A Clinical, Biological, and Biomaterials Perspective into Tendon Injuries and Regeneration

Abstract

Tendon injury is common and debilitating, and it is associated with long-term pain and ineffective healing. It is estimated to afflict 25% of the adult population and is often a career-ending disease in athletes and racehorses. Tendon injury is associated with high morbidity, pain, and long-term suffering for the patient. Due to the low cellularity and vascularity of tendon tissue, once damage has occurred, the repair process is slow and inefficient, resulting in mechanically, structurally, and functionally inferior tissue. Current treatment options focus on pain management, often being palliative and temporary and ending in reduced function. Most treatments available do not address the underlying cause of the disease and, as such, are often ineffective with variable results. The need for an advanced therapeutic that addresses the underlying pathology is evident. Tissue engineering and regenerative medicine is an emerging field that is aimed at stimulating the body's own repair system to produce de novo tissue through the use of factors such as cells, proteins, and genes that are delivered by a biomaterial scaffold. Successful tissue engineering strategies for tendon regeneration should be built on a foundation of understanding of the molecular and cellular composition of healthy compared with damaged tendon, and the inherent differences seen in the tissue after disease. This article presents a comprehensive clinical, biological, and biomaterials insight into tendon tissue engineering and regeneration toward more advanced therapeutics.

Triggering the activation of Activin A type II receptor in human adipose stem cells towards tenogenic commitment using mechanomagnetic stimulation

“…Moreover, FMOD was suggested to play a role in the formation of ECM and to regulate TGF-β levels. 42 Also, mutations in the small leucine-rich proteoglycan gene FMOD result in irregularities in the diameter of collagen fibers in the tendons. 43 Herein, the higher deposition of TNMD and FMOD together with Sirius Red/Fast Green Collagen staining assay and RT-PCR, confirms the hypothesis of magnetically actuated MNPs-tagged hASCs towards a tenogenic commitment.…”

Tendon injury and repair – A perspective on the basic mechanisms of tendon disease and future clinical therapy

“…This review is far from comprehensive, and we refer the interested reader to excellent focused reviews [187,[211][212][213].…”

Tendon Biomimetic Electrospun PLGA Fleeces Induce an Early Epithelial-Mesenchymal Transition and Tenogenic Differentiation on Amniotic Epithelial Stem Cells

“…In this field, the design of a biomimetic scaffold and the choice of the cell source are two fundamental aspects to be considered. In particular, one important aspect is the correct design of non-woven fleeces that mimic the collagen parallel structure and the biomechanics of the native ECM of the tendon [8,9]. Electrospinning has been identified as a valuable manufacturing process to generate constructs mimicking the micro and submicron-scaled fibrous structure of the native ECM of various soft tissues [10][11][12][13].…”