JoVE Logo
Faculty Resource Center

Sign In





Representative Results






Integrated Bone Formation Through In Vivo Endochondral Ossification Using Mesenchymal Stem Cells

Published: July 14th, 2023



1Department of Molecular Craniofacial Embryology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 2Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 3Department of Regenerative and Reconstructive Dental Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University

Bone therapy via endochondral ossification by implanting artificial cartilage tissue produced from mesenchymal stem cells has the potential to circumvent the drawbacks of conventional therapies. Hyaluronic acid hydrogels are effective in scaling up uniformly differentiated cartilage grafts as well as creating integrated bone with vascularization between fused grafts in vivo.

Conventional bone regeneration therapy using mesenchymal stem cells (MSCs) is difficult to apply to bone defects larger than the critical size because it does not have a mechanism to induce angiogenesis. Implanting artificial cartilage tissue fabricated from MSCs induces angiogenesis and bone formation in vivo via endochondral ossification (ECO). Therefore, this ECO-mediated approach may be a promising bone regeneration therapy in the future. An important aspect of the clinical application of this ECO-mediated approach is establishing a protocol for preparing enough cartilage to be implanted to repair the bone defect. It is especially not practical to design a single mass of grafted cartilage of a size that conforms to the shape of the actual bone defect. Therefore, the cartilage to be transplanted must have the property of forming bone integrally when multiple pieces are implanted. Hydrogels may be an attractive tool for scaling up tissue-engineered grafts for endochondral ossification to meet clinical requirements. Although many naturally derived hydrogels support MSC cartilage formation in vitro and ECO in vivo, the optimal scaffold material to meet the needs of clinical applications has yet to be determined. Hyaluronic acid (HA) is a crucial component of the cartilage extracellular matrix and is a biodegradable and biocompatible polysaccharide. Here, we show that HA hydrogels have excellent properties to support in vitro differentiation of MSC-based cartilage tissue and promote endochondral bone formation in vivo.

Autologous bone is still the gold standard for repairing bone defects due to trauma, congenital defects, and surgical resection. However, autogenous bone grafting has significant limitations, including donor pain, risk of infection, and limited bone volume that can be isolated from the patients1,2,3,4. Numerous biomaterials have been developed as bone substitutes, combining natural or synthetic polymers with mineralized materials such as calcium phosphate or hydroxyapatite5,6. Bone f....

Log in or to access full content. Learn more about your institution’s access to JoVE content here

This protocol uses 4-week-old male nude mice. House four mice in a cage under a 12 h light/dark cycle at 22−24 °C and 50%−70% relative humidity. All animal experiments were conducted in accordance with the guidelines approved by the Institutional Animal Care and Use Committee of Tokyo Medical and Dental University (approval ID: A2019-204C, A2020-116A, and A2021-121A).

1. Preparation of buffers and reagents

  1. Prepare mesenchymal stem cell growth mediu.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

MSC-encapsulated HA hydrogels were cultured in chondrogenic medium supplemented with TGFβ3, an inducer of chondrogenesis41 (step 4.1). We compared the properties of HA with those of collagen, which has been shown to be effective in creating MSC-based artificial cartilage grafts for endochondral ossification, as described previously38. Undifferentiated MSCs were not included as negative controls in this study because it has been demonstrated that undifferentiated MSCs r.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

Using appropriate scaffold materials that promote the transition from hypertrophic cartilage to bone is a promising approach to scale up MSC-based engineered hypertrophic cartilage grafts and treat bone defects of clinically significant size. Here, we show that HA is an excellent scaffold material to support the differentiation of MSC-based hypertrophic cartilage tissue in vitro and to promote endochondral bone formation in vivo38. Furthermore, in vivo, HA constructs wer.......

Log in or to access full content. Learn more about your institution’s access to JoVE content here

This work was supported by a Grant-in-Aid for Scientific Research (KAKENHI) from the Japan Society for the Promotion of Science (JSPS) (grant nos. JP19K10259 and 22K10032 to MAI).


Log in or to access full content. Learn more about your institution’s access to JoVE content here

NameCompanyCatalog NumberComments
0.25w/v% Trypsin-1mmol/L EDTA.4Na SolutionFUJIFILM Wako Pure Chemical 209-16941
AntisedanNippon Zenyaku Kogyo
ascorbate-2-phosphateNacalai Tesque13571-14
BambankerGC LymphotecCS-02-001
basic fibroblastic growth factorReprocellRCHEOT002 
bovine serum albuminFUJIFILM Wako Pure Chemical 012-238817.5 w/v%
Countess Automated Cell Counter with cell counting chamber slides and Trypan Blue stain 0.4%InvitrogenC10283
DomitorNippon Zenyaku Kogyo
DormicumAstellas Pharma
Dulbecco's Modified Eagle MediumMerckD6429high glucose
Dulbecco's Modified Eagle's Medium/Nutrient Mixture F-12 HamMerckD6421
Fetal bovine serumHycloneSH30396.03
Gentamicin sulfateFUJIFILM Wako Pure Chemical 1676045 10 mg/mL
Haccpper GeneratorTechnoMaxCH-400-5QB50 ppm hypochlorous acid water
Human Mesenchymal Stem CellsLonzaPT-2501
HyStem Cell Culture Scaffold KitMerckHYS020
ITS-G supplementFUJIFILM Wako Pure Chemical 090-06741×100
L-Alanyl-L-GlutamineFUJIFILM Wako Pure Chemical 016-21841200mmol/L (×100)
L-prolineNacalai Tesque29001-42
MSCGM Mesenchymal Stem Cell Growth Medium
paraffinFUJIFILM Wako Pure Chemical 165-13375
PBS / pH7.4 100mlMedicago09-2051-100
TGF-β3 ProteintechHZ-1090
VetorphaleMeiji Seika Kaisha
Visiocare OintmentSAVAVET/SAVA Healthcare
β-glycerophosphateFUJIFILM Wako Pure Chemical 048-34332

  1. Goldberg, V. M., Stevenson, S. Natural history of autografts and allografts. Clinical Orthopaedics and Related Research. (225), 7-16 (1987).
  2. Amini, A. R., Laurencin, C. T., Nukavarapu, S. P. Bone tissue engineering: recent advances and challenges. Critical Reviews in Biomedical Engineering. 40 (5), 363-408 (2012).
  3. Vining, N. C., Warme, W. J., Mosca, V. S. Comparison of structural bone autografts and allografts in pediatric foot surgery. Critical Reviews in Biomedical Engineering. 32 (7), 719-723 (2012).
  4. Roddy, E., DeBaun, M. R., Daoud-Gray, A., Yang, Y. P., Gardner, M. J. Treatment of critical-sized bone defects: clinical and tissue engineering perspectives. European Journal of Orthopaedic Surgery and Traumatology. 28 (3), 351-362 (2018).
  5. Rezwan, K., Chen, Q. Z., Blaker, J. J., Boccaccini, A. R. Biodegradable and bioactive porous polymer/inorganic composite scaffolds for bone tissue engineering. Biomaterials. 27 (18), 3413-3431 (2006).
  6. Swetha, M., et al. Biocomposites containing natural polymers and hydroxyapatite for bone tissue engineering. International Journal of Biological Macromolecules. 47 (1), 1-4 (2010).
  7. Meijer, G. J., de Bruijn, J. D., Koole, R., van Blitterswijk, C. A. Cell-based bone tissue engineering. PLOS Medicine. 4 (2), e9 (2007).
  8. Tremblay, P. L., Hudon, V., Berthod, F., Germain, L., Auger, F. A. Inosculation of tissue-engineered capillaries with the host's vasculature in a reconstructed skin transplanted on mice. American Journal of Transplantation. 5 (5), 1002-1010 (2005).
  9. Ko, H. C., Milthorpe, B. K., McFarland, C. D. Engineering thick tissues--the vascularisation problem. European Cells and Materials. 14, 1-19 (2007).
  10. Santos, M. I., Reis, R. L. Vascularization in bone tissue engineering: physiology, current strategies, major hurdles and future challenges. Macromolecular Bioscience. 10 (1), 12-27 (2010).
  11. Almubarak, S., et al. Tissue engineering strategies for promoting vascularized bone regeneration. Bone. 83, 197-209 (2016).
  12. Kronenberg, H. M. Developmental regulation of the growth plate. Nature. 423 (6937), 332-336 (2003).
  13. Farrell, E., et al. Chondrogenic priming of human bone marrow stromal cells: a better route to bone repair. Tissue Engineering Part C: Methods. 15 (2), 285-295 (2009).
  14. Scotti, C., et al. Recapitulation of endochondral bone formation using human adult mesenchymal stem cells as a paradigm for developmental engineering. Proceedings of the National Academy of Sciences of the United States of America. 107 (16), 7251-7256 (2010).
  15. Janicki, P., Kasten, P., Kleinschmidt, K., Luginbuehl, R., Richter, W. Chondrogenic pre-induction of human mesenchymal stem cells on beta-TCP: enhanced bone quality by endochondral heterotopic bone formation. Acta Biomaterialia. 6 (8), 3292-3301 (2010).
  16. Farrell, E., et al. In-vivo generation of bone via endochondral ossification by in-vitro chondrogenic priming of adult human and rat mesenchymal stem cells. BMC Musculoskeletal Disorders. 12, 31 (2011).
  17. Scotti, C., et al. Engineering of a functional bone organ through endochondral ossification. Proceedings of the National Academy of Sciences of the United States of America. 110 (10), 3997-4002 (2013).
  18. Harada, N., et al. Bone regeneration in a massive rat femur defect through endochondral ossification achieved with chondrogenically differentiated MSCs in a degradable scaffold. Biomaterials. 35 (27), 7800-7810 (2014).
  19. van der Stok, J., et al. Chondrogenically differentiated mesenchymal stromal cell pellets stimulate endochondral bone regeneration in critical-sized bone defects. European Cells and Materials. 27, 137-148 (2014).
  20. Sheehy, E. J., Vinardell, T., Toner, M. E., Buckley, C. T., Kelly, D. J. Altering the architecture of tissue engineered hypertrophic cartilaginous grafts facilitates vascularisation and accelerates mineralisation. PLoS One. 9 (3), e90716 (2014).
  21. Sheehy, E. J., Mesallati, T., Vinardell, T., Kelly, D. J. Engineering cartilage or endochondral bone: a comparison of different naturally derived hydrogels. Acta Biomaterialia. 13, 245-253 (2015).
  22. Bahney, C. S., et al. Stem cell-derived endochondral cartilage stimulates bone healing by tissue transformation. Journal of Bone and Mineral Research. 29 (5), 1269-1282 (2014).
  23. Mauck, R. L., Yuan, X., Tuan, R. S. Chondrogenic differentiation and functional maturation of bovine mesenchymal stem cells in long-term agarose culture. Osteoarthritis Cartilage. 14 (2), 179-189 (2006).
  24. Dickhut, A., Gottwald, E., Steck, E., Heisel, C., Richter, W. Chondrogenesis of mesenchymal stem cells in gel-like biomaterials in vitro and in vivo. Frontiers in Bioscience. 13, 4517-4528 (2008).
  25. Chung, C., Burdick, J. A. Influence of three-dimensional hyaluronic acid microenvironments on mesenchymal stem cell chondrogenesis. Tissue Engineering Part A. 15 (2), 243-254 (2009).
  26. Erickson, I. E., et al. Macromer density influences mesenchymal stem cell chondrogenesis and maturation in photocrosslinked hyaluronic acid hydrogels. Osteoarthritis Cartilage. 17 (12), 1639-1648 (2009).
  27. Sheehy, E. J., Buckley, C. T., Kelly, D. J. Chondrocytes and bone marrow-derived mesenchymal stem cells undergoing chondrogenesis in agarose hydrogels of solid and channelled architectures respond differentially to dynamic culture conditions. Journal of tissue engineering and regenerative medicine. 5 (9), 747-758 (2011).
  28. Erickson, I. E., et al. High mesenchymal stem cell seeding densities in hyaluronic acid hydrogels produce engineered cartilage with native tissue properties. Acta Biomaterialia. 8 (8), 3027-3034 (2012).
  29. Ma, K., Titan, A. L., Stafford, M., Zheng, C., Levenston, M. E. Variations in chondrogenesis of human bone marrow-derived mesenchymal stem cells in fibrin/alginate blended hydrogels. Acta Biomaterialia. 8 (10), 3754-3764 (2012).
  30. Levett, P. A., et al. A biomimetic extracellular matrix for cartilage tissue engineering centered on photocurable gelatin, hyaluronic acid and chondroitin sulfate. Acta Biomaterialia. 10 (1), 214-223 (2014).
  31. Reppel, L., et al. Chondrogenic induction of mesenchymal stromal/stem cells from Wharton's jelly embedded in alginate hydrogel and without added growth factor: an alternative stem cell source for cartilage tissue engineering. Stem Cell Research & Therapy. 6, 260 (2015).
  32. Amann, E., Wolff, P., Breel, E., van Griensven, M., Balmayor, E. R. Hyaluronic acid facilitates chondrogenesis and matrix deposition of human adipose derived mesenchymal stem cells and human chondrocytes co-cultures. Acta Biomaterialia. 52, 130-144 (2017).
  33. Hemshekhar, M., et al. Emerging roles of hyaluronic acid bioscaffolds in tissue engineering and regenerative medicine. International Journal of Biological Macromolecules. 86, 917-928 (2016).
  34. Pfeifer, C. G., et al. Higher Ratios of Hyaluronic Acid Enhance Chondrogenic Differentiation of Human MSCs in a Hyaluronic Acid-Gelatin Composite Scaffold. Materials (Basel). 9 (5), (2016).
  35. La Noce, M., et al. Hyaluronan-Based Gel Promotes Human Dental Pulp Stem Cells Bone Differentiation by Activating YAP/TAZ Pathway. Cells. 10 (11), (2021).
  36. Thompson, E. M., Matsiko, A., Kelly, D. J., Gleeson, J. P., O'Brien, F. J. An Endochondral Ossification-Based Approach to Bone Repair: Chondrogenically Primed Mesenchymal Stem Cell-Laden Scaffolds Support Greater Repair of Critical-Sized Cranial Defects Than Osteogenically Stimulated Constructs In Vivo. Tissue Engineering Part A. 22 (5-6), 556-567 (2016).
  37. Wang, H., et al. Cell-mediated injectable blend hydrogel-BCP ceramic scaffold for in situ condylar osteochondral repair. Acta Biomaterialia. 123, 364-378 (2021).
  38. Yamazaki, S., et al. Hyaluronic acid hydrogels support to generate integrated bone formation through endochondral ossification in vivo using mesenchymal stem cells. PLoS One. 18 (2), e0281345 (2023).
  39. Zarembinski, T., Skardal, A. . Hydrogels - Smart Materials for Biomedical Applications. , (2019).
  40. Vinardell, T., Sheehy, E. J., Buckley, C. T., Kelly, D. J. A comparison of the functionality and in vivo phenotypic stability of cartilaginous tissues engineered from different stem cell sources. Tissue Engineering Part A. 18 (11-12), 1161-1170 (2012).
  41. Mueller, M. B., et al. Hypertrophy in mesenchymal stem cell chondrogenesis: effect of TGF-beta isoforms and chondrogenic conditioning. Cells Tissues Organs. 192 (3), 158-166 (2010).
  42. Lertkiatmongkol, P., Liao, D., Mei, H., Hu, Y., Newman, P. J. Endothelial functions of platelet/endothelial cell adhesion molecule-1 (CD31). Current Opinion in Hematology. 23 (3), 253-259 (2016).
  43. Kloxin, A. M., Kasko, A. M., Salinas, C. N., Anseth, K. S. Photodegradable hydrogels for dynamic tuning of physical and chemical properties. Science. 324 (5923), 59-63 (2009).
  44. Chan, C. K., et al. Endochondral ossification is required for haematopoietic stem-cell niche formation. Nature. 457 (7228), 490-494 (2009).
  45. Murdoch, A. D., et al. Chondrogenic differentiation of human bone marrow stem cells in transwell cultures: generation of scaffold-free cartilage. Stem Cells. 25 (11), 2786-2796 (2007).
  46. Tortelli, F., Tasso, R., Loiacono, F., Cancedda, R. The development of tissue-engineered bone of different origin through endochondral and intramembranous ossification following the implantation of mesenchymal stem cells and osteoblasts in a murine model. Biomaterials. 31 (2), 242-249 (2010).
  47. Knuth, C. A., Witte-Bouma, J., Ridwan, Y., Wolvius, E. B., Farrell, E. Mesenchymal stem cell-mediated endochondral ossification utilising micropellets and brief chondrogenic priming. European Cells and Materials. 34, 142-161 (2017).
  48. Simmons, C. A., Alsberg, E., Hsiong, S., Kim, W. J., Mooney, D. J. Dual growth factor delivery and controlled scaffold degradation enhance in vivo bone formation by transplanted bone marrow stromal cells. Bone. 35 (2), 562-569 (2004).

This article has been published

Video Coming Soon

JoVE Logo


Terms of Use





Copyright © 2024 MyJoVE Corporation. All rights reserved