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- Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie (Chirurgische Klinik II) (18)
- Graduate School of Life Sciences (15)
- Abteilung für Funktionswerkstoffe der Medizin und der Zahnheilkunde (9)
- Lehrstuhl für Orthopädie (5)
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- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen (1)
- Medizinische Klinik und Poliklinik II (1)
Sonstige beteiligte Institutionen
In reconstructive and plastic surgery, there exists a growing demand of adequate tissue implants, since currently available strategies for autologous transplantation are limited by complications including transplant failure and donor site morbidity. By developing in vitro and in vivo autologous substitutes for defective tissue sites, adipose tissue engineering can address these challenges, although there are several obstacles to overcome. One of the major limitations is the sufficient vascularization of in vitro engineered large constructs that remains crucial and demanding for functional tissues. Decellularized jejunal segments may represent a suitable scaffolding system with preexisting capillary structures that can be repopulated with human microvascular endothelial cells (hMVECs), and a luminal matrix applicable for the adipogenic differentiation of human adipose-derived stem cells (hASCs). Hence, co-culture of these cells in jejunal segments, utilizing a custom-made bioreactor system, was characterized in terms of vascularization and adipose tissue development. Substantial adipogenesis of hASCs was demonstrated within the jejunal lumen in contrast to non-induced controls, and the increase of key adipogenic markers was verified over time upon induction. The development of major extracellular matrix components of mature adipose tissue, such as laminin and collagen IV, was shown within the scaffold in induced samples. Successful reseeding of the vascular network with hMVECs was demonstrated in long-term culture and co-localization of vascular structures and adipogenically differentiated hASCs was observed. Therefore, these results represent a novel approach for in vitro engineering of vascularized adipose tissue constructs that warrants further investigations in preclinical studies.
Another still existing obstacle in adipose tissue engineering is the insufficient knowledge about the applied cells, for instance the understanding of how cells can be optimally expanded and differentiated for successful engineering of tissue transplants. Even though hASCs can be easily isolated from liposuction of abdominal fat depots, yielding low donor site morbidity, huge numbers of cells are required to entirely seed complex and large 3D matrices or scaffolds. Thus, cells need to be large-scale expanded in vitro on the premise of not losing their differentiation capacity caused by replicative aging. Accordingly, an improved differentiation of hASCs in adipose tissue engineering approaches remains still desirable since most engineered constructs exhibit an inhomogeneous differentiation pattern. For mesenchymal stem cells (MSCs), it has been shown that growth factor application can lead to a significant improvement of both proliferation and differentiation capacity. Especially basic fibroblast growth factor (bFGF) represents a potent mitogen for MSCs, while maintaining or even promoting their osteogenic, chondrogenic and adipogenic differentiation potential. As there are currently different contradictory information present in literature about the applied bFGF concentration and the explicit effect of bFGF on ASC differentiation, here, the effect of bFGF on hASC proliferation and differentiation capacity was investigated at different concentrations and time points in 2D culture. Preculture of hASCs with bFGF prior to adipogenic induction showed a remarkable effect, whereas administration of bFGF during culture did not improve adipogenic differentiation capacity. Furthermore, the observations indicated as mode of action an impact of this preculture on cell proliferation capacity, resulting in increased cellular density at the time of adipogenic induction. The difference in cell density at this time point appeared to be pivotal for increased adipogenic capacity of the cells, which was confirmed in a further experiment employing different seeding densities. Interestingly, furthermore, the obtained results suggested a cell-cell contact-mediated mechanism positively influencing adipogenic differentiation. As a consequence, subsequently, studies were conducted focusing on intercellular communication of these cells, which has hardly been investigated to date.
Despite the multitude of literature on the differentiation capacity of ASCs, little is reported about the physiological properties contributing to and controlling the process of lineage differentiation. Direct intercellular communication between adjacent cells via gap junctions has been shown to modulate differentiation processes in other cell types, with connexin 43 (Cx43) being the most abundant isoform of the gap junction-forming connexins. Thus, in the present study we focused on the expression of Cx43 and gap junctional intercellular communication (GJIC) in hASCs, and its significance for adipogenic differentiation of these cells. Cx43 expression in hASCs was demonstrated histologically and on the gene and protein expression level and was shown to be greatly positively influenced by cell seeding density. Functionality of gap junctions was proven by dye transfer analysis in growth medium. Adipogenic differentiation of hASCs was shown to be also distinctly elevated at higher cell seeding densities. Inhibition of GJIC by 18α-glycyrrhetinic acid significantly compromised adipogenic differentiation, as demonstrated by histology, triglyceride quantification, and adipogenic marker gene expression. Flow cytometry analysis showed a lower proportion of cells undergoing adipogenesis when GJIC was inhibited, further indicating the importance of GJIC in the differentiation process. Altogether, these results demonstrate the impact of direct cell-cell communication via gap junctions on the adipogenic differentiation process of hASCs and may contribute to further integrate direct intercellular crosstalk in rationales for tissue engineering approaches.
The implantation of any foreign material into the body automatically starts an immune reaction that serves as the first, mandatory step to regenerate tissue. The course of this initial immune reaction decides on the fate of the implant: either the biomaterial will be integrated into the host tissue to subsequently fulfill its intended function (e.g., tissue regeneration), or it will be repelled by fibrous encapsulation that determines the implant failure. Especially neutrophils and macrophages play major roles during this inflammatory response and hence mainly decide on the biomaterial's fate. For clinically relevant tissue engineering approaches, biomaterials may be designed in shape and morphology as well as in their surface functionality to improve the healing outcome, but also to trigger stem cell responses during the subsequent tissue regeneration phase.
The main focus of this thesis was to unravel the influence of scaffold characteristics, including scaffold morphology and surface functionality, on primary human innate immune cells (neutrophils and macrophages) and human mesenchymal stromal cells (hMSCs) to assess their in vitro immune response and tissue regeneration capacity, respectively. The fiber-based constructs were produced either via melt electrowriting (MEW), when the precise control over scaffold morphology was required, or via solution electrospinning (ES), when the scaffold design could be neglected. All the fiber-based scaffolds used throughout this thesis were composed of the polymer poly(ε caprolactone) (PCL).
A novel strategy to model and alleviate the first direct cell contact of the immune system with a peptide-bioactived fibrous material was presented in chapter 3 by treating the material with human neutrophil elastase (HNE) to imitate the neutrophil attack. The main focus of this study was put on the effect of HNE towards an RGDS-based peptide that was immobilized on the surface of a fibrous material to improve subsequent L929 cell adhesion. The elastase efficiently degraded the peptide-functionality, as evidenced by a decreased L929 cell adhesion, since the peptide integrated a specific HNE-cleavage site (AAPV-motif). A sacrificial hydrogel coating based on primary oxidized hyaluronic acid (proxHA), which dissolved within a few days after the neutrophil attack, provided an optimal protection of the peptide-bioactivated fibrous mesh, i.e, the hydrogel alleviated the neutrophil attack and largely ensured the biomaterial's integrity. Thus, according to these results, a means to protect the biomaterial is required to overcome the neutrophil attack.
Chapter 4 was based on the advancement of melt electrowriting (MEW) to improve the printing resolution of MEW scaffolds in terms of minimal inter-fiber distances and a concomitant high stacking precision. Initially, to gain a better MEW understanding, the influence of several parameters, including spinneret diameter, applied pressure, and collector velocity on mechanical properties, crystallinity, fiber diameter and fiber surface morphology was analyzed. Afterward, innovative MEW designs (e.g., box-, triangle-, round , and wall-shaped scaffolds) have been established by pushing the printing parameters to their physical limits. Further, the inter-fiber distance within a standardized box-structured scaffold was successfully reduced to 40 µm, while simultaneously a high stacking precision was maintained. In collaboration with a co-worker of my department (Tina Tylek, who performed all cell-based experiments in this study), these novel MEW scaffolds have been proven to facilitate human monocyte-derived macrophage polarization towards the regenerative M2 type in an elongation-driven manner with a more pronounced effect with decreasing pore sizes.
Finally, a pro-adipogenic platform for hMSCs was developed in chapter 5 using MEW scaffolds with immobilized, complex ECM proteins (e.g., human decellularized adipose tissue (DAT), laminin (LN), and fibronectin (FN)) to test for the adipogenic differentiation potential in vitro. Within this thesis, a special short-term adipogenic induction regime enabled to more thoroughly assess the intrinsic pro-adipogenic capacity of the composite biomaterials and prevented any possible masking by the commonly used long-term application of adipogenic differentiation reagents. The scaffolds with incorporated DAT consistently showed the highest adipogenic outcome and hence provided an adipo-inductive microenvironment for hMSCs, which holds great promise for applications in soft tissue regeneration.
Future studies should combine all three addressed projects in a more in vivo-related manner, comprising a co-cultivation setup of neutrophils, macrophages, and MSCs. The MEW-scaffold, particularly due to its ability to combine surface functionality and adjustable morphology, has been proven to be a successful approach for wound healing and paves the way for subsequent tissue regeneration.
Adipose tissue defects and related pathologies still represent major challenges in reconstructive surgery. Based on to the paradigm ‘replace with alike’, adipose tissue is considered the ideal substitute material for damaged soft tissue [1-3]. Yet the transfer of autologous fat, particularly larger volumes, is confined by deficient and unpredictable long term results, as well as considerable operative morbidity at the donor and recipient site [4-6], calling for innovative treatment options to improve patient care.
With the aim to achieve complete regeneration of soft tissue defects, adipose tissue engineering holds great promise to provide functional, biologically active adipose tissue equivalents. Here, especially long-term maintenance of volume and shape, as well as sufficient vascularization of engineered adipose tissue represent critical and unresolved challenges [7-9]. For adipose tissue engineering approaches to be successful, it is thus essential to generate constructs that retain their initial volume in vivo, as well as to ensure their rapid vascularization to support cell survival and differentiation for full tissue regeneration [9,10]. Therefore, it was the ultimate goal of this thesis to develop volume-stable 3D adipose tissue constructs and to identify applicable strategies for sufficient vascularization of engineered constructs. The feasibility of the investigated approaches was verified by translation from in vitro to in vivo as a critical step for the advancement of potential regenerative therapies.
For the development of volume-stable constructs, the combination of two biomaterials with complementary properties was successfully implemented. In contrast to previous approaches in the field using mainly non-degradable solid structures for mechanical protection of developing adipose tissue [11-13], the combination of a cell-instructive hydrogel component with a biodegradable porous support structure of adequate texture was shown advantageous for the generation of volume-stable adipose tissue. Specifically, stable fibrin hydrogels previously developed in our group [14] served as cell carrier and supported the adipogenic development of adipose-derived stem cells (ASCs) as reflected by lipid accumulation and leptin secretion. Stable fibrin gels were thereby shown to be equally supportive of adipogenesis compared to commercial TissuCol hydrogels in vitro. Using ASCs as a safe source of autologous cells [15,16] added substantial practicability to the approach. To enhance the mechanical strength of the engineered constructs, porous biodegradable poly(ε caprolactone)-based polyurethane (PU) scaffolds were introduced as support structures and shown to exhibit adequately sized pores to host adipocytes as well as interconnectivity to allow coherent tissue formation and vascularization. Low wettability and impaired cell attachment indicated that PU scaffolds alone were insufficient in retaining cells within the pores, yet cytocompatibility and differentiation of ASCs were adequately demonstrated, rendering the PU scaffolds suitable as support structures for the generation of stable fibrin/PU composite constructs (Chapter 3).
Volume-stable adipose tissue constructs were generated by seeding the pre-established stable fibrin/PU composites with ASCs. Investigation of size and weight in vitro revealed that composite constructs featured enhanced stability relative to stable fibrin gels alone. Comparing stable fibrin gels and TissuCol as hydrogel components, it was found that TissuCol gels were less resilient to degradation and contraction. Composite constructs were fully characterized, showing good cell viability of ASCs and strong adipogenic development as indicated by functional analysis via histological Oil Red O staining of lipid vacuoles, qRT-PCR analysis of prominent adipogenic markers (PPARγ, C/EBPα, GLUT4, aP2) and quantification of leptin secretion. In a pilot study in vivo, investigating the suitability of the constructs for transplantation, stable fibrin/PU composites provided with a vascular pedicle gave rise to areas of well-vascularized adipose tissue, contrasted by insufficient capillary formation and adipogenesis in constructs implanted without pedicle. The biomaterial combination of stable fibrin gels and porous biodegradable PU scaffolds was thereby shown highly suitable for the generation of volume-stable adipose tissue constructs in vivo, and in addition, the effectiveness of immediate vascularization upon implantation to support adipose tissue formation was demonstrated (Chapter 4).
Further pursuing the objective to investigate adequate vascularization strategies for engineered adipose tissue, hypoxic preconditioning was conducted as a possible approach for in vitro prevascularization. In 2D culture experiments, analysis on the cellular level illustrated that the adipogenic potential of ASCs was reduced under hypoxic conditions when applied in the differentiation phase, irrespective of the oxygen tension encountered by the cells during expansion. Hypoxic treatment of ASCs in 3D constructs prepared from stable fibrin gels similarly resulted in reduced adipogenesis, whereas endothelial CD31 expression as well as enhanced leptin and vascular endothelial growth factor (VEGF) secretion indicated that hypoxic treatment indeed resulted in a pro-angiogenic response of ASCs. Especially the observed profound regulation of leptin production by hypoxia and the dual role of leptin as adipokine and angiogenic modulator were considered an interesting connection advocating further study. Having confirmed the hypothesis that hypoxia may generate a pro-angiogenic milieu inside ASC-seeded constructs, faster vessel ingrowth and improved vascularization as well as an enhanced tolerance of hypoxia-treated ASCs towards ischemic conditions upon implanatation may be expected, but remain to be verified in rodent models in vivo (Chapter 5).
Having previously been utilized for bone and cartilage engineering [17-19], as well as for revascularization and wound healing applications [20-22], stromal-vascular fraction (SVF) cells were investigated as a novel cell source for adipose tissue engineering. Providing cells with adipogenic differentiation as well as vascularization potential, the SVF was applied with the specific aim to promote adipogenesis and vascularization in engineered constructs in vivo. With only basic in vitro investigations by Lin et al. addressing the SVF for adipose repair to date [23], the present work thoroughly investigated SVF cells for adipose tissue construct generation in vitro, and in particular, pioneered the application of these cells for adipose tissue engineering in vivo.
Initial in vitro experiments compared SVF- and ASC-seeded stable fibrin constructs in different medium compositions employing preadipocyte (PGM-2) and endothelial cell culture medium (EGM-2). It was found that a 1:1 mixture of PGM-2 and EGM-2, as previously established for co-culture models of adipogenesis [24], efficiently maintained cells with adipogenic and endothelial potential in SVF-seeded constructs in short and long-term culture setups. Observations on the cellular level were supported by analysis of mRNA expression of characteristic adipogenic and endothelial markers. In preparation of the evaluation of SVF-seeded constructs under in vivo conditions, a whole mount staining (WMS) method, facilitating the 3D visualization of adipocytes and blood vessels, was successfully established and optimized using native adipose tissue as template (Chapter 6).
In a subcutaneous nude mouse model, SVF cells were, for the first time in vivo, elucidated for their potential to support the functional assembly of vascularized adipose tissue. Investigating the effect of adipogenic precultivation of SVF-seeded stable fibrin constructs in vitro prior to implantation on the in vivo outcome, hormonal induction was shown beneficial in terms of adipocyte development, whereas a strong vascularization potential was observed when no adipogenic inducers were added. Via histological analysis, it was proven that the developed structures were of human origin and derived from the implanted cells. Applying SVF cells without precultivation in vitro but comparing two different fibrin carriers, namely stable fibrin and TissuCol gels, revealed that TissuCol profoundly supported adipose formation by SVF cells in vivo. This was contrasted by only minor SVF cell development and a strong reduction of cell numbers in stable fibrin gels implanted without precultivation. Histomorphometric analysis of adipocytes and capillary structures was conducted to verify the qualitative results, concluding that particularly SVF cells in TissuCol were highly suited for adipose regeneration in vivo. Employing the established WMS technique, the close interaction of mature adipocytes and blood vessels in TissuCol constructs was impressively shown and via species-specific human vimentin staining, the expected strong involvement of implanted SVF cells in the formation of coherent adipose tissue was confirmed (Chapter 7).
With the development of biodegradable volume-stable adipose tissue constructs, the application of ASCs and SVF cells as two promising cell sources for functional adipose regeneration, as well as the thorough evaluation of strategies for construct vascularization in vitro and in vivo, this thesis provides valuable solutions to current challenges in adipose tissue engineering. The presented findings further open up new perspectives for innovative treatments to cure soft tissue defects and serve as a basis for directed approaches towards the generation of clinically applicable soft tissue substitutes.
Weißes Fettgewebe (WAT) stellt heute aus vielerlei Hinsicht ein interessantes Forschungsgebiet dar. Zum einen ist die Prävalenz der Adipositas weiterhin sehr hoch; mit ihr einher gehen Gesundheitsprobleme wie Bluthochdruck, Diabetes, Dyslipidämie und Atherosklerose, sowie deshalb das Bestreben, bessere Behandlungsmöglichkeiten zu entwickeln. Zum anderen hofft man im Bereich des Tissue Engineering, zukünftig mit in vitro hergestelltem weißem Fettgewebe Weichteildefekte decken zu können. Aus therapeutischer Sicht ist die weitere Erforschung von weißem Fettgewebe deshalb von großer Wichtigkeit. In vivo ist weißes Fettgewebe stark vaskularisiert. Die starken physiologischen Schwankungen von Fettgewebe erfordern deshalb ein besonders dynamisches Gefäßwachstum. Für ein genaueres Verständnis der Physiologie von WAT ist es unerlässlich das Zusammenspiel von Gefäß- und Fettzellen zu verstehen. 2-dimensionale Kultursysteme sind in ihrer Aussagekraft über die Bedingungen in vivo jedoch sehr limitiert. Deshalb kommt in der Erforschung von WAT zunehmend die 3-dimensionale Kultivierung zur Anwendung, welche bezüglich des Gewebekontextes einem lebenden Organismus näher kommt und damit eine größere Aussagekraft haben kann.
Ein Ziel dieser Arbeit war, die Voraussetzungen für die Untersuchung der einzelnen Zellfraktionen von Kokulturen aus mesenchymalen Stammzellen aus humanem Fettgewebe (ASC) und mikrovaskulären Endothelzellen (MVEC) zu schaffen. Hierfür wurde erfolgreich ein Protokoll zur Trennung solcher Zellsuspensionen mittels Magnetic Activated Cell Sorting (MACS) etabliert. Während in vorangegangenen Arbeiten nur eine der beiden Zellfraktionen analysiert werden konnte, ermöglichte es dieses Protokoll nun beide Zellfraktionen einer Kokultur verunreinigungsfrei zu isolieren und zu analysieren.
Dies eröffnet neue Möglichkeiten in der Erforschung des Zusammenspiels dieser beiden Zelltypen. Um diese zu demonstrieren wurde in dieser Arbeit die Expression von vier Genen in ASC und MVEC aus gemeinsamer Kokultivierung in einem 3-dimensionalen Sphäroid-Modell analysiert. Hierbei konnte festgestellt werden, dass die Expression der Gene Angiopoietin-2, Interleukin-1B, Interleukin-6 und Leukemia Inhibitory Factor in MVEC bei 3-dimensionaler Kokultivierung mit ASC nach zwei Tagen Kultur stark anstieg, während sich in der Fraktion der ASC kaum Veränderungen zeigten. Dies wiederum spricht für eine angiogene Aktivität der MVEC. Ohne ein Protokoll zur Trennung solcher ASC-MVEC-Kokulturen mittels MACS, welche die weitere Analyse beider Zelltypen erlaubt, wäre diese Untersuchung so nicht möglich gewesen
Ziel dieser Arbeit war auch, der Hypothese über eine Beteiligung des Wnt-Signalwegs an der Steuerung der Adipogenese durch Endothelzellen in ASC-MVEC-Kokultur-Sphäroiden nachzugehen. Zuvor konnte beobachtet werden, dass in diesen die Triglyceridsynthese lokal reduziert war, während sie in ASC-Monokultur-Sphäroiden homogen verteilt und nicht inhibiert war. Hierfür wurden Schnitte von adipogen induzierten ASC-MVEC-Kokultur-Sphäroiden und ASC-Monokultur-Sphäroiden immunhistochemisch auf aktives beta-Catenin gefärbt, wodurch der aktive Wnt-Signalweg innerhalb des Sphäroids dargestellt werden konnte. Tatsächlich konnte innerhalb der Kokultur-Sphäroide für die Hälfte der untersuchten Schnitte eine regionale Erhöhung von aktivem beta-Catenin festgestellt werden, welche auf der Seite der ASC-Monokultur-Sphäroide nicht nachweisbar war. In Betrachtung der Ergebnisse dieser Arbeit -- auch im Kontext weiterer Forschungsergebnisse -- erscheint eine Beteiligung des Wnt-Signalwegs an der Steuerung der Adipogenese in ASC-MVEC-Kokultur-Sphäroiden sehr wahrscheinlich.
In dieser Arbeit konnte ein Beitrag zum Verständnis des Zusammenspiels von ASC und MVEC in 3-dimensionaler Kokultivierung sowie dessen weiterer Untersuchung geleistet werden. Die gewonnenen Erkenntnisse unterstreichen die Anwendbarkeit und Wichtigkeit von 3-dimensionalen Kulturumgebungen in der Erforschung von weißem Fettgewebe, sowohl für die Adipositasforschung als auch für Adipose Tissue Engineering.
Tumorzellen, Stromazellen, Extrazellulärmatrix (EZM) und lösliche Faktoren in der Tumormikroumgebung beeinflussen und verstärken sich gegenseitig in der Ausbildung eines malignen Phänotyps. Sowohl die fibrotische EZM als auch eine kleine Subpopulation von pluripotenten Tumorstammzellen sind bekanntermaßen für die Steigerung der Tumoraggressivität verantwortlich. Inwiefern diese beiden unabhängigen Faktoren im Kontext von Brustkrebs miteinander in Beziehung stehen, ist jedoch bis heute unklar.
Um untersuchen zu können, welchen Beitrag Tumorzellen, Stromazellen, EZM und lösliche Faktoren einzeln und im Zusammenspiel zur Malignität eines Tumors leisten, ist die Entwicklung geeigneter in-vitro-Modelle unabdingbar. Daher war es das Ziel dieser Arbeit, ein 3D-Mikrotumormodell zu generieren, in dem eine Analyse dieser genannten Faktoren stattfinden könnte. An diesem Modell wurden darüber hinaus erste Untersuchungen von im Tumorkontext bekannten EZM-Proteinen durchgeführt. Um die dreidimensionale Anordnung von Tumorzellen und ihrer Gewebeumgebung adäquat wiedergeben zu können, beinhalteten die 3D-Tumorsphäroide sowohl Brustkrebszellen (MDA-MB-231) als auch Stromazellen (hASCs).
Die EZM als wichtiger Bestandteil der (Tumor-) Mikroumgebung sollte übersichtshalber durch Hämatoxylin-Eosin-Färbung und detaillierter durch immunhistochemische Analyse nach zwei verschiedenen Kulturzeitpunkten charakterisiert werden, um EZM-Veränderungen im zeitlichen Verlauf darzustellen. Im Fokus der Analyse standen die beiden wichtigsten profibrotischen EZM-Proteine Fibronektin und Kollagen I, die maßgeblich an der Pathogenese von Brustkrebs beteiligt sind. Zudem wurde das Vorkommen des Myofibroblastenmarkers α-SMA untersucht.
An den Sphäroiden einer Kontrollgruppe, die lediglich hASCs beinhaltete, sollte vergleichend eine Analyse der genannten EZM-Proteine sowie α-SMA durchgeführt werden. Um schließlich den Einfluss der von Tumorzellen sezernierten löslichen Faktoren in der Tumormikroumgebung herauszustellen, wurden Sphäroide aus hASCs in tumorkonditioniertem Medium gezüchtet und darin ebenfalls Matrixproteine und α-SMA untersucht.
Abschließend erfolgte eine Korrelation der EZM-Analyse mit dem Vorhandensein von Tumorstammzellen in den 3D-Tumorsphäroiden. Dafür wurden die Tumorstammzellen mithilfe eines GFP-basierten Reporters für den Stammzellmarker NANOG (NANOG-GFP-Reporterzelllinie) in mikroskopischen Aufnahmen der 3D-Tumorsphäroide nachgewiesen und im Kontext mit der EZM lokalisiert.
Die Erzeugung von klinisch in der plastischen und rekonstruktiven Chirurgie nutzbarem Fettgewebe stellt einen sehr wichtigen Aspekt in aktuellen Arbeiten des Tissue Engineerings, also der Erzeugung von spezifischem Gewebe aus Spenderzellen dar. Sollte es gelingen, aus patienteneigenen Zellen wieder neues Gewebe zu züchten, so würden daraus eine Fülle neuer Behandlungsmöglichkeiten für Gewebedefekte resultieren. In einer Vorgängerarbeit zu der vorliegenden Arbeit konnte gezeigt werden, dass die Adipogenese in vivo von Fettgewebe aus Vorläuferzellen, den Präadipozyten, durch geeignete Methoden der Vorkultivierung in vitro beeinflusst werden kann.
Die Unterschiede in der Vorbehandlung lagen in einer Induktion der Differenzierung der Präadipozyten bei gleichzeitigem Stopp der Proliferation und einer anschließenden verschieden langen Ausdifferenzierungsphase der Zellen in vitro im Brutschrank. Die resultierenden Konstrukte wurden in jeweils drei Mäuse in vier Gruppen implantiert und nach 1, 5, 12 und 24 Wochen entnommen und untersucht. Während die Präadipozyten von Gruppe 1 keine Induktion erfuhren, erfolgte diese bei den anderen drei Gruppen. Die Konstrukte der Gruppe 2 wurden dann bereits nach 2 Tagen der Induktion der Präadipozyten implantiert, die Konstrukte der Gruppe 3 blieben zur Differenzierung noch 7 Tage, die der Gruppe 4 noch 33 Tage im Brutschrank, bevor sie in die Versuchstiere eingebracht wurden.
Ziel der vorliegenden Arbeit war es zunächst, an den Gewebekonstrukten der Vorgängerarbeit eine histomorphometrische Analyse der resultierenden Adipozyten in vivo über die Zeit durchzuführen, um eine detaillierte Beurteilung des Verlaufs der Fettgewebeentwicklung anhand resultierender Zellzahlen darzustellen. Hierfür wurden die Gewebedünnschnitte der Mäuse nach einer HE-Anfärbung mikroskopisch untersucht und die Zellzahlen resultierend jeweils aus unreifen und reifen Adipozyten histomorphometrisch quantifiziert. Die Unterscheidung erfolgte mittels einer Größenzuordnung, wobei Zellen kleiner 20 µm Durchmesser den unreifen und Zellen größer 20 µm Durchmesser den reifen Adipozyten zugeordnet wurden.
Aus der quantitativen Analyse mittels Histomorphometrie ergab sich, dass in allen Konstrukten die Zahlen an Zellen der den unreifen Adipozyten zugeordneten Größenordnung von kleiner als 20µm tendenziell während der gesamten Zeit in vivo klein bleibt. Die Zellzahlen resultierend aus großen Zellen mit einem Durchmesser mehr als 20µm, die den reifen Adipozyten zugeordnet wurden, steigen dagegen in allen Proben leicht an, wobei die Konstrukte der Gruppe 4 den absolut höchsten Wert aufwiesen. In der HE-Anfärbung ist demgemäß in Gruppe 4 eine Vielzahl reifer Adipozyten zu erkennen.
Das zweite Ziel dieser Arbeit war es, durch Anfärbung charakteristischer Proteine der extrazellulären Matrix mittels markierter Antikörper und einer anschließenden immunohistochemischen Analyse des Verlaufs der Signalintensität dieser markierten Komponenten in der EZM die Adipogenese mittels Analyse der entstehenden Gerüstproteine zu verfolgen. Hierfür wurde durch eine umfangreiche immunohistochemische Analyse die Bildung der Kollagene I, IV und VI sowie von Laminin als Bestandteile der EZM analysiert und damit die Art und der Umfang der entstandenen extrazellulären Matrix während der Adipogenese qualitativ beurteilt. Die Fluoreszenz-Bilder der Proben nach den jeweiligen Gruppen und Wochen in vivo zeigen einen deutlichen Hinweis im Sinne der Bildung von Fettgewebe in den Gewebe-Konstrukten der Gruppe 4. Während in den Gruppen 1 und 2 fast durchweg faserartige Bindegewebsstrukturen, verbunden mit den entsprechenden eher fibrillärem Aussehen der Signale für die untersuchten Kollagene I, IV, VI und für Laminin gefunden werden konnten, zeigen die Konstrukte der Gruppe 3 und insbesondere von Gruppe 4 in den Fluoreszenz-Abbildungen deutlich ausgeprägtere, netzartig ausgebildete Strukturen.
Aus den Resultaten der vorliegenden Arbeit kann demnach geschlossen werden, dass die Art der Vorkultivierung eine spätere Adipogenese eindeutig beeinflussen kann. Eine längere Inkubationszeit nach erfolgter Induktion der Präadipozyten zur Förderung der Reifung zu Adipozyten vor der Implantation fördert die Bildung einer höheren Anzahl von Adipozyten und die Ausbildung einer charakteristischen EZM. Diese Erkenntnisse eröffnen für zukünftige Arbeiten die Möglichkeit, durch die weitere Optimierung der Vorkultivierung, verbunden mit einer eventuell noch besseren Überlebensrate der ursprünglich eingebrachten Zellen, die Herstellung von klinisch geeigneten Konstrukten aus Fettgewebe weiter voranzutreiben.
Knorpelintegration unter Hemmung der Kollagensynthese im Disc-Ring-Modell: eine In-vitro-Studie
(2021)
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 für 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 Integrationsstärke. Auch histologisch und immunhistochemisch zeigten sich Glykosaminoglykan- und Kollagen Typ II-Synthese im Defektbereich. Dies zeigt die Abhängigkeit der lateralen Integration von der Kollagensynthese im multifaktoriellen Prozess der Knorpelintegration.
Im Rahmen neuer Therapieansätze der Arthrose versucht man mittels Tissue Engineering transplantationsfähige, hochwertige Knorpelkonstrukte zu züchten. Dabei kommen häufig auch expandierte und redifferenzierte zonenspezifische Chondrozyten-Subpopulationen zum Einsatz. Wenige Studien beschäftigten sich bisher mit dem Redifferenzierungspotential dieser Zellen und dem Effekt einer zonalen Schichtung unter verschiedenen Kulturbedingungen. In dieser Arbeit konnten Ähnlichkeiten im Phänotyp sowie der Chondrogenese der redifferenzierten Zellen zu den jeweiligen Subpopulationen in nativem Knorpel nachgewiesen werden. Sowohl die zonale Schichtung als auch Veränderungen im Studienprotokoll zeigten sich als entscheidende Einflussfaktoren auf das Zellverhalten. Die Frage nach den optimalen Kulturbedingungen stellt die Forschung jedoch weiterhin vor eine große Herausforderung.
Testung verschiedener Strategien für die Regeneration von Knorpeldefekten im Ex vivo-Testsystem
(2021)
Die Degeneration des Gelenkknorpels ist Hauptursache für chronische Schmerzen und eine dadurch bedingte Einschränkung der Lebensqualität. Für die Sozialversicherungssysteme ist dies mit steigenden Kosten verbunden. Gegenwärtige Behandlungsoptionen wie die Mikrofrakturierung oder die (matrix-assoziierte) Autologe Chondrozytentransplantation (M-) ACT führen 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 für nachhaltige Beschwerdefreiheit erzeugen. Das hier verwendete kürzlich etablierte osteochondrale Ex vivo-Testsystem (EVTS) eignet sich zur Evaluation unterschiedlicher zellbasierter Behandlungsansätze für 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) gefüllt, die in Kollagen Typ I Hydrogel eingebettet waren. Nach vierwöchiger Kultivierung wurden die Proben histologisch und immunhistochemisch gefärbt (Safranin-O-Färbung, Kollagen Typ II, Aggrekan), die Zellvitalität (Lebend-Tot-Färbung) überprüft und die extrazelluläre Matrixproduktion analysiert. Nach vierwöchiger Kultur im EVTS in Normoxie und Hypoxie zeigten sich die in Kollagen-I-Hydrogel eingebetteten Zellen lebensfähig. Die Auswertung der verschiedenen Ansätze erfolgte über den standardisierten ICRS-II-Score der International Cartilage Repair Society (ICRS) mit drei unabhängigen 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, könnten 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 bestätigt 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, Knorpeldefektgröße und Kultivierung in Hypoxie oder Normoxie Einfluss auf die Ausbildung der extrazellulären Matrix haben. Weiterhin fehlt jedoch das Verständnis für die genauen Mechanismen des Knorpelregenerationsverhaltens. Ex vivo-Testsysteme können dabei helfen ein weiteres Verständnis zu erlangen und entsprechende Behandlungsstrategien zu evaluieren.
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.
Each year millions of plastic and reconstructive procedures are performed to regenerate soft tissue defects after, for example, traumata, deep burns or tumor resections. Tissue engineered adipose tissue grafts are a promising alternative to autologous fat transfer or synthetic implants to meet this demand for adipose tissue. Strategies of tissue engineering, especially the use of cell carriers, provide an environment for better cell survival, an easier positioning and supplemented with the appropriate conditions a faster vascularization in vivo. To successfully engineer an adipose tissue substitute for clinical use, it is crucial to know the actual intended application. In some areas, like the upper and lower extremities, only a thin subcutaneous fat layer is needed and in others, large volumes of vascularized fat grafts are more desirable. The use and interplay of stem cells and selected scaffolds were investigated and provide now a basis for the generation of fitted and suitable substitutes in two different application areas.
Complex injuries of the upper and lower extremities, in many cases, lead to excessive scarring. Due to severe damage to the subcutaneous fat layer, a common sequela is adhesion formation to mobile structures like tendons, nerves, and blood vessels resulting in restricted motion and disabling pain [Moor 1996, McHugh 1997]. In order to generate a subcutaneous fat layer to cushion scarred tissue after substantial burns or injuries, different collagen matrices were tested for clinical handling and the ability to support adipogenesis. When testing five different collagen matrices, PermacolTM and StratticeTM showed promising characteristics; additionally both possess the clinical approval. Under culture conditions, only PermacolTM, a cross-linked collagen matrix, exhibited an excellent long-term stability. Ranking nearly on the same level was StratticeTM, a non-cross-linked dermal scaffold; it only exhibited a slight shrinkage. All other scaffolds tested were severely compromised in stability under culture conditions. Engineering a subcutaneous fat layer, a construct would be desirable with a thin layer of emerging fat for cushioning on one side, and a non-seeded other side for cell migration and host integration. With PermacolTM and StratticeTM, it was possible to produce constructs with ASC (adipose derived stem cells) seeded on one side, which could be adipogenically differentiated. Additionally, the thickness of the cell layer could be varied. Thereby, it becomes possible to adjust the thickness of the construct to the surrounding tissue. In order to reduce the pre-implantation time ex vivo and the costs, the culture time was varied by testing different induction protocols. An adipogenic induction period of only four days was demonstrated to be sufficient to obtain a substantial adipogenic differentiation of the applied ASC. Thus, seeded with ASC, PermacolTM and StratticeTM are suitable scaffolds to engineer subcutaneous fat layers for reconstruction of the upper and lower extremities, as they support adipogenesis and are appropriately thin, and therefore would not compromise the cosmesis.
For the engineering of large-volume adipose tissue, adequate vascularization still represents a major challenge. With the objective to engineer vascularized fat pads, it is important to consider the slow kinetics of revascularization in vivo. Therefore, a decellularized porcine jejunum with pre-existing vascular structures and pedicles to connect to the host vasculature or the circulation of a bioreactor system was used. In a first step, the ability of a small decellularized jejunal section was tested for cell adhesion and for supporting adipogenic differentiation of hASC mono-cultures. Cell adhesion and adipogenic maturation of ASC seeded on the jejunal material was verified through histological and molecular analysis. After the successful mono-culture, the goal was to establish a MVEC (microvascular endothelial cells) and ASC co-culture; suitable culture conditions had to be found, which support the viability of both cell types and do not interfere with the adipogenic differentiation. After the elimination of EGF (epidermal growth factor) from the co-culture medium, substantial adipogenic maturation was observed. In the next step, a large jejunal segment (length 8 cm), with its pre-existing vascular structures and arterial/venous pedicles, was connected to the supply system of a custom-made bioreactor. After successful reseeding the vascular structure with endothelial cells, the lumen was seeded with ASC which were then adipogenically induced. Histological and molecular examinations confirmed adipogenic maturation and the existence of seeded vessels within the engineered construct. Noteworthily, a co-localization of adipogenically differentiating ASC and endothelial cells in vascular networks could be observed. So, for the first time a vascularized fat construct was developed in vitro, based on the use of a decellularized porcine jejunum. As this engineered construct can be connected to a supply system or even to a patient vasculature, it is versatile in use, for example, as transplant in plastic and reconstruction surgery, as model in basic research or as an in vitro drug testing system.
To summarize, in this work a promising substitute for subcutaneous fat layer reconstruction, in the upper and lower extremities, was developed, and the first, as far as reported, in vitro generated adipose tissue construct with integrated vascular networks was successfully engineered.
Technische Neuerungen und steigende Ansprüche an die Gesundheit stellen die moderne Medizin immer wieder vor neue Herausforderungen und führen zur Entwicklung von neuen Therapiekonzepten wie dem Tissue Engineering. Vielfach kommen dabei adulte pluripotente Stammzellen zum Einsatz. Bei der Regeneration mesenchymalen Gewebes wie Knochen, Knorpel und Muskulatur leisten Mesenchymale Stammzellen (MSCs) einen entscheidenden Beitrag. Diese lassen sich aus allen mesenchymalen Geweben des Körpers gewinnen und stellen daher zwar keine homogene Zellpopulation dar, doch sie lassen sich aufgrund phänotypischer und molekularbiologischer Gemeinsamkeiten charakterisieren.
In großer Zahl lassen sich MSCs aus dem Knochenmark gewinnen und werden als stromale MSCs bzw. mhMSCs (marrow-derived human MSCs) bezeichnet. Auf der Suche nach homogenen Subpopulationen von MSCs wurde in dieser Arbeit eine Zellpopulation aus Knochentrabekeln gewonnen, sogenannte bhMSCs (trabecular bone-derived MSCs), und anhand ihrer Genexpression mit mhMSCs verglichen. Dafür wurde RNA aus beiden Populationen in einem Microarray mit anschließender SAM (significance analysis of microarrays) analysiert um unterschiedliche Expressionsmuster zwischen mhMSCs und bhMSCs aufzuzeigen. Diese Ergebnisse wurden durch konventionelle Reverse Transkriptase Polymerase Kettenreaktion (RT-PCR) bestätigt, wobei das Augenmerk vor allem auf solche Gene gerichtet wurde, die differentiell exprimiert waren und zudem als Markergene ein Differenzierungspotential in bestimmte Gewebe wie Muskel und Knochen vorhersagen. Dabei konnte sowohl eine gute Übereinstimmung zwischen Microarray und RT-PCR demonstriert als auch die Hoffnung auf eine homogene (trabekuläre) MSC-Population mit anderen Differenzierungseigenschaften geweckt werden.
Im Verlauf weitergehender Untersuchungen der SAM fiel eine unerklärlich hohe Expression von Immunglobulinketten in der mhMSC-Kultur (Passage 0) auf, die letztlich auf eine Kontamination der Zellkultur mit Plasmazellen schließen ließ.
Da die Ergebnisse des Microarrays (Passage 0 Kultur) somit zu hinterfragen waren, wurde die Kontamination der Plasmazellen durch Passagieren der mhMSC-Zellkultur (Passage 1) beseitigt und erneut ein Microarray mit SAM durchgeführt. Dabei relativierten sich fast alle Expressionsunterschiede, die somit auf die Kontamination der Plasmazellen zurückgeführt werden mussten.
Einzig drei Gene (CD24, TRIB2, AHNAK) wurden in diesem zweiten Array differentiell exprimiert, was sich bei CD24 und TRIB2 auch durch RT-PCR untermauern ließ.
Es lässt sich also schlussfolgern, dass bhMSCs wahrscheinlich in der Zukunft des Tissue Engineering keinen Stellenwert haben werden, zumal ihre Gewinnung im Vergleich zu mhMSC deutlich aufwendiger ist.
Die in vitro Differenzierung von Knorpelgewebe unter Verwendung von mesenchymalen Stromazellen aus dem Knochenmark (BMSCs) als Zellquelle und Transforming growth factor ß (TGF-ß1) als Wachstumsfaktor ist bereits etabliert. In weiteren Studien haben sich neue möglich Differenzierungsfaktoren wie Kartogenin und Peptidsequenzen wie KLER und WYRGRL gezeigt.
Ziel dieser Arbeit war es, den Effekt dieser drei Substanzen auf die chondrogene Differenzierung von mesenchymalen Stromazellen in einer Pelletkultur in Anwesenheit von TGF-β zu evaluieren. Die Analyse erfolgte (immun)histologisch und biochemisch durch Bestimmung der knorpelspezifischen EZM-Moleküle wie Kollagen II und Glykosaminoglykane bzw. des GAG- und Gesamtkollagengehaltes. Insgesamt konnte nach dreiwöchiger Kultur für keinen der drei zugegebenen Faktoren ein eindeutig positiver Effekt auf die chondrogene Differenzierung von BMSCs nachgewiesen werden. Unter konstanter KGN- Zugabe zeigte sich eine intensivere Kollagen II-Färbung, sowie ein signifikant höherer Kollagen- und GAG-Gehalt an Tag 10, jedoch auch eine intensivere Kollagen X Färbung. Diesbezüglich sollten noch weitere Untersuchungen, insbesondere auf mögliche unerwünschte hypertrophe Effekte durchgeführt werden.
Articular cartilage damage caused by sports accidents, trauma or gradual wear and tear can lead to degeneration and the development of osteoarthritis because cartilage tissue has only limited capacity for intrinsic healing. Osteoarthritis causes reduction of mobility and chronic pain and is one of the leading causes of disability in the elderly population. Current clinical treatment options can reduce pain and restore mobility for some time, but the formed repair tissue has mostly inferior functionality compared to healthy articular cartilage and does not last long-term. Articular cartilage tissue engineering is a promising approach for the improvement of the quality of cartilage repair tissue and regeneration. In this thesis, a promising new cell type for articular cartilage tissue engineering, the so-called articular cartilage progenitor cell (ACPC), was investigated for the first time in the two different hydrogels agarose and HA-SH/P(AGE-co-G) in comparison to mesenchymal stromal cells (MSCs). In agarose, ACPCs´ and MSCs´ chondrogenic capacity was investigated under normoxic (21 % oxygen) and hypoxic (2 % oxygen) conditions in monoculture constructs and in zonally layered co-culture constructs with ACPCs in the upper layer and MSCs in the lower layer. In the newly developed hyaluronic acid (HA)-based hydrogel HA-SH/P(AGE-co-G), chondrogenesis of ACPCs and MSCs was also evaluated in monoculture constructs and in zonally layered co-culture constructs like in agarose hydrogel. Additionally, the contribution of the bioactive molecule hyaluronic acid to chondrogenic gene expression of MSCs was investigated in 2D monolayer, 3D pellet and HA-SH hydrogel culture. It was shown that both ACPCs and MSCs could chondrogenically differentiate in agarose and HA-SH/P(AGE-co-G) hydrogels. In agarose hydrogel, ACPCs produced a more articular cartilage-like tissue than MSCs that contained more glycosaminoglycan (GAG), less type I collagen and only little alkaline phosphatase (ALP) activity. Hypoxic conditions did not increase extracellular matrix (ECM) production of ACPCs and MSCs significantly but improved the quality of the neo-cartilage tissue produced by MSCs. The creation of zonal agarose constructs with ACPCs in the upper layer and MSCs in the lower layer led to an ECM production in zonal hydrogels that lay in general in between the ECM production of non-zonal ACPC and MSC hydrogels. Even though zonal co-culture of ACPCs and MSCs did not increase ECM production, the two cell types influenced each other and, for example, modulated the staining intensities of type II and type I collagen in comparison to non-zonal constructs under normoxic and hypoxic conditions. In HA-SH/P(AGE-co-G) hydrogel, MSCs produced more ECM than ACPCs, but the ECM was limited to the pericellular region for both cell types. Zonal HASH/P(AGE-co-G) hydrogels resulted in a native-like zonal distribution of ECM as MSCs in the lower zone produced more ECM than ACPCs in the upper zone. It appeared that chondrogenesis of ACPCs was supported by hydrogels without biological attachment sites such as agarose, and that chondrogenesis of MSCs benefited from hydrogels with biological cues like HA. As HA is an attractive material for cartilage tissue engineering, and the HA-based hydrogel HA-SH/P(AGE-co-G) appeared to be beneficial for MSC chondrogenic differentiation, the contribution of HA to chondrogenic gene expression of MSCs was investigated. An upregulation of chondrogenic gene expression was found in 2D monolayer and 3D pellet culture of MSCs in response to HA supplementation, while gene expression of osteogenic and adipogenic transcription factors was not upregulated. MSCs, encapsulated in a HA-based hydrogel, showed upregulation of gene expression for chondrogenic, osteogenic and adipogenic differentiation markers as well as for stemness markers. In a 3D bioprinting process, using the HA-based hydrogel, gene expression levels of MSCs mostly did not change. Nevertheless, expression of three tested genes (COL2A1, SOX2, CD168) was downregulated in printed in comparison to cast constructs, underscoring the importance of closely monitoring cellular behaviour during and after the printing process. In summary, it was confirmed that ACPCs are a promising cell source for articular cartilage engineering with advantages over MSCs when they were cultured in a suitable hydrogel like agarose. The performance of the cells was strongly dependent on the hydrogel environment they were cultured in. The different chondrogenic performance of ACPCs and MSCs in agarose and HA-SH/P(AGE-co-G) hydrogels highlighted the importance of choosing suitable hydrogels for the different cell types used in articular cartilage tissue engineering. Hydrogels with high polymer content, such as the investigated HA-SH/P(AGE-co-G) hydrogels, can limit ECM distribution to the pericellular area and should be developed further towards less polymer content, leading to more homogenous ECM distribution of the cultured cells. The influence of HA on chondrogenic gene expression and on the balance between differentiation and maintenance of stemness in MSCs was demonstrated. More studies should be performed in the future to further elucidate the signalling functions of HA and the effects of 3D bioprinting in HA-based hydrogels. Taken together, the results of this thesis expand the knowledge in the area of articular cartilage engineering with regard to the rational combination of cell types and hydrogel materials and open up new possible approaches to the regeneration of articular cartilage tissue.
Angiopoetin-like 4 (ANGPTL-4) ist ein Adipokin, das in der extrazellulären Matrix lokalisiert ist und das neben seinen Aufgaben im Fettstoffwechsel auch die Zellmigration, Zellinvasion und die Angioneogenese reguliert. Da es zusätzlich auch den Knochenabbau fördert, wirkt es als Tumorpromotor speziell für Knochentumore. Aufgrund der gesteigerten Expression in Tumorgewebe ist es potenzielles Ziel für molekulare Bildgebung. Mittels Expressionsanalysen auf mRNA- und Proteinebene sollte ein besseres Verständnis der Regulation von ANGPTL-4 erreicht werden. Dexamethason und die 9-cis-Retinsäure beeinflussten die Expression von ANGPTL-4 in MDA Zellen im positiven Sinne, wohingegen der Adenylatcyclase Aktivator Forskolin die Expression supprimierte. In MCF-7 Zellen wurde ANGPTL-4 durch den Phorbolester PMA und durch den Epidermalen Wachstumsfaktor (EGF) induziert. Eine Modulation von ANGPTL-4 könnte von klinischem Nutzen sein, speziell bei der Behandlung von Knochentumoren. Zusätzlich könnte die Trennschärfe von molekularen bildgebenden Verfahren gesteigert werden.
The human body has very good self-healing capabilities for numerous different injuries to a variety of different tissues. This includes the main human mechanical framework, the skeleton. The skeleton is limited in its healing without additional aid by medicine mostly by the defect size. When the defect reaches a size above 2.5 cm the regeneration of the defect ends up faulty. Here is where implants, defect fillers and other support approaches developed in medicine can help the body to heal the big defect still successfully.
Usually sturdy implants (auto-/allo-/xenogenic) are implanted in the defect to bridge the distance, but for auto- and allogenic implants a suitable donor site must be found and for all sources the implant needs to be shaped into the defect specific site to ensure a perfect fit, the best support and good healing. This shaping is very time consuming and prone to error, already in the planning phase. The use of a material that is moldable and sets in the desired shape shortly after applying negates these disadvantages. Cementitious materials offer exactly this property by being in a pasty stage after the powder and liquid components have been mixed and the subsequently hardening to a solid implant. These properties also enable the extrusion, and therefore may also enable the injection, of the cement via a syringe in a minimal invasive approach.
To enable a good injection of the cement modifications are necessary. This work aimed to modify commonly used calcium phosphate-based cement systems based on α-TCP (apatitic) and β-TCP (brushitic). These have been modified with sodium phytate and phytic acid, respectively. Additionally, the α-TCP system has been modified with sodium pyrophosphate, in a second study, to create a storable aqueous paste that can be activated once needed with a highly concentrated sodium orthophosphate solution.
The powder phase of the α-TCP cement system consisted of nine parts α-TCP and one part CDHA. These were prepared to have different particle sizes and therefore enable a better powder flowability through the bimodal size distribution. α-TCP had a main particle size of 20 μm and CDHA of 2.6 μm. The modification with sodium phytate led to an adsorption of phytate ions on the surface of the α-TCP particles, where they started to form complexes with the Ca2+ ions in the solution. This adsorption had two effects. The first was to make the calcium ions unavailable, preventing supersaturation and ultimately the precipitation of CDHA what would lead to the cement hardening. The second was the increase of the absolute value of the surface charge, zeta potential, of the powder in the cement paste. Here a decrease from +3 mV to -40 mV could be measured. A strong value for the zeta potential leads to a higher repulsion of similarly charged particles and therefore prevents powder agglomeration and clogging on the nozzle during injection. These two modifications (bimodal particles size distribution and phytic acid) lead to a significant increase in the paste injectability. The unmodified paste was injectable for 30 % only, where all modified pastes were practically fully injectable ~90 % (the residual paste remained in the nozzle, while the syringe plunger already reached the end of the syringe).
A very similar observation could be made for the β-TCP system. This system was modified with phytic acid. The zeta potential was decreased even stronger from -10 ± 1.5 mV to -71.5 ± 12 mV. The adsorption of the phytate ions and subsequent formation of chelate complexes with the newly dissolved Ca2+ ions also showed a retarding effect in the cements setting reaction. Where the unmodified cement was not measurable in the rheometer, as the reaction was faster than the measurement setup (~1.5 min), the modified cements showed a transition through the gel point between 3-6 min. This means the pastes stayed between 2 and 4 times longer viscous than without the modification. Like with the first cement system also here the effects of the phytate addition showed its beneficial influence in the injectability measurement. The unmodified cement was not injectable at all, due to the same issue already encountered at the rheology measurements, but all modified pastes were fully injectable for at least 5 min (lowest phytate concentration) and at least 10 min (all other concentrations) after the mixing of powder and liquid.
The main goal of the last modification with sodium pyrophosphate was to create a paste that was stable in aqueous environment without setting until the activation takes place, but it should still show good injectability as this was the desired way of application after activation. Like before also the zeta potential changed after the addition of pyrophosphate. It could be lowered from -22 ± 2mV down to -61 to -68 ± 4mV (depending on the pyrophosphate concentration). The pastes were stored in airtight containers at room temperature and checked for their phase composition over 14 days. The unmodified paste showed a beginning phase conversion to hydroxyapatite between 7 and 14 days. All other pastes were still stable and unreacted. The pastes were activated with a high concentrated (30 wt%) sodium orthophosphate solution. After the activation the pastes were checked for their injectability and showed an increase from -57 ± 11% for the unmodified paste to -89 ± 3% (practically fully injectable as described earlier) for the best modified paste (PP005).
It can be concluded that the goal of enabling full injection of conventional calcium phosphate bone cement systems was reached. Additional work produced a storage stable paste that still ensures full injectability. Subsequent work already used the storable paste and modified it with hyaluronic acid to create an ink for 3D extrusion printing. The first two cement systems have also already been investigated in cell culture for their influence on osteoblasts and osteoclasts. The next steps would have to go more into the direction of translation. Figuring out what properties still need to be checked and where the modification needs adjustment to enable a clinical use of the presented systems.
Articular cartilage defects represent one of the most challenging clinical problem for orthopedic surgeons and cartilage damage after trauma can result in debilitating joint pain, functional impairment and in the long-term development of osteoarthritis. The lateral cartilage-cartilage integration is crucial for the long-term success and to prevent further tissue degeneration. Tissue adhesives and sealants are becoming increasingly more popular and can be a beneficial approach in fostering tissue integration, particularly in tissues like cartilage where alternative techniques, such as suturing, would instead introduce further damage. However, adhesive materials still require optimization regarding the maximization of adhesion strength on the one hand and long-term tissue integration on the other hand. In vitro models can be a valuable support in the investigation of potential candidates and their functional mechanisms. For the conducted experiments within this work, an in vitro disc/ring model obtained from porcine articular cartilage tissue was established. In addition to qualitative evaluation of regeneration, this model facilitates the implementation of biomechanical tests to quantify cartilage integration strength. Construct harvesting for histology and other evaluation methods could be standardized and is ethically less questionable compared to in vivo testing. The opportunity of cell culture technique application for the in vitro model allowed a better understanding of cartilage integration processes.
Tissue bonding requires chemical or physical interaction of the adhesive material and the substrate. Adhesive hydrogels can bind to the defect interface and simultaneously fill the gap of irregularly shaped defect voids. Fibrin gels are derived from the physiological blood-clot formation and are clinically applied for wound closure. Within this work, comparisons of different fibrin glue formulations with the commercial BioGlue® were assessed, which highlighted the need for good biocompatibility when applied on cartilage tissue in order to achieve satisfying long-term integration. Fibrin gel formulations can be adapted with regard to their long-term stability and when applied on cartilage disc/ring constructs improved integrative repair is observable. The kinetic of repairing processes was investigated in fibrin-treated cartilage composites as part of this work. After three days in vitro cultivation, deposited extracellular matrix (ECM) was obvious at the glued interface that increased further over time. Interfacial cell invasion from the surrounding native cartilage was detected from day ten of tissue culture. The ECM formation relies on molecular factors, e.g., as was shown representatively for ascorbic acid, and contributes to increasing integration strengths over time. The experiments performed with fibrin revealed that the treatment with a biocompatible adhesive that allows cartilage neosynthesis favors lateral cartilage integration in the long term. However, fibrin has limited immediate bonding strength, which is disadvantageous for use on articular cartilage that is subject to high mechanical stress. The continuing aim of this thesis was to further develop adhesive mechanisms and new adhesive hydrogels that retain the positive properties of fibrin but have an increased immediate bonding strength.
Two different photochemical approaches with the advantage of on-demand bonding were tested. Such treatment potentially eases the application for the professional user. First, an UV light induced crosslinking mechanism was transferred to fibrin glue to provide additional bonding strength. For this, the cartilage surface was functionalized with highly reactive light-sensitive diazirine groups, which allowed additional covalent bonds to the fibrin matrix and thus increased the adhesive strength. However, the disadvantages of this approach were the multi-step bonding reactions, the need for enzymatic pretreatment of the cartilage, expensive reagents, potential UV-light damage, and potential toxicity hazards. Due to the mentioned disadvantages, no further experiments, including long-term culture, were carried out. A second photosensitive approach focused on blue light induced crosslinking of fibrinogen (RuFib) via a photoinitiator molecule instead of using thrombin as a crosslinking mediator like in normal fibrin glue. The used ruthenium complex allowed inter- and intramolecular dityrosine binding of fibrinogen molecules. The advantage of this method is a one-step curing of fibrinogen via visible light that further achieved higher adhesive strengths than fibrin. In contrast to diazirine functionalization of cartilage, the ruthenium complex is of less toxicological concern. However, after in vitro cultivation of the disc/ring constructs, there was a decrease in integration strength. Compared to fibrin, a reduced cartilage synthesis was observed at the defect. It is also disadvantageous that a direct adjustment of the adhesive can only be made via protein concentration, since fibrinogen is a natural protein that has a fixed number of tyrosine binding sites without chemical modification.
An additional cartilage adhesive was developed that is based on a mussel-inspired adhesive mechanism in which reactivity to a variety of substrates is enabled via free DOPA amino acids. DOPA-based adhesion is known to function in moist environments, a major advantage for application on water-rich cartilage tissue surrounded by synovial liquid. Reactive DOPA groups were synthetically attached to a polymer, here POx, to allow easy chemical modifiability, e.g. insertion of hydrolyzable ester motifs for tunable degradation. The possibility of preparing an adhesive hybrid hydrogel of POx in combination with fibrinogen led to good cell compatibility as was similarly observed with fibrin, but with increased immediate adhesive strength. Degradation could be adjusted by the amount of ester linkages on the POx and a direct influence of degradation rates on the development of integration in the in vitro model could be shown.
Hydrogels are well suited to fill defect gaps and immediate integration can be achieved via adhesive properties. The results obtained show that for the success of long-term integration, a good ability of the adhesive to take up synthesized ECM components and cells to enable regeneration is required. The degradation kinetics of the adhesive must match the remodeling process to avoid intermediate loss of integration power and to allow long-term firm adhesion to the native tissue.
Hydrogels are not only important as adhesives for smaller lesions, but also for filling large defect volumes and populating them with cells to produce tissue engineered cartilage. Many different hydrogel types suitable for cartilage synthesis are reported in the literature. A long-term stable fibrin formulation was tested in this work not only as an adhesive but also as a bulk hydrogel construct. Agarose is also a material widely used in cartilage tissue engineering that has shown good cartilage neosynthesis and was included in integration assessment. In addition, a synthetic hyaluronic acid-based hydrogel (HA SH/P(AGE/G)) was used. The disc/ring construct was adapted for such experiments and the inner lumen of the cartilage ring was filled with the respective hydrogel. In contrast to agarose, fibrin and HA-SH/P(AGE/G) gels have a crosslink mechanism that led to immediate bonding upon contact with cartilage during curing. The enhanced cartilage neosynthesis in agarose compared to the other hydrogel types resulted in improved integration during in vitro culture. This shows that for the long-term success of a treatment, remodeling of the hydrogel into functional cartilage tissue is a very high priority. In order to successfully treat larger cartilage defects with hydrogels, new materials with these properties in combination with chemical modifiability and a direct adhesion mechanism are one of the most promising approaches.
Untersucht wurde der Einfluss mehrerer Chemotherapeutika auf den Chemokinrezeptor CXCR4 in
Myelomzelllinien auf Ebene des Promotors, der mRNA und der Rezeptorverteilung, wobei drei
Substanzen (Etoposid, Bortezomib und Dexamethason) als potenzielle Suppressoren des Promotors ausgemacht werden konnten. Abhängig vom Myelom-Zelltyp und der Dosierung können so evtl.
Rückschlüsse auf die beobachtete Suppression von CXCR4 bei erkrankten Patienten mit hoher CXCR4-Aktivität (hier: Malignes Myelom) durch die begleitende Chemotherapie gezogen werden, welche eine Diagnostik und Therapie bei diesen Patienten erschwert.
Hintergrund: Hintergrund für diese Arbeit waren Beobachtungen in klinischen Fallstudien von Lapa et al. am Universitätsklinikum Würzburg, die sich auf CXCR4 bezogen, welches u.a. bei Patienten mit
Multiplem Myelom überexprimiert wird und dadurch bereits als Target für Diagnostik und Therapie in der Klinik Anwendung findet. Dabei konnte bei PET-CT Untersuchungen in der Nuklearmedizin beobachtet werden, dass es durch die begleitende Chemotherapie der Patienten zu einer Suppression des markierten CXCR4-Signals kam, so dass es nicht mehr zur Verlaufsbeobachtung und
vor allem nicht mehr zur Radiotherapie und Therapiekontrolle verwendet werden konnte.
Um den Einfluss und mögliche Interaktionen der Chemotherapeutika auf CXCR4 zu untersuchen, war es Ziel dieser Arbeit, ein vergleichbares Szenario in-vitro nachzustellen und Einflüsse messbar zu
machen, um so mögliche Ansätze und Verbesserungsvorschläge für die klinische Anwendung zu
liefern.
Methoden/Ergebnisse: Hierfür wurden im ersten Teil INA-6 (Myelomzellen) und Mesenchymale
Stammzellen (MSC) kultiviert, in Ko-Kultur gebracht und nach einer bestimmten Zeit wieder getrennt, um anschließend den gegenseitigen Einfluss in Bezug auf CXCR4 zu messen. Zudem wurde der Einfluss von Dexamethason untersucht. Es zeigte sich eine enge Bindung zwischen INA-6 und MSC
sowie eine hohe CXCR4-Aktivität bei INA-6, jedoch konnte keine Induktion der CXCR4-Aktivität in MSC durch INA-6-Kontakt oder Dexamethason quantifiziert werden. Die Immunzytologie erwies sich aufgrund einer schweren Anfärbbarkeit von CXCR4 – auch mit verschiedensten Antikörpern und sogar Liganden-gekoppeltem Farbstoff– als kaum auswertbar, wobei eine Darstellung von CXCR4
generell aber gelang.
Der CXCR4-Promotor wurde mittels Software genauer analysiert, wobei einige relevante Bindestellen, u.a. für Glukokortikoide und NFkB gefunden wurden. Die Herstellung eines CXCR4-
pGl4.14-Promotor-Konstrukts war erfolgreich, ebenso dessen Einschleusung in Myelomzellen. Auch gelang die Herstellung stabiler transfizierter INA-6, sodass mit diesen anschließend konstantere Ergebnisse erzielt werden konnten.
Im größten Teil der Arbeit wurden geeignete Chemotherapeutika-Konzentrationen ermittelt und in Viabilitäts- und Apoptose-Versuchen überprüft. Die Stimulationsversuche mit diesen zeigten variable
Effekte abhängig vom Zelltyp (INA-6, MM1S), jedoch konnten Bortezomib, Etoposid und
Dexamethason konzentrationsabhängig als starke Suppressoren der CXCR4-Aktivität ausgemacht
werden, was sich v.a. auf Ebene der Promotoraktivität – gemessen mittels Luciferase - zeigte. Interpretation: In-vitro konnten somit drei potenzielle Suppressoren der CXCR4-Aktivität ausgemacht
werden: Etoposid, Bortezomib und Dexamethason. Zumindest beim INA-6-Zelltyp fiel dieser Effekt deutlich aus, wobei in der Klinik der entsprechende Zelltyp sowie die Dosierung der Medikamente berücksichtigt werden müssen. Hinzu kommen weitere Einflussfaktoren des menschlichen Körpers,
die nicht berücksichtig werden konnten. Die genauen Mechanismen der Suppression könnten sich aus den Bindestellen des Promotors erklären, die von uns analysiert wurden, aber auf die in weiteren Arbeiten noch näher eingegangen werden muss.
Gelenkknorpel besitzt aufgrund seiner avaskulären Natur und der fehlenden mitotischen Aktivität der Chondrozyten bei Schäden kaum Potential zur Selbstheilung. Traumatische Läsionen und degenerative Veränderungen münden im Krankheitsbild der Osteoarthrose, welches mit dem Untergang des Gelenkknorpels einhergeht. Ein neuerer Therapieansatz ist das Tissue Engineering von Gelenkknorpel, wobei jedoch die laterale Integration der Implantate mit dem nativen Knorpelgewebe problematisch bleibt. Ein Adhäsivum kann neben einer adäquaten Sofortadhäsion die Langzeitintegration fördern.
In dieser Arbeit wurden verschiedene Polyethylenglykol (PEG)-basierte Zweikomponentenkleber, ausgehend vom kommerziell erhältlichen Gewebekleber CoSeal™, auf ihre Eignung für Gelenkknorpel untersucht. Dabei wurde Hyaluronsäure (HA) als physiologischer Bestandteil von Gelenkknorpel in thiolierter Form (HA-SH) als Komponente verwendet und auf seine prointegrativen Eigenschaften untersucht.
Der den CoSeal™-Komponenten entsprechende 4-Succinimidyl-Glutarat/4-Thiol-PEG (4SG/4T-PEG)-Kleber hatte sich trotz seiner hohen Sofortadhäsionskraft auch nach der Substitution des 4T-PEG mit HA-SH als zu schnell in flüssiger Umgebung degradierend gezeigt, um eine suffiziente Langzeitintegration zu erreichen. Durch die Verwendung der langsamer degradierenden funktionellen 4-Succinimidyl-Carbonat-PEG (4C-PEG)-Komponente konnte die Langzeitadhäsionskraft in Kombination mit 4-Amin-PEG (4A-PEG) durch die stabilere Amid-Bindung zum einen und in Kombination mit HA-SH zum anderen signifikant gesteigert werden. Immunhistochemisch konnten bei beiden HA-haltigen Klebern Zeichen von Knorpelintegration nachgewiesen werden, während der 4C/4A-PEG-Kleber keine Integrationszeichen aufwies. Im 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium Bromid (MTT)-Assay war bei keinem Adhäsivum eine zytotoxische Wirkung zu erkennen.
Insgesamt bieten die untersuchten PEG-basierten Adhäsiva im Vergleich zu den weitverbreiteten Fibrinklebern eine deutlich höhere Sofortadhäsion, welche vergleichbar mit glutaraldehydbasierten Klebern ist. Allerdings können die initialen adhäsiven Kräfte, trotz histologisch nachweisbaren Integrationszeichen bei Inkorporation von HA, nicht langfristig aufrechterhalten werden, so dass Fibrinkleber weiterhin die Spitzengruppe in Sachen Langzeitadhäsion bilden. Da PEG eine ausgezeichnete Biokompatibilität, einfache Anwendbarkeit und zahlreiche weitere chemische Anpassungsmöglichkeiten zur Feinabstimmung der Degradationseigenschaften bietet, ist in Zukunft ein erfolgreicher Einsatz auch im Bereich von Gelenkknorpel denkbar.
Für die experimentelle Untersuchung von Adhäsiva und Gelenkknorpel werden biomechanische Versuchsmodelle benötigt. Der Tensile-Test des Sandwich-Modells konnte im Rahmen dieser Arbeit erfolgreich etabliert und ein Protokoll festgelegt werden. In einem vergleichenden Versuch mit dem Push-Out-Test des Disc-Ring-Modells, welches als Referenzmodell dient, konnte in Bezug auf die Reproduzierbarkeit und Qualität der Messergebnisse die Gleichwertigkeit gezeigt werden. Insgesamt bietet er eine gute Alternative zum Push-Out-Test, um weiterführende Fragestellung, wie z.B. extrinsische Kraftwirkungen auf das Konstrukt, zu untersuchen.
Mineral biocements are brittle materials, which usually results in catastrophic failure during mechanical loading. Here, previous works demonstrated the feasibility of reducing brittleness by a dual-setting approach, in which a silica sol was simultaneously gelled during the setting of a brushite forming cement. The current thesis aimed at further improving this concept by both using a novel silicate based cement matrix for an enhanced bonding between cement and silica matrix as well as multifunctional silica precursors to increase the network density of the gel. Due to its well-known biocompatibility and osteogenic regeneration capacity, baghdadite was chosen as mineral component of such composites. This required in a first approach the conversion of baghdadite ceramics into self-setting cement formulations. This was investigated initially by using baghdadite as reactive filler in a brushite forming cement (Chapter 4). Here, the ß-TCP component in a equimolar mixture of ß-TCP and acidic monocalcium phosphate anhydrous was subsequently replaced by baghdadite at various concentrations (0, 5, 10, 20, 30, 50, and 100 wt%) to study the influence on physicochemical cement properties such as mechanical performance, radiopacity, phase composition and microstructure. X-ray diffraction profiles demonstrated the dissolution of baghdadite during the cement reaction without affecting the crystal structure of the precipitated brushite phase. In addition, EDX analysis showed that calcium is homogeneously distributed in the cement matrix, while zirconium and silicon form cluster-like aggregates ranging in size from a few micrometers to more than 50 µm. X-ray images and µ-CT analyses indicate improved X-ray visibility with increased incorporation of baghdadite in brushite cement, with an aluminum equivalent thickness nearly doubling at a baghdadite content of 50 wt%. At the same time, the compressive strength of brushite cement increased from 12.9 ± 3.1 MPa to 21.1 ± 4.1 MPa at a baghdadite content of 10 wt%. Cell culture medium conditioned with powdered brushite cement approached physiological pH values when increasing amounts of baghdadite were added to the cement (pH = 6.47 for pure brushite, pH = 7.02 for brushite with 20 wt% baghdadite substitution). Baghdadite substitution also affected the ion content in the culture medium and thus the proliferation activity of primary human osteoblasts in vitro. The results demonstrated for the first time the suitability of baghdadite as a reactive cement additive for improving the radiopacity, mechanical performance, and cytocompatibility of brushite cements.
A second approach (Chapter 5) aimed to produce single component baghdadite cements by an increase of baghdadite solubility to initiate a self-setting cement reaction. For this, the material was mechanically activated by longer grinding times of up to 24h leading to both a decrease in particle and crystallite size as well as a partial amorphization of baghdadite. Baghdadite cements were formed by adding water at a powder to liquid ratio of 2.0 g/ml. Maximum compressive strengths were determined to be ~2 MPa after 3 days of setting for a 24-hour ground material. Inductively coupled plasma mass spectrometry (ICP-MS) measurements showed an incongruent dissolution profile of the set cements, with preferential dissolution of calcium and only minor release of zirconium ions. Cement formation occurs under alkaline conditions, with the unground raw powder resulting in a pH of 11.9 during setting, while prolonged grinding increases the pH to about 12.3.
Finally, mechanically activated baghdadite cements were combined with inorganic silica networks (Chapter 6) to create dual-setting cements with a further improvement of mechanical performance. While a modification of the cement pastes with a TEOS derived sol was already thought to improve strength, it was hypothesized that using multi-arm silica precursors can further enhance their mechanical performance due to a higher network density. In addition, this should also reduce pore size of both gels and cement and hence will be able to adjust the release kinetics of incorporated drugs. For this, multi-armed silica precursors were synthesized by the reaction of various multivalent alcohols (ethylene glycol, glycerine, pentaerythrit) with an isocyanate modified silica precursor. After hydrolysis under acidic conditions, the sols were mixed with baghdadite cement powders in order to allow a simultaneous gel formation and cement setting. Since the silica monomers have a high degree of linkage sites, this resulted in a branched network that interpenetrated with the growing cement crystals. In addition to minor changes in the crystalline phase composition as determined by X-ray diffraction, the novel composites exhibited improved mechanical properties with up to 20 times higher compressive strength and further benefit from an about 50% lower overall porosity than the reference pure baghdadite cement. In addition, the initial burst release of the model drug vancomycin was completely inhibited by the added silica matrix. This observation was verified by testing for the antimicrobial activity with Staphylococcus aureus by measuring the inhibition zones of selected samples after 24 h and 48 h, whereas the antimicrobial effectiveness of a constant vancomycin release could be demonstrated.
The current thesis clearly demonstrated the high potential of baghdadite as a cement formulation for medical application. The initially poor mechanical properties of such cements can be overcome by special processing techniques or by combination with silica networks. The achieved mechanical performance is > 10 MPa and hence suitable for bone replacement under non-load bearing conditions. The high intrinsic radiopacity as well as the alkaline pH during setting may open the way ahead to further dental applications, e.g. as root canal sealers or filler in dental composites. Here, the high pH is thought to lead to antimicrobial properties of such materials similar to commonly applied calcium hydroxide or calcium silicates, however combined with an intrinsic radiopacity for X-ray imaging. This would simplify such formulations to single component materials which are less susceptible to demixing processes during transport, storage or processing.