Looking Ahead to Engineering Epimorphic Regeneration of a Human Digit or Limb.

Approximately 2 million people have had limb amputations in the United States due to disease or injury, with more than 185,000 new amputations every year. The ability to promote epimorphic regeneration, or the regrowth of a biologically based digit or limb, would radically change the prognosis for amputees. This ambitious goal includes the regrowth of a large number of tissues that need to be properly assembled and patterned to create a fully functional structure. We have yet to even identify, let alone address, all the obstacles along the extended progression that limit epimorphic regeneration in humans. This review aims to present introductory fundamentals in epimorphic regeneration to facilitate design and conduct of research from a tissue engineering and regenerative medicine perspective. We describe the clinical scenario of human digit healing, featuring published reports of regenerative potential. We then broadly delineate the processes of epimorphic regeneration in nonmammalian systems and describe a few mammalian regeneration models. We give particular focus to the murine digit tip, which allows for comparative studies of regeneration-competent and regeneration-incompetent outcomes in the same animal. Finally, we describe a few forward-thinking opportunities for promoting epimorphic regeneration in humans.

Correlating the effects of bone morphogenic protein to secreted soluble factors from fibroblasts and mesenchymal stem cells in regulating regenerative processes in vitro.

The capacity to regenerate complex tissue structures after amputation in humans is limited to the digit tip. In a comparable mouse digit model, which includes both distal regeneration-competent and proximal regeneration-incompetent regions, successful regeneration involves precise orchestration of complex microenvironmental cues, including paracrine signaling via heterogeneous cell-cell interactions. Initial cellular processes, such as proliferation and migration, are critical in the formation of an initial stable cell mass and the ultimate regenerative outcome. Hence, the objective of these in vitro studies was to investigate the effect of soluble factors secreted by fibroblasts and mesenchymal stem cells (MSCs) on the proliferation and migration of cells from the regeneration-competent (P3) and -incompetent (P2) regions of the mouse digit tip. We found that P2 and P3 cells were more responsive to fibroblasts than MSCs and that the effects were mediated by bi-directional communication. To initiate understanding of the specific soluble factors that may be involved in the fibroblast-mediated changes in migration of P2 and P3 cells, bone morphogenic protein 2 (BMP2) was exogenously added to the medium. We found that changes in migration of P3 cells were similar when exposed to BMP2 or co-cultured with fibroblasts, indicating that BMP signaling may be responsible for the migratory response of P3 cells to the presence of fibroblasts. Furthermore, BMP2 expression in fibroblasts was shown to be responsive to tensile strain, as is present during wound closure. Therefore, these in vitro studies indicate that regenerative processes may be regulated by fibroblast-secreted soluble factors, which, in turn, are modulated by both cross-talk between heterogeneous phenotypes and the physical microenvironment of the healing site.

Modulating the physical microenvironment to study regenerative processes in vitro using cells from mouse phalangeal elements.

Epimorphic regeneration in humans of complex multitissue structures is primarily limited to the digit tip. In a comparable mouse model, the response is level-specific in that regeneration occurs after amputation at the distal end of the terminal phalanx, but not more proximally. Recent isolation of stromal cells from CD1 murine phalangeal elements two and three (P2 and P3) allow for comparative studies of cells prevalent at the amputation plane of a more proximal region (considered nonregenerative) and a more distal region (considered regenerative), respectively. This study used adherent, suspension, and collagen gel cultures to investigate cellular processes relevant to the initial response to injury. Overall, P2 cells were both more migratory and able to compact collagen gels to a greater extent compared to P3 cells. This observed increased capacity of P2 cells to generate traction forces was likely related to the higher expression of key cytoskeletal proteins (e.g., microfilament, nonkeratin intermediate filaments, and microtubules) compared to P3 cells. In contrast, P3 cells were found to be more proliferative than P2 cells under all three culture conditions and to have higher expression of keratin proteins. In addition, when cultured in suspension rather than on adherent surfaces, P3 cells were both more proliferative and had greater gene expression for matrix proteins. Together these results add to the known inherent differences in these stromal cells by characterizing responses to the physical microenvironment. Further, while compaction by P2 cells confirm that collagen gels is a useful model to study wound healing, the response of P3 cells indicate that suspension culture, in which cell-cell interactions dominate like in the blastema, may be better suited to study regeneration. Therefore, this study can help develop clinical strategies for promoting regeneration through increased understanding in the properties of cells involved in endogenous repair as well as informed selection of useful in vitro models.