Approximately
half of annual musculoskeletal injuries in the US
involve tendon tears. The naturally hypocellular and hypovascular
tendon environment makes tendons injury-prone and heal slowly. Tendon
tissue engineering strategies often use biomimetic scaffolds combined
with bioactive factors and/or cells to enhance healing. FDA-approved
growth factors to promote tendon healing are lacking, which highlights
the need for safe and effective bioactive factors. Our previous work
evaluated insulin as a bioactive factor and identified an optimal
dose to promote in vitro mesenchymal stem cell survival, division,
and tenogenesis. The present work evaluates the ability of insulin-functionalized
electrospun nanofiber matrices with or without mesenchymal stem cells
to enhance tendon repair in a rat Achilles injury model. Electrospun
nanofiber matrices were functionalized with insulin, cultured with
or without mesenchymal stem cells, and sutured to transected Achilles
tendons in rats. We analyzed rat tendons 4 and 8 weeks after surgery
for the tendon morphology, collagen production, and mechanical properties.
Bioactive insulin-functionalized fiber matrices with mesenchymal stem
cells resulted in significantly increased collagen I and III at 4
and 8 weeks postsurgery. Additionally, these matrices supported highly
aligned collagen fibrils in the regenerated tendon tissue at 8 weeks.
However, treatment- and control-regenerated tissues had similar tensile
properties at 8 weeks, which were less than that of the native Achilles
tendon. Our preliminary results establish the benefits of insulin-functionalized
fiber matrices in promoting higher levels of collagen synthesis and
alignment needed for functional recovery of tendon repair.