Co-effect of silk and amniotic membrane for tendon repair

The objective of the present study was to determine the feasibility and biocompatibility of a silk scaffold and a composite silk scaffold in terms of new tendon generation using a rabbit Achilles tendon model. The silk scaffold was constructed using a weaving machine, then soaked in a 1% collagen–hyaluronan (HA) solution and air-dried, whereas the composite silk scaffold was composed of a silk scaffold containing a lyophilized collagen–HA substrate. Tenocytes were cultured in vitro to compare cell populations in the two groups. The cellular densities on composite silk scaffolds were 40% higher on average than those on silk scaffolds in 30-day tenocyte cultures. The tendon scaffolds had implanted into Achilles tendon defects in 16 white New Zealand rabbits. Rabbits were randomly divided into the following three groups: group I, silk scaffold alone; group II, composite silk scaffold; and group III, composite silk scaffold wrapped by an amniotic membrane. Implants were harvested 2, 8, and 12 weeks post-implantation. Histological examinations were conducted using hematoxylin-eosin (H&E), Masson’s trichrome, and by performing immunohistochemical staining for CD34. After 12 weeks, the three groups were distinguishable based on gross examination. The histological examination revealed more organized collagen fibrils in groups III, which showed a dense, parallel, linear organization of collagen bundles. CD34 staining revealed neoangiogenesis in groups III. The results of this research showed that collagen–HA substrates with amniotic membrane accelerate cellular migration and angiogenesis in neotendons.     

骨形态发生蛋白12诱导骨髓间充质干细胞构建组织工程肌腱

背景：以往肌腱损伤的修复方法有端端吻合、自体肌腱移植、同种异体肌腱或人工肌腱移植等,但均有其各自缺点。 目的：探讨以家兔骨髓间充质干细胞为种子细胞,骨形态发生蛋白12诱导,聚羟基乙酸复合材料作为支架材料,预构组织工程化肌腱重建家兔跟腱缺损的可能性。 方法：家兔抽取股骨近端骨髓,分离所得细胞传代至第2代,加入10 μg/L骨形态发生蛋白12诱导分化,并与Ⅰ型胶原溶液按一定比例移植于预张的聚羟基乙酸缝线上预制组织工程化肌腱备用。将家兔制备成跟腱缺损模型,分别采用不同方法修复跟腱缺损：组织工程化肌腱修复,Ⅰ型胶原-聚羟基乙酸缝线修复,丝线行端端修复。修复12周对各组肌腱行形态学、力学及组织病理学观察。 结果与结论：修复12周家兔肌腱组织病理切片：组织工程化肌腱组可见大量梭形纤维母细胞顺应力学方向排列均匀分布于胶原中,纤维细胞明显增多,胶原致密;Ⅰ型胶原-聚羟基乙酸缝线组可见部分纤维组织增生伴少许肉芽组织形成,胶原纤维呈松散网丝状,细胞排列紊乱分布不均;丝线组可见纤维组织旁见大量肉芽组织形成。修复12周家兔肌腱生物力学强度：骨形态发生蛋白12+聚羟基乙酸重建肌腱的力学强度明显优于Ⅰ型胶原-聚羟基乙酸组,与丝线缝合组差异无显著性意义;但骨形态发生蛋白12+聚羟基乙酸重建肌腱的力学强度低于正常肌腱。提示以自体骨髓间充质干细胞作为种子细胞,骨形态发生蛋白12诱导,以聚羟基乙酸为支架,可望构建组织工程化肌腱。构建的组织工程肌腱具有一定的生物力学特性,能用于修复跟腱缺损。     

Knitted poly-lactide-co-glycolide scaffold loaded with bone marrow stromal cells in repair and regeneration of rabbit Achilles tendon

The objectives of this study were to evaluate the morphology and biomechanical function of Achilles tendons regenerated using knitted poly-lactide-co-glycolide (PLGA) loaded with bone marrow stromal cells (bMSCs). The animal model used was that of an adult female New Zealand White rabbit with a 10-mm gap defect of the Achilles tendon. In group I, 19 hind legs with the created defects were treated with allogeneic bMSCs seeded on knitted PLGA scaffold. In group II, the Achilles tendon defects in 19 hind legs were repaired using the knitted PLGA scaffold alone, and in group III, 6 hind legs were used as normal control. The tendon-implant constructs of groups I and II were evaluated postoperatively at 2, 4, 8, and 12 weeks using macroscopic, histological, and immunohistochemical techniques. In addition, specimens from group I (n = 7), group II (n = 7), and group III (n = 6) were harvested for biomechanical test 12 weeks after surgery. Postoperatively, at 2 and 4 weeks, the histology of group I specimens exhibited a higher rate of tissue formation and remodeling as compared with group II, whereas at 8 and 12 weeks postoperation, the histology of both group I and group II was similar to that of native tendon tissue. The wound sites of group I healed well and there was no apparent lymphocyte infiltration. Immunohistochemical analysis showed that the regenerated tendons were composed of collagen types I and type III fibers. The tensile stiffness and modulus of group I were 87 and 62.6% of normal tendon, respectively, whereas those of group II were about 56.4 and 52.9% of normal tendon, respectively. These results suggest that the knitted PLGA biodegradable scaffold loaded with allogeneic bone marrow stromal cells has the potential to regenerate and repair gap defect of Achilles tendon and to effectively restore structure and function.     

仿生活性人工软骨的体外构建及其异位成软骨分化实验研究

应用先进快速成形技术(RP)制备32枚粒度均匀(尺寸均为4mm×4mm×4mm)的聚乳酸-聚羟乙酸(PLGA)人工载体,该载体经I型胶原表面修饰后均分为A、B两组。A组载体复合人骨形态发生蛋白-2基因转染(rAAV-hBM P-2)的兔骨髓基质细胞(M SC s,2×104个细胞/枚);B组每枚载体复合等量、同代次、未基因转染M SC s。体外培养第5 d,从两组各取12枚细胞-载体复合物植入裸鼠皮下,术后30 d取材观察。结果发现rAAV-hBM P-2转染的M SC s成功表达目的基因。RP制备的PLGA载体具有良好的空间结构,大孔及材料表面微孔孔径分别为300μm和3~5μm。体外培养3~5 d,两组载体均复合生长着大量种子细胞。皮下埋植30 d,A组植入物形成较为典型的软骨细胞及基质,II型胶原蛋白表达阳性;同期B组植入物无软骨组织形成。A组聚酯材料面积百分率显著低于B组(P<0.01)。结果表明RP结合载体材料表面修饰,能制备出兼具理想孔隙结构和良好生物相容性的组织工程支架载体,该载体高效复合rAAV-hBM P-2转染的M SC s为组织工程软骨构建创造有利条件。     

聚己二酸丁二醇酯-对苯二甲酸丁二醇酯/Ⅰ型胶原取向纤维促进前交叉韧带断裂后腱-骨愈合

背景:材料表面的微/纳米结构对细胞的行为具有调控作用,肌腱组织主要由平行的胶原纤维组成,因此取向纤维结构对腱-骨愈合具有一定的促进作用.目的:探索聚己二酸丁二醇酯-对苯二甲酸丁二醇酯[poly(butylene adipate-co-terephthalate),PBAT]/Ⅰ型胶原取向纤维支架的生物相容性和成骨诱导活...     

Anterior cruciate ligament regeneration using mesenchymal stem cells and silk scaffold in large animal model

Although in vivo studies in small animal model show the ligament regeneration by implanting mesenchymal stem cells (MSCs) and silk scaffold, large animal studies are still needed to evaluate the silk scaffold before starting a clinical trial. The aim of this study is to regenerate anterior cruciate ligament (ACL) in pig model. The micro-porous silk mesh was fabricated by incorporating silk sponges into knitted silk mesh with lyophilization. Then the scaffold was prepared by rolling the micro-porous silk mesh around a braided silk cord to produce a tightly wound shaft. In vitro study indicated that MSCs proliferated profusely on scaffold and differentiated into fibroblast-like cells by expressing collagen I, collagen III and tenascin-C genes in mRNA level. Then the MSCs-seeded scaffold was implanted in pig model to regenerate ACL. At 24 weeks postoperatively, the MSCs in regenerated ligament exhibited fibroblast morphology. The key ligament-specific extracellular matrix components were produced prominently and indirect ligament–bone insertion with three zones (bone, Sharpey's fibers and ligament) was observed. Although there was remarkable scaffold degradation, the maximum tensile load of regenerated ligament could be maintained after 24 weeks of implantation. In conclusion, the results imply that silk-based material has great potentials for clinical applications.     

Cartilage-like tissue engineering using silk scaffolds and mesenchymal stem cells

Silk fibroin scaffolds were studied as a new biomaterial option for tissue-engineered cartilage-like tissue. Human bone marrow-derived mesenchymal stem cells (MSCs) were seeded on silk, collagen, and crosslinked collagen scaffolds and cultured for 21 days in serum-free chondrogenic medium. Cells proliferated more rapidly on the silk fibroin scaffolds than on the collagen matrices. The total content of glycosaminoglycan deposition was three times higher on silk as compared to collagen scaffolds. Glycosaminoglycan deposition coincided with overexpression of collagen type II and aggrecan genes. Cartilage-like tissue was homogeneously distributed throughout the entire silk scaffolds, while on the collagen and crosslinked collagen systems tissue formation was restricted to the outer rim, leaving a doughnut appearance. Round or angular-shaped cells resided in deep lacunae in the silk systems and stained positively for collagen type II. The aggregate modulus of the tissue-engineered cartilage constructs was more than 2-fold higher than that of the unseeded silk scaffold controls. These results suggest that silk fibroin scaffolds are suitable biomaterial substrates for autologous cartilage tissue engineering in serum-free medium and enable mechanical improvements along with compositional features suitable for durable implants to generate or regenerate cartilage.     

A hybrid silk/RADA-based fibrous scaffold with triple hierarchy for ligament regeneration

While silk-based microfibrous scaffolds possess excellent mechanical properties and have been used for ligament tissue-engineering applications, the microenvironment in these scaffolds is not biomimetic. We hypothesized that coating a hybrid silk scaffold with an extracellular matrix (ECM)-like network of self-assembling peptide nanofibers would provide a biomimetic three-dimensional nanofibrous microenvironment and enhance ligament tissue regeneration after bone marrow-derived mesenchymal stem cell (BMSC)-seeding. A novel scaffold possessing a triple structural hierarchy comprising macrofibrous knitted silk fibers, a silk microsponge, and a peptide nanofiber mesh was developed by coating self-assembled RADA16 peptide nanofibers on a silk microfiber-reinforced-sponge scaffold. Compared with the uncoated control, RADA-coated scaffolds showed enhanced BMSC proliferation, metabolism, and fibroblastic differentiation during the 3 weeks of culture. BMSC-seeded RADA-coated scaffolds showed an increasing temporal expression of key fibroblastic ECM proteins (collagen type I and III, tenascin-C), with a significantly higher tenascin-C expression compared with the controls. BMSC-seeded RADA-coated scaffolds also showed a temporal increase in total collagen and glycosaminoglycan production (the amount produced being higher than in control scaffolds) during 3 weeks of culture, and possessed 7% higher maximum tensile load compared with the BMSC-seeded control scaffolds. The results indicate that the BMSC-seeded RADA-coated hybrid silk scaffold system has the potential for use in ligament tissue-engineering applications.     

Mechanical characterization of collagen fibers and scaffolds for tissue engineering

Engineered tissues must utilize scaffolding biomaterials that support desired cellular functions and possess or can develop appropriate mechanical characteristics. This study assessed properties of collagen as a scaffolding biomaterial for ligament replacements. Mechanical properties of extruded bovine achilles tendon collagen fibers were significantly affected by fiber diameter, with smaller fibers displaying higher tangent moduli and peak stresses. Mechanical properties of 125 micrometer-diameter extruded fibers (tangent modulus of 359.6+/-28.4MPa; peak stress of 36.0+/-5.4MPa) were similar to properties reported for human ligaments. Scaffolds of extruded fibers did not exhibit viscoelastic creep properties similar to natural ligaments. Collagen fibers from rat tail tendon (a well-studied comparison material) displayed characteristic strain-softening behavior, and scaffolds of rat tail fibers demonstrated a non-intuitive relationship between tangent modulus and specimen length. Composite scaffolds (extruded collagen fibers cast within a gel of Type I rat tail tendon collagen) were maintained with and without fibroblasts under standard culture conditions for 25 days; cell-incorporated scaffolds displayed significantly higher tangent moduli and peak stresses than those without cells. Because tissue-engineered products must possess appropriate mechanical as well as biological/chemical properties, data from this study should help enable the development of improved tissue analogues.     

BMP12基因和间充质干细胞修复兔跟腱缺损的形态学研究

目的　观察用BMP12基因和间充质干细胞修复兔跟腱缺损的形态学变化。方法　模拟微重力条件下构建两种组织工程化肌腱。 2 4只新西兰白兔分为 4组 :①单纯人发角蛋白 (HHK对照组 )组 ;②骨髓间充质干细胞 (MSCs) /HHK组织工程化肌腱组 ;③骨形态发生蛋白 12 (BMP12 )基因诱导的腱细胞 /HHK组织工程化肌腱组 ;④pTARGET BMP12质粒 /HHK组。采用光电镜、免疫组织化学和RT PCR方法观察术后不同时期损伤肌腱的修复情况。结果　MSCs/HHK组织工程化肌腱组和基因诱导的腱细胞 /HHK组织工程化肌腱组的缺损肌腱的再生修复效果均优于单纯HHK组 ,尤以基因诱导的腱细胞 /HHK组织工程化肌腱组的修复效果最佳 ,且伴随有Ⅰ型胶原mRNA表达的增高。结论　BMP12基因和MSCs通过促进内源性愈合参与了缺损肌腱的再生修复。     

Increasing the pore sizes of bone-mimetic electrospun scaffolds comprised of polycaprolactone, collagen I and hydroxyapatite to enhance cell infiltration

Bone-mimetic electrospun scaffolds consisting of polycaprolactone (PCL), collagen I and nanoparticulate hydroxyapatite (HA) have previously been shown to support the adhesion, integrin-related signaling and proliferation of mesenchymal stem cells (MSCs), suggesting these matrices serve as promising degradable substrates for osteoregeneration. However, the small pore sizes in electrospun scaffolds hinder cell infiltration in vitro and tissue-ingrowth into the scaffold in vivo, limiting their clinical potential. In this study, three separate techniques were evaluated for their capability to increase the pore size of the PCL/col I/nanoHA scaffolds: limited protease digestion, decreasing the fiber packing density during electrospinning, and inclusion of sacrificial fibers of the water-soluble polymer PEO. The PEO sacrificial fiber approach was found to be the most effective in increasing scaffold pore size. Furthermore, the use of sacrificial fibers promoted increased MSC infiltration into the scaffolds, as well as greater infiltration of endogenous cells within bone upon placement of scaffolds within calvarial organ cultures. These collective findings support the use of sacrificial PEO fibers as a means to increase the porosity of complex, bone-mimicking electrospun scaffolds, thereby enhancing tissue regenerative processes that depend upon cell infiltration, such as vascularization and replacement of the scaffold with native bone tissue.     

The role of three-dimensional pure bovine gelatin scaffolds in tendon healing,modeling, and remodeling: an in vivo investigation with potential clinical value

Aim of the study: Large tendon defects involving extensive tissue loss present complex clinical problems. Surgical reconstruction of such injuries is normally performed by transplanting autogenous and allogenous soft tissues that are expected to remodel to mimic a normal tendon. However, the use of grafts has always been associated with significant limitations. Tissue engineering employing artificial scaffolds may provide acceptable alternatives. Gelatin is a hydrolyzed form of collagen that is bioactive, biodegradable, and biocompatible. The present study has investigated the suitability of gelatin scaffold for promoting healing of a large tendon-defect model in rabbits. Materials and methods: An experimental model of a large tendon defect was produced by partial excision of the Achilles tendon of the left hind leg in adult rabbits. To standardize and stabilize the length of the tendon defect a modified Kessler core suture was anchored in the sectioned tendon ends. The defects were either left untreated or filled with three-dimensional gelatin scaffold. Before euthanasia 60 days after injury, the progress of healing was evaluated clinically. Samples of healing tendon were harvested at autopsy and evaluated by gross, histopathologic, scanning, and transmission electron microscopy, and by biomechanical testing. Results: The treated animals showed superior weight-bearing and physical activity compared with those untreated, while frequency of peritendinous adhesions around the healing site was reduced. The gelatin scaffold itself was totally degraded and replaced by neo-tendon that morphologically had significantly greater numbers, diameters, density, and maturation of collagen fibrils, fibers, and fiber bundles than untreated tendon scar tissue. It also had mechanically higher ultimate load, yield load, stiffness, maximum stress and elastic modulus, when compared to the untreated tendons. Conclusion: Gelatin scaffold may be a valuable option in surgical reconstruction of large tendon defects.     

Bone Tissue Engineering Using Human Mesenchymal Stem Cells: Effects of Scaffold Material and Medium Flow

We report studies of bone tissue engineering using human mesenchymal stem cells (MSCs), a protein substrate (film or scaffold; fast degrading unmodified collagen, or slowly degrading cross-linked collagen and silk), and a bioreactor (static culture, spinner flask, or perfused cartridge). MSCs were isolated from human bone marrow, characterized for the expression of cell surface markers and the ability to undergo chondrogenesis and osteogenesis in vitro, and cultured for 5 weeks. MSCs were positive for CD105/endoglin, and had a potential for chondrogenic and osteogenic differentiation. In static culture, calcium deposition was similar for MSC grown on collagen scaffolds and films. Under medium flow, MSC on collagen scaffolds deposited more calcium and had a higher alcaline phosphatase (AP) activity than MSC on collagen films. The amounts of DNA were markedly higher in constructs based on slowly degrading (modified collagen and silk) scaffolds than on fast degrading (unmodified collagen) scaffolds. In spinner flasks, medium flow around constructs resulted in the formation of bone rods within the peripheral region, that were interconnected and perpendicular to the construct surface, whereas in perfused constructs, individual bone rods oriented in the direction of fluid flow formed throughout the construct volume. These results suggest that osteogenesis in cultured MSC can be modulated by scaffold properties and flow environment.     

Modulation of immunological properties of allogeneic mesenchymal stem cells by collagen scaffolds in cartilage tissue engineering

Influence of the structures of some collagen scaffolds on immunological properties of the seeded allogeneic mesenchymal stem cells (MSCs) was studied in this article. Hydrogels, sponge, and membrane were prepared from type-I collagen. These scaffolds were seeded with neonatal rabbit MSCs and cultured for different periods. Changes of the immunological properties associated with different scaffolds were analyzed and compared. It was found that the expression of major histocompatibility complex (MHC) class I and II molecules on MSCs increased gradually in all scaffolds, but the least increment was recorded in hydrogels. Mixed lymphocyte reactions (MLR) showed that the MSC-hydrogel constructs invoked considerably low allogeneic lymphocytes proliferation. Even in presence of interferon-γ (IFN-γ), the hydrogels with higher concentration gave comparatively lower increment of MHC-II expression and allogeneic lymphocytes proliferation. These results suggest that different scaffold structures may provide different microenvironments and extents of isolation from the host immune system for the seed cells, thereby affecting their immunological properties. Therefore, scaffold structures may modulate the immunological properties of tissue-engineered cartilage with allogeneic cells. Hydrogels, especially which were prepared from higher collagen concentrations, were found to be a promising scaffold structure, from the perspective of avoiding severe immune rejection.     

不同来源蚕丝蛋白修复骨软骨组织缺损的效果比较

背景：目前还没有研究比较不同种属来源蚕丝蛋白修复骨软骨的效果。 目的：观察桑蚕和柞蚕来源蚕丝蛋白支架材料修复骨软骨缺损的效果差异。 方法：取新西兰兔20只,制备单侧膝关节骨软骨缺损模型,随机分为5组：其中1组不植入任何材料,作为空白对照;实验1组将3层桑蚕丝蛋白支架粘在一起,充填于缺损处;实验2组将1个包被转化生长因子β3的桑蚕丝蛋白支架与2个包被骨形态发生蛋白2的桑蚕丝蛋白支架粘在一起,充填于缺损处;实验3组将3层柞蚕丝蛋白支架粘在一起,充填于缺损处;实验4组将1个包被转化生长因子β3的柞蚕丝蛋白支架与2个包被骨形态发生蛋白2的柞蚕丝蛋白支架粘在一起,充填于缺损处。术后8周,取关节骨软骨修复区行组织病理学观察,检测Ⅰ型和Ⅱ型胶原蛋白表达。 结果与结论：实验1组胶原蛋白广泛分布于缺损区全层;实验2组胶原纤维在修复区表面呈平行分布,在中间和底部呈垂直顶部的方向分布;实验3组在修复区表面可见胶原;实验4组在支架表面和底部可见软骨样细胞有成团分布。4个实验组修复区Ⅰ型胶原蛋白呈强阳性表达;实验1组、实验2组修复区Ⅱ型胶原蛋白呈微弱表达,实验3组、实验4组修复区Ⅱ型胶原蛋白呈强阳性表达。表明两种蚕丝蛋白均能修复骨软骨缺损,桑蚕丝蛋白倾向于形成骨组织,柞蚕丝蛋白倾向于形成软骨组织。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程      

In vitro cartilage tissue engineering with 3D porous aqueous-derived silk scaffolds and mesenchymal stem cells

Adult cartilage tissue has limited self-repair capacity, especially in the case of severe damages caused by developmental abnormalities, trauma, or aging-related degeneration like osteoarthritis. Adult mesenchymal stem cells (MSCs) have the potential to differentiate into cells of different lineages including bone, cartilage, and fat. In vitro cartilage tissue engineering using autologous MSCs and three-dimensional (3-D) porous scaffolds has the potential for the successful repair of severe cartilage damage. Ideally, scaffolds designed for cartilage tissue engineering should have optimal structural and mechanical properties, excellent biocompatibility, controlled degradation rate, and good handling characteristics. In the present work, a novel, highly porous silk scaffold was developed by an aqueous process according to these criteria and subsequently combined with MSCs for in vitro cartilage tissue engineering. Chondrogenesis of MSCs in the silk scaffold was evident by real-time RT-PCR analysis for cartilage-specific ECM gene markers, histological and immunohistochemical evaluations of cartilage-specific ECM components. Dexamethasone and TGF-beta3 were essential for the survival, proliferation and chondrogenesis of MSCs in the silk scaffolds. The attachment, proliferation, and differentiation of MSCs in the silk scaffold showed unique characteristics. After 3 weeks of cultivation, the spatial cell arrangement and the collagen type-II distribution in the MSCs-silk scaffold constructs resembles those in native articular cartilage tissue, suggesting promise for these novel 3-D degradable silk-based scaffolds in MSC-based cartilage repair. Further in vivo evaluation is necessary to fully recognize the clinical relevance of these observations.     

脱细胞近交系微型猪肌腱修复兔跟腱缺损

背景：异体肌腱移植是目前修复肌腱缺损的理想方法,但移植后的排斥反应是其使用受到限制的主要原因。 目的：观察脱细胞处理的版纳近交系微型猪肌腱移植修复兔跟腱缺损的疗效,以及其作为异种肌腱移植支架材料的可行性。 方法：将40只日本大白兔制作双后肢跟腱缺损实验动物模型后,随机均分为2组,脱细胞猪肌腱组用脱细胞版纳近交系微型猪肌腱修复,自体肌腱组用自体肌腱修复,术后用3-0肌腱线改良HEMI-KESSLER法进行端端原位吻合。 结果与结论：①移植后2周内,脱细胞猪肌腱组与自体肌腱组白细胞计数、C-反应蛋白测量结果差异无显著性意义(P > 0.05)。②两组移植后局部反应小,伤口一期愈合,屈踝功能恢复正常。③组织学检查均未见明显淋巴细胞浸润,肌腱缝合处胶原纤维相互衔接。结果说明脱细胞版纳近交系微型猪肌腱能成功修复兔跟腱缺损,且具有组织相容性好、移植排斥反应轻的优点。