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Kennedy CS, Núñez CNV, Poli A, Vega-Soto E, Arruda EM, Larkin LM. Engineered Tissue Graft for Repair of Injured Infraspinatus Rotator Cuff Tendon. Tissue Eng Part A 2023; 29:471-480. [PMID: 37542392 PMCID: PMC10517321 DOI: 10.1089/ten.tea.2022.0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/28/2023] [Indexed: 08/06/2023] Open
Abstract
Rotator cuff tears constitute a vast majority of shoulder-related injuries, occurring in a wide population range and increasing in incidence with age. Current treatments for full thickness tears use suture to secure the ruptured tendon back to its native attachment site and often retear due to improper enthesis regeneration. To reduce the occurrence of retear, our laboratory developed an engineered tendon graft for rotator cuff repair (ETG-RC) to serve as an underlayment to traditional suture repair. We hypothesize the ETG-RC will aid in the repair of the torn rotator cuff tendon by promoting the regeneration of a functional enthesis. This devitalized graft fabricated from ovine-derived bone marrow stromal cells was evaluated for biomechanical and histomorphology properties in an ovine infraspinatus rotator cuff repair model. Compared with a current standard practice Suture-Only model, the ETG-RC repair showed comparable high strain-to-failure forces, greater fibrocartilage deposition, regeneration of zonal gradients, and Shapey's fibers formation, indicative of enthesis regeneration. Enthesis regeneration after rotator cuff repair should repair mechanical properties and alleviate the need for subsequent surgeries required due to retear. The ETG-RC could potentially be used for repairing other tendon injuries throughout the body.
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Affiliation(s)
- Christopher S. Kennedy
- Department of Molecular and Integrative Physiology, The University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrea Poli
- Department of Mechanical Engineering, The University of Michigan, Ann Arbor, Michigan, USA
| | - Emmanuel Vega-Soto
- Department of Molecular and Integrative Physiology, The University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen M. Arruda
- Department of Mechanical Engineering, The University of Michigan, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, and The University of Michigan, Ann Arbor, Michigan, USA
- Department of Macromolecular Science and Engineering, The University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa M. Larkin
- Department of Molecular and Integrative Physiology, The University of Michigan, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, and The University of Michigan, Ann Arbor, Michigan, USA
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Cai J, Xu J, Ye Z, Wang L, Zheng T, Zhang T, Li Y, Jiang J, Zhao J. Exosomes Derived From Kartogenin-Preconditioned Mesenchymal Stem Cells Promote Cartilage Formation and Collagen Maturation for Enthesis Regeneration in a Rat Model of Chronic Rotator Cuff Tear. Am J Sports Med 2023; 51:1267-1276. [PMID: 36917828 DOI: 10.1177/03635465231155927] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Poor tendon-to-bone healing in chronic rotator cuff tears (RCTs) is related to unsatisfactory outcomes. Exosomes derived from mesenchymal stem cells reportedly enhance rotator cuff healing. However, the difficulty in producing exosomes with a stronger effect on enthesis regeneration must be resolved. PURPOSE To study the effect of exosomes derived from kartogenin (KGN)-preconditioned human bone marrow mesenchymal stem cells (KGN-Exos) on tendon-to-bone healing in a rat model of chronic RCT. STUDY DESIGN Controlled laboratory study. METHODS Exosome-loaded sodium alginate hydrogel (SAH) was prepared. Moreover, exosomes were labeled with 1,1'-dioctadecyl-3,3,3',3'-tetramethylindotricarbocyanine iodide (DiR) or 1,1'-dioctadecyl-3,3,3'3'-tetramethylindocarbocyanine perchlorate (Dil) for in vivo tracking. Bilateral rotator cuff repair (RCR) was conducted in an established chronic RCT rat model. A total of 66 rats were randomized to control, untreated exosome (un-Exos), and KGN-Exos groups to receive local injections of pure SAH, un-Exos, or KGN-Exos SAH at the repaired site. The presence of DiR/Dil-labeled exosomes was assessed at 1 day and 1 week, and tendon-to-bone healing was evaluated histologically, immunohistochemically, and biomechanically at 4 and 8 weeks. RESULTS Both un-Exos and KGN-Exos exhibited sustained release from SAH for up to 96 hours. In vivo study revealed that un-Exos and KGN-Exos were localized to the repaired site at 1 week. Moreover, the KGN-Exos group showed a higher histological score and increased glycosaminoglycan and collagen II expression at 4 and 8 weeks. In addition, more mature and better-organized collagen fibers with higher ratios of collagen I to collagen III were observed at 8 weeks in the tendon-to-bone interface compared with those in the control and un-Exos groups. Biomechanically, the KGN-Exos group had the highest failure load (28.12 ± 2.40 N) and stiffness (28.57 ± 2.49 N/mm) among the 3 groups at 8 weeks. CONCLUSION Local injection of SAH with sustained KGN-Exos release could effectively promote cartilage formation as well as collagen maturation and organization for enthesis regeneration, contributing to enhanced biomechanical properties after RCR. CLINICAL RELEVANCE KGN-Exos injection may be used as a cell-free therapeutic option to accelerate tendon-to-bone healing in chronic RCT.
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Affiliation(s)
- Jiangyu Cai
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liren Wang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Zheng
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianlun Zhang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufeng Li
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Shi Q, Chen Y, Li M, Zhang T, Ding S, Xu Y, Hu J, Chen C, Lu H. Designing a novel vacuum aspiration system to decellularize large-size enthesis with preservation of physicochemical and biological properties. Ann Transl Med 2020; 8:1364. [PMID: 33313109 PMCID: PMC7723548 DOI: 10.21037/atm-20-3661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Functional and rapid enthesis regeneration remains a challenge after arthroscopic rotator cuff (RC) repair. Tissue-engineering a large-size biomimetic scaffold may be an adjuvant strategy to improve this clinical dilemma. Herein, we developed an optimized protocol to decellularize large-size enthesis as scaffolds for augmenting RC tear. Methods A novel vacuum aspiration system (VAS) was set up, which can provide a negative pressure to suck out cellular substances from tissue blocks without using chemical detergents. Large-size enthesis tissue specimens were harvested from canine infraspinatus tendon (IT) insertion, and then decellularized with an optimized protocol [freeze-thaw processing followed by nuclease digestion and phosphate buffer saline (PBS) rinsing in the custom-designed VAS], or a conventional protocol (freeze-thaw processing followed by nuclease digestion and PBS rinsing), thus fabricating two kinds of acellular enthesis matrix (AEM), namely C-AEM and O-AEM. After that, the C-AEM and O-AEM were comparatively evaluated from the aspect of their physicochemical and biological properties. Results Physiochemically, the O-AEM preserved the morphologies, ingredients, and tensile properties much better than the C-AEM. Biologically, in vitro studies demonstrated that both C-AEM and O-AEM show no cytotoxicity and low immunogenicity, which could promote stem cells attachment and proliferation. Interestingly, O-AEM showed better region-specific inducibility on the interacted stem cell down osteogenic, chondrogenic and tenogenic lineages compared with C-AEM. Additionally, using a canine IT repair model, the injured enthesis patched with O-AEM showed a significant improvement compared with the injured enthesis patched with C-AEM or direct suture histologically. Conclusions The proposed VAS may help us fabricate large-size AEM with good physicochemical and biological properties, and this AEM may have potential clinical applications in patching large/massive RC tear.
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Affiliation(s)
- Qiang Shi
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Yang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Muzhi Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Shulin Ding
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Jianzhong Hu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
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Su M, Zhang Q, Zhu Y, Wang S, Lv J, Sun J, Qiu P, Fan S, Jin K, Chen L, Lin X. Preparation of Decellularized Triphasic Hierarchical Bone-Fibrocartilage-Tendon Composite Extracellular Matrix for Enthesis Regeneration. Adv Healthc Mater 2019; 8:e1900831. [PMID: 31464099 DOI: 10.1002/adhm.201900831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/29/2019] [Indexed: 01/30/2023]
Abstract
Tendon to bone (enthesis) rupture, which may cause disability and persistent pain, shows high rate of re-rupture after surgical repair. Tendon or enthesis scaffolds have been widely studied, but few of these materials can recapitulate the tissue continuity. Thus, this study is conducted to prepare a triphasic decellularized bone-fibrocartilage-tendon (D-BFT) composite scaffold. The D-BFT scaffold is developed using a combination of physical, chemical, and enzymatic treatments using liquid nitrogen, Triton-X 100, sodium-dodecyl sulfate, and DNase I, which effectively removes the cell components while preserving the biological composite and microstructure. Moreover, the mechanical properties of D-BFT are highly preserved and similar to those of the human Achilles tendon. Additionally, in vitro, mesenchymal stem cells (MSCs) adhered, proliferated, and infiltrated into the D-BFT scaffold, and MSC differentiation is confirmed by up-regulation of osteogenic-related and tenogenic-related genes. The repair outcomes are explored by applying the D-BFT scaffold in the model of femur-tibia defects in vivo, which shows good repair results. Thus, the D-BFT scaffold developed in this study is a promising graft for enthesis regeneration.
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Affiliation(s)
- Mingzhen Su
- Department of OrthopaedicsThe First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Qi Zhang
- Department of OrthopaedicsThe First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Yiwei Zhu
- Department of OrthopaedicsThe First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Shengyu Wang
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Jiawen Lv
- Department of OrthopaedicsThe First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Jiaan Sun
- Department of OrthopaedicsThe First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Pengchen Qiu
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Shunwu Fan
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
| | - Keke Jin
- Department of PathophysiologyWenzhou Medical University Wenzhou 325000 China
| | - Lei Chen
- Department of OrthopaedicsThe First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China
| | - Xianfeng Lin
- Department of OrthopaedicsThe First Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China
- Department of Orthopaedic SurgerySir Run Run Shaw HospitalMedical College of Zhejiang University Hangzhou 310000 China
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Abstract
BACKGROUND Various suture materials can be clinically used for rotator cuff repair (RCR). RCR with high-strength nonabsorbable sutures may not be ideal, because it may cause stress shielding, which may hinder enthesis regeneration and maturation in the tendon-bone interface. RCR with strength-decreasing sutures (ie, absorbable sutures) may be a better choice. However, the effects of suture absorbability on enthesis regeneration and maturation have not been investigated. HYPOTHESIS The use of absorbable sutures in RCR would produce a better tendon-bone connection structure, which provides histological and biomechanical advantages over the use of nonabsorbable sutures. STUDY DESIGN Controlled laboratory study. METHODS A supraspinatus tear was created on the right shoulder in 108 of 120 skeletally mature male rabbits. The animals were randomly divided into 3 groups, with 36 rabbits in each group, to undergo RCR individually with total absorbable, partial absorbable, and nonabsorbable sutures (TAS, PAS, and NAS). Twelve animals in each group were sacrificed at 4, 8, and 12 weeks after surgery, with 6 operated shoulders used for histological evaluation to detect enthesis regeneration and maturation and the other 6 for biomechanical testing. The remaining 12 animals without supraspinatus tear were used as control. RESULTS At 12 weeks, in the tendon-bone interface, enthesis regeneration was detected in the TAS group but not in the NAS group. A mature enthesis appeared in the TAS group but not in the NAS group. In the PAS group, enthesis regeneration was also observed; however, the fibrocartilage was not abundant and the enthesis maturity not good as compared with the TAS group. Biomechanical testing showed that the rotator cuff-greater tuberosity connection structure in the TAS and PAS groups had greater values of ultimate load to failure, stiffness, and stress than the NAS group at all time points. CONCLUSION In RCR in an acute rabbit rotator cuff tear model, the use of sutures with absorbability lead to enthesis regeneration, increased maturity of rotator cuff insertion, and enhanced rotator cuff-greater tuberosity connection. CLINICAL RELEVANCE Compared with the use of NAS, the use of TAS or PAS might be a better choice for RCR.
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Affiliation(s)
- Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wenxiao Qi
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaoxi Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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