Response of human chondrocytes and mesenchymal stromal cells to a decellularized human dermis
© Giavaresi et al.; licensee BioMed Central Ltd. 2013
Received: 18 January 2012
Accepted: 31 December 2012
Published: 7 January 2013
Although progress has been made in the treatment of articular cartilage lesions, they are still a major challenge because current techniques do not provide satisfactory long-term outcomes. Tissue engineering and the use of functional biomaterials might be an alternative regenerative strategy and fulfill clinical needs. Decellularized extracellular matrices have generated interest as functional biologic scaffolds, but there are few studies on cartilage regeneration. The aim of this study was to evaluate in vitro the biological influence of a newly developed decellularized human dermal extracellular matrix on two human primary cultures.
Normal human articular chondrocytes (NHAC-kn) and human mesenchymal stromal cells (hMSC) from healthy donors were seeded in polystyrene wells as controls (CTR), and on decellularized human dermis batches (HDM_derm) for 7 and 14 days. Cellular proliferation and differentiation, and anabolic and catabolic synthetic activity were quantified at each experimental time. Histology and scanning electron microscopy were used to evaluate morphology and ultrastructure.
Both cell cultures had a similar proliferation rate that increased significantly (p < 0.0005) at 14 days. In comparison with CTR, at 14 days NHAC-kn enhanced procollagen type II (CPII, p < 0.05) and aggrecan synthesis (p < 0.0005), whereas hMSC significantly enhanced aggrecan synthesis (p < 0.0005) and transforming growth factor-beta1 release (TGF-β1, p < 0.0005) at both experimental times. Neither inflammatory stimulus nor catabolic activity induction was observed. By comparing data of the two primary cells, NHAC-kn synthesized significantly more CPII than did hMSC at both experimental times (p < 0.005), whereas hMSC synthesized more aggrecan at 7 days (p < 0.005) and TGF-β1 at both experimental times than did NHAC-kn (p < 0.005).
The results obtained showed that in in vitro conditions HDM_derm behaves as a suitable scaffold for the growth of both well-differentiated chondrocytes and undifferentiated mesenchymal cells, thus ensuring a biocompatible and bioactive substrate. Further studies are mandatory to test the use of HDM_derm with tissue engineering to assess its therapeutic and functional effectiveness in cartilage regeneration.
KeywordsArticular chondrocytes Mesenchymal bone marrow stromal cells Decellularized dermis Bioactivity In vitro study Cartilage tissue engineering
Articular cartilage lesions following acute trauma or pathological conditions such as osteonecrosis, osteochondritis and rheumatoid arthritis are responsible for the highest rate of disability worldwide . These pathologies represent a serious socio-economic problem for the patient with regards to morbidity, gait abnormality, pain and inability to return to work and for health systems due to the high related costs. Present treatment methods do not provide a satisfactory long-term outcome; an innovative and widely investigated approach consists of grafting scaffold alone or immature tissue to allow chondrogenesis to occur in situ[2, 3]. Functional biomaterials for cartilage regeneration should ideally provide (1) specific biomimetic hierarchical structures that might result in the formation of hyaline cartilage; (2) mechanical compatibility that could maintain original biomaterial morphology under repetitive physiological loads; (3) release of biosignals to promote chondrogenesis differentiation; and (4) enhanced integration properties with host tissues, thus allowing host cell infiltration and ideally even enhance the biology of healing .
Xenogenic and allogenic decellularized extracellular matrices (ECMs) have aroused great interest as functional biologic scaffolds also in cartilage tissue regeration [1, 5]. ECMs elicit distinct host-tissue histological and morphologic responses, depending on the species of origin, tissue of origin, processing methods, and/or method of terminal sterilization . They provide a compromise between biomechanical and biological function for the healing process, modulating host cell response and, consequently, accelerating the biology of tissue repair and integration with adjacent cartilage [6, 7].
To the authors’ knowledge, there are few studies that assess the biological properties of acellular ECM membranes as scaffolds for cartilage tissue engineering and regenerative medicine, not only in terms of proliferation and viability, but also anabolic and catabolic synthetic activity [8–13]. Yang Q et al. and Yang Z et al. developed a natural acellular 3D interconnected porous scaffold which resulted in a valid support for the attachment, proliferation and differentiation of bone marrow mesenchymal stromal cells into chondrocytes. Gong et al. proposed a sandwich model of an acellular cartilage sheet for in vitro and in vivo cartilage engineering, thus mimicking the native environment and the structure of cartilage. Finally, a previous study by the current authors on the behaviour of a decellularized human dermis (HDM_derm), cultured with primary rat tenocytes, showed in vitro a high biological performance and mechanical competence of HDM_derm .
The aim of the present study was to evaluate in vitro the biological influence of this newly developed decellularized human dermal ECM on two human primary cultures - normal human articular chondrocytes (NHAC-kn) derived from knee articular cartilage, which represents the mature phenotype of hyaline articular cartilage, and human mesenchymal stromal cells (hMSC) derived from bone marrow.
Decellularization of human dermis
Decellularized human dermis (HDM_derm) was taken from the back of four multi-organ and/or multi-tissue donors by following strictly Directive 2004/23/EC and Italian Transplant Center Guidelines on harvesting, processing and distributing tissues for transplantation.
In sterile conditions, using an electric dermatome, the epidermis was separated from the dermis trunk area and dermis samples of about 10 cm2 were dissected. The thickness of the dermal samples was about 0.8 mm. The dermis grafts were rinsed with 0.9% NaCl solution and stored in this solution for transport (2-4°C) to the treatment station (< 12 hrs) where they were submitted aseptically to a combined treatment of decellularization. The tissue was treated with 2.5% trypsin (GIBCO, catalogue n. 15090) and placed in an incubator overnight (5% CO2 at 37°C), washed twice with sterile 0.9% NaCl to remove trypsin remnants, then dipped in RPMI medium (containing 10000 IU/ml penicillin, 10 mg/ml streptomycin, 25 μg/ml amphotericin B) for 15 minutes and sealed inside cryofreezing bags (Hemofreeze bag – DF 700–3 by Fresenius Kabi) without adding cryoprotectors. Finally, the dermis was submitted to irradiation with γ rays (100 Gy) and stored in nitrogen vapour at -180/-190°C. This method provides a decellularized ECM scaffold, as shown by histology (H&E, DAPI stain), Transmission Electron Microscopy, cell viability test and DNA amount (Picogreen DNA Assay) .
Cell proliferation and biosynthesis on decellularized human dermis
where ODs was the optical density of the sample and OD CTR was the optical density of control wells.
Histology and scanning electron microscopy
After 14 days of cell culture, the seeded membranes were studied to evaluate chondrocyte and mesenchymal stromal cell colonization inside HDM_derm by histology and scanning electron microscopy (SEM). For histology, specimens were fixed in 10% buffered formalin solution in PBS (pH 7.4), embedded in paraffin and sections were cut to 6-μm thickness and stained with Haematoxilin & Eosin, Safranin O and Alcian Blue. Images were grabbed by using an Olympus BX51 microscope equipped with XC30 Olympus camera. For SEM, specimens were fixed in 2.5% v/v glutaraldehyde (pH 7.4 in PBS 0.01M, 1h) and dehydrated in graded ethanol series. After a passage in hexamethyldisilazane, the samples were air dried, then sputter-coated with gold before being examined by a Philips XL-20 SEM.
Statistical evaluation of data was performed using the SPSS/PC+ Statistics TM 12.1 (SPSS Inc., Chicago, IL USA) software package. Data are reported as Mean ± SD at a significance level of p < 0.05. After checking normal distribution and homogeneity of variance, two-way ANOVA (group and experimental time) followed by Bonferroni’s t test were used to compare results. Student’s t test was used to compare cell vitality index results.
In vitro model
At 24 hours after seeding, cells adhered consistently to HDM_derm membranes (93% and 98% for NHAC-kn and hMSC, respectively). At 7 days, the cell vitality index was 98% for both cell cultures seeded on HDM_derm. After 14 days of culture, these indexes significantly (p < 0.0005) increased for both cell cultures (NHAC-kn 136%, hMSC 263%).
In vitro results of NHAC-kn cultured on HDM_derm and CTR for 7 and 14 days
79.0 ± 13.5*
145.0 ± 21.2*,°
39.8 ± 13.8
71.0 ± 7.4
F=6.9, p < 0.05
490.8 ± 60.0
937.4 ± 76.2***,°°°
517.6 ± 32.8
583.4 ± 20.8
F=66.5, p < 0.0005
2821.7 ± 145.7
2785.6 ± 405.1
3015.7 ± 125.6
2332.3 ± 89.4°
F=10.2, p < 0.05
0.8 ± 0.1
1.0 ± 0.2
0.8 ± 0.0
0.8 ± 0.0
5.8 ± 3.8**
3.3 ± 1.5
18.6 ± 1.7
5.8 ± 0.2°°
F=16.7, p < 0.005
In vitro results of hMSC cultured on HDM_derm and CTR for 7 and 14 days
82.2 ± 1.5
136.8 ± 3.0°
90.9 ± 4.1
140.9 ± 2.6°
F=4.86, p < 0.05
191.7 ± 6.1***
265.7 ± 7.4***, °°°
129.7 ± 3.5
184.0 ± 5.0°°°
F=24.02, p < 0.0005
926.9 ± 4.5***
894.1 ± 18.9***
644.2 ± 23.1
324.1 ± 75.6°°°
F=37.3, p < 0.0005
0.5 ± 0.0
0.5 ± 0.1
0.4 ± 0.0
0.6 ± 0.0
0.01 ± 0.01
0.18 ± 0.03
Normalized data of NHAC-kn and hMSC on HDM_derm to control at 7 and 14 days
2.02 ± 0.31**
0.90 ± 0.02
2.07 ± 0.28**
0.97 ± 0.02 °
0.92 ± 0.12
1.48 ± 0.04**
1.58 ± 0.13°°
1.45 ± 0.03
0.95 ± 0.05
1.44 ± 0.01**
1.22 ± 0.17 °
2.76 ± 0.06**,°°
Histology and Scanning Electron Microscopy (SEM)
SEM analysis performed 14 days after seeding on HDM showed different patterns for NHAC-kn and hMSC, respectively. A homogeneous and multilayered surface-covering colonization with possibly living cells was found for NHAC-kn on HDM_derm: they had a polygonal-rounded morphology or fusiform shape. Most of the cells were connected to each other by forming cell aggregations and were tightly interwoven within the collagen network. Conversely, hMSCs partially covered HDM_derm by cell aggregates associated with a clear-cut collagen meshwork (Figure 1g,h).
The aim of the present study was to assess the influence of HDM_derm on two human primary cells – NHAC-kn and hMSC −, in terms of CPII, aggrecan, TGF-β1, IL-1β and MMP-3 release, in order to evaluate its possible use as a scaffold for in situ tissue engineering techniques in cartilage regenerative treatments. Human primary cells were chosen because they provide conditions that closely simulate a living model, thus yielding more physiologically significant results than animal-derived cells or cell lines. Since it is recognized that intra-species variability occurs, reproducibility of results was checked by taking into consideration dermis donor variability and not donor cell variability and thus four different dermis donors were tested.
The current results showed that HDM_derm supported NHAC-kn and hMSC cell adhesion, vitality, chondrogenic differentiation and synthetic activity. The NHAC-kn cultures maintained their phenotype with significantly increased synthesis of CPII and aggrecan, whereas the hMSC cultures showed a significant increase in aggrecan and TGF-β1 secretion. Furthermore, HDM-derm did not induce the release of IL-1β and MMP-3 that are often used as markers to measure inflammatory and catabolic stimuli in vitro. The comparison between NHAC-kn and hMSC normalized data revealed that, compared with hMSC, NHAC-kn were able to increase CPII synthesis at both experimental times, whereas hMSC were able to increase aggrecan at 7 days and TGF-β1 at both experimental times in comparison with NHAC-kn. In addition, the increased production of TGF-β1 by hMSC cells over the control wells may be responsible for the increased aggrecan synthesis via autocrine and paracrine pathways, as also suggested by other authors [15, 16]. In the present authors’ opinion, the differences observed between the cell-seeded construct and empty polystyrene wells were due to several factors: (1) stage of chondrogenic differentiation, NHAC-kn being already phenotypically differentiated chondrocyte cells; (2) the presence of a bioactive ECM membrane, as an environmental condition that is recognized as being a key factor in regulating cell behavior ; (3) the 3D-culture system condition, that is known to affect chondrogenesis in particular.
The reason why HDM_derm retained bioactivity upon decellularization might be because it participates and directly enhances cellular adhesion and proliferation indexes as found with NHAC-kn and hMSC, at least in the early stages of culture. Some authors found differences among growth factors (GFs) such as VEGF, FGF and TGF-β release in the extraction vehicle from different decellularized membranes [5, 18, 19]. Some TGF-β1 activity was still detected in the extract of the tested decellularized HDM_derm (428.36 ± 58.89 pg/mg) almost at the same concentration as the non-decellularized HDM_derm (417.01 ± 146.16 pg/mg), suggesting that HDM_derm is a bioactive substrate . In the present authors’ opinion, the native retained TGF-β1 is released from decellularized samples in a short culture time (within 6 days), thus affecting cell adhesion and early proliferation [5, 6, 8, 20]. After that, it might be assumed that the anabolic action of native TGF-β1 is almost completely exhausted by replacing medium twice a week and degradation processes, due to its finite lifespan.
Histological and SEM investigations supported in vitro data and showed that the HDM_derm was colonized by both cell types. Safranin O staining showed proteoglycans mainly at intracellular level and partially just around cells in both cultures, whereas Alcian Blue staining indicated glycosaminoglycan deposition at extracellular levels. These findings may suggest that, although GAGs have already been secreted by both primary cells, the macromolecules of proteoglycans, consisting of a core protein on which numerous GAG chains are attached, have yet to be assembled.
The experimental set up of the study had some weaknesses. First of all, the lack of a more clinically relevant matrix as a control was a major limitation. The ideal control material for the present study would be a dermis from the same donors decellularized by an already developed and recognized procedure. Unfortunately, these decellularization techniques that are used in the production of clinically accepted products are patented and it was not possible to reproduce this technique on the dermis derived from the donors included in the present study. Therefore, it was preferred to perform experiments without using other materials with different chemical and physical properties such as synthetic scaffolds or hydrogels.
The use of single-cell seeding density and relatively short culture time was the second weaknesses of the current experimental set up. Therefore, the seeding of HDM_derm probably needed an improvement in the in vitro culture conditions. In further in vitro experiments, the amount of cells seeded on the scaffold should be addressed, to try and increase the number up to 106 or 107 cells/ml, in order to study the influence of cell concentration on improving the building of a cartilage construct. However, the choice of cell density and experimental times was made to prevent irreversible contact-inhibition and senescence processes that affect NHAC-kn cell controls especially and in light of the authors’ previous in vitro experience with primary cultures of rat tenocytes seeded onto HDM_derm .
A further improvement in the current study set up might be to adopt a dynamic standardized culture condition by using bioreactors able to ensure efficient cell seeding, colonizing the scaffold deeply and also able to reproduce a mechanical stimulus to improve the cartilage-construct differentiation and maturation as well as regulate microenvironmental key factors in promoting chondrogenesis, such as oxygen concentration and pressure, or the presence of proteases [17, 21].
Finally, the strengths of the current study were: (1) the use of a new decellularization method on allogenic human dermis that provided a reliable 3D structural and biological scaffold for chondrocytes and MSCs; (2) the use of primary non-transformed human cells that closely simulate a living model, thus yielding more physiologically significant results than animal derived cells.
Various in vitro studies have been performed with different kinds of scaffolds with chondrocytes or MSCs for cartilage regeneration and most of them employed synthetic, biological or composite biomaterials such as poly-(lactic-co-glycolic acid) (PLGA), poly (lactic acid) PLA, poly (glycolic acid) PGA, hydrogel, chondroitin sulphate, hyaluronic acid, collagen, agarose, alginate, chitosan, gelatine, fibroin, fibrin glue or hybrid PLGA-gelatin/chondroitin sulphate/hyaluronic acid as cell supports [22–36].
Over the last few years, decellularized xenogenic and allogenic ECMs have started to be investigated for cartilage tissue engineering, because they retain structural and functional proteins and antibacterial activity, which has been shown within degradation products of biological scaffolds composed of extracellular matrix . However, the few studies testing ECMs, such as bovine cartilage , porcine adipose tissue , or cartilage [11, 13], human adipose tissue , or cartilage [9, 13], investigating mainly the behaviour of chondrocytes or MSCs in terms of proliferation and viability, concluded that ECMs provided suitable 3D substrates not only for the growth of cells, but also for promoting the formation of new cartilaginous engineered tissue. To our knowledge, the current study is the first to address the use of human decellularized ECM as an alternative 3D scaffold for cartilage regeneration. By comparing the present results to previously cited literature [8–13], it is evident that inflammatory stimuli, and anabolic and catabolic synthetic activity are not deeply investigated biological aspects to evaluate a possible influence of ECM on chondrocyte or MSC behaviour. The decellularization technique employed for the present scaffold did not adversely affect the structural integrity and biological activity of the remaining ECM of HDM_derm, thus its mechanical competence was maintained [6, 14]. The advantage of the technique, consisting of a combination of trypsin washes and the extremely low dosage of gamma-ray irradiation (about 0.1 kGy), is to avoid the use of strong chemical agents, which might lead to toxic leachables in the decellularized products, and the terminal sterilization process, which are known to be the main causes of distinct host tissue histological and morphologic responses [6, 14].
Further in vitro studies are mandatory to test the use of HDM_derm with tissue engineering techniques. The present study on the possible application of HDM_derm for cartilage suggests that this derived matrix might be investigated also as a functional scaffold for chondrocyte repopulation for in situ engineering techniques. HDM_derm seems to be a suitable matrix for cartilage regeneration, because it has been shown by the present study to maintain cellular viability and differentiation, and to retain structure and bioactivity, particularly TGF-β1 that might counteract catabolic IL-1β effects, whose levels have been found to correlate with the severity of cartilage damage in vivo. Finally, all in vitro data need to be transferred in vivo into specific preclinical validated models of acute, chronic or degenerative cartilage lesions to assess the therapeutic and functional effectiveness of HDM_derm in cartilage repair or regeneration.
In summary, to the present authors’ knowledge, this study is the first piece of evidence to support the potential use of human decellularized dermal matrix as a scaffold for cartilage regeneration. The results showed that the developed HDM_derm might be used as a scaffold by acting as a biological and bioactive substrate for cell seeding, proliferation and synthetic activity. HDM_derm sustained the growth and colonization of a well-differentiated phenotype NHAC-kn as well as undifferentiated hMSCs. These results support the use of HDM_derm for further preclinical in vitro and in vivo models for cartilage tissue engineering.
Chondrocyte Differentiation Medium
Chondrocyte Growth Medium
Procollagen Type II C-Propetide
Fibroblast Growth Factor
Decellularized Human Dermis
Human Mesenchymal Bone Marrow-Derived Stromal Cells
Interleukin 1 Beta
Matrix Metalloprotease 3
Mesenchymal Stem Cell Growth Medium
Normal Human Knee Cartilage-Derived Articular Chondrocytes
Scanning Electron Microscopy
Transforming Growth Factor Beta1
Vascular Endothelial Growth Factor.
The present work was supported by Ministero dell’Università e della Ricerca, FIRB 2010 Project n. RBAP10MLK7 “Scaffolds for skeletal tissue regeneration: preclinical evaluation of biocompatibility and effectiveness” and by the Project “Regione Emilia Romagna Programma di Ricerca Regione-Università 2007-2009” (Regenerative Medicine in Osteoarticular Disease). The authors wish to thank Mr. Keith Smith for his assistance in language supervision.
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