Bone morphogenetic protein-2 (BMP-2) and transforming growth factor-β1 (TGF-β1) reportedly induce the osteogenic and tenogenic differentiation of anterior cruciate ligament (ACL)-derived stem cells (LDSCs), respectively. However, few studies have investigated the effect of BMP-2/TGF-β1 on the differentiation of LDSC. We developed a BMP-2/TGF-β1 gene insertion into an LDSC cell sheet that promotes tendon-bone healing in a mouse ACL reconstruction (ACLR) model. CD34 + LDSCs were isolated from human ACL stump tissues, virally transduced to express BMP-2 or TGF-β1, and then embedded within cell sheets. All mice underwent ACLR using an autograft wrapped with a cell sheet and were randomly divided into three groups: BMP-2-, TGF-β1-, and BMP-2/TGF-β1-transduced. At 4 and 8 weeks, tendon-bone healing was evaluated by micro-CT, biomechanical test, and histological analysis. BMP-2 and TGF-β1 promoted the osteogenic and tenogenic differentiation of LDSC in vitro. BMP-2/TGF-β1-transduced LDSC sheet application contributed to early improvement in mean failure load and graft stiffness, accelerated maturation of the tendon-bone junction, and inhibited bone tunnel widening. Furthermore, reduced M1 macrophage infiltration and a higher M2 macrophage percentage were observed in the BMP-2/TGF-β1-transduced LDSC group. This work demonstrated that BMP-2 and TGF-β1 promoted CD34 + LDSCs osteogenic and tenogenic differentiation in vitro and in vivo, which accelerated the tendon-bone healing after ACLR using autografts wrapped with cell sheets in a mouse model.
K E Y W O R D Santerior cruciate ligament (ACL)-derived stem cells, anterior cruciate ligament reconstruction, bone morphogenetic protein-2, differentiation, tendon-bone healing, transforming growth factor-β1Abbreviations: ACL, anterior cruciate ligament; ACLR, ACL reconstruction; Ad, adenoviral vectors; BMP-2, bone morphogenetic protein-2; BMSC, bone marrow mesenchymal stem cell; BV/TV, bone volume/total volume fraction; ECM, extracellular matrix; FTGT, femur-tendon graft-tibia; GFP, green fluorescent protein; H&E, hematoxylin and eosin; IHC, immunohistochemistry; LDSC, ACL-derived stem cell; TGF-β1, transforming growth factor-β1.