|Year : 2015 | Volume
| Issue : 4 | Page : 163-169
The regenerative effect of human umbilical cord blood mesenchymal stem cells in a rabbit model of osteoarthritis
Ola Gharbia1, Abd Elmoaty Afify1, Hassan Abd El Ghaffar2, Sherif El Bassiony MD 1, Amira K El Hawary3, Ahmed Lotfy4, Aziza Elsayed4, Amel A Mahmoud4, Amir Youssef1
1 Department of Rheumatology and Rehabilitation, Faculty of Medicine, Mansoura University, Mansoura, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
3 Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
4 Department of Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
|Date of Submission||15-Feb-2015|
|Date of Acceptance||21-Jul-2015|
|Date of Web Publication||26-Oct-2015|
Sherif El Bassiony
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Mansoura University, Mansoura
Source of Support: None, Conflict of Interest: None
Osteoarthritis (OA) is a degenerative disorder characterized by changes in subchondral and periarticular bone. The limited number of therapeutic choices for articular injury and disease has increased the need for stem cells as a biological replacement for damaged cartilage. Umbilical cord (UC) blood cells are easily available and less immunogenic than other sources of stem cells, and there are no ethical concerns surrounding their use. These cells are isolated from young donors. Human umbilical cord blood mesenchymal stem cells (HUCB-MSCs) appear to be an ideal candidate for cartilage regeneration.
The aim of the study was to investigate the regenerative effect of HUCB stem cells on degenerated articular cartilage in New Zealand white rabbits experimentally induced with OA.
Materials and methods
This study was performed on 42 New Zealand white rabbits. They were surgically induced with OA in the left knees by cutting the anterior cruciate ligament. After confirmation of the development of OA histopathologically, we delivered a single dose of HUCB-MSCs directly intra-articularly in the cell-treated groups. Controls were injected with only suspension media. Histopathological tests were performed 8 and 24 weeks after injection.
Histopathologically, 8 weeks after the injection, cell-treated rabbits showed better cartilage quality and lower degree of degeneration, whereas 24 weeks after the injection all parameters in the cell-treated groups were significantly better.
HUCB-MSCs are a promising stem cell source for cartilage tissue formation and can decrease the development of OA in rabbits.
Keywords: mesenchymal cell osteoarthritis, stem cell, umbilical cord
|How to cite this article:|
Gharbia O, Afify AE, El Ghaffar HA, El Bassiony S, El Hawary AK, Lotfy A, Elsayed A, Mahmoud AA, Youssef A. The regenerative effect of human umbilical cord blood mesenchymal stem cells in a rabbit model of osteoarthritis. Egypt Rheumatol Rehabil 2015;42:163-9
|How to cite this URL:|
Gharbia O, Afify AE, El Ghaffar HA, El Bassiony S, El Hawary AK, Lotfy A, Elsayed A, Mahmoud AA, Youssef A. The regenerative effect of human umbilical cord blood mesenchymal stem cells in a rabbit model of osteoarthritis. Egypt Rheumatol Rehabil [serial online] 2015 [cited 2018 Jun 18];42:163-9. Available from: http://www.err.eg.net/text.asp?2015/42/4/163/168151
| Introduction|| |
Osteoarthritis (OA) is a degenerative process characterized by cartilage destruction and joint stiffness. OA associated with focal articular cartilage loss can be associated with subchondral and periarticular bone changes such as cyst, sclerosis, and osteophyte ,, .
It comprises specialized cells such as chondrocytes embedded in highly hydrated and organized extracellular matrix consisting of collagen fibers and type I proteoglycans  .
The current treatments of articular injury aim to decrease inflammation and pain, but fail to curb the progress of OA. The potential of cell-based strategies to provide a biological replacement for damaged cartilage is of great interest in younger OA patients  .
Strategies using mesenchymal stem cells (MSCs) are emerging tools for cartilage repair; these cells can differentiate into different forms of connective tissues such as cartilage, bone, fat, tendon, ligament, and bone marrow  . In addition, MSCs secrete wide forms of bioactive small molecules that could inhibit scar formation, suppress apoptosis, and enhance the activity of resident progenitor cells. This remarkable 'trophic activity' can inhibit lymphocyte proliferation and modulate the function of major immune cells  .
Umbilical cord (UC) blood cells are less immunogenic than other sources of stem cells such as bone marrow, and they could serve as starting material for isolation and expansion of cells for allogenic and autologous transplantations  . The human UC is considered a major source of MSCs, and therefore is used in stem cell therapy  .
The first application of MSCs in cartilage repair was conducted on rabbits, where full-thickness defects were filled with collagen scaffold seeded with MSCs and mechanically loaded. The short-term observation showed regeneration of cartilage and bone .
| Materials and methods|| |
The present study is the first to use human umbilical cord blood mesenchymal stem cells (HUCB-MSCs) in regenerating experimentally induced OA in New Zealand white rabbits.
The present study was conducted at Medical Experimental Research Center (MERC), Mansoura University, between January 2011 and April 2013. The animal ethics committee approved the study.
Forty-two adult (6 months old) male New Zealand white rabbits weighing 3.5-4 kg were housed in quarantine conditions for 14 days to be monitored for normality and to allow time for acclimatization to the new environment and handling. Normal activity and parameter assessment were defined as normal food and water consumption, normal stool formation, normal behavior, no respiratory distress or nasal discharge, and a temperature between 38 and 40.6°C. The rabbits were placed individually into 4 square foot stainless steel cages and housed in the same room with a temperature of 21-22°C.
The rabbits were skeletally mature. They were given the same tap water and food during the experiment. Kept in separate cages, they were allowed to move freely.
All rabbits underwent surgical induction of OA in their left knees by cutting the anterior cruciate ligament (ACL). They were observed clinically for 12 weeks and assessed by measuring their voluntary motion in comparison with controls.
Twelve weeks after surgery, two rabbits died; their knee joints were excised and evaluated histopathologically. The remaining 40 rabbits were randomly assigned to one of four groups (n = 10/group) after proving OA clinically and histopathologically:
Group 1: Osteoarthritic left knees were injected with human UC stem cells and followed up after 2 months.
Group 2: Osteoarthritic left knees were injected with culture media and followed up after 2 months.
Group 3: Osteoarthritic left knees were injected with human UC stem cells and followed up after 6 months.
Group 4: Osteoarthritic left knees were injected with culture media and followed up after 6 months.
Surgical induction of osteoarthritis
The surgery was performed by a veterinary surgeon under sterile conditions. Trimethoprim-sulfamide 15 mg/kg, subcutaneous, was administered immediately preoperatively. The rabbits were then premedicated and anesthetized with xylazine 3 mg/kg, intramuscular, glycopyrrolate 0.01 mg/kg, intramuscular, and ketamine 17 mg/kg, intramuscular. The left ACL was exposed by a medial parapatellar skin incision, the patella was subluxated laterally, and the knee was fixed in complete flexion. The ACL was transected, and the incision was sutured in a routine manner. Analgesia was achieved by adding buprenorphine 0.03 mg/kg, subcutaneous, preoperatively and then again 12 h later. After the surgery, the rabbits were housed separately and permitted free cage activity until the termination of the study.
Preparation of mesenchymal stem cells
Isolation of umbilical cord-mesenchymal stem cells
Fresh human UCs were extracted after full-term births (cesarean section or normal vaginal delivery) with informed consent.
The UCs were washed with PBS containing 1% antibiotic-antimycotic solution (Thermo Scientific, Miami, Florida, USA). This step was repeated until the cord became clear. The cords were cut longitudinally and minced into 1-2 mm 3 fragments, and incubated with enzyme cocktail of 0.1% collagenase and 0.25% trypsin (Sigma Aldrich, USA) at 37°C with shaking at 100 rpm for 45 min. After digestion, the enzyme activity was neutralized by adding the same volume of Dulbecco's modified Eagle's medium (DMEM) that contains 10% fetal bovine serum (Thermo Scientific). To achieve complete cell suspension, the mixture was passed through a 100 μm filter (BD Falcon, USA). Then the sample was centrifuged at 2000 rpm for 5 min at room temperature, followed by the cells being cultured in DMEM with 10% fetal bovine serum and 1% antibiotic-antimycotic solution in a 25 cm 2 culture flask and maintained in an incubator with humidified atmosphere of 5% CO 2 at 37°C  .
After 1 day, nonadherent cells were washed 2-3 times with PBS and adherent cells further cultured in complete medium, which was changed every 3 days until the monolayer of adherent cells reached 70-80% confluence. For passage 1, trypsinization for cell splitting was achieved using trypsin-EDTA solution (0.25%; Sigma Aldrich). The number of cells was evaluated with a hemocytometer and cellular viability with the trypan blue exclusion test. Each 250-300×10 3 cell was inoculated in a 75 cm 2 culture flask incubated at 37°C and 5% CO 2 . Cell cultivation was maintained up to the third passage  .
Flow cytometric analysis
Cells were characterized using cell surface markers by fluorescence-activated cell sorting analyses. The cells were stained with different fluorescently labeled monoclonal antibodies (mAb). In brief, 5×10 5 cells [in 100 μl PBS/0.5% bovine serum albumin (BSA)/2 mmol/EDTA] were mixed with 10 μl of the fluorescently labeled mAb and incubated in the dark at 2-8°C for 30 min. Washing with PBS containing 2% BSA was done twice, and the pellet was resuspended in PBS and analyzed immediately by flow cytometry.
For isolating of HUCB-MSC's, we used the mouse anti-human CD90-PCY5 mAb, CD105-PE mAb, CD29-FITC mAb, CD13-FITC mAb, CD34-PE mAb, CD11b-FITC mAb, CD19-PCY5 mAb, CD45-PCY5 mAb, and CD14-FITC (all from eBioscience, Miami, Florida, USA). The fluorescence intensity of the cells was evaluated by Epics XL Flow Cytometry (Coulter, Miami, Florida, USA)  .
Colony forming unit-fibroblast assay 
For the colony forming unit-fibroblast assay, about 100 cells were plated per 100-mm tissue culture dish (BD Falcon) in complete culture medium. Cells were incubated for 10-14 days at 37°C in 5% humidified CO 2 , washed with PBS, and fixed in 95% ethanol for 5 min. Next, the cells were incubated for 20-30 min at room temperature in 0.5% crystal violet (Sigma Aldrich) in 95% ethanol. The plate was washed twice with distilled H 2 O, and when it dried the colony forming unit-fibroblast units were counted.
Umbilical cord-mesenchymal stem cells differentiation assay 
For chondrogenic differentiation, the pellet culture system described by Sekiya et al.  was used. The cells were counted and seeded at a density of 0.25×10 6 per Eppendorf tube in a chondrogenic differentiation medium, which consisted of high glucose DMEM supplemented with 10 ng/ml TGF-β3, 100 nmol/l dexamethasone, 200 μmol/l ascorbate-2-phosphate, 40 μg/ml proline, 1 mmol/l pyruvate, 1 mg/ml BSA, and 50 mg/ml ITS+3. The medium was replaced every 2-3 days for 21 days.
Sulfated glycosaminoglycan (GAG) appeared on the frozen sections (5-μm-thick) with 1% toluidine blue (Sigma Aldrich). The production of sulfated GAG was measured in an alcian blue binding assay after digestion in 100 μl papain solution. Absorbance was reported at 630 nm.
The UC-MSCs tended to differentiate into chondrocytes. There was significant difference in the production of sulfated GAG between UC-MSCs cultured in chondrogenic differentiation medium and UC-MSCs cultured in normal media.
The cultures were observed using an inverted microscope. The attachment of spindle-shaped cells to the tissue culture plastic flask was recorded after 1 day. Primary cultures reached 70-80% confluence in 5 days. After the third passage, cultures were composed of a homogenously fibroblastic cell.
The third passage UC-MSCs were analyzed for markers of cell surface; UC-MSCs were negative for CD34, CD11b, CD19, CD45, and CD14, with percentages 0.18, 1.02, 0.06, 0.03, and 0.5, respectively; UC-MSCs were positive for CD90, CD105, CD29, and CD13, with percentages 97.3, 99.8, 99.5, and 76.9, respectively.
Injection of stem cells
Stem cell-treated group
A single dose of one million cells suspended in 1 ml of medium was delivered to the operated knee by direct aseptic intra-articular injection.
The control group received 1 ml of medium without cells. All rabbits were killed by an intravenous injection of thiopentone.
Assessment of osteoarthritis
After killing the animals, the femoral condyle and tibial plateau were resected and fixed in 10% formalin solution. The sections were decalcified in 0.5% EDTA and stored in paraffin. We collected the tissue section from the same anatomical site on the condyle and plateau to avoid bias. All samples were read blindly by one observer  .
Hind legs were thawed, knee joints opened, and articular surfaces subjected to photographic documentation.
Macroscopic grading was used to assess cartilage integrity in each of the four compartments of the rabbit femorotibial joint  .
The grading of OA was carried out following the procedure of Mankin et al.  .
The distribution of data was nonparametric; therefore, we used a nonparametric test (the Mann-Whitney U-test) for comparison between groups. Statistical analyses were performed using SPSS (version 20; SPSS Inc., Chicago, Illinois, USA). Data were presented as median and range. P values less than 0.05 were considered statistically significant.
| Results|| |
The results are shown in [Table 1], [Table 2], [Table 3], [Table 4] ([Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]).
|Figure 1 Cartilage from the stem cell-treated group 8 weeks after injection. It exhibited slight irregularities in its surface and hypercellularity of chondrocytes under light microscopy. H and E, ×100.|
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|Figure 2 Cartilage from the control group 8 weeks after injection, which exhibited superficial fibrillation and hypocellularity of chondrocytes under light microscopy. H and E, ×100.|
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|Figure 3 Cartilage from the stem cell-treated group 24 weeks after injection. It exhibited a marked reduction in morphological changes of osteoarthritis, including smooth surface of the cartilage and slight hypercellularity of chondrocytes under light microscopy. H and E, ×100.|
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|Figure 4 Cartilage from the control group at 24 weeks after injection, exhibiting no staining for safranin-O under light microscopy. Safranin, ×200.|
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|Figure 5 Cartilage from the stem cell-treated group 24 weeks after injection, exhibiting mild reduction of safranin-O staining under light microscopy. Safranin, ×100.|
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|Table 1 The weight and macroscopic and histologic grading of the left tibial plateau and femoral condyle in the animal model after 12 weeks |
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|Table 2 The weight and macroscopic and histologic grading of the left tibial plateau and femoral condyle in cell-treated and cell-free groups at 2 months (groups 1 and 2) and at 6 months (groups 3 and 4) after injection |
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|Table 3 Comparison of macroscopic and histological grading scores of the left tibial plateau and femoral condyle in cell-treated and cell-free groups at 2 months (groups 1 and 2) after injection |
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|Table 4 Comparison of macroscopic and histologic grading scores of the left tibial plateau and femoral condyle in cell-treated and cell-free groups at 6 months (groups 3 and 4) after injection |
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It was noted that, compared with the control group, the patient group showed great limitation in voluntary movements.
| Discussion|| |
This study was conducted on 42 New Zealand white rabbits. All rabbits underwent surgical induction of OA by cutting the ACL in their left knees. After the confirmation of development of OA histopathologically, we delivered a single dose of HUCB-MSCs directly intra-articularly into the cell-treated groups. The control groups were injected only with suspension media.
We delivered a single dose of one million HUCB stem cells suspended in 1 ml of medium to the OA knees by means of direct intra-articular injection. Eight weeks later, on macroscopic and histopathologic assessment, the rabbits showed better cartilage quality and lower degree of cartilage degeneration and there was a trend towards higher scores for all parameters in the cell-treated group.
Twenty-four weeks after the stem cell injection, macroscopic and histopathologic grading was significantly better than that performed 8 weeks after the injection, and the scores were significantly higher.
Løken et al.  pointed out that only long-term results are of great interest. Different time intervals have been used to study cartilage repair simulating clinical settings.
In the present study 24 weeks was deemed to be an adequately long observation time to keep the rabbits alive to perform reasonable statistical analysis.
In animal models, OA is induced primarily by surgical procedures such as ACL transaction  , ACL transaction combined with complete medial meniscectomy  , or chemical adjuvants (using collagenase enzyme type II)  . Surgically induced OA is better than chemically induced OA because the biochemical and pathological changes are similar to human OA  .
Our findings are in accordance with a study by Toghraie et al.  , who reported that participants injected with MSCs showed good cartilage quality and lower degrees of cartilage degeneration, osteophyte formation, and subchondral sclerosis compared with the control group. They added that direct intra-articular injection of MSCs decreased the progress of advanced OA lesions in a rabbit model.
To the best of our knowledge, this study is the first to evaluate the efficacy of direct intra-articular injection of HUCB stem cells in regenerating rabbit articular cartilage.
In the present study the assessment of cell-treated rabbits was performed twice instead of once (8 and 24 weeks after injection). This allowed better follow-up of the effect of injected cells in regeneration of cartilage at a longer duration.
In the present study we opted for HUCB stem cells as it is an available and cheap source of stem cells.
The UC blood is a source of noncontroversial, 'embryonic-like' stem cells that are collected at the time of birth through a simple, safe and painless procedure, and are preserved for future use  .
HUCB-MSCs have a high chondrogenic differentiation potential that might lead to regeneration of damaged cartilage. HUCB-MSCs also show potent immunosuppression and anti-inflammatory effects  .
We concluded that HUCB-MSCs are a promising cell source for cartilage tissue engineering and can reduce the development of OA lesions in a rabbit model.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rollín R, Marco F, Camafeita E, Calvo E, López-Durán L, Jover JA, et al
. Differential proteome of bone marrow mesenchymal stem cells from osteoarthritis patients. Osteoarthritis Cartilage 2008; 16
Vangsness CT Jr, Kurzweil PR, Lieberman JR. Restoring articular cartilage in the knee. Am J Orthop (Belle Mead NJ) 2004; 33(Suppl)
Hunter DJ. Pharmacologic therapy for osteoarthritis - the era of disease modification. Nat Rev Rheumatol 2011; 7
Lodi D, Iannitti T, Palmieri B. Stem cells in clinical practice: applications and warnings. J Exp Clin Cancer Res 2011; 30
Guan X, Furth ME, Childers MK. Stem cell use in musculoskeletal disorders. PM R 2011; 3(Suppl 1)
Fallahi-Sichani M, Soleimani M, Najafi SM, Kiani J, Arefian E, Atashi A. In vitro
differentiation of cord blood unrestricted somatic stem cells expressing dopamine-associated genes into neuron-like cells. Cell Biol Int 2007; 31
Kim JY, Jeon HB, Yang YS, Oh W, Chang JW. Application of human umbilical cord blood-derived mesenchymal stem cells in disease models. World J Stem Cells 2010; 2
Sellers RS, Zhang R, Glasson SS, Kim HD, Peluso D, D′Augusta DA, et al
. Repair of articular cartilage defects one year after treatment with recombinant human bone morphogenetic protein-2 (rhBMP-2). J Bone Joint Surg Am 2000; 82
Wang HS, Hung SC, Peng ST, Huang CC, Wei HM, Guo YJ, et al.
Mesenchymal stem cells in the Wharton′s jelly of the human umbilical cord. Stem Cells 2004; 22
Sarugaser R, Lickorish D, Baksh D, Hosseini MM, Davies JE. Human umbilical cord perivascular (HUCPV) cells: a source of mesenchymal progenitors. Stem Cells 2005; 23
Bunnell BA, Flaat M, Gagliardi C, Patel B, Ripoll C. Adipose-derived stem cells: isolation, expansion and differentiation. Methods 2008; 45
Sekiya I, Larson BL, Vuoristo JT, Reger RL, Prockop DJ. Comparison of effect of BMP-2, -4, and -6 on in vitro cartilage formation of human adult stem cells from bone marrow stroma. Cell Tissue Res 2005; 320
Yoshioka M, Coutts RD, Amiel D, Hacker SA. Characterization of a model of osteoarthritis in the rabbit knee. Osteoarthritis Cartilage 1996; 4
Mankin HJ, Dorfman H, Lippiello L, Zarins A. Biochemical and metabolic abnormalities in articular cartilage from osteo-arthritic human hips. II. Correlation of morphology with biochemical and metabolic data. J Bone Joint Surg Am 1971; 53
Løken S, Jakobsen RB, Arøen A, Heir S, Shahdadfar A, Brinchmann JE, et al
. Bone marrow mesenchymal stem cells in a hyaluronan scaffold for treatment of an osteochondral defect in a rabbit model. Knee Surg Sports Traumatol Arthrosc 2008; 16
Chen WP, Bao JP, Hu PF, Feng J, Wu LD. Alleviation of osteoarthritis by trichostatin A, a histone deacetylase inhibitor, in experimental osteoarthritis. Mol Biol Rep 2010; 37
Murphy JM, Fink DJ, Hunziker EB, Barry FP. Stem cell therapy in a caprine model of osteoarthritis. Arthritis Rheum 2003; 48
Janusz MJ, Bendele AM, Brown KK, Taiwo YO, Hsieh L, Heitmeyer SA. Induction of osteoarthritis in the rat by surgical tear of the meniscus: inhibition of joint damage by a matrix metalloproteinase inhibitor. Osteoarthritis Cartilage 2002; 10
Jean YH, Wen ZH, Chang YC, Lee HS, Hsieh SP, Wu CT, et al.
Hyaluronic acid attenuates osteoarthritis development in the anterior cruciate ligament-transected knee: Association with excitatory amino acid release in the joint dialysate. J Orthop Res 2006; 24
Toghraie FS, Chenari N, Gholipour MA, Faghih Z, Torabinejad S, Dehghani S, Ghaderi A. Treatment of osteoarthritis with infrapatellar fat pad derived mesenchymal stem cells in rabbit. Knee 2011; 18
Jiang Y, Jahagirdar BN, Reinhardt RL, Schwartz RE, Keene CD, Ortiz-Gonzalez XR, et al.
Pluripotency of mesenchymal stem cells derived from adult marrow. Nature 2002; 418
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4]