The authors would like to thank Gabriel Arom and Michael Yeranosian for their technical contributions to earlier iterations of this project. This project was funded by the OREF Clinician Scientist Training Grant (NL), H H Lee Surgical Research Grant (NL), Veterans Administration BLR&#38;D Merit Review 1 I01 BX00012601 (DM) and Musculoskeletal Transplantation Foundation Young Investigator Award (FP).

NOTE: All animal surgeries were approved by the local veterinary staff and animal use committee prior to commencing the experiments.
1. Preparation of Electrospun Polycaprolactone Scaffolds
<ol>
	<li>Weigh and dissolve medical grade ester terminated poly (&#949;-caprolactone) in granule form in 1,1,1,3,3,3-hexafluoro-2-propanol to create a 10% w/w solution of the PCL polymer. Let the solution stir using a stir plate for at least 3 hr to ensure a homogenous solution.</li>
	<li>Electrospin the PCL solution to create a cuff of highly aligned PCL fibers for scaffold fabrication.
	<ol>
		<li>Prepare the electrospinning setup in a chemical fume hood with the fan on at all times. This consists of a large acrylic box that will serve as an isolated vacuum medium for the electrospinning process and has entry points for the source PCL solution driven by a voltage source, the motor-powered collecting mandrel, and a vacuum port. Clean the acrylic box thoroughly with ethanol and cover all surfaces with Parafilm sheets to remove any impurities that may compromise the quality of the electrospun product.</li>
		<li>Load approximately 3 ml of the above solution into a 10 ml syringe with a blunt ended 18 G, 1 &#189; inch needle. Remove any air bubbles by pushing the syringe up. Lock solution into a programmable syringe pump. Insert the needle through a small hole into the acrylic box while leaving about &#189; inch of the needle outside of the acrylic box for attachment of the voltage source wire.</li>
		<li>Use a 30 mm rotating lathe mandrel as the collector for the highly aligned PCL fibers; cover the mandrel tightly with a thin strip of aluminum foil. Lock the mandrel into the motor on the opposite side of the box about 15 cm away from the syringe needle.</li>
		<li>Insert the plastic hose into the vacuum port and connect to the fume hood vacuum source. Turn on the vacuum source and cover the acrylic box with a lid.</li>
		<li>Set the infusion rate of the programmable syringe pump to 2.5 ml/hr. Turn on the motor to operate the mandrel at 3,450 rpm and attach the positive lead of the voltage source to the needle tip outside of the box using an alligator clip.</li>
		<li>Once infusion of the PCL solution has begun, turn on the voltage source and set to a 20 kV operating voltage.</li>
		<li>Infuse the solution for 12 min to create a homogenous cuff from 0.5 ml of the PCL solution. 
		NOTE: On average, each cuff has enough electrospun material to create two six-strip sheets, which can be used to create a total of three four-layered scaffolds.</li>
	</ol>
	</li>
	<li>Laser cut the PCL cuff to form multiple small sheets on a VersaLaser Cutter 2.3 operated at low-vacuum setting, 10.0 keV landing voltage, 6.4 mm working distance, and probe diameter of 3.0. 
	NOTE: In this example, a computer aided design was used to instruct the cutter to yield multiple sheets of 1.5 mm x 35 mm x 150 &#181;m scaffolds with evenly distributed 150 &#181;m diameter holes at 15% pore area.</li>
	<li>Plasma etch the PCL scaffolds using a plasma cleaner to induce hydrophilicity of the PCL surface with ion acceleration. Set the vacuum to 450 mTorr and the treat the scaffolds for 30 sec at high power (29.6 W).</li>
	<li>Bathe the scaffolds in 70% ethanol in a sterile environment.</li>
	<li>Coat the individual scaffolds with collagen to facilitate cellular adhesion and proliferation in vivo.
	<ol>
		<li>Create a collagen coating solution by diluting a 8:1:2.5 sterile solution of Purecol collagen 3 mg/ml standard solution, 10x PBS and 0.1 N NaOH 1:9 in 1x PBS at 4 &#176;C. Mix thoroughly to ensure solution homogeneity.</li>
		<li>Coat individual 1.5 mm x 35 mm x 150 &#181;m scaffolds with a thin layer film of the above collagen solution. Allow to dry for 24 hr in a sterile environment.</li>
	</ol>
	</li>
	<li>Using 5-0 Vicryl sutures, stack and affix four individual 1.5 mm x 35 mm x 150 &#181;m scaffolds using a Krackow stitch to create a final 0.6 mm thick, multi-layered, collagen-coated scaffold that is ready for implantation.</li>
</ol>
2. Rat Surgery Protocol
<ol>
	<li>Induce anesthesia by placing rat in inhalation chamber and delivering 2% isoflurane with 2 L/min oxygen. Confirm the rat is adequately anesthetized by applying pressure to hind foot and evaluating for any response.</li>
	<li>On the non-sterile back table, subcutaneously inject 25 mg/kg ampicillin and 0.03 mg/kg buprenorphine.</li>
	<li>Apply ophthalmic ointment to the eyes. Clip the fur from the operative hind limb and prep the surgical site with three alternating scrubs of chlorhexidine and 70% ethanol.</li>
	<li>Transfer the rat to the operating table, on a heated pad to prevent hypothermia. Secure nose cone, and maintain anesthesia through the procedure with 2% isoflurane in 2 L/min oxygen, delivered nose cone. Drape in a sterile manner, leaving the operative limb exposed.&#160;</li>
	<li>Before starting the surgery, first confirm adequate anesthetization by lack of a response to hind foot pressure.</li>
	<li>Make a 2 cm long vertical incision medial to the knee, centered at the level of the patella. Retract the skin laterally until the incision is centered over the knee.</li>
	<li>Use a scalpel to make a medial parapatellar arthrotomy by cutting just medial to the patella and extending proximally to the level of the musculotendinous junction of the quadriceps and distally to the level of the patellar tendon insertion on the tibial tubercule. Take care not to cut the patellar or quadriceps tendons.</li>
	<li>Release patella laterally by making a 1 cm vertical incision through the knee capsule just lateral to the patellar tendon.</li>
	<li>Ensure the knee is extended. Take a pair of fine scissors and pass under the patella from lateral to medial. Spread the scissors a couple times so that the extensor mechanism can be translated to either side.</li>
	<li>While flexing the knee, translate the patella laterally to expose the inside of the knee joint. Ensure clear visualization of the intercondylar notch and femoral condyles. Using a scalpel, transect the ACL and PCL in the notch.</li>
	<li>Load power drill with a 1.6 mm k-wire. Place k-wire tip on ACL origin in the intercondylar notch. Drill superolaterally and visualize the exit point on the lateral aspect of the femur, removing any soft tissue as necessary with a scalpel. Pass the k-wire in and out a few times to ensure clear passage for the graft.</li>
	<li>Place the k-wire on the ACL footprint on the tibial plateau. Drill anterolaterally and visualize exit point on the anterolateral proximal tibia. Use scalpel to clear soft tissue as necessary so that the point where the k-wire exits the tibia is fully visualized.</li>
	<li>Pass a shortened Keith needle (ideally no more than 2 inches long) through the femoral bone tunnel. Thread the two suture ends from one end of the graft through the eye of the Keith needle. Use the needle to pull one end of the graft through the femoral tunnel.</li>
	<li>Repeat the prior step to pass the other end of the graft through the tibial tunnel.</li>
	<li>Use 4-0 Vicryl suture to affix the femoral end of the graft to surrounding periosteum or other soft tissue with a figure-of-eight stitch. Manually tension the graft with the knee in extension. Affix the tibial end of the graft to surrounding periosteum or other soft tissue with a figure-of-eight stitch.</li>
	<li>Use a scissor to cut off excess graft on both ends, leaving 1-2 mm on each end past the figure-of-eight stitch.</li>
	<li>Extend the knee and reduce the patella. Using 4-0 vicryl, place a single figure-of-eight stitch to close the medial joint capsule, preventing lateral subluxation of the patella.</li>
	<li>Close the skin with a running subcuticular 5-0 Monocryl or Vicryl suture, with care not to suture the underlying muscle or have any visible suture once the skin is closed.</li>
	<li>Inject rats subcutaneously with buprenorphine every 12 hr for a total of three days postoperatively. Check surgical site for any drainage or wound dehiscence at the time of injection. Limping and some swelling are normal in the first few days after surgery, but promptly address any postoperative concerns in conjunction with veterinary staff. &#160;The animal may be return to social housing at 2 weeks postoperatively, when surgical incisions are completely healed.</li>
</ol>
3. Data Collection Protocol
<ol>
	<li>At the time of sacrifice, asphyxiate rats individually in a closed CO2 chamber followed by thoracotomy.</li>
	<li>Harvest both the surgically reconstructed and contralateral limbs by separating at the hip joint.
	<ol>
		<li>For the reconstructed limbs, remove all soft tissue, including the posterior cruciate ligament and the remnants from the surgically disrupted native ACL, by fine dissection to isolate only the femur, tibia, and graft.</li>
		<li>For the contralateral limbs, remove all soft tissue except the native ACL as well as the femur and tibia by fine dissection.</li>
		<li>Use a rotary tool such as Dremel, to remove all but &#190; to 1 cm of bone from each end of the femur-graft-tibia complex.</li>
		<li>During this process and throughout biomechanical testing, regularly and frequently spray the ligamentous regions with normal saline to prevent desiccation of the harvested knee which may falsely alter results.</li>
	</ol>
	</li>
	<li>For histological analysis, fix each knee individually in 4% paraformaldehyde solution at 25 &#176;C for 48 hr. Next, submerge the knee in a solution of Immunocal reagent for complete decalcification; this process is dependent on the calcific contents of the sample and may take up to five days. Check individual samples daily to assess progress as incomplete decalcification can lower sample quality. Once complete, perform sectioning, slide mounting, and staining as desired.</li>
	<li>Perform biomechanical testing to assess the functional capacity of the tissue engineered ligament.
	<ol>
		<li>Secure the femur and tibia by wrapping 28 G&#160;galvanized steel wire around the epiphysis of each bone separately. This is to prevent inaccurate biomechanical testing data from premature tensile failure of the sample at the bone rather than at the ligament of interest.</li>
		<li>Pot the femur into a mixture of polymethylmethacrylate (PMMA) bone cement. To do this, mix the two cement components and immediately use the viscous mixture to secure the femur into the metal, completely encasing the diaphysis of the bone in the cemented pot with the epiphysis and attached ligament protruding freely. Allow spontaneous free radical polymerization to gradually transform the mixed viscous components to a doughy material and eventually into a solid hardened matrix. 
		NOTE: This process takes several minutes and can be monitored by manually assessing the temperature of a bolus made from the remaining cement; the temperature should transiently increase during the exothermic polymerization reaction and subside to RT after the material solidifies.</li>
		<li>Repeat the same process above for cementing the tibia, except while maintaining the knee ligament at 20&#176; flexion for ideal mechanical testing.</li>
		<li>Mount the cemented femur-graft-tibia complex onto a tensile testing apparatus, and prepare to record load and displacement as a function of time from the beginning of tension to failure. In this example, we used an Instron Model 5564 with a 1 kN load cell.</li>
		<li>Pre-tension the graft to 2 N at a ramp rate of 0.5 N/min and then test the graft to failure at a strain rate of 0.5 mm/sec. During the process, be sure that the ligament is failing at the mid-substance and that the bony femur and tibia are secure and not prematurely failing, which may inaccurately assess biomechanical properties of the tested ligament.</li>
		<li>Use the generated load-displacement curves to compute the failure load and stiffness of the tested ligament.</li>
	</ol>
	</li>
</ol>

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F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histological+and+biomechanical+studies+of+inter-strand+healing+in+four-strand+autograft+anterior+cruciate+ligament+reconstruction+in+a+rabbit+model.">Histological and biomechanical studies of inter-strand healing in four-strand autograft anterior cruciate ligament reconstruction in a rabbit model.</a> Knee Surg Sports Traumatol Arthrosc. 17 (7), 770-777 (2009).</li><li>Shino, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Replacement+of+the+anterior+cruciate+ligament+by+an+allogeneic+tendon+graft.+An+experimental+study+in+the+dog.">Replacement of the anterior cruciate ligament by an allogeneic tendon graft. An experimental study in the dog.</a> J Bone Joint Surg Br. 66 (5), 672-681 (1984).</li><li>Stasiak, M. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+device+to+apply+controlled+flexion+and+extension+to+the+rat+knee+following+anterior+cruciate+ligament+reconstruction.">A novel device to apply controlled flexion and extension to the rat knee following anterior cruciate ligament reconstruction.</a> J Biomech Eng. 134 (4), 041008 (2012).</li><li>Brophy, R. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+short-duration+low-magnitude+cyclic+loading+versus+immobilization+on+tendon-bone+healing+after+ACL+reconstruction+in+a+rat+model.">Effect of short-duration low-magnitude cyclic loading versus immobilization on tendon-bone healing after ACL reconstruction in a rat model.</a> J Bone Joint Surg Am. 93 (4), 381-393 (2011).</li></ol>

The authors declare that they have no competing financial interests.

ACL injuries are a common condition in orthopaedic sports surgery, with limited options for reconstruction at the present time. In order to develop an appropriate tissue-engineered substitute for the ACL that will allow regeneration in vivo, a suitable animal model is required. In this study, the fabrication of a biodegradable engineered graft is described, as is its in vivo implantation using a reproducible model of ACL reconstruction in an athymic rat. This model can be utilized to evaluate different ...

Rupture of the anterior cruciate ligament (ACL) is one of most common ligament injuries of the knee1. Because the ruptured ACL&#8217;s is unable to heal without surgical intervention, the limitations in activities of daily living as well as participation in sports drive over 175,000 patients to undergo surgery each year2, with an estimated cost of one billion dollars annually3. Currently, either autograft or allograft tendon is used for ligament reconstruction. Though high success rates can be achieved with both autograft and allograft replacement, serious complications are associated with these reconstruction options4. Autograft tissue is associated with donor site morbidity and is limited in supply, especially in instances of re-rupture or multi-ligamentous injury. On the other hand, allograft tissue is linked with delayed graft integration, adverse inflammatory response, theoretical infectious risk, and limited supply5. Synthetic non-degradable grafts were developed in the 1970s and 1980s but were hampered by premature graft rupture, foreign body reactions, osteolysis, and synovitis6. As a result of these serious concerns, there are currently no synthetic grafts available for clinical use in the United States.
Due to these limitations with existing graft options and to recent developments in biology, engineering, and regenerative medicine, there has been great interest in a tissue engineered solution for ACL grafting. Current tissue engineering strategies employ degradable biological and synthetic materials to allow for host tissue ingrowth while avoiding the limitations associated with permanent synthetic material implantation7.
Polycaprolactone (PCL) is a biodegradable polymer that is FDA approved for a number of medical applications including adhesion barrier and wound dressing8, that has been used in a wide variety of applications including vascular, bone, cartilage, nerve, skin, and esophageal tissue engineering5,9-16. Favorable biocompatibility, relatively long in-vivo half-life, adequate mechanical strength, and high elasticity contribute to the popularity of this polymer in tissue engineering. In a rodent model of wound healing, implanted electrospun PCL was shown to be non-immunogenic and to integrate into local tissue without adverse reactions13. An SEM image of electrospun PCL is shown in Figure 1.
With current FDA regulatory standards, efficacy and safety in both small and large animal models would be required for a PCL or any other engineered ACL graft to move into clinical trials in the United States. Additionally, in vivo conditions can often augment the properties of an in vitro tissue engineered ACL graft. A rat model of autologous ACL reconstruction with flexor digitorum longus tendon has been previously described, in which the native ACL was severed, femoral and tibial tunnels were drilled, and the graft was passed and secured in place with suture17-22. In this paper, we will describe a modification of this model for the evaluation of engineered ACL replacements rather than for autograft-based reconstruction (Figure 2).
Although many animal models exist for ligament tissue engineering, the rat is advantageous compared to larger models for a number of reasons. These advantages include easier husbandry and handling, fewer ethical considerations, and reduced cost17,23. In addition, the rat model has been used extensively as a model for orthopaedic tissue regeneration, including cartilage, tendon, and bone tissue engineering24. In particular, athymic nude rats were chosen due to their lack of cell-mediated immune response25, allowing for the eventual implantation of xenogeneic donor cells in this model to further enhance the engineered graft in the future. In this methods paper, we describe the fabrication and surgical implantation of an acellular, biodegradable polymer graft in an athymic rat model of ACL reconstruction.

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			<td height="34" style="height:34px;width:347px;">Name of Material/ Equipment</td>
			<td style="width:147px;">Company</td>
			<td style="width:77px;">Catalog Number</td>
			<td style="width:317px;">Comments/Description</td>
		</tr>
		<tr height="34">
			<td height="34" style="height:34px;width:347px;">Medical grade ester terminated poly (&#949;-caprolactone), granule form (MW = 110,000)</td>
			<td style="width:147px;">Lactel Absorbable Polymers</td>
			<td style="width:77px;"></td>
			<td style="width:317px;">Custom synthesized polymer to desired molecular weight</td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">1,1,1,3,3,3-hexafluoro-2-propanol</td>
			<td style="width:147px;">Sigma-Aldrich</td>
			<td>105228</td>
			<td style="width:317px;">Solvent for PCL polymer</td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">18G x 1 1/2&#34;bevel needle</td>
			<td style="width:147px;">BD Medical</td>
			<td>305196</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">Remote Infuse/Withdraw Programmable Syringe Pump</td>
			<td style="width:147px;">Harvard Apparatus</td>
			<td style="width:77px;">702101</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">VersaLaser VLS2.30 Laser Engraver</td>
			<td style="width:147px;">Microgeo USA</td>
			<td style="width:77px;">VLS2.30</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="34">
			<td height="34" style="height:34px;width:347px;">Expanded Plasma Cleaner 115V</td>
			<td style="width:147px;">Harrick Plasma</td>
			<td style="width:77px;">PDC-001</td>
			<td style="width:317px;">Plasma etch just prior to collagen coating for surface modification</td>
		</tr>
		<tr height="34">
			<td height="34" style="height:34px;width:347px;">PureCol&#160; Collagen Standard Solution, 3 mg/ml</td>
			<td style="width:147px;">Advanced Biomatrix</td>
			<td style="width:77px;">5015-A</td>
			<td style="width:317px;">Mix 8:1:2.5 solution of PureCol, 10x PBS, 0.1N NaOH 1:9 in 1x PBS</td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">Suture, 5-0 Vicryl</td>
			<td style="width:147px;">Henry Schein</td>
			<td style="width:77px;">1086471</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;">Suture, 4-0 Vicryl</td>
			<td style="width:147px;">Henry Schein</td>
			<td style="width:77px;">6540072</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">Sharp-pointed Dissecting Scissors (Straight; 4.5 inch)</td>
			<td style="width:147px;">Fisher Scientific</td>
			<td style="width:77px;">8940</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="34">
			<td height="34" style="height:34px;width:347px;">Buphrenorphine hydrochloride</td>
			<td style="width:147px;">Sigma-Aldrich</td>
			<td style="width:77px;">B9275</td>
			<td style="width:317px;">Use 0.03 mg/kg for both intra- and post-operatively for pain control</td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">Ampicillin, injectable</td>
			<td style="width:147px;">Henry Schein</td>
			<td style="width:77px;">1185678</td>
			<td style="width:317px;">Use 25 mg/kg subcutaneously during the procedure</td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">K-wire, 1.6 mm</td>
			<td style="width:147px;">Spectrum Surgical</td>
			<td style="width:77px;">SI040062</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:347px;">Keith Needle, Straight 1 1/2&#34;</td>
			<td style="width:147px;">Delasco Dermatology Lab &#38; Supply</td>
			<td style="width:77px;">KE-112</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="17">
			<td height="17" style="height:17px;width:347px;">Immunocal Decalcifying Solution</td>
			<td style="width:147px;">Fisher Scientific</td>
			<td>NC9491030</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="34">
			<td height="34" style="height:34px;width:347px;">Opticryl Acrylic Resin Bone Cement (PMMA) (Monomer and polymer)</td>
			<td style="width:147px;">US Dental Depot</td>
			<td style="width:77px;">OPTICRYL 100410&#160;</td>
			<td style="width:317px;"></td>
		</tr>
		<tr height="23">
			<td height="23" style="height:23px;width:347px;">Instron Model 5564 Tensile Testing Machine</td>
			<td style="width:147px;">Instron</td>
			<td style="width:77px;">5564</td>
			<td style="width:317px;">Any comparable tensile testing apparatus is suitable</td>
		</tr>
	</tbody>
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athymic rat model for evaluation of engineered anterior cruciate ligament grafts

Anterior cruciate ligament (ACL) rupture is a common ligamentous injury that often requires surgery because the ACL does not heal well without intervention. Current treatment strategies include ligament reconstruction with either autograft or allograft, which each have their associated limitations. Thus, there is interest in designing a tissue-engineered graft for use in ACL reconstruction. We describe the fabrication of an electrospun polymer graft for use in ACL tissue engineering. This polycaprolactone graft is biocompatible, biodegradable, porous, and is comprised of aligned fibers. Because an animal model is necessary to evaluate such a graft, this paper describes an intra-articular athymic rat model of ACL reconstruction that can be used to evaluate engineered grafts, including those seeded with xenogeneic cells. Representative histology and biomechanical testing results at 16 weeks postoperatively are presented, with grafts tested immediately post-implantation and contralateral native ACLs serving as controls. The present study provides a reproducible animal model with which to evaluate tissue engineered ACL grafts, and demonstrates the potential of a regenerative medicine approach to treatment of ACL rupture.

In our experience of 92 rat surgeries by a single surgeon, mean operative time from incision to completion of wound was 16.9 min, with a standard deviation of 4.7 min. At the time of sacrifice, rats weighed 356 &#177; 23 g. All rats tolerated the surgery well, and experienced no complications. Immediately after surgery, the rats were noted to bear weight on the operative extremity, but exhibited a slight limp. By one week post-operatively, all rats were ambulating with no appreciable limp. The animals all gained weight s...

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Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts

Animal models are important tools for the evaluation of tissue-engineered grafts. This paper presents the protocol for preparing an electrospun biodegradable polymer graft for use in anterior cruciate ligament tissue engineering, as well as a surgical protocol for implantation in a rat model.

Anterior cruciate ligament (ACL) rupture is a common ligamentous injury that often requires surgery because the ACL does not heal well without ...

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Research

JoVE Journal

Bioengineering

10.3K Views.  University of California Los Angeles. Animal models are important tools for the evaluation of tissue-engineered grafts. This paper presents the protocol for preparing an electrospun biodegradable polymer graft for use in anterior cruciate ligament tissue engineering, as well as a surgical protocol for implantation in a rat model.

Video: Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts

Magnetic Resonance Elastography Methodology for the Evaluation of Tissue Engineered Construct Growth

Traditional mechanical testing often results in the destruction of the sample, and in the case of long term tissue engineered construct studies, the use of destructive assessment is not acceptable. A proposed alternative is the use of an imaging process called magnetic resonance elastography. Elastography is a nondestructive method for determining the engineered outcome by measuring local mechanical property values (i.e., complex shear modulus), which are essential markers for identifying the structure and functionality of a tissue. As a noninvasive means for evaluation, the monitoring of engineered constructs with imaging modalities such as magnetic resonance imaging (MRI) has seen increasing interest in the past decade1. For example, the magnetic resonance (MR) techniques of diffusion and relaxometry have been able to characterize the changes in chemical and physical properties during engineered tissue development2. The method proposed in the following protocol uses microscopic magnetic resonance elastography (&mu;MRE) as a noninvasive MR based technique for measuring the mechanical properties of small soft tissues3. MRE is achieved by coupling a sonic mechanical actuator with the tissue of interest and recording the shear wave propagation with an MR scanner4. Recently, &mu;MRE has been applied in tissue engineering to acquire essential growth information that is traditionally measured using destructive mechanical macroscopic techniques5. In the following procedure, elastography is achieved through the imaging of engineered constructs with a modified Hahn spin-echo sequence coupled with a mechanical actuator. As shown in Figure 1, the modified sequence synchronizes image acquisition with the transmission of external shear waves; subsequently, the motion is sensitized through the use of oscillating bipolar pairs. Following collection of images with positive and negative motion sensitization, complex division of the data produce a shear wave image. Then, the image is assessed using an inversion algorithm to generate a shear stiffness map6. The resulting measurements at each voxel have been shown to strongly correlate (R2&gt;0.9914) with data collected using dynamic mechanical analysis7. In this study, elastography is integrated into the tissue development process for monitoring human mesenchymal stem cell (hMSC) differentiation into adipogenic and osteogenic constructs as shown in Figure 2.

The procedure demonstrates the methodology of magnetic resonance elastography for monitoring the engineered outcome of adipose and osteogenic tissue engineered constructs through noninvasive local assessment of the mechanical properties using microscopic magnetic resonance elastography (&mu;MRE).

Traditional mechanical testing often results in the destruction of the sample, and in the case of long term tissue engineered construct studies, the use ...

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Injury to the ACL is a commonly encountered problem in active individuals. Even partial tears of this intra-articular knee ligament lead to biomechanical deficiencies that impair function and stability. Current options for the treatment of partial ACL tears range from nonoperative, conservative management to multiple surgical options, such as: thermal modification, single-bundle repair, complete reconstruction, and reconstruction of the damaged portion of the native ligament. Few studies, if any, have demonstrated any single method for management to be consistently superior, and in many cases patients continue to demonstrate persistent instability and other comorbidities.
The goal of this study is to identify a potential cell source for utilization in the development of a tissue engineered patch that could be implemented in the repair of a partially torn ACL. A novel protocol was developed for the expansion of cells derived from patients undergoing ACL reconstruction. To isolate the cells, minced hACL tissue obtained during ACL reconstruction was digested in a Collagenase solution. Expansion was performed using DMEM/F12 medium supplemented with 10% fetal bovine serum (FBS) and 1% penicillin/streptomycin (P/S). The cells were then stored at -80 &#186;C or in liquid nitrogen in a freezing medium consisting of DMSO, FBS and the expansion medium. After thawing, the hACL derived cells were then seeded onto a tissue engineered scaffold, PLAGA (Poly lactic-co-glycolic acid) and control Tissue culture polystyrene (TCPS). After 7 days, SEM was performed to compare cellular adhesion to the PLAGA versus the control TCPS. Cellular morphology was evaluated using immunofluorescence staining. SEM (Scanning Electron Microscope) micrographs demonstrated that cells grew and adhered on both PLAGA and TCPS surfaces and were confluent over the entire surfaces by day 7. Immunofluorescence staining showed normal, non-stressed morphological patterns on both surfaces. This technique is promising for applications in ACL regeneration and reconstruction.

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

For future applications as a patch to repair partial tears of the Anterior Cruciate Ligament (ACL), human ACL derived cells were isolated from tissue obtained during reconstructive procedures, expanded in vitro and grown on tissue engineered scaffolds. Cellular adhesion and morphology was then performed to confirm biocompatibility on scaffold surface.

Injury to the ACL is a commonly encountered problem in active individuals. Even partial tears of this intra-articular knee ligament lead to biomechanical ...

Surgical Technique for the Implantation of Tissue Engineered Vascular Grafts and Subsequent In Vivo Monitoring

The development of Tissue Engineered Vessels (TEVs) is advanced by the ability to routinely and effectively implant TEVs (4-5 mm in diameter) into a large animal model. A step by-step protocol for inter-positional placement of the TEV and real-time digital assessment of the TEV and native carotid arteries is described here. In vivo monitoring is made possible by the implantation of flow probes, catheters and ultrasonic crystals (capable of recording dynamic diameter changes of implanted TEVs and native carotid arteries) at the time of surgery. Once implanted, researchers can calculate arterial blood flow patterns, invasive blood pressure and artery diameter yielding parameters such as pulse wave velocity, augmentation index, pulse pressures and compliance. Data acquisition is accomplished using a single computer program for analysis throughout the duration of the experiment. Such invaluable data provides insight into TEV matrix remodeling, its resemblance to native/sham controls and overall TEV performance in vivo.

Surgical Technique for the Implantation of Tissue Engineered Vascular Grafts and Subsequent In Vivo Monitoring

A step-by-step protocol for the inter-positional placement of Tissue Engineered Vessels (TEVs) into the carotid artery of a sheep using end-to-end anastomosis and real-time digital assessment in vivo until animal sacrifice.

The development of Tissue Engineered Vessels (TEVs) is advanced by the ability to routinely and effectively implant TEVs (4-5 mm in diameter) into a large ...

Generation and Grafting of Tissue-engineered Vessels in a Mouse Model

The construction of vascular conduits is a fundamental strategy for surgical repair of damaged and injured vessels resulting from cardiovascular diseases. The current protocol presents an efficient and reproducible strategy in which functional tissue engineered vessel grafts can be generated using partially induced pluripotent stem cell (PiPSC) from human fibroblasts. We designed a decellularized vessel scaffold bioreactor, which closely mimics the matrix protein structure and blood flow that exists within a native vessel, for seeding of PiPSC-endothelial cells or smooth muscle cells prior to grafting into mice. This approach was demonstrated to be advantageous because immune-deficient mice engrafted with the PiPSC-derived grafts presented with markedly increased survival rate 3 weeks after surgery. This protocol represents a valuable tool for regenerative medicine, tissue engineering and potentially patient-specific cell-therapy in the near future.

Here, we present a protocol to generate tissue engineered vessel grafts that are functional for grafting into mice by double seeding partially induced pluripotent stem cell (PiPSC) - derived smooth muscle cells and PiPSC - derived endothelial cells on a decellularized vessel scaffold bioreactor.

The construction of vascular conduits is a fundamental strategy for surgical repair of damaged and injured vessels resulting from cardiovascular diseases. ...

Production, Characterization and Potential Uses of a 3D Tissue-engineered Human Esophageal Mucosal Model

The incidence of both esophageal adenocarcinoma and its precursor, Barrett&#8217;s Metaplasia, are rising rapidly in the western world. Furthermore esophageal adenocarcinoma generally has a poor prognosis, with little improvement in survival rates in recent years. These are difficult conditions to study and there has been a lack of suitable experimental platforms to investigate disorders of the esophageal mucosa.
A model of the human esophageal mucosa has been developed in the MacNeil laboratory which, unlike conventional 2D cell culture systems, recapitulates the cell-cell and cell-matrix interactions present in vivo and produces a mature, stratified epithelium similar to that of the normal human esophagus. Briefly, the model utilizes non-transformed normal primary human esophageal fibroblasts and epithelial cells grown within a porcine-derived acellular esophageal scaffold. Immunohistochemical characterization of this model by CK4, CK14, Ki67 and involucrin staining demonstrates appropriate recapitulation of the histology of the normal human esophageal mucosa.
This model provides a robust, biologically relevant experimental model of the human esophageal mucosa. It can easily be manipulated to investigate a number of research questions including the effectiveness of pharmacological agents and the impact of exposure to environmental factors such as alcohol, toxins, high temperature or gastro-esophageal refluxate components. The model also facilitates extended culture periods not achievable with conventional 2D cell culture, enabling, inter alia, the study of the impact of repeated exposure of a mature epithelium to the agent of interest for up to 20 days. Furthermore, a variety of cell lines, such as those derived from esophageal tumors or Barrett&#8217;s Metaplasia, can be incorporated into the model to investigate processes such as tumor invasion and drug responsiveness in a more biologically relevant environment.

This manuscript describes the production, characterization and potential uses of a tissue engineered 3D esophageal construct prepared from normal primary human esophageal fibroblast and squamous epithelial cells seeded within a de-cellularized porcine scaffold. The results demonstrate the formation of a mature stratified epithelium similar to the normal human esophagus.

The incidence of both esophageal adenocarcinoma and its precursor, Barrett&#8217;s Metaplasia, are rising rapidly in the western world. Furthermore ...

Engineered 3D Silk-collagen-based Model of Polarized Neural Tissue

Despite huge efforts to decipher the anatomy, composition and function of the brain, it remains the least understood organ of the human body. To gain a deeper comprehension of the neural system scientists aim to simplistically reconstruct the tissue by assembling it in vitro from basic building blocks using a tissue engineering approach. Our group developed a tissue-engineered silk and collagen-based 3D brain-like model resembling the white and gray matter of the cortex. The model consists of silk porous sponge, which is pre-seeded with rat brain-derived neurons, immersed in soft collagen matrix. Polarized neuronal outgrowth and network formation is observed with separate axonal and cell body localization. This compartmental architecture allows for the unique development of niches mimicking native neural tissue, thus enabling research on neuronal network assembly, axonal guidance, cell-cell and cell-matrix interactions and electrical functions.

Insight into the complex actions of the brain requires advanced research tools. Here we demonstrate a novel silk-collagen-based 3D engineered model of neural tissue resembling brain-like architecture. The model can be used to study neuronal network assembly, axonal guidance, cell-cell interactions and electrical activity.

Despite huge efforts to decipher the anatomy, composition and function of the brain, it remains the least understood organ of the human body. To gain a ...

Applications of In Vivo Functional Testing of the Rat Tibialis Anterior for Evaluating Tissue Engineered Skeletal Muscle Repair

Despite the regenerative capacity of skeletal muscle, permanent functional and/or cosmetic deficits (e.g., volumetric muscle loss (VML) resulting from traumatic injury, disease and various congenital, genetic and acquired conditions are quite common. Tissue engineering and regenerative medicine technologies have enormous potential to provide a therapeutic solution. However, utilization of biologically relevant animal models in combination with longitudinal assessments of pertinent functional measures are critical to the development of improved regenerative therapeutics for treatment of VML-like injuries. In that regard, a commercial muscle lever system can be used to measure length, tension, force and velocity parameters in skeletal muscle. We used this system, in conjunction with a high power, bi-phase stimulator, to measure in vivo force production in response to activation of the anterior crural compartment of the rat hindlimb. We have previously used this equipment to assess the functional impact of VML injury on the tibialis anterior (TA) muscle, as well as the extent of functional recovery following treatment of the injured TA muscle with our tissue engineered muscle repair (TEMR) technology. For such studies, the left foot of an anaesthetized rat is securely anchored to a footplate linked to a servomotor, and the common peroneal nerve is stimulated by two percutaneous needle electrodes to elicit muscle contraction and dorsiflexion of the foot. The peroneal nerve stimulation-induced muscle contraction is measured over a range of stimulation frequencies (1-200 Hz), to ensure an eventual plateau in force production that allows for an accurate determination of peak tetanic force. In addition to evaluation of the extent of VML injury as well as the degree of functional recovery following treatment, this methodology can be easily applied to study diverse aspects of muscle physiology and pathophysiology. Such an approach should assist with the more rational development of improved therapeutics for muscle repair and regeneration.

Applications of In Vivo Functional Testing of the Rat Tibialis Anterior for Evaluating Tissue Engineered Skeletal Muscle Repair

We describe an in vivo protocol to measure dorsiflexion of the foot following stimulation of the peroneal nerve and contraction of the anterior crural compartment of the rat hindlimb. Such measurements are an indispensable translational tool for evaluating skeletal muscle pathology and tissue engineering approaches to muscle repair and regeneration.

Despite the regenerative capacity of skeletal muscle, permanent functional and/or cosmetic deficits (e.g., volumetric muscle loss (VML) resulting from ...

Scaling of Engineered Vascular Grafts Using 3D Printed Guides and the Ring Stacking Method

Coronary artery disease remains a leading cause of death, affecting millions of Americans. With the lack of autologous vascular grafts available, engineered grafts offer great potential for patient treatment. However, engineered vascular grafts are generally not easily scalable, requiring manufacture of custom molds or polymer tubes in order to customize to different sizes, constituting a time-consuming and costly practice. Human arteries range in lumen diameter from about 2.0-38 mm and in wall thickness from about 0.5-2.5 mm. We have created a method, termed the "Ring Stacking Method," in which variable size rings of tissue of the desired cell type, demonstrated here with vascular smooth muscle cells (SMCs), can be created using guides of center posts to control lumen diameter and outer shells to dictate vessel wall thickness. These tissue rings are then stacked to create a tubular construct, mimicking the natural form of a blood vessel. The vessel length can be tailored by simply stacking the number of rings required to constitute the length needed. With our technique, tissues of tubular forms, similar to a blood vessel, can be readily manufactured in a variety of dimensions and lengths to meet the needs of the clinic and patient.

Scalable engineered blood vessels would improve clinical applicability. Using easily sizable 3D-printed guides, rings of vascular smooth muscle were created and stacked into a tubular form, forming a vascular graft. Grafts can be sized to meet the range of human coronary artery dimensions by simply changing the 3D-printed guide size.

Coronary artery disease remains a leading cause of death, affecting millions of Americans. With the lack of autologous vascular grafts available, ...

Treatment of Ligament Constructs with Exercise-conditioned Serum: A Translational Tissue Engineering Model

In vitro experiments are essential to understand biological mechanisms; however, the gap between monolayer tissue culture and human physiology is large, and translation of findings is often poor. Thus, there is ample opportunity for alternative experimental approaches. Here we present an approach in which human cells are isolated from human anterior cruciate ligament tissue remnants, expanded in culture, and used to form engineered ligaments. Exercise alters the biochemical milieu in the blood such that the function of many tissues, organs and bodily processes are improved. In this experiment, ligament construct culture media was supplemented with experimental human serum that has been &#39;conditioned&#39; by exercise. Thus the intervention is more biologically relevant since an experimental tissue is exposed to the full endogenous biochemical milieu, including binding proteins and adjunct compounds that may be altered in tandem with the activity of an unknown agent of interest. After treatment, engineered ligaments can be analyzed for mechanical function, collagen content, morphology, and cellular biochemistry. Overall, there are four major advantages versus traditional monolayer culture and animal models, of the physiological model of ligament tissue that is presented here. First, ligament constructs are three-dimensional, allowing for mechanical properties (i.e., function) such as ultimate tensile stress, maximal tensile load, and modulus, to be quantified. Second, the enthesis, the interface between boney and sinew elements, can be examined in detail and within functional context. Third, preparing media with post-exercise serum allows for the effects of the exercise-induced biochemical milieu, which is responsible for the wide range of health benefits of exercise, to be investigated in an unbiased manner. Finally, this experimental model advances scientific research in a humane and ethical manner by replacing the use of animals, a core mandate of the National Institutes of Health, the Center for Disease Control, and the Food and Drug Administration.

We present a model of ligament tissue in which three-dimensional constructs are treated with the human exercise-conditioned serum and analyzed for collagen content, function, and cellular biochemistry.

In vitro experiments are essential to understand biological mechanisms; however, the gap between monolayer tissue culture and human physiology is large, ...

Use of High-Throughput Automated Microbioreactor System for Production of Model IgG1 in CHO Cells

Automated microscale bioreactors (15 mL) can be a useful tool for cell culture engineers. They facilitate the simultaneous execution of a wide variety of experimental conditions while minimizing potential process variability. Applications of this approach include: clone screening, temperature and pH shifts,&#160;media and supplement optimization. Furthermore, the small reactor volumes are conducive to large Design of Experiments that investigate a wide range of conditions. This allows upstream processes to be significantly optimized before scale-up where experimentation is more limited in scope due to time and economic constraints. Automated microscale bioreactor systems offer various advantages over traditional small scale cell culture units, such as shake flasks or spinner flasks. However, during pilot scale process development&#160;significant care must be taken to ensure that these advantages are realized. When run with care, the system can enable high level automation, can be programmed to run DOE&#39;s with a higher number of variables&#160;and can reduce sampling time when integrated with a nutrient analyzer or cell counter. Integration of the expert-derived heuristics presented here, with current automated microscale bioreactor experiments can minimize common pitfalls that hinder meaningful results. In the extreme, failure to adhere to the principles laid out here can lead to equipment damage that requires expensive repairs. Furthermore, the microbioreactor systems have small culture volumes&#160;making characterization of cell culture conditions difficult. The number and amount of samples taken in-process in batch mode culture is limited as operating volumes cannot fall below 10 mL. This method will discuss the benefits and drawbacks of microscale bioreactor systems.

A detailed protocol for the concurrent operation of 48 parallel cell cultures under varied conditions in a microbioreactor system is presented. Cell culture process, harvest and subsequent antibody titer analysis are described.

Automated microscale bioreactors (15 mL) can be a useful tool for cell culture engineers. They facilitate the simultaneous execution of a wide variety of ...