Cartilage Regeneration in Reinforced Gelatin-Based Hydrogels

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BiofaBrication of implants for articular joint repair Cartilage regeneration in reinforced gelatin-based hydrogels Jetze Visser 2015 promotor Prof. dr. W.J.A. Dhert copromotoren Dr. ir. J. Malda Dr. ir. D. Gawlitta Biofabrication of implants for articular joint repair: Cartilage regeneration in reinforced gelatin-based hydrogels Jetze Visser PhD thesis, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands Copyright © J. Visser 2015. All rights reserved. No parts of this thesis may be reproduced, stored in a retrieval system of any nature or transmitted in any form or by any means, without prior written consent of the author. The copyright of the articles that have been published has been transferred to the respective journals. Financial support for the printing of this thesis was generously provided by: De Nederlandse Orthopaedische Vereniging, the Dutch society for Biomaterials and Tissue Engineering, Anna Fonds te Leiden, Livit Orthopedie MRI Centrum and Chipsoft. The research in this thesis was financially supported by: the Netherlands Institute for Regenerative Medicine, the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n309962 (HydroZONES) and the Dutch Arthritis Foundation. ISBN 978-94-6169-706-6 Layout and printing: Optima Grafische Communicatie, Rotterdam, the Netherlands Cover design: Marco Bot Biofabrication of implants for articular joint repair Cartilage regeneration in reinforced gelatin-based hydrogels Bioprinten van implantaten voor het herstel van gewrichtsschade Kraakbeenregeneratie in verstevigde gelatine hydrogel (met een samenvatting in het Nederlands) proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof. dr. G.J. van der Zwaan, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op dinsdag 25 augustus 2015 des avonds te 6.00 uur door Jetze Visser geboren op 6 januari 1985 te Gaasterland this thesis is Based upon the following puBlications: Reinforcement of hydrogels using three-dimensionally printed microfibres. Visser J, Melchels FPW, Jeon JE, van Bussel EM, Kimpton LS, Byrne HM, Dhert WJA, Dalton PD, Hutmacher DW, Malda J. Nature Communications. 2015;6:6933 doi: 10.1038/ncomms7933 Crosslinkable Hydrogels derived from Cartilage, Meniscus and Tendon Tissue. Visser J, Levett PA, Te Moller NC, Besems J, Boere KW, Van Rijen MH, de Grauw JC, Dhert WJA, van Weeren PR, Malda J. Tissue Engineering Part A. 2015 Apr;21(7-8):1195-206 Endochondral bone formation in gelatin methacrylamide hydrogel with embedded cartilage-derived matrix particles. Visser J, Gawlitta D, Benders KE, Toma SM, Pouran B, van Weeren PR, Dhert WJA, Malda J. Biomaterials. 2015 Jan;37:174-182 Biofabrication of tissue constructs by 3D bioprinting of cell-laden microcarriers. Levato R, Visser J, Planell JA, Engel E, Malda J, Mateos-Timoneda MA. Biofabrication. 2014 Sep;6(3):035020 Covalent attachment of a three-dimensionally printed thermoplast to a gelatin hydrogel for mechanically enhanced cartilage constructs. Boere KW*, Visser J*, Seyednejad H, Rahimian S, Gawlitta D, van Steenbergen MJ, Dhert WJA, Hennink WE, Vermonden T, Malda J. Acta Biomaterialia. 2014 Jun;10(6):2602-11 *Authors contributed equally to this manuscript Weefsel uit de printer: de mogelijkheden van 3D-printen in de geneeskunde. Visser J, Melchels FP, Dhert WJ, Malda J. Nederlands Tijdschrijft voor Geneeskunde. 2013;157(52):A7043 Engineering hydrogels for biofabrication. Malda J, Visser J, Melchels FP, Jüngst T, Hennink WE, Dhert WJA, Groll J, Hutmacher DW. Advanced Materials. 2013 Sep;25(36):5011-28 Biofabrication of multi-material anatomically shaped tissue constructs. Visser J, Peters B, Burger TJ, Boomstra J, Dhert WJ, Melchels FP, Malda J. Biofabrication. 2013 Sep;5(3):035007 taBle of contents introduction Chapter 1 General introduction, outline and research questions 9 Chapter 2 Engineering hydrogels for biofabrication 27 part i Biological improvement of gelMA hydrogel with tissue-derived matrices Chapter 3 Crosslinkable hydrogels derived from cartilage, meniscus and tendon tissue 61 Chapter 4 Endochondral bone formation in gelatin methacrylamide hydrogel with 81 embedded cartilage-derived matrix particles part II mechanical improvement of gelMA hydrogel constructs with 3d-printed scaffolds Chapter 5 Covalent attachment of a three-dimensionally printed thermoplast to a gelatin 103 hydrogel for mechanically enhanced cartilage constructs Chapter 6 Reinforcement of hydrogels with three-dimensionally printed microfibres 127 Chapter 7 Preliminary results of a translational animal model 153 Cartilage repair with a combination of chondrons and MSCs in gelatin methacrylamide hydrogel: the establishment of an equine model part III Biofabrication of complex shaped constructs from gelMA for osteochondral tissue repair Chapter 8 Biofabrication of multi-material anatomically shaped tissue constructs 171 Chapter 9 Biofabrication of tissue constructs by 3D bioprinting of cell-laden microcarriers 187 Chapter 10 Preliminary results of a translational animal model 207 Biofabrication of anatomically shaped implants for regeneration of the rabbit humeral head discussion and summary Chapter 11 General discussion and future perspectives 221 References 237 List of abbreviations 265 Summary and answers to the research questions 271 Nederlandse samenvatting 281 Papers not included in this thesis 289 Acknowlegements/Dankwoord 291 Curriculum Vitae 295 Chapter 1 General Introduction, Outline and Research Questions This introduction was partially based on the following publication: Visser J, Melchels FP, Dhert WJ, Malda J. Weefsel uit de printer: de mogelijkheden van 3D-printen in de geneeskunde. [Tissue printing: the potential application of 3D printing in medicine]. Nederlands Tijdschrift voor Geneeskunde. 2013;157(52):A7043. Introduction 11 introduction regenerative medicine The acute or chronic degeneration of tissues in the human body can be regarded as the fundamental cause for morbidity and mortality1. All tissues degenerate over time, only some regenerate (heal) better than others. For example, a small skin laceration or stable bone fracture is likely to heal spontaneously. In contrast, heart and brain tissue have poor regenerative capacities, which becomes clinically evident by organ failure after hypoxia2,3. Cartilage is another tissue with very limited healing capacities, as no nerves and blood vessels are present to initiate regeneration4. Therefore, cartilage defects can occur already in young patients, usually as a result of acute degeneration5,6. Chronic degeneration of cartilage is a common problem in middle-aged and older patients: a disease known as osteoarthritis7. The field of regenerative medicine aims to assist the body to restore the function of an injured tissue. Traditionally, the development of regenerative therapies relies on the engineering of tissues by a combination of cells, growth factors and biomaterials8,9. Based on these principles, the first regenerative therapies for the repair of focal cartilage defects have already been implemented in health care6. Multiple disciplines contribute to further development of regenerative medicine. Advances in stem cell research offer increasing knowledge on the differentiation of multipotent mesenchymal stromal cells (MSCs) as the cellular component of regenera- tive therapies10. In addition, advances in the field of biomaterials and bioengineering have yielded materials and techniques to potentially create implants with biological and mechanical compatibility for the regeneration of tissues11,12. This chapter is an introduction to cartilage tissue, its acute and chronic degeneration and the current options and challenges in treatment. Next, biofabrication is introduced as a tool for the engineering of implants in regenerative medicine. This chapter con- cludes with research questions that focus on the biofabrication of implants for articular joint repair. articular cartilage tissue In every articulating joint, the long bones are covered by a layer of cartilage that pro- vides smooth articulation and shock absorption. Cartilage is avascular and aneural, and separated from the underlying bone by a calcified cartilage zone and a tidemark layer13. Therefore, nutrition of the cartilage tissue predominantly depends on the synovial fluid. The unique mechanical properties of cartilage can be ascribed to its specific extracel- lular matrix (ECM) composition, being water (70%), within a network of collagen type II and proteoglycans13. Chondrocytes are the only residing cells. A superficial, transitional 12 Chapter 1 and bottom zone can be identified in cartilage, based on its ECM composition, collagen alignment and chondrocyte subtype14. For example, collagen type II fibers form an organized matrix with an arching align- ment, resulting in fibers perpendicular to the articulating surface in the bottom layer and parallel to the surface in the superficial layer (Fig. 1)15. The superficial collagen fibers provide the highest stiffness and tensile strength, which gradually decreases in the transitional and bottom layer14. The compressive strength of cartilage tissue is mainly provided by the fluid pressurization of the proteoglycan matrix16. Proteoglycans are large proteins with attached glycosaminoglycans (GAGs), which surround the collagen matrix. As GAGs are negatively charged, they attract positive ions, which in turn resorb and retain water in the cartilage tissue13.
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