Helge Bertram

Vascular Endothelial Growth Factor Gene‐Activated Matrix (VEGF165‐GAM) Enhances Osteogenesis and Angiogenesis in Large Segmental Bone Defects

Healing of fractures is dependent on vascularization of bone, which is in turn promoted by VEGF. It was shown that 0.1 and 1 mg of pVEGF165‐GAM led to a significant increase in vascularization and bone regeneration in defects that would otherwise have led to atrophic nonunions.

Vascular endothelial growth factor (VEGF-A) expression in human mesenchymal stem cells: autocrine and paracrine role on osteoblastic and endothelial differentiation.

Angiogenesis is essential in bone fracture healing for restoring blood flow to the fracture site. Vascular endothelial growth factor (VEGF) and its receptor have been implicated in this process. Despite the importance of angiogenesis for the healing processes of damaged bones, the role of VEGF signaling in modulation of osteogenic differentiation in human mesenchymal stem cells has not been investigated in great detail. We examined the expression of VEGF‐A and VEGFR‐1 in human adult mesenchymal stem cells derived from trabecular bone (hTBCs). VEGF‐A was found to be secreted in a differentiation dependent manner during osteogenesis. Transcripts for VEGF‐A were also seen to be elevated during osteogenesis. In addition, transcripts for VEGF‐A and the corresponding receptor VEGFR‐1 were upregulated under hypoxic conditions in undifferentiated hTBCs. To investigate the signaling of VEGF‐A on osteogenesis recombinant hTBCs were generated. High expression of VEGF‐A stimulated mineralization, whereas high expression of sFLT‐1, an antagonist to VEGF‐A, reduced mineralization suggesting that VEGF‐A acts as autocrine factor for osteoblast differentiation. In addition, VEGF‐A secreted by hTBCs promotes sprouting of endothelial cells (HUVE) demonstrating a paracrine role in blood vessel formation. In summary, an in vitro analysis of transgene effects on cellular behavior can be used to predict an effective ex vivo gene therapy.

Induction of Intervertebral Disc–Like Cells From Adult Mesenchymal Stem Cells

The potential of adult mesenchymal stem cells (MSCs) to differentiate towards cartilage, bone, adipose tissue, or muscle is well established. However, the capacity of MSCs to differentiate towards intervertebral disc (IVD)‐like cells is unknown. The aim of this study was to compare the molecular phenotype of human IVD cells and articular chondrocytes and to analyze whether mesenchymal stem cells can differentiate towards both cell types after transforming growth factor β (TGFβ)‐mediated induction in vitro.

Stimulation of gene expression and loss of anular architecture caused by experimental disc degeneration--an in vivo animal study.

Study Design. An external compression model was used to evaluate gene and protein expression in intervertebral discs with moderate disc degeneration. Objective. To determine messenger ribonucleic acid and protein expression levels of relevant disc components. Summary of Background Data. An animal model of mechanically induced disc degeneration was developed and characterized histologically. However, little is known at the molecular level in moderate disc degeneration. Methods. There were 8 New Zealand white rabbits subjected to monosegmental posterior compression to induce moderate disc degeneration. Twelve animals served as controls or sham controls. Discs were analyzed using immunohistochemistry for collagen type 1 (COL1), COL2, aggrecan, and bone morphogenetic protein-2/4 (BMP-2/4). For gene analysis, conventional and quantitative polymerase chain reactions were used for COL1A2, COL2A1, aggrecan, BMP-2, biglycan, decorin, osteonectin, fibromodulin, fibronectin, matrix metalloproteinase-13 (MMP-13), and tissue inhibitor of MMP-1. Gene expression for nontreated, sham-treated, and compressed discs was quantified in relation to the housekeeping gene glyceraldehyde-3-phosphate dehydrogenase. Results. Immunohistochemistry of compressed discs showed a loss of anular architecture, and a significant reduction of BMP-2/4 and COL2 positive cells. Gene expression analysis showed a significant up-regulation of COL1A2, osteonectin, decorin, fibronectin, tissue inhibitor of MMP-1, BMP-2, and MMP-13 in compressed discs. Conclusions. Experimental moderate disc degeneration is characterized by a loss of BMP-2/4 and COL2 positive cells, although gene expression of disc constituents, catabolic enzymes, and growth factors is stimulated to reestablish disc integrity.

A new porcine in vivo animal model of disc degeneration: response of anulus fibrosus cells, chondrocyte-like nucleus pulposus cells, and notochordal nucleus pulposus cells to partial nucleotomy.

Study Design. In vivo animal study. Objectives. To describe a new porcine disc degeneration model, and to analyze disc remodeling and degeneration after nucleotomy with special view to the different nucleus pulposus (NP) cell types. Summary of Background Data. Thus far, predominantly smaller animals were used for disc degeneration models; however, such small discs were inappropriate to investigate cell implementation therapies. Though notochordal cells (NCs) are important for disc formation and maintenance, differences in the amount of NCs between human and animal discs have often been neglected. Methods. Twenty-four Goettingen minipigs underwent partial nucleotomy with a 16G biopsy cannula, to remove ∼10% of total NP volume. Animals were followed up for 3, or 24 weeks and analyzed by radiographs, MRIs, (immuno)histology, gene expression analysis, and biomechanical testing. Results. Three weeks after nucleotomy disc height was reduced by 26%, and magnetic resonance imaging signal intensity by 40%. At 24 weeks disc height was decreased by 32%. Increased degenerative changes were found in a histodegeneration score 3 and 24 weeks after nucleotomy, as well as considerable NP scarification after 3 weeks. In controls, cytokeratin-8 immunohistochemistry identified NCs in proximity to chondrocyte-like NP cells at approximately equal ratio. After nucleotomy, NCs were considerably reduced to <10% of total NP cells. Matrix genes were upregulated, except for aggrecan that decreased to 35% of initial values 3 weeks after nucleotomy. Matrix degrading factors (matrix metalloproteinases 13 and 3) were continuously upregulated, whereas transcripts of their inhibitors (tissue inhibitors of matrix metalloproteinase 2 and 3) were downregulated. No significant changes in segmental spinal flexibility or bone density were found after nucleotomy. Conclusion. We introduced a new disc degeneration model with relatively large discs that could be used for cell therapeutic approaches. The study gives further information about disc remodeling after nucleotomy and indicates the relevance of an altered cellular composition for the development of disc degeneration.

Expression of TRAIL and the death receptors DR4 and DR5 correlates with progression of degeneration in human intervertebral disks.

Intervertebral disks degenerate far earlier than other musculoskeletal tissues and apoptosis has been suggested to have a vital function in promoting the degeneration process that is strongly associated with back pain. However, the molecular mediators of apoptosis in the intervertebral disk are poorly understood. Fas/FasL, TRAIL/DR4, TRAIL/DR5 and TNF-α/TNFR1 are ligand/receptor pairs of the tumor necrosis factor/nerve growth factor family, which are able to induce apoptosis by trimerization of the receptor by its corresponding ligand. We investigated which of these molecules are expressed in intervertebral disks and whether their expression correlates to disk degeneration. Intervertebral disks from 28 donors (age 12–70 years) suffering from scoliosis, vertebrae fracture or disk degeneration were scored histologically for degeneration and analyzed for gene expression of FasL/Fas, TRAIL/DR4, TNF-α/TNFR1 and caspase 8. Protein expression of FasL and TRAIL was assessed by immunohistology and apoptotic cell death was quantified by poly(ADP-ribose) polymerase (PARP) p85 staining. Isolated disk cells were analyzed by flow cytometry for Fas, FasL, TRAIL, DR4 and DR5 expression. Gene expression of TRAIL (P=0.002) and caspase 8 (P=0.027) significantly correlated with degeneration. TRAIL expression further correlated with cellularity (P=0.04), muccoid matrix changes (P=0.009) and tears and cleft formation (P=0.019). FasL and TRAIL expression was confirmed by immunohistology and PARP cleavage was significantly associated with degeneration (P=0.027). Flow cytometry on isolated disk cells revealed correlations between DR4 and degeneration (P=0.014), DR4/DR5 double-positive cells and degeneration (P=0.019), as well as DR5 and changes in tissue granularity (P=0.03). This is the first study that shows that intervertebral disk cells express TRAIL, DR4 and DR5, which correlate to the degenerative state of the disk. Therefore, disk cells inherit the molecular machinery to induce and undergo cellular apoptosis, and the frequency of cytokine expression suggests that the TRAIL/DR4/DR5 axis is an important molecular mediator of apoptosis induction in disk tissue.

Development of Novel Scaffolds for Tissue Engineering by Flock Technology

Flock technology is a method well known in the textile industry. Short fibers are applied almost vertically on a substrate, coated with a flocking adhesive. Until now, this technology has not been used in the field of biomaterials. Our aim was to use electrostatic flocking for fabricating a novel type of scaffolds for tissue engineering. This method offers the possibility to create matrices with anisotropic properties that have a high compressive strength despite high porosity. First, experiments were performed using a membrane made of mineralized collagen as substrate, gelatine as adhesive and polyamide flock fibers. Different kinds of cells were cultured in the scaffolds for up to six weeks. Using microscopic methods and biochemical analyses, we could demonstrate that cells adhered and proliferated well in this new type of scaffold. Therefore, we can summarize that flocking is a technology suitable for fabrication of scaffolds for cell cultivation and tissue engineering.

In-vitro-Manipulation von primären humanen Osteoprogenitorzellen für die gewebetechnologische Herstellung von Knochen

Ziel der vorliegenden Arbeit war die Untersuchung der Wirkung von Zytokinen auf die Proliferation und Differenzierung humaner mesenchymaler Stammzellen (MSZ) des Beckenkamms in vitro sowie der Effekt der Transfektion mit dem BMP-2-Gen in vivo. Die in Differenzierungsmedium kultivierten MSZ zeigten nach Isolierung durch Auswachsen aus Spongiosaproben in vitro neben osteogenen Markergenen wie Kollagen I auch die Expression chondrogener Transkripte, Kollagen II und Kollagen X, während bei der Anwendung anderer Isolierungsverfahren keine chondrogenen Marker exprimiert wurden. Die Differenzierung konnte durch die Zugabe von BMP-2 in vitro gesteigert werden. Die Transfektion der MSZ mit dem BMP-2-Gen hatte nach i.m.-Reimplantation in vivo einen verstärkenden Effekt auf die Bildung mineralisierten Gewebes. The aim of the present study was to evaluate the effect of three different techniques for isolation of human bone-marrow-derived mesenchymal stem cells (MSCs) on the in vitro differentiation of these cells. Furthermore, the use of BMP-2 was assessed and the effect of gene transfer of the BMP-2 gene into these cells was evaluated. Reverse transcription polymerase chain reaction showed that isolation of MSCs by outgrowth from cancellous chips resulted in expression of both osteogenic and chondrogenic markers, while cells cultivated from marrow aspirates exhibited only osteogenic markers. Intramuscular reimplantation of BMP-2-transfected cells in poly-(L/DL 70/30) lactic acid fleeces resulted in formation of mineralized tissue after 8 weeks in athymic rats, while control-transfected cells exhibited matrix synthesis without mineralized tissue after intramuscular reimplantation.The aim of the present study was to evaluate the effect of three different techniques for isolation of human bone-marrow-derived mesenchymal stem cells (MSCs) on the in vitro differentiation of these cells. Furthermore, the use of BMP-2 was assessed and the effect of gene transfer of the BMP-2 gene into these cells was evaluated. Reverse transcription polymerase chain reaction showed that isolation of MSCs by outgrowth from cancellous chips resulted in expression of both osteogenic and chondrogenic markers, while cells cultivated from marrow aspirates exhibited only osteogenic markers. Intramuscular reimplantation of BMP-2-transfected cells in poly-(L/DL 70/30) lactic acid fleeces resulted in formation of mineralized tissue after 8 weeks in athymic rats, while control-transfected cells exhibited matrix synthesis without mineralized tissue after intramuscular reimplantation.