Clinical Implementation Of Bone Regeneration And Maintenance

Author : Jenna N. Harvestine
Publisher :
ISBN 13 : 9780438930759
Total Pages : pages
Book Rating : 4.9/5 (37 download)

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Download or read book Natural- and Cell-derived Matrices as Biomaterials in Bone Regeneration written by Jenna N. Harvestine and published by . This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: With over 2 million bone graft procedures ever year, bone is the second most transplanted material behind blood. However, limited tissue supply and post-operative concerns for donor site pain and morbidity motivate alternative strategies to drive bone regeneration. Mesenchymal stem cells (MSCs) are found within multiple tissue compartments in the postnatal organism, making them widely accessible for autologous cell therapy and a promising alternative to bone grafts. However, loss of osteogenic phenotype, poor cell viability, and insufficient vasculature infiltration after implantation challenge clinical application of tissue engineered constructs. Cell-derived extracellular matrix (ECM), is a biomimetic platform that provides a natural niche to promote trophic factor secretion, cell adhesion, survival, and osteogenic differentiation. We hypothesized a cell-secreted ECM would select endothelial and stem/progenitor cell populations from tissue aspirates to enhance cell survival and instruct cell function, resulting in improved osteogenic potential. First, we hypothesized MSC-derived ECM-coated scaffolds would enhance osteogenic differentiation and bone formation by culture expanded bone marrow-derived MSCs. Human MSCs cultured on ECM-coated scaffolds exhibited increased metabolic activity and decreased apoptosis compared to uncoated scaffolds. In short-term culture, MSCs on ECM-coated substrates secreted more proangiogenic factors while maintaining markers of osteogenic differentiation. Upon implantation, we detected improved survival of MSCs on ECM-coated scaffolds over 3 weeks. Histological evaluation revealed enhanced cellularization and osteogenic differentiation in ECM-coated scaffolds compared to controls. To determine whether the bioactivity of cell-secreted ECM was dependent on cell source, we assessed the osteogenic response of human stromal vascular fraction (SVF) on ECMs secreted by bone marrow-derived mesenchymal stem cells (MSCs) as well as adipose stem/stromal cells (ASCs) and human dermal fibroblasts (HDFs). Mass spectrometry analysis identified 278, 225, and 150 distinct proteins within MSC-, ASC-, and HDF-derived ECMs, respectively, suggesting that stromal cell-derived ECMs are more complex than HDF-derived ECMs which contained nearly 50% fewer distinct proteins. Regardless of ECM source, SVF deposited over 8- and 1.3-fold more calcium compared to tissue culture plastic (TCP) and collagen-coated controls, respectively. Flow cytometry confirmed that SVF cultured on ECM retained CD31 and CD34 positive cell populations better than TCP confirming a role for accessory cells in osteogenic differentiation by tissue aspirates. In addition to lipoaspirates, bone marrow aspirates (BMA) contain a rich source of cells for use in several clinical indications including bone repair. However, progenitor cells such as MSCs account for a small fraction of nucleated cells in BMA, requiring extensive in vitro culture for expansion. We hypothesized that cell-secreted ECM could be used to sequester MSCs and accessory cells from BMA for bone regeneration. To generate 3D implantable constructs, BMA was resuspended in media with or without type I collagen or ECM and injected into a perfusion bioreactor system. Compared to uncoated scaffolds, we observed a 30- and 143- fold increase in MSCs when fresh BMA was cultured on collagen- or ECM-coated scaffolds, respectively. Upon subcutaneous implantation, ECM-coated scaffolds promoted cell survival and early vascularization, yet bone formation was comparable across all implant groups, suggesting additional osteogenic cues are necessary. To determine if osteogenic pre-conditioning would improve the bone forming potential of BMA, cells were perfused on ECM-coated scaffold for either 20 hours or 14 days to generate naïve and pre-conditioned constructs, respectively. Naïve constructs secreted high levels of pro-angiogenic growth factors, while pre-conditioned cells exhibited an osteogenic phenotype and scaffolds contained more MSCs and endothelial cells. Constructs were implanted into 3.5 mm defects made in the calvariae of nude rats then monitored for vascular invasion and bone formation over 10 weeks. Vascular infiltration into pre-conditioned implants occurred rapidly over the first 14 days, resulting in greater vessel density compared to naïve implants which peaked at 28 days. Early advantages in vessel formation correlated to increased bone volume and tissue mineral density in pre-conditioned implants at 10 weeks confirming the synergy between angiogenesis and bone formation. Collectively, this dissertation describes the capacity of cell-secreted ECM to sequester, maintain, and direct osteogenic differentiation by two clinically investigated tissue aspirates for bone tissue engineering. Novel strategies that augment bone repair using autologous tissues address a critically unmet need and have direct implications to improve current standards of care at the forefront of orthopaedic regenerative medicine.