 years. The Visual Analogue Score (VAS) was most commonly used to assess function and patients generally showed an improvement. There were no reported adverse events. CONCLUSION Despite positive results from animal models, there is currently a lack of evidence in humans to conclude that stem cells can form durable neotissue similar to original human meniscus. There is a need for standardisation of protocol before further trials are considered. Initial outcomes from human studies are promising and mesenchymal stem cells may play an important role in meniscal repair in years to come.
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Affiliation(s)
- Ernest Chew
- Department of Trauma and Orthopaedics, St Mary's Hospital, London, W2 1NY, United Kingdom
| | - Rohan Prakash
- Department of Trauma and Orthopaedics, Royal Free Hospital, London, NW3 2QG, United Kingdom
| | - Wasim Khan
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
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Collins A, Ross J, Lang SH. A systematic review of the asymmetric inheritance of cellular organelles in eukaryotes: A critique of basic science validity and imprecision. PLoS One 2017; 12:e0178645. [PMID: 28562636 PMCID: PMC5451095 DOI: 10.1371/journal.pone.0178645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/16/2017] [Indexed: 01/03/2023] Open
Abstract
We performed a systematic review to identify all original publications describing the asymmetric inheritance of cellular organelles in normal animal eukaryotic cells and to critique the validity and imprecision of the evidence. Searches were performed in Embase, MEDLINE and Pubmed up to November 2015. Screening of titles, abstracts and full papers was performed by two independent reviewers. Data extraction and validity were performed by one reviewer and checked by a second reviewer. Study quality was assessed using the SYRCLE risk of bias tool, for animal studies and by developing validity tools for the experimental model, organelle markers and imprecision. A narrative data synthesis was performed. We identified 31 studies (34 publications) of the asymmetric inheritance of organelles after mitotic or meiotic division. Studies for the asymmetric inheritance of centrosomes (n = 9); endosomes (n = 6), P granules (n = 4), the midbody (n = 3), mitochondria (n = 3), proteosomes (n = 2), spectrosomes (n = 2), cilia (n = 2) and endoplasmic reticulum (n = 2) were identified. Asymmetry was defined and quantified by variable methods. Assessment of the statistical reliability of the results indicated only two studies (7%) were judged to have low concern, the majority of studies (77%) were 'unclear' and five (16%) were judged to have 'high concerns'; the main reasons were low technical repeats (<10). Assessment of model validity indicated that the majority of studies (61%) were judged to be valid, ten studies (32%) were unclear and two studies (7%) were judged to have 'high concerns'; both described 'stem cells' without providing experimental evidence to confirm this (pluripotency and self-renewal). Assessment of marker validity indicated that no studies had low concern, most studies were unclear (96.5%), indicating there were insufficient details to judge if the markers were appropriate. One study had high concern for marker validity due to the contradictory results of two markers for the same organelle. For most studies the validity and imprecision of results could not be confirmed. In particular, data were limited due to a lack of reporting of interassay variability, sample size calculations, controls and functional validation of organelle markers. An evaluation of 16 systematic reviews containing cell assays found that only 50% reported adherence to PRISMA or ARRIVE reporting guidelines and 38% reported a formal risk of bias assessment. 44% of the reviews did not consider how relevant or valid the models were to the research question. 75% reviews did not consider how valid the markers were. 69% of reviews did not consider the impact of the statistical reliability of the results. Future systematic reviews in basic or preclinical research should ensure the rigorous reporting of the statistical reliability of the results in addition to the validity of the methods. Increased awareness of the importance of reporting guidelines and validation tools is needed for the scientific community.
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Affiliation(s)
- Anne Collins
- Department of Biology, University of York, Heslington, United Kingdom
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