Roger A. Brooks

Articular cartilage tissue engineering TODAY’S RESEARCH, TOMORROW’S PRACTICE?

Articular cartilage repair remains a challenge to surgeons and basic scientists. The field of tissue engineering allows the simultaneous use of material scaffolds, cells and signalling molecules to attempt to modulate the regenerative tissue. This review summarises the research that has been undertaken to date using this approach, with a particular emphasis on those techniques that have been introduced into clinical practice, via in vitro and preclinical studies.

Regeneration and repair of tendon and ligament tissue using collagen fibre biomaterials.

Collagen fibres are ubiquitous macromolecular assemblies in nature, providing the structures that support tensile mechanical loads within the human body. Aligned type I collagen fibres are the primary structural motif for tendon and ligament, and therefore biomaterials based on these structures are considered promising candidates for mediating regeneration of these tissues. However, despite considerable investigation, there remains no collagen-fibre-based biomaterial that has undergone clinical evaluation for this application. Recent research in this area has significantly enhanced our understanding of these complex and challenging biomaterials, and is reinvigorating interest in the development of such structures to recapitulate mechanical function. In this review we describe the progress to date towards a ligament or tendon regeneration template based on collagen fibre scaffolds. We highlight reports of particular relevance to the development of the underlying biomaterials science in this area. In addition, the potential for tailoring and manipulating the interactions between collagen fibres and biological systems, as hybrid biomaterial-biological ensembles, is discussed in the context of developing novel tissue engineering strategies for tendon and ligament.

Repair of defects in articular joints: Prospects for material-based solutions in tissue engineering

©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B8. 15609

Exploring the Application of Stem Cells in Tendon Repair and Regeneration

2.00 J Bone Joint Surg [Br] 2004;86-B:1093-9. Each year, more than one million procedures to treat defects of articular cartilage are performed in the knee alone.1 While removal of loose bodies and the chondroplastic procedures of debridement and shaving account for approximately half of these, the remainder involve treatment of defects which are sufficiently severe to require the replacement or assisted regeneration of damaged hyaline cartilage. Over the past decade, methods based on the principles of tissue engineering and regenerative medicine have emerged as the most promising approaches for the repair of defects in articular joints.2,3 These make use of combinations of cells, signalling molecules and scaffolds to augment the natural regenerative capacity of the body, with the aim of restoring healthy structure and function to damage or diseased tissue.4 Tissue engineering has produced success in a number of soft-tissue applications,5,6 but the regeneration of articular surfaces poses a unique challenge, in that articular cartilage has a limited capacity for self-repair and mechanical stimuli play a large role in the structure and function of cartilage and subchondral bone. While these factors place special demands on all aspects of tissue engineering, scaffold design takes on a role of particular importance. This review addresses the design requirements for scaffolds used in the treatment of chondral and osteochondral defects. Particular emphasis is placed on recent trends in scaffold design and their potential for clinical application.

Assessment of the biocompatibility of photosensitive polyimide for implantable medical device use

PURPOSE To conduct a systematic review of the current evidence for the effects of stem cells on tendon healing in preclinical studies and human studies. METHODS A systematic search of the PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, and Embase databases was performed for stem cells and tendons with their associated terminology. Data validity was assessed, and data were collected on the outcomes of trials. RESULTS A total of 27 preclinical studies and 5 clinical studies met the inclusion criteria. Preclinical studies have shown that stem cells are able to survive and differentiate into tendon cells when placed into a new tendon environment, leading to regeneration and biomechanical benefit to the tendon. Studies have been reported showing that stem cell therapy can be enhanced by molecular signaling adjunct, mechanical stimulation of cells, and the use of augmentation delivery devices. Studies have also shown alternatives to the standard method of bone marrow-derived mesenchymal stem cell therapy. Of the 5 human studies, only 1 was a randomized controlled trial, which showed that skin-derived tendon cells had a greater clinical benefit than autologous plasma. One cohort study showed the benefit of stem cells in rotator cuff tears and another in lateral epicondylitis. Two of the human studies showed how stem cells were successfully extracted from the humerus and, when tagged with insulin, became tendon cells. CONCLUSIONS The current evidence shows that stem cells can have a positive effect on tendon healing. This is most likely because stem cells have regeneration potential, producing tissue that is similar to the preinjury state, but the results can be variable. The use of adjuncts such as molecular signaling, mechanical stimulation, and augmentation devices can potentially enhance stem cell therapy. Initial clinical trials are promising, with adjuncts for stem cell therapy in development.

The role of surface wettability and surface charge of electrosprayed nanoapatites on the behaviour of osteoblasts

Polyimides have been widely used for biosensor encapsulation and more recently as substrates for neural implants. They have excellent thermal stability, high chemical resistance, and can be prepared as thin, flexible films. Photosensitive polyimides present similar physical properties to polyimides, and have the advantage that they can be photo-lithographically patterned. However, to date little data on their biocompatibility has been reported. Two commercially available polyimides (PI) and one photo-sensitive polyimide (PSPI) were evaluated in vitro using the ISO 10993 standard on biocompatibility. The materials were Dupont Kapton foil HN, HD Microsystem PI2611, and Fujifilm Durimide 7020 (PSPI). PI2611 and Durimide 7020 were spin-coated on silicon wafers, cured at temperatures ranging from 150 to 450 degrees C, and sterilized by autoclave. All materials were evaluated using a scanning electron microscope pre- and postcell culture. Cell viability was determined by an MTS assay. Their mechanical properties and stability during cell culture as a function of time and environment were investigated by nanoindentation. The MTS results show that PSPI is noncytotoxic compared with the negative control of polyethylene and the conventional PIs tested. Fibroblast adhesion, morphology, and spreading were good and better on the PSPI substrate than on the PI2611. Schwann cell appearance was similar on each of the PIs and the PSPI tested. The results suggest that PSPIs may have potential use for biological microsystem and neuroprosthetic applications.

The effects of particulate bone cements at the bone-implant interface.

A new deposition method is presented, based on electrospraying, that can build bioceramic structures with desirable surface properties. This technology allows nanoapatite crystals, including hydroxyapatite (nHA), carbonate-substituted HA (nCHA) and silicon-substituted HA (nSiHA), to be electrosprayed on glass substrates. Human osteoblast cells cultured on nSiHA showed enhanced cell attachment, proliferation and protein expression, namely alkaline phosphatase, type 1 collagen and osteocalcin, as compared to nHA and nCHA. The modification of nanoapatite by the addition of silicon into the HA lattice structure renders the electrosprayed surface more hydrophilic and electronegatively charged.

The role of electrosprayed apatite nanocrystals in guiding osteoblast behaviour.

We used a rat model in vivo to study the effects of particulate bone cements at the bone-implant interface. A ceramic pin was implanted into the tibiae of 48 rats. Three types of particle of clinically relevant size were produced from one bone-cement base without radio-opacifier, with zirconium dioxide (ZrO2) and with barium sulphate (BaSO4). The rats were randomly assigned to four groups to receive one of the three bone cements or normal saline with 2% v/v Sprague-Dawley serum as the control. A total of 10(9) particles was injected into the knee at 8, 10 and 12 weeks after the original surgery. The animals were killed at 14 weeks and the tibiae processed for histomorphometry. The area of fibrous tissue and the gap between the implant and bone were measured using image analysis. All three types of particle were associated with a larger area of bone resorption than the control. Only in the case of the BaSO4-containing cement did this reach statistical significance (p = 0.01). Particles of bone cement appear to promote osteolysis at the bone-implant interface and this effect is most marked when BaSO4 is used as the radiopaque agent.

Evaluation of early-stage osteochondral defect repair using a biphasic scaffold based on a collagen-glycosaminoglycan biopolymer in a caprine model.

Apatite nanocrystals, which mimic the dimensions of natural bone mineral, were electrosprayed on glass substrates, as a suitable synthetic biomedical material for osteoblast outgrowth was explored. A variety of topographic patterns were deposited and the influence of these designs on osteoblast alignment and cell differentiation was investigated. Patterned cell growth and enhanced cell differentiation were seen. Osteoblasts were also cultured on apatite nanocrystals chemically modified with either carbonate or silicon ions. Enhanced cell proliferation and early formation of mineral nodules were observed on apatite nanocrystals with silicon addition. This work highlights the importance of the combined effects of surface topography and surface chemistry in the guidance of cell behaviour.

Effects of lactic acid and glycolic acid on human osteoblasts: a way to understand PLGA involvement in PLGA/calcium phosphate composite failure.

The aim of this study was to evaluate a new collagen-GAG-calcium phosphate biphasic scaffold for the repair of surgically created osteochondral defects in goats. Comparison of morphological, histological and mechanical performance of the repair tissue was made with defects repaired using a synthetic polymer scaffold. Defects were created in the medial femoral condyle (MFC) and lateral trochlear sulcus (LTS) of Boer Cross goats and evaluated at 12 and 26 weeks. It was found that the total histology score of the collagen-GAG based biomaterial (23.8; SD 1.7) provided a significant improvement (p<0.05) over the biphasic PLGA material (19;3) and the empty control defect (17.3;1.2) in the LTS. The overall trajectory of histological and morphological improvement between 12 and 26 weeks was found to be higher for the collagen-GAG scaffold compared to the PLGA material. The occurrence of sub-chondral bone cysts was lower for the collagen-GAG scaffold with an incidence of 17% of defects, compared to 67% for the PLGA material at 26 weeks. The cartilage repair tissue for both materials evaluated was superior after 26 weeks implantation than the empty control with 75% of the collagen-GAG-treated defects showing markedly more hyaline-like cartilage and 50% of the PLGA sites exhibiting hyaline-like appearances, compared to 17% for the empty control. These early stage data indicate biphasic scaffolds based on collagen-GAG and PLGA both provide indications of satisfactory development of a structural repair to surgically prepared osteochondral defects. Furthermore, the biomaterial composition of the collagen-GAG may provide a more favourable environment for osteochondral repair.