Quantification of expression levels of cellular differentiation markers does not support a general shift in the cellular phenotype of osteoarthritic chondrocytes.

Many studies have shown increased anabolic activity in osteoarthritic cartilage and have suggested changes in the cellular phenotypes of articular chondrocytes. Most of these studies relied on non-quantitative technologies, which did not allow the estimation of the relative importance of the different differentiation phenomena. In the present study, we developed and used quantitative PCR assays for collagen types I, II(total), IIA, III, and X as marker genes indicating cellular synthetic activity (collagen type II) as well as differentiation pattern of chondrocytes (collagen types I, IIA, III, and X) and quantified these genes in normal, early degenerative, and late stage osteoarthritic cartilage in parallel.At first sight, our results confirmed previously published data showing hardly any expression of collagen genes in normal and significantly enhanced expression in osteoarthritic cartilage. This included collagen types II, III, and IIA, but also collagen types I(alpha1) and X. However, if one considers the ratios of the various markers of chondrocytic differentiation in comparison to collagen type II, the main synthetic product of differentiated chondrocytes, no shift in the cellular phenotype was detectable. In fact, expression ratios remained constant or were even decreased in osteoarthritic cartilage.Our results confirm that normal adult human articular chondrocytes display hardly any expression activity of the collagen types investigated, whereas osteoarthritic chondrocytes show very increased synthetic activity. The largely unchanged ratios of collagen subtypes investigated indicate that no general shift in the cellular phenotype does occur in osteoarthritic cartilage as suggested by previous investigations.     

The use of mesenchymal stem cells for chondrogenesis

The application of autologous chondrocytes in cartilage repair procedures is associated with several disadvantages, including injury of healthy cartilage in a preceding surgery frequently resulting in formation of inferior fibrocartilage at defect sites. In order to improve the quality of regeneration, adult mesenchymal stem cells (MSC) are regarded as a promising alternative. The great challenge, when considering MSC for articular cartilage repair, is to generate cells with features of stable chondrocytes which are resistant to hypertrophy and terminal differentiation, as found in hyaline articular cartilage. Common in vitro protocols for chondrogenic differentiation of MSC successfully induce expression of multiple cartilage-specific molecules, including collagen type II and aggrecan, and result in a chondrocyte-like phenotype. However, in vitro chondrogenesis of MSC additionally promotes induction of fibrocartilage-like features such as expression of collagen type I, and hypertrophy, as demonstrated by up-regulation of collagen type X, MMP13 and ALP-activity. As a consequence, differentiated MSC pellets undergo mineralisation and vascularisation after ectopic transplantation in a process similar to endochondral ossification. This review discusses the complexity and entailed challenges when considering MSC from various sources for clinical application and the necessity to optimise chondrogenesis by repressing hypertrophy to obtain functional and suitable cells for cartilage repair.     

Transient chondrogenic phase in the intramembranous pathway during normal skeletal development.

Calvarial and facial bones form by intramembranous ossification, in which bone cells arise directly from mesenchyme without an intermediate cartilage anlage. However, a number of studies have reported the emergence of chondrocytes from in vitro calvarial cell or organ cultures and the expression of type II collagen, a cartilage-characteristic marker, in developing calvarial bones. Based on these findings we hypothesized that a covert chondrogenic phase may be an integral part of the normal intramembranous pathway. To test this hypothesis, we analyzed the temporal and spatial expression patterns of cartilage characteristic genes in normal membranous bones from chick embryos at various developmental stages (days 12, 15 and 19). Northern and RNAse protection analyses revealed that embryonic frontal bones expressed not only the type I collagen gene but also a subset of cartilage characteristic genes, types IIA and XI collagen and aggrecan, thus resembling a phenotype of prechondrogenic-condensing mesenchyme. The expression of cartilage-characteristic genes decreased with the progression of bone maturation. Immunohistochemical analyses of developing embryonic chick heads indicated that type II collagen and aggrecan were produced by alkaline phosphatase activity positive cells engaged in early stages of osteogenic differentiation, such as cells in preosteogenic-condensing mesenchyme, the cambium layer of periosteum, the advancing osteogenic front, and osteoid bone. Type IIB and X collagen messenger RNAs (mRNA), markers for mature chondrocytes, were also detected at low levels in calvarial bone but not until late embryonic stages (day 19), indicating that some calvarial cells may undergo overt chondrogenesis. On the basis of our findings, we propose that the normal intramembranous pathway in chicks includes a previously unrecognized transient chondrogenic phase similar to prechondrogenic mesenchyme, and that the cells in this phase retain chondrogenic potential that can be expressed in specific in vitro and in vivo microenvironments.     

Low-intensity ultrasound stimulation enhances chondrogenic differentiation in alginate culture of mesenchymal stem cells

Mesenchymal stem cells (MSCs) are regarded as a potential autologous source for cartilage repair, because they can differentiate into chondrocytes by transforming growth factor-beta (TGF-beta) treatment under the 3-dimensional (3-D) culture condition. However, more efficient and versatile methods for chondrogenic differentiation of MSCs are still in demand for its clinical application. Recently, low-intensity ultrasound (LIUS) was shown to enhance fracture healing in vitro and induce chondrogenesis of MSCs in vitro. In this study, we investigated the effects of LIUS on the chondrogenesis of rabbit MSCs (rMSCs) in a 3-D alginate culture and on the maintenance of chondrogenic phenotypes after replating them on a monolayer culture. The LIUS treatment of rMSCs increased: (i) the matrix formation; (ii) the expression of chondrogenic markers such as collagen type II, aggrecan, and Sox-9; (iii) the expression of tissue inhibitor of metalloprotease-2 implicated in the integrity of cartilage matrix; and (iv) the capacity to maintain the chondrogenic phenotypes in a monolayer culture. Notably, LIUS effects were clearly shown even without TGF-beta treatment. These results suggest that LIUS treatment could be an efficient and cost-effective method to induce chondrogenic differentiation of MSCs in vitro for cartilage tissue engineering.     

Bone morphogenetic protein (BMP)-2 enhances the expression of type II collagen and aggrecan in chondrocytes embedded in alginate beads

OBJECTIVE: For autologous chondrocyte transplantation (ACT) chondrocytes are expanded in vitro. During expansion these cells may dedifferentiate. This change in phenotype is characterized by a raised expression of type I collagen and a decrease in type II collagen expression. Since high expression of type II collagen is of central importance for the properties of hyaline cartilage, we investigated if the growth factor bone morphogenetic protein-2 (BMP-2) may modulate the chondrogenic phenotype in monolayer cell cultures and in three-dimensional culture systems. DESIGN: Chondrocytes from articular knee cartilage of 11 individuals (average age: 39.8 years) with no history of joint disease were isolated and seeded either in monolayer cultures or embedded in alginate beads in presence or absence of human recombinant BMP-2 (hr-BMP-2). Then, cells were harvested and analysis of the chondrogenic phenotype was performed using quantitative RT-PCR, immunocytochemistry and ELISA. RESULTS: Addition of BMP-2 to chondrocytes expanded in two-dimensional (2D) cultures during the first subculture (P1) had no effect on mRNA amounts encoding type II collagen and interleukin-1beta (IL-1beta). In contrast, seeding chondrocytes in three-dimensional (3D) alginate cultures raised type II collagen expression significantly and addition of BMP-2 enhanced this effect. CONCLUSIONS: We conclude that chondrocytes during expansion for ACT may benefit from BMP-2 activation only when seeded in an appropriate 3D culture system.     

Development of a new method to harvest chondroprogenitor cells from underneath cartilage defects in the knees

Background  Mesenchymal progenitor cells from bone marrow hold great potential as a cell source for cartilage repair. Aspiration from the iliac crest is the most widely used method to harvest bone marrow cells for cartilage repair. The objective of our study was to establish a new method to isolate mesenchymal progenitor cells by direct aspiration of bone marrow from the subchondral spongious bone underneath cartilage defects during microfracture treatment and to confirm the chondrogenic potential of the resulting cell cultures. Methods  Bone marrow was aspirated arthroscopically from patients treated for isolated cartilage defects. Adherent stromal cells were isolated, expanded in monolayer cultures, and characterized by flow cytometry. Chondrogenic induction of cells was achieved by combination of spheroid cultures in hanging drops and the concomitant use of transforming growth factor-β (TGFβ). Articular chondrocytes established in three-dimensional (3D) cultures were used as positive cartilage-forming units, and skin fibroblasts were used as negative controls. Three-dimensional constructs were stained for immunohistochemical and histological examination, and a real-time polymerase chain reaction (PCR) was performed to quantify the expression of aggrecan, collagen types 1 and 2, and Sox9. Results  Mesenchymal stem cell-like progenitor cells (MSCs) displaying chondrogenic differentiation capacity were harvested arthroscopically from underneath cartilage lesions on distal femurs using the one-hole technique. Stem cell-related surface antigens analyzed by flow cytometry confirmed the nature of the isolated adherent cells. MSC spheroids stained positive for glycosaminoglycans and collagen type 2. Realtime PCR showed that MSCs in 3D spheroids significantly increased gene expression of collagen type 2, aggrecan, and Sox 9 and down-regulated expression of collagen type 1 when compared to the mRNA levels measured in MSCs monolayers. Conclusions  We describe a new technique that may be applied for harvesting bone marrow cells from cartilage defects during arthroscopic intervention of the knee. Cells harvested in this way hold full chondrogenic differentiation potential. Our data imply that MSC storage may be established by using marrow from this approach, bypassing the need for cell aspiration from the iliac crest.     

骨髓间质干细胞向软骨细胞表型定向诱导分化的实验研究

目的 研究体外培养的猪骨髓间质干细胞（Bone Marrow Stem Cells,MSCs)在特定培养液作用下向软骨细胞表型转化，探讨其作为组织工程化软骨的种子细胞的可行性。方法 取成年崇明长枫杂交猪髂骨骨髓5ml，在低糖DMEM完全培养液培养2周，传代后以高糖DMEM无血清特定培养液诱导（含胰岛素2mg/L、转铁蛋白3mg/L、丙酮酸100mg/L、地塞米松10^-7mol/L、TGF－β1 10ng/ml)，在相关显微镜和电镜下进行观察，免疫组化检测Ⅱ型胶原分泌，原位杂交检测Ⅱ型胶原mRNA表达。结果 细胞形态由成纤维样梭形向多角形、多边形转变，透视电镜观察见大量扩张粗面内质网、高尔基体、线粒体。诱导培养后第7，14dⅡ型胶原免疫组化阳性，同时原位杂交检测Ⅱ型胶原mRNA表达呈阳性。结论 MSCs在特定培养液诱导下能向软骨细胞表型转化，并能分泌软膏特异性基质，有可能成为软骨组织工程较理想的种子细胞来源的应用前景。     

Induction of CD-RAP mRNA during periosteal chondrogenesis.

Induction of chondrogenesis and maintenance of the chondrocyte phenotype are critical events for autologous periosteal transplantation, which is a viable approach for cartilage repair. Cartilage-derived retinoic acid-sensitive protein (CD-RAP) is a recently discovered protein that is mainly produced in cartilage. During development, CD-RAP expression starts at the beginning of chondrogenesis and continues throughout cartilage maturation. In order to investigate the involvement of CD-RAP during periosteal chondrogenesis we have determined the nucleotide sequence of the rabbit CD-RAP mRNA and utilized this information to evaluate the temporal and spatial expression pattern of CD-RAP at the mRNA level during chondrogenesis. When the periosteal explants were cultured under chondrogenic conditions, the expression of CD-RAP was induced, as shown by a 40-fold increase in CD-RAP mRNA between days 7 and 10. The temporal expression pattern of CD-RAP closely mimicked that of collagen type IIB mRNA. Also, the CD-RAP mRNA was localized to the matrix forming chondrocytes in the cambium layer of the periosteum by in situ hybridization as indicated by colocalization with collagen type II mRNA and positive safranin O staining. These data suggest a regulatory role of CD-RAP in periosteal chondrogenesis, which is potentially important for both cartilage repair and fracture healing via callus formation.     

Enhanced chondrogenesis from chondrocytes co-cultured on mesenchymal stromal cells: Implication for cartilage repair

Cellular therapy based on chondrocytes implantation is the most widely used procedure for inducing cartilage regeneration. However, the dedifferentiation process that these cells suffer and their limited capacity of proliferation, when they are cultured in vitro, restrict their use in cellular therapy protocols. To investigate the capacity of mesenchymal stromal cells (MSCs) to promote chondrogenesis from chondrocytes or chondrons in 2D and 3D coculture systems. Murine chondrocytes and chondrons were cocultured with MSCs at different cell ratios (100/0, 50/50, 70/30, 0/100) in two-dimensional (2D) and three-dimensional (3D) culture systems. High proliferation of cells with chondrocyte morphology, enhanced GAG production and expression of cartilage genes (aggrecan, type II collagen, and SOX-9) were observed in chondrocytes/MSCs cocultures. In contrast, fibroblastoid cells, down-regulation of cartilage gene expression and reduction of GAG production were observed in chondrons/MSCs cocultures. Chondrocytes within cartilage lacunae and surrounded by extracellular matrix were observed in chondrocytes/MSC pellets. MSCs promote the proliferation of functional chondrocytes in 2D and 3D culture systems. Transplantation of chondrogenic construct based on MSCs and chondrocytes may constitute a potential treatment for inducing cartilage repair.     

TGF-β2体外诱导骨髓间充质干细胞表达软骨细胞表型的观察

目的：观察骨髓间充质干细胞（MSCs）在TGF-β2诱导下向软骨细胞表型转化的能力,探讨其作为软骨组织工程种子细胞的可能性。方法：抽取兔髂骨骨髓液3-4ml,进行原代和传代培养,传代后实验组以高糖DMEM无血清特定培养液诱导f含TGF-β2 10ng／ml、地塞米松10^-7M、维生素C50μmol／L）,对照组以高糖DMEM无血清培养液培养,相差显微镜下观察细胞形态变化,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。结果：诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21天后细胞形态变化最为显著,Ⅱ型胶原免疫组化染色深而均匀。结论：TGF-β2可有效诱导MSCs向软骨细胞表型转化,分泌软骨细胞特异性基质,有可能成为软骨组织工程较理想的种子细胞来源。     

骨髓间质干细胞体外定向诱导分化为软骨细胞的实验研究

目的：探讨分离骨髓间充质干细胞（MSCs）并诱导其向软骨细胞转化的体外培养方法,为软骨组织工程的种子细胞来源提供实验依据。方法：抽取兔髂骨骨髓液,经梯度离心法和贴壁法进行体外培养,贴壁细胞传代,取第3代细胞在培养基中添加软骨分化诱导剂[含转化生长因子（TGF-β2）10ng／ml、地塞米松10^7mol／L、维生素C50μmol／L,经7、14、21d诱导培养后,倒置显微镜观察细胞形态,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。将诱导细胞与软骨支架材料-聚磷酸钙纤维／左旋聚乳酸（CPP／PLLA）复合,1周后终止培养,扫描电镜观察细胞黏附情况。结果：诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21d后细胞形态变化最为显著,Ⅱ型胶原免疫组化染色深而均匀。诱导后的MSCs可在支架材料内良好黏附生长。结论：体外培养的MSCs可定向诱导分化为软骨细胞,分泌软骨细胞特异性基质,可用作软骨组织工程的种子细胞。     

细胞间直接接触诱导BMSC软骨分化的初步研究

目的探讨细胞间直接接触是否能够单独诱导骨髓基质干细胞(Bone Marrow Stromal Cells,BMSC)软骨分化。方法体外培养扩增猪BMSC与关节软骨细胞,将1.0×106的细胞总量以2000r/min离心8min,制成细胞团块,即Pellet培养。实验分为5组,实验组:经0.5%多聚甲醛固定的软骨细胞与BMSC以1∶1混合;对照组1:同等数量的未经多聚甲醛固定的软骨细胞与BMSC1:1共培养制成Pellet;对照组2:同等数量的单纯软骨细胞制成Pellet;对照组3:同等数量的单纯BMSC制成Pellet;对照组4:同等数量的单纯经多聚甲醛固定的软骨细胞制成Pellet。每3天换液一次,每组3例。培养4周后,以大体观察、组织学、免疫组织化学、RT-PCR等方法对Pellet进行全面评价。结果培养4周后,实验组形成的Pellet,明显缩小,形状略不规则,颜色灰暗,柔软且没有弹性,组织学检测提示主要为纤维性成分及死细胞样结构,Safranin O染色及Ⅱ型胶原免疫组化均为阴性,RT-PCR检测未表达Ⅱ型胶原。对照组1和对照组2均形成圆盘状组织块,表面光滑,触之有一定弹性,组织学检测软骨陷窝形态规则,Safranin O染色及Ⅱ型胶原免疫组化均有阳性表达,RT-PCR检测Ⅱ型胶原高表达。对照组3的组织块明显收缩,呈褐色,无弹性。对照组4,细胞松散,不能形成Pellet。对照组3和4的各种软骨特异性相关检测均为阴性。结论细胞间直接接触不能够单独诱导BMSC向软骨分化,不是软骨细胞与BMSC混合共培养中发挥诱导作用的主要因素。     

Human peripheral blood derived mesenchymal stem cells demonstrate similar characteristics and chondrogenic differentiation potential to bone marrow derived mesenchymal stem cells

The use of mesenchymal stem cells (MSCs) for cartilage repair has generated much interest owing to their multipotentiality. However, their significant presence in peripheral blood (PB) has been a matter of much debate. The objectives of this study are to isolate and characterize MSCs derived from PB and, compare their chondrogenic potential to MSC derived from bone marrow (BM). PB and BM derived MSCs from 20 patients were isolated and characterized. From 2 ml of PB and BM, 5.4 ± 0.6 million and 10.5 ± 0.8 million adherent cells, respectively, were obtained by cell cultures at passage 2. Both PB and BM derived MSCs were able to undergo tri‐lineage differentiation and showed negative expression of CD34 and CD45, but positively expressed CD105, CD166, and CD29. Qualitative and quantitative examinations on the chondrogenic potential of PB and BM derived MSCs expressed similar cartilage specific gene (COMP) and proteoglycan levels, respectively. Furthermore, the s‐GAG levels expressed by chondrogenic MSCs in cultures were similar to that of native chondrocytes. In conclusion, this study demonstrates that MSCs from PB maintain similar characteristics and have similar chondrogenic differentiation potential to those derived from BM, while producing comparable s‐GAG expressions to chondrocytes. © 2011 Orthopaedic Research Society. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:634–642, 2012     

Connective tissue growth factor mRNA expression pattern in cartilages is associated with their type I collagen expression

Connective tissue growth factor (CTGF) has been identified as a secretory protein encoded by an immediate early gene and is a member of the CCN family. In vitro CTGF directly regulates the proliferation and differentiation of chondrocytes; however, a previous study showed that it was localized only in the hypertrophic chondrocytes in the costal cartilages of E 18 mouse embryos. We described the expression of CTGF mRNA and protein in chondrocytes of different types of cartilages, including femoral growth plate cartilage, costal cartilage, femoral articular cartilage, mandibular condylar cartilage, and cartilage formed during the healing of mandibular ramus fractures revealed by in situ hybridization and immunohistochemistry. To characterize the CTGF-expressing cells, we also analyzed the distribution of the type I, type II, and type X collagen mRNA expression. Among these different types of cartilages we found distinct patterns of CTGF mRNA and protein expression. Growth plate cartilage and the costal cartilage showed localization of CTGF mRNA and protein in the hypertrophic chondrocytes that expressed type X collagen mRNA with less expression in proliferating chondrocytes that expressed type II collagen mRNA, whereas it was also expressed in the proliferating chondrocytes that expressed type I collagen mRNA in the condylar cartilage, the articular cartilage, and the cartilage appearing during fracture healing. In contrast, the growth plate cartilages or the costal cartilages were negative for type I collagen and showed sparse expression of CTGF mRNA in the proliferating chondrocytes. We found for the first time that CTGF mRNA could be differentially expressed in five different types of cartilage associated with those expressing type I collagen. Moreover, the spatial distribution of CTGF mRNA in the cartilages with type I collagen mRNA suggested its roles in the early differentiation, as well as in the proliferation and the terminal differentiation, of those cartilages.     

骨髓基质细胞源性软骨细胞修复兔全层关节软骨缺损

目的观察体外诱导骨髓基质细胞(MSCs)源性软骨细胞在兔股骨滑车关节面全层软骨缺损修复中的作用. 方法高密度传代培养第3代诱导MSCs分化为软骨细胞,以酸溶性Ⅰ型胶原为载体,两者混合后形成凝胶样植入物(细胞浓度为5×106/ml).于36只新西兰大耳白兔一侧股骨滑车关节面造成3 mm×5 mm全层关节软骨缺损,凝胶样植入为实验侧;另一侧分别为单纯胶原植入组(18个膝关节)和空白对照组(18个膝关节).术后4、8、12、24、32和48周取材观察缺损修复情况及新生组织的类型.参照Pineda标准对新生组织评分. 结果实验侧术后4周,植入细胞类似软骨细胞,周围有异染基质,形成透明软骨样组织;8周,深层有软骨下骨形成,软骨细胞层较正常关节软骨厚;12周,新生软骨厚度减小,与正常软骨相近,细胞呈柱状排列,结构与正常关节软骨相似,软骨下骨形成,潮线恢复;24周,新生软骨厚度较正常薄,约占55%,表面平整,潮线附近仍有肥大的软骨细胞;32周,潮线附近无肥大软骨细胞;48周,组织结构与32周时基本相同,为类透明软骨.Pineda评分24、32和48周间无差异,与4周比较有统计学意义(P＜0.05).实验组2～48周期间关节功能良好.单纯胶原组与空白对照组缺损无修复,48周时软骨下骨外露,关节退变;关节功能逐渐减退,动度受限. 结论 MSCs源性软骨细胞移植体内可形成透明样软骨组织,24周后新生软骨特性稳定,48周时为透明样软骨,能维持良好的关节功能.