Mesenchymal Stem Cell-Seeded High-Density Collagen Gel for Annular Repair: 6-Week Results From In Vivo Sheep Models

• Published in: Neurosurgery Vol. 85; no. 2; pp. E350 - E359
• Main Authors: Hussain, Ibrahim, Sloan, Stephen R, Wipplinger, Christoph, Navarro-Ramirez, Rodrigo, Zubkov, Micaella, Kim, Eliana, Kirnaz, Sertac, Bonassar, Lawrence J, Härtl, Roger
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-08-2019; Wolters Kluwer Health, Inc
• Subjects: Animals; Annulus Fibrosus - surgery; Care and treatment; Collagen; Disease Models, Animal; Gels - therapeutic use; Injuries; Intervertebral Disc Degeneration - surgery; Mesenchymal Stem Cell Transplantation - methods; Mesenchymal Stem Cells; Neurosurgery; Sheep; Stem cells; Tissue Engineering - methods; Tissue Scaffolds - chemistry; Transplantation; Vertebrae, Lumbar; United States; Mesenchymal stem cell; Annulus fibrosus; Sheep; Disc; Collagen; Annular repair
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyy523

Our group has previously demonstrated in vivo annulus fibrosus repair in animal models using an acellular, riboflavin crosslinked, high-density collagen (HDC) gel.
To assess if seeding allogenic mesenchymal stem cells (MSCs) into this gel yields improved histological and radiographic benefits in an in vivo sheep model of annular injury.
Fifteen lumbar intervertebral discs (IVDs) were randomized into 4 groups: intact, injury only, injury + acellular gel treatment, or injury + MSC-seeded gel treatment. Sheep were sacrificed at 6 wk. Disc height index (DHI), Pfirrmann grade, nucleus pulposus area, and T2 relaxation time (T2-RT) were calculated for each IVD and standardized to healthy controls from the same sheep. Quantitative histological assessment was also performed using the Han scoring system.
All treated IVDs retained gel plugs on gross assessment and there were no adverse perioperative complications. The MSC-seeded gel treatment group demonstrated statistically significant improvement over other experimental groups in DHI (P = .002), Pfirrmann grade (P < .001), and T2-RT (P = .015). There was a trend for greater Han scores in the MSC-seeded gel-treated discs compared with injury only and acellular gel-treated IVDs (P = .246).
MSC-seeded HDC gel can be delivered into injured IVDs and maintained safely in live sheep to 6 wk. Compared with no treatment and acellular HDC gel, our data show that MSC-seeded HDC gel improves outcomes in DHI, Pfirrmann grade, and T2-RT. Histological analysis shows improved annulus fibrosus and nucleus pulposus reconstitution and organization over other experimental groups as well.