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Mehdipour chari K, Enderami SE, Mansour RN, Hasanzadeh E, Amini Mahabadi J, Abazari M, Asadi P, Hojjat A. Applications of blood plasma derivatives for cutaneous wound healing: A mini-review of clinical studies. Regen Ther 2024; 27:251-258. [PMID: 38596823 PMCID: PMC11002853 DOI: 10.1016/j.reth.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 04/11/2024] Open
Abstract
Skin injuries are a global healthcare problem. Chronic ulcers do not heal in a timely fashion, so it is essential to help the body with skin repair. There are some treatments that have been applied to chronic ulcers. One of these treatments is growth factor (GF) therapy. Platelet-rich plasma (PRP) and Platelet-poor plasma (PPP) are two types of plasma derivatives containing many GFs important for wound healing. Several works have reported their application in wound healing and tissue regeneration. The use of autologous PRP is now an adequate alternative in regenerative medicine. It was also demonstrated that PPP is a hemostatic agent for wounds. This review has studied the latest clinical studies, which have applied PRP and PPP to patients with chronic wounds.
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Affiliation(s)
- Kayvan Mehdipour chari
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Ehsan Enderami
- Immunogenetics Research Center, Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reyhaneh Nassiri Mansour
- Immunogenetics Research Center, Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Tissue Engineering & Regenerative Medicine, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Hasanzadeh
- Department of Tissue Engineering & Regenerative Medicine, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mohamadfoad Abazari
- Division of Medical Sciences, Island Medical Program, University of British Columbia, Victoria, BC, Canada
- Department of Biology, Centre for Biomedical Research, University of Victoria, Victoria, Canada
| | - Peyman Asadi
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Atefeh Hojjat
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Vaidakis D, Papapanou M, Siristatidis CS. Autologous platelet-rich plasma for assisted reproduction. Cochrane Database Syst Rev 2024; 4:CD013875. [PMID: 38682756 PMCID: PMC11057220 DOI: 10.1002/14651858.cd013875.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) consists of plasma and a concentrate of platelets extracted from fresh whole blood of the person being treated. Research has suggested that intrauterine or intraovarian infusion/injection of PRP before embryo transfer may improve endometrial receptivity and response to ovarian stimulation in women undergoing assisted reproduction. We compared these interventions to standard treatment, placebo, or other interventions (mechanical or pharmacological). OBJECTIVES To assess the effectiveness and safety of intrauterine and intraovarian infusion/injection of platelet-rich plasma in infertile women undergoing assisted reproductive technology cycles. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, and the Epistemonikos database in January 2023. We also searched the reference lists of relevant articles and contacted the trial authors and experts in the field for any additional trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) that evaluated the application of PRP in the uterine cavity, ovaries, or both versus no intervention, placebo, or any other intervention (either mechanical or pharmacological) in women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures recommended by Cochrane, including use of the updated risk of bias tool (RoB 2). The primary outcomes were live birth (or ongoing pregnancy) and miscarriage. The secondary outcomes were clinical pregnancy, complications of the procedure, multiple pregnancy, ectopic pregnancy, fetal growth restriction, preterm delivery, and fetal abnormality. We estimated the average effect of the interventions by fitting a Der Simonian-Laird's random-effects meta-analysis model. We reported pooled odds ratios (ORs) with 95% confidence intervals (CIs). We restricted the primary analyses to trials at low risk of bias for the outcomes and performed sensitivity analyses that included all studies. MAIN RESULTS We included 12 parallel-group RCTs that recruited a total of 1069 women. We identified three different comparison groups. Using GRADE, we assessed the certainty of evidence as very low for almost all outcomes. Intrauterine injection/infusion of platelet-rich plasma versus no intervention or placebo Nine studies evaluated intrauterine PRP versus no intervention or placebo. Eight included women with at least two or three previous implantation failures. Only one was assessed at low risk of bias for each outcome. This study provided very low-certainty evidence about the effect of intrauterine PRP injection versus no intervention on live birth (OR 1.10, 95% CI 0.38 to 3.14; 94 women) and miscarriage (OR 0.96, 95% CI 0.13 to 7.09; 94 women). If the likelihood of live birth following no intervention is assumed to be 17%, then the likelihood following intrauterine PRP would be 7% to 40%; and if the risk of miscarriage following no intervention is 4%, then the risk following intrauterine PRP would be 1% to 24%. When we analyzed all studies (regardless of risk of bias), we found very low-certainty evidence about the effect of intrauterine PRP compared with placebo or no intervention on live birth or ongoing pregnancy (OR 2.38, 95% CI 1.16 to 4.86; I² = 54%; 6 studies, 564 women) and miscarriage (OR 1.54, 95% CI 0.59 to 4.01; I² = 0%; 5 studies, 504 women). The study at low risk of bias provided very low-certainty evidence about the effect of intrauterine PRP compared with no intervention on clinical pregnancy (OR 1.55, 95% CI 0.64 to 3.76; 94 women) and ectopic pregnancy (OR 2.94, 95% CI 0.12 to 73.95; 94 women). The synthesis of all studies provided very low-certainty evidence about the effect of intrauterine PRP compared with placebo or no intervention on clinical pregnancy (OR 2.22, 95% CI 1.50 to 3.27; I² = 24%; 9 studies, 824 women), multiple pregnancy (OR 2.68, 95% CI 0.81 to 8.88; I² = 0%; 2 studies, 240 women), and ectopic pregnancy (OR 2.94, 95% CI 0.12 to 73.95; 1 study, 94 women; very low-certainty evidence). Intrauterine infusion of PRP may increase the risk of preterm delivery compared with no intervention (OR 8.02, 95% CI 1.72 to 37.33; 1 study, 120 women; low-certainty evidence). No studies reported pain, infection, allergic reaction, fetal growth restriction, or fetal abnormality. Intrauterine infusion of platelet-rich plasma versus intrauterine infusion of granulocyte colony-stimulating factor Two RCTs evaluated intrauterine PRP versus intrauterine granulocyte colony-stimulating factor (G-CSF); both included women with thin endometrium, and neither was judged at low risk of bias for any outcome. We are uncertain about the effect of intrauterine PRP compared with intrauterine G-CSF on live birth (OR 0.88, 95% CI 0.43 to 1.81; 1 study, 132 women; very low-certainty evidence), miscarriage (OR 1.94, 95% CI 0.63 to 5.96; 1 study, 132 women; very low-certainty evidence), and clinical pregnancy (OR 1.24, 95% CI 0.66 to 2.35; 2 studies, 172 women; very low-certainty evidence). Neither study reported adverse outcomes other than miscarriage. Intraovarian injection of platelet-rich plasma versus no intervention One RCT evaluated PRP injection into both ovaries versus no intervention; it was judged at high risk of bias for the two outcomes it reported. We are uncertain about the effect of intraovarian PRP injection compared with no intervention on ongoing pregnancy (OR 1.09, 95% CI 0.33 to 3.63; 73 women; very low-certainty evidence) and clinical pregnancy (OR 0.90, 95% CI 0.31 to 2.60; 73 women; very low-certainty evidence). The study examined no safety outcomes. AUTHORS' CONCLUSIONS We are uncertain about the effect of intrauterine or intraovarian administration of PRP on outcomes of assisted reproduction technology in infertile women. The pooled results should be interpreted with caution. Only one of the 12 included studies was judged at low risk of bias. Other limitations of the included trials were failure to report live birth, poor reporting of methods, lack of prospective protocol registration, low precision due to the small number of enrolled participants, indirectness due to the specific subpopulations and settings studied, and insufficient or absent safety data.
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Affiliation(s)
- Dennis Vaidakis
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia, Nicosia, Cyprus
| | - Michail Papapanou
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Obstetrics, Gynecology and Reproductive Medicine Working Group, Society of Junior Doctors, Athens, Greece
| | - Charalampos S Siristatidis
- Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Peng L, Li H, Deng H, Gao T, Li R, Xu Z, Tian Q, Zhao T, Li J, Yang Y, Wang C, Liu S, Guo Q. Combination of a human articular cartilage-derived extracellular matrix scaffold and microfracture techniques for cartilage regeneration: A proof of concept in a sheep model. J Orthop Translat 2024; 44:72-87. [PMID: 38259590 PMCID: PMC10801125 DOI: 10.1016/j.jot.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background The utilization of decellularized extracellular matrix has gained considerable attention across numerous areas in regenerative research. Of particular interest is the human articular cartilage-derived extracellular matrix (hACECM), which presents as a promising facilitator for cartilage regeneration. Concurrently, the microfracture (MF) technique, a well-established marrow stimulation method, has proven efficacious in the repair of cartilage defects. However, as of the current literature review, no investigations have explored the potential of a combined application of hACECM and the microfracture technique in the repair of cartilage defects within a sheep model. Hypothesis The combination of hACECM scaffold and microfracture will result in improved repair of full-thickness femoral condyle articular cartilage defects compared to the use of either technique alone. Study design Controlled laboratory study. Methods Full-thickness femoral condyle articular cartilage defect (diameter, 7.0 mm; debrided down to the subchondral bone plate) were created in the weight-bearing area of the femoral medial and lateral condyles (n = 24). All of defected sheep were randomly divided into four groups: control, microfracture, hACECM scaffold, and hACECM scaffold + microfracture. After 3, 6 and 12 months, the chondral repair was assessed for standardized (semi-) quantitative macroscopic, imaging, histological, immunohistochemical, mechanics, and biochemical analyses in each group. Result At 3, 6 and 12 months after implantation, the gross view and pathological staining of regenerative tissues were better in the hACECM scaffold and hACECM scaffold + microfracture groups than in the microfracture and control groups; Micro-CT result showed that the parameters about the calcified layer of cartilage and subchondral bone were better in the hACECM scaffold and hACECM scaffold + microfracture groups than the others, and excessive subchondral bone proliferation in the microfracture group. The results demonstrate that human cartilage extracellular matrix scaffold alone is an efficient, safe and simple way to repair cartilage defects. Conclusion hACECM scaffolds combined with/without microfracture facilitate chondral defect repair. The translational potential of this article Preclinical large animal models represent an important adjunct and surrogate for studies on articular cartilage repair, while the sheep stifle joint reflects many key features of the human knee and are therefore optimal experimental model for future clinical application in human. In this study, we developed a human articular cartilage-derived extracellular matrix scaffold and to verify the viability of its use in sheep animal models. Clinical studies are warranted to further quantify the effects of hACECM scaffolds in similar settings.
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Affiliation(s)
- Liqing Peng
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Orthopedics, First People's Hospital of Shuangliu District, No. 120, Chengbeishang Street, Shuangliu District, Chengdu, 610200, China
| | - Hao Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Haoyuan Deng
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Tianze Gao
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Runmeng Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Ziheng Xu
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Qinyu Tian
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tianyuan Zhao
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Jianwei Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Yongkang Yang
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Chao Wang
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shuyun Liu
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Quanyi Guo
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
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Rojas-Murillo JA, Simental-Mendía MA, Moncada-Saucedo NK, Delgado-Gonzalez P, Islas JF, Roacho-Pérez JA, Garza-Treviño EN. Physical, Mechanical, and Biological Properties of Fibrin Scaffolds for Cartilage Repair. Int J Mol Sci 2022; 23:ijms23179879. [PMID: 36077276 PMCID: PMC9456199 DOI: 10.3390/ijms23179879] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Articular cartilage is a highly organized tissue that provides remarkable load-bearing and low friction properties, allowing for smooth movement of diarthrodial joints; however, due to the avascular, aneural, and non-lymphatic characteristics of cartilage, joint cartilage has self-regeneration and repair limitations. Cartilage tissue engineering is a promising alternative for chondral defect repair. It proposes models that mimic natural tissue structure through the use of cells, scaffolds, and signaling factors to repair, replace, maintain, or improve the specific function of the tissue. In chondral tissue engineering, fibrin is a biocompatible biomaterial suitable for cell growth and differentiation with adequate properties to regenerate damaged cartilage. Additionally, its mechanical, biological, and physical properties can be enhanced by combining it with other materials or biological components. This review addresses the biological, physical, and mechanical properties of fibrin as a biomaterial for cartilage tissue engineering and as an element to enhance the regeneration or repair of chondral lesions.
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Affiliation(s)
- Juan Antonio Rojas-Murillo
- Laboratorio de Terapia Celular, Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, NL, Mexico
| | - Mario A. Simental-Mendía
- Servicio de Ortopedia y Traumatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, NL, Mexico
| | - Nidia K. Moncada-Saucedo
- Departamento de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, NL, Mexico
| | - Paulina Delgado-Gonzalez
- Laboratorio de Terapia Celular, Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, NL, Mexico
| | - José Francisco Islas
- Laboratorio de Terapia Celular, Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, NL, Mexico
| | - Jorge A. Roacho-Pérez
- Laboratorio de Terapia Celular, Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, NL, Mexico
| | - Elsa N. Garza-Treviño
- Laboratorio de Terapia Celular, Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, NL, Mexico
- Correspondence: ; Tel.: +52-81-83294173
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Vaidakis D, Sertedaki E, Karageorgiou V, Siristatidis CS. Autologous platelet-rich plasma for assisted reproduction. Hippokratia 2021. [DOI: 10.1002/14651858.cd013875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Dennis Vaidakis
- Department of Basic and Clinical Sciences; University of Nicosia; Nicosia Cyprus
| | | | - Vasilios Karageorgiou
- Second Department of Psychiatry; Medical School, National and Kapodistrian University of Athens; Athens Greece
| | - Charalampos S Siristatidis
- Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynaecology; Medical School, National and Kapodistrian University of Athens; Athens Greece
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Sha'ban M, Ahmad Radzi MA. Scaffolds for Cartilage Regeneration: To Use or Not to Use? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1249:97-114. [PMID: 32602093 DOI: 10.1007/978-981-15-3258-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Joint cartilage has been a significant focus on the field of tissue engineering and regenerative medicine (TERM) since its inception in the 1980s. Represented by only one cell type, cartilage has been a simple tissue that is thought to be straightforward to deal with. After three decades, engineering cartilage has proven to be anything but easy. With the demographic shift in the distribution of world population towards ageing, it is expected that there is a growing need for more effective options for joint restoration and repair. Despite the increasing understanding of the factors governing cartilage development, there is still a lot to do to bridge the gap from bench to bedside. Dedicated methods to regenerate reliable articular cartilage that would be equivalent to the original tissue are still lacking. The use of cells, scaffolds and signalling factors has always been central to the TERM. However, without denying the importance of cells and signalling factors, the question posed in this chapter is whether the answer would come from the methods to use or not to use scaffold for cartilage TERM. This paper presents some efforts in TERM area and proposes a solution that will transpire from the ongoing attempts to understand certain aspects of cartilage development, degeneration and regeneration. While an ideal formulation for cartilage regeneration has yet to be resolved, it is felt that scaffold is still needed for cartilage TERM for years to come.
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Affiliation(s)
- Munirah Sha'ban
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
| | - Muhammad Aa'zamuddin Ahmad Radzi
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Arthroscopic gel-type autologous chondrocyte implantation presents histologic evidence of regenerating hyaline-like cartilage in the knee with articular cartilage defect. Knee Surg Sports Traumatol Arthrosc 2020; 28:941-951. [PMID: 31240378 DOI: 10.1007/s00167-019-05572-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the clinical, radiological, and histological results of arthroscopic gel-type autologous chondrocyte implantation (GACI) in treating chondral defects of the knee. METHODS This study prospectively examined five males and five females with a mean age of 40.3 ± 10.3 years who underwent arthroscopic GACI between March 2012 and February 2013. The gel comprised a mixture of 1 ml of fibrinogen plus 0.1-0.2 ml of thrombin. The mean size of chondral defect was 2.9 ± 1.2 cm2 (range 1.2-5.4 cm2). International knee documentation committee (IKDC) subjective score, knee injury and osteoarthritis outcome score (KOOS), knee society score, and visual analog scale (VAS) for pain were assessed preoperatively and during regular follow-up examinations performed for up to 5 years postoperatively. Serial magnetic resonance imaging was performed for up to 2 years after the surgery to observe healing, using the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. In eight patients, second-look arthroscopy was performed at 1 year after the implantation to assess the status of treated cartilage, and a portion of regenerated cartilage was harvested for histologic evaluation. RESULTS The mean VAS score (p = 0.045), IKDC subjective score (p = 0.041), KOOS pain (p = 0.025), KOOS activities of daily living (p = 0.048), and KOOS quality of life (p = 0.029) showed significant improvement at 5 years after the surgery. The modified MOCART evaluation showed that the scores were 59.5 ± 29.4 and 85.0 ± 8.0 at 12 weeks and 2 years after the operation, respectively. Histologic examination demonstrated a mean regenerated cartilage thickness of 3.5 ± 0.8 mm and a mean Oswestry score of 8.2 ± 1.8. Immunohistochemistry analysis showed that the expression of collagen type II was more evident and more evenly distributed than collagen type I in regenerated cartilage. There was a significant correlation between Oswestry score and change in VAS scale from postoperative 2-5 years. CONCLUSIONS Arthroscopic GACI produces satisfactory clinical and radiologic outcomes, and histologic evaluation confirms sufficient regeneration of hyaline-like cartilage that correlates with improved symptoms. Therefore, it is an acceptable, minimally invasive, and technically simple option for the restoration of cartilage defects of the knee. LEVEL OF EVIDENCE IV.
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Ribitsch I, Mayer RL, Egerbacher M, Gabner S, Kańduła MM, Rosser J, Haltmayer E, Auer U, Gültekin S, Huber J, Bileck A, Kreil DP, Gerner C, Jenner F. Fetal articular cartilage regeneration versus adult fibrocartilaginous repair: secretome proteomics unravels molecular mechanisms in an ovine model. Dis Model Mech 2018; 11:11/7/dmm033092. [PMID: 29991479 PMCID: PMC6078409 DOI: 10.1242/dmm.033092] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/18/2018] [Indexed: 12/27/2022] Open
Abstract
Osteoarthritis (OA), a degenerative joint disease characterized by progressive cartilage degeneration, is one of the leading causes of disability worldwide owing to the limited regenerative capacity of adult articular cartilage. Currently, there are no disease-modifying pharmacological or surgical therapies for OA. Fetal mammals, in contrast to adults, are capable of regenerating injured cartilage in the first two trimesters of gestation. A deeper understanding of the properties intrinsic to the response of fetal tissue to injury would allow us to modulate the way in which adult tissue responds to injury. In this study, we employed secretome proteomics to compare fetal and adult protein regulation in response to cartilage injury using an ovine cartilage defect model. The most relevant events comprised proteins associated with the immune response and inflammation, proteins specific for cartilage tissue and cartilage development, and proteins involved in cell growth and proliferation. Alarmins S100A8, S100A9 and S100A12 and coiled-coil domain containing 88A (CCDC88A), which are associated with inflammatory processes, were found to be significantly upregulated following injury in adult, but not in fetal animals. By contrast, cartilage-specific proteins like proteoglycan 4 were upregulated in response to injury only in fetal sheep postinjury. Our results demonstrate the power and relevance of the ovine fetal cartilage regeneration model presented here for the first time. The identification of previously unrecognized modulatory proteins that plausibly affect the healing process holds great promise for potential therapeutic interventions. Summary: Secretome proteomics identifies differential regulation of inflammation modulators during fetal and adult articular cartilage defect healing, offering novel strategies for therapy.
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Affiliation(s)
- Iris Ribitsch
- VETERM, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Rupert L Mayer
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna 1090, Austria
| | - Monika Egerbacher
- Histology & Embryology, Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Simone Gabner
- Histology & Embryology, Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Maciej M Kańduła
- Department of Biotechnology, Boku University Vienna, Vienna 1180, Austria.,Institute of Bioinformatics, Johannes Kepler University, Linz 4040, Austria
| | - Julie Rosser
- VETERM, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Eva Haltmayer
- VETERM, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Ulrike Auer
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Sinan Gültekin
- VETERM, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Johann Huber
- Teaching and Research Farm Kremesberg, Clinical Unit for Herd Health Management in Ruminants, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine Vienna, Vienna 1210, Austria
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna 1090, Austria
| | - David P Kreil
- Department of Biotechnology, Boku University Vienna, Vienna 1180, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna 1090, Austria
| | - Florien Jenner
- VETERM, University Equine Hospital, University of Veterinary Medicine Vienna, Vienna 1210, Austria
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Arthroscopic Cartilage Lesion Preparation in the Human Cadaveric Knee Using a Curette Technique Demonstrates Clinically Relevant Histologic Variation. Arthroscopy 2018; 34:2179-2188. [PMID: 29653795 DOI: 10.1016/j.arthro.2018.01.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the quality of arthroscopic cartilage debridement using a curette technique by comparing regional and morphologic variations within cartilage lesions prepared in human cadaveric knee specimens for the purpose of cartilage repair procedures. A secondary aim was to compare the histologic properties of cartilage lesions prepared by surgeons of varying experience. METHODS Standardized cartilage lesions (8 mm × 15 mm), located to the medial/lateral condyle and medial/lateral trochlea were created within 12 human cadaver knees by 40 orthopaedic surgeons. Participants were instructed to create full-thickness cartilage defects within the marked area, shouldered by uninjured vertical walls of cartilage, and to remove the calcified cartilage layer, without violating the subchondral plate. Histologic specimens were prepared to examine the verticality of surrounding cartilage walls at the front and rear aspects of the lesions, and to characterize the properties of the surrounding cartilage, the cartilage wall profile, the debrided lesion depth, bone sinusoid access, and the bone surface profile. Comparative analysis of cartilage wall verticality measured as deviation from perpendicular was performed, and Spearman's rank correlation analysis was used to examine associations between debrided wall verticality and surgeon experience. RESULTS Mean cartilage wall verticality relative to the base of the lesion was superior at the rear aspect of the lesion compared to the front aspect (12.9° vs 29.2°, P < .001). Variability was identified in the morphology of the surrounding cartilage (P < .001), cartilage wall profile (P = .016), debrided lesion depth (P = .028), bone surface profile (P = .040), and bone sinusoid access (P = .009), with sinusoid access identified in 42% of cases. There was no significant association of cartilage lesion wall verticality and surgeon years in practice (rs = 0.161, P = .065) or arthroscopic caseload (rs = -0.071, P = .419). CONCLUSIONS Arthroscopic cartilage lesion preparation using standard curette technique in a human cadaveric knee model results in inferior perpendicularity of the surrounding cartilage walls at the front aspect of the defect, compared to the rear aspect. This technique has shown significant variability in the depth of debridement, with debridement depths identified as either too superficial or too deep to the calcified cartilage layer in more than 60% of cases in this study. Surgeon experience does not appear to impact the morphologic properties of cartilage lesions prepared arthroscopically using ring curettes. CLINICAL RELEVANCE: To optimize restoration of hyaline-like cartilage tissue, careful attention to prepared cartilage lesion morphology is advised when arthroscopically performing cartilage repair, given the tendency for standard curette technique to create inferior verticality of cartilage walls at the front of the lesion, and the variable depth of debridement achieved.
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Ude CC, Miskon A, Idrus RBH, Abu Bakar MB. Application of stem cells in tissue engineering for defense medicine. Mil Med Res 2018; 5:7. [PMID: 29502528 PMCID: PMC6389246 DOI: 10.1186/s40779-018-0154-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/07/2018] [Indexed: 01/08/2023] Open
Abstract
The dynamic nature of modern warfare, including threats and injuries faced by soldiers, necessitates the development of countermeasures that address a wide variety of injuries. Tissue engineering has emerged as a field with the potential to provide contemporary solutions. In this review, discussions focus on the applications of stem cells in tissue engineering to address health risks frequently faced by combatants at war. Human development depends intimately on stem cells, the mysterious precursor to every kind of cell in the body that, with proper instruction, can grow and differentiate into any new tissue or organ. Recent reports have suggested the greater therapeutic effects of the anti-inflammatory, trophic, paracrine and immune-modulatory functions associated with these cells, which induce them to restore normal healing and tissue regeneration by modulating immune reactions, regulating inflammation, and suppressing fibrosis. Therefore, the use of stem cells holds significant promise for the treatment of many battlefield injuries and their complications. These applications include the treatment of injuries to the skin, sensory organs, nervous system tissues, the musculoskeletal system, circulatory/pulmonary tissues and genitals/testicles and of acute radiation syndrome and the development of novel biosensors. The new research developments in these areas suggest that solutions are being developed to reduce critical consequences of wounds and exposures suffered in warfare. Current military applications of stem cell-based therapies are already saving the lives of soldiers who would have died in previous conflicts. Injuries that would have resulted in deaths previously now result in wounds today; similarly, today's permanent wounds may be reduced to tomorrow's bad memories with further advances in stem cell-based therapies.
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Affiliation(s)
- Chinedu Cletus Ude
- Bio-artifical Organ and Regenerative Medicine Unit, National Defence University of Malaysia, Sungai Besi Camp, 57000, Kuala Lumpur, Malaysia
| | - Azizi Miskon
- Bio-artifical Organ and Regenerative Medicine Unit, National Defence University of Malaysia, Sungai Besi Camp, 57000, Kuala Lumpur, Malaysia.
| | - Ruszymah Bt Hj Idrus
- Department of Physiology, Pre-clinical Block, National University of Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Muhamad Bin Abu Bakar
- Bio-artifical Organ and Regenerative Medicine Unit, National Defence University of Malaysia, Sungai Besi Camp, 57000, Kuala Lumpur, Malaysia
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11
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Sridharan B, Laflin AD, Holtz MA, Pacicca DM, Wischmeier NK, Detamore MS. In vivo evaluation of stem cell aggregates on osteochondral regeneration. J Orthop Res 2017; 35:1606-1616. [PMID: 27770610 DOI: 10.1002/jor.23467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/29/2016] [Indexed: 02/04/2023]
Abstract
To date, many osteochondral regenerative approaches have utilized varied combinations of biocompatible materials and cells to engineer cartilage. Even in cell-based approaches, to date, no study has utilized stem cell aggregates alone for regenerating articular cartilage. Thus, the purpose of this study was to evaluate the performance of a novel stem cell-based aggregate approach in a fibrin carrier to regenerate osteochondral defects in the Sprague-Dawley rat trochlear groove model. Two different densities of rat bone marrow mesenchymal stem cell (rBMSC) aggregates were fabricated by the hanging drop technique. At 8 weeks, the cell aggregates supported the defects and served as a catalyst for neo-cartilage synthesis, and the experimental groups may have been beneficial for bone and cartilage regeneration compared to the fibrin-only control and sham groups, as evidenced by histological assessment. The cell density of rBMSC aggregates may thus directly impact chondrogenesis. The usage of cell aggregates with fibrin as a cell-based technology is a promising and translational new treatment strategy for repair of cartilage defects. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1606-1616, 2017.
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Affiliation(s)
| | - Amy D Laflin
- Department of Chemical and Petroleum Engineering, University of Kansas, 4132 Learned Hall, 1530W 15th St., Lawrence, Kansas, 66045
| | - Michael A Holtz
- Department of Chemical and Petroleum Engineering, University of Kansas, 4132 Learned Hall, 1530W 15th St., Lawrence, Kansas, 66045
| | - Donna M Pacicca
- Pediatric Orthopedic Surgery, Children's Mercy Hospital, Kansas City, Missouri, 64108
| | - Nicholas K Wischmeier
- Orthopedic Surgery Residency Program, University of Kansas Medical Center, Kansas City, Kansas, 66160
| | - Michael S Detamore
- Bioengineering Program, University of Kansas, Lawrence, Kansas
- Department of Chemical and Petroleum Engineering, University of Kansas, 4132 Learned Hall, 1530W 15th St., Lawrence, Kansas, 66045
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12
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Radhakrishnan J, Subramanian A, Krishnan UM, Sethuraman S. Injectable and 3D Bioprinted Polysaccharide Hydrogels: From Cartilage to Osteochondral Tissue Engineering. Biomacromolecules 2016; 18:1-26. [PMID: 27966916 DOI: 10.1021/acs.biomac.6b01619] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biomechanical performance of functional cartilage is executed by the exclusive anisotropic composition and spatially varying intricate architecture in articulating ends of diarthrodial joint. Osteochondral tissue constituting the articulating ends comprise superfical soft cartilage over hard subchondral bone sandwiching interfacial soft-hard tissue. The shock-absorbent, lubricating property of cartilage and mechanical stability of subchondral bone regions are rendered by extended chemical structure of glycosaminoglycans and mineral deposition, respectively. Extracellular matrix glycosaminoglycans analogous polysaccharides are major class of hydrogels investigated for restoration of functional cartilage. Recently, injectable hydrogels have gained momentum as it offers patient compliance, tunable mechanical properties, cell deliverability, and facile administration at physiological condition with long-term functionality and hyaline cartilage construction. Interestingly, facile modifiable functional groups in carbohydrate polymers impart tailorability of desired physicochemical properties and versatile injectable chemistry for the development of highly potent biomimetic in situ forming scaffold. The scaffold design strategies have also evolved from single component to bi- or multilayered and graded constructs with osteogenic properties for deep subchondral regeneration. This review highlights the significance of polysaccharide structure-based functions in engineering cartilage tissue, injectable chemistries, strategies for combining analogous matrices with cells/stem cells and biomolecules and multicomponent approaches for osteochondral mimetic constructs. Further, the rheology and precise spatiotemporal positioning of cells in hydrogel bioink for rapid prototyping of complex three-dimensional anisotropic cartilage have also been discussed.
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Affiliation(s)
- Janani Radhakrishnan
- Centre for Nanotechnology and Advanced Biomaterials, School of Chemical and Biotechnology, SASTRA University , Thanjavur-613401, India
| | - Anuradha Subramanian
- Centre for Nanotechnology and Advanced Biomaterials, School of Chemical and Biotechnology, SASTRA University , Thanjavur-613401, India
| | - Uma Maheswari Krishnan
- Centre for Nanotechnology and Advanced Biomaterials, School of Chemical and Biotechnology, SASTRA University , Thanjavur-613401, India
| | - Swaminathan Sethuraman
- Centre for Nanotechnology and Advanced Biomaterials, School of Chemical and Biotechnology, SASTRA University , Thanjavur-613401, India
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13
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Martinez‐Zapata MJ, Martí‐Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, Garcia J, Zaror C. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev 2016; 2016:CD006899. [PMID: 27223580 PMCID: PMC9308064 DOI: 10.1002/14651858.cd006899.pub3] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) is a treatment that contains fibrin and high concentrations of growth factors with the potential to improve the healing of chronic wounds. This is the first update of a review first published in 2012. OBJECTIVES To determine whether autologous PRP promotes the healing of chronic wounds. SEARCH METHODS In June 2015, for this first update, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library): Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We also searched for ongoing and unpublished clinical trials in the WHO International Clinical Trials Registry Platform (ICTRP) (searched January 2015). We did not impose any restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared autologous PRP with placebo or alternative treatments for any type of chronic wound in adults. We did not apply any date or language restrictions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology, including two reviewers independently selecting studies for inclusion, extracting data, and assessing risk of bias. MAIN RESULTS The search identified one new RCT, making a total of 10 included RCTs (442 participants, 42% women). The median number of participants per RCT was 29 (range 10 to 117). Four RCTs recruited people with a range of chronic wounds; three RCTs recruited people with venous leg ulcers, and three RCTs considered foot ulcers in people with diabetes. The median length of treatment was 12 weeks (range 8 to 40 weeks).It is unclear whether autologous PRP improves the healing of chronic wounds generally compared with standard treatment (with or without placebo) (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.95 to 1.50; I(2) = 27%, low quality evidence, 8 RCTs, 391 participants). Autologous PRP may increase the healing of foot ulcers in people with diabetes compared with standard care (with or without placebo) (RR 1.22, 95% CI 1.01 to 1.49; I(2) = 0%, low quality evidence, 2 RCTs, 189 participants). It is unclear if autologous PRP affects the healing of venous leg ulcers (RR 1.02, 95% CI 0.81 to 1.27; I(2) = 0% ). It is unclear if there is a difference in the risk of adverse events in people treated with PRP or standard care (RR 1.05, 95% CI 0.29 to 3.88; I(2) = 0%, low quality evidence from 3 trials, 102 participants). AUTHORS' CONCLUSIONS PRP may improve the healing of foot ulcers associated with diabetes, but this conclusion is based on low quality evidence from two small RCTs. It is unclear whether PRP influences the healing of other chronic wounds. The overall quality of evidence of autologous PRP for treating chronic wounds is low. There are very few RCTs evaluating PRP, they are underpowered to detect treatment effects, if they exist, and are generally at high or unclear risk of bias. Well designed and adequately powered clinical trials are needed.
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Affiliation(s)
- Maria José Martinez‐Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
| | | | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
| | - José Angel Expósito
- Agency for Health Quality and Assessment of Catalonia (AQuAS)Roc Boronat, 81‐95BarcelonaCataloniaSpain08805
| | - Ignasi Bolíbar
- Hospital de la Santa Creu i Sant PauEpidemiología Clínica y Salud PúblicaSant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaCatalunyaSpain08041
| | - Luciano Rodríguez
- Banc de Sang i TeixitsTissue BankPasseig Taulat 106‐116BarcelonaCatalunyaSpain080035
| | - Joan Garcia
- Departament de Salut. Generalitat de CatalunyaCentre de Teixits i Teràpia CellularAutovia de Castelldedels, Km 2.7L'Hospitalet de LLobregatBarcelonaCatalunyaSpain08907
| | - Carlos Zaror
- Faculty of Dentistry, Universidad de la FronteraDepartment of Pediatric Dentistry and OrthodonticTemucoChile
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Ishak MFB, See GB, Hui CK, Abdullah AB, Saim LB, Saim AB, Idrus RBH. The formation of human auricular cartilage from microtic tissue: An in vivo study. Int J Pediatr Otorhinolaryngol 2015; 79:1634-9. [PMID: 26250439 DOI: 10.1016/j.ijporl.2015.06.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study aimed to isolate, culture-expand and characterize the chondrocytes isolated from microtic cartilage and evaluate its potential as a cell source for ear cartilage reconstruction. Specific attention was to construct the auricular cartilage tissue by using fibrin as scaffold. STUDY DESIGN Cell culture experiment with the use of microtic chondrocytes. DESIGN Cell culture experiment with the use of microtic chondrocytes. METHODS After ear reconstructive surgery at the Universiti Kebangsaan Malaysia Medical Center, chondrocytes were isolated from microtic cartilage. Chondrocytes isolated from the tissue were cultured expanded until passage 4 (P4). Upon confluency at P4, chondrocytes were harvested and tissue engineered constructs were made with human plasma polymerized to fibrin. Constructs formed later is implanted at the dorsal part of nude mice for 8 weeks, followed by post-implantation evaluation with histology staining (Hematoxylin and Eosin (H&E) and Safranin O), immunohistochemistry and RT-PCR for chondrogenic associated genes expression level. RESULTS Under gross assessment, the construct after 8 weeks of implantation showed similar physical characteristics that of cartilage. Histological staining showed abundant lacunae cells embedded in extracellular matrix similar to that of native cartilage. Safranin O staining showed positive staining which indicates the presence of proteoglycan-rich matrix. Immunohistochemistry analysis showed the strong positive staining for collagen type II, the specific collagen type in the cartilage. Gene expression quantification showed no significant differences in the expression of chondrogenic gene used which is collagen type I, collagen type II, aggrecan core protein (ACP), elastin and sox9 genes when compared to construct formed from normal auricular tissue. CONCLUSION Chondrocytes isolated from microtia cartilage has the potential to be used as an alternative cell source for external ear reconstruction in future clinical application.
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Affiliation(s)
- Mohamad Fikeri bin Ishak
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Goh Bee See
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Chua Kien Hui
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Asma bt Abdullah
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Lokman bin Saim
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Aminuddin bin Saim
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Ear, Nose and Throat Consultant Clinic, Ampang Puteri Specialist Hospital, Kuala Lumpur, Malaysia
| | - Ruszymah bt Haji Idrus
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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15
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Mohan N, Gupta V, Sridharan BP, Mellott AJ, Easley JT, Palmer RH, Galbraith RA, Key VH, Berkland CJ, Detamore MS. Microsphere-based gradient implants for osteochondral regeneration: a long-term study in sheep. Regen Med 2015; 10:709-28. [PMID: 26418471 DOI: 10.2217/rme.15.38] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The microfracture technique for cartilage repair has limited ability to regenerate hyaline cartilage. AIM The current study made a direct comparison between microfracture and an osteochondral approach with microsphere-based gradient plugs. MATERIALS & METHODS The PLGA-based scaffolds had opposing gradients of chondroitin sulfate and β-tricalcium phosphate. A 1-year repair study in sheep was conducted. RESULTS The repair tissues in the microfracture were mostly fibrous and had scattered fissures with degenerative changes. Cartilage regenerated with the gradient plugs had equal or superior mechanical properties; had lacunated cells and stable matrix as in hyaline cartilage. CONCLUSION This first report of gradient scaffolds in a long-term, large animal, osteochondral defect demonstrated potential for equal or better cartilage repair than microfracture.
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Affiliation(s)
- Neethu Mohan
- Department of Chemical & Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA.,Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala 695011, India
| | - Vineet Gupta
- Bioengineering Graduate Program, University of Kansas, Lawrence, KS 66045, USA
| | | | - Adam J Mellott
- Department of Chemical & Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Ross H Palmer
- Preclinical Surgical Research Laboratory, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | | | - Vincent H Key
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Cory J Berkland
- Department of Chemical & Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA.,Bioengineering Graduate Program, University of Kansas, Lawrence, KS 66045, USA.,Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS 66045, USA
| | - Michael S Detamore
- Department of Chemical & Petroleum Engineering, University of Kansas, Lawrence, KS 66045, USA.,Bioengineering Graduate Program, University of Kansas, Lawrence, KS 66045, USA
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16
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Abdul Rahman R, Mohamad Sukri N, Md Nazir N, Ahmad Radzi MA, Zulkifly AH, Che Ahmad A, Hashi AA, Abdul Rahman S, Sha'ban M. The potential of 3-dimensional construct engineered from poly(lactic-co-glycolic acid)/fibrin hybrid scaffold seeded with bone marrow mesenchymal stem cells for in vitro cartilage tissue engineering. Tissue Cell 2015; 47:420-30. [PMID: 26100682 DOI: 10.1016/j.tice.2015.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/26/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Abstract
Articular cartilage is well known for its simple uniqueness of avascular and aneural structure that has limited capacity to heal itself when injured. The use of three dimensional construct in tissue engineering holds great potential in regenerating cartilage defects. This study evaluated the in vitro cartilaginous tissue formation using rabbit's bone marrow mesenchymal stem cells (BMSCs)-seeded onto poly(lactic-co-glycolic acid) PLGA/fibrin and PLGA scaffolds. The in vitro cartilaginous engineered constructs were evaluated by gross inspection, histology, cell proliferation, gene expression and sulphated glycosaminoglycan (sGAG) production at week 1, 2 and 3. After 3 weeks of culture, the PLGA/fibrin construct demonstrated gross features similar to the native tissue with smooth, firm and glistening appearance, superior histoarchitectural and better cartilaginous extracellular matrix compound in concert with the positive glycosaminoglycan accumulation on Alcian blue. Significantly higher cell proliferation in PLGA/fibrin construct was noted at day-7, day-14 and day-21 (p<0.05 respectively). Both constructs expressed the accumulation of collagen type II, collagen type IX, aggrecan and sox9, showed down-regulation of collagen type I as well as produced relative sGAG content with PLGA/fibrin construct exhibited better gene expression in all profiles and showed significantly higher relative sGAG content at each time point (p<0.05). This study suggested that with optimum in vitro manipulation, PLGA/fibrin when seeded with pluripotent non-committed BMSCs has the capability to differentiate into chondrogenic lineage and may serve as a prospective construct to be developed as functional tissue engineered cartilage.
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Affiliation(s)
- Rozlin Abdul Rahman
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Norhamiza Mohamad Sukri
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Noorhidayah Md Nazir
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Muhammad Aa'zamuddin Ahmad Radzi
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Ahmad Hafiz Zulkifly
- Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Aminudin Che Ahmad
- Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Abdurezak Abdulahi Hashi
- Department of Biotechnology, Kulliyyah of Science, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Suzanah Abdul Rahman
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia
| | - Munirah Sha'ban
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur, Malaysia.
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17
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Jamil K, Chua KH, Joudi S, Ng SL, Yahaya NH. Development of a cartilage composite utilizing porous tantalum, fibrin, and rabbit chondrocytes for treatment of cartilage defect. J Orthop Surg Res 2015; 10:27. [PMID: 25889942 PMCID: PMC4327955 DOI: 10.1186/s13018-015-0166-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/14/2015] [Indexed: 12/01/2022] Open
Abstract
Objective Functional tissue engineering has emerged as a potential means for treatment of cartilage defect. Development of a stable cartilage composite is considered to be a good option. The aim of the study was to observe whether the incorporation of cultured chondrocytes on porous tantalum utilizing fibrin as a cell carrier would promote cartilage tissue formation. Methods Rabbit articular chondrocytes were cultured and seeded onto tantalum with fibrin as temporary matrix in a composite, which was divided into three groups. The first group was kept in vitro while a total of 12 constructs were implanted into the dorsum of mice for the second and third groups. The implanted tissues were harvested after 4 weeks (second group) and after 8 weeks (third group). Specific characteristic of cartilage growth were studied by histological and biochemical assessment, immunohistochemistry, and quantitative PCR analysis. Results Histological and biochemical evaluation of the formed cartilage using hematoxylin and eosin and Alcian blue staining showed lacunae chondrocytes embedded in the proteoglycan rich matrix. Dimethylmethylene blue assay demonstrated high glycosaminoglycans content in the removed tissue following 8 weeks of implantation. Immunohistochemistry results showed the composites after implantation expressed high collagen type II. Quantitative PCR results confirmed a significant increase in cartilage associated genes expression (collagen type II, AggC, Sox 9) after implantation. Conclusion Tantalum scaffold with fibrin as cell carrier promotes chondrocyte proliferation and cartilaginous tissue formation. Producing hyaline cartilage within a stable construct of tantalum and fibrin has a potential for treatment of cartilage defect.
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Affiliation(s)
- Kamal Jamil
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Kien-Hui Chua
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Samad Joudi
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Sook-Luan Ng
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Nor Hamdan Yahaya
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
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18
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Yotsu RR, Hagiwara S, Okochi H, Tamaki T. Case series of patients with chronic foot ulcers treated with autologous platelet-rich plasma. J Dermatol 2015; 42:288-95. [DOI: 10.1111/1346-8138.12777] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Rie R. Yotsu
- Department of Dermatology; National Center for Global Health and Medicine; Tokyo Japan
- Department of Dermatology; National Suruga Sanatorium; Shizuoka Japan
| | - Shotaro Hagiwara
- Department of Hematology; National Center for Global Health and Medicine; Tokyo Japan
| | - Hitoshi Okochi
- Department of Dermatology; National Center for Global Health and Medicine; Tokyo Japan
- Department of Regenerative Medicine; National Center for Global Health and Medicine; Tokyo Japan
| | - Takeshi Tamaki
- Department of Dermatology; National Center for Global Health and Medicine; Tokyo Japan
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Arthroscopy of the normal cadaveric ovine femorotibial joint: a systematic approach to the cranial and caudal compartments. Vet Comp Orthop Traumatol 2014; 27:387-94. [PMID: 25213032 DOI: 10.3415/vcot-14-03-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 07/13/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Preclinical studies using large animal models play an intergral part in translational research. For this study, our objectives were: to develop and validate arthroscopic approaches to four compartments of the stifle joint as determined via the gross and arthroscopic anatomy of the cranial and caudal aspects of the joint. METHODS Cadaveric hindlimbs (n = 39) were harvested from mature ewes. The anatomy was examined by tissue dissection (n = 6), transverse sections (n = 4), and computed tomography (n = 4). The joint was arthroscopically explored in 25 hindlimbs. RESULTS A cranio-medial portal was created medial to the patellar ligament. The cranio-lateral portal was made medial to the extensor digitorum longus tendon. The medial femoral condyle was visible, as well as the cranial cruciate ligament, caudal cruciate ligament and both menisci with the intermeniscal ligament. Valgus stress improved visibility of the caudal horn of the medial meniscus and tibial plateau. To explore the caudal compartments, a portal was created 1 cm proximal to the most caudal aspect of the tibial condyle. Both femoral condyles, menisci, caudal cruciate ligament, the popliteal tendon and the menisco-femoral ligament were visible. The common peroneal nerve and popliteal artery and vein are vulnerable structures to injury during arthroscopy. CLINICAL SIGNIFICANCE The arthroscopic approach developed in this research is ideal to evaluate the ovine stifle joint.
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Baums MH, Schultz W, Kostuj T, Klinger HM. Cartilage repair techniques of the talus: An update. World J Orthop 2014; 5:171-179. [PMID: 25035819 PMCID: PMC4095009 DOI: 10.5312/wjo.v5.i3.171] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.
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Shamsul BS, Tan KK, Chen HC, Aminuddin BS, Ruszymah BHI. Posterolateral spinal fusion with ostegenesis induced BMSC seeded TCP/HA in a sheep model. Tissue Cell 2014; 46:152-8. [PMID: 24630213 DOI: 10.1016/j.tice.2014.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 11/26/2022]
Abstract
Autogenous bone graft is the gold standard for fusion procedure. However, pain at donor site and inconsistent outcome have left a surgeon to venture into some other technique for spinal fusion. The objective of this study was to determine whether osteogenesis induced bone marrow stem cells with the combination of ceramics granules (HA or TCP/HA), and fibrin could serve as an alternative to generate spinal fusion. The sheep's bone marrow mesenchymal stem cells (BMSCs) were aspirated form iliac crest and cultured for several passages until confluence. BMSCs were trypsinized and seeded on hydroxyapatite scaffold (HA) and tricalcium phosphate/hydroxyapatite (TCP/HA) for further osteogenic differentiation in the osteogenic medium one week before implantation. Six adult sheep underwent three-level, bilateral, posterolateral intertransverse process fusions at L1-L6. Three fusion sites in each animal were assigned to three treatments: (a) HA constructs group/L1-L2, (b) TCP/HA constructs group/L2-L3, and (c) autogenous bone graft group/L5-L6. The spinal fusion segments were evaluated using radiography, manual palpation, histological analysis and scanning electron microscopy (SEM) 12 weeks post implantation. The TCP/HA constructs achieved superior lumbar intertransverse fusion compared to HA construct but autogenous bone graft still produced the best fusion among all.
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Affiliation(s)
- B S Shamsul
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - K K Tan
- Orthopedic and Spinal Surgery Consultant Clinic, Johor Specialist Hospital, Malaysia
| | - H C Chen
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, Malaysia
| | - B S Aminuddin
- Ear, Nose & Throat Consultant Clinic, Ampang Puteri Specialist Hospital, Malaysia; Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - B H I Ruszymah
- Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Malaysia; Department of Physiology, Medical Faculty Universiti Kebangsaan Malaysia, Malaysia.
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Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Bellmunt-Montoya S, Cid J, Urrútia G. Autologous platelet-rich plasma for treating surgical wounds. Hippokratia 2013. [DOI: 10.1002/14651858.cd010739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Maria José Martinez-Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre. Universitat Autònoma de Barcelona. Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona; Sant Antoni M. Claret 171 Casa de Convalescència Barcelona Catalonia Spain 08041
| | - Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo; Centro Cochrane Ecuador; Universidad Tecnológica Equinoccial Quito Ecuador
| | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre, Institute of Biomedical Research (IIB Sant Pau); Sant Antoni Maria Claret 171 - Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
| | - Sergi Bellmunt-Montoya
- Hospital de la Santa Creu i Sant Pau, IBB Sant Pau; Angiology, Vascular and Endovascular Surgery; Sant Quinti No. 89 Barcelona Spain 08041
| | - Joan Cid
- Hospital Universitari Joan XXIII; Hematology; C/. Dr. Mallafré Guasch, 4 Tarragona Spain 43007
| | - Gerard Urrútia
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre - IIB Sant Pau; c/ Sant Antoni Maria Claret 171 Barcelona Spain 08041
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Fonseca C, Caminal M, Peris D, Barrachina J, Fàbregas PJ, Garcia F, Cairó JJ, Gòdia F, Pla A, Vives J. An arthroscopic approach for the treatment of osteochondral focal defects with cell-free and cell-loaded PLGA scaffolds in sheep. Cytotechnology 2013; 66:345-54. [PMID: 23673652 DOI: 10.1007/s10616-013-9581-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 04/30/2013] [Indexed: 12/25/2022] Open
Abstract
Osteochondral injuries are common in humans and are relatively difficult to manage with current treatment options. The combination of novel biomaterials and expanded progenitor or stem cells provides a source of therapeutic and immunologically compatible medicines that can be used in regenerative medicine. However, such new medicinal products need to be tested in translational animal models using the intended route of administration in humans and the intended delivery device. In this study, we evaluated the feasibility of an arthroscopic approach for the implantation of biocompatible copolymeric poly-D,L-lactide-co-glycolide (PLGA) scaffolds in an ovine preclinical model of knee osteochondral defects. Moreover this procedure was further tested using ex vivo expanded autologous chondrocytes derived from cartilaginous tissue, which were loaded in PLGA scaffolds and their potential to generate hyaline cartilage was evaluated. All scaffolds were successfully implanted arthroscopically and the clinical evolution of the animals was followed by non invasive MRI techniques, similar to the standard in human clinical practice. No clinical complications occurred after the transplantation procedures in any of the animals. Interestingly, the macroscopic evaluation demonstrated significant improvement after treatment with scaffolds loaded with cells compared to untreated controls.
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Affiliation(s)
- C Fonseca
- Departament de Medicina i Cirurgia Animals, Àrea de Medicina i Cirurgia Animal, Facultat de Veterinària, Edifici V, Campus de la UAB, 08193, Bellaterra, Cerdanyola del Vallès, Spain
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Abstract
In this article, our research on osteochondral lesions of the talus (OLTs) is summarized, the orthopedic literature is reviewed, and the direction of future research and treatment trends are discussed. Our research has explored the role of lesion size, significance of marrow edema, relationship of patient age, importance of lesion containment, and role of a stable cartilage lesion cap in the prognosis and outcomes of these lesions. We have identified smaller sized lesions, younger patients and contained lesions as independent predictors of success for the operative treatment of OLTs. Our data should facilitate the development of a more comprehensive treatment algorithm to more accurately predict success in operative management of these lesions.
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Patel DV, McKelvie J, Sherwin T, McGhee C. Keratocyte progenitor cell transplantation: A novel therapeutic strategy for corneal disease. Med Hypotheses 2013. [DOI: 10.1016/j.mehy.2012.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Orth P, Madry H. A low morbidity surgical approach to the sheep femoral trochlea. BMC Musculoskelet Disord 2013; 14:5. [PMID: 23286467 PMCID: PMC3539878 DOI: 10.1186/1471-2474-14-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 12/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ovine stifle joint is an important location for investigations on the repair of articular cartilage defects in preclinical large animals. The classical medial parapatellar approach to the femoral trochlea is hazardous because of the high risk of postoperative patellar luxation. Here, we describe a low morbidity surgical exposure of the ovine trochlea without the necessity for intraoperative patellar luxation. METHODS Bilateral surgical exposure of the femoral trochlea of the sheep stifle joint was performed using the classical medial parapatellar approach with intraoperative lateral patellar luxation and transection of the medial patellar retinaculum in 28 ovine stifle joints. A low morbidity approach was performed bilaterally in 116 joints through a mini-arthrotomy without the need to transect the medial patellar retinaculum or the oblique medial vastus muscle nor surgical patellar luxation. Postoperatively, all 72 animals were monitored to exclude patellar luxations and deep wound infections. RESULTS The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet. No postoperative patellar luxations were observed compared to a postoperative patellar luxation rate of 25% experienced with the classical medial parapatellar approach and a re-luxation rate of 80% following revision surgery. No signs of lameness, wound infections, or empyema were observed for both approaches. CONCLUSIONS The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach. It is therefore suitable to create articular cartilage defects on the femoral trochlea without the risk of postoperative patellar luxation.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Saar, Germany
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The use of fibrin matrix-mixed gel-type autologous chondrocyte implantation in the treatment for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2013; 21:1251-60. [PMID: 22752415 PMCID: PMC3657090 DOI: 10.1007/s00167-012-2096-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 06/05/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE This study assessed the clinical results and second-look arthroscopy after fibrin matrix-mixed gel-type autologous chondrocyte implantation to treat osteochondral lesions of the talus. METHODS Chondrocytes were harvested from the cuboid surface of the calcaneus in 38 patients and cultured, and gel-type autologous chondrocyte implantation was performed with or without medial malleolar osteotomy. Preoperative American orthopedic foot and ankle society ankle-hind foot scores, visual analogue score, Hannover scoring system and subjective satisfaction were investigated, and the comparison of arthroscopic results (36/38, 94.7 %) and MRI investigation of chondral recovery was performed. Direct tenderness and relationship to the active daily life of the donor site was evaluated. RESULTS The preoperative mean ankle-hind foot scores (71 ± 14) and Hannover scoring system (65 ± 10) had increased to 91 ± 12 and 93 ± 14, respectively, at 24-month follow-up (p < 0.0001), and the preoperative visual analogue score of 58 mm had decreased to 21 mm (p < 0.0001). Regarding subjective satisfaction, 34 cases (89.5 %) reported excellent, good or fair. Chondral regeneration was analysed by second-look arthroscopy and MRI. Complications included one non-union and two delayed-unions of the osteotomy sites, and 9 ankles (9/31, 29.0 %) sustained damaged medial malleolar cartilage due to osteotomy. Marked symptoms at the biopsy site did not adversely affect the patient's active daily life. CONCLUSIONS Fibrin matrix-mixed gel-type autologous chondrocyte implantation using the cuboid surface of the calcaneus as a donor can be used for treating osteochondral lesions of the talus.
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Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, Garcia J. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev 2012; 10:CD006899. [PMID: 23076929 DOI: 10.1002/14651858.cd006899.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) is a treatment that contains fibrin and high concentrations of growth factors and has the potential to aid wound healing. OBJECTIVES To determine whether autologous PRP promotes the healing of chronic wounds. SEARCH METHODS We searched the Cochrane Wounds Group Specialised Register (searched 15 August 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 8); Ovid MEDLINE (1950 to August Week 1 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 14, 2012); Ovid EMBASE (1980 to 2012 Week 32); EBSCO CINAHL (1982 to 10 August 2012) and International Clinical Trials Registry Platform (ICTRP)(accessed 22 August 2012). No date or language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared autologous PRP with placebo or alternative treatments for any type of chronic wound in adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each study against the inclusion criteria, extracted data and assessed risk of bias for all included trials. We calculated the risk ratio (RR) or the mean difference (MD) and time to wound healing was analysed as survival data using the hazard ratio (HR). We considered heterogeneity as significant when I(2) was >75%. MAIN RESULTS Nine eligible RCTs were included, with a total of 325 participants of whom 44% were women. The median number of participants per RCT was 26 (range 10 to 86). Four RCTs recruited people with mixed chronic wounds (there were participants with wounds caused by more than one aetiology and participants who had wounds of several aetiologies in the same trial), three RCTs recruited people with venous leg ulcers and two RCTs considered foot ulcers in people with diabetes. The median length of treatment was 12 weeks (range eight to 40 weeks).One study was at low risk of bias, three studies were at high risk of bias with the remainder being at overall unclear risk of bias. The proportion of completely healed chronic wounds was reported in seven RCTs that compared PRP with standard treatment or placebo, with no statistically significant difference between the groups, in diabetic foot ulcers (RR 1.16; 95% CI 0.57 to 2.35), in venous leg ulcers (pooled RR 1.02; 95% CI 0.81 to 1.27; I(2)=0% ) and in mixed chronic wounds (pooled RR 1.85; 95% CI 0.76 to 4.51; I(2)=42%). The total area epithelialised at the end of the intervention was reported in three RCTs of mixed chronic wounds, there was no statistically significant difference between the groups (pooled MD -1.94 cm(2); 95% CI -4.74 to 0.86; I(2)=47%). The percentage of wound area healed was reported in two RCTs of mixed chronic wounds, and results were statistically significant in favour of the PRP group (RR 51.78%; 95% CI 32.70 to 70.86; I(2)= 0%). Wound complications like infection or necrosis were reported by three RCTs, and there was no statistically significant difference between groups (RR 1.08; 95% CI 0.31 to 3.73). Adverse effects were reported by three studies and there was no statistically significant difference between people treated with PRP and those not given PRP (pooled RR 1.07; 95% CI 0.32 to 3.58; I(2)=0%). AUTHORS' CONCLUSIONS There is currently no evidence to suggest that autologous PRP is of value for treating chronic wounds. However, current evidence is based on a small number of RCTs, most of which are either at high or unclear risk of bias. Well-designed and adequately powered clinical trials are needed.
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Affiliation(s)
- Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre. Universitat Autònoma de Barcelona. Institute of Biomedical Research Sant Pau (IIB Sant Pau),Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Barcelona, Spain.
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Goebel L, Orth P, Müller A, Zurakowski D, Bücker A, Cucchiarini M, Pape D, Madry H. Experimental scoring systems for macroscopic articular cartilage repair correlate with the MOCART score assessed by a high-field MRI at 9.4 T--comparative evaluation of five macroscopic scoring systems in a large animal cartilage defect model. Osteoarthritis Cartilage 2012; 20:1046-55. [PMID: 22698442 DOI: 10.1016/j.joca.2012.05.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 04/11/2012] [Accepted: 05/30/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a new macroscopic scoring system which allows for an overall judgment of experimental articular cartilage repair and compare it with four existing scoring systems and high-field magnetic resonance imaging (MRI). METHODS A new macroscopic scoring system was developed to assess the repair of cartilage defects. Cartilage repair was graded by three observers with different experience in cartilage research at 2-3 time points and compared with the protocol A of the international cartilage repair society (ICRS) cartilage repair assessment score, the Oswestry arthroscopy score, and macroscopic grading systems designed by Jung and O'Driscoll. Parameters were correlated with the two-dimensional (2D) magnetic resonance observation of cartilage repair tissue (MOCART) score based on a 9.4 T MRI as an external reference standard. RESULTS All macroscopic scores exhibited high intra- and interobserver reliability and high internal correlation. The newly developed macroscopic scoring system had the highest intraobserver [0.866 ≤ intraclass correlation (ICC) ≤ 0.895] and the highest interobserver reliability (ICC = 0.905) for "total points". Here, Cronbach's alpha indicated good homogeneity and functioning of the items (mean = 0.782). "Total points" of the 2D MOCART score correlated with all macroscopic scores (all P < 0.0001). The newly developed macroscopic scoring system yielded the highest correlation for the MRI parameter "defect fill" (rho = 0.765; all P < 0.0001). CONCLUSIONS "Total points" and "defect fill", two clinically relevant indicators of cartilage repair, can be reliably and directly assessed by macroscopic evaluation, using either system. These data support the use of macroscopic assessment to precisely judge cartilage repair in preclinical large animal models.
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Affiliation(s)
- L Goebel
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany.
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Schulz RM, Haberhauer M, Zernia G, Pösel C, Thümmler C, Somerson JS, Huster D. Comprehensive characterization of chondrocyte cultures in plasma and whole blood biomatrices for cartilage tissue engineering. J Tissue Eng Regen Med 2012; 8:566-77. [PMID: 22761174 DOI: 10.1002/term.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 05/07/2012] [Accepted: 05/29/2012] [Indexed: 11/12/2022]
Abstract
Many synthetic polymers and biomaterials have been used as matrices for 3D chondrocyte seeding and transplantation in the field of cartilage tissue engineering. To develop a fully autologous carrier for chondrocyte cultivation, we examined the feasibility of allogeneic plasma and whole blood-based matrices and compared them to agarose constructs. Primary articular chondrocytes isolated from 12-month-old pigs were embedded into agarose, plasma and whole blood matrices and cultivated under static-free swelling conditions for up to four weeks. To evaluate the quality of the synthesized extracellular matrix (ECM), constructs were subjected to weekly examinations using histological staining, spectrophotometry, immunohistochemistry and biochemical analysis. In addition, gene expression of cartilage-specific markers such as aggrecan, Sox9 and collagen types I, II and X was determined by RT-PCR. Chondrocyte morphology was assessed via scanning electron microscopy and viability staining, including proliferation and apoptosis assays. Finally, (13) C NMR spectroscopy provided further evidence of synthesis of ECM components. It was shown that chondrocyte cultivation in allogeneic plasma and whole-blood matrices promoted sufficient chondrocyte viability and differentiation behaviour, resulting in neo-formation of a hyaline-like cartilage matrix.
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Affiliation(s)
- Ronny M Schulz
- Department of Cell Techniques and Applied Stem Cell Biology, Center of Biotechnology and Biomedicine, University of Leipzig, Deutscher Platz 5, D-04103, Leipzig, Germany; Translational Centre for Regenerative Medicine, University of Leipzig, Philipp-Rosenthal-Str. 55, D-04105, Leipzig, Germany
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Egli RJ, Wernike E, Grad S, Luginbühl R. Physiological cartilage tissue engineering effect of oxygen and biomechanics. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2012; 289:37-87. [PMID: 21749898 DOI: 10.1016/b978-0-12-386039-2.00002-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In vitro engineering of cartilaginous tissues has been studied for many years, and tissue-engineered constructs are sought to be used clinically for treating articular cartilage defects. Even though there is a plethora of studies and data available, no breakthroughs have been achieved yet that allow for implanting in vivo cultured articular cartilaginous tissues in patients. A review of contributions to cartilage tissue engineering over the past decades emphasizes that most of the studies were performed under environmental conditions neglecting the physiological situation. This is specifically pronounced in the use of bioreactor systems which neither allow for application of near physiomechanical stimulations nor for controlling a hypoxic environment as it is experienced in synovial joints. It is suspected that the negligence of these important parameters has slowed down progress and prevented major breakthroughs in the field. This review focuses on the main aspects of cartilage tissue engineering with emphasis on the relation and understanding of employing physiological conditions.
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Herfat ST, Boguszewski DV, Shearn JT. Applying simulated in vivo motions to measure human knee and ACL kinetics. Ann Biomed Eng 2012; 40:1545-53. [PMID: 22227973 DOI: 10.1007/s10439-011-0500-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/23/2011] [Indexed: 12/22/2022]
Abstract
Patients frequently experience anterior cruciate ligament (ACL) injuries but current ACL reconstruction strategies do not restore the native biomechanics of the knee, which can contribute to the early onset of osteoarthritis in the long term. To design more effective treatments, investigators must first understand normal in vivo knee function for multiple activities of daily living (ADLs). While the 3D kinematics of the human knee have been measured for various ADLs, the 3D kinetics cannot be directly measured in vivo. Alternatively, the 3D kinetics of the knee and its structures can be measured in an animal model by simulating and applying subject-specific in vivo joint motions to a joint using robotics. However, a suitable biomechanical surrogate should first be established. This study was designed to apply a simulated human in vivo motion to human knees to measure the kinetics of the human knee and ACL. In pursuit of establishing a viable biomechanical surrogate, a simulated in vivo ovine motion was also applied to human knees to compare the loads produced by the human and ovine motions. The motions from the two species produced similar kinetics in the human knee and ACL. The only significant difference was the intact knee compression force produced by the two input motions.
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Affiliation(s)
- Safa T Herfat
- Department of Biomedical Engineering, Tissue Engineering and Biomechanics Laboratories, 2901 Campus Drive, 852 Engineering Research Center, Cincinnati, OH 45221-0012, USA
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Ishak MF, Chua KH, Asma A, Saim L, Aminuddin BS, Ruszymah BHI, Goh BS. Stem cell genes are poorly expressed in chondrocytes from microtic cartilage. Int J Pediatr Otorhinolaryngol 2011; 75:835-40. [PMID: 21543123 DOI: 10.1016/j.ijporl.2011.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/23/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study was aimed to see the difference between chondrocytes from normal cartilage compared to chondrocytes from microtic cartilage. Specific attentions were to characterize the growth of chondrocytes in terms of cell morphology, growth profile and RT-PCR analysis. STUDY DESIGN Laboratory experiment using auricular chondrocytes. METHODS Chondrocytes were isolated from normal and microtic human auricular cartilage after ear reconstructive surgeries carried out at the Universiti Kebangsaan Malaysia Medical Centre. Chondrocytes were cultured in vitro and subcultured until passage 4. Upon confluency, cultured chondrocytes at each passage (P1, P2, P3 and P4) were harvested and subjected to growth profile and gene expression analyses. Comparison was made between the microtic and normal chondrocytes. RESULTS For growth profile analysis cell viability did not show significant differences between both samples. There are no significance differences between both samples in terms of its growth rate, except in passage 1 where microtic chondrocytes were significant lower in their growth rate. Population doubling time and total number of cell doubling of all samples also did not show any significant differences. Gene expression is measured using Real Time-Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). There is no significant differences in the expression of collagen type I, collagen type II, collagen type X, aggrecan core protein, elastin and sox9 genes in both samples. There are significant lower in the expression of sox2, nestin, BST-1 and OCT-4 gene in microtic chondrocytes compared to the normal chondrocytes. Stem cells markers are included in this study as stemness in cells may imply a greater proliferative potential and plasticity in vitro. CONCLUSION Chondrocytes from microtic samples have the same properties as chondrocytes from normal samples and hold promises to be used as a starting material in the reconstruction of the external ear in future clinical application. The reduction in sox2, nestin, BST-1 and OCT-4 gene expression in microtic samples could be the possible cause of the arrested development of the external ear.
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Affiliation(s)
- M F Ishak
- Dept. of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Taylor WR, Poepplau BM, König C, Ehrig RM, Zachow S, Duda GN, Heller MO. The medial-lateral force distribution in the ovine stifle joint during walking. J Orthop Res 2011; 29:567-71. [PMID: 20957731 DOI: 10.1002/jor.21254] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 08/12/2010] [Indexed: 02/04/2023]
Abstract
Knowledge of the load distribution in the knee is essential for understanding the interaction between mechanics and biology in both the healthy and diseased joint. While the sheep stifle joint is a predominant model for better understanding regeneration after injury, little is known about the compartmental force distribution between the medial and lateral condyles. By including sheep specific anatomy and gait analyses, we used computational musculoskeletal analyses to estimate the medial-lateral joint contact force distribution in ovine stifle joints during walking by simplifying the system of equations into a 2D problem that was solved directly. Gait analysis was conducted using bone markers in three female Merino-mix sheep. Joint contact forces were computed with respect to the specific anatomy of the ovine tibia, resulting in low (<0.13 bodyweight) mean anteroposterior shear forces throughout the gait cycle, with mean peak contact forces perpendicular to the tibial plateau of 2.2 times bodyweight. The medial-lateral compartmental load distribution across the tibial condyles was determined and revealed loading predominantly on the medial condyle, bearing approximately 75% of the total load during phases of peak loading. By considering the anatomical characteristics of the ovine stifle joint, together with the dynamic forces during gait, this study provides evidence for predominantly medial loading in sheep, somewhat similar to the distribution reported in man. However, the exact conditions under which the loading in the ovine stifle joint is representative of the human situation will need to be elucidated in further studies.
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Affiliation(s)
- William R Taylor
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Centrum für Sportwissenschaft und Sportmedizin Berlin (CSSB), Berlin, Germany.
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Osterhoff G, Löffler S, Steinke H, Feja C, Josten C, Hepp P. Comparative anatomical measurements of osseous structures in the ovine and human knee. Knee 2011; 18:98-103. [PMID: 20188573 DOI: 10.1016/j.knee.2010.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 01/29/2010] [Accepted: 02/01/2010] [Indexed: 02/02/2023]
Abstract
The ovine stifle has been increasingly used as a large animal model for the human knee. Still, comparative anatomical measurements of the knee in sheep and humans are missing. Thus, the purpose of this study was to describe and measure the osseous anatomy of the ovine stifle in comparison to the human knee. Twenty-four stifles of skeletal-mature merino-sheep and 24 human cadaver knees were obtained and distances between selected anatomical structures of the distal femur, the proximal tibia, and the patella were measured digitally and documented. Based on these, intercondylar ratio, tibial aspect ratio, patella aspect ratio and the cortical index were calculated. Regarding epicondylar width, lateral condylar width, medial condylar width and the tibial dimensions, the ovine stifle can be considered as a human knee scaled down by one third. However, sheep have a smaller trochlear width and a narrower femoral intercondylar notch than humans resulting in lower relative values for intercondylar width and intercondylar height. The distal femur's cortical index is the same in both species. In contrast, sheep have a massive bone stock below their tibial plateau and a proximal tibial shaft with remarkably thick cortical bone. The ovine stifle can be regarded as a useful model for the human knee. However, future studies should consider the differences in the femoral intercondylar notch width, the patellofemoral joint's biomechanics and the proximal tibia's cortical bone stock.
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Affiliation(s)
- Georg Osterhoff
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
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Munirah S, Samsudin OC, Aminuddin BS, Ruszymah BHI. Expansion of human articular chondrocytes and formation of tissue-engineered cartilage: a step towards exploring a potential use of matrix-induced cell therapy. Tissue Cell 2011; 42:282-92. [PMID: 20810142 DOI: 10.1016/j.tice.2010.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/28/2010] [Accepted: 07/01/2010] [Indexed: 12/27/2022]
Abstract
Monolayer culture expansion remains as a fundamental step to acquire sufficient number of cells for 3D constructs formation. It has been well-documented that cell expansion is however accompanied by cellular dedifferentiation. In order to promote cell growth and circumvent cellular dedifferentiation, we evaluated the effects of Transforming Growth Factor Beta-2 (TGF-β2), Insulin-like Growth Factor-I (IGF-I) and basic Fibroblast Growth Factor (bFGF) combination on articular chondrocytes culture and 'chondrocytes-fibrin' construct formation. Chondrocytes were serially cultured in: (1) F12:DMEM+10% Foetal Bovine Serum (FBS) with growth factors (FD10GFs), (2) F12:DMEM+2%FBS with the growth factors (FD2GFs) and, (3) F12:DMEM+10%FBS without growth factors (FD) as control. Cultured chondrocytes were evaluated by means of growth kinetics parameters, cell cycle analysis, quantitative phenotypic expression of collagen type II, aggrecan core protein sox-9 and collagen type I and, immunochemistry technique. Harvested chondrocytes were incorporated with plasma-derived fibrin and were polymerized to form the 3D constructs and implanted subcutaneously at the dorsum of athymic nude mice for eight (8) weeks. Resulted constructs were assigned for gross inspections and microscopic evaluation using standard histochemicals staining, immunochemistry technique and, quantitative phenotypic expression of cartilage markers to reassure cartilaginous tissue formation. Growth kinetics performance of chondrocytes cultured in three (3) types of culture media from the most to least was in the following order: FD10GFs>FD2GFs>FD. Following growth kinetics analysis, we decided to use FD10GFs and FD (control) for further evaluation and 'chondrocytes-fibrin' constructs formation. Chondrocytes cultured in FD10GFs preserved the normal diploid state (2c) with no evidence of aneuploidy, haploidy or tetraploidy. Expression of cartilage-specific markers namely collagen type II, aggrecan core protein and sox-9 were significantly higher in FD10GFs when compared to control. After implantation, 'chondrocytes-fibrin' constructs exhibited firm, white, smooth and glistening cartilage-like properties. FD10GFs constructs formed better quality cartilage-like tissue than FD constructs in term of overall cartilaginous tissue formation, cells organization and extracellular matrix distribution in the specimens. Cartilaginous tissue formation was confirmed by the presence of lacunae and cartilage-isolated cells embedded within basophilic ground substance. Presence of proteoglycan was confirmed by positive Safranin O staining. Collagen type II exhibited immunopositivity at the pericellular and inter-territorial matrix area. Chondrogenic properties of the construct were further confirmed by the expression of genes encoding collagen type II, aggrecan core protein and sox9. In conclusion, FD10GFs promotes the proliferation of chondrocytes and formation of good quality 'chondrocytes-fibrin' constructs which may have potential use of matrix-induced cell implantation.
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Affiliation(s)
- S Munirah
- Department of Basic Health Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, 25200 Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, Kuantan, Pahang, Malaysia
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A hybrid scaffold of poly(lactide-co-glycolide) sponge filled with fibrin gel for cartilage tissue engineering. CHINESE JOURNAL OF POLYMER SCIENCE 2010. [DOI: 10.1007/s10118-010-1026-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dickhut A, Dexheimer V, Martin K, Lauinger R, Heisel C, Richter W. Chondrogenesis of human mesenchymal stem cells by local transforming growth factor-beta delivery in a biphasic resorbable carrier. Tissue Eng Part A 2010; 16:453-64. [PMID: 19705961 DOI: 10.1089/ten.tea.2009.0168] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Little is known about the potential of growth factor-augmented biphasic implants composed of a gel and a solid scaffold to enhance chondrogenesis of mesenchymal stem cells (MSCs). We analyzed whether a collagen type I/III carrier and fibrin glue (FG) combined to a biphasic construct support in vitro chondrogenesis of MSCs and allow for local release of bioactive transforming growth factor-beta1 (TGF-beta1). Further, a possible advantage of partial autologous fibrin glue (PAF) over commercial FG was assessed. Collagen carriers seeded with 5 x 10(5) human MSCs with or without FG, PAF, or TGF-beta1-upgraded FG were cultured for 6 weeks in chondrogenic medium with or without TGF-beta1. Pellets with or without FG/PAF served as controls. FG and collagen carriers allowed strong upregulation of COL2A1, AGC, and COL10A1 mRNA, deposition of collagen-type II, and mediated a significantly higher proteoglycan content compared with biomaterial-free pellets. Collagen-carrier groups contained significantly more proteoglycan than FG and PAF pellets, whereas biphasic PAF-carrier constructs were inferior to FG-carrier constructs. Upgrading of biphasic FG-carrier constructs with 50 ng TGF-beta1/construct mediated chondrogenesis as successfully as supply of TGF-beta1 via the medium. In conclusion, the biphasic carrier constructs showed a high biofunctionality by continuous form stability with improved chondrogenesis and long-term local supply of bioactive TGF-beta1 which may be useful to enhance matrix-assisted repair strategies for damaged cartilage.
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Affiliation(s)
- Andrea Dickhut
- Division of Experimental Orthopaedics, Orthopaedic University Hospital, Heidelberg, Germany
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Drobnič M, Radosavljevič D, Cör A, Brittberg M, Stražar K. Debridement of cartilage lesions before autologous chondrocyte implantation by open or transarthroscopic techniques. ACTA ACUST UNITED AC 2010; 92:602-8. [DOI: 10.1302/0301-620x.92b3.22558] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the quality of debridement of chondral lesions performed by four arthroscopic (SH, shaver; CU, curette; SHCU, shaver and curette; BP, bipolar electrodes) and one open technique (OPEN, scalpel and curette) which are used prior to autologous chondrocyte implantation (ACI). The ex vivo simulation of all five techniques was carried out on six juvenile equine stifle joints. The OPEN, SH and SHCU techniques were tested on knees harvested from six adult human cadavers. The most vertical walls with the least adjacent damage to cartilage were obtained with the OPEN technique. The CU and SHCU methods gave inferior, but still acceptable results whereas the SH technique alone resulted in a crater-like defect and the BP method undermined the cartilage wall. The subchondral bone was severely violated in all the equine samples which might have been peculiar to this model. The predominant depth of the debridement in the adult human samples was at the level of the calcified cartilage. Some minor penetrations of the subchondral end-plate were induced regardless of the instrumentation used. Our study suggests that not all routine arthroscopic instruments are suitable for the preparation of a defect for ACI. We have shown that the preferred debridement technique is either open or arthroscopically-assisted manual curettage. The use of juvenile equine stifles was not appropriate for the study of the cartilage-subchondral bone interface.
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Affiliation(s)
- M. Drobnič
- Department of Orthopaedic Surgery, University Medical Centre, Zaloška ulica 9, SI-1000 Ljubljana, Slovenia
| | - D. Radosavljevič
- Department of Orthopaedic Surgery, University Medical Centre, Zaloška ulica 9, SI-1000 Ljubljana, Slovenia
| | - A. Cör
- College of Health Care Izola, Polje 42, SI-6310 Izola, Slovenia
| | - M. Brittberg
- Cartilage Research Unit, Department of Orthopaedics Kungsbacka Hospital, S-434 40, Kungsbacka, Sweden
| | - K. Stražar
- Department of Orthopaedic Surgery, University Medical Centre, Zaloška ulica 9, SI-1000 Ljubljana, Slovenia
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Kim MK, Choi SW, Kim SR, Oh IS, Won MH. Autologous chondrocyte implantation in the knee using fibrin. Knee Surg Sports Traumatol Arthrosc 2010; 18:528-34. [PMID: 19763540 DOI: 10.1007/s00167-009-0905-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 08/15/2009] [Indexed: 01/02/2023]
Abstract
Autologous chondrocyte implantation (ACI) is widely used to treat symptomatic articular cartilage injury of the knee. Fibrin ACI is a new tissue-engineering technique for the treatment of full-thickness articular cartilage defects, in which autologous chondrocytes are inserted into a three-dimensional scaffold provided by fibrin gel. The objective of this study is to document and compare mean changes in overall clinical scores at both baseline and follow-up. Fibrin ACI was used to treat deep cartilage defects of the femoral condyle in 30 patients. There were 24 men and 6 women with a median age of 35 years (range 15-55) and with a mean defect size of 5.8 cm(2) (range 2.3-12). Clinical and functional knee evaluations were performed using different scoring systems, MRI was performed 24 months postoperatively, and arthroscopy was performed 12 months postoperatively. All patients achieved clinical and functional status improvements following surgery (P < 0.01). The mean scores of the Henderson classification (MRI evaluation) significantly improved from 14.4 to 7 (P = 0.001), and no graft-associated complications were noted. Arthroscopic assessments performed 12 months postoperatively produced nearly normal (grade II) International Cartilage Repair Society scores in 8 of the 10 study patients. Fibrin ACI offers the advantages of technical simplicity, minimal invasiveness, a short surgery time, and easier access to difficult sites than classical ACI. Based on the findings of this clinical pilot study, we conclude that fibrin ACI offers a reliable means of treating articular cartilage defects of the knee.
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Affiliation(s)
- Myung Ku Kim
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
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O'Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 2010; 38:392-404. [PMID: 19561175 DOI: 10.1177/0363546509336336] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Osteochondral lesions of the ankle are a more common source of ankle pain than previously recognized. Although the exact pathophysiology of the condition has not been clearly established, it is likely that a variety of etiological factors play a role, with trauma, typically from ankle sprains, being the most common. Technological advancements in ankle arthroscopy and radiologic imaging, most importantly magnetic resonance imaging, have improved diagnostic capabilities for detecting osteochondral lesions of the ankle. Moreover, these technologies have allowed for the development of more sophisticated classification systems that may, in due course, direct specific future treatment strategies. Nonoperative treatment yields best results when employed in select pediatric and adolescent patients with osteochondritis dissecans. However, operative treatment, which is dependent on the size and site of the lesion, as well as the presence or absence of cartilage damage, is frequently warranted in both children and adults with osteochondral lesions. Arthroscopic microdrilling, micropicking, and open procedures, such as osteochondral autograft transfer system and matrix-induced autologous chondrocyte implantation, are frequently employed. The purpose of this article is to review the history, etiology, and classification systems for osteochondral lesions of the ankle, as well as to describe current approaches to diagnosis and management.
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Løken S, Ludvigsen TC, Høysveen T, Holm I, Engebretsen L, Reinholt FP. Autologous chondrocyte implantation to repair knee cartilage injury: ultrastructural evaluation at 2 years and long-term follow-up including muscle strength measurements. Knee Surg Sports Traumatol Arthrosc 2009; 17:1278-88. [PMID: 19572120 DOI: 10.1007/s00167-009-0854-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 06/11/2009] [Indexed: 11/28/2022]
Abstract
Autologous chondrocyte implantation (ACI) usually results in improvement in clinical scores. However, long-term isokinetic muscle strength measurements have not been reported. Biopsies from the repair tissue have shown variable proportions of hyaline-like cartilage. In this study, 21 consecutive patients were treated with autologous cartilage implantations in the knee. Mean size of the lesions was 5.5 cm(2). Follow-up arthroscopy with biopsy was performed at 2 years in 19 patients. The biopsies were examined with both light microscopy and transmission electron microscopy (TEM) techniques including immunogold analysis of collagen type 1. Patient function was evaluated with modified 10-point scales of the Cincinnati knee rating system obtained preoperatively and at 1 and 8.1 years. Isokinetic quadriceps and hamstrings muscle strength testing was performed at 1, 2 and 7.4 years. Light microscopy and TEM both showed predominately fibrous cartilage. The immunogold analysis showed a high percentage of collagen type I. At 7.4 years, the total work deficits when compared with the contra-lateral leg for isokinetic extension were 19.1 and 11.4%, and for isokinetic flexion 11.8 and 8.5% for 60 and 240 masculine/s, respectively. Mean pain score improved from 4.3 preoperatively to 6.3 at 1 year (p = 0.031) and 6.6 at 8.1 years (p = 0.013). Overall health condition score improved from 4.1 preoperatively to 6.1 at 1 year (p = 0.004) and 6.5 at 8.1 years (p = 0.008). Three patients later went through revision surgery with other resurfacing techniques and are considered failures. In summary, the formation of fibrous cartilage following ACI was confirmed by TEM with immunogold histochemistry. Although the functional scores were generally good, strength measurements demonstrated that the surgically treated leg remained significantly weaker.
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Affiliation(s)
- Sverre Løken
- Orthopaedic Centre, Ullevål University Hospital and Medical School, Oslo, Norway.
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44
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Hepp P, Osterhoff G, Niederhagen M, Marquass B, Aigner T, Bader A, Josten C, Schulz R. Perilesional changes of focal osteochondral defects in an ovine model and their relevance to human osteochondral injuries. ACTA ACUST UNITED AC 2009; 91:1110-9. [DOI: 10.1302/0301-620x.91b8.22057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Perilesional changes of chronic focal osteochondral defects were assessed in the knees of 23 sheep. An osteochondral defect was created in the main load-bearing region of the medial condyle of the knees in a controlled, standardised manner. The perilesional cartilage was evaluated macroscopically and biopsies were taken at the time of production of the defect (T0), during a second operation one month later (T1), and after killing animals at three (T3; n = 8), four (T4; n = 8), and seven (T7; n = 8) months. All the samples were histologically assessed by the International Cartilage Repair Society grading system and Mankin histological scores. Biopsies were taken from human patients (n = 10) with chronic articular cartilage lesions and compared with the ovine specimens. The ovine perilesional cartilage presented with macroscopic and histological signs of degeneration. At T1 the International Cartilage Repair Society ‘Subchondral Bone’ score decreased from a mean of 3.0 (sd 0) to a mean of 1.9 (sd 0.3) and the ‘Matrix’ score from a mean of 3.0 (sd 0) to a mean of 2.5 (sd 0.5). This progressed further at T3, with the International Cartilage Repair Society ‘Surface’ grading, the ‘Matrix’ grading, ‘Cell Distribution’ and ‘Cell Viability’ grading further decreasing and the Mankin score rising from a mean of 1.3 (sd 1.4) to a mean of 5.1 (sd 1.6). Human biopsies achieved Mankin grading of a mean of 4.2 (sd 1.6) and were comparable with the ovine histology at T1 and T3. The perilesional cartilage in the animal model became chronic at one month and its histological appearance may be considered comparable with that seen in human osteochondral defects after trauma.
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Affiliation(s)
- P. Hepp
- Department of Trauma and Reconstructive Surgery University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - G. Osterhoff
- Department of Trauma and Reconstructive Surgery University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - M. Niederhagen
- Department of Pathology University of Munich (LMU), Thalkirchner Strasse 36, 80337 Munich, Germany
| | - B. Marquass
- Department of Trauma and Reconstructive Surgery University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - T. Aigner
- Department of Pathology University of Leipzig, Liebigstrasse 26, 04103 Leipzig, Germany
| | - A. Bader
- Department of Cell Techniques and Applied Stem Cell Biology University of Leipzig, Center of Biotechnology and Biomedicine, Leipzig, Germany
| | - C. Josten
- Department of Trauma and Reconstructive Surgery University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - R. Schulz
- Department of Cell Techniques and Applied Stem Cell Biology University of Leipzig, Center of Biotechnology and Biomedicine, Leipzig, Germany
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Ozsoy MH, Aydogdu S, Taskiran D, Sezak M, Hayran M, Oztop F, Ozsoy A. The effects of early or late treatment of osteochondral defects on joint homoeostasis: an experimental study in rabbits. Knee Surg Sports Traumatol Arthrosc 2009; 17:578-89. [PMID: 19083207 DOI: 10.1007/s00167-008-0675-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
Abstract
A 3.5 x 4 mm tubular osteochondral defect was created on the right medial femoral condyles of 51 adult rabbits. In the control group (CG), defects were left untreated. In the early-(ETG) and late-(LTG) treatment groups, defects were treated by an osteoperiosteal graft 1 and 12 weeks, respectively, after the index procedure. Synovial fluid (SF) samples were collected regularly and proteoglycan fragments (PF), total collagen (TC) and collagenase (MMP-1) levels were measured. Rabbits were killed at 4 (early period), 12 (intermediate period), or 24 (late period) weeks postoperatively. Histological examination indicated a more successful healing in both grafting groups than in the CG, but without any difference at any time period between the grafting groups. In the CG, PF, and TC levels in SF increased continuously until the late period, indicating an ongoing degenerative activity in the joints. In contrast, SF marker levels in both grafting groups indicated that normalization in joint metabolism could be achieved-at least partially-after treatment. However, PF levels in the SF showed that the treatment of defects in earlier stages might result in better outcomes since the negative effects were more prominent in chronic stages, presumably due to the more prolonged period of disturbed homeostasis. Thus, histological values and SF marker levels indicated that treatment of osteochondral defects at any time of the disease had a positive effect on healing when compared to no treatment. Early treatment might better assist the recovery of joint homeostasis than late treatment.
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Affiliation(s)
- Mehmet Hakan Ozsoy
- 1st Clinic of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey.
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Bilayered chitosan-based scaffolds for osteochondral tissue engineering: influence of hydroxyapatite on in vitro cytotoxicity and dynamic bioactivity studies in a specific double-chamber bioreactor. Acta Biomater 2009; 5:644-60. [PMID: 18951857 DOI: 10.1016/j.actbio.2008.09.017] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 09/23/2008] [Accepted: 09/23/2008] [Indexed: 01/08/2023]
Abstract
Osteochondral tissue engineering presents a current research challenge due to the necessity of combining both bone and cartilage tissue engineering principles. In the present study, bilayered chitosan-based scaffolds are developed based on the optimization of both polymeric and composite scaffolds. A particle aggregation methodology is proposed in order to achieve an improved integrative bone-cartilage interface needed for this application, since any discontinuity is likely to cause long-term device failure. Cytotoxicity was evaluated by the MTS assay with the L929 fibroblast cell line for different conditions. Surprisingly, in composite scaffolds using unsintered hydroxyapatite, cytotoxicity was observed in vitro. This work reports the investigation that was conducted to overcome and explain this behaviour. It is suggest that the uptake of divalent cations may induce the cytotoxic behaviour. Sintered hydroxyapatite was consequently used and showed no cytotoxicity when compared to the controls. Microcomputed tomography (micro-CT) was carried out to accurately quantify porosity, interconnectivity, ceramic content, particle and pore sizes. The results showed that the developed scaffolds are highly interconnected and present the ideal pore size range to be morphometrically suitable for the proposed applications. Dynamical mechanical analysis (DMA) demonstrated that the scaffolds are mechanically stable in the wet state even under dynamic compression. The obtained elastic modulus was, respectively, 4.21+/-1.04, 7.98+/-1.77 and 6.26+/-1.04 MPa at 1 Hz frequency for polymeric, composite and bilayered scaffolds. Bioactivity studies using both a simulated body fluid (SBF) and a simulated synovial fluid (SSF) were conducted in order to assure that the polymeric component for chondrogenic part would not mineralize, as confirmed by scanning electron microscopy (SEM), inductively coupled plasma-optical emission spectroscopy (ICP) and energy-dispersive spectroscopy (EDS) for different immersion periods. The assays were carried out also under dynamic conditions using, for this purpose, a specifically designed double-chamber bioreactor, aiming at a future osteochondral application. It was concluded that chitosan-based bilayered scaffolds produced by particle aggregation overcome any risk of delamination of both polymeric and composite parts designed, respectively, for chondrogenic and osteogenic components that are mechanically stable. Moreover, the proposed bilayered scaffolds could serve as alternative, biocompatible and safe biodegradable scaffolds for osteochondral tissue engineering applications.
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47
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Sha'ban M, Yoon SJ, Ko YK, Ha HJ, Kim SH, So JW, Idrus RBH, Khang G. Fibrin promotes proliferation and matrix production of intervertebral disc cells cultured in three-dimensional poly(lactic-co-glycolic acid) scaffold. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2008; 19:1219-37. [PMID: 18727862 DOI: 10.1163/156856208785540163] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Previously, we have proven that fibrin and poly(lactic-co-glycolic acid) (PLGA) scaffolds facilitate cell proliferation, matrix production and early chondrogenesis of rabbit articular chondrocytes in in vitro and in vivo experiments. In this study, we evaluated the potential of fibrin/PLGA scaffold for intervertebral disc (IVD) tissue engineering using annulus fibrosus (AF) and nucleus pulposus (NP) cells in relation to potential clinical application. PLGA scaffolds were soaked in cells-fibrin suspension and polymerized by dropping thrombin-sodium chloride (CaCl(2)) solution. A PLGA-cell complex without fibrin was used as control. Higher cellular proliferation activity was observed in fibrin/PLGA-seeded AF and NP cells at each time point of 3, 7, 14 and 7 days using the MTT assay. After 3 weeks in vitro incubation, fibrin/PLGA exhibited a firmer gross morphology than PLGA groups. A significant cartilaginous tissue formation was observed in fibrin/PLGA, as proven by the development of cells cluster of various sizes and three-dimensional (3D) cartilaginous histoarchitecture and the presence of proteoglycan-rich matrix and glycosaminoglycan (GAG). The sGAG production measured by 1,9-dimethylmethylene blue (DMMB) assay revealed greater sGAG production in fibrin/PLGA than PLGA group. Immunohistochemical analyses showed expressions of collagen type II, aggrecan core protein and collagen type I genes throughout in vitro culture in both fibrin/PLGA and PLGA. In conclusion, fibrin promotes cell proliferation, stable in vitro tissue morphology, superior cartilaginous tissue formation and sGAG production of AF and NP cells cultured in PLGA scaffold. The 3D porous PLGA scaffold-cell complexes using fibrin can provide a vehicle for delivery of cells to regenerate tissue-engineered IVD tissue.
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Affiliation(s)
- Munirah Sha'ban
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Martínez-Zapata MJ, Martí-Carvajal A, Solà I, Bolibar I, Angel Expósito J, Rodriguez L, García J. Efficacy and safety of the use of autologous plasma rich in platelets for tissue regeneration: a systematic review. Transfusion 2008; 49:44-56. [PMID: 18954394 DOI: 10.1111/j.1537-2995.2008.01945.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Autologous plasma rich in platelets (PRP) is a derived blood product whose application in clinical practice is growing. A systematic review was conducted to evaluate its efficacy and safety. STUDY DESIGN AND METHODS A search was performed in electronic databases. Randomized controlled clinical trials (RCTs) in adult patients were included and assessed for methodologic quality. The main outcomes were "tissue regeneration" and "safety." Relative risks (RRs) and standardized mean differences (SMDs) were calculated to show pooled estimates for these outcomes. When the results heterogeneity was more than 50 percent, a sensitivity analysis was performed. RESULTS Twenty RCTs were included (11 of oral and maxillofacial surgery, 7 of chronic skin ulcers, and 2 of surgery wounds). Four RCTs evaluated the depth reduction in gingival recession in chronic periodontitis; the SMD was 0.54 (95% confidence interval [CI], 0.16 to 0.92) mm, favorable to PRP. Three RCTs evaluated the clinical attachment level in chronic periodontitis; the SMD was 0.33 (95% CI, -0.71 to 1.37) mm. Six RCTs assessed the complete skin epithelialization in wound ulcers; the RR was 1.40 (95% CI, 0.85 to 2.31). Only 6 RCTs reported adverse effects without differences between groups. CONCLUSIONS PRP improves the gingival recession but not the clinical attachment level in chronic periodontitis. In the complete healing process of chronic skin ulcers, the results are inconclusive. There are little data about PRP safety. There are several methodologic limitations and, consequently, future research should focus on strong and well-designed RCTs that assess the efficacy and safety of PRP.
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Affiliation(s)
- Ma José Martínez-Zapata
- Iberoamerican Cochrane Center, Epidemiology and Public Health Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Selmi TAS, Verdonk P, Chambat P, Dubrana F, Potel JF, Barnouin L, Neyret P. Autologous chondrocyte implantation in a novel alginate-agarose hydrogel: outcome at two years. ACTA ACUST UNITED AC 2008; 90:597-604. [PMID: 18450625 DOI: 10.1302/0301-620x.90b5.20360] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Autologous chondrocyte implantation is an established method of treatment for symptomatic articular defects of cartilage. CARTIPATCH is a monolayer-expanded cartilage cell product which is combined with a novel hydrogel to improve cell phenotypic stability and ease of surgical handling. Our aim in this prospective, multicentre study on 17 patients was to investigate the clinical, radiological, arthroscopic and histological outcome at a minimum follow-up of two years after the implantation of autologous chondrocytes embedded in a three-dimensional alginate-agarose hydrogel for the treatment of chondral and osteochondral defects. Clinically, all the patients improved significantly. Patients with lesions larger than 3 cm(2) improved significantly more than those with smaller lesions. There was no correlation between the clinical outcome and the body mass index, age, duration of symptoms and location of the defects. The mean arthroscopic International Cartilage Repair Society score was 10 (5 to 12) of a maximum of 12. Predominantly hyaline cartilage was seen in eight of the 13 patients (62%) who had follow-up biopsies. Our findings suggest that autologous chondrocyte implantation in combination with a novel hydrogel results in a significant clinical improvement at follow-up at two years, more so for larger and deeper lesions. The surgical procedure is uncomplicated, and predominantly hyaline cartilage-like repair tissue was observed in eight patients.
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Affiliation(s)
- T A S Selmi
- Centre Livet, Centre Albert, Trillat, 8 rue de Margnolles, 69300 Lyon-Caluire, France
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Sha'ban M, Kim SH, Idrus RB, Khang G. Fibrin and poly(lactic-co-glycolic acid) hybrid scaffold promotes early chondrogenesis of articular chondrocytes: an in vitro study. J Orthop Surg Res 2008; 3:17. [PMID: 18435862 PMCID: PMC2405772 DOI: 10.1186/1749-799x-3-17] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 04/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Synthetic- and naturally derived- biodegradable polymers have been widely used to construct scaffolds for cartilage tissue engineering. Poly(lactic-co-glycolic acid) (PLGA) are bioresorbable and biocompatible, rendering them as a promising tool for clinical application. To minimize cells lost during the seeding procedure, we used the natural polymer fibrin to immobilize cells and to provide homogenous cells distribution in PLGA scaffolds. We evaluated in vitro chondrogenesis of rabbit articular chondrocytes in PLGA scaffolds using fibrin as cell transplantation matrix. METHODS PLGA scaffolds were soaked in chondrocytes-fibrin suspension (1 x 10(6) cells/scaffold) and polymerized by dropping thrombin-calcium chloride (CaCl2) solution. PLGA-seeded chondrocytes was used as control. All constructs were cultured for a maximum of 21 days. Cell proliferation activity was measured at 1, 3, 7, 14 and 21 days in vitro using 3-(4,5-dimethylthiazole-2-yl)-2-, 5-diphenyltetrazolium-bromide (MTT) assay. Morphological observation, histology, immunohistochemistry (IHC), gene expression and sulphated-glycosaminoglycan (sGAG) analyses were performed at each time point of 1, 2 and 3 weeks to elucidate in vitro cartilage development and deposition of cartilage-specific extracellular matrix (ECM). RESULTS Cell proliferation activity was gradually increased from day-1 until day-14 and declined by day-21. A significant cartilaginous tissue formation was detected as early as 2-week in fibrin/PLGA hybrid construct as confirmed by the presence of cartilage-isolated cells and lacunae embedded within basophilic ECM. Cartilage formation was remarkably evidenced after 3 weeks. Presence of cartilage-specific proteoglycan and glycosaminoglycan (GAG) in fibrin/PLGA hybrid constructs were confirmed by positive Safranin O and Alcian Blue staining. Collagen type II exhibited intense immunopositivity at the pericellular matrix. Chondrogenic properties were further demonstrated by the expression of genes encoded for cartilage-specific markers, collagen type II and aggrecan core protein. Interestingly, suppression of cartilage dedifferentiation marker; collagen type I was observed after 2 and 3 weeks of in vitro culture. The sulphated-glycosaminoglycan (sGAG) production in fibrin/PLGA was significantly higher than in PLGA. CONCLUSION Fibrin/PLGA promotes early in vitro chondrogenesis of rabbit articular chondrocytes. This study suggests that fibrin/PLGA may serve as a potential cell delivery vehicle and a structural basis for in vitro tissue-engineered articular cartilage.
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Affiliation(s)
- Munirah Sha'ban
- BK-21 Polymer BIN Fusion Research Team, Department of Polymer Science and Technology, Chonbuk National University, 664-14 Dukjin, Jeonju 561-756, Seoul, Korea
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