Chondrocytes or adult stem cells for cartilage repair: the indisputable role of growth factors

Articular cartilage is easily injured but difficult to repair and cell therapies are proposed as tools to regenerate the defects in the tissue. Both differentiated chondrocytes and adult mesenchymal stem cells (MSCs) are regarded as cells potentially able to restore a functional cartilage. However, it is a complex process from the cell level to the tissue end product, during which growth factors play important roles from cell proliferation, extracellular matrix synthesis, maintenance of the phenotype to induction of MSCs towards chondrogenesis. Members of the TGF-β superfamily, are especially important in fulfilling these roles. Depending on the cell type chosen to restore cartilage, the effect of growth factors will vary. In this review, the roles of these factors in the maintenance of the chondrocyte phenotype are discussed and compared with those of factors involved in the repair of cartilage defects, using chondrocytes or adult mesenchymal stem cells.     

Mesenchymal stem cells for cartilage regeneration in osteoarthritis

Osteoarthritis(OA) is a slowly progressive disease where cartilage of the synovial joint degenerates. It is most common in the elderly where patients experience pain and reduce physical activity. In combination with lack of conventional treatment, patients are often left with no other choices than arthroplasty. Over the last years, multipotent stromal cells have been used in efforts to treat OA. Mesenchymal stem/progenitor cells(MSCs) are stromal cells that can differentiate into bone, fat, and cartilage cells. They reside within bone marrow and fat. MSCs can also be found in synovial joints where they affect the progression of OA. They can be isolated and proliferated in an incubator before being applied in clinical trials. When it comes to treatment, emphasis has hitherto been on autologous MSCs, but allogenic cells from healthy donors are emerging as another source of the cells. The first adaptations of MSCs revolved in the use of cellrich matrix, delivered as invasive surgical procedure, which resulted in production of hyaline cartilage and fibrocartilage. However, the demand for less invasive delivery of cells has prompted the use of direct intraarticular injections, wherein a large amount of suspended cells are implanted in the cartilage defect.     

Clonal growth of human articular cartilage and the functional role of the periosteum in chondrogenesis

OBJECTIVE: Clinical cartilage repair with transplantation of cultured chondrocytes, the first described technique introduced in 1994, includes a periosteal membrane but today cells are also implanted without the periosteal combination. The aim of this study was to see if the periosteum had more than a biomechanical function and if the periosteum had a biological effect on the seeded cells tested in an agarose system in which the clonal growth in agarose and the external growth stimulation could be analysed. METHODS: Four different experiments were used to study the growth of human chondrocytes in agarose and the periosteal influence. Human chondrocytes were isolated and transferred to either primary or secondary agarose culture. After 4 weeks, the total number of clones >50 microm was counted. Cocultures of chondrocytes and periosteal tissue, cultures of chondrocytes with conditioned medium from chondrocytes, periosteal cells and fibroblast were used to study a potential stimulatory effect on growth and different cytokines and growth factors were analysed. RESULTS: It was found that the human chondrocytes had different growth properties in agarose with the formation of four different types of clones: a homogenous clone without matrix production, a homogenous clone with matrix production, a differentiated clone with matrix production and finally a differentiated clone without matrix production. The periosteum exerted a paracrine effect on cultured chondrocytes in agarose resulting in a higher degree of cloning. The chondrocytes produced significant amounts of interleukin (IL)-6, IL-8, granulocyte-macrophage colony-stimulating factor (GM-CSF) and transforming growth factor (TGF)-beta. The periosteum produced significant amounts of IL-6, IL-8 and TGF-beta. Cocultures of chondrocytes and periosteum demonstrated a potentiation of IL-6 and IL-8 release but not of TGF-beta and GM-CSF. CONCLUSION: Articular chondrocytes are able to form clones of different properties in agarose and the periosteum has a capacity of stimulating chondrocyte clonal growth and differentiation and secretes significant amounts of IL-6, IL-8, GM-CSF and TGF-beta. It may be that the repair of cartilage defects with seeded chondrocytes could benefit from the combination with a periosteal graft. The production of TGF-beta by implanted chondrocytes could influence the chondrogenic cells in the periosteum to start a periosteal chondrogenesis and together with the matrix from implanted chondrocyte production, a repair of cartilaginous appearance may develop; a dual chondrogenic response is possible.     

组织工程化软骨分泌的可溶性因子对骨髓基质干细胞诱导作用的实验研究

目的 探讨组织工程化软骨分泌的可溶性因子是否能够单独诱导骨髓基质干细胞(bone marrow stromai cells,BMSCs)软骨分化.方法 体外培养扩增猪BMSCs、猪关节软骨细胞以及皮肤成纤维细胞,以5.0×107/ml的细胞终浓度分别接种于聚羟基乙酸/聚乳酸(PGA/PLA)支架,应用隔离池进行隔离共培养.以软骨细胞-材料复合物与BMSCs-材料复合物隔离共培养为实验组,以皮肤成纤维细胞-材料复合物与BMSCs-材料复合物隔离共培养为对照组1,以单纯BMSCs-材料复合物为对照组2.各组标本均于体外培养8周后取材,通过大体观察,组织学,以及免疫组织化学,RT-PCR等方法对新生组织进行评价.结果 隔离共培养8周后,实验组软骨细胞材料-复合物诱导的BMSCs-材料复合物形成的组织略有缩小,外观类似软骨组织,组织学检测见软骨陷窝样结构,SafraninO染色可见软骨特异性基质分泌,免疫组化显示有大量Ⅱ型胶原沉积,RT-PCR检测组织表达Ⅱ型胶原、Ⅸ型胶原、COMP、Sox9等软骨特异性基因,提示形成了较成熟软骨样组织;而对照组成纤维细胞材料复合物诱导的BMSCs-材料复合物和未经任何诱导的BMSCs-材料复合物形成的组织淡黄色,明显缩小、变薄、质地较软,组织学检测均未形成软骨陷窝样结构,主要为纤维性成分,各种软骨特异性相关检测均为阴性.结论 软骨细胞分泌的可溶性因子能够单独诱导BMSCs软骨分化,可能是软骨细胞形成的微环境中发挥诱导作用的主要因素.     

组织工程化软骨分泌的可溶性因子对骨髓基质干细胞诱导作用的实验研究

目的 探讨组织工程化软骨分泌的可溶性因子是否能够单独诱导骨髓基质干细胞(bone marrow stromai cells,BMSCs)软骨分化.方法 体外培养扩增猪BMSCs、猪关节软骨细胞以及皮肤成纤维细胞,以5.0×107/ml的细胞终浓度分别接种于聚羟基乙酸/聚乳酸(PGA/PLA)支架,应用隔离池进行隔离共培养.以软骨细胞-材料复合物与BMSCs-材料复合物隔离共培养为实验组,以皮肤成纤维细胞-材料复合物与BMSCs-材料复合物隔离共培养为对照组1,以单纯BMSCs-材料复合物为对照组2.各组标本均于体外培养8周后取材,通过大体观察,组织学,以及免疫组织化学,RT-PCR等方法对新生组织进行评价.结果 隔离共培养8周后,实验组软骨细胞材料-复合物诱导的BMSCs-材料复合物形成的组织略有缩小,外观类似软骨组织,组织学检测见软骨陷窝样结构,SafraninO染色可见软骨特异性基质分泌,免疫组化显示有大量Ⅱ型胶原沉积,RT-PCR检测组织表达Ⅱ型胶原、Ⅸ型胶原、COMP、Sox9等软骨特异性基因,提示形成了较成熟软骨样组织;而对照组成纤维细胞材料复合物诱导的BMSCs-材料复合物和未经任何诱导的BMSCs-材料复合物形成的组织淡黄色,明显缩小、变薄、质地较软,组织学检测均未形成软骨陷窝样结构,主要为纤维性成分,各种软骨特异性相关检测均为阴性.结论 软骨细胞分泌的可溶性因子能够单独诱导BMSCs软骨分化,可能是软骨细胞形成的微环境中发挥诱导作用的主要因素.     

组织工程化软骨分泌的可溶性因子对骨髓基质干细胞诱导作用的实验研究

目的 探讨组织工程化软骨分泌的可溶性因子是否能够单独诱导骨髓基质干细胞(bone marrow stromai cells,BMSCs)软骨分化.方法 体外培养扩增猪BMSCs、猪关节软骨细胞以及皮肤成纤维细胞,以5.0×107/ml的细胞终浓度分别接种于聚羟基乙酸/聚乳酸(PGA/PLA)支架,应用隔离池进行隔离共培养.以软骨细胞-材料复合物与BMSCs-材料复合物隔离共培养为实验组,以皮肤成纤维细胞-材料复合物与BMSCs-材料复合物隔离共培养为对照组1,以单纯BMSCs-材料复合物为对照组2.各组标本均于体外培养8周后取材,通过大体观察,组织学,以及免疫组织化学,RT-PCR等方法对新生组织进行评价.结果 隔离共培养8周后,实验组软骨细胞材料-复合物诱导的BMSCs-材料复合物形成的组织略有缩小,外观类似软骨组织,组织学检测见软骨陷窝样结构,SafraninO染色可见软骨特异性基质分泌,免疫组化显示有大量Ⅱ型胶原沉积,RT-PCR检测组织表达Ⅱ型胶原、Ⅸ型胶原、COMP、Sox9等软骨特异性基因,提示形成了较成熟软骨样组织;而对照组成纤维细胞材料复合物诱导的BMSCs-材料复合物和未经任何诱导的BMSCs-材料复合物形成的组织淡黄色,明显缩小、变薄、质地较软,组织学检测均未形成软骨陷窝样结构,主要为纤维性成分,各种软骨特异性相关检测均为阴性.结论 软骨细胞分泌的可溶性因子能够单独诱导BMSCs软骨分化,可能是软骨细胞形成的微环境中发挥诱导作用的主要因素.     

The role of hepatocyte growth factor in growth plate cartilage

To investigate the physiological role of hepatocyte growth factor (HGF) in endochondral bone formation, we examined the expression of HGF and its receptor c-met and the effects of HGF on growth plate chondrocytes. HGF was highly expressed in the prehypertrophic zone and hypertrophic zone in rat costal growth plate cartilage. The expression of HGF increased in rabbit chondrocytes as they matured in culture. Conversely, c-met expression was down regulated along maturation of growth plate chondrocytes. HGF had weak stimulatory effects on DNA and proteoglycan synthesis of growth plate chondrocytes. However, HGF strongly inhibited expression of terminal differentiation-related phenotypes, such as type X collagen and alkaline phosphatase (APase) synthesis and cartilage matrix mineralization. When HGF was removed from the cultures, cells quickly expressed type X collagen and APase. Once chondrocytes differentiated to mature chondrocytes, HGF did not inhibit further differentiation of these cells. These results suggested that HGF is a negative regulator of terminal differentiation of growth plate chondrocytes.. Received: Feb. 12, 1998 / Accepted: March 12, 1998     

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.     

The use of growth factors in cartilage repair

Articular cartilage, which enables smooth gliding of joints during skeletal motion, is vulnerable to injuries and degenerative diseases over time. Bone growth factors have a role in the preservation of the cartilage matrix. This article reviews the potential to treat cartilage damage for bone morphogenetic proteins, insulin-like growth factors, hepatocyte growth factor, basic fibroblast growth factor, and transforming growth factor beta.     

The enhancement of nerve regeneration using growth factors: a brief review

The management of peripheral nerve injuries continues to challenge the surgeon. Despite advances in surgical technique, return of normal function is uncommon after the repair of a transected nerve. It is now possible to enhance the process of nerve regeneration in animals using growth factors carried in silicone nerve guides. In this article the biological process of nerve regeneration is described and contemporary research involving the use of growth factor implants to facilitate nerve regeneration is reviewed.     

The effect of growth factors and synovial fluid on chondrogenesis in perichondrium

Reconstruction of cartilage with perichondrium depends on the chondrogenic property of the perichondrial fibrocytes. The present investigation concerns the conditions for the differentiation of fibrocytes into chondrocytes both in vivo and in vitro. For the in vivo studies specimens of rib and auricular perichondrium from adult rabbits were wrapped round silicon rods which were enclosed in dialysis bags. One was placed in the suprapatellar pouch of the knee joint and one was placed intraperitoneally in each rabbit. After two months the bags were extracted, the perichondrium prepared for microscopic examination, and the chondrogenesis evaluated. In vitro the perichondrium was divided into small pieces and incubated with tissue culture medium. The medium was supplemented with fetal calf serum, together with epidermal growth factor, platelet derived growth factor, synovial fluid, or with human serum albumin (control group). After three weeks the explants were prepared for microscopy. Chondrogenesis was judged by the degree of cellular enlargement, capsule formation, deposition of matrix, and activation of the outer fibrocytic layer. In vivo, good cartilage development was found in all specimens placed in the knee joint but, in those placed intraperitoneally, little if any chondrogenesis was seen. In vitro profound differentiation occurred in all cultures supplemented with epidermal growth factor and platelet derived growth factor. An equivalent differentiation was found in perichondrium that had been incubated with synovial fluid. We conclude that the differentiation of perichondrial fibrocytes is initiated in vitro by growth factors. In addition, we have shown that synovial fluid contains factors that promote and enhance the development of cartilage from perichondrium.     

Fibroblast growth factor-18 stimulates chondrogenesis and cartilage repair in a rat model of injury-induced osteoarthritis

OBJECTIVE: Osteoarthritis (OA) is the most common form of arthritis and a primary cause of disability, however, there are no treatments that can slow disease progression or repair damaged joint cartilage. Fibroblast growth factor-18 (FGF18) has been reported to have significant anabolic effects on cartilage. We therefore examined its effects on repair of cartilage damage in a rat meniscal tear model of OA. DESIGN: Surgical damage to the meniscus in rats leads to joint instability and significant damage to the articular cartilage at 3 weeks post-surgery. At this time, animals received bi-weekly intra-articular injections of FGF18 for 3 weeks, and the knee joints were then harvested for histologic examination. RESULTS: FGF18-induced dose-dependent increases in cartilage thickness of the tibial plateau, due to new cartilage formation at the articular surface and the joint periphery. The generation of new cartilage resulted in significant reductions in cartilage degeneration scores. The highest dose of FGF18 also induced an increase in chondrophyte size and increased remodeling of the subchondral bone. CONCLUSIONS: The results of this study demonstrate that FGF18 can stimulate repair of damaged cartilage in a setting of rapidly progressive OA in rats.     

The role of mesenchymal stem cells in bone repair and regeneration

Despite the undisputed modern development of synthetic biomaterials that range from bioactive unresorbable to restorable materials, clinically applied osteoconduction bone substitutes still have limitations in the treatment of bone defects. These are the result of the physical and chemical properties of the utilized materials and the biological interactions associated with both local and general reactions of the organism. Mesenchymal stem cells constitute a promising treatment alternative in orthopedics. Preclinical studies regarding the use of mesenchymal stem cells have shown good therapeutic results. However, it is still necessary to advance further in this area and enable the treatment of patients with critically large bone defects. The aim of this review is to describe the role of mesenchymal stem cells in bone repair and regeneration, describe the techniques used in the clinical application of mesenchymal stem cells and outline future research endeavors in this area.     

Potential of exogenous cartilage proteoglycan as a new material for cartilage regeneration

Background  

Although proteoglycan (PG) is one of the major components of cartilage matrices, its biological function is not fully elucidated.     

The spread of cell death from impact damaged cartilage: lack of evidence for the role of nitric oxide and caspases

Over 21 days in culture, cell death spreads, both radially and transversely, from loaded to surrounding cartilage. This spread was prevented by physical separation and separate culture post-impact. OBJECTIVE: One aim was to determine if nitric oxide (NO) is the intercellular signal mediating cell death. Another aim was to clarify the nature of the cell death, whether caspase mediated apoptosis or necrosis. DESIGN: Cyclic impacts were applied to the central 2 mm core of 4 mm canine articular cartilage discs. Post-impact culturing was for 21 days in the presence or absence of the iNOS inhibitor, L-NAME, or the broad-spectrum caspase inhibitor, Z-VAD FMK. Cell death was quantified using the TUNEL assay. Culture media were collected every 2 days for measurements of glycosaminoglycan (GAG) and NO release. RESULTS: Cell death spread from the loaded core into the surrounding ring over 21 days in culture. Although L-NAME significantly reduced nitrite release into the culture media of both loaded and control cartilage, the spread of cell death was not prevented. Neither was the spread of cell death prevented by Z-VAD FMK. CONCLUSIONS: These data indicate that NO is not acting as an intercellular signalling factor in this in vitro system and that the cell death post-impact is not caspase mediated.