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  • Biomaterial Scaffolds for Mesenchymal Stem Cell Based Therapy Aimed at Tissue Engineering Application for Osteoarthritis

    Abstract

    RDegenerative joint diseases have seen a rise in the past few decades. Among them, the prevalence of Osteoarthritis (OA) is the highest as compared to the other types of arthritis. It involves the degradation of cartilage in joints that ultimately leads to their degeneration. Globally, it affects over 200 million people and the statistics are only expected to increase over the next few decades. The treatment approach for initial stages of OA involves changes in the lifestyle, use of analgesics, NSAIDs and other medications. As the condition worsens, the end point treatment is generally a prosthetic implant followed by surgery. These approaches are short-term and the patients are often found complaining of the post-surgical complications of the invasive methods. This has created the need for less invasive and sustainable treatment approaches. Mesenchymal stem cells (MSCs) have the potential to be differentiated into various kinds of cells making stem cell based therapy an attractive approach for both, researchers and medical experts. We aimed at fabricating biomaterials and microstructures that would provide these MSCs with support and would allow them to organize themselves. The biomaterial and micro-structures fabricated by the "Layer-by-Layer"(L-b-l) method exhibited extracellular matrix (ECM) like properties enhancing the adhesion and differentiation of the MSCs. Similar activity has been claimed by researchers of Osaka University who have filed a patent for self-organization for osteochondral regeneration. It was observed that the human MSCs organized themselves better on the biomaterial that we had fabricated for them. We also found that the micro-structures had the potential to give rise to a complex scaffold system.

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  • Regenerative Injection Treatment in the Spine: Review and Case Series with Platelet Rich Plasma

    Abstract

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    Background: Platelet-Rich Plasma (PRP) has been used for a variety of musculoskeletal disorders including tendinopathies and Osteoarthritis. Few\nstudies exist for PRP in the spine, except for studies involving disc pathology. However, numerous studies exist involving the use of Prolotherapy for spinal disorders. Both Prolotherapy and PRP can be considered within the broad category of Regenerative Injection Treatment (RIT), which are proposed to strengthen or repair injured ligaments, tendons, muscle, cartilage, and bone via injections of proliferative solutions, growth factors, or cells. Provided that double blind randomized controlled trials have shownboth PRP and Prolotherapy to be effective in treating similar regions of the body, it is reasonable to consider that PRP could be comparatively effective as Prolotherapy in treating pain related to the facet joints, capsules and associated spinal ligaments.

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  • Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction

    Abstract

    Platelet-rich plasma (PRP) has been tested in vitro, in animal models, and clinically for its efficacy in enhancing the rate of wound healing, reducing pain associated with injuries, and promoting axon regeneration. Although extensive data indicate that PRP-released factors induce these effects, the claims are often weakened because many studies were not rigorous or controlled, the data were limited, and other studies yielded contrary results. Critical to assessing whether PRP is effective are the large number of variables in these studies, including the method of PRP preparation, which influences the composition of PRP; type of application; type of wounds; target tissues; and diverse animal models and clinical studies. All these variables raise the question of whether one can anticipate consistent influences and raise the possibility that most of the results are correct under the circumstances where PRP was tested. This review examines evidence on the potential influences of PRP and whether PRP-released factors could induce the reported influences and concludes that the preponderance of evidence suggests that PRP has the capacity to induce all the claimed influences, although this position cannot be definitively argued. Well-defined and rigorously controlled studies of the potential influences of PRP are required in which PRP is isolated and applied using consistent techniques, protocols, and models. Finally, it is concluded that, because of the purported benefits of PRP administration and the lack of adverse events, further animal and clinical studies should be performed to explore the potential influences of PRP.

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  • Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses

    Purpose

    The aims of this study were (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) injection in the treatment of knee joint cartilage degenerative pathology, (2) to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for use (or lack thereof) of PRP in the setting of knee osteoarthritis (OA), and (3) to identify literature gaps where continued investigation would be suggested.

    Methods

    Literature searches were performed for meta-analyses examining use of PRP versus corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo. Clinical data were extracted, and meta-analysis quality was assessed. The Jadad algorithm was applied to determine meta-analyses that provided the highest level of evidence.

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  • Yes-associated protein (YAP) is a negative regulator of chondrogenesis in mesenchymal stem cells

    Introduction

    The control of differentiation of mesenchymal stromal/stem cells (MSCs) is crucial for tissue engineering strategies employing MSCs. The purpose of this study was to investigate whether the transcriptional co-factor Yes-associated protein (YAP) regulates chondrogenic differentiation of MSCs.

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    Methods

    Expression of total YAP, its paralogue transcriptional co-activator with PDZ-binding motif (TAZ), and individual YAP transcript variants during in vitro chondrogenesis of human MSCs was determined by quantitative reverse transcription polymerase chain reaction (RT-PCR). YAP expression was confirmed by western blotting. To determine the effect of high YAP activity on chondrogenesis, C3H10T1/2 MSC-like cells were transduced with human (h)YAP and treated in micromass with bone morphogenetic protein-2 (BMP-2). Chondrogenic differentiation was assessed by alcian blue staining and expression of chondrocyte-lineage genes. BMP signalling was determined by detection of pSmad1,5,8 by western blotting and expression of BMP target genes by quantitative RT-PCR. Finally, YAP and pYAP were detected in mouse embryo hindlimbs by immunohistochemistry.

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  • Cartilage repair by human umbilical cord blood-derived mesenchymal stem cells with different hydrogels in a rat model € 

    Abstract

    This study was carried out to assess the feasibility of human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in articular cartilage repair and to further determine a suitable delivering hydrogel in a rat model. Critical sized full thickness cartilage defects were created. The hUCB-MSCs and three different hydrogel composites (hydrogel A; 4% hyaluronic acid/30% pluronic (1:1, v/v), hydrogel B; 4% hyaluronic acid, and hydrogel C; 4% hyaluronic acid/30% pluronic/chitosan (1:1:2, v/v)) were implanted into the experimental knee (right knee) and hydrogels without hUCB-MSCs were implanted into the control knee (left knee). Defects were evaluated after 8 weeks. The hUCB-MSCs with hydrogels composites resulted in a better repair as seen by gross and histological evaluation compared with hydrogels without hUCB-MSCs. Among the three different hydrogels, the 4% hyaluronic acid hydrogel composite (hydorgel B) showed the best result in cartilage repair as seen by the histological evaluation compared with the other hydrogel composites (hydrogel A and C). The results of this study suggest that hUCB-MSCs may be a promising cell source in combination with 4% hyaluronic acid hydrogels in the in vivo repair of cartilage defects. This article is protected by copyright. All rights reserved

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  • Platelet-rich plasma increases proliferation of tendon cells by modulating Stat3 and p27 to up-regulate expression of cyclins and cyclin-dependent kinases

    Objectives

    To investigate effects of platelet-rich plasma on tendon cell proliferation and the underlying molecular mechanisms.

    Materials and methods

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    Platelet-rich plasma was prepared manually by two-step centrifugation. Proliferation was evaluated in cultured rat tendon cells by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay. Cell cycle progression was assessed by flow cytometry. Messenger RNA expression of proliferating cell nuclear antigen (PCNA), cyclin E1, A2 and B1, and cyclin-dependent kinases (Cdks) 1 and 2 was assessed by real-time polymerase chain reaction. Protein expression of the above cyclins and Cdks and of signal transducer and activator of transcription (Stat) 3 and p27 was evaluated by western blotting.

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  • Human somatic stem cell-based therapy for cartilage regeneration

    Abstract

    Clinical investigations using human somatic tissue derived stem cells for a variety of different diseases have been performed. Neural crest-derived stem cells exhibit somatic organization, can contribute to mesenchymal stem/stromal cells (MSCs) (1) and are used for cartilage treatment, bone reconstruction and anti-inflammatory treatments for diseases. The most common cell source for cartilage treatment is MSCs (2,3). Many clinical studies have used neural crest-derived stem cells (or MSCs) from different tissues and different methodologies. These differences in the generation of somatic tissue-derived stem cells have led to variable results in clinical studies. Although stem cell properties have been poorly characterized, human trials are presently under way.

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  • Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients

    Abstract

    Aim : Osteoarthritis is a degenerative joint disease characterized by the destruction of joint cartilage. Mesenchymal stem cells (MSCs) are found in low numbers in normal cartilage, mainly in the superficial layer, acting as repairing agents. In OA, MSCs are seen in larger numbers, but act chaotic and are unable to repair the cartilage. The synovial membrane becomes inflamed and interacts with the cartilage. Transplanted MSC have the ability to normalize them, redirecting them to their normal function. In a preliminary study, we showed that MSC could improve knee OA in four patients at 6

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  • Strategies to stimulate mobilization and homing of endogenous stem and progenitor cells for bone tissue repair

    Abstract

    The gold standard for the treatment of critical sized bone defects is autologous or allogenic bone graft. This has several limitations including donor site morbidity and the restricted supply of graft material. Cell-based tissue engineering strategies represent an alternative approach. Mesenchymal stem cells (MSCs) have been considered as a source of osteoprogenitor cells. More recently, focus has been placed on the use of endothelial progenitor cells (EPCs), since vascularization is a critical step in bone healing. Although many of these approaches have demonstrated effectiveness for bone regeneration, cell-based therapies require time consuming and cost expensive in vitro cell expansion procedures. Accordingly, research is becoming increasingly focused on the homing and stimulation of native cells. The stromal cell-derived factor 1 (SDF-1) - CXCR4 axis has been shown to be critical for the recruitment of MSCs and EPCs. Vascular endothelial growth factor (VEGF) is a key factor in angiogenesis and has been targeted in many studies. Here, we present an overview of the different approaches for delivering homing factors to the defect site by absorption or incorporation to biomaterials, gene therapy or via genetically manipulated cells. We further review strategies focusing on the stimulation of endogenous cells to support bone repair. Finally, we discuss the major challenges in the treatment of critical size bone defects and fracture non-unions.

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  • In Vivo Kinetics of Mesenchymal Stem Cells Transplanted into the Knee Joint in a Rat Model Using a Novel Magnetic Method of Localization

    Abstract

    We have developed a magnetic system for targeting cells in minimally invasive cell transplantation. Magnetically labeled MSCs (m-MSCs) with nanoscale iron particles can be guided into the desired region by magnetic force from an extracorporeal device. We reported that magnetic targeting of m-MSCs enhances cartilage repair in a mini-pig model. However, the detailed kinetics of these magnetically targeted m-MSCs remain unknown. For clinical use, this aspect should be clarified from a safety standpoint. We therefore investigated the spatial and temporal distribution of the fluorescently-labeled m-MSCs transplanted into the knee joint using in vivo fluorescence combined with three-dimensional computed tomographic imaging in a rat model. Although the intraarticularly injected m-MSCs were spread throughout the joint cavity in the absence of magnetic force, the magnetic force caused the injected m-MSCs to accumulate around the chondral lesion. Further examinations including ex vivo imaging, histological assessments and reverse transcription polymerase chain reaction revealed that transplanted MSCs were not present in any major organs after intraarticular administration, regardless of magnetic targeting. Our data suggest that m-MSCs can be accumulated efficiently into a chondral lesion using our magnetic targeting system, while none of the intraarticularly transplanted MSCs migrate to other major organs. Clin Trans Sci 2015;

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  • The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial

    Abstract

    Introduction: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA). Materials and Methods: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded. Results: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment: 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 °C increase in temperature —and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur. Conclusion: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

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  • Meniscus repair using mesenchymal stem cells - a comprehensive review

    Abstract

    The menisci are a pair of semilunar fibrocartilage structures that play an essential role in maintaining normal knee function. Injury to the menisci can disrupt joint stability and lead to debilitating results. Because natural meniscal healing is limited, an efficient method of repair is necessary. Tissue engineering (TE) combines the principles of life sciences and engineering to restore the unique architecture of the native meniscus. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential both in vitro and in vivo. This comprehensive review examines the English literature identified through a database search using Medline, Embase, Engineering Village, and SPORTDiscus. The search results were classified based on MSC type, animal model, and method of MSC delivery/culture. A variety of MSC types, including bone marrow-derived, synovium-derived, adipose-derived, and meniscus-derived MSCs, has been examined. Research results were categorized into and discussed by the different animal models used; namely murine, leporine, porcine, caprine, bovine, ovine, canine, equine, and human models of meniscus defect/repair. Within each animal model, studies were categorized further according to MSC delivery/culture techniques. These techniques included direct application, fibrin glue/gel/clot, intra-articular injection, scaffold, tissue-engineered construct, meniscus tissue, pellets/aggregates, and hydrogel. The purpose of this review is to inform the reader about the current state and advances in meniscus TE using MSCs. Future directions of MSC-based meniscus TE are also suggested to help guide prospective research.

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  • Resveratrol rescued the TNF-α-induced impairments of osteogenesis of bone-marrow derived mesenchymal stem cells and inhibited the TNF-α-activated NF-кB signaling pathway

    Abstract

    Resveratrol, trans-3,4 '-trihydroxystilbene, is a natural phytoalexin. Its anti-inflammatory activity has attracted more and more attention in clinic over the years for the treatment of inflammatory diseases. However, its effect on bone repair and new bone formation in an inflammatory microenvironment is quite little understood, especially when bone-marrow derived mesenchymal stem cells (MSCs) are used in stem cell therapy for the treatment of inflammatory bone diseases. In the present study, we investigated the effect of resveratrol on osteogenic differentiation of primary mouse bone marrow derived MSCs and potential mechanism involved when cells were exposed to TNF-α treatment. We found that resveratrol reversed the apoptotic effect of TNF-α and abrogated its inhibitory effect on osteogenic differentiation of bone marrow derived MSCs. Mechanistic studies demonstrated that resveratrol rescued the TNF-α-induced impairments of osteogenesis, and inhibited TNF-α-activated NF-κB signaling. Our study may help understand the mechanism involved in the inhibitory effect of inflammatory cytokines on osteogenic differentiation, and highlights the role of resveratrol as a potential therapeutic agent for bone repair and especially in MSC-based cell therapy for the treatment of inflammation-associated bone diseases.

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  • Engineering of Hyaline Cartilage with a Calcified Zone Using Bone Marrow Stromal Cells

    Objective

    In healthy joints, a zone of calcified cartilage (ZCC) provides the mechanical integration between articular cartilage and subchondral bone. Recapitulation of this architectural feature should serve to resist the constant shear force from the movement of the joint and prevent the delamination of tissue-engineered cartilage. Previous approaches to create the ZCC at the cartilage-substrate interface have relied on strategic use of exogenous scaffolds and adhesives, which are susceptible to failure by degradation and wear. In contrast, we report a successful scaffold-free engineering of ZCC to integrate tissue-engineered cartilage and a porous biodegradable bone substitute, using sheep bone marrow stromal cells (BMSCs) as the cell source for both cartilaginous zones.

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  • Anti-inflammatory effects of platelet biomaterials in a macrophage cellular model

    Background and Objectives

    Recent clinical data suggested that platelet materials used in regenerative medicine exert anti-inflammatory effects. One must understand whether functionality varies among platelet preparations and also the role of the various protein compartments.

    Materials and Methods

    Platelet-poor-plasma (PPP), platelet lysate with cell debris (PL) or cell-free (CFPL), platelet gel releasate (PGR) and solvent/detergent-treated PL (SDPL) were prepared from four apheresis platelet donations. Protein profile was examined by SDS-PAGE, and growth factors and cytokines by ELISA, multiplexed Luminex assay and cytokine array. Anti-inflammatory activity was evaluated in RAW 264 ·7 mouse macrophages treated for 24  h with the blood fractions followed by 24  h of stimulation with 500  ng/ml lipopolysaccharides (LPS). Inflammatory marker nitric oxide (NO) was determined by colorimetry, tumour necrosis factor (TNF)-α by ELISA and inducible NO synthase (iNOS) and cyclooxygenase (COX)-2 by Western blotting.

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  • Hypertonic Dextrose Injection (Prolotherapy) for knee osteoarthritis: Long term outcomes

    Abstract

    Objective

    Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p<.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA.

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  • Ultrasound guided Distal Bicep Tendon injection using a posterior approach

    Abstract

    Distal biceps tendinopathy is an uncommon but increasingly diagnosed etiology in individuals with elbow pain. When traditional treatments are unsuccessful, practitioners have utilized ultrasound-guided tendon injections to this region using an anterior approach. Though there has been reported success, this approach may lead to a neurovascular injury. This is the first case report in the literature describing an ultrasound- guided distal bicep tendon injection via a posterior approach. The patient had an excellent clinical outcome with no adverse events. This outcome suggests that ultrasound guided posterior percutaneous tendon injection might be a safe, viable non-surgical option for recalcitrant distal biceps tendinopathy.

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  • Pericytes, mesenchymal stem cells and their contributions to tissue repair

    Abstract

    Regenerative medicine using mesenchymal stem cells for the purposes of tissue repair has garnered considerable public attention due to the potential of returning tissues and organs to a normal, healthy state after injury or damage has occurred. To achieve this, progenitor cells such as pericytes and bone marrow-derived mesenchymal stem cells can be delivered exogenously, mobilised and recruited from within the body or transplanted in the form organs and tissues grown in the laboratory from stem cells. In this review, we summarise the recent evidence supporting the use of endogenously mobilised stem cell populations to enhance tissue repair along with the use of mesenchymal stem cells and pericytes in the development of engineered tissues. Finally, we conclude with an overview of currently available therapeutic options to manipulate endogenous stem cells to promote tissue repair.

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  • Engineering physiologically stiff and stratified human cartilage by fusing condensed mesenchymal stem cells

    Abstract

    For a long time, clinically sized and mechanically functional cartilage could be engineered from young animal chondrocytes, but not from adult human mesenchymal stem cells that are of primary clinical interest. The approaches developed for primary chondrocytes were not successful when used with human mesenchymal cells. The method discussed here was designed to employ a mechanism similar to pre-cartilaginous condensation and fusion of mesenchymal stem cells at a precisely defined time. The formation of cartilage was initiated by press-molding the mesenchymal bodies onto the surface of a bone substrate. By image-guided fabrication of the bone substrate and the molds, the osteochondral constructs were engineered in anatomically precise shapes and sizes. After 5

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