مقالات پذیرفته شده در سومین کنگره بین المللی زیست پزشکی
Biomaterials in Tendon Tissue Engineering: Current Trends and Challenges
Biomaterials in Tendon Tissue Engineering: Current Trends and Challenges
Ahmadreza Ghasemi amineh,1,*Mehdi Tagheh delshad,2SayedAli Mousavi ,3
1. Advanced Materials Research Center, Department of Materials Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran 2. Advanced Materials Research Center, Department of Materials Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran 3. Department of Mechanical Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran
Introduction: Tendon is a load-bearing, connective tissue within the musculoskeletal system. Their first function is to transfer high tensile loads from muscle to bone, which results in movement. The tendon body is defined by significant (90%) extracellular matrix (ECM) content along with sparsely incorporated cells (tenocytes, TCs). The ECM in ten¬don is primarily composed of type I collagen and elastin and is notably structured in a complex hierarchy, with collagen molecules being the most basic unit of this hierarchy. Collagen molecules (∼1.5 nm) come together to create collagen fibrils (∼50–500 nm), which then make up tendon fascicles (∼50–100 μm), which are crimped to form the macroscopic tendon structure.
Energy-storing tendons have significantly lower elastic moduli but significantly higher ultimate strain and hence ultimate strength versus positional tendons. The cellularity and bioactivity of TCs within positional and energy-storing tendons differs significantly as well.
Tendon injuries constitute an unmet clinical need for both human and equine patients. Over 30million human tendon-related procedures take place annually worldwide with an estimated healthcare expenditure in excess of €140 billion per year.
Because of the lack of blood supply and poor intrinsic repair abilities of tenocytes, tendon injuries undergo slow regeneration. The natural repair processes in tendons can be accelerated by fibroblasts and blood vessels, which usually cause the formation of granulated tissue and inevitably lead to scar formation. As a result, tendon fibers become disordered when injured, causing a decrease in the mechanical properties of tendons and further impacts on their motor functions. In addition, the invasion of peripheral tissues may lead to tendon adhesion.
The goal of tissue engineering approaches for tendon injuries is to create a microen¬vironment which presents the correct combination and sequence of biochemical and biomechanical cues to induce improved healing or regeneration of tendon tissue after injury.
Tissue engineered tendons and ligaments include whole organ replacements as well as reinforcements by augmenting the damaged tissue. They should have a mechanical behavior similar to undamaged tissues—or at least allow early active mobilization during the rehabilitation including the biomechanical strength necessary for that. Therefore, in order to be able to compare biomechanical properties of materials aimed at tendon tissue engineering, the first step is to consider the natural biomechanical characteristics of tendons and ligaments—including peak in vivo values as well as cadaver ultimate strength values (failure values).
Methods: 1. Hortensius, R., L. Mozdzen, and B. Harley, Biomaterial Scaffolds for Tendon Tissue Engineering, in Tendon Regeneration. 2015, Elsevier. p. 349-380.
2. Lomas, A., et al., The past, present and future in scaffold-based tendon treatments. Advanced drug delivery reviews, 2015. 84: p. 257-277.
3. Wang, S., et al., Decellularized tendon as a prospective scaffold for tendon repair. Materials Science and Engineering: C, 2017. 77: p. 1290-1301.
4. Livermore, A. and J.L. Tueting, Biomechanics of tendon transfers. Hand clinics, 2016. 32(3): p. 291-302.
5. Buschmann, J. and G. Meier Bürgisser, 2 - Biomechanical properties of tendons and ligaments in humans and animals, in Biomechanics of Tendons and Ligaments, J. Buschmann and G. Meier Bürgisser, Editors. 2017, Woodhead Publishing. p. 31-61.
6. Yang, G., et al., Multilayered polycaprolactone/gelatin fiber-hydrogel composite for tendon tissue engineering. Acta biomaterialia, 2016. 35: p. 68-76.
7. Walden, G., et al., A Clinical, Biological, and Biomaterials Perspective into Tendon Injuries and Regeneration. Tissue engineering. Part B, Reviews, 2017. 23(1): p. 44-58.
8. Linderman, S.W., et al., Cell and Biologic-Based Treatment of Flexor Tendon Injuries. Operative Techniques in Orthopaedics, 2016. 26(3): p. 206-215.
9. Tellado, S.F., E.R. Balmayor, and M. Van Griensven, Strategies to engineer tendon/ligament-to-bone interface: biomaterials, cells and growth factors. Advanced drug delivery reviews, 2015. 94: p. 126-140.
10. Correia Pinto, V., et al., Exploring the in vitro and in vivo compatibility of PLA, PLA/GNP and PLA/CNT‐COOH biodegradable nanocomposites: Prospects for tendon and ligament applications. Journal of Biomedical Materials Research Part A, 2017. 105(8): p. 2182-2190.
11. Pinto, V.C., et al., Dispersion and failure analysis of PLA, PLA/GNP and PLA/CNT-COOH biodegradable nanocomposites by SEM and DIC inspection. Engineering failure analysis, 2017. 71: p. 63-71.
12. Sanami, M., et al., Biophysical and biological characterisation of collagen/resilin-like protein composite fibres. Biomedical Materials, 2015. 10(6): p. 065005.
13. Baker, B.M., et al., Fabrication and modeling of dynamic multipolymer nanofibrous scaffolds. Journal of biomechanical engineering, 2009. 131(10): p. 101012-101012.
14. Sahoo, S., J. Goh Cho-Hong, and T. Siew-Lok, Development of hybrid polymer scaffolds for potential applications in ligament and tendon tissue engineering. Vol. 2. 2007. 169-73.
15. Caliari, S.R., M.A. Ramirez, and B.A.C. Harley, The development of collagen-GAG scaffold-membrane composites for tendon tissue engineering. Biomaterials, 2011. 32(34): p. 8990-8998.
16. Majima, T., et al., Chitosan-based hyaluronan hybrid polymer fibre scaffold for ligament and tendon tissue engineering. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 2007. 221(5): p. 537-546.
17. Oryan, A., et al., Implantation of a novel biologic and hybridized tissue engineered bioimplant in large tendon defect: an in vivo investigation. Tissue engineering. Part A, 2014. 20(3-4): p. 447-465.
18. Majima, T., et al., Alginate and chitosan polyion complex hybrid fibers for scaffolds in ligament and tendon tissue engineering. Journal of Orthopaedic Science, 2005. 10(3): p. 302-307.
19. Yang, G., et al., Multilayered Polycaprolactone/Gelatin Fiber-Hydrogel Composite for Tendon Tissue Engineering. Vol. 35. 2016.
20. Sawaguchi, N., et al., Effect of cyclic three-dimensional strain on cell proliferation and collagen synthesis of fibroblast-seeded chitosan-hyaluronan hybrid polymer fiber. Vol. 15. 2010. 569-77.
21. Shepherd, J., et al., Effect of fiber crosslinking on collagen-fiber reinforced collagen-chondroitin-6-sulfate materials for regenerating load-bearing soft tissues. Vol. 101A. 2013.
22. Chen, J.L., et al., Efficacy of hESC-MSCs in knitted silk-collagen scaffold for tendon tissue engineering and their roles. Biomaterials, 2010. 31(36): p. 9438-9451.
23. Shen, W., et al., The effect of incorporation of exogenous stromal cell-derived factor-1 alpha within a knitted silk-collagen sponge scaffold on tendon regeneration. Biomaterials, 2010. 31(28): p. 7239-7249.
24. Chen, X., et al., Scleraxis overexpression hESC-MSCs for Tendon Tissue Engineering with Knitted Silk-Collagen Scaffold. Vol. 20. 2013.
25. Sahoo, S., S. Lok Toh, and J. Cho Hong Goh, PLGA nanofiber-coated silk microfibrous scaffold for connective tissue engineering. Vol. 95. 2010. 19-28.
26. Naghashzargar, E., et al., Nano/micro hybrid scaffold of PCL or P3HB nanofibers combined with silk fibroin for tendon and ligament tissue engineering. Vol. 13. 2015.
27. Teh, T., S. Lok Toh, and J. Cho Hong Goh, Aligned Fibrous Scaffolds for Enhanced Mechanoresponse and Tenogenesis of Mesenchymal Stem Cells. Vol. 19. 2013.
28. Alshomer, F., et al., Micropatterning of nanocomposite polymer scaffolds using sacrificial phosphate glass fibers for tendon tissue engineering applications. Nanomedicine: Nanotechnology, Biology and Medicine, 2017. 13(3): p. 1267-1277.
29. Deng, D., et al., Repair of Achilles tendon defect with autologous ASCs engineered tendon in a rabbit model. Vol. 35. 2014.
30. Sahoo, S., S.L. Toh, and J.C.H. Goh, A bFGF-releasing silk/PLGA-based biohybrid scaffold for ligament/tendon tissue engineering using mesenchymal progenitor cells. Biomaterials, 2010. 31(11): p. 2990-2998.
31. sharifi-aghdam, M., et al., Preparation of collagen/polyurethane/knitted silk as a composite scaffold for tendon tissue engineering. Vol. 231. 2017. 954411917697751.
32. Xu, Y., et al., Fabrication of Electrospun Poly(L-Lactide-co-ɛ-Caprolactone)/Collagen Nanoyarn Network as a Novel, Three-Dimensional, Macroporous, Aligned Scaffold for Tendon Tissue Engineering. Vol. 19. 2013.
33. Xu, Y., et al., The effect of mechanical stimulation on the maturation of TDSCs-poly(L-lactide-co-e-caprolactone)/collagen scaffold constructs for tendon tissue engineering. Biomaterials, 2014. 35(9): p. 2760-2772.
34. Bhagwat, P.K. and P.B. Dandge, Collagen and collagenolytic proteases: A review. Biocatalysis and Agricultural Biotechnology, 2018. 15: p. 43-55.
35. Buschmann, J. and G. Meier, Collagen for tendon and ligament repair. 2017. p. 193-224.
36. Han, F., et al., Hydroxyapatite-doped polycaprolactone nanofiber membrane improves tendon-bone interface healing for anterior cruciate ligament reconstruction. International journal of nanomedicine, 2015. 10: p. 7333-7343.
37. Wu, G., et al., Enhanced biological properties of biomimetic apatite fabricated polycaprolactone/chitosan nanofibrous bio-composite for tendon and ligament regeneration. Journal of Photochemistry and Photobiology B: Biology, 2018. 178: p. 27-32.
38. Gonçalves, A.I., et al., Exploring the potential of starch/polycaprolactone aligned magnetic responsive scaffolds for tendon regeneration. Advanced healthcare materials, 2016. 5(2): p. 213-222.
39. LogithKumar, R., et al., A review of chitosan and its derivatives in bone tissue engineering. Carbohydrate Polymers, 2016. 151: p. 172-188.
40. Chen, E., et al., An asymmetric chitosan scaffold for tendon tissue engineering: In vitro and in vivo evaluation with rat tendon stem/progenitor cells. Acta Biomaterialia, 2018. 73: p. 377-387.
41. Yamaguchi, I., et al., The chitosan prepared from crab tendon I: the characterization and the mechanical properties. Biomaterials, 2003. 24(12): p. 2031-2036.
Results: Treatment of tendon injuries and tendinopathies currently remains a challenge, with repair often resulting in the production of inferior tissue and long-term complications and morbidity for patients. The need for a treatment strategy that addresses the underlying pathophysiology of the damaged tissue is evident. The results of in vitro and in vivo investigations of many bio¬material constructs suggest that the properties of an ECM analog must be tailored to the specific wound site and species, requiring further development of appropriate in vivo and in vitro models to further understand the complexity of cell–scaffold interactions and the process of induced regeneration.
[1]. Future exploration should be focused around the discovery of the optimum combination of cells, proteins, genes, and scaffolds that is able to orchestrate the complex chain of events leading to a regenerated tissue mimicking the native pre-damaged tendon, rather than the characteristic inferior scar tissue currently associated with repair.
Conclusion: Although therapy for tendon still remains a challenge, by healing often resulting in the production of tissue. The demand for a healing strategy that indicate the fundamental pathophysiology of the impaired tissue is obvious. The article represents a brief of biological methods and also common biomaterials that used in field of tendon tissue engineering.
In tendon tissue engineering some items important that should indicate.
First, the need for an ideal evaluation identifying the mechanical demands for profitable tendon repair is deficient. The second item is to address and check the feedback of the nearby tissue to implanted scaffold. To date, this has been restricted to study of the inherent treatment response throughout in vivo application. Besides, most of the researches demonstrated utilization wide arrange of biomaterials for tendon tissue engineering.