Influence of Xenogeneic and Alloplastic Carriers for Bone Augmentation on Human Unrestricted Somatic Stem Cells.

Alloplastic and xenogeneic bone grafting materials are frequently used for bone augmentation. The effect of these materials on precursor cells for bone augmentation is yet to be determined. The aim of this study was to ascertain, in vitro, how augmentation materials influence the growth rates and viability of human unrestricted somatic stem cells. The biocompatibility of two xenogeneic and one alloplastic bone graft was tested using human unrestricted somatic stem cells (USSCs). Proliferation, growth, survival and attachment of unrestricted somatic stem cells were monitored after 24 h, 48 h and 7 days. Furthermore, cell shape and morphology were evaluated by SEM. Scaffolds were assessed for their physical properties by Micro-CT imaging. USSCs showed distinct proliferation on the different carriers. Greatest proliferation was observed on the xenogeneic carriers along with improved viability of the cells. Pore sizes of the scaffolds varied significantly, with the xenogeneic materials providing greater pore sizes than the synthetic inorganic material. Unrestricted somatic stem cells in combination with a bovine collagenous bone block seem to be very compatible. A scaffold's surface morphology, pore size and bioactive characteristics influence the proliferation, attachment and viability of USSCs.

Analysis of Spontaneous and Induced Osteogenic Differentiation in 3D-micromasses of Human Multipotent Stem Cells.

BACKGROUND/AIM: Craniofacial reconstruction of extensive bone defects causes high morbidity to patients. Contemporary reconstructive surgery aims at restoring lost bone with either autogenous bone or substitutes. Multipotent unrestricted somatic stem cells (USSC) show a potential for osteoblast differentiation and are increasingly used in tissue engineering. The osteogenic potential of USSC micromasses influenced by dexamethasone, ascorbic acid and ß-glycerophosphate (DAG) seems promising. The present study evaluated the effects of DAG and MAPK, ERK and PI3K/Akt-pathway inhibitors on growth and mineralization of USSC micromasses. MATERIALS AND METHODS: Cells: i) USSC-18 (female, Passage 8), ii) USSC-8 (female Passage 9), and iii) USSC-8/17 (male, Passage 8), all cultured in 350 ml DMEM, with 150 ml fetal bovine serum, 5 ml penicillin/streptomycin and 5 ml L-glutamine. Differentiation was induced using 50 µM dexamethasone in DMEM, 50 mM ascorbic acid in PBS and 1 M ß-glycerolphosphate in PBS. Microtome slices were dyed with OsteoImage™ and analyzed under fluorescence microscopy. RESULTS: Significant increase in size and mineralization of DAG-treated micromasses was found on days 3 (p<0.001), 6 (p<0.001) and 7 (p<0.001). The ERK-pathway inhibitor, FR180204, significantly reduced micromass growth and mineralization in non-DAG treated cells (p<0.001) but showed increased mineralization in DAG-treated cells (p=0.014). The PI3K/Akt-pathway inhibitor, LY294002, did not significantly affect micromass growth but significantly decreased mineralization (p<0.001). The MAP-kinase inhibitor, U0126, significantly reduced micromass growth (p=0.001) and mineralization (p=0.001) of DAG-treated cells. CONCLUSION: DAG is a strong initiator of osteogenic differentiation. The PI3K/Akt-pathway inhibitor and the ERK-pathway inhibitor, FR180204, control osteogenic differentiation of 3D-micromasses. These results may facilitate preconditioning of cell cultures in guided tissue regeneration.

Release kinetics of the model protein FITC-BSA from different polymer-coated bovine bone substitutes.

BACKGROUND: Controlled release of proteins bound to conventional bone substitutes is still insufficient. Therefore, this study evaluates in-vitro release kinetics of the model protein FITC-BSA (fluorescein conjugated bovine serum albumine) from insoluble bovine collagenous bone matrices (ICBM) with different polymer coatings. Analyzes aim at comparing FITC-BSA release from uncoated versus coated ICBM over time to find bone substitute coatings with consistent release profiles. METHODS: Release kinetics of FITC-BSA from uncoated as well as coated ICBM with five different polymers (RESOMER R 203 H, RG 503 H, RG 504 H, RG 505, L 206 S) were measured over a period of 11 days (d). Measurements were conducted after 6 h (h), 12 h, 24 h, 3 d, 5 d, 7 d, 9 d and 11 d with six samples for each coated ICBM. Two groups were formed (1) with and (2) without medium change at times of measurement. For each group ANOVA with post-hoc Bonferroni testing was used. Scanning electron microscopy assessed morphologic differences between ICBM coating. RESULTS: In group 1 approx. 70% of FITC-BSA release from uncoated ICBM occurred after 6 h compared to approx. 50% in group 2. Only polymers with medium inherent viscosity, i.e. RESOMER RG 503 H, constantly showed significantly more FITC-BSA release throughout 11 d than uncoated ICBM (p = 0.007). The same was found for group 2 (p = 0.005). No significant differences between PLA and PLGA polymers were found. Scanning electron microscopy results indicate a weak adhesion of polymer coatings to ICBM explaining its rather weak retentive effect on overall FITC-BSA release. CONCLUSIONS: Medium molecular size polymers reduce the overall released FITC-BSA from ICBM over time. In clinical practice these polymers may prove ideal for bone substitute materials.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering.

OBJECTIVES: Cell-based therapies for bone augmentation after tooth loss and for the treatment of periodontal defects improve healing defects. Usually, osteogenic cells or stem cells are cultivated in 2D primary cultures, before they are combined with scaffold materials, even though this means a loss of the endogenous 3D microenvironment for the cells. Moreover, the use of single-cell suspensions for the inoculation of scaffolds or for the direct application into an area of interest has the disadvantages of low initial cell numbers and susceptibility to unwanted cellular distribution, respectively. MATERIALS AND METHODS: We addressed the question whether an alternative to monolayer cultures, namely 3D microtissues, has the potential to improve osteogenic tissue engineering and its clinical outcome. RESULTS: By contrast, to monolayer cultures, osteogenic differentiation of 3D microtissues is enhanced by mimicking in vivo conditions. It seems that the osteogenic differentiation in microtissues is enhanced by strong integrin-extracellular matrix interaction and by stronger autocrine BMP2 signaling. Moreover, microtissues are less prone to wash out by body fluids and allow the precise administration of large cell numbers. CONCLUSION: Microtissue cultures have closer characteristics with cells in vivo and their enhanced osteogenic differentiation makes scaffold-free microtissues a promising concept in osteogenic tissue engineering. CLINICAL RELEVANCE: Microtissues are particularly suitable for tissue engineering because they improve seeding efficiency of biomaterials by increasing the cell load of a scaffold. This results in accelerated osteogenic tissue formation and could contribute to earlier implant stability in mandibular bone augmentation.

Biocompatibility of membranes with unrestricted somatic stem cells.

AIM: The biocompatibility of human osteoblasts (HOB) and human unrestricted somatic stem cells (USSCs) with membranes (BioGide®, GORE-TEX®, GENTA-FOIL resorb®, RESODONT®, BioMend®, BioMend® Extend™) was evaluated. MATERIALS AND METHODS: After osteogenic differentiation (dexamethasone, ascorbic acid and ß-glycerolphosphate) cells were seeded on membranes. On days 1, 3 and 7, attachment, proliferation, cell vitality, cytotoxicty and cell morphology were analyzed. RESULTS: Cells on BioGide® and RESODONT® exhibited significantly higher attachment (p<0.005) and proliferation (p<0.005). On BioMend® cells showed a significantly higher attachment compared to BioMend® Extend™ (p<0.005), whereas on BioMend® Extend™ cells had significantly higher proliferation (p<0.005). The vitality of cells was significantly better on BioGide® and RESODONT® (p<0.005). There were no significant differences between USSCs and HOBs. Scanning electron microscopy confirmed these results. CONCLUSION: BioGide® and RESODONT® had the best biocompatibility and are appropriate membranes for use in stem cell-derived regeneration of bone.

Impact of DAG stimulation on mineral synthesis, mineral structure and osteogenic differentiation of human cord blood stem cells.

It remains unexplored in what way osteogenic stimulation with dexamethasone, ascorbic acid and ß-glycerol phosphate (DAG) influences the process of mineralization, the composition and structure of the assembled mineral. Therefore, we analyzed and characterized biomineralization in DAG-stimulated and unstimulated 3D human unrestricted somatic stem cell (USSC) cultures. Microspheres were analyzed by histological staining, scanning electron microscopy (SEM), semi-quantitative energy-dispersive X-ray spectroscopy (EDX), quantitative wavelength-dispersive X-ray spectroscopy (WDX), transmission electron microscopy (TEM), selected area electron diffraction (SAED) and Raman spectroscopy. Mineral material was detected by SEM and histological staining in both groups, and showed structural differences. DAG influenced the differentiation of USSCs and the formation, structure and composition of the assembled mineral. SEM showed that cells of the +DAG spheres exhibited morphological signs of osteoblast-like cells. EDX and WDX confirmed a Ca-P mineral in both groups. Overall, the mineral material found showed structural similarities to the mineral substance of bony material.

Improvement of the cell-loading efficiency of biomaterials by inoculation with stem cell-based microspheres, in osteogenesis.

In critical-size bone defects, autologous or allogenic cells are required in addition to compatible biomaterials for the successful defect healing. State of the art inoculation methods of biomaterials are based on the application of cell suspensions to the biomaterial. However, only less amounts of cells can be applied and sufficient adhesion to the material is required. Therefore, it was investigated whether the advantages of stem cell-based microspheres and insoluble collagenous bone matrix (ICBM) scaffolds can be combined which can lead to an advancement in cell seeding on biomaterials. Microspheres were produced from unrestricted somatic stem cells from human umbilical cord blood and were mounted on ICBM scaffolds. Following the incubation with osteogenic or control medium, the constructs were analyzed histologically after 3, 7, 14, and 28 days. Alizarin Red S and von Kossa staining revealed microsphere mineralization after 3 days in osteogenic and after 14 days in control medium. Meanwhile, a time-dependent increase in tissue, growing out of the microspheres, was detected. Our results provide evidence that microsphere-ICBM constructs are promising candidates for approaches of bone regeneration. They allow the transfer of substantially high numbers of cells in partially mineralized constructs.

Generation and differentiation of microtissues from multipotent precursor cells for use in tissue engineering.

This protocol describes an effective method for the production of spherical microtissues (microspheres), which can be used for a variety of tissue-engineering purposes. The obtained microtissues are well suited for the study of osteogenesis in vitro when multipotent stem cells are used. The dimensions of the microspheres can easily be adjusted according to the cell numbers applied in an individual experiment. Thus, microspheres allow for the precise administration of defined cell numbers at well-defined sites. Here we describe a detailed workflow for the production of microspheres using unrestricted somatic stem cells from human umbilical cord blood and adapted protocols for the use of these microspheres in histological analysis. RNA extraction methods for mineralized microtissues are specifically modified for optimum yields. The duration of running the complete protocol without preparatory cell culture but including 2 weeks of microsphere incubation, histological staining and RNA isolation is about 3 weeks.

Biocompatibility of osteogenic predifferentiated human cord blood stem cells with biomaterials and the influence of the biomaterial on the process of differentiation.

Modern cell-based bone reconstruction therapies offer new therapeutic opportunities and tissue engineering represents a more biological-oriented approach to heal bone defects of the skeleton. Human unrestricted somatic stem cells (USSCs) derived form umbilical cord blood offer new promising aspects e.g., can differentiate into osteogenetic cells. Furthermore these cells have fewer ethical and legal restrictions compared to embryonic stem cells (ESCs). The purpose of this study was to evaluate the compatibility of osteogenic pre-differentiated USSCs with various biomaterials and to address the question, whether biomaterials influence the process of differentiation of the USSCs. After osteogenic differentiation with DAG USSCs were cultivated with various biomaterials. To asses the biocompatibility of USSCs the attachment and the proliferation of the cells on the biomaterial were measured by a CyQUANT(®) assay, the morphology was analyzed by scanning electron microscopy and the influence of the gene expression was analyzed by real time PCR. Our results provide evidence that insoluble collagenous bone matrix followed by ß-tricalciumphosphate is highly suitable for bone tissue engineering regarding cell attachment and proliferation. The gene expression analysis indicates that biomaterials influence the gene expression of USSCs. These results are in concordance with our previous study with ESCs.

Comparison of ectopic bone formation of embryonic stem cells and cord blood stem cells in vivo.

Cell-based reconstruction therapies promise new therapeutic opportunities for bone regeneration. Unrestricted somatic stem cells (USSC) from cord blood and embryonic stem cells (ESCs) can be differentiated into osteogenic cells. The purpose of this in vivo study was to compare their ability to induce ectopic bone formation in vivo. Human USSCs and murine ESCs were cultured as both monolayer cultures and micromasses and seeded on insoluble collagenous bone matrix (ICBM). One week and 1, 2, and 3 months after implanting the constructs in immune-deficient rats, computed tomography scans were performed to detect any calcification. Subsequently, the implanted constructs were examined histologically. The radiological examination showed a steep increase in the mineralized bone-like tissue in the USSC groups. This increase can be considered as statistically significant compared to the basic value. Moreover, the volume and the calcium portion measured by computed tomography scans were about 10 times higher than in the ESC group. The volume of mineralization in the ESC group increased to a much smaller extent over the course of time, and the control group (ICBM without cells) showed almost no alterations during the study. The histological examinations parallel the radiological findings. Cord blood stem cells in combination with ICBM-induced ectopic bone formation in vivo are stronger than ESCs.

Embryonic stem cells induce ectopic bone formation in rats.

BACKGROUND: Surgery often leads to massive destruction of the skeleton. Cell-based bone reconstruction therapies promise new therapeutic opportunities for the repair of bone. Embryonic stem cells (ESCs) can be differentiated into osteogenic cells and are a potential cell source for bone tissue engineering. The purpose of this in vivo study was to investigate the bone formation in various constructs containing ESCs (with and without micromass technology) and insoluble collagenous bone matrix (ICBM). METHODS: Murine ESCs were cultured as monolayer cultures as well as micromasses and seeded on ICBM. These constructs were implanted in immunodeficient rats. After one week, one, two and three months CT-scans were performed to detect any calcifications and the rats were sacrificed. RESULTS: The radiological examination shows a steep increase of the mineralized tissue in group 1 (ICBM+seeded ESC). This increase can be considered as statistical significant. In contrast, the volume of the mineralization in group 2 (ICBM+ESC-spheres) and group 3 (ESC-spheres) does not increase significantly during the study. CONCLUSION: ESCs in combination with ICBM do promote ectopic bone formation in vivo. Thus, this cell population as well as the biomaterial ICBM might be promising components for bone tissue engineering.

Osteogenic differentiation influences stem cell migration out of scaffold-free microspheres.

Complete bone regeneration of critical-size defects frequently fail because of the use of acellular bone substitutes and because of partially negative influences of artificial scaffolds. However, the supply of cells to critical-size defects is essential for the regeneration. Therefore, engineered scaffold-free tissues, with outgrowing cells that fill up spaces in the bony defect, are promising candidates for bone regeneration approaches. Here, we demonstrate such a scaffold-free tissue construct (microspheres) that, if osteogenic differentiated, mineralizes while maintaining the capability to let cells grow out of the united cell structure. A superior outgrowth capability of microspheres composed of human cord blood-derived unrestricted somatic stem cells compared with murine embryonic stem cells was found and a time-dependent reduction in outgrowth was evident in vitro. Even after 5 days of osteoinduction and strong mineralization, the cells migrate out of the microsphere. As migration of cells out of unrestricted somatic stem cell microspheres was also found in extracellular matrix gel, we suggest that cells would migrate also in vivo. Thus, microspheres could serve as the scaffold and the source of osteogenic cells in future bone regeneration approaches. Further, microspheres permit the precise administration of large amount of cells into an area of interest.

Compatibility of embryonic stem cells with biomaterials.

Periodontal bone defects and atrophy of the jaws in an aging population are of special concern. Tissue engineering using embryonic stem cells (ESCs) and biomaterials may offer new therapeutic options. The purpose of this study is to evaluate the compatibility of ESCs with biomaterials and the influence of biomaterials on the osteogenic gene expression profile.Therefore, ESCs are cultured with various biomaterials. The cytocompatibility of murine ESCs is measured regarding the proliferation of the cells on the materials by CyQUANT assay, the morphology by scanning electron microscopy, and the influence on the gene expression by real time PCR.The results show that insoluble collagenous bone matrix, followed by beta-tricalciumphosphate, is most suitable for bone tissue engineering regarding cell proliferation, and phenotype. The gene expression analysis indicates that biomaterials do influence the gene expression of ESCs.Our results provide new insight into the cytocompatibility of ESCs on different scaffolds.

Induction of osteogenic markers in differentially treated cultures of embryonic stem cells.

BACKGROUND: Facial trauma or tumor surgery in the head and face area often lead to massive destruction of the facial skeleton. Cell-based bone reconstruction therapies promise to offer new therapeutic opportunities for the repair of bone damaged by disease or injury. Currently, embryonic stem cells (ESCs) are discussed to be a potential cell source for bone tissue engineering. The purpose of this study was to investigate various supplements in culture media with respect to the induction of osteogenic differentiation. METHODS: Murine ESCs were cultured in the presence of LIF (leukemia inhibitory factor), DAG (dexamethasone, ascorbic acid and beta-glycerophosphate) or bone morphogenetic protein-2 (BMP-2). Microscopical analyses were performed using von Kossa staining, and expression of osteogenic marker genes was determined by real time PCR. RESULTS: ESCs cultured with DAG showed by far the largest deposition of calcium phosphate-containing minerals. Starting at day 9 of culture, a strong increase in collagen I mRNA expression was detected in the DAG-treated cells. In BMP-2-treated ESCs the collagen I mRNA induction was less increased. Expression of osteocalcin, a highly specific marker for osteogentic differentiation, showed a double-peaked curve in DAG-treated cells. ESCs cultured in the presence of DAG showed a strong increase in osteocalcin mRNA at day 9 followed by a second peak starting at day 17. CONCLUSION: Supplementation of ESC cell cultures with DAG is effective in inducing osteogenic differentiation and appears to be more potent than stimulation with BMP-2 alone. Thus, DAG treatment can be recommended for generating ESC populations with osteogenic differentiation that are intended for use in bone tissue engineering.

Cell-based bone reconstruction therapies-principles of clinical approaches.

Cell-based bone tissue engineering is a rapidly evolving therapy option in bone reconstruction strategies. Some cell-driven approaches, especially the biophysical stimulation of the host cell population surrounded by the bone defect, are common treatment methods in maxillofacial surgery. Others, such as autologous cell implantation, have now gained acceptance for clinical trials. More advanced or complex therapeutical options (extracorporeal tissue engineering, stem cell use, genetic engineering) have been tested in preclinical investigations but have not reached the level of clinical use. Two different aspects are of special relevance in cell-based bone reconstruction therapies. The source of cells used to regenerate bone (discussed in detail in a complementary review in this issue of The International Journal of Oral and Maxillofacial Implants) as well as the principal approach of a cell-driven bone regeneration therapy influence the outcome of such engineering strategies. All of the cell-driven repair strategies are under intensive investigation in an effort to provide surgeons with a limitless supply of tissue for bone repair and reconstruction in future procedures. An overview of the basic biological aspects as well as the inherent constraints of different cell-based approaches are given in this paper.