@phdthesis{Buss2021,
  author    = {Buss, Alexa},
  title     = {Testung verschiedener Strategien f{\"u}r die Regeneration von Knorpeldefekten im Ex vivo-Testsystem},
  doi       = {10.25972/OPUS-24671},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-246714},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Die Degeneration des Gelenkknorpels ist Hauptursache f{\"u}r chronische Schmerzen und eine dadurch bedingte Einschr{\"a}nkung der Lebensqualit{\"a}t. F{\"u}r die Sozialversicherungssysteme ist dies mit steigenden Kosten verbunden. Gegenw{\"a}rtige Behandlungsoptionen wie die Mikrofrakturierung oder die (matrix-assoziierte) Autologe Chondrozytentransplantation (M-) ACT f{\"u}hren zu einem minderwertigen Reparaturgewebe aus Faserknorpel mit unzureichenden mechanischen Eigenschaften an der Defektstelle. Es besteht ein Bedarf an der Entwicklung und Testung neuer Knorpeltherapien, die ein funktionelles Reparaturgewebe f{\"u}r nachhaltige Beschwerdefreiheit erzeugen. Das hier verwendete k{\"u}rzlich etablierte osteochondrale Ex vivo-Testsystem (EVTS) eignet sich zur Evaluation unterschiedlicher zellbasierter Behandlungsans{\"a}tze f{\"u}r die Knorpelregeneration. Aus der medialen Femurkondyle von Schweinen wurden zylindrische 8 mm große osteochondrale Explantate (OCE) isoliert. Es wurden Knorpel-Knochendefekte und reine Knorpeldefekte kreiert und mit autologen Schweine-Chondrozyten (CZ) bzw. einer Mischung aus CZ und mesenchymalen Stammzellen (MSC) gef{\"u}llt, die in Kollagen Typ I Hydrogel eingebettet waren. Nach vierw{\"o}chiger Kultivierung wurden die Proben histologisch und immunhistochemisch gef{\"a}rbt (Safranin-O-F{\"a}rbung, Kollagen Typ II, Aggrekan), die Zellvitalit{\"a}t (Lebend-Tot-F{\"a}rbung) {\"u}berpr{\"u}ft und die extrazellul{\"a}re Matrixproduktion analysiert. Nach vierw{\"o}chiger Kultur im EVTS in Normoxie und Hypoxie zeigten sich die in Kollagen-I-Hydrogel eingebetteten Zellen lebensf{\"a}hig. Die Auswertung der verschiedenen Ans{\"a}tze erfolgte {\"u}ber den standardisierten ICRS-II-Score der International Cartilage Repair Society (ICRS) mit drei unabh{\"a}ngigen Bewertern. Insgesamt resultierten bessere Ergebnisse im Hinblick auf die Matrixsynthese in den Monokulturen aus CZ im Vergleich zu den Co-Kulturen aus CZ und MSCs. Da dieser Unterschied nicht groß war, k{\"o}nnten MSCs zur Einsparung autologer CZ eine Alternative in der Behandlung von Knorpeldefekten darstellen. Hypoxie spielte eine Rolle bei reinen Knorpeldefekten, nicht bei Knorpel-Knochendefekten. Dies best{\"a}tigt die Bedeutung des physiologischen hypoxischen Milieus des Gelenkknorpels, das einen niedrigen Sauerstoffgehalt von 2-5 VII \% aufweist. Die Ergebnisse zeigen, dass die unterschiedlichen Faktoren aus Zellkombination, Knorpeldefektgr{\"o}ße und Kultivierung in Hypoxie oder Normoxie Einfluss auf die Ausbildung der extrazellul{\"a}ren Matrix haben. Weiterhin fehlt jedoch das Verst{\"a}ndnis f{\"u}r die genauen Mechanismen des Knorpelregenerationsverhaltens. Ex vivo-Testsysteme k{\"o}nnen dabei helfen ein weiteres Verst{\"a}ndnis zu erlangen und entsprechende Behandlungsstrategien zu evaluieren.},
  subject      = {cartilage},
  language  = {de}
}
@phdthesis{Bleuel2021,
  author    = {Bleuel, Gabriel},
  title     = {Entwicklung und Validierung eines quantitativen Verfahrens zur Beurteilung der Viabilit{\"a}t von entsprechend der GMP-Richtlinien hergestellter Knorpelimplantate f{\"u}r das Knie},
  doi       = {10.25972/OPUS-24248},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-242481},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Due to the reversing age pyramid in Germany, more and more people are already suffering from joint cartilage damage. But not only age, but also accidents and sports injuries and being overweight can lead to irreversible cartilage defects. Although there are various treatment options, the previous methods cannot be considered a permanent cure. As part of the international research project BIO-CHIP, a promising treatment method with novel drugs was to be investigated. The patient's own cartilage cells from the nose serve as the starting material for the drug, a manufactured cartilage implant. These are isolated, multiplied and ultimately cultivated on a matrix to form a cartilage implant. In addition to toxicological and biological safety tests, an essential prerequisite for the approval of the implant is the assessment of the viability. This was previously carried out on the basis of histology from the pathology department. The aim of the present work was the development and validation of a standardized and objective viability test for the chondrocytes within the cartilage matrix. For this, the LDH was used as a marker for irreversibly damaged cells. The LDH concentration could be measured with the CyQuant LDH assay by measuring the absorption. It could be proven that LDH has the required stability and detectability in the medium. With the help of the lysis, of cultivated mini-cartilage implants, the maximum achievable LDH concentrations could be determined. A calibration curve was generated using these concentrations. This serves to assess the viability of future measured absorptions of the supernatant medium. The developed method does not require any invasive interventions on the implant and is characterized by its simple implementation, since only the protrusion has to be measured. The validation of the method certified a high level of robustness, linearity, accuracy and precision.},
  subject      = {Hyaliner Knorpel},
  language  = {de}
}
@phdthesis{Kiepe2021,
  author    = {Kiepe, Felix},
  title     = {Knorpelintegration unter Hemmung der Kollagensynthese im Disc-Ring-Modell: eine In-vitro-Studie},
  doi       = {10.25972/OPUS-23761},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-237610},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Biomechanische, histologische und immunhistochemische Analyse der lateralen Integration von nativem hyalinem Knorpel in einen Gelenkknorpeldefekt unter Beeinflussung der Kollagensynthese.im Rahmen der in vitro Kultivierung f{\"u}r 7,14 und 21 Tage. Unter Hemmung der Kollagensynthese mittels Ethyl-3,4-dihydroxybenzoat (EDHB) zeigte sich weder kollagene, noch nicht-kollagene Matrixsynthese im Defektbereich. Eine mechanische Integration zeigte sich ebenso nicht. Gruppen ohne Hemmung der Kollagensynthese zeigten im Laufe der Kultivierung einen signifikanten Zuwachs der biomechanisch messbaren Integrationsst{\"a}rke. Auch histologisch und immunhistochemisch zeigten sich Glykosaminoglykan- und Kollagen Typ II-Synthese im Defektbereich. Dies zeigt die Abh{\"a}ngigkeit der lateralen Integration von der Kollagensynthese im multifaktoriellen Prozess der Knorpelintegration.},
  subject      = {Knorpelintegration},
  language  = {de}
}
@phdthesis{Frischholz2021,
  author    = {Frischholz, Sebastian},
  title     = {Resveratrol Counteracts IL-1β-mediated Impairment of Extracellular Matrix Deposition in 3D Articular Chondrocyte Constructs},
  doi       = {10.25972/OPUS-23745},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-237453},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Articular cartilage is an exceptional connective tissue which by a network of fibrillar collagen and glycosaminoglycan (GAG) molecules allows both low- friction articulation and distribution of loads to the subchondral bone (Armiento et al., 2018, Ulrich-Vinther et al., 2003). Because of its very limited ability to self-repair, chondral defects following traumatic injury increase the risk for secondary osteoarthritis (OA) (Muthuri et al., 2011). Still, current OA treatments such as common nonsteroidal anti-inflammatory drugs (NSAIDs) and joint replacement primarily address end-stage symptoms (Tonge et al., 2014). As low-grade inflammation plays a pivotal role in the pathogenesis of OA (Robinson et al., 2016), there is a strong demand for novel therapeutic concepts, such as integrating application of anti-inflammatory agents into cartilage cell- based therapies in order to effectively treat OA affected joints in early disease stages. The polyphenolic phytoalexin resveratrol (RSV), found in the skin of red grapes, berries, and peanuts, has been shown to have effective anti-inflammatory properties (Shen et al., 2012). However, its long-term effects on 3D chondrocyte constructs cultured in an inflammatory environment with regard to tissue quality have remained unexplored so far. Therefore, in this study, pellets made from expanded porcine articular chondrocytes were cultured for 14 days with either the pro-inflammatory cytokine interleukin-1β (IL-1β) (1 - 10 ng/ml) or RSV (50 μM) alone, or a co-treatment with both agents. Constructs treated with chondrocyte medium only served as control. Treatment with IL-1β at 10 ng/ml resulted in a significantly smaller pellet size and reduced DNA content. However, RSV counteracted the IL-1β-induced decrease and significantly enhanced diameter and DNA content. Also, in terms of GAG deposition, treatment with IL-1β at 10 ng/ml resulted in a tremendous depletion of absolute GAG content and GAG/DNA. Again, RSV co-treatment counteracted the inflammatory stimulus and led to a partial recovery of GAG content. Histological analysis utilizing safranin-O staining confirmed these findings. Marked expression of the cartilage-degrading enzyme matrix metalloproteinase 13 (MMP13) was detected in IL-1β-treated pellets, but none upon RSV co- treatment. Moreover, co-treatment of IL-1β-challenged constructs with RSV significantly increased absolute collagen content. However, under non- inflammatory conditions, RSV induced gene expression and protein accumulation of collagen type X, a marker for undesirable hypertrophy. Taken together, in the present thesis, RSV was demonstrated to elicit marked beneficial effects on the extracellular matrix composition of 3D cartilaginous constructs in long-term inflammatory culture in vitro, but also induced hypertrophy under non-inflammatory conditions. Based on these findings, further experiments examining multiple concentrations of RSV under various inflammatory conditions appear desirable concerning potential therapeutic applicability in OA.},
  subject      = {Resveratrol},
  language  = {en}
}
@phdthesis{Stuckensen2016,
  author    = {Stuckensen, Kai},
  title     = {Fabrication of hierarchical cell carrier matrices for tissue regeneration by directional solidification},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-145510},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2016},
  abstract  = {The key hypothesis of this work represented the question, if mimicking the zonal composition and structural porosity of musculoskeletal tissues influences invading cells positively and leads to advantageous results for tissue engineering. Conventional approaches in tissue engineering are limited in producing monolithic "scaffolds" that provide locally variating biological key signals and pore architectures, imitating the alignment of collagenous fibres in bone and cartilage tissues, respectively. In order to fill this gap in available tissue engineering strategies, a new fabrication technique was evolved for the production of scaffolds to validate the hypothesis. Therefore, a new solidification based platform procedure was developed. This process comprises the directional solidification of multiple flowable precursors that are "cryostructured" to prepare a controlled anisotropic pore structure. Porous scaffolds are attained through ice crystal removal by lyophilisation. Optionally, electrostatic spinning of polymers may be applied to provide an external mesh on top or around the scaffolds. A consolidation step generates monolithic matrices from multi zonal structures. To serve as matrix for tissue engineering approaches or direct implantation as medical device, the scaffold is sterilized. An Adjustable Cryostructuring Device (ACD) was successively developed; individual parts were conceptualized by computer aided design (CAD) and assembled. During optimisation, a significant performance improvement of the ACDs accessible external temperature gradient was achieved, from (1.3 ± 0.1) K/mm to (9.0 ± 0.1) K/mm. Additionally, four different configurations of the device were made available that enabled the directional solidification of collagenous precursors in a highly controlled manner with various sample sizes and shapes. By using alginate as a model substance the process was systematically evaluated. Cryostructuring diagraphs were analysed yielding solidification parameters, which were associated to pore sizes and alignments that were determined by image processing. Thereby, a precise control over pore size and alignment through electrical regulation of the ACD could be demonstrated. To obtain tissue mimetic scaffolds for the musculoskeletal system, collagens and calcium phosphates had to be prepared to serve as raw materials. Extraction and purification protocols were established to generate collagen I and collagen II, while the calcium phosphates brushite and hydroxyapatite were produced by precipitation reactions. Besides the successive augmentation of the ACD also an optimization of the processing steps was crucial. Firstly, the concentrations and the individual behaviour of respective precursor components had to be screened. Together with the insights gained by videographic examination of solidifying collagen solutions, essential knowledge was gained that facilitated the production of more complex scaffolds. Phenomena of ice crystal growth during cryostructuring were discussed. By evolutionary steps, a cryostructuring of multi-layered precursors with consecutive anisotropic pores could be achieved and successfully transferred from alginate to collagenous precursors. Finally, very smooth interfaces that were hardly detectable by scanning electron microscopy (SEM) could be attained. For the used collagenous systems, a dependency relation between adjustable processing parameters and different resulting solidification morphologies was created. Dehydrothermal-, diisocyanate-, and carbodiimide- based cross linking methods were evaluated, whereby the "zero length" cross linking by carbodiimide was found to be most suitable. Afterwards, a formulation for the cross linking solution was elaborated, which generated favourable outcomes by application inside a reduced pressure apparatus. As a consequence, a pore collapse during wet chemical cross linking could be avoided. Complex monolithic scaffolds featuring continuous pores were fabricated that mimicked structure and respective composition of different areas of native tissues by the presence of biochemical key stimulants. At first, three types of bone scaffolds were produced from collagen I and hydroxyapatite with appropriate sizes to fit critical sized defects in rat femurs. They either featured an isotropic or anisotropic porosity and partly also contained glycosaminoglycans (GAGs). Furthermore, meniscus scaffolds were prepared by processing two precursors with biomimetic contents of collagen I, collagen II and GAGs. Here, the pore structures were created under boundary conditions, which allowed an ice crystal growth that was nearly orthogonal to the external temperature gradient. Thereby, the preferential alignment of collagen fibres in the natural meniscus tissue could be mimicked. Those scaffolds owned appropriate sizes for cell culture in well plates or even an authentic meniscus shape and size. Finally, osteochondral scaffolds, sized to either fit well plates or perfusion reactors for cell culture, were fabricated to mimic the composition of subchondral bone and different cartilage zones. Collagen I and the resorbable calcium phosphate brushite were used for the subchondral zone, whereas the cartilage zones were composed out of collagen I, collagen II and tissue mimetic contents of GAGs. The pore structure corresponded to the one that is dominating the volume of natural osteochondral tissue. Energy dispersive X-ray spectroscopy (EDX) and SEM were used to analyse the composition and pore structure of the individual scaffold zones, respectively. The cross section pore diameters were determined to (65 ± 25) µm, (88 ± 35) µm and(93 ± 42) µm for the anisotropic, the isotropic and GAG containing isotropic bone scaffolds. Furthermore, the meniscus scaffolds showed pore diameters of (93 ± 21) µm in the inner meniscus zone and (248 ± 63) µm inside the outer meniscus zone. Pore sizes of (82 ± 25) µm, (83 ± 29) µm and (85 ± 39) µm were present inside the subchondral, the lower chondral and the upper chondral zone of osteochondral scaffolds. Depending on the fabrication parameters, the respective scaffold zones were also found to feature a specific micro- and nanostructure at their inner surfaces. Degradation studies were carried out under physiological conditions and resulted in a mean mass loss of (0.52 ± 0.13) \%, (1.56 ± 0.10) \% and (0.80 ± 0.10) \% per day for bone, meniscus and osteochondral scaffolds, respectively. Rheological measurements were used to determine the viscosity changes upon cooling of different precursors. Micro computer tomography (µ-CT) investigations were applied to characterize the 3D microstructure of osteochondral scaffolds. To obtain an osteochondral scaffold with four zones of tissue mimetic microstructure alignment, a poly (D, L-lactide-co-glycolide) mesh was deposited on the upper chondral zone by electrostatic spinning. In case of the bone scaffolds, the retention / release capacity of bone morphogenetic protein 2 (BMP-2) was evaluated by an enzyme linked immunosorbent assay (ELISA). Due to the high presence of attractive BMP binding sites, only less than 0.1 \% of the initially loaded cytokine was released. The suitability of combining the cryostructuring process with 3D powder printed calcium phosphate substrates was evaluated with osteochondral scaffolds, but did not appear to yield more preferable results than the non-combined approach. A new custom build confined compression setup was elaborated together with a suitable evaluation procedure for the mechanical characterisation under physiological conditions. For bone and cartilage scaffolds, apparent elastic moduli of (37.6 ± 6.9) kPa and (3.14 ± 0.85) kPa were measured. A similar behaviour of the scaffolds to natural cartilage and bone tissue was demonstrated in terms of elastic energy storage. Under physiological frequencies, less than 1.0 \% and 0.8 \% of the exerted energy was lost for bone and cartilage scaffolds, respectively. With average relaxation times of (0.613 ± 0.040) sec and (0.815 ± 0.077) sec, measured for the cartilage and bone scaffolds, they respond four orders of magnitude faster than the native tissues. Additionally, all kinds of produced scaffolds were able to withstand cyclic compression at un-physiological frequencies as high as 20 Hz without a loss in structural integrity. With the presented new method, scaffolds could be fabricated whose extent in mimicking of native tissues exceeded the one of scaffolds producible by state of the art methods. This allowed a testing of the key hypothesis: The biological evaluation of an anisotropic pore structure in vivo revealed a higher functionality of immigrated cells and led finally to advantageous healing outcomes. Moreover, the mimicking of local compositions in combination with a consecutive anisotropic porosity that approaches native tissue structures could be demonstrated to induce zone specific matrix remodelling in stem cells in vitro. Additionally, clues for a zone specific chondrogenic stem cell differentiation were attained without the supplementation of growth factors. Thereby, the hypothesis that an increased approximation of the hierarchically compositional and structurally anisotropic properties of musculoskeletal tissues would lead to an improved cellular response and a better healing quality, could be confirmed. With a special focus on cell free in situ tissue engineering approaches, the insights gained within this thesis may be directly transferred to clinical regenerative therapies.},
  subject      = {Tissue Engineering},
  language  = {en}
}