Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous...Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous and fibrous,exist in interfaces.The gradual fibrocartilaginous type is in rotator cuff tendons and is more frequently injured due to the poor healing capacity that leads to loss of the original structural and biomechanical properties and is attributed to the high prevalence of retears.Fluctuating methodologies and outcomes of biological approaches are challenges to overcome for them to be routinely used in clinics.Therefore,stratifying the existing literature according to different categories(chronicity,extent of tear,and studied population)would effectively guide repair approaches.This literature review supports tissue engineering approaches to promote rotator cuff enthesis healing employing cells,growth factors,and scaffolds period.Outcomes suggest its promising role in animal studies as well as some clinical trials and that combination therapies are more beneficial than individualized ones.It then highlights the importance of tailoring interventions according to the tear extent,chronicity,and the population being treated.Contributing factors such as loading,deficiencies,and lifestyle habits should also be taken into consideration.Optimum results can be achieved if biological,mechanical,and environmental factors are approached.It is challenging to determine whether variations are due to the interventions themselves,the animal models,loading regimen,materials,or tear mechanisms.Future research should focus on tailoring interventions for different categories to formulate protocols,which would best guide regenerative medicine decision making.展开更多
Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring t...Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells(MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy.展开更多
Rotator cuff(RC)attaches to humerus across a triphasic yet continuous tissue zones(bone-fibrocartilage-tendon),termed“enthesis”.Regrettably,rapid and functional enthesis regeneration is challenging after RC tear.The...Rotator cuff(RC)attaches to humerus across a triphasic yet continuous tissue zones(bone-fibrocartilage-tendon),termed“enthesis”.Regrettably,rapid and functional enthesis regeneration is challenging after RC tear.The existing grafts bioengineered for RC repair are insufficient,as they were engineered by a scaffold that did not mimic normal enthesis in morphology,composition,and tensile property,meanwhile cannot simultaneously stimulate the formation of bone-fibrocartilage-tendon tissues.Herein,an optimized decellularization approach based on a vacuum aspiration device(VAD)was developed to fabricate a book-shaped decellularized enthesis matrix(O-BDEM).Then,three recombinant growth factors(CBP-GFs)capable of binding collagen were synthesized by fusing a collagen-binding peptide(CBP)into the N-terminal of BMP-2,TGF-β3,or GDF-7,and zone-specifically tethered to the collagen of O-BDEM to fabricate a novel scaffold(CBP-GFs/O-BDEM)satisfying the above-mentioned requirements.After ensuring the low immunogenicity of CBP-GFs/O-BDEM by a novel single-cell mass cytometry in a mouse model,we interleaved urine-derived stem cell-sheets into this CBP-GFs/O-BDEM to bioengineer an enthesis-like graft.Its high-performance on regenerating enthesis was determined in a canine model.These findings indicate this CBP-GFs/O-BDEM may be an excellent scaffold for constructing enthesis-like graft to patch large/massive RC tears,and provide breakthroughs in fabricating graded interfacial tissue.展开更多
Electrospun fibers,with proven ability to promote tissue regeneration,are widely being explored for rotator cuff repairing.However,without post treatment,the microstructure of the electrospun scaffold is vastly differ...Electrospun fibers,with proven ability to promote tissue regeneration,are widely being explored for rotator cuff repairing.However,without post treatment,the microstructure of the electrospun scaffold is vastly different from that of natural extracellular matrix(ECM).Moreover,during mechanical loading,the nanofibers slip that hampers the proliferation and differentiation of migrating stem cells.Here,electrospun nanofiber scaffolds,with crimped nanofibers and welded joints to biomimic the intricate natural microstructure of tendon-to-bone insertion,were prepared using poly(ester-urethane)urea and gelatin via electrospinning and double crosslinking by a multi-bonding network densification strategy.The crimped nanofiber scaffold(CNS)features bionic tensile stress and induces chondrogenic differentiation,laying credible basis for in vivo experimentation.After repairing a rabbit massive rotator cuff tear using a CNS for 3 months,the continuous translational tendon-to-bone interface was fully regenerated,and fatty infiltration was simultaneously inhibited.Instead of micro-CT,μCT was employed to visualize the integrity and intricateness of the three-dimensional microstructure of the CNS-induced-healed tendon-to-bone interface at an ultra-high resolution of less than 1μm.This study sheds light on the correlation between nanofiber post treatment and massive rotator cuff repair and provides a general strategy for crimped nanofiber preparation and tendon-to-bone interface imaging characterization.展开更多
文摘Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous and fibrous,exist in interfaces.The gradual fibrocartilaginous type is in rotator cuff tendons and is more frequently injured due to the poor healing capacity that leads to loss of the original structural and biomechanical properties and is attributed to the high prevalence of retears.Fluctuating methodologies and outcomes of biological approaches are challenges to overcome for them to be routinely used in clinics.Therefore,stratifying the existing literature according to different categories(chronicity,extent of tear,and studied population)would effectively guide repair approaches.This literature review supports tissue engineering approaches to promote rotator cuff enthesis healing employing cells,growth factors,and scaffolds period.Outcomes suggest its promising role in animal studies as well as some clinical trials and that combination therapies are more beneficial than individualized ones.It then highlights the importance of tailoring interventions according to the tear extent,chronicity,and the population being treated.Contributing factors such as loading,deficiencies,and lifestyle habits should also be taken into consideration.Optimum results can be achieved if biological,mechanical,and environmental factors are approached.It is challenging to determine whether variations are due to the interventions themselves,the animal models,loading regimen,materials,or tear mechanisms.Future research should focus on tailoring interventions for different categories to formulate protocols,which would best guide regenerative medicine decision making.
文摘Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells(MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy.
基金supported by the National Natural Science Foundation of China(Nos.81902192 and 81730068)the Science and Technology Major Project of Changsha(No.kh2003015)+1 种基金the Postdoctoral Science Foundation of China(No.2019M652809)Additionally,we thank the staffs at BL01B station of National Facility for Protein Science Shanghai and the BL15U1 station of the Shanghai Synchrotron Radiation Facility,Shanghai,China,for their kind assistance during the experiments.
文摘Rotator cuff(RC)attaches to humerus across a triphasic yet continuous tissue zones(bone-fibrocartilage-tendon),termed“enthesis”.Regrettably,rapid and functional enthesis regeneration is challenging after RC tear.The existing grafts bioengineered for RC repair are insufficient,as they were engineered by a scaffold that did not mimic normal enthesis in morphology,composition,and tensile property,meanwhile cannot simultaneously stimulate the formation of bone-fibrocartilage-tendon tissues.Herein,an optimized decellularization approach based on a vacuum aspiration device(VAD)was developed to fabricate a book-shaped decellularized enthesis matrix(O-BDEM).Then,three recombinant growth factors(CBP-GFs)capable of binding collagen were synthesized by fusing a collagen-binding peptide(CBP)into the N-terminal of BMP-2,TGF-β3,or GDF-7,and zone-specifically tethered to the collagen of O-BDEM to fabricate a novel scaffold(CBP-GFs/O-BDEM)satisfying the above-mentioned requirements.After ensuring the low immunogenicity of CBP-GFs/O-BDEM by a novel single-cell mass cytometry in a mouse model,we interleaved urine-derived stem cell-sheets into this CBP-GFs/O-BDEM to bioengineer an enthesis-like graft.Its high-performance on regenerating enthesis was determined in a canine model.These findings indicate this CBP-GFs/O-BDEM may be an excellent scaffold for constructing enthesis-like graft to patch large/massive RC tears,and provide breakthroughs in fabricating graded interfacial tissue.
基金supported by Instrumental Analysis Center of Shanghai Jiao Tong University.This work was supported by the National Natural Science Foundation of China[Grant No.81902186,81671920,31972923,81871753,81772341]National Key Research and Development Program of China[Grant No.2018YFC1106200,2018YFC1106201,2018YFC1106202]Technology Support Project of Science and Technology Commission of Shanghai Municipality of China[Grant No.19441901700,19441901701,19441901702,18441902800].
文摘Electrospun fibers,with proven ability to promote tissue regeneration,are widely being explored for rotator cuff repairing.However,without post treatment,the microstructure of the electrospun scaffold is vastly different from that of natural extracellular matrix(ECM).Moreover,during mechanical loading,the nanofibers slip that hampers the proliferation and differentiation of migrating stem cells.Here,electrospun nanofiber scaffolds,with crimped nanofibers and welded joints to biomimic the intricate natural microstructure of tendon-to-bone insertion,were prepared using poly(ester-urethane)urea and gelatin via electrospinning and double crosslinking by a multi-bonding network densification strategy.The crimped nanofiber scaffold(CNS)features bionic tensile stress and induces chondrogenic differentiation,laying credible basis for in vivo experimentation.After repairing a rabbit massive rotator cuff tear using a CNS for 3 months,the continuous translational tendon-to-bone interface was fully regenerated,and fatty infiltration was simultaneously inhibited.Instead of micro-CT,μCT was employed to visualize the integrity and intricateness of the three-dimensional microstructure of the CNS-induced-healed tendon-to-bone interface at an ultra-high resolution of less than 1μm.This study sheds light on the correlation between nanofiber post treatment and massive rotator cuff repair and provides a general strategy for crimped nanofiber preparation and tendon-to-bone interface imaging characterization.
