Pierre-Alexis Mouthuy

Synthetic and degradable patches: an emerging solution for rotator cuff repair.

The use of rotator cuff augmentation has increased dramatically over the last 10 years in response to the high rate of failure observed after non‐augmented surgery. However, although augmentations have been shown to reduce shoulder pain, there is no consensus or clear guideline as to what is the safest or most efficacious material. Current augmentations, either available commercially or in development, can be classified into three categories: non‐degradable structures, extra cellular matrix (ECM)‐based patches and degradable synthetic scaffolds. Non‐degradable structures have excellent mechanical properties, but can cause problems of infection and loss of integrity in the long‐term. ECM‐based patches usually demonstrate excellent biological properties in vitro, but studies have highlighted complications in vivo due to poor mechanical support and to infection or inflammation. Degradable synthetic scaffolds represent the new generation of implants. It is proposed that a combination of good mechanical properties, active promotion of biological healing, low infection risk and bio‐absorption are the ideal characteristics of an augmentation material. Among the materials with these features, those processed by electrospinning have shown great promis. However, their clinical effectiveness has yet to be proven and well conducted clinical trials are urgently required.

Physico-chemical characterization of functional electrospun scaffolds for bone and cartilage tissue engineering.

Abstract Mimicking the zonal organization of the bone–cartilage interface will aid the production of functional osteochondral grafts for regeneration of skeletal joint defects. This study investigates the potential of the electrospinning technique to build a three-dimensional construct recapitulating the zonal matrix of this interface. Poly(lactic-co-glycolic acid) (PLGA) and PLGA–collagen solutions containing different concentrations of hydroxyapatite nanoparticles (nHAp) were electrospun on a thin layer of phosphate buffer saline solution spread on the collector in order to facilitate membrane detachment and recovery. Incorporation of increasing amounts of nHAp in PLGA solutions did not affect significantly the average diameter of the fibres, which was about 700 nm. However, in the presence of collagen, fibres with diameters below 100 nm were generally observed and the number of these fibres was inversely proportional to the ratio PLGA:collagen and proportional to the content of nHAp. PLGA membranes were rather hydrophobic, although the aqueous drop contact angles progressively fell from 125° to 110° when the content of nHAp was increased from 0 per cent to 50 per cent (w/v). PLGA–collagen membranes were more hydrophilic with contact angles between 60° and 110°; the values being proportional to the ratio PLGA:collagen and the content of nHAp. Also, the addition of nHAp from 0 per cent to 50 per cent (w/v) in the absence of collagen resulted in decreasing dramatically both the Youngs modulus (Y m), from 34.3 ± 1.8 MPa to 0.10 ± 0.06 MPa, and the ultimate tensile strain (ε max), from a value higher than 40 per cent to 5 per cent. However, the presence of collagen together with nHAp allowed the creation of membranes much stiffer, although more brittle, as shown for membranes made with a ratio 8:2 and 10 per cent of nHAp, for which Y m  =  70.0 ± 6.6 MPa and ε max  =  7 per cent.

Biocompatibility of implantable materials: An oxidative stress viewpoint

Oxidative stress occurs when the production of oxidants surpasses the antioxidant capacity in living cells. Oxidative stress is implicated in a number of pathological conditions such as cardiovascular and neurodegenerative diseases but it also has crucial roles in the regulation of cellular activities. Over the last few decades, many studies have identified significant connections between oxidative stress, inflammation and healing. In particular, increasing evidence indicates that the production of oxidants and the cellular response to oxidative stress are intricately connected to the fate of implanted biomaterials. This review article provides an overview of the major mechanisms underlying the link between oxidative stress and the biocompatibility of biomaterials. ROS, RNS and lipid peroxidation products act as chemo-attractants, signalling molecules and agents of degradation during the inflammation and healing phases. As chemo-attractants and signalling molecules, they contribute to the recruitment and activation of inflammatory and healing cells, which in turn produce more oxidants. As agents of degradation, they contribute to the maturation of the extracellular matrix at the healing site and to the degradation of the implanted material. Oxidative stress is itself influenced by the material properties, such as by their composition, their surface properties and their degradation products. Because both cells and materials produce and react with oxidants, oxidative stress may be the most direct route mediating the communication between cells and materials. Improved understanding of the oxidative stress mechanisms following biomaterial implantation may therefore help the development of new biomaterials with enhanced biocompatibility.

A layered electrospun and woven surgical scaffold to enhance endogenous tendon repair.

Surgical reattachments of tendon to bone in the rotator cuff are reported to fail in around 40% of cases. There are no adequate solutions to improve tendon healing currently available. Electrospun, sub-micron materials, have been extensively studied as scaffolds for tendon repair with promising results, but are too weak to be surgically implanted or to mechanically support the healing tendon. To address this, we developed a bonding technique that enables the processing of electrospun sheets into multi-layered, robust, implantable fabrics. Here, we show a first prototype scaffold created with this method, where an electrospun sheet was reinforced with a woven layer. The resulting scaffold presents a maximum suture pull out strength of 167N, closely matched with human rotator cuff tendons, and the desired nanofibre-mediated bioactivity in vitro and in vivo. This type of scaffold has potential for broader application for augmenting other soft tissues.

Fabrication of continuous electrospun filaments with potential for use as medical fibres.

Soft tissue injuries represent a substantial and growing social and economic burden. Medical fibres are commonly used to repair these injuries during surgery. Patients outcomes are, however, not promising with around 40% of surgical repairs failing within the first few months after surgery due to poor tissue regeneration. The application of nanofibrous filaments and yarns as medical fibres and scaffolds has been suggested to improve soft tissue regeneration and enhance the quality of the repair. However, due to a lack of robustness and reliability of the current fabrication methods, continuous nanofibrous filaments cannot be manufactured and scaled up in industrial settings and are not currently available for clinical use. We have developed a robust and automated method that enables the manufacture of continuous electrospun filaments and which has the potential to be integrated into existing textile production lines. The technology uses a wire guide to form submicrofibres in a dense, narrow mesh which can be detached as a long and continuous thread. The thread can then be stretched and used to create multifilament yarns which can imitate the hierarchical architecture of tissues such as tendons and ligaments. Electrospun polydioxanone yarns produced by this method showed improved cellular proliferation and adhesion when compared to medical monofilament fibres in current clinical use. In vivo, the electrospun yarns showed a good safety profile with mild foreign body reaction and complete degradation within 5 months after implantation. These results suggest that this filament collection method has the potential to become a useful platform for the fabrication of future medical textiles.

Layering PLGA-based electrospun membranes and cell sheets for engineering cartilage-bone transition.

It is now widely acknowledged that implants that have been designed with an effort towards reconstructing the transition between tissues might improve their functionality and integration in vivo. This paper contributes to the development of improved treatment for articular cartilage repair by exploring the potential of the combination of electrospinning technology and cell sheet engineering to create cartilage tissue. Poly(lactic‐co‐glycolic acid) (PLGA) was used to create the electrospun membranes. The focus being on the cartilage–bone transition, collagen type I and hydroxyapatite (HA) were also added to the scaffolds to increase the histological biocompatibility. Human mesenchymal stem cells (hMSCs) were cultured in thermoresponsive dishes to allow non‐enzymatic removal of an intact cell layer after reaching confluence. The tissue constructs were created by layering electrospun membranes with sheets of hMSCs and were cultured under chondrogenic conditions for up to 21 days. High viability was found to be maintained in the multilayered construct. Under chondrogenic conditions, reverse‐transcription–polymerase chain reaction (RT–PCR) and immunohistochemistry have shown high expression levels of collagen type X, a form of collagen typically found in the calcified zone of articular cartilage, suggesting an induction of chondrocyte hypertrophy in the PLGA‐based scaffolds. To conclude, this paper suggests that layering electrospun scaffolds and cell sheets is an efficient approach for the engineering of tissue transitions, and in particular the cartilage–bone transition. The use of PLGA‐based scaffold might be particularly useful for the bone–cartilage reconstruction, since the differentiated tissue constructs seem to show characteristics of calcified cartilage. Copyright

Performances of a portable electrospinning apparatus

To demonstrate that portable electrospinning devices can spin a wide range of polymers into submicron fibres and provide a mesh quality comparable to those produced with benchtop machines. We have designed a small, battery-operated electrospinning apparatus which enables control over the voltage and the flow rate of the polymer solution via a microcontroller. It can be used to electrospin a range of commonly used polymers including poly(ε-caprolactone), poly(p-dioxanone), poly(lactic-co-glycolic acid), poly(3-hydroxybutyrate), poly(ethylene oxide), poly(vinyl acohol) and poly(vinyl butyral). Moreover, electrospun meshes are produced with a quality comparable to a benchtop machine. We also show that the portable apparatus is able to electrospray beads and microparticles. Finally, we highlight the potential of the device for wound healing applications by demonstrating the possibility of electrospinning onto pig and human skins. Portable electrospinning devices are still at an early stage of development but they could soon become an attractive alternative to benchtop machines, in particular for uses that require mobility and a higher degree of flexibility, such as for wound healing applications.

Repairing damaged tendon and muscle: are mesenchymal stem cells and scaffolds the answer?

Mesenchymal stem cells (MSCs) have become an area of intense interest in the treatment of musculoskeletal conditions, such as muscle and tendon injury, as various animal and human trials have demonstrated that implantation with MSCs leads to improved healing and function. However, these trials have usually been relatively small scale and lacking in adequate controls. Additionally, the optimum source of these cells has yet to be determined, partly due to a lack of understanding as to how MSCs produce their beneficial effects when implanted. Scaffolds have been shown to improve tissue-engineering repairs but require further work to optimize their interactions with both native tissue and implanted MSCs. Robust, well-controlled trials are therefore required to determine the usefulness of MSCs in musculoskeletal tissue repair.

Translating Regenerative Biomaterials Into Clinical Practice.

Globally health care spending is increasing unsustainably. This is especially true of the treatment of musculoskeletal (MSK) disease where in the United States the MSK disease burden has doubled over the last 15 years. With an aging and increasingly obese population, the surge in MSK related spending is only set to worsen. Despite increased funding, research and attention to this pressing health need, little progress has been made toward novel therapies. Tissue engineering and regenerative medicine (TERM) strategies could provide the solutions required to mitigate this mounting burden. Biomaterial‐based treatments in particular present a promising field of potentially cost‐effective therapies. However, the translation of a scientific development to a successful treatment is fraught with difficulties. These barriers have so far limited translation of TERM science into clinical treatments. It is crucial for primary researchers to be aware of the barriers currently restricting the progression of science to treatments. Researchers need to act prospectively to ensure the clinical, financial, and regulatory hurdles which seem so far removed from laboratory science do not stall or prevent the subsequent translation of their idea into a treatment. The aim of this review is to explore the development and translation of new treatments. Increasing the understanding of these complexities and barriers among primary researchers could enhance the efficiency of biomaterial translation. J. Cell. Physiol. 230: 36–49, 2016.

Growing tissue grafts on humanoid robots: A future strategy in regenerative medicine?

Humanoid robots may enhance growth of musculoskeletal tissue grafts for tissue transplant applications. Humanoid robots may enhance growth of musculoskeletal tissue grafts for tissue transplant applications.