REGENERATION OF ELECTROSPUN BIORESORBABLE VASCULAR GRAFTS: A PHENOMENON ASSOCIATED WITH VASCULAR GRAFT PROPERTIES AND MACROPHAGE PHENOTYPES (M1/M2)

Macrophages (MФ) and mast cells are important cell types in the context of tissue remodeling and regeneration. Mast cells participate in the early stages of wound healing and modulate the acute inflammatory responses to biomaterials. Mast cells can secrete a myriad of different cytokines by the process of degranulation; the process of regulated secretion in which preformed contents stored in their granules are rapidly released by exocytosis. Some of these cytokines such as IL-4, IL-13 and TNF-α can modulate the MФ phenotype. Macrophages (MΦ) are innate immune cells, crucial for tissue homeostasis, presentation of foreign and self-antigens following infection/injury, pathogen clearance, inflammation resolution, angiogenesis, and wound healing. MΦ display plasticity and can acquire pro-inflammatory (M1) or angiogenic/wound healing (M2) phenotypes depending upon the environmental stimuli. The phenotypic profile of MФ as M1 or M2 following exposure to the biomaterial can dictate the downstream processes of tissue remodeling and angiogenesis. An analysis of how these two cell types interact with electrospun biomaterials and how different properties of an electrospun biomaterial impacts the MΦ phenotype is the focus of this thesis. Mast cells synthesize several potent angiogenic factors and can also stimulate fibroblasts, endothelial cells and macrophages. An understanding of how they participate in wound healing and angiogenesis is important to further our knowledge about in situ vascular prosthetic regeneration. The adhesion, proliferation and cytokine secretion of bone marrow derived murine mast cells (BMMC) on electrospun polydioxanone (PDO), polycaprolactone (PCL) and silk scaffolds, as well as tissue culture plastic (TCP) has been investigated in the presence or absence of IL-3, SCF, IgE and IgE with a crosslinking antigen, dinitrophenol-conjugated albumin (DNP). It was previously believed that only activated BMMCs exhibit adhesion and cytokine secretion. However, this study shows non-activated BMMC adhesion to electrospun scaffolds. Silk scaffold was not found to be conducive for mast cell adhesion and cytokine secretion. Activation by IgE and DNP significantly enhanced mast cell adhesion, proliferation, migration and secretion of TNF-α, MIP-1α and IL-13. This indicates that mast cells might play a role in MФ polarization (M1/M2), biomaterial integration into the host tissue, regeneration, and possibly angiogenesis. In the next study, bone marrow derived murine macrophages (BMMΦs, 106 cells) were seeded on TCP (24 well plate) and PDO scaffolds (15 mm discs) electrospun from varying polymer concentrations (60, 100, and 140 mg/ml). Scaffold evaluation showed that large polymer concentrations led to larger fiber diameters, which in turn led to larger pore-sizes and porosity but a smaller surface area to volume ratio. After 24 hrs of culture, the cell lysates were analyzed for Arginase (Arg1) and inducible nitric oxide synthase (iNOS) expression by western blot and cell culture supernatants were analyzed for Nitric oxide (NO2-), Tumor Necrosis Factor – alpha (TNF-α), Interleukin-6 (IL-6), Vascular Endothelial Growth Factor (VEGF), Transforming Growth Factor – beta1 (TGF-β1) and basic fibroblast growth factor (bFGF) levels. The results indicated a correlation between Arg1 expression and increasing fiber/pore-size, indicating that the larger fiber/pore-sizes polarize towards a M2 phenotype. Also, the expression of iNOS was downregulated on the larger fiber/pore-size. The levels of NO2- were significantly higher on the lower fiber/pore-sizes indicating an M1 phenotype. The levels of VEGF, TGF-β1 and bFGF increased with increasing fiber/pore-sizes. The results showed higher Arg1 expression in M2s on the 60 mg/ml scaffold created by the air-flow impedance method compared to the 60 mg/ml scaffold created on the solid mandrel created by traditional electrospinning. The Arg1 expression was reduced on the compressed 140 mg/ml PDO scaffold compared to the normal 140 mg/ml scaffold. This result indicates that pore-size might be playing a greater role compared to fiber diameter in BMMФ phenotype modulation. In order to assess the angiogenic potential of BMMΦs cultured on PDO scaffolds, a 3D angiogenesis bead assay was performed using conditioned media from the BMMΦ:PDO interaction. The results of the 3D angiogenesis bead assay showed that the conditioned media from BMMΦs of M0 and M2 phenotypes cultured on the 140 mg/ml PDO scaffold induced larger sprouting and higher percentage density of sprouts when compared to the 60 mg/ml PDO scaffold and TCP. To investigate the signaling mechanism involved in this phenotypic switch, BMMΦs were isolated from the bone marrow of MyD88 knockout (KO) mice (Jackson Laboratories) and cultured on PDO (60 and 140 mg/ml) scaffolds (106 /disc) and TCP for 24 hrs and their Arg1 and iNOS expression was analyzed by western blot. The expression of Arg1 and iNOS was severely impaired on the BMMΦs from MyD88-/- mice cultured on the 140 mg/ml scaffold when compared to the 60 mg/ml PDO scaffold and TCP. This result indicates that scaffolds with different fiber/pore-sizes signal differently. A subcutaneous mouse model (described in Chapter 6) was used to evaluate the angiogenic and regenerative potential of PDO scaffolds in vivo. The DIVAA assay showed statistically higher FITC-dextran signal intensity for the 140 mg/ml scaffold compared to the 60 mg/ml scaffold indicating greater angiogenic response in the 140 mg/ml tube. However, problems of high background were observed in this assay with the use of electrospun PDO. The observed high background was probably due to the formation of complexes between dextran and adsorbed plasma proteins on the surface of the PDO. More studies are needed to optimize this assay for use with biomaterials such as PDO. H&E staining of the harvested PDO tubes (60 mg/ml and 140 mg/ml) was also performed. The cross-sections of these tubes showed greater cell recruitment and infiltration into the fibrous structures of the 140 mg/ml tube compared to the 60 mg/ml tube. This result corroborates the in vitro result of BMMФ infiltrating deeper into the structures of the 140 mg/ml scaffold compared to the 60 mg/ml scaffold. The scaffolds were also analyzed by immunostaining for iNOS (indicative of M1 phenotype of MФs). The results showed statistically higher ratios of iNOS positive:negative areas on the 60 mg/ml scaffold compared to the 140 mg/ml scaffold. Overall, these studies indicate that 140 mg/ml scaffold supports greater cell recruitment and cell infiltration in vivo but a smaller ratio of iNOS positive:negative areas compared to the 60 mg/ml scaffold, which supports a predominately M1 MФ phenotype. The studies indicate that varying properties of PDO can alter both the phenotype and function of BMMΦs in vitro and in vivo. We have also shown that the 140 mg/ml scaffold signal BMMΦs through MyD88-dependent mechanisms. A complete understanding of the way materials signal would allow us to control or modulate undesirable immune reactions to biomaterials in vivo. These studies would also help engineer biomaterials that promote angiogenesis and regeneration

ANGIOGENIC POTENTIAL OF HUMAN MACROPHAGES ON ELECTROSPUN BIORESORBABLE VASCULAR GRAFTS

The aim of this study was to investigate macrophage interactions with electrospun scaffolds and quantify the expression of vital angiogenic growth factors in vitro. This study will further help in evaluating the potential of these electrospun constructs as vascular grafts for tissue repair and regeneration in situ. Human peripheral blood macrophages were seeded in serum free media on electrospun (10 mm) discs of polydioxanone (PDO), elastin and PDO:elastin blends (50:50, 70:30 and 90:10). The growth factor secretion was analyzed by ELISA. Macrophages produced high levels of vascular endothelial growth factor (VEGF) and acidic fibroblast growth factor (aFGF). Transforming growth factor beta-1 (TGF-β1) secretion was relatively low and there was negligible production of basic fibroblast growth factor (bFGF). Histology revealed direct correlation between cell infiltration into scaffolds and the PDO concentration. There was greater macrophage infiltration through fibrous networks of the PDO and 90:10 scaffolds. Therefore, it can be anticipated that these scaffolds will support tissue regeneration and angiogenesis

Role of Stem Cells and Extracellular Matrix in the Regeneration of Skeletal Muscle

Adult skeletal muscle has a remarkable capacity to initiate a rapid and extensive repair process after damage due to injury or degenerative disease. Although satellite cells are the primary skeletal muscle stem cells, there are many reports of non-satellite cell populations with myogenic capacity resident within skeletal muscle. The activity of muscle-resident stem cells during the regeneration process is tightly controlled through the dynamic interactions between intrinsic factors within the cells and extrinsic factors constituting the muscle stem cell niche. The extracellular matrix (ECM) in skeletal muscle plays an integral role in force transmission, structural maintenance, and regulation of stem cell niche. ECM interacts with stem cells either directly by binding cell surface receptors or indirectly through growth factor presentation, and maintains a balance between their quiescence, self-renewal, and differentiation. These interactions are reciprocal since the stem cells can remodel the niche and secrete or degrade ECM components. Natural ECM scaffolds, derived from decellularized tissues can influence stem cell activity both in vitro and in vivo and are widely being investigated for skeletal muscle repair. In this chapter, we discuss the regenerative potential of stem cell populations and ECM bioscaffolds in the treatment of skeletal muscle injury and disease

Impairment of early fracture healing by skeletal muscle trauma is restored by FK506

BACKGROUND: Heightened local inflammation due to muscle trauma or disease is associated with impaired bone regeneration. METHODS: We hypothesized that FK506, an FDA approved immunomodulatory compound with neurotrophic and osteogenic effects, will rescue the early phase of fracture healing which is impaired by concomitant muscle trauma in male (~4 months old) Lewis rats. FK506 (1 mg/kg; i.p.) or saline was administered systemically for 14 days after an endogenously healing tibia osteotomy was created and fixed with an intermedullary pin, and the overlying tibialis anterior (TA) muscle was either left uninjured or incurred volumetric muscle loss injury (6 mm full thickness biopsy from middle third of the muscle). RESULTS: The salient observations of this study were that 1) concomitant TA muscle trauma impaired recovery of tibia mechanical properties 28 days post-injury, 2) FK506 administration rescued the recovery of tibia mechanical properties in the presence of concomitant TA muscle trauma but did not augment mechanical recovery of an isolated osteotomy (no muscle trauma), 3) T lymphocytes and macrophage presence within the traumatized musculature were heightened by trauma and attenuated by FK506 3 days post-injury, and 4) T lymphocyte but not macrophage presence within the fracture callus were attenuated by FK506 at 14 days post-injury. FK506 did not improve TA muscle isometric torque production CONCLUSION: Collectively, these findings support the administration of FK506 to ameliorate healing of fractures with severe muscle trauma comorbidity. The results suggest one potential mechanism of action is a reduction in local T lymphocytes within the injured musculoskeletal tissue, though other mechanisms to include direct osteogenic effects of FK506 require further investigation

A Preliminary Study on the Potential of Manuka Honey and Platelet-Rich Plasma in Wound Healing

Aim. The purpose of this study was to determine the in vitro response of cells critical to the wound healing process in culture media supplemented with a lyophilized preparation rich in growth factors (PRGF) and Manuka honey. Materials and Methods. This study utilized cell culture media supplemented with PRGF, as well as whole Manuka honey and the medical-grade Medihoney (MH), a Manuka honey product. The response of human fibroblasts (hDF), macrophages, and endothelial cells (hPMEC) was evaluated, with respect to cell proliferation, chemotaxis, collagen matrix production, and angiogenic potential, when subjected to culture with media containing PRGF, MH, Manuka honey, and a combination of PRGF and MH. Results. All three cell types demonstrated increases in cellular activity in the presence of PRGF, with further increases in activity seen in the presence of PRGF+MH. hDFs proved to be the most positively responsive cells, as they experienced enhanced proliferation, collagen matrix production, and migration into an in vitro wound healing model with the PRGF+MH-supplemented media. Conclusion. This preliminary in vitro study is the first to evaluate the combination of PRGF and Manuka honey, two products with the potential to increase regeneration individually, as a combined product to enhance dermal regeneration

A Preliminary Study on the Potential of Manuka Honey and Platelet-Rich Plasma in Wound Healing

Aim. The purpose of this study was to determine the in vitro response of cells critical to the wound healing process in culture media supplemented with a lyophilized preparation rich in growth factors (PRGF) and Manuka honey. Materials and Methods. This study utilized cell culture media supplemented with PRGF, as well as whole Manuka honey and the medical-grade Medihoney (MH), a Manuka honey product. The response of human fibroblasts (hDF), macrophages, and endothelial cells (hPMEC) was evaluated, with respect to cell proliferation, chemotaxis, collagen matrix production, and angiogenic potential, when subjected to culture with media containing PRGF, MH, Manuka honey, and a combination of PRGF and MH. Results. All three cell types demonstrated increases in cellular activity in the presence of PRGF, with further increases in activity seen in the presence of PRGF+MH. hDFs proved to be the most positively responsive cells, as they experienced enhanced proliferation, collagen matrix production, and migration into an in vitro wound healing model with the PRGF+MH-supplemented media. Conclusion. This preliminary in vitro study is the first to evaluate the combination of PRGF and Manuka honey, two products with the potential to increase regeneration individually, as a combined product to enhance dermal regeneration

A Preliminary Study on the Potential of Manuka Honey and Platelet-Rich Plasma in Wound Healing

Aim. The purpose of this study was to determine the in vitro response of cells critical to the wound healing process in culture media supplemented with a lyophilized preparation rich in growth factors (PRGF) and Manuka honey. Materials and Methods. This study utilized cell culture media supplemented with PRGF, as well as whole Manuka honey and the medical-grade Medihoney (MH), a Manuka honey product. The response of human fibroblasts (hDF), macrophages, and endothelial cells (hPMEC) was evaluated, with respect to cell proliferation, chemotaxis, collagen matrix production, and angiogenic potential, when subjected to culture with media containing PRGF, MH, Manuka honey, and a combination of PRGF and MH. Results. All three cell types demonstrated increases in cellular activity in the presence of PRGF, with further increases in activity seen in the presence of PRGF+MH. hDFs proved to be the most positively responsive cells, as they experienced enhanced proliferation, collagen matrix production, and migration into an in vitro wound healing model with the PRGF+MH-supplemented media. Conclusion. This preliminary in vitro study is the first to evaluate the combination of PRGF and Manuka honey, two products with the potential to increase regeneration individually, as a combined product to enhance dermal regeneration

Electrospinning and its influence on the structure of polymeric nanofibers

Electrospinning is a process of creating solid continuous fibers of material with diameter in the micro- to nanometer range by using electric fields. Electrospinning has attracted increased attention in the past few years in a broad range of biomedical and industrial applications due to the ease of forming fibers with a wide range of properties. This chapter discusses the basic electrospinning technique and the factors that influence the process and the resulting nanofibers. Information on the creation of various types of nanofibers (such as hollow, helical, porous, flat, aligned, non-woven and conductive) has also been provided. The section on fiber structure describes some of the unique features of electrospun fibers. The chapter ends with a description of the impact of structure on the properties of fibers (such as mechanical, thermal, transport and surface)

The Role of Innate and Adaptive Immune Cells in Skeletal Muscle Regeneration

Skeletal muscle regeneration is highly dependent on the inflammatory response. A wide variety of innate and adaptive immune cells orchestrate the complex process of muscle repair. This review provides information about the various types of immune cells and biomolecules that have been shown to mediate muscle regeneration following injury and degenerative diseases. Recently developed cell and drug-based immunomodulatory strategies are highlighted. An improved understanding of the immune response to injured and diseased skeletal muscle will be essential for the development of therapeutic strategies